"Still Feeling Healthy After All These Years": The Paradox of Subjective Stability Versus Objective Decline in Very Old Adults' Health and Functioning Across Five Years

• Published in: Psychology and aging 2016-12, Vol.31 (8), p.815-830
• Main Authors: Wettstein, Markus, Schilling, Oliver K., Wahl, Hans-Werner
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Age; Aged, 80 and over; Aging; Aging - physiology; Aging - psychology; Cognitive Ability; Cognitive Impairment; Competence; Diagnostic Self Evaluation; Female; Grip strength; Health; Health Status; Human; Humans; Life changes; Longitudinal Studies; Male; Measurement; Motor ability; Older Adulthood; Older people; Perceptual Motor Processes; Personal health; Self Report; Sensory perception; Subjective judgments; Symptoms; Very old; Visual Acuity
• ISSN: 0882-7974; 1939-1498
• DOI: 10.1037/pag0000137

Indicators of objective functioning, such as everyday competence or sensory and sensorimotor functions, typically show pronounced declines in very old age. However, less is known about how very old adults perceive their abilities across multiple domains of health and functioning and to what extent changes in perceived functioning mirror changes in objective functioning. We compared changes in perceived versus objective health and functioning indicators among very old adults (n = 124; baseline age between 87 and 97 years, M = 90.56 years, SD = 2.92 years) across 11 measurement occasions, spanning approximately 5 years. Functioning was assessed by self-reports (subjective health, subjective movement ability, subjective vision, and number of perceived symptoms) and by objective and mostly performance-based tests (everyday competence, visual acuity, chair stand test, and grip strength). All objective measures exhibited a significant mean-level decline across 5 years, whereas most subjective indicators did not reveal significant mean-level changes. Interindividual variation in intraindividual change patterns was considerable in most domains. Correlations between trajectories of the different indicators were mostly weak, and predicting late-life changes in subjective functioning by time-varying objective functioning indicators accounted for only modest amounts of variance. Our findings suggest that there is a somewhat paradoxical pattern of discrepant late-life change trends in subjective versus objective indicators of health and functioning. We argue that a differentiated understanding of the fourth age is required and that common health definitions frequently applied to old and very old age need to be challenged.