Accepted Manuscript

Title: Family ties and functional limitation in the elderly:

Results from the Survey of Health Ageing and Retirement in
Europe (SHARE)

Authors: Katerina Micheli, Nikoleta Ratsika, Maria Vozikaki,

Gregory Chlouverakis, Anastas Philalithis

PII: S0167-4943(18)30112-2
DOI: https://doi.org/10.1016/j.archger.2018.05.023
Reference: AGG 3687

To appear in: Archives of Gerontology and Geriatrics

Received date: 19-2-2018

Revised date: 17-5-2018
Accepted date: 31-5-2018

Please cite this article as: Micheli K, Ratsika N, Vozikaki M, Chlouverakis G, Philalithis
A, Family ties and functional limitation in the elderly: Results from the Survey of Health
Ageing and Retirement in Europe (SHARE), Archives of Gerontology and Geriatrics
(2018), https://doi.org/10.1016/j.archger.2018.05.023

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FAMILY TIES AND FUNCTIONAL LIMITATION

Family ties and functional limitation in the elderly: Results from the Survey of

Health Ageing and Retirement in Europe (SHARE)

Word counts for the text 3861

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Katerina Micheli MPH1m, Nikoleta Ratsika PhD2, Maria Vozikaki MPH1,

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Gregory Chlouverakis PhD1, Anastas Philalithis PhD1

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1
Department of social Medicine, Faculty of Medicine, University of Crete, Greece
2
Department of Social Work, T.E.I of Crete, Greece
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Corresponding author: Katerina Micheli, E-mail addresskaterinamicheli@yahoo.gr
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Author Information
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Katerina Micheli planned the study, participated in the data analysis including the
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development of the instrument and wrote the paper

Ratsika Nikoleta contributed to the planning of the study and helped to revise the
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paper
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Maria Vozikaki contributed to revising the paper

Gregory Chlouverakis contributed to the planning of the study

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Anastas Philalithis supervised the study and to revising the manuscript

Highlights

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FAMILY TIES AND FUNCTIONAL LIMITATION

 Functional limitation is associated with biological and demographic

factors

 Functional limitation is not associated with few family ties

 Low contact with family members seems to affect functional

limitation.

 Persons that live alone did not show worse functional status,

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

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Southern and Mediterranean countries have both closer family ties and

adults with higher functional limitation.

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SC
Abstract

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Objectives: To examine if family ties are strong predictors of functional limitation in
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older adults in Europe.
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Methods: Cross sectional data were used and included 14 European countries from
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the second wave (w2) of the survey on Health, Ageing, and Retirement in Europe.

13,974 adults aged 50+ (45.2% males and 54.8%females) were included in the study.
ED

Functional limitation was assessed using activities of daily living (ADL), instrumental

activities of daily living (i-ADL) and mobility sensory index. Family ties were based
PT

on a customized model of family structural aspects. Multiple logistic regression

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analyses were used to examine the risk of functional limitations.

CC

Results: Functional limitation was associated with females, age, self-rated health, and

an increased number of chronic conditions, disease symptoms and depressive

A

symptoms but not with few family ties. After controlling for potential confounders,

respondents with lower family contacts showed higher risk for functional limitation.

Southern and Mediterranean countries have both closer family ties and adults with

higher functional limitation.

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FAMILY TIES AND FUNCTIONAL LIMITATION

Conclusion: Functional limitation is associated with biological and demographic

factors as well as little contact with family members. Further longitudinal research is

required in order to determine the association and the causal relationship between

functional limitation and family ties.

Key words: functional status, family support, third age

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Introduction

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Elderly people aged 65 years or over constitute the highest proportion of the
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population in Europe. According to the baseline projection of Eurostat, the percentage
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of elderly people in Europe will increase by more than 28% in the year 2050 (Börsch-
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Supan et al, 2005). Rising longevity and declining fertility are reflected in a major

transformation in the age composition of European populations (European

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Commission 2014; Lee 2003). Moreover living arrangements of older adults have

changed dramatically over time (Tomassini 2004). The demographic transition and
PT

changes in the economy have important implications for family structure and as a

consequence it is unclear how people related to each other (Cherlin 2010; Lee 2003).
E
CC

A major problem faced by the elderly is a decline in their functional capacity

(Hebert 1997) and consequently, having to resign themselves to a more dependent

A

way of life. Thus, estimating elderly health involves the assessment of both their

physical and functional status (Schultz 1992). Functional limitations constitute

restrictions in performing fundamental physical and mental actions used in daily life

by one’s age-sex group (Verbrugge & Jette 1994).

