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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 6/2012

01-06-2012 | Original Research

Subjective Social Status and Functional Decline in Older Adults

Authors: Bonnie Chen, MD, Kenneth E. Covinsky, MD, Irena Stijacic Cenzer, MA, Nancy Adler, PhD, Brie A. Williams, MD, MS

Published in: Journal of General Internal Medicine | Issue 6/2012

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ABSTRACT

BACKGROUND

It is unknown whether subjective assessment of social status predicts health outcomes in older adults.

OBJECTIVE

To describe the relationship between subjective social status and functional decline in older adults.

DESIGN

Longitudinal cohort study.

SETTING

The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008).

PARTICIPANTS

Two thousand five hundred and twenty-three community-dwelling older adults.

MAIN MEASURES

Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death)

KEY RESULTS

Mean age was 64; 46% were male, 85% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4 years, 50% in the lowest SSS group declined in function, compared to the middle and highest groups (28% and 26%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.–9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08–1.73).

CONCLUSIONS

In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.
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Metadata
Title
Subjective Social Status and Functional Decline in Older Adults
Authors
Bonnie Chen, MD
Kenneth E. Covinsky, MD
Irena Stijacic Cenzer, MA
Nancy Adler, PhD
Brie A. Williams, MD, MS
Publication date
01-06-2012
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 6/2012
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-011-1963-7

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