Objective and Subjective Health Measures; What do They Tell us?

A variety of measures have been used to examine individuals’ health status. The most frequently used measures are subjective ones, such as self-rated health (SRH) and self-perceived dependence in activities of daily living (ADL). Objective measures and biomarkers are rarely used in this context. The introduction of such measures may provide an important complement to SRH and similar indicators. Recently objective measures such as grip strength and lung function gained popularity. SRH and grip strength are static indicators, capturing deviations from a norm perceived as healthy.

In order to increase our understanding of objective and subjective health measures among community-dwelling older people this study investigated relationships between subjective (SRH and dependence in ADL) and objective (grip strength and lung function) health indicators, and examined variation in predictor variables among health outcomes. It was conducted on 766 individuals aged ≥ 45 years in India using the 2010 pilot wave of the Longitudinal Aging Study in India (LASI). Correlations between and gender differences in objective and health measures were examined. Multivariate logistic regression analyses, accounting for sample design, were conducted to identify predictors of poor health. Fewer individuals were classified as at risk according to subjective health measures (only 9% to 12% measured by SRH and dependence in ADL) than objective health measures (57% to 87% measured by grip strength and lung function). Furthermore, very weak almost non-significant relations were found between subjective and objective health measures.

This study added weight and detail to the findings of similar studies with the use of two objective health outcomes, as well as subjective measures, in the assessment of health in India’s elderly population. The main contribution of this research to the existing literature is the finding that there is no strong relationship between the health outcomes examined. The disparity between the small percentages of the population classified as ‘at risk’ according to subjective measures, and the majority of individuals determined to be at risk according to objective indicators, suggests that they reflect different ‘parts’ of mortality and morbidity. While ADL or SRH is expected to be low in our study sample, the high proportion of older people in India with low grip strength and poor lung function is a concern. Further study is thus warranted to obtain a full understanding of the correct application and interpretation of different health indicators depending on the problem of interest, the context in which it is investigated, and the population involved.


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Jane Murray Cramm

About Jane Murray Cramm

Jane Murray Cramm is an Associate Professor at the Institute of Health Policy and Management, Erasmus University Rotterdam, in the Netherlands. She is also cofounder of the Credit for Rehabilitation Aimed at the Marginalized Minorities Foundation, which provides microcredit to people with disabilities and women in developing countries. Jane holds a master's degree in health care management and a doctorate in sociomedical sciences from Erasmus University. Research on quality of care, co-creation of care and patient-centeredness, especially for frail (older) populations has been a core component of her career. Global ageing is also a core research theme of Jane. She has been a senior researcher in studies evaluating several large-scale complex intervention programs. Jane has published over a 100 peer reviewed articles.

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