Feeling Better at This Age? Investigating Three Explanations for Self-Rated Health Improvements Among the Oldest-Old

Background and Objectives
Although the majority of individuals in their 80s or 90s do not experience improving health, a significant portion of this age group either (a) subjectively assess their health as improving; or (b) demonstrate self-rated health improvements when comparing consecutive surveys. While there is a body of research that examines self-rated health declines in older ages, much less work has studied possible determinants of self-rated health improvements. This is important, since there is increasing evidence that oldest-old adults have unique health evaluative processes that are not yet well-understood.

Research Design and Methods
Using 21,155 observations from eight waves of the Asset and Health Dynamics survey (the oldest-old portion of the Health and Retirement Study), I use hierarchical linear models to test three explanations as to why the oldest-old may report or demonstrate self-rated health improvements: (a) normalized pre-existing chronic conditions, (b) positive lifestyle changes, and (c) recovery from recent prior health shocks.

Results
Health improvements calculated by comparing consecutive surveys were related to a recovery from four particular serious health diagnoses (cancer, stroke, heart disease, and lung disease). Conversely, explicitly reported health improvements were associated with normalizing pre-existing conditions. Lastly, starting a regular exercise routine was related to both types of health improvements; while the cessation of negative health behaviors (i.e., drinking and smoking) was not related to either type.

Discussion and Implications
These results suggest that while subjective health “improvements” among the oldest-old may be a sign of successful aging, they should be interpreted critically and cautiously.