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FAMILY TIES AND FUNCTIONAL LIMITATION

The degree of functionality is considered an important determinant of the

quality of life of older people, as it constitutes a strong indicator of aging and

independent living (Schultz 1992; Nikolova et al 2011), as well as a strong indicator

of disability (Guralnik & Kaplan 1989) and, as a consequence, of mortality (Dale

2012), institutionalization (Hajek et al 2015) and increased use of health services

(Guralnik et al 1996; Stuck 1999). Hence the ability of societies to continue to meet

T
the needs of their oldest members may be increasingly challenged by an increase in

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the rates of physical impairment due to advanced aging (Litwin et al 2012). However,

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it has been noted that such a decline in health may not be inevitable and is certainly

SC
not experienced equally by all older adults (Seeman 2002).

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A major challenge for health workers is the reduction of functional limitation.
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Understanding the factors that contribute to functional limitation may help all the
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elderly health care workers in the development of efficient preventive strategies.
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Several studies have addressed the risk factors for functional decline, which were

summarized in biological, psychological and social factors such as co-morbidity, body

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mass index, health related behaviors such as drinking and smoking, demographical

factors, family and social contacts, cognitive impairment, depression and stress (Stuck
PT

1999).

Apart from biological characteristics, social relations in the form of social

E
CC

support and family ties are among the factors which are known to have a beneficial

influence on the maintenance or improvement of functional ability (Avlund 2004).

A

However, there are relatively few studies on the effects of family support on

functional limitation. In a variety of studies, cohabitation status in terms of unmarried,

living alone or living with children or non spousal family members predicts functional

decline (Saito et al 2017; Saito et al 2014; Wang et al 2013; Wang et al 2009; Spalter

4
FAMILY TIES AND FUNCTIONAL LIMITATION

et al 2013; Nilsson et al 2011; Lund et al 2010; Michael et al 2001; Nilsson et al

2008). Moreover other aspects of family support such as frequency of contacts, and

family ties have been associated with development of functional decline (Murata 2017

et al; Rico-Uribe et al 2016; Avlund et al 2004; Zunzunequi et al 2005; Mendez de

Leon et al 1999). However, in some other studies, social and family ties did not seem

to constitute a protective factor for functional limitation (Strawbridge et al 1993; Liu

T
et al 1995). Social and family networks are associated with functional ability in a

IP
protective way. These protective effects of social networks may come as a result of

R
several supportive processes that include providing health-related information,

SC
encouraging healthy behaviors, health care utilization, providing emotional support so

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as to facilitate coping with life stress, enhancing feelings of self-esteem and control as
N
well as affecting neuroendocrine or immune functioning (Unger et al 1999; Seeman et
A
al 1996).
M

Strong family and social ties may promote emotional, financial or practical

support leading to several positive health outcomes (Mair 2013). The sole presence of
ED

family is an important indicator of positive health outcomes, even if family ties do not

always result in positive resources (Ramage-Morin 2017; Rico-Uribe 2016;Belanger

PT

2016; Mair 2013). The disablement process of functional limitation has various

biological and social factors. Therefore, gaining insight into which factors have a
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CC

greater impact on the functional capacity of the elderly is, indeed, a matter of great

interest.
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To the best of our knowledge, this is the first study which examines a wide

range of socio-demographic, biological and family variables in relation to functional

limitation in a representative sample of adults aged 50 years and over. The purpose of

the present study is to determine the associations of family ties and functional

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FAMILY TIES AND FUNCTIONAL LIMITATION

limitation. More specifically, this study investigates whether functional limitation is

always characterized by accumulation of several physical or mental adverse health

outcomes, or whether it can be attributed to the presence of independent psycho-social

parameters. The study examines the following hypotheses: i) few family ties are

associated with functional limitations; ii) Functional limitations are mostly associated

with few family ties rather than socio-demographic factors such as gender, age,

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education, income, etc, or biological factors, such as co-morbidity; and iii) Evidence

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of regional variations with regard to the association of family ties and functional

R
limitations.

