Lower self-rated health linked to daily functional limitations for patients with CKD
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Findings from a retrospective cohort study demonstrated a significant association between lower self-rated health and limitations to performing various activities of daily living.
Most common among these limitations was ambulation, the team of investigators from University of Pittsburgh School of Medicine determined.
“In patients with [chronic kidney disease] CKD, poor self-rated health has been shown to be associated with mortality, kidney disease progression and worse patient-centered outcomes such as anxiety, depression, coping, autonomy and self-esteem. Consequently, poor self-rated health may directly or indirectly affect patients’ ability to perform activities of daily living (ADLs) and impair their functional independence, which is a priority for most patients with CKD,” Jacqueline Lee, MS, of the University of Pittsburgh School of Medicine, and colleagues wrote. “Limitations in ADLs can in turn worsen patients’ self-rated health. We previously showed that poor self-rated health was associated with frailty and disability among older patients with advanced CKD. However, the relationship between self-rated health and functional status among patients across the spectrum of CKD stages and age groups has not been assessed.”
Self-rated health and activities of daily living
For the study, Lee and colleagues surveyed 1,268 patients receiving care at one nephrology outpatient clinic in Pennsylvania. Researchers determined self-rated health with the question: “In general, compared to other people your age, would you say that your health is?” Patients also rated their health utilizing the Likert scale. Based on these responses together, researchers categorized participants into the poor-to-fair self-rated health group or the good-to-excellent self-rated health group.
Both cognitive (eg, executive function and memory) and physical ADLs were assessed through questionnaires. Physical ADLs included walking, dressing and shopping.
Overall, 41% of patients reported poor-to-fair health and 59% reported good-to-excellent health.
Self-rated health scores were lower for women and unmarried patients, as well as patients younger than 65 years. Older patients were more likely to rate their health as good-to-excellent, which researchers suggested may be due to the fact that older patients have expectations of poorer health, causing them to “normalize” the experience.
Physical vs cognitive limitations
Participants who rated their health as poor-to-fair experienced more limitations in each ADL category, as well as in the composite score, with a stronger association observed for physical limitations (odds ratio = 8.29) than for cognitive ones (OR = 5.84).
“Physical ADL limitations were commonly reported in our study and had a stronger association with poor-to-fair self-rated health than cognitive ADLs,” Lee and colleagues wrote. “This may be because physical ADL limitations have a greater perceived impact on a person’s participation in family and social life, and independence in accomplishing day-to-day tasks. In addition, patients may have poorer insight into cognitive decline, especially at earlier stages and cognitive decline may be perceived as part of the normal aging process by some patients and have less of an impact on perception of health than physical limitations.”
Regarding specific limitations, ambulation was the most frequently reported among all participants; it was more common in patients with poor-to-fair health compared with those who reported good-to-excellent health (58.1% vs. 17.4%).
“Future research should evaluate whether self-rated health can serve as a simple screening tool to identify patients who could benefit from additional healthcare resources for evaluation and treatment of functional limitations to improve person-centered outcomes,” the researchers concluded.
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