Feeling Better at This Age? Investigating Three Explanations for Self-Rated Health Improvements Among the Oldest-Old

Background and Objectives: Although the majority of individuals in their 80s or 90s do not experience improving health, a significant portion of this age group either (a) subjectively assess their health as improving; or (b) demonstrate self-rated health improvements when comparing consecutive surveys. While there is a body of research that examines self-rated health declines in older ages, much less work has studied possible determinants of self-rated health improvements. This is important, since there is increasing evidence that oldest-old adults have unique health evaluative processes that are not yet well-understood. Research Design and Methods: Using 21,155 observations from eight waves of the Asset and Health Dynamics survey (the oldest-old portion of the Health and Retirement Study), I use hierarchical linear models to test three explanations as to why the oldest-old may report or demonstrate self-rated health improvements: (a) normalized pre-existing chronic conditions, (b) positive lifestyle changes, and (c) recovery from recent prior health shocks. Results: Health improvements calculated by comparing consecutive surveys were related to a recovery from four particular serious health diagnoses (cancer, stroke, heart disease, and lung disease). Conversely, explicitly reported health improvements were associated with normalizing pre-existing conditions. Lastly, starting a regular exercise routine was related to both types of health improvements; while the cessation of negative health behaviors (i.e., drinking and smoking) was not related to either type. Discussion and Implications: These results suggest that while subjective health "improvements" among the oldest-old may be a sign of successful aging, they should be interpreted critically and cautiously.