Subjective health in old age from a salutogenic perspective.

OBJECTIVE: We applied Antonovsky's salutogenic model to healthy ageing. Basically, salutogenic theory states that generalized resistance resources build-up the sense of coherence which in turn determines an individual's health level. Specifically, we explored the status of the sense of coherence as a mediator variable. DESIGN AND METHOD: We conducted a cross-sectional questionnaire study with 387 volunteering elders (73.4% women and 22.2% nursing home residents) at the mean age of 74 (SD=7.58) years. We assessed 19 bio-psychosocial resources, the sense of coherence, and three subjective health measures - psychological health, symptom reporting, and physical health. As nursing home residents were generally inferior, our study controlled for dependent living. RESULTS: Resources, sense of coherence, and subjective health were significantly inter-related. A regression showed that optimism, self-esteem, low depressive mood, self-efficacy, and social support predicted the sense of coherence significantly. Predicting psychological health and symptom reporting, the sense of coherence remained significant when resources were added in the final step of the regression. This pattern was not found for physical health. Mediator analyses using Preacher and Hayes' paradigm showed that every eligible resource influenced both psychological health and symptom reporting, but not physical health, indirectly via the sense of coherence. CONCLUSION: The sense of coherence is largely shaped by individual difference variables. As a mediator variable, it strongly accounts for the relation between resources and psychogenic aspects of health, whereas its relative significance for physical health is not corroborated. Our findings emphasize the importance of resource-oriented health care for elders.

Dimensions and profiles of the generalized health-related self-concept.

OBJECTIVES: We explore the significance of health as a potentially self-relevant category from the perspective of dynamic self-concept theory. Our intention was to describe the dimensional structure of the generalized health-related self-concept, to identify particular prototypes of health-related self-definition, and to see if these prototypes would differ with respect to appraisals of health behaviour and subjective health. DESIGN: We conducted a cross-sectional questionnaire study involving 545 college students (23.3% male) at the mean age of 22 years. METHODS: The self-administered questionnaire assessed a relevant spectrum of health-related cognitions denoting their generalized declarative knowledge about their health (the generalized health-related self-concept). Additionally, participants rated their multiple health behaviour, their perceived health, and their anticipated vulnerability. RESULTS: A principal components analysis of the health-related cognitions revealed the following five dimensions: health-protective dispositions, health-protective motivation, vulnerability, health-risky habits, and external, avoidant motivation. A two-step cluster analysis of the five components identified six profiles of health-related self-concept: careless/carefree, omnipotents, risk-takers, mentally affected, reluctant-avoidant, and medically fragile. These prototypes could be successfully reclassified (97.6%). The six profiles differed with respect to their health behaviour and subjective health appraisals. CONCLUSIONS: The dimensional structure represents both resources and deficits with respect to an individual's health-related self-concept. An individual's profile of these dimensions might correspond to a characteristic set of particular health needs and motivations. Successful health communications should follow a complementary strategy of affirming the self-concept.