Subjective social status and functional decline in older adults.

TitleSubjective social status and functional decline in older adults.
Publication TypeJournal Article
Year of Publication2012
AuthorsChen, B, Covinsky, KE, Cenzer, IStijacic, Adler, NE, Williams, BA
JournalJournal of General Internal Medicine
ISSN Number1525-1497
KeywordsActivities of Daily Living, Aged, Aging, Female, Health Status Disparities, Humans, Longitudinal Studies, Male, Middle Aged, Mobility Limitation, Risk Factors, Self Report, Social Class

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.

Endnote Keywords

health outcomes/socioeconomic Differences/social status/social status/functional decline/functional decline/ADL and IADL Impairments

Endnote ID


Citation Key7680
PubMed ID22215272
PubMed Central IDPMC3358399
Grant ListK23 AG033102 / AG / NIA NIH HHS / United States
K24 AG029812 / AG / NIA NIH HHS / United States
R01 AG028481 / AG / NIA NIH HHS / United States
K23AG033102 / AG / NIA NIH HHS / United States