SC
Methods
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N
For the purpose of the present study, data were drawn from the second wave
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(w2) of the Survey of Health, Ageing and Retirement in Europe (SHARE), carried out
M

during 2006-2007. Data for the second wave included information of 14 European

countries (Sweden, Denmark, Germany, The Netherlands, Belgium, France,

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Switzerland, Austria, Italy, Spain, Greece, Ireland, Poland, and the Czech Republic).

SHARE is the first European multidisciplinary, cross country longitudinal

PT

survey that combines information on socioeconomic status, health and family

relationships of individuals aged >50 years. The survey has been organized and
E
CC

coordinated by Mannheim Research Institute for the Economics of Ageing (Germany)

(Borch-Supan 2005).
A

The targeted population of the survey consisted of households with at least one

individual aged 50 and over who was a resident of that country and spoke the

country’s official language. Participants were excluded if they were institutionalized,

did not reside at the sample address at the time of the survey, were physically or

6
FAMILY TIES AND FUNCTIONAL LIMITATION

mentally unable to participate, or could not speak the language of the national

questionnaire. The studied population was selected in each country according to the

complex multistage stratification design so as to constitute a true representation of the

particular European community. A detailed description of the survey methodology

(including sampling procedures. recruitment rates. ethical issues etc.) has been

reported elsewhere (Borscsh-Supan 2005 ; Borscsh-Supan at al 2013)

T
Because the focus of the present study was mainly on the more intimate family

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ties, the sample was restricted to people aged 50 years and over with children.

R
Moreover, people with dementia were excluded from the analysis. In total, 13,974

SC
adults were eligible for inclusion in the present analysis.

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Data Collection
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The main survey data was collected using computer-assisted personal
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interviews (CAPI) consisting of 20 modules which included demographic

characteristics, physical and mental health, social activities, behavioral risks, social
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support, cognitive function, health care, household income etc. In order to investigate

more sensitive questions, the interviews were further completed by a brief self-
PT

completed drop-off part.

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CC

Measures

Physical functioning: Three self-reported measures of impairments in

A

functional ability were used: i) questions of mobility related activities (mobility

sensory functioning questions) (Nikolas et al 2003) ii) questions on Activities of Daily

Living (Nikolas et al 2003) iii) questions on Instrumental Activities of daily life

(Nikolas et al 2003; Lawton et al 1969). The present study also sought to estimate the

7
FAMILY TIES AND FUNCTIONAL LIMITATION

functional limitation index by adding the 13 limitations registered in the ADL and i-

ADL scales and the 10 self-reported questions of mobility limitation, thus giving a

composite score from 0 to 23. A higher score was considered to be indicative of

greater difficulties in physical functioning.

T
Family ties:

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In determining family ties, variables of family structures were included. i)

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marital status (living alone vs living with spouse /partner); ii) number of children; iii)

SC
frequency of family contact over the last 12 months; iv) family spatial proximity.

U
The categories of contact with family members were defined as: about once a month
N
or less or never, about once a week or every two weeks, several times a week, daily.
A
The second indicator was based on the reported spatial density of the family network.
M

The categories of family spatial proximity were defined as: low spatial proximity

between 100 and 500 kilometers, moderate spatial proximity between 25 and 100
ED

kilometers, high spatial proximity between 5 and 25 kilometers and very high

proximity (same house or building).

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A total ‘family ties’ index was estimated by summing up the scores of each

indicator. The score ranges from 0 to 9, with higher scores indicating higher levels of
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CC

family ties.
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Additional Measures

Sociodemographics and health parameters were included in the present study

as well. Sociodemographic characteristics included gender, age, years of education,

retirement status, European region (north, central, south) and income. Income was

8
FAMILY TIES AND FUNCTIONAL LIMITATION

classified using country specific quartiles for all participants in SHARE, while years

of education were calculated using the total time of study at various levels of

education, as established by the national education systems. Physical health was

assessed by the presence of chronic conditions, chronic disease symptoms, self-rated

health and mental health. To assess chronic conditions, participants were asked if a

doctor had diagnosed 11 diseases (stroke, low/high blood pressure, hypertension, as

T
well as other conditions). To assess the number of symptoms experienced,

IP
participants were asked if they had had any of the 11 symptoms (e.g falls. dizziness.

R
stomach problems and other) over a period of six months prior to the date of the

SC
interview. Responses for both medically diagnosed chronic conditions and self-

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reported symptoms were divided into three categories 1- zero 2- one or two, 3-three or
N
more. Self-rated health was assessed by having participants report their health as
A
excellent, very good, good, fair and poor. Mental health status was measured by the
M

EURO-D depression symptom scale (Prince et al 1999).

