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Background
Elective surgeries are among the most common health stressors in later life and put a significant risk at functional and mental health, making them an important target of research into healthy aging and physical resilience. Large-scale longitudinal research mostly conducted in non-clinical samples provided support of the predictive value of self-rated health (SRH) for both functional and mental health. Thus, SRH may have the potential to predict favorable adaptation processes after significant health stressors, that is, physical resilience. So far, a study examining the interplay between SRH, functional and mental health and their relative importance for health changes in the context of health stressors was missing. The present study aimed at addressing this gap.
Methods
We used prospective data of 1,580 inpatients (794 complete cases) aged 70 years or older of the PAWEL study, collected between October 2017 and May 2019 in Germany. Our analyses were based on SRH, functional health (Barthel Index) and self-reported mental health problems (PHQ-4) before and 12 months after major elective surgery. To examine changes and interrelationships in these health indicators, bivariate latent change score (BLCS) models were applied.
Results
Our analyses provided evidence for improvements of SRH, functional and mental health from pre-to-post surgery. BLCS models based on complete cases and the total sample pointed to a complex interplay of SRH, functional health and mental health with bidirectional coupling effects. Better pre-surgery SRH was associated with improvements in functional and mental health, and better pre-surgery functional health and mental health were associated with improvements in SRH from pre-to-post surgery. Effects of pre-surgery SRH on changes in functional health were smaller than those of functional health on changes in SRH.
Conclusions
Meaningful changes of SRH, functional and mental health and their interplay could be depicted for the first time in a clinical setting. Our findings provide preliminary support for SRH as a physical resilience factor being associated with improvements in other health indicators after health stressors. Longitudinal studies with more timepoints are needed to fully understand the predictive value of SRH for multidimensional health.
Trial registration
PAWEL study, German Clinical Trials Register, number DRKS00013311. Registered 10 November 2017 – Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013311.
Background
Self-reported time-use in relation to health-related quality of life (HRQoL) has been widely studied, yet less is known about the directionality of the association and how it compares across genders when controlling for sociodemographic confounders.
Methods
This study focused on the working population of the most recent waves (2013–2018) of the Core-Study of the German Socio-Economic Panel (N = 30,518, 46.70% female, M = 39.24 years). It examined the relationship between three time-use categories (contracted, committed, & leisure time) and HRQoL (self-rated health & life satisfaction) in men and women via multigroup fixed effects cross-lagged panel models. The models controlled for sociodemographic background (age, household income, number of children living in household, employment status, education, & marital status), which was associated with time-use and psychosocial health in previous research.
Results
Contracted time showed consistent positive relationships with HRQoL across genders while associations with the other types of time use differed significantly between men and women and across indicators of HRQoL.
Conclusions
The way we spend our time directly predicts our health perceptions, but in the same vein our health also predicts how we can spend our time. Contracted time in particular was associated with positive HRQoL, across genders, and beyond sociodemographic predictors, highlighting the important role of employment in health, for men and women alike. The impact of commitments beyond contracted time-use—like household chores and childcare—however, continues to affect mainly women, which ultimately reflects in poorer health outcomes.