gms | German Medical Science

50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds)
12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie (dae)

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie
Deutsche Arbeitsgemeinschaft für Epidemiologie

12. bis 15.09.2005, Freiburg im Breisgau

Comorbidity, impaired cognitive function, and decline in personal satisfaction over 10 years

Meeting Abstract

  • Desiree Debling - Department of Psychology, University of Heidelberg, Germany
  • Manfred Amelang - Department of Psychology, University of Heidelberg, Germany
  • Petra Hasselbach - Department of Psychology, University of Heidelberg, Germany
  • Til Stürmer - Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women´s Hospital, Harvard Medical School, Boston, USA

Deutsche Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie. Deutsche Arbeitsgemeinschaft für Epidemiologie. 50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie. Freiburg im Breisgau, 12.-15.09.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc05gmds340

The electronic version of this article is the complete one and can be found online at:

Published: September 8, 2005

© 2005 Debling et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




Because of the suggestion that health status and cognitive function could influence satisfaction in life [1], it seems interesting to examine impaired cognitive function and physician diagnosed diseases and their relation to a decline in satisfaction especially in the elderly normal population. Valkamo et al. [2] found mental disorders to be related to life dissatisfaction. Recent evidence indicates that e.g. women who survived breast cancer reported similar scores of global health on a quality of life scale one year after the diagnosis compared with the normal population [3]. The results of the few published studies on cognitive function and different kinds of satisfaction are inconclusive [2], [4], [5]. The objective of this analysis was to examine the association between physician diagnosed incident diseases, impaired cognitive function and a decline in different kinds of satisfaction over approximately 10 years in an ongoing population based cohort study of the elderly.

Research design and Methods

The HeiDE-study („Heidelberger Langzeitstudie zu Risikofaktoren und Diagnose chronischer Erkrankungen“) is an ongoing population-based cohort study. A random sample from Heidelberg and surrounding communities was recruited from 1991 to 1995 (5114 participants; 40-65 years old) responded to a questionnaire.

All HeiDE participants had a follow-up after approximately 10-years to assess the development of individual health conditions and mortality between baseline and follow-up (2002-2003). From those alive, 4010 (83%) sent back the questionnaire and gave written informed consent for future contact and follow-up.

In 2003, we chose those participants who were 70 years or older and had returned the follow-up questionnaire (740) to participate in an auxiliary study on cognitive function. The Telephone Interview of Cognitive Status (TICS) is a validated instrument to assess cognitive function [6]. It consists of different parts addressing short term and long term memory, prospective memory, and orientation in time and space (41 dichotomous items). As there was no instrument for telephone interviews in German, the existing English version was translated into German and back-translated for this project. Depressive symptoms were measured using the Geriatric Depression Scale (GDS [7]). A history of physician diagnosed diseases was asked for by self-report at baseline and follow-up.

To assess change in different kinds of satisfaction, we used exactly the same scales in baseline and follow-up questionnaires. The different kinds of satisfaction were general satisfaction, living, finances, leisure time, health, family, and friends and neighbours (values ranged from 1 to 7 (with 1 for very dissatisfied)). Decline was defined as the follow-up value being lower than the baseline value.

We first estimated the individual role of incidence of each comorbidity (for all 4010 participants), impaired cognitive function (473 participants 70 years and older) and decline in different kinds of satisfaction over 10 years using separate multivariable logistic regression models controlling for baseline covariates. To assess incidence of comorbidities, individuals with the corresponding condition at baseline were excluded from the corresponding analysis. Since we had no assessment of cognitive function at baseline, a cognitive function score below the 25th percentile at follow-up was considered as incident cognitive impairment.


All 5114 participants of the whole cohort were contacted at least once in 2002 to 2003 and asked to participate in the follow-up of the HeiDE study. Of all participants still alive (4857), 4010 (83%) sent back the questionnaire. A subgroup of participants at the age of 70 and older (740) was additionally contacted by mail at least once (100%) in 2003. Of those still alive (729), 240 (32.9%) refused to participate and 16 (2.2%) could not be reached. The remaining 473 participants (64.9%) gave written informed consent and were interviewed. Out of 4010 participants interviewed, 1004 participants show a decline in general satisfaction between baseline and follow-up (25.0%).

