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Frailty and types of social relationships among older adults in 17 European countries: A latent class analysis
Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0003-2665-1736
Umeå University, Faculty of Social Sciences, Department of Social Work.ORCID iD: 0000-0003-0108-4237
Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.ORCID iD: 0000-0003-3187-1987
Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Department of Geography.
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2022 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 101, article id 104705Article in journal (Refereed) Published
Abstract [en]

Background: Frailty is a syndrome commonly associated with old age. Social relationships are an essential determinant of frailty progression, and frailty can negatively affect social relationships.

Objectives: To identify social relationship types among older adults in Europe; to evaluate whether social relationship types differ across European regions; and to assess the association between frailty status and social relationship type.

Methods: We used data from 56,226 individuals from 17 European countries who participated in Wave 6 of the Survey of Health, Ageing and Retirement in Europe. We constructed social relationship types from social relationship variables (contacts frequency, perceived emotional support, participation in social activities, providing and receiving instrumental support) using latent class analysis (LCA). Associations between social relationship types and frailty were examined using multinomial regression analyses integrated with LCA.

Results: We identified four social relationship types: ‘poor’; ‘frequent and emotionally close’; ‘frequent, emotionally close, and supportive’; and ‘frequent, emotionally close, and active’. Type 3 is also characterised by participation in sport/social clubs (in the northern region) or receiving support (in the eastern region). Participation in volunteering/charity activities (in the central and northern regions) and instrumental support provision (in the northern region) are Type 4′s characteristics as well. In all regions, being frail was associated with less active social relationships (Types 1, 2, and 3) relative to the more ‘active’ type (Type 4).

Conclusion: Frailty status was associated with social relationship types. The identified types may help tailor intervention programmes for older adults to prevent worsening frailty.

Place, publisher, year, edition, pages
2022. Vol. 101, article id 104705
Keywords [en]
Frailty, Latent class analysis, Older age, SHARE, Social participation, Social support
National Category
Other Social Sciences not elsewhere specified Gerontology, specialising in Medical and Health Sciences
Identifiers
URN: urn:nbn:se:umu:diva-194900DOI: 10.1016/j.archger.2022.104705ISI: 000793742700007PubMedID: 35461166Scopus ID: 2-s2.0-85129513398OAI: oai:DiVA.org:umu-194900DiVA, id: diva2:1663067
Funder
Swedish Research Council, 2020-0254Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-05196Available from: 2022-06-01 Created: 2022-06-01 Last updated: 2023-03-24Bibliographically approved
In thesis
1. Active and healthy ageing in Europe: significance of social relationships
Open this publication in new window or tab >>Active and healthy ageing in Europe: significance of social relationships
2022 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Aktivt och hälsosamt åldrande i Europa : betydelsen av sociala relationer
Abstract [en]

Background: Social relationships have important roles in achieving active and healthy ageing. Social relationships are dynamic across the life course. A myriad of contextual and individual (e.g., sociodemographic and health-related) factors shape the levels of social relationship constructs (e.g., social contact, participation, and support) and how they change over time. This thesis aims to contribute to a better understanding of social relationships among the older European population, the impact of health on social relationships, the influence of social relationships on quality of life, and the impact of the COVID-19 pandemic on the levels of social relationships.

Methods: The study subjects were community-dwelling Europeans aged 50 and over who participated in the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2004 and 2020. In Sub-study 1, multilevel growth modelling was used to analyse the trajectories of seven social relationship constructs, i.e., provision and receipt of instrumental support, social contact, and participation in volunteer work, sport/social club, educational activity, and political/community organisation. Sub-study 2 used latent class analysis (LCA) to identify social relationship typologies based on the seven social relationship constructs and perceived emotional support. Next, the associations between frailty and social relationship typologies were analysed using LCA-with-covariates. Sub-study 3 evaluated the possible causal effect of social support provision, support receipt, and participation on quality of life using doubly robust estimation and sensitivity analysis for unobserved confounding. Sub-study 4 used multilevel logistic regression analysis to determine whether individuals’ exposure to COVID-19 and the country’s COVID-19 policies stringency index (S-Index) were associated with the initiation of provision and receipt of instrumental support and volunteering during the first phase of the COVID-19 pandemic. 

