Independent Functioning Among the Oldest-Old in 27 European Countries: A Cross-Sectional Analysis of the SHARE Study

OBJECTIVES: To estimate the prevalence and analyze the factors associated with independent functioning among the oldest-old people living in Europe. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Community-dwelling adults aged 85 and older living in 27 European countries. METHODS: Data from Wave 9 (2021-2022) of the Survey of Health, Ageing and Retirement in Europe (SHARE) study were considered. Independent functioning was defined as the absence of limitations in basic activities of daily living (BADLs) and/or instrumental activities of daily living (IADLs). Univariate analysis was conducted by using the χ² test or Fisher's exact test for categorical variables as well as the Student's t-test for quantitative variables. We applied simple and multiple Poisson regression models, considering prevalence ratio (PR) as the association measure. Confidence intervals (CIs) were calculated for a 95% confidence level. RESULTS: The prevalence of independent functioning was 65.8% (CI, 64.4-67.1) among the sample of 4532 individuals. The Northern and Western regions had a greater proportion of independent functioning; the prevalence rates were lower and the gender gap wider in Southern and Eastern Europe. Physical activity (PR = 2.178; CI, 1.932-2.454), unimpaired orientation (PR = 1.495; CI, 1.344-1.662), absence of depressive symptoms (PR = 1.373; CI, 1.252-1.505), absence of polypharmacy (PR = 1.347; CI, 1.241-1.463) and multimorbidity (PR = 1.257; CI, 1.170-1.350), male gender (PR = 1.222; CI, 1.141-1.310), absence of loneliness (PR = 1.190; CI, 1.111-1.274), unimpaired numeracy (PR = 1.196; CI, 1.102-1.298), unimpaired memory (PR = 1.113; CI, 1.037-1.194), and lower age (PR = 0.938; CI, 0.924-0.952) were significantly associated with independent functioning, adjusted by the educational level and European region. CONCLUSIONS AND IMPLICATIONS: Northern and Western Europe show greater functional independence in late life than Eastern and Southern Europe. Several factors were significantly associated with independent functioning, including physical activity, polypharmacy, absence of multimorbidity, absence of depressive symptoms, absence of loneliness, unimpaired cognition, lower age, and male gender. Our results should be considered to target interventions aiming at healthy aging in these individuals.