The effect of frailty on hospitalisation trajectories in adults aged 65 and older across 10 European countries: a 14-year longitudinal analysis from the Survey of Health, Ageing, and Retirement in Europe (SHARE)

Frailty is associated with adverse health outcomes in ageing populations, yet its long-term effect on the development of disability is not well defined. The study examines to what extent frailty affects disability trajectories over 15 years in older adults aged 50+. Using seven waves of data from the Survey of Health, Ageing and Retirement in Europe (SHARE), the study estimates the effect of baseline frailty on subsequent disability trajectories by multilevel growth curve models. The sample included 94360 individuals from 28 European countries. Baseline frailty was assessed at baseline, using the sex-specific SHARE-Frailty-Instrument (SHARE-FI), including weight loss, exhaustion, muscle weakness, slowness, and low physical activity. Disability outcomes were the sum score of limitations in activities of daily living (ADL) and Instrumental ADL (IADL). Analyses were stratified by sex. Over 15 years, baseline frailty score was positively associated with disability trajectories in men [βADL = 0.074, 95% confidence interval (CI) = 0.064; P = .083; βIADL = 0.094, 95% CI = 0.080; P = 0.107] and women (βADL = 0.097, 95% CI = 0.089; P = .105; βIADL = 0.108, 95% CI = 0.097; P = .118). Frail participants showed higher ADL and IADL disability levels, independent of baseline disability, compared with prefrail and robust participants across all age groups. Overall, participants displayed higher levels of IADL disability than ADL disability. Study findings indicate the importance of early frailty assessment using the SHARE-FI in individuals 50 and older as it provides valuable insight into future disability outcomes.

The Survey of Health, Ageing and Retirement in Europe (SHARE) is a unique multidisciplinary and cross-national panel database of ex ante harmonized microdata on health, socioeconomic status, and social and family networks covering most of the European Union and Israel. To date, SHARE has collected five waves of data in 2-year intervals since 2004, including current living circumstances and retrospective life histories. A sixth wave is currently (2015) in the field. Four additional waves are planned until 2024. More than 230,000 interviews conducted so far give a broad picture of life after age 50, measuring physical and mental health, both objectively and subjectively; economic and noneconomic activities, income, and wealth by sources; intergenerational transfers of time and money within and outside of the family; as well as life satisfaction and well-being. The data are available to the scientific community free of charge at www.share-project.org after registration. SHARE is harmonized with the US Health and Retirement Study (HRS) and the English Longitudinal Study of Ageing (ELSA) and has become a role model for several aging surveys worldwide. SHARE’s scientific power is based on its panel design that grasps the dynamic character of the aging process, its multidisciplinary approach that delivers the full picture of the individual and societal aging, and its cross-nationally ex ante harmonized design that permits international comparisons of health, economic, and social outcomes in Europe and the USA. Due to their harmonization, the SHARE data and their international sisters encompass a worldwide “historical laboratory” to assess the effects of different policies on health, socioeconomic status, and well-being after age 50. To date (May 2015), more than 1,200 SHARE-based publications assess the chances and challenges of individual and societal aging by exploiting the links between health, economic, and social conditions over the life course observable in SHARE. Among the key findings is a European North–South gradient in many more dimensions than previously documented. In addition to the well-known income gradient, the health and wellbeing differences between North and South contradict mortality data and folklore about healthy Mediterranean lifestyle. SHARE has sparked an entire new area of research by revealing a strong correlation between early retirement and the loss of cognitive abilities, social contacts, and well-

BackgroundThe promotion of physical activity (PA) plays a major role for healthy ageing even in older age. There is a lack of cross-sectional and longitudinal studies explicitly dealing with barriers and drivers to PA in older adults. Therefore the aims of this study are a) to determine the prevalence of insufficient physical activity (IPA) in 65 to 75-year-olds in Europe and to identify factors associated with IPA in cross-section and b) to identify longitudinal risk factors for IPA in prior active persons.MethodsThis study is using data of the Survey of Health, Ageing and Retirement in Europe (SHARE). SHARE is a cross-national panel database including individual data of the non-institutionalised population aged 50+ from 27 European countries. For the present paper, we included a cohort that participated in all first four waves of SHARE (2004–2011) aged 65-to-75–years at wave four (male n = 1761, female n = 2085) from 10 European countries. To identify cross-sectional and longitudinal associations, we calculated prevalence odds ratios and hazard ratios with 95% confidence intervals.ResultsThe prevalence of IPA in 65–75-year-olds varied widely between countries, ranging from 55.4% to 83.3% in women and from 46.6% to 73.7% in men. IPA was associated with several intrapersonal factors and strength of association was similar for men and women for almost all investigated factors. Statistically significant associated with