Health Perceptions and Health Status Measurement among Rural Appalachian Elders

To conceptualize the meaning of "health" from a rural Appalachian elder's perspective, it is essential to consider the individual in the context of interrelated factors rooted in sociocultural conditions (Ma and Henderson 1999). Health is both a subjective (Feinstein 1992; Groves, Fultz and Martin 1992) and an objective state (National Center for Health Statistics [NCHS] 1999) with physical, social, and psychological including the perception of well-being dimensions (Hazzard et al. 1999). Subjective health represents, for purposes of this paper, an elder's cognitive appraisal of overall well-being and reflects a synthesis of various life experiences (Hazzard et al. 1999). Objective health, also for purposes of this paper, is the professional measurement of health status in terms of the elder's physical, psychological, and social functioning (Hazzard et al. 1999). There can be considerable disparity between an individual's subjective health and his or her objective health. Measurement of an elder's current health state does not always match the elder's perception of well-being (Hazzard et al. 1999). Moreover, research on health perception ratings demonstrates strong and independent associations with increased risk of mortality (NCHS 1999). In other words, perceptions of health are important predictors of health outcomes, independent of health status measures, age or diagnosis (Hazzard et al. 1999). Over the last decade, rural Appalachia culture has undergone dramatic changes in terms of the fabric of the rural community, including tumultuous changes in the health care system. For the rural Appalachian elder, residential mobility and population turnover have changed the social structure so that proximate friends and neighbors may no longer be well known or trusted (Fitchen 1991; Mclnnis-Dittrich 2000). Redefinition of the traditional rural