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Statistical analysis

Data were analyzed using the SPSS software (IBM SPSS Statistics for
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Windows. Version 230. Armonk. NY: IBM Corp) and Stata/MP 3.1. Weights were

applied reflecting non responses and stratification design according to the complex
E
CC

sampling design of the study. The prevalence and corresponding 95% Confidence

Intervals (95% C.I) of the components of family ties and functional limitations were
A

estimated. Tests of independence (based on adjusted – F) were estimated in order to

identify differences between functional limitations categories and family ties.

Nested multiple logistic regression models were further performed to examine

the association between functional limitations, family ties and the other variables. In

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the first model, we examined the association between functional limitations and all

the significant health demographics and family ties factors. All the factors were tested

simultaneously in the model. In the second model, we examined the association

between function limitations and each family factor, including potential confounders.

Adjusted ORs were estimated separately for each family factor. 95% CIs were

computed to estimate the degree of association. Finally, mean levels of composite

T
score of family ties and index of functional limitations were graphically illustrated.

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Results

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Baseline characteristics of the study sample are shown in table 1. The sample

U
had a majority of women (54.8%), while the mean age of the whole sample was 66.6
N
years. Average education was 8-12 years. A greater percentage of participants
A
expressed fair or poor self-rated health (36.9%). A significant part of the overall
M

sample reported suffering from 3+ chronic diseases (23.2%), 3+ disease symptoms

(28.1%) and symptoms of depression (25.3%). The majority of participants were

ED

retired and lived in central Europe. According to the Index of Functional Limitations,

47.9% of the participants expressed no limitations while 28.6% expressed 3+

PT

functional limitations.

Table 2 presents the score of family ties in the study sample. The mean value
E
CC

of family ties was 5.98. Almost half of the sample participants reported having more

than 2 children and high proximity to the family network. Additionally, a relatively
A

high percentage reported daily contact with family members.

Table 3 presents the relationship between the prevalence of functional

limitations and the components of family ties. The prevalence of participants with 3 or

more functional limitations was significantly higher among those who live alone

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(54.9% p<0.001) and reported 2 or more children. As regards family ties, participants

who reported functional limitations lived within close distance of the whole family

and had daily contact with the rest of the family members.

In table 4, results of multivariate analyses between the association of

functional limitations and all the covariates are presented. Females (OR 1.76 95% CI

1.43-2.17), age (OR 1.72 95%C.I 1.54—1.93), self rated health (OR 2.85 95%C.I

T
2.45-3.32), chronic diseases (OR 1.46 95%C.I 1.30-1.65), disease symptoms (OR

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3.29 95%C.I 2.92-3.71), and depressive symptoms (OR 1.93 95%C.I 1.70-2.22),

R
showed significantly greater risk of functional limitation. There is no association

SC
between few family ties and higher functional limitations.

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Table 5 presents the association between each family type and functional
N
limitation after adjusting for potential confounders. Few family contact shows greater
A
risk for functional limitations after adjusting for potential confounders (OR 1.58 95%
M

CI 1.13-2.22). Family spatial proximity and family status seem to be a protective

factor for functional limitation. There is no association between functional limitation

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and lower number of children.

Figure 1 illustrates the mean levels of family ties and functional limitations
PT

among thirteen European populations. Countries with higher family ties have higher

scores of functional limitations. Specifically, northern European and Mediterranean

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CC

regions show significally higher rates of family ties and a higher score of functional

limitations compared to central European countries.

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Discussion

Understanding the factors that are accountable for functional limitation can

lead to the development of strategical functions in health services. Early recognition

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FAMILY TIES AND FUNCTIONAL LIMITATION

of signs indicating that elderly people are at risk of losing their autonomy, as well as

the implementation of an assessment coping strategy could prevent or delay the onset

of functional limitation. Moreover, further efforts in determining family ties could

provide us with vital insight into the social and family profile of the elderly. The aim

of this cross sectional study was to determine whether the burden of functional

limitation is always characterized by the accumulation of multiple physical or mental

T
health problems or whether it can also be attributed to the presence of other

IP
psychosocial parameters in the European study sample of the SHARE study.

R
Furthermore, the prevalence of functional limitation and the kind of family relations

SC
were measured, in the European Study sample of the SHARE study.

