Autopercepción de la salud, presencia de comorbilidades y depresión en adultos mayores mexicanos: propuesta y validación de un marco conceptual simple

  • Eduardo Bustos-Vázquez Escuela de Salud Pública de México, Cuernavaca, México
  • Julián Alfredo Fernández-Niño Departamento de Salud Pública, Escuela de Medicina, Facultad de Salud, Universidad Industrial de Santander, Bucaramanga, Colombia
  • Claudia Iveth Astudillo-Garcia Escuela de Salud Pública de México, Cuernavaca, México
Palabras clave: autoevaluación, estado de salud, comorbilidad, depresión, envejecimiento, determinantes sociales de la salud, México

Resumen

Introducción. La autopercepción de la salud es una concepción individual y subjetiva que resulta de la intersección entre factores biológicos, sociales y psicológicos, y proporciona una evaluación única e inestimable del estado general de salud de una persona.
Objetivo. Proponer y evaluar un modelo conceptual simple para entender la autopercepción de la salud y su relación con la presencia de comorbilidades, discapacidad y síntomas depresivos en adultos mayores mexicanos.
Materiales y métodos. Se hizo un estudio transversal basado en una muestra representativa nacional de 8.874 adultos de 60 y más años. Se determinó la autopercepción positiva de la salud mediante una escala de tipo Likert con la pregunta: “¿Cómo considera que es su estado actual de salud?”, así como de las variables intermedias de presencia de comorbilidades, discapacidad y síntomas depresivos, y variables exógenas dicotómicas (sexo, tener pareja, percepción de la participación en las decisiones del hogar y pobreza). Para validar el modelo conceptual propuesto, se diseñó un modelo generalizado de ecuaciones estructurales con función de enlace logit para la autopercepción positiva de la salud.
Resultados. Se encontró una asociación de vías directas entre la presencia de comorbilidades y la autopercepción positiva de la salud (odds ratio, OR=0,48; IC95% 0,42-0,55), entre la discapacidad y la autopercepción positiva de la salud (OR=0,35; IC95% 0,30-0,40),y entre los síntomas depresivos y la autopercepción positiva de la salud (OR=0,38; IC95% 0,34-0,43). El modelo también validó asociaciones indirectas entre discapacidad y síntomas depresivos (OR=2,25; IC95% 2,01-2,52), presencia de comorbilidades y síntomas depresivos (OR=1,79; IC95% 1,61-2,00), y presencia de comorbilidades y discapacidad (OR=1,98; IC95% 1,78-2,20).
Conclusiones. Se hizo la evaluación empírica de un modelo teórico parsimonioso, lo cual permitió determinar asociaciones directas e indirectas con la autopercepción positiva de la salud.

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Referencias

Sadana R. Comparative analyses of more than 50 household surveys on health status. Geneva: WHO; 2000.

Idler EL, Benyamini Y. Community studies reporting association between self-rated health and mortality. Res Aging. 1999;21: 392-401. http://dx.doi.org/10.1177/0164027599213002

Idler EL, Benyamini Y. Self-rated health and mortality: A review of twenty-seven community studies. J Health Soc Behav. 1997;38:21-37.

Phillips LJ, Hammock RL, Blanton JM. Predictors of selfrated health status among Texas residents. Prev Chronic Dis. 2005;2:A12.

Suija K, Kalda R, Maaroos HI. Patients with depressive disorder, their co-morbidity, visiting rate and disability in relation to self-evaluation of physical and mental health: A cross-sectional study in family practice. BMC Fam Pract. 2009;10:38. http://dx.doi.org/10.1186/1471-2296-10-38

Mossey JM, Shapiro E. Self-rated health: A predictor of mortality among the elderly. Am J Public Health. 1982;72:800-8.

Jylhä M. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Soc Sci Med. 2009;69:307-16. http://dx.doi.org/10.1016/j.socscimed.2009.05.013

Birch S, Eyles J, Newbold KB. Proxies for healthcare need among populations: Validation of alternatives--a study in Quebec. J Epidemiol Community Health. 1996;50:564-9.

DeSalvo KB, Bloser N, Reynolds K, He J, Muntner P. Mortality prediction with a single general self-rated health question. A meta-analysis. J Gen Intern Med. 2006;21:267-75. http://dx.doi.org/10.1111/j.1525-1497.2005.00291.x

Friedsam H, Martin HW. A comparison of self and physicians’ health ratings in an older population. J Health Hum Behav.1963:179-83.

Maddox GL, Douglass EB. Self-assessment of health: A longitudinal study of elderly subjects. J Health Soc Behav.1973;4:87-93.

LaRue A, Bank L, Jarvik U, Hetland M. Health in old age: How do physicians’ ratings and self-ratings compare? J Gerontol. 1979;34:687-91. http://dx.doi.org/10.1093/geronj/34.5.687

Linn BS, Linn MW. Objective and self-assessed health in the old and very old. Soc Sci Med Med Psychol Med Sociol. 1980;14:311-5.