Results: In contrast to instrumental support receipt, the probability of instrumental support provision, social contact, and participation declined slightly over time (Sub-study 1). Four social relationship types were identified: 1) poor, 2) frequent and emotionally close, 3) frequent, emotionally close, and supportive, and 4) frequent, emotionally close, and active (Sub-study 2). Poor self-rated health limited instrumental support provision and increased instrumental support receipt from outside the household (Sub-study 1). Being pre-frail or frail was associated with less active social relationship types, i.e., Types 1, 2, and 3 (Sub-study 2). Social participation and instrumental support provision for people outside the household were correlated with a higher quality of life while receiving instrumental support was associated with a lower quality of life. None of these associations could be considered causal (Sub-study 3). During the COVID-19 pandemic, the level of volunteering and instrumental support provision was lower, but the level of instrumental support receipt was higher than before the pandemic. Being exposed to COVID-19 was positively associated with support receipt initiation. The close ones’ exposure to COVID-19 was positively associated with volunteering, support provision, and support receipt. S-Index was positively associated with instrumental support provision initiation but negatively associated with support receipt initiation (Sub-study 4).

Conclusions: A significant share of older Europeans was socially active. Their engagement in social contact, support, and participation changed over time. The four social relationship types revealed the importance of having frequent contact in initiating instrumental support exchange and social participation. Health is a vital determinant of older adults’ social relationships. On the other hand, observed associations indicate that social relationships may influence older adults’ quality of life. The pandemic might lower social support provision and volunteering and increase support receipt levels in the population. However, the pandemic might also encourage older adults to provide help, likely to people within their neighbourhood. Overall, maintaining close social ties, especially with family and close friends, is important to stimulate active engagement in social support exchange and participation, which promotes healthy ageing.

Abstract [sv]

Bakgrund: Sociala relationer har stor betydelse för ett hälsosamt och aktivt åldrande, vilket också kan återspegla en hög livskvalitet bland äldre människor. Sociala relationer förändras över hela livet, och en rad olika kontextuella och individuella (d.v.s. sociodemografiska och hälsorelaterade) faktorer påverkar nivån och karaktären av våra sociala relationer (sociala kontakter, socialt deltagande och stöd) över tid. Syftet med denna avhandling är att bidra till en ökad förståelse av sociala relationer bland den åldrande befolkningen i Europa; hur hälsan inverkar på sociala relationer; hur sociala relationer inverkar på livskvalitet; samt hur COVID-19-pandemin inverkat på sociala relationer. 

Metod: Avhandlingen baseras på data från män och kvinnor, 50 år och äldre, som deltagit i undersökningen om ”hälsa, åldrande och pensionering i Europa” (SHARE) mellan åren 2004 och 2020. I delstudie 1 användes flernivåmodeller för att analysera trajektorier av sju typer av sociala relationer; tillhandahållande och mottagande av instrumentellt stöd, sociala kontakter, samt socialt deltagande i volontärarbete, -sport/social klubb, - utbildningsverksamhet och -politisk/samhällsorganisation. I delstudie 2 användes latent klassanalys (LCA) för att identifiera sociala relationstypologier baserat på de sju sociala relationerna och upplevt emotionellt stöd. Därefter analyserades sambanden mellan sociala relationstypologier och åldersskörhet. I delstudie 3 undersöktes ett möjligt orsakssamband mellan sociala relationer (tillhandahållande av socialt stöd, mottagande av socialt stöd, och socialt deltagande) och livskvalitet bland äldre, med hjälp av robust skattning och känslighetsanalys för icke-observerade faktorer. I delstudie 4 användes logistisk regression med flernivåanalys för att analysera om individers exponering för covid-19 och landets covid-19 policy, mätt som stringensindex (S-index,) var associerat med initieringen av tillhandahållande och mottagande av instrumentellt stöd och volontärarbete under den första fasen av covid-19-pandemin. 