U
Initially, an effort was made to associate functional limitation with all the
N
predisposing factors of the study. With regard to our main hypothesis, the results of
A
our primary regression analysis provide no evidence that few family ties are
M

associated with functional limitation. On the contrary, functional capacity is affected

by biological and demographic factors as regards co-morbidity. A possible

ED

interpretation of this is that we examined family relations through the quantitative

terms of family closeness and social contacts without taking into consideration the
PT

qualitative measurement of the family relations. The result of this examination

indicates that the family tends to “keep” the functionally- limited elderly within close
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CC

proximity irrespective of the quality of their relations. In this study, the focus is on

family ties, in terms of family structure, family contact and family spatial proximity
A

as well as the potential risk factors for instrumental functional disability, excluding

models that examine cognitive function, although other studies analyze the

development of disability in relation to cognitive function in addition to other aspects

of social and family ties such as cohabitation status.

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As regards the burden of functional limitation due to biological and

demographic factors, our findings are consistent with similar findings of the

international literature (Pope et al 2001; Jenkins 2004). As for the influence of family

or social ties on functional ability, the results in comparison to the literature are

conflicting. In several other prospective studies, measures of social, psychological and

family ties in terms of closeness and frequency of contact have been identified as a

T
protective factor for functional decline (Murata et al 2017; Zunzunequi et al 2005;

IP
Strawbridge et al 1996; Mendes de Leon et al 1999; Unger et al 1993; Seeman et al

R
1996;). However, these results are contradictory to our study. While other studies

SC
demonstrate no significant association to the burden of functional limitation

U
(Strawbridge et al 1993; Liu et al 1995), their findings are consistent with the results
N
of our study. It was difficult to compare our findings with other studies due to many
A
factors such as: i) different sample size and nature of the study sample. ii) different
M

measures and definitions of social or family relations iii) in prospective studies, the

intervals over which the changes are examined vary iv) age differences among subject
ED

samples in most studies. Moreover, the design of the current study is cross sectional,

while the other studies are longitudinal.

PT

In partial confirmation of our hypothesis regarding specific types of family

ties, we found that the factor of low family contact constitutes a great risk for
E
CC

functional limitations after adjusting for potential confounders. This result is

consistent with relatively similar findings of the literature, indicating that instrumental
A

or emotional support, loneliness and close family ties affect functionality. (Murata et

al 2017; Rico-Uribe 2016 ;Wang et al 2013; Lund et al 2010; Seeman et al 1996;

Unger et al 1993; Mendez de Leon et al 2001). One possible explanation for the worst

functioning profile of the elderly could be the feeling of losing support and, as a

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consequence, the negative effect of feeling alone and helpless. It has been previously

mentioned in the literature that relationships in general, including social and family

ties, can improve adverse health outcomes through a variety of psychological

mechanisms. (Fiori et al 2007; Mendes de Leon et al 2001).

According to the results of our research, persons that live alone did not show

worse functional status, these findings being consistent with previous studies (Wang

T
et al 2013; Wang et al 2009). One possible explanation for this situation could be that

IP
functional disability may facilitate cohabitation. In other words, the elderly would

R
tend to cohabit in the absence of functional ability. On the contrary, other studies,

SC
mostly in men, have shown a higher risk of functional disability in older adults living

U
alone (Saito et al 2017; Lund et al 2010; Nilsson et al 2008). This disagreement
N
between the findings could be explained by the degree of social satisfaction of the
A
elderly, higher satisfaction reducing the risk of disability (Lund et al 2010). However
M

further investigation is needed in order to explain the cohabitation status risk in the

association with family support and functional limitation.

ED

In an attempt to better understand the role of family ties and their potential

influence on functional ability we should take into account the consequences of the
PT

demographic transition. Firstly, in industrial economies, individuals move away from

relatives in order to look for a better job. Moreover, as mortality rates decline, people
E
CC

may suffer from more diseases. As a consequence, they need more care and help.

Also, as fertility declines, the number of older children available to help frail parents
A

is reduced, as well as the overall size of kin networks (Sear and Coall 2011).

Nevertheless it should be noted that changes in demographic characteristics, due to

age growth and the altered structure of the family, may lead to a greater degree of

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complexity in family life. The changes in family patterns in recent decades complicate

the way that people view their obligations to each other (Cherlin2010).