Linn MW, Hunter KI, Linn BS. Self-assessed health, impairment and disability in Anglo, Black and Cuban elderly. Med Care. 1980;18:282-8.

Pattussi MP, Peres KG, Boing AF, Peres MA, Da Costa JS. Self-rated oral health and associated factors in Brazilian elders. Community Dent Oral Epidemiol. 2010;38:348-59. http://dx.doi.org/10.1111/j.1600-0528.2010.00542.x

Moreno X, Huerta M, Albala C. Global self-rated health and mortality in older people. Gac Sanit. 2014;28:246-52. http://dx.doi.org/10.1016/j.gaceta.2013.07.006

Rennemark M, Hagberg B. What makes old people perceive symptoms of illness? The impact of psychological and social factors. Aging Ment Health. 1999;3:79-87. http://dx.doi.org/10.1080/13607869956460

Evans ME. Physical illness and depression. En: Copeland JR, Abou-Saleh MT, Blazer DG, editores. Principles and Practice of Geriatric Psychiatry. Second edition. Chichester, UK.: John Wiley & Sons, Ltd; 2002. p. 417-22. http://dx.doi.org/10.1002/0470846410.ch75a

Ratner PA, Johnson JL, Jeffery B. Examining emotional, physical, social, and spiritual health as determinants of selfrated health status. Am J Health Promot. 1998;12:275-82. http://dx.doi.org/10.4278/0890-1171-12.4.275

Paskulin L, Vianna L, Molzahn A. Factors associated with quality of life of Brazilian older adults. Int Nurs Rev. 2009;56:109-15. http://dx.doi.org/10.1111/j.1466-7657.2008.00671.x

Reynolds SL, Silverstein M. Observing the onset of disability in older adults. Soc Sci Med. 2003;57:1875-89. http://dx.doi.org/10.1016/S0277-9536(03)00053-4

Knäuper B, Turner PA. Measuring health: Improving the validity of health assessments. Qual Life Res. 2003;12:81-9.

Fýlkesnes K, Førde OH. Determinants and dimensions involved in self-evaluation of health. Soc Sci Med. 1992;35:271-9.

Luppa M, Sikorski C, Luck T, Ehreke L, Konnopka A, Wiese B, et al. Age-and gender-specific prevalence of depression in latest-life – Systematic review and metaanalysis.J Affect Disord. 2012;136:212-21. http://dx.doi.org/10.1016/j.jad.2010.11.033

Gallegos-Carrillo K, García-Peña C, Durán-Muñoz C, Reyes H, Durán-Arenas L. Autopercepción del estado de salud: una aproximación a los ancianos en México. Rev Saúde Pública. 2006;40:792-801. http://dx.doi.org/10.1590/S0034-89102006000600008

Romero-Martínez M, Shamah-Levy T, Franco-Núñez A, Villalpando S, Cuevas-Nasu L, Gutiérrez JP, et al. Encuesta Nacional de Salud y Nutrición 2012: diseño y cobertura. Salud Pública Mex. 2013;55:S332-40.

Huang CQ, Dong BR, Lu ZC, Yue JR, Liu QX. Chronic diseases and risk for depression in old age: A meta-analysis of published literature. Ageing Res Rev. 2010;9:131-41. http://dx.doi.org/10.1016/j.arr.2009.05.005

Fernández-Niño JA, Manrique-Espinoza BS, Bojórquez-Chapela I, Salinas-Rodríguez A. Income inequality, socioeconomic deprivation and depressive symptoms among older adults in México. PLoS One. 2014;9:e108127. http://dx.doi.org/10.1371/journal.pone.0108127

Diederichs C, Berger K, Bartels DB. The measurement of multiple chronic diseases — A systematic review on existing multimorbidity indices. J Gerontol A-Biol. 2011;66:301-11. http://dx.doi.org/10.1093/gerona/glq208

Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: Toward a more uniform methodology. Ann Fam Med. 2012;10:142-51. http://dx.doi.org/10.1370/afm.1337

Katz S, Branch LG, Branson MH, Papsidero JA, Beck JC, Greer DS. Active life expectancy. New Engl J Med. 1983;309:1218-24. http://dx.doi.org/10.1056/NEJM198311173092005

Herrero J, Gracia E. Una medida breve de la sintomatología depresiva. Salud Mental. 2007;30:40-6.

Salinas-Rodríguez A, Manrique-Espinoza B, Acosta-Castillo GI, Franco-Núñez A, Rosas-Carrasco Ó, Gutiérrez-Robledo LM, et al. Validación de un punto de corte para la versión breve de la Escala de Depresión del Centro de Estudios Epidemiológicos en adultos mayores mexicanos. Salud Pública Mex. 2014;56:279-85.