Resultat: Till skillnad från mottagande av instrumentellt stöd minskade sannolikheten för tillhandahållande av instrumentellt stöd, sociala kontakter och socialt deltagande något över tiden (delstudie 1). Fyra sociala relationstypologier identifierades: 1) Svag, 2) Frekvent och känslomässigt nära, 3) Frekvent, känslomässigt nära och stödjande och 4) Frekvent, känslomässigt nära och aktiv (delstudie 2). Dålig självskattad hälsa minskade sannolikheten för tillhandahållande av instrumentellt stöd men ökade sannolikheten för mottagandet av instrumentellt stöd ixfrån någon utanför hushållet (Delstudie 1). Att vara pre-åldersskör eller åldersskör var associerat med de mindre aktiva typerna av sociala relationer, det vill säga typ 1, 2 och 3 (delstudie 2). Socialt deltagande och tillhandahållande av instrumentellt stöd till personer utanför hushållet var korrelerat med högre livskvalitet, medan mottagande av instrumentellt stöd var associerat med lägre livskvalitet. Inget av dessa samband kunde dock anses vara orsakssamband (delstudie 3). Under covid-19-pandemin var nivån på volontärarbete och tillhandahållande av instrumentellt stöd lägre, men nivån av mottagande av instrumentellt stöd högre än före pandemin. Att exponeras för covid-19 var positivt förknippat med initiering av mottagande av stöd. Närståendes exponering för covid-19 var positivt förknippad med volontärarbete, samt tillhandahållande och mottagande av instrumentellt stöd. S-Index var positivt associerat med initiering av tillhandahållande av instrumentellt stöd men negativt associerat med initiering av mottagande av instrumentellt stöd (delstudie 4).

Slutsatser: En betydande andel av äldre européer var socialt aktiva. Deras engagemang i sociala kontakter, tillhandahållande och mottagande av instrumentellt stöd och sociala deltagande förändrades över tid. De fyra sociala relationstypologierna visar på betydelsen av att ha täta sociala kontakter för att initiera tillhandahållande och mottagande av instrumentellt stöd, såväl som socialt deltagande. Hälsan är en avgörande bestämningsfaktor för äldres sociala relationer. Å andra sidan indikerar avhandlingsresultaten också att sociala relationer kan påverka livskvalitet. Pandemin kan ha begränsat tillhandahållandet av stöd och volontärarbete man stimulerat mottagande av instrumentellt stöd. Betydelsen av sociala band mellan människor för att initiera utbyte av socialt stöd blev mer påtaglig under pandemin. Sammantaget visar avhandlingen att det är viktigt att upprätthålla nära sociala band, särskilt med familj och vänner, för att uppmuntra aktivt engagemang i socialt stödutbyte och socialt deltagande, vilket främjar ett hälsosamt åldrande.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2022. p. 125
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2206
Keywords
older population, ageing, social relationships, social support, social participation, social contact, quality of life, frailty, panel data, latent class analysis, growth model, multilevel logistic regression, pandemic, Europe, SHARE, äldre befolkning, åldrande, sociala relationer, socialt stöd, socialt deltagande, sociala kontakter, livskvalitet, åldersskörhet, paneldata, latent klassanalys, tillväxtmodell, flernivålogistisk regression, pandemi, Europa, SHARE
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health
Identifiers
urn:nbn:se:umu:diva-200969 (URN)978-91-7855-919-0 (ISBN)978-91-7855-918-3 (ISBN)
Public defence
2022-12-09, Sal Q0, Bergasalen, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2022-11-18 Created: 2022-11-14 Last updated: 2022-11-17Bibliographically approved

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Lestari, Septi KEriksson, Malinde Luna, XavierMalmberg, GunnarNg, Nawi

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