Physical functioning and frailty in very old age in Germany

INTRODUCTION: Physical functional capacity is central to autonomy and participation in very old age. The aim of this study is to describe functional limitations among the oldest old in Germany using a global indicator (Global Activity Limitation Indicator - GALI) and domain-specific indicators (activities of daily living, mobility, sensory function, urinary incontinence). In addition, frailty is examined as a risk factor. METHODS: The analyses are based on data from the 2023 German Ageing Survey (DEAS) (n = 938) and the 2021/22 Health 65+ study (n = 2028) for persons aged 80 and older living in private households. GALI is analysed across datasets, while further indicators are analysed separately for each dataset. Results are stratified by gender and income. RESULTS: About one quarter of the oldest old have severe functional limitations; this finding is consistent across both datasets. In daily living activities, men show significantly better scores than women. Around one third are severely limited in walking more than one kilometre, and just under one sixth are severely limited in climbing stairs. Severe sensory limitations affect 10% in vision and 27% in hearing. Urinary incontinence is reported by 40% of the oldest old, more often by women than by men. According to the selected criteria, almost half are robust, 43% are pre-frail and 8.6% are frail. Differences between income groups are only partly evident and are not consistent. DISCUSSION: Functional limitations are widespread among the oldest old living in private households, particularly among women and, in some cases, among those with low income. Sensory impairments, urinary incontinence and frailty are common and highly relevant for health and social care. Prevention and care should start early and take gender and socioeconomic position into account.