Health incongruence in later life: implications for subsequent well-being and health care.

OBJECTIVE: The premise that pessimistic health appraisals compromise well-being whereas optimistic appraisals are compensatory was examined in a longitudinal study of 232 community-dwelling older adults (ages 79-98 years). DESIGN: Subjective health (SH) appraisals were contrasted with objective health (OH) to identify realists, whose ratings were congruent (SH = OH), distinguishing them from health pessimists (SH < OH) and health optimists (SH > OH), whose ratings were incongruent. Analyses of covariance were used to examine group differences 2 years later on well-being and health care. MAIN OUTCOME MEASURES: Outcome measures were psychological well-being (life satisfaction, positive and negative emotions), functional well-being (objective and perceived physical activity, activity restriction), and health care (health care management, hospital admissions, length of hospital stays). RESULTS: Compared with realists, pessimists had significantly poorer outcomes and optimists had better outcomes. Because perceived control (PC) was weaker among pessimists and stronger among optimists, supplemental analysis determined whether PC differences explained these findings. When accounting for PC, many pessimism and optimism effects became nonsignificant, yet effects on functional well-being remained unchanged. CONCLUSION: Findings have implications for older adults at risk of functional decline.