A High Sense of Coherence as Protection Against Adverse Health Outcomes in Patients Aged 80 Years and Older

Ann Fam Med. 2016 Jul;14(4):337-43. doi: 10.1370/afm.1950.


Purpose: We set out to assess whether a high sense of coherence (SOC) protects from adverse health outcomes in patients aged 80 years and older who have multiple chronic diseases.

Methods: A population-based prospective cohort study in 29 primary care practices throughout Belgium included 567 individuals aged 80 years and older. We plotted the highest tertile of SOC scores in Kaplan-Meier curves representing 3-year mortality and time to first hospitalization. Using Cox proportional hazard regression analyses and multiple logistic regression analyses adjusted for sociodemographic characteristics, depression, cognition, disability, and multimorbidity we examined the relationship between SOC and mortality, hospitalization, and decline in performance of activities of daily living (ADL).

Results: Subjects with high SOC scores showed a higher cumulative survival than others (Log rank = 0.004) independent of other prognostic characteristics (adjusted hazard ratio 0.62 (95% CI, 0.38-1.00), P = .049). For ADL decline, a high SOC was shown to be protective, and this effect tended to be independent from the covariates under study (adjusted odds ratio 0.56 (95% CI, 0.31-1.0), P = .05).

Conclusion: Even very elderly persons with high SOC scores were shown to have lower mortality rates and less functional decline. These effects were independent of multimorbidity, depression, cognition, disability, and sociodemographic characteristics.

Keywords: aged, 80 and over; depression; functional decline; mortality; multimorbidity; sense of coherence.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living*
  • Aged, 80 and over
  • Aging / psychology*
  • Chronic Disease
  • Comorbidity
  • Female
  • Hospital Mortality
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Predictive Value of Tests
  • Primary Health Care
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Life / psychology
  • Sense of Coherence*
  • Survival Analysis