Disability and social ties: comparative findings of the CLESA study

Abstract

The associations between prevalence, incidence and recovery from activities of daily living (ADL) disability and social ties among community-dwelling persons over 65 in Finland, The Netherlands and Spain are examined. Data were harmonized in the CLESA study. The baseline sample was composed of 3,648 subjects between 65 and 85 years old, living in Finland, The Netherlands and Spain. Disability in four activities of daily living was determined at baseline and at follow-up. Social participation, number of family ties and presence of friends were added to obtain a social ties index. Logistic regressions were fitted to the prevalence, incidence and recovery data to estimate the associations between disability and social ties, adjusting for education, comorbidity and self-rated health. The modifying effects of country, age and sex were tested in all models. For every country, the social ties index, having friends and social participation were negatively associated with ADL disability prevalence. ADL incidence was negatively related to the number of family ties, with a stronger relationship in Spain than in The Netherlands or Finland. ADL recovery was associated with the social ties index. No age or gender differences in these associations were found. Social ties appear to generate a beneficial effect on the maintenance and restoration of ADL function. While social ties play an important role in maintaining and restoring function in all three countries, family ties appear to generate a stronger effect on protection from disability incidence than does social participation, and the strength of this effect varies by culture.

Functional performance and social relations among the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based epidemiological study

“…As discussed previously, various cohort studies have shown that social relations are determinants of future performance of ADL in the elderly 3,5,6,7,8,9,10,11,12,13,14 . Other cohort studies have shown that both emotional support 8 and size of total social network (especially the family network) 7 predict not only future functional limitation but also recovery from it, suggesting a bidirectional association.…”

“…Evidence suggests that cultural differences can modify social behaviors 29 , as well as satisfaction with life and friends 30 . Zunzunegui et al 9 assessed the influence of presence or absence of friends on the incidence and prevalence of functional limitation among elderly in three different countries (Finland, Netherlands, and Note: estimated percentages, considering the sampling parameters. Spain).…”

“…As for social network, the number of components (number of the elder's family members and number of friends and relatives to whom the elder feels close) 5,6,7,8 , number of components in the family network (spouse, children, and siblings) 9 , limited diversity in social relations (number of categories with which the elder has contact, such as children, grandchildren, siblings, other relatives, and friends) 10 , limited social participation (social activities outside the home and visits to others) 9,11,12 , as well as less contact with family members 5 and friends 8,13 to whom the elder feels close showed independent associations with future functional limitation. As for social support, dissatisfaction with social support 4,10 , perception of receiving little social support 14 , and large instrumental support (specific assistance such as provision of material needs in general and help with practical tasks such as house-cleaning, preparing meals, and provision of transportation) 7,10 have been described as determinants of worse functional performance, even after adjusting for other relevant factors.…”

Estudo de base populacional dos fatores associados à incapacidade funcional entre idosos na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

“…Cerhan & Wallace 35 afirmam que a interação entre as relações sociais e a saúde é bidirecional: a piora no estado de saúde induz a uma restrição da rede social, enquanto um decréscimo nas redes sociais, de maneira repetida e prospectiva, prediz a mortalidade e morbidade graves. Isso ocorre tanto em estudos populacionais quanto em indivíduos com morbidade conhecida 36,37 e piora com a idade 39 . Um estudo multicêntrico conduzido na Finlândia, Holanda e Espanha, que comparou a prevalência, a incidência e a recuperação da incapacidade entre idosos que vivem na comunidade, demonstrou que ainda que existam diferenças culturais, os laços sociais (familiares e não-familiares) são protetores da incapacidade na velhice 39 .…”

“…Isso ocorre tanto em estudos populacionais quanto em indivíduos com morbidade conhecida 36,37 e piora com a idade 39 . Um estudo multicêntrico conduzido na Finlândia, Holanda e Espanha, que comparou a prevalência, a incidência e a recuperação da incapacidade entre idosos que vivem na comunidade, demonstrou que ainda que existam diferenças culturais, os laços sociais (familiares e não-familiares) são protetores da incapacidade na velhice 39 . Quando considerada a incidência da incapacidade, os laços familiares têm maiores efeitos protetores do que os laços não-familiares, mas quando considerada a prevalência da incapacidade, os laços não-familiares são mais protetores.…”