Planning health services for seniors: Can we use patient's own perception?

Abstract

Objectives The objectives of this study were to identify needs and to estimate whether self-reported health can be used as an indicator of service needs among seniors. Methods This was a cross-sectional survey. Age- and sex-adjusted logistic regression was used to estimate the link between functional status indicators and fair or poor self-reported health. Forward stepwise logistic regression was performed to identify the strongest contributors of poor health. Positive predictive value (PPV), sensitivity, and specificity were calculated to identify whether health perception could be used to identify people in need of physical rehabilitation services. Results 142 seniors agreed to answer the survey, yielding a response rate of 73%. Among the respondents (mean age 79±7; 60% women), 40% rated their health as fair or poor. Seniors perceiving their health as fair or poor had higher odds of reporting impairments, activity limitations, and participation restrictions (OR ranging from 2.37 95%CI: 1.03-5-45 to 12.22 95%CI: 2.68-55.78) in comparison to those perceiving their health as good or better. The strongest contributors for poor/ fair health were depression, difficulty performing household tasks, pain, and dizziness (c-statistic = 0.91 and a maximum adjusted r-squared of 0.60). Self-rated health used as singleitem showed a positive predictive value (PPV) of 1, sensitivity of 52%, and specificity of 100%. Conclusion Our results indicate that all seniors participating in this study and reporting fair or poor health have indicators of need for further rehabilitation services. Asking patients to rate their own health may be an alternate way of querying about need, as many older persons are afraid to report disability because of fear of further institutionalization.