Self-rated health assessment and development of both cardiovascular and dementing illnesses in an ambulatory elderly population: a report from the Bronx Longitudinal Aging Study.
As part of the Bronx Longitudinal Aging Study, a prospective, community-based study designed to assess risk factors for cardiovascular and cerebrovascular morbidity and mortality and all-cause dementia, the investigators sought to determine whether a self-rated health assessment (SRHA) could be used as an independent predictor of new cardiovascular events and dementia (Alzheimer type and multi-infarct). A population of elderly (mean age 79 years) outpatient, ambulatory, nondemented patients (n = 487, 65% women) participated in this longitudinal study. Clinical diagnoses were made according to established criteria. At baseline, participants were asked to rate their current SRHA as excellent, good, fair, or poor, and were evaluated annually for as long as 10 years. Baseline SRHA findings were related to development of cardiovascular events and dementia. The SRHA was reported as excellent by 45 patients (9.4%), good by 212 (44.4%), fair by 178 (37.3%), and poor by 42 (8.8%). Using a multivariate analysis, patients whose SRHA was poor were 4.5 times more likely than those whose SRHA was excellent to have a fatal cardiovascular event, 2.6 times more likely to have a nonfatal cardiovascular event, and 5.3 times more likely to develop Alzheimer type and multi-infarct dementia. Similar findings were observed with dichotomous SRHA responses (comparing excellent/good to fair/poor). In an elderly population, SRHA appears to be an independent predictor of future cardiovascular and cerebrovascular events and development of all-cause dementia, which has possible therapeutic implications for prevention and treatment.