Furthermore, the present study attempted to find the prevalence of functional

disability and family relations separately for each of the European countries of the

study sample. As indicated in the study, Mediterranean countries, in addition to

Poland, show higher rates of dysfunction and simultaneously higher rates of family

T
ties. On the contrary, countries of northern and central Europe seem to have a lower

IP
mean score of family ties and lower rates of dysfunction. Cultural differences may

R
partly explain the prevalence of differentiations within the European countries. Each

SC
country may interpret the meaning for the burden of functional disability and family

U
ties in a different way. In northern Europe, autonomy and independent living are
N
considered to be quite high, which explains the few family ties despite the burden of
A
limitations. On the contrary, in southern countries, assisting family members is
M

considered to be of greater value. (Zunzunegui et al 2005). Furthermore, northern

countries place more emphasis on the social care system which promotes independent
ED

living.

Our study has some limitations. Firstly, the design of the study is cross
PT

sectional, providing weak explanatory interpretation of the described correlations. For

this reason, conducting a longitudinal study in the future, or analyzing changes over
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CC

time, to examine the association between family ties and functional capacity is

considered necessary. Secondly, self-reported data cannot exclude the possibility of a

A

bias in the measurement method. However, using self-reported data in large scale

population studies is an acceptable method of studying social phenomena

(Baranowski 1985; Brener et al 2003). Thirdly, the lack of qualitative measurements

of family ties may inaccurately interpret the results of family relationships.

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FAMILY TIES AND FUNCTIONAL LIMITATION

Furthermore, the data in our study is from the period 2006-2007, since data is not

available from all the participating countries in successive waves of the study. For

instance, Greece did not participate in waves 4 and 5 of SHARE, because of the fiscal

crisis. However, the longitudinal design of SHARE allows for future research in order

to examine the changes in association between family ties and functional disability.

Comparisons between waves might yield evidence to explain the association between

T
low family ties and functional limitations, to understand the complex underlying

IP
process, and to explain the magnitude of these effects over time. In addition, it would

R
be interesting to evaluate the association between family ties and functional disability

SC
across Europe. Finally, the current study excludes adults without children and

U
consequently a full representation of family deficiencies pertaining to all the subjects
N
of the study is not feasible. Strengths of the present study include the large sample
A
size of the study which could be considered as representative of the general
M

population. Moreover, the exclusion of adults with dementia reduced the likelihood of

having to interpret the answers.

ED

Conclusions
PT

The present study provides evidence that risk in functionality is higher due to

biological and demographic factors. Nevertheless, reduced contact with family

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CC

members seems to affect functional limitation. In order to determine prevention

strategies for disability, health professionals should take family relations into account.
A

In particular, changes in the dynamics of family relations or the progression of

diseases require a deeper and better understanding.

Future longitudinal studies are needed to confirm the associations of

functional limitation and family ties and to better understand the complex underlying

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FAMILY TIES AND FUNCTIONAL LIMITATION

processes. This finding may indicate that this correlation may be more complicated,

and a model of causal relationship is needed in order to prove the reliability of the

results. Nevertheless, the cross sectional design of the current study cannot detect

causal relationship for the current findings.

Conflicts of interest

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None

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Acknowledgments

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This research study uses data from SHARE project release 2.3.0. SHARE data

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collection in 2004-2007 was primarily funded by the European Commission through
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its 5th and 6th framework programmes (project numbers QLK6-CT-2001- 00360;
A
RII-CT- 2006-062193; CIT5-CT-2005-028857). Additional funding by the US
M

National Institute on Aging (grant numbers U01 AG09740-13S2; P01 AG005842;

P01 AG08291; P30 AG12815; Y1-AG-4553- 01; OGHA 04-064; R21 AG025169).
ED

Further funds were allocated by national sources (see http://www.share-project.org for

a full list of funding institutions). The SHARE data set is introduced in Borsch-
PT

Supan.30 methodological details are contained in Borsch-Supan and Jurges (2005).

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CC

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Figure legend
ED

Fig 1. Mean levels of Composite Score of Family Ties and index of Functional
PT

Limitations in the sample of 13.974 European adults, aged 50+ years, among thirteen

European populations (SHARE study. wave II. 2006/07).

E
CC
A

24
FAMILY TIES AND FUNCTIONAL LIMITATION

T
R IP
SC
U
N
A

Τable 1. Descriptive characteristics of 13.974 adults, aged 50+ years in the SHARE
M

study (wave II. 2006/07).

