Self-Rated Health, Social Engagement, and "Older Places"

This dissertation consists of three essays that are motivated by an aging world. Its primary goals are to (a) identify how older adult health and its correlates--with a particular focus on social engagement--systematically differ by residential context; and (b) consider the implications of subjective health changes across older ages. The first chapter explores how the type and intensity of older-adult social participation varies by county-level population density. Using the 2003 and 2011 waves of the Wisconsin Longitudinal Study (n=3,006), I find that older adults living in rural counties with relatively low population densities are less socially active than their counterparts in higher-density counties. I also find that just five (of twelve) social activities are related to better health; while only three are associated with health change. Chapter two examines relationships between older adult health and living in relatively older and younger municipalities. Using a national sample of almost 5,000 Japanese older adults over two decades, I employ growth curve models to estimate how self-rated health and self-rated health trajectories differs by local area age structure. I find older adults living in the "oldest places" of Japan are more likely to report less than good health, when compared to those living in younger areas. In addition, relatively high levels of social engagement among older adults living in oldest areas help mitigate even greater odds of reporting worse health in these places. Chapter three explores how two measures of self-rated health (SRH) change are related to mortality. Data come from the Asset and Health Dynamics survey--the "oldest-old" portion of the Health and Retirement Study--and follow 6,233 individuals over thirteen years. After controlling for morbidity, individual characteristics, and SRH, those who changed SRH categories between survey waves and those who retrospectively reported an improvement in health continue to have a greater risk of death; when compared to those with no change. These findings suggest that the well-established associations between SRH status and mortality may understate the risk of death for oldest-old individuals with recent subjective health improvements.

Social sciences