Individual and social determinants of self-rated health and
					well-being in the elderly population of Portugal

Silva, Pedro Alcântara da

doi:10.1590/0102-311X00173813

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Article • Cad. Saúde Pública 30 (11) • Nov 2014 • https://doi.org/10.1590/0102-311X00173813 copy

Individual and social determinants of self-rated health and well-being in the elderly population of Portugal

Determinantes individuais e sociais do estado de saúde subjetivo e de bem-estar da população sênior de Portugal

Determinantes individuales y sociales del estado de salud subjetivo y bienestar de la población de la tercera edad de Portugal

Authorship SCIMAGO INSTITUTIONS RANKINGS

This article aims to identify the main determinants of self-rated health and well-being in the elderly Portuguese population, using a set of dimensions including demographic and socioeconomic indicators, characteristics of interpersonal networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to analyze the explanatory value of the interrelated dimensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partially offsetting the effect of socioeconomic factors and illness associated with age.

Demographic Aging; Self-Assessment; Health of the Elderly

	n	%	Mean	Minimum	Maximum	SD
Dependent variables
Self-rated health status			3.13	1.00	5.00	0.908
Very bad	53	5.3
Bad	133	13.3
Fair	504	50.5
Good	246	24.6
Very good	62	6.3
Total	997	100.0
Feeling of happiness			3.70	1.00	5.00	0.764
Very unhappy	11	1.1
Unhappy	58	5.8
Neither happy nor unhappy	246	24.7
Happy	587	59
Very happy	93	9.3
Total	995	100.0
Demographic and socioeconomic
Age	-	-	65.26	50.00	97.00	10.261
Gender			-	-	-	-
Male	447	44.7
Female	553	55.3
Total	1,000	100.0
Education			-	-	-	-
Can neither read nor write	61	6.2
Can read and write/1^st cycle primary school	515	51.9
2^nd cycle primary school	65	6.5
3^rd cycle primary school	140	14.1
Secondary school	104	10.4
University	108	10.9
Total	993	100.0
Profession *			-	-	-	-
Owners, managers, professionals	70	7.7
Middle and university level personnel	148	16.2
Non-manual workers	260	28.4
Skilled manual workers	289	31.6
Unskilled manual workers	147	16.0
Total	914	100.0
Employment status			-	-	-	-
Employed	249	25.7
Retired	573	59.2
Unemployed	77	7.9
Housework	69	7.2
Total	968	100.0
Income bracket **	-	-	4.31	1.00	7.00	1.623
Housing status ***			1.43	1.00	4.00	0.742
In good or perfect state of repair	676	69.5
Needs minor repairs	193	19.9
Needs some repair work	80	19.9
Needs major repair work	23	2.3
Total	972	100.0
Personal networks
Size of network ^#	-	-	2.38	1.00	8.00	1.37
Composition of network			-	-	-	-
Predominantly family	687	76.0
Predominantly non-family	217	24.0
Total	904	100.0
Living situation			-	-	-	-
Living alone	201	20.1
Living with others	799	79.9
Total	1,000	100.0
Frequency of need for emotional support			2.36	1.00	4.00	1.039
Never	275	27.5
Rarely	243	24.4
Sometimes	331	33.2
Often	149	14.9
Total	998	100.0
Needs more emotional support			-	-	-	-
Yes	349	35.8
No	625	64.2
Total	974	10.0
Expression of affects ^##	-	-	2.99	1.00	6.00	1.518
Social activities
Number of activities at home ^###	-	-	5.83	0.00	10.00	2.104
Number of activities away from home	-	-	2.91	0.00	10.00	1.759
Number of activities mostly at home	-	-	4.69	0.00	6.00	1.821
Number of activities mostly away from home	-	-	1.99	0.00	6.00	1.25
Belongs to some association ^§			1.98	1.00	4.00	1.045
Never belonged	427	43.0
Used to belong	285	28.7
Belongs as non-active member	157	15.8
Belongs as active member	125	12.6
Total	994	100.0
Active aging index	-	-	2.51	1.00	4.73	0.83
Representations of aging ^§§	-	-	3.85	1.00	5.00	0.742
Health
Chronic disease			-	-	-	-
Yes	538	53.9
No	460	46.1
Total	998	100.00
Physical and psychological impairments			1.54	1.00	4.00	0.975
None	740	74.7
Very few	40	4.0
A few	143	14.4
Many	68	6.9
Total	991	100.0
Sexual activity
Sexually active in the previous 3 months			-	-	-	-
Yes	462	53.3
No	405	46.7
Total	867	100.0
Importance of sexual activity			2.52	1.00	4.00	1.071
Unimportant	235	25.7
Slightly important	139	15.2
Important	365	40.0
Very important	174	19.1
Total	914	100.0