ED

n %

Gender males 6.310 45.2

PT

females 7.664 54.8

Age (years) 50-59 4.228 30.3
E

60-69 4.752 34.0

70-79 3.446 24.7
CC

80+ 1.548 11.1

mean ± standard deviation (min-max) 66.6±9.9 (50-101)
A

Education
0-7 4.035 28.9
(years)
8-12 6.351 45.5
13+ 3.573 25.6
mean ± standard deviation (min-max) 9.8±4.5 (0-25)
Self-rated health Fair, poor 5.150 36.9

25
FAMILY TIES AND FUNCTIONAL LIMITATION

a
Chronic diseases 3+ 3.241 23.2
Disease symptoms 3+ 3.932 28.1
European Depression Scale Score 4+ 3.496 25.3
Retirement status Retired 8.069 58.0
European region North 2.736 19.6
Central 8.587 61.4
South 2.651 19.0
Income b Lower quartile 3.236 23.2

T
Index of Functional Limitations c None limitation 6.695 47.9

IP
1 1.934 13.8
2 1.349 9.7

R
3+ 3.996 28.6
a
exclusion of people with alzheimer's disease, dementia and senility.

SC
b
Income was classified using country-specific quartiles for all participants in
SHARE survey in 2006/07.
c
U
Index was estimated by adding up 13 limitations [as Activities of Daily
N
Living (ADL) and instrumental activities of daily living - (I)ADL] with 10 mobility
A
dysfunctions and giving a composite score from 0 to 23
M

Table 2. Indexes and Score of Family Ties in the sample of 13.974 European adults,
ED

aged 50+ years.

weight Estimated
Indexes and score of family ties Scoring n 95% CI
PT

% population

Living status Alone 0 4.871 42.0 35.6. 48.7 22.838.041

E

With spouse. partner 1 9.103 58.0 51.3. 64.4 31.510.840

CC

Children 1 0 2.414 18.8 17.7. 20.0 10.221.626

2 1 6.130 42.1 40.1. 44.2 22.894.704

A

3+ 2 5.403 39.1 37.1. 41.1 21.232.551

family Low proximity (between 100

0 1.115 8.9 8.1. 9.9 4.861.442
spatial -500 km)

Proximity Moderate proximity 1 1.260 8.6 7.7. 9.7 4.695.725

26
FAMILY TIES AND FUNCTIONAL LIMITATION

index (between 25-100 km)

High proximity (between 5-

2 7.649 49.3 46.4. 52.2 26.789.907
25 km)

Very high proximity (same

3 3.950 33.1 30.1. 36.3 18.001.807
building or house)

About once a month or less

Family 0 707 5.8 4.9. 7.0 3.160.239

T
or never
contact

IP
About once a week or every
index 1 2.664 18.9 17.6. 20.2 10.265.903
two weeks

R
Several times a week 2 4.912 31.2 29.7. 32.8 16.974.764

SC
Daily 3 5.691 44.1 41.6. 46.5 23.947.975

Composite Score

of Family Ties a
mean (95% CI)
U
5.98 (5.90. 6.06)
N
95% CI: 95% confidence intervals. C.I estimated through the complex sample
A
design procedure.
a
The Composite Score of Family Ties ranges from 0 to 9, according to scoring
M

levels in 4 indexes. Higher scores indicating higher levels of family ties.

ED
E PT
CC
A

27
 FAMILY TIES AND FUNCTIONAL LIMITATION

Table 3. Prevalence of functional limitations according to indexes of Family Ties in

the sample of 13.974 European adults, aged 50+ years.

Index of functional limitations

0-2 limitations 3+

p-value
Indexes and Score of Family Ties weight % (n)
a

Living status alone 36.0 (2.982) 54.9 (1.889)

T
<0.001

IP
With spouse. partner 64.0 (6.996) 45.1(2.107)

Children 1 18.7 (1.671) 19.1 (743)

R
2 44.9 (4.560) 36.2 (1.570) <0.001

SC
3+ 36.4 (3.747) 44.7 (1.683)

Family Low proximity (between 100 -500 km) 10.3 (868) 6.1 (247)

Proximity U
N
Moderate proximity (between 25-100 km) 9.4 (957) 6.9 (303)
index <0.001
A
high proximity (between 5-25 km) 48.2 (5.430) 51.5 (2.219)
M

