02044nas a2200169 4500008004100000022001400041245007700055210006900132260001600201300000800217490000800225520154100233100002401774700002301798700001701821856003601838 2009 eng d a0162-145900aJoint modeling of self-rated health and changes in physical functioning.0 aJoint modeling of selfrated health and changes in physical funct c2009 Sep 01 a9120 v1043 a
Self-rated health is an important indicator of future morbidity and mortality. Past research has indicated that self-rated health is related to both levels of and changes in physical functioning. However, no previous study has jointly modeled longitudinal functional status and self-rated health trajectories. We propose a joint model for self-rated health and physical functioning that describes the relationship between perceptions of health and the rate of change of physical functioning or disability. Our joint model uses a non-homogeneous Markov process for discrete physical functioning states and connects this to a logistic regression model for "healthy" versus "unhealthy" self-rated health through parameters of the physical functioning model. We use simulation studies to establish finite sample properties of our estimators and show that this model is robust to misspecification of the functional form of the relationship between self-rated health and rate of change of physical functioning. We also show that our joint model performs better than an empirical model based on observed changes in functional status. We apply our joint model to data from the Cardiovascular Health Study (CHS), a large, multi-center, longitudinal study of older adults. Our analysis indicates that self-rated health is associated both with level of functioning as indicated by difficulty with activities of daily living (ADL) and instrumental activities of daily living (IADL), and the risk of increasing difficulty with ADLs and IADLs.
1 aHubbard, Rebecca, A1 aInoue, Lurdes, Y T1 aDiehr, Paula uhttps://chs-nhlbi.org/node/1167