Damian J, Pastor-Barriuso R, Valderrama-Gama E. Factors associated with self-rated health in older people living in institutions. BMC Geriatr. 2008;8:5. http://dx.doi.org/10.1186/1471-2318-8-5

Wilcox VL, Kasl SV, Idler EL. Self-rated health and physical disability in elderly survivors of a major medical event. J Gerontol B Psychol Sci Soc Sci. 1996;51:S96-104.

Han B. Depressive symptoms and self-rated health in community-dwelling older adults: A longitudinal study. J Am Geriatr Soc. 2002;50:1549-56. http://dx.doi.org/10.1046/j.1532-5415.2002.50411.x

Kondo N, Sembajwe G, Kawachi I, van Dam RM, Subramanian SV, Yamagata Z. Income inequality, mortality, and self rated health: Meta-analysis of multilevel studies. BMJ. 2009;339:b4471. http://dx.doi.org/10.1136/bmj.b4471

Gunasekara FI, Carter K, Blakely T. Change in income and change in self-rated health: Systematic review of studies using repeated measures to control for confounding bias. Soc Sci Med. 2011;72:193-201. http://dx.doi.org/10.1016/j.socscimed.2010.10.029.

Deeg DJ, Kriegsman DM. Concepts of self-rated health: Specifying the gender difference in mortality risk. Gerontologist. 2003;43:376-86. http://dx.doi.org/10.1093/geront/43.3.376

Shi L, Starfield B. Primary care, income inequality, and selfrated health in the United States: A mixed-level analysis. Int J Health Serv. 2000;30:541-55. http://dx.doi.org/10.2190/N4M8-303M-72UA-P1K1

Goldstein MS, Siegel JM, Boyer R. Predicting changes in perceived health status. Am J Public Health. 1984;74:611-4.

Brook RH, Ware JE, Davies-Avery A, Stewart AL, Donald CA, Rogers WH, et al. Overview of adult health status measures fielded in Rand’s Health Insurance Study. Med Care. 1979:17:i-131.

Nieminen T, Martelin T, Koskinen S, Aro H, Alanen E, Hyyppa MT. Social capital as a determinant of self-rated health and psychological well-being. Int J Public Health. 2010;55:531-42. http://dx.doi.org/10.1007/s00038-010-0138-3

Kim D, Kawachi I. A multilevel analysis of key forms of community- and individual-level social capital as predictors of self-rated health in the United States. J Urban Health. 2006;83:813-26. http://dx.doi.org/10.1007/s11524-006-9082-1

Fayers PM, Sprangers MA. Understanding self-rated health. Lancet. 2002;359:187-8. http://dx.doi.org/10.1016/s0140-6736(02)07466-4

Mohan R, Beydoun HA, Beydoun MA, Barnes-Eley M, Davis J, Lance R, et al. Self-rated health as a tool for estimating health-adjusted life expectancy among patients newly diagnosed with localized prostate cancer: A preliminary study. Qual Life Res. 2011;20:713-21. http://dx.doi.org/10.1007/s11136-010-9805-3

Lee Y, Shinkai S. A comparison of correlates of self-rated health and functional disability of older persons in the Far East: Japan and Korea. Arch Gerontol Geriatr. 2003;37:63-76. http://dx.doi.org/10.1016/S0167-4943(03)00021-9

Verropoulou G. Key elements composing self-rated health in older adults: A comparative study of 11 European countries. Eur J Ageing. 2009;6:213-26. http://dx.doi.org/10.1007/s10433-009-0125-9

Bombak AE, Bruce SG. Self-rated health and ethnicity: Focus on indigenous populations. J Circumpolar Health. 2012;71:18538. http://dx.doi.org/10.3402/ijch.v71i0.18538

Nielsen AB, Siersma V, Waldemar G, Waldorff FB. Poor self-rated health did not increase risk of permanent nursing placement or mortality in people with mild Alzheimer’s disease. BMC Geriatr. 2016;16:1-8. http://dx.doi.org/10.1186/s12877-016-0262-x

Pinto JM, Fontaine AM, Neri AL. The influence of physical and mental health on life satisfaction is mediated by selfrated health: A study with Brazilian elderly. Arch Gerontol Geriatr. 2016;65:104-10. http://dx.doi.org/10.1016/j.archger.2016.03.009

Publicado
2017-04-01
Cómo citar
Bustos-Vázquez, E., Fernández-Niño, J., & Astudillo-Garcia, C. (2017). Autopercepción de la salud, presencia de comorbilidades y depresión en adultos mayores mexicanos: propuesta y validación de un marco conceptual simple. Biomédica, 37, 92-103. https://doi.org/10.7705/biomedica.v37i3.3070