Impaired cognitive function and a history of cancer were associated with a general decline in satisfaction after 10 years (impaired cognitive function: multivariable adjusted odds ratio (OR): 2.0; 95% confidence interval (CI) 1.2-3.3; cancer: multivariable adjusted OR: 2.7; 95% CI 1.1-6.5). People with a history of myocardial infarction showed also an association with a decline in financial satisfaction (multivariable adjusted OR: 5.1; 95% CI 1.6-16.4). A history of cancer showed a trend of decline in satisfaction with social contact to friends and neighbors (multivariable adjusted OR: 2.3; 95% CI 1.0-5.8). A history of diseases like stroke, myocardial infarction, cancer, or diabetes and impaired cognitive function were not associated with a decline in satisfaction with living situation, satisfaction with leisure time, and satisfaction with family situation.

Impaired cognitive function, a history of myocardial infarction, and cancer were associated with a decline in satisfaction with health (impaired cognitive function: multivariable adjusted OR: 1.6; 95% CI 1.0-2.7; myocardial infarction: multivariable adjusted OR: 3.8; 95% CI 1.2-12.0; cancer: multivariable adjusted OR: 2.6; 95% CI 1.1-6.1). A general history of at least one incident disease (stroke, myocardial infarction, cancer, or diabetes) showed a trend of decline in satisfaction with health (multivariable adjusted OR: 1.6; 95% CI 0.9-2.8).


From four diseases and impaired cognitive function, mainly participants who had impaired cognitive function or cancer had a decline in satisfaction. Steen et al. [4] reported life satisfaction not correlated to either cognitive reduction or to cognitive style in a study of 68-year-old men (n=500) with a 2-year follow-up conducted in Malmö, Sweden. In a study on cognition, life satisfaction, and attitudes regarding life support (n=66 elderly women and men), Greer [8] observed a significant positive correlation between mental status and life satisfaction. Our findings are in accordance with Greer [8] insofar as we also observed an association between impaired cognitive function and a decline in satisfaction. We generalize their results to a broader population-based sample of men and women at older age and add information on different kinds of satisfaction.

The strength of our study is the population-based sample. Our study includes both sexes, a wide range of socio-economic backgrounds, and is likely much less selected with respect to health consciousness. Therefore, our results are likely to be generalizable to the general population. Several limitations should be considered. The main limitation of our study is the cross-sectional design assessing cognitive function approximately one year after the follow-up examination. Decline in satisfaction may result in impaired cognitive function or diseases rather than vice-versa, i.e. reversed causality. Since we do not have data on cognitive function from baseline, reversed causality bias cannot be completely excluded. Despite controlling for several confounding variables, confounding bias due to unmeasured or residual confounding could explain the results.

We conclude that impaired cognitive function and comorbidity may lead to a decline in satisfaction.


The study was supported by a grant from the German Research Foundation (Graduiertenkolleg 793).


Kerr EA, Smith DM, Kaplan SH, et al. The association between three different measures of health status and satisfaction among patients with diabetes. Med Care Res Rev 2003; 60: 158-77.
Valkamo M, Koivumaa-Honkanen HT, Hintikka J, et al. Life satisfaction in patients with chest pain subsequently diagnosed as coronary heart disease--connection through depressive symptoms? Qual Life Res 2003; 12: 1099-105.
Arndt V, Merx H, Sturmer T, et al. Age-specific detriments to quality of life among breast cancer patients one year after diagnosis. Eur J Cancer 2004; 40: 673-80.
Steen G, Hagberg B, Johnson G, et al. Cognitive function, cognitive style and life satisfaction in a 68-year-old male population. Social & Applied Sciences 1987; 1: 54-61.
Troyer AK. Improving memory knowledge, satisfaction, and functioning via an education and intervention program for older adults. Aging, Neuropsychology, & Cognition 2001; 8: 256-68.
Brandt J, Spencer M, Folstein M. The Telephone Interview for Cognitive Status Neuropsychiatry. Neuropsychol Behav Neurol 1988; 1: 111-7.
Gauggel S, Birkner B. Validität und Reliabilität einer deutschen Version der Geriatrischen Depressionsskala (GDS). Zeitschrift für Klinische Psychologie 1999; 28: 18-27.
Greer MB. Cognition, life satisfaction, and attitudes regarding life support among the elderly. Dissertation Abstracts International Section A: Humanities & Social Sciences. US: Univ Microfilms International 1994; 55: 1063.