Elsevier

Social Science & Medicine

Volume 61, Issue 5, September 2005, Pages 1083-1094
Social Science & Medicine

Expectations regarding length and health related quality of life: Some empirical findings

https://doi.org/10.1016/j.socscimed.2005.01.008Get rights and content

Abstract

Own expectations regarding length and future quality of life can differ from objective measures such as actuarial life expectancy. If so, this may have implications for health behaviour, seeking medical care and for methods used in health economic research. In this paper, we present evidence on own expectations regarding length and quality of life, using data obtained from a Dutch convenience sample (n=600). Data were obtained through a written questionnaire and a web-based survey. Own expectations regarding future quality of life were obtained by using the EQ-5D descriptive system on which respondents could indicate expected health profiles for the ages 60–90.

We find that respondents significantly overestimate life expectancy (by 4.1 years, males 7.0 years and females 1.7 years), but appear to underestimate future quality of life from the age 70 onward. Regression analysis is used to explain individual expectations. Age, current health status and the perception of current lifestyle are especially important explanatory variables of people's own expectations regarding length and quality of life. Average age of death of relatives moreover explains self-estimated life expectancy, whereas self-estimated life expectancy explains expectations regarding quality of life.

Given the influence inaccurate expectations may have on actual behaviour, more research on own expectations and their relation with actual behaviour is needed.

Introduction

If asked, many individuals nowadays will indicate that the most important thing in life is to live a long and healthy life. However, not all of us will be so fortunate as to indeed stay healthy and reach an old age. Probably, many individuals will have some kind of expectation regarding what their future will look like, including their future health. They may have some expectation regarding what age they will reach and in what condition they will reach this age, for instance by looking at (grand)parents or relevant others in society. However, individuals own expectations regarding future health need not always coincide with objective predictions of length and health related quality of life. Previous studies have shown that individuals often do not predict their objective or actual life expectancy accurately.

Mirowky (1999) for example maps the relationship between self-estimated and actuarial life expectancy in a sample of 2037 Americans aged 18 to 95. He finds that self-estimates parallel age-specific actuarial ones based on age-specific mortality rates. However, males expect to live about 3 years longer than the actuarial estimate and blacks expect to live about 6 years longer. This optimism in terms of overestimating actuarial life expectancy remains after adjusting for socio-economic status and the signs and symptoms of good health. Mirowsky moreover does not find young adults adjusting their self-estimated life expectancies upward to account for the favourable trends in mortality rates.

Ross and Mirowsky (2002) investigate (using the same sample as Mirowky, 1999) the relationship between self-estimated (subjective as they call it) life expectancy and family relationships and social support, indicating that having adult children and surviving parents increases the self-estimated life expectancy. Marriage only contributes years of life expected for older men. People moreover expected to live longer when they report high levels of emotional support, and the association is mediated entirely by the perception that one has someone to call on when one is sick. People with informal health support (especially for physical impairments) expect to live longer than those without it. In addition, Ross and Mirowsky (2002) report that people who smoke, drink heavily, and have poor nutritional habits expect shorter lives, and those who walk and exercise expect longer lives. They also find that a better (self-rated) current health is associated with a higher self-estimated life expectancy.

Besides the question whether one will grow old, there is also the question of how one will grow old, i.e. the quality of life one expects to have at older ages. There also have been a few investigations into these expectations, although these mainly relate to studies looking at whether older people expect to age ‘successfully’. For instance, Sarkisian, Hays, and Mangione (2002) using a validated instrument for determining expectations of elderly, report that more than 50% of their respondents (aged 65–100) felt it was an expected part of aging to become depressed, to become more dependent, to have more aches and pains, to be less able to have sex, and to have less energy. After adjusting for socio-demographic and health characteristics using multivariate regression, older age was independently associated with lower expectations regarding aging, as was having lower physical and mental health-related quality of life. Having lower expectations regarding aging was moreover independently associated with placing less importance on seeking health care. Busschbach, Hessing, and De Charro (1993) indicate that people also attach different values to health at different stages in life. Respondents of all age categories (except the very young) considered health in the early stages of life more important than health in advanced stages of life.

There also has been attention for the fact that elderly and young value health states differently. For example, Mangione, Marcantonio, and Goldman (1993) indicate that despite poorer role function, poorer energy and fatigue scores, and poorer physical function, elderly persons in their study had similar global health perception when compared with younger individuals. Their study suggests that global health perception may be determined by different factors in the elderly or that the elderly have fundamentally different expectations of what their global health status should be. A similar result was reported by Tsevat, Dawson, and Wu (1998), who indicate that elderly patients (often in less than perfect health states) showed high TTO valuations of their own health states.

Self-estimated future quality of life in the general public is an under-explored topic, especially in relation to observed (or actual) quality of life at more advanced stages of life. Still, peoples’ predictions of future health related quality of life may be considered to be just as important as their self-estimated life expectancy. Inaccurate self-estimates of health related quality of life in advanced stages of life may bias health related decisions with long-term consequences (like adopting a healthy lifestyle) or induce individuals to view reaching old age as undesirable (when the expected health related quality of life in advanced stages of life is low). Indeed, the finding of Sarkisian et al. (2002) that having lower expectations regarding aging was independently associated with placing less importance on seeking health care indicates how own expectations can result in potentially undesirable actions, especially when actual expectations for future quality of life are more favourable.

Moreover, inaccurate expectations regarding length and quality of life may have important implications for current methods used to assign health state values and to derive discount rates. For instance, Brouwer and van Exel (2004) reported that the weight people attach to future health gains may be related to their beliefs about growth rates of life expectancy. van Nooten and Brouwer (2004) found that subjective expectations regarding length and quality of life affect answers in time trade offs using a fixed life expectancy. People who expect to live longer than the life span assigned to them in the time trade off survey, were found to be less willing to sacrifice life-years in order to improve quality of life, while those who expected to live shorter were more willing to do so. Kattan, Fearn, and Miles (2001) similarly argued that self-estimated life expectancy rather than actual life expectancy should be used in health state valuations for patients.

In this paper, new evidence of self-estimated life expectancy and self-estimated future health related quality of life is presented, based on the results of two surveys used in convenience samples from the Dutch general public (n=672). The aim of our study was to investigate what age respondents expect to reach and what their self-estimated health related quality of life is at older ages (60, 70, 80 and 90 years of age). Moreover, differences between available actual and self-estimated expectations are analysed and self-estimates of length and future quality of life are tentatively explained.

Section snippets

Methods and data

In order to investigate individuals self-estimates regarding length and quality of life, we developed a questionnaire, which was used in a paper and a web-based survey.

Respondents were first asked some socio-demographic questions, such as age, gender, educational level, current health status and so on. Secondly, they were asked to indicate the health related quality of life they expected persons like themselves to have at the ages of 60, 70, 80 and 90. To this end, we used the EuroQol-5D

Results

A total of 672 respondents participated in this study. This group consisted of 446 respondents completing the written questionnaire (it was not assessed how many people declined the request to complete the questionnaire) and 226 completing the web-based survey (out of 400 people approached). Observations with missing values on age, gender or self-estimated life expectancy were removed from the sample (n=72). Missing values on EuroQol-5D were estimated based on EuroQol-VAS (n=2), by imputing the

Discussion and conclusion

In this paper, we have presented self-estimated expectations regarding duration and future quality of life, using a convenience sample taken from the Dutch general public. On average, people tend to overestimate their length of life but appear to underestimate their future health related quality of life beyond the age of 60. Males overestimate their length of life rather strongly, i.e. by 7 years (Table 2). Females have self-estimated expectations that are more in line with actual expectations,

References (16)

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