Very high proximity (same building or

32.0 (2.723) 35.5 (1.227)
house)
ED

Family About once a month or less or never 5.5 (470) 6.4 (237)

contact About once a week or every two weeks 19.8 (1.989) 17.0 (675)
PT

<0.001
index Several times a week 33.3 (3.705) 26.9 (1.207)
E

Daily 41.1 (3.184) 19.6 (1.877)

CC

Composite Score of Family Ties b <25th percentile 71.4 (1.859) 28.6 (728)

25th to 75th 67.3 (6.068) 32.7 (2.392) 0.113

A

>75th 66.9 (2.051) 33.1 (876)

a
Tests of independence (based of adjusted-F). They were estimated through the
complex sample design procedure.
b
Composite Score of Family Ties: <25th percentile (score <5) indicates few family
ties >75th percentile (score >7) indicates higher family ties.

28
FAMILY TIES AND FUNCTIONAL LIMITATION

Τable 4. Adjusted odds ratios of Index of Functional Limitations in 13.974 adults,

aged 50+ years in the SHARE study (wave II. 2006/07). in relation to categories of

their characteristics and Composite Score of Family Ties

Index of Functional

Limitationsa

Adjusted Odds Ratiosb

T
(95%CIs)c

IP
Gender (females vs males) 1.76 (1.43. 2.17)

R
Age (by one category of years) 1.72 (1.54. 1.93)

SC
Education (by one category of years) 0.75 (0.67. 0.83)

Self-rated health (across to excellent/very good. good and

2.85 (2.45. 3.32)
fair/poor)
U
N
Chronic diseases (by one category) 1.46 (1.30. 1.65)
A
Disease symptoms (by one category) 3.29 (2.92. 3.71)
M

European Depression Scale (score 4+vs score <4) 1.93 (1.70. 2.22)

Retirement status (retired vs not retired) 0.94 (0.75. 1.17)

ED

European region (across to north. central and south countries) 1.03 (0.88. 1.21)

Income (by one category) 0.99 (0.88. 1.12)

PT

Composite Score of Family Ties d <25th percentile 0.87 (0.70. 1.08)

25th to 75th 0.99 (0.83. 1.19)

E

>75th reference
CC

Wald F 171.1 (p<0.001)

d.f.1/d.f.2 12/80
A

Pseudo RNagelkerke 0.535

a
Index was estimated by adding up 13 limitations [as ADL and - (I)ADL] with 10
mobility dysfunctions and giving a composite score from 0 to 23.
b
In relation to having 0-2 limitations.
c
95%CIs. 95% confidence intervals.
d
Composite Score of Family Ties: <25th percentile (score <5) indicates few family
ties and >75th percentile (score >7) indicates higher family ties.

29
FAMILY TIES AND FUNCTIONAL LIMITATION

Τable 5. Adjusted ORs of Index of Functional Limitations in 13.974 adults, aged 50+

years in the SHARE study (wave II. 2006/07), in relation to categories of indexes

Composite Score of Family Ties.

Index of Functional

Limitationsa

Adjusted Odds Ratiosb

T
Indexes and Score of Family Ties
(95%CIs)c

IP
Living status alone 0.95 (0.82. 1.11)

R
with spouse. partner reference

SC
Children 1 1.01 (0.82. 1.24)

2 0.92 (0.78. 1.08)

3+
U reference
N
Family proximity Low proximity (between 100 -500 km) 0.69 (0.46. 1.03)
A
index Moderate proximity (between 25-100 km) 0.82 (0.58. 1.17)
M

high proximity (between 5-25 km) 0.96 (0.81. 1.14)

Very high proximity (same building or

reference
ED

house)

Family contact About once a month or less or never 1.58 (1.13. 2.22)
PT

index About once a week or every two weeks 1.13 (0.86. 0.48)

Several times a week 0.99 (0.83. 1.19)

E

Daily reference
CC

a
Index was estimated by adding up 13 limitations [as ADL and - (I)ADL] with 10
mobility dysfunctions and giving a composite score from 0 to 23.
A

b
In relation to having 0-2 limitations.
c
95%CIs. 95% confidence intervals.
Multiple logistic regression analysis (estimations according to the complex sampling
design of the study). As covariates were used the gender, age, education status, self-
rated health status, chronic diseases, disease symptoms, European Depression Scale
score, retirement status, European regions and income levels.

30
FAMILY TIES AND FUNCTIONAL LIMITATION

T
RIP
SC
U
N
A
M
ED
E PT
CC
A

31