SD: standard deviation.
Note: Dummy variables in the regression models included gender (reference group = female); profession (reference group = skilled manual workers; situation in the profession (reference group = skilled manual workers); composition of network (reference group = family network); living situation (reference group = living with others); more emotional support (reference group = no); chronic disease (reference group = yes); sexually active in previous three months (referencegroup = yes). All the statistical analyses used IBM SPSS version 21 (IBM Corp., Armonk, USA).
^*
Profession consisted of the combination of each individual’s profession (National Classification of Professions 2010 –National Institute of Statistics, Portugal) and employment status;
^**
Family member’s income bracket (monthly net mean in Euros), where “1 = A” is the lowest value (≤ € 350) and “7 = G” is the highest (> € 2,500);
^***
Classification of the housing’s state of repair was based on the interviewer’s assessment;
^#
Number of persons listed by the interviewee when asked about the persons he or she had spoken to in the previous 12 months about day-to-day problems, concerns, or other topics he or she considered important (up to 8 important persons, including family and non- family);
^##
The variable resulted from the construction of an index based on three questions concerning the frequency with which they had hugged, kissed, or caressed their spouse or partner, the frequency with which they had hugged an adult (other than spouse or partner), and the frequency with which they had hugged a child (in the previous four weeks and with answers varying from “1 = Daily” to “6 = Never”), showing Cronbach’s alpha = 0.56;
^###
The indicators for activities resulted from the type and frequency with which each of the following activities was performed, ranging from “1 = Never” to “6 = Daily”: “household chores”, “handicrafts, manual work, home repairs”, “free-time computer use”, “participation in events such as those held by political parties, trade unions, or civic movements”, “visiting friends or acquaintances and inviting them to one’s home”, “crosswords or jigsaw puzzles”, “flower or vegetable gardening”, “reading”, “listening to the radio”, “watching TV”, “keeping a pet”, “listening to music”, “outings”, “practicing a sport”, “performing some artistic activity”, “going to the movies, concerts, theater, museums, galleries, or art exhibits”, “attending sports events”, “playing table games”, “attending training courses or activities at one’s own initiative”;
^§
Resulted from the combination of two questions on whether the person is, used to be, or has never been a member of associations (sports clubs; trade unions, professional associations, company unions; political parties; and various associations such as those involving open-air and cultural activities, consumer groups, heritage group, parents’ and educational communities, social solidarity, and neighborhood associations) and the frequency with which the person had participated in meetings, events, or reunions of these organizations in the previous twelve months (ranging from 1 = “daily” to 6 = “never”);
^§§
Resulted from the construction of an index based on a set of eight indicators (“feeling less and less respected”; “feeling more and more alone”; “knowing more what you want”; “continuing to make plans”; “taking less advantage of life”; “feeling like you wouldn’t be missed”; and “still being capable of learning new things and having more free time”, on a scale of agreement from 1 = “disagree totally” to 5 = “agree totally”). By recoding and orienting the scale of indicators in the same direction, and after finding a considerable degree of consistency between them (Cronbach’s alpha = 0.71), a single variable was constructed in which the lowest point on the scale (1) meant a “pessimistic view of aging” and the highest point (5) an “optimistic view”).

