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Subjective Social Status and Functional Decline in Older Adults

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ABSTRACT

BACKGROUND

It is unknown whether subjective assessment of social status predicts health outcomes in older adults.

OBJECTIVE

To describe the relationship between subjective social status and functional decline in older adults.

DESIGN

Longitudinal cohort study.

SETTING

The Health and Retirement Study, a nationally representative survey of community-dwelling older adults (2004-2008).

PARTICIPANTS

Two thousand five hundred and twenty-three community-dwelling older adults.

MAIN MEASURES

Self-report of social status (SSS), categorized into three groups, reported by participants who marked a 10-rung ladder to represent where they stand in society. Four-year functional decline (new difficulty in any of five activities of daily living, mobility decline and/or death)

KEY RESULTS

Mean age was 64; 46% were male, 85% were white. At baseline, lower SSS was associated with being younger, unmarried, of nonwhite race/ethnicity, higher rates of chronic medical conditions and ADL impairment (P < 0.01). Over 4 years, 50% in the lowest SSS group declined in function, compared to the middle and highest groups (28% and 26%), P-trend <0.001. Those in the lowest rungs of SSS were at increased risk of 4-year functional decline (unadjusted RR = 1.91, CI 1.–9-2.46). The relationship between a subjective belief that one is worse off than others and functional decline persisted after serial adjustment for demographics, objective SES measures, and baseline health and functional status (RR 1.36, CI 1.08–1.73).

CONCLUSIONS

In older adults, the belief that one is in the lowest rungs of social status is a measure of socioeconomic distress and of significant risk for functional decline. These findings suggest that self-report of low subjective social status may give clinicians additional information about which older adults are at high risk for future functional decline.

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Author Contributions

Study Concept and Design: Chen, Williams

Acquisition of Data: Williams, Stijacic-Cenzer, Covinsky

Analysis and Interpretation of Data: Chen, Stijacic-Cenzer, Covinsky, Adler and Williams

Preparation of Manuscript and Critical Review: Chen, Stijacic-Cenzer, Covinsky, Adler and Williams

No other parties contributed substantially to this research or to preparation of this manuscript.

Funders

Dr. Williams was funded by the Brookdale Leadership in Aging Fellowship, the National Institute on Aging (K23AG033102), the UCSF Hartford Foundation Center of Excellence Physician-Scholar Award and the Program for the Aging Century. Dr. Covinsky was supported by the National Institute on Aging (R01 AG028481and K24 AG029812). The R01 was administered by the Northern California Institute for Research and Education, and with resources of the San Francisco Veterans Affairs Medical Center. Dr. Adler received support from the MacArthur Foundation Research Network on Socioeconomic Status and Health. These funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript. This work was supported with resources of the Veterans Affairs Medical Center, San Francisco, California. Drs. Williams and Covinsky are employees of the Department of Veterans Affairs. The opinions expressed in this manuscript may not represent those of the VA.

Prior Presentations

This paper was presented as an oral presentation at the 33rd Annual Meeting of the Society for General Internal Medicine on April 29, 2010.

Conflict of interest

None disclosed.

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Authors and Affiliations

  1. Department of Medicine, University of California, San Francisco, CA, USA

    Bonnie Chen MD

  2. Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA

    Kenneth E. Covinsky MD, Irena Stijacic Cenzer MA & Brie A. Williams MD, MS

  3. San Francisco VA Medical Center, Health Services Research and Development Research Enhancement Award Program, San Francisco, CA, USA

    Kenneth E. Covinsky MD & Brie A. Williams MD, MS

  4. Departments of Psychiatry and Pediatrics, University of California, San Francisco, CA, USA

    Nancy Adler PhD

  5. Center for Health and Community, University of California, San Francisco, CA, USA

    Nancy Adler PhD

Authors
  1. Bonnie Chen MD
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  2. Kenneth E. Covinsky MD
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  3. Irena Stijacic Cenzer MA
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  4. Nancy Adler PhD
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  5. Brie A. Williams MD, MS
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Corresponding author

Correspondence to Brie A. Williams MD, MS.

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Chen, B., Covinsky, K.E., Cenzer, I.S. et al. Subjective Social Status and Functional Decline in Older Adults. J GEN INTERN MED 27, 693–699 (2012). https://doi.org/10.1007/s11606-011-1963-7

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  • DOI: https://doi.org/10.1007/s11606-011-1963-7

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