Policies Mediating the Social Context of the Disablement Process Among Older Europeans

Liili Abuladze, Estonian Institute for Population Studies, Tallinn University
Luule Sakkeus, Estonian Institute for Population Studies, Tallinn University
Adriana Santacroce, Sapienza Università di Roma

Successful ageing in the context of increasing life expectancies is one of the main research focuses in the population ageing domain. Only a minority of European countries have aged “successfully” in terms of healthy life years during the last decades. Moreover, successfully aged countries belong to different welfare regimes. Our main research question is: which policy measures are effective in balancing the country differences in the social network effects of the disablement process? We use data from the SHARE survey Waves 4 till 6 of people aged 50+ from 14 countries that participated in all three waves. Preliminary results from multinomial regression analysis indicate that satisfaction with social networks play a positive role against disability development, other social network aspects are related to maintaining the status quo of disability status as well as when limitations become more restrictive. Estonia and Germany have the highest risk of people staying in always severely limited situation, after controlling for demographic, health and social network variables. Estonia is the only country having significantly higher risk of people moving to more severe level of limitations. At the same time, Estonia and Germany have parallel existing trajectories – that of worsening as well as improving health. Further research will employ multilevel modelling to estimate the role of policies in disability outcomes. We will include the following macro-level variables: social protection expenditure, poverty of older people, general level of formal long-term care, out of pocket expenditure on health, general attitude towards older people.


One of the challenges in times ofincreasing longevity is whether people also live healthier. Sanderson andScherbov (2015) suggest that faster increase in life expectancy could lead toslower population ageing. However, Crimmins and colleagues (2016) don’t findevidence of morbidity compression in the US over the last four decades.

Lengthening the period of activeparticipation in the society to postpone morbidities and activity limitationsfurther into later ages as well as organising care for disabled population aresome of the solutions according to the concept of successful ageing (Rowe andKahn 1987, 2015, Tesch-Römer and Wahl 2017). Successful ageing occurs whenhealthy life expectancy increases quicker than life expectancy (Tesch-Römer andWahl 2017). However, a minority of European countries have aged successfully(Figure 1), and they belong to different welfare systems.


Figure 1. Successful ageing(+) and ageing with disability (-) in Europe (difference between increase inlife expectancy and healthy life years in 2005-2009 vs 2010-2014). Source:Eurostat 2017


Support systems in European countries are usuallydivided based on being familialistic or de-familialised (Saraceno and Keck 2010).Intergenerational contracts being in a dynamic change (Saraceno 2008) poses thequestion of how societies organise care and support services.  Disability ishigher in countries without well organised services, where the care burden is onthe shoulders of family members (Verbrugge and Jette 1994).


Satisfaction with social networks plays a positiverole against disability development in European countries, other networkaspects play a role in maintaining the status quo of disability status as wellas when limitations become more restrictive (Sakkeus et al 2018).


Our main research question is: which policy measures balancethe country differences in the social network effects of the disablementprocess?





Data and Methods


We use data from the SHARE (Survey on Health, Ageingand Retirement in Europe) panel survey of Wave 4 (2010-2011) till Wave 6 (2015).People aged 50+ were interviewed. The information on disability relies on theGlobal Activity Limitation Index (GALI) (Jagger et al 2010). We include 14countries that participated in all three waves.


Through multinomial regression we obtainedassociations between changes in disability over time and changes in socialnetwork. Secondly, we will employ the GLLAMM method (Grilli and Rampichini 2015)for multilevel modelling with less than 15 countries to estimate the role ofpolicies in disability outcomes. Several macro-level indicators measuringsocio-economic situation and ageist attitudes will be included.


Preliminary Results

Regression results indicate Estonians and Germans havingthe highest risk of staying always severely limited, after controlling for demographic,health and social network variables (Figure 2). Estonians have significantlyhigher risk of moving from less to more limitations (health worsening).Estonia, Poland, the Czech Republic and Germany have significantly higher riskto experience a transition from more to less limitations (becoming healthier). Trajectoriesof worsening and improvement of health over four years exist in Estonia andGermany. Next we will employ the GLLAMM method to understand the role ofpolicies in disability outcomes.



Figure 2. Relative riskratios of country indicators (reference: Austria) in transitions to differentdisability outcomes between SHARE Wave 4 and Wave 6. These are final modelscontrolling fordemographic, health and social network characteristics.Statistically significant (p<0.1) results are presented with highlightedbars.




Crimmins,E., Zhang, Y., Saito,Y. (2016). Trends Over 4Decades in Disability-Free Life Expectancy in the United States. AmericanJournal of Public Health. Vol 106, No. 7: 1287-1293.


Eurostat(2017). Database. Population and socialconditions. Life expectancy. Healthy Life years. http://ec.europa.eu/eurostat/data/database (last accessed September 28, 2017).


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Sakkeus, L., Abuladze, L.,  Santacroce, A. (2018).Interactions of social networks in the disablement process in Europe. EuropeanJournal of Ageing (forthcoming).


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Presented in Session 1123: Ageing and Intergenerational Relations