		Block 1 (Demographic and socioeconomic)	Block 2 (Personal networks)	Block 3 (Social activities)	Block 4 (Health)	Block 5 (Sexual activity)	Block 6 (Happiness)
Age		-0.182 *	-0.198 *	-0.160 **	-0.116 **	-0.117 ***	-0.117 ***
Gender (female)		0.155 *	0.154 *	0.117 **	0.033	0.019	0.023
Education		0.140 **	0.137 **	0.042	0.024	0.032	0.045
Owners, managers, and professionals (skilled manual workers)		0.100 ***	0.097 ***	0.075	0.069	0.067	0.068
Middle and university-level personnel (skilled manual workers)		0.063	0.057	0.044	0.026	0.013	0.013
Non-manual workers (skilled manual workers)		0.022	0.022	0.016	0.019	0.013	0.021
Unskilled manual workers (skilled manual workers)		-0.021	-0.016	0.000	0.005	0.001	0.002
Employed (retired)		0.083	0.075	0.052	-0.029	-0.018	-0.010
Unemployed (retired)		0.009	0.011	-0.015	-0.029	-0.030	-0.029
Domestic (retired)		0.099 ***	0.099 ***	0.081 ***	0.027	0.033	0.039
Income		0.093 ***	0.104 ***	0.052	0.005	0.007	-0.008
Network size			0.076 ***	0.052	0.090 **	0.088 **	0.089 **
Network composition (family network)			-0.049	-0.050	-0.038	-0.033	-0.019
Living situation (living with others)			0.040	0.029	0.010	0.014	0.037
Number of activities at home				0.114	0.088	0.085	0.085
Number of activities away from home				0.109	0.157 ***	0.167 **	0.169 **
Number of activities mostly at home				-0.067	-0.054	-0.062	-0.052
Number of activities mostly away from home				0.159 **	0.167 **	0.176 *	0.176 *
Belongs to some association				-0.031	0.025	0.028	0.036
Active aging index				0.243 **	0.196 **	0.187 **	0.143 ***
Chronic disease (yes)					0.381 *	0.372 *	0.369 *
Physical and psychological impairments					-0.128 *	-0.135 *	-0.110 **
Sexual activity in previous 3 months (yes)						0.085 ***	0.110 **
Importance of sexual activity						0.110 **	0.106 **
Happiness							0.141 *

	Δ R²	0.211	0.009	0.042	0.161	0.008	0.015
	Adjusted R²	0.197	0.202	0.237	0.401	0.408	0.422

		Block 1 (Demographic and socioeconomic)	Block 2 (Personal networks)	Block 3 (Social activities)	Block 4 (Health)	Block 5 (Sexual activity)
Age		-0.107 *	-0.040	0.025	0.037	0.080
Gender (female)		0.102 **	0.073	0.053	0.039	-0.002
Education		-0.014	-0.002	-0.104 *	-0.108 *	-0.109 *
Owners, managers, and professionals (skilled manual workers)		0.023	0.017	-0.002	-0.013	-0.014
Middle and university-level personnel (skilled manual workers)		0.006	0.012	0.008	0.003	0.011
Non-manual workers (skilled manual workers)		-0.065	-0.055	-0.075	-0.076	-0.078
Unskilled manual workers (skilled manual workers)		-0.023	0.011	0.025	0.019	0.024
Employed (retired)		0.024	0.012	0.023	0.015	0.008
Unemployed (retired)		0.067	0.065	0.032	0.029	0.028
Domestic (retired)		0.018	0.007	-0.012	-0.024	-0.032
Member’s income		0.237 ***	0.164 ***	0.092 *	0.081	0.068
Housing status		-0.068	-0.026	-0.007	-0.009	0.002
Network size			-0.034	-0.050	-.055	-0.054
Network composition (family)			-0.068	-0.079 *	-0.075 *	-0.074 *
Living situation (living with others)			-0.158 ***	-0.147 ***	-0.148 ***	-0.143 ***
Frequency of need for emotional support			-0.220 ***	-0.182 ***	-0.156 ***	-0.154 ***
More emotional support (no)			-0.058	-0.015	-0.007	-0.005
Outward expression of affects			-0.169 ***	-0.095 *	-0.097	-0.092 *
Belongs to some association				-0.060	-0.060	-0.064
Active aging index				0.158 ***	0.142 **	0.118 *
Representations of aging				0.317 ***	0.286 ***	0.275 ***
Self-rated health status					0.106 *	0.117 **
Chronic disease (yes)					-0.033	-0.038
Physical and psychological impairments					-0.073	-0.055
Sexual activity in previous 3 months (yes)						-0.157 ***
Importance of sexual activity						0.006

	Δ R²	0.126	0.119	0.930	0.120	0.160
	Adjusted R²	0.107	0.221	0.314	0.322	0.336

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[1] Correspondence: P. A. Silva. Instituto de Ciências Sociais, Universidade de Lisboa. Av. Professor Aníbal de Bettencourt 9, Lisboa, Portugal, 1600-189. pedro.alcantara@ics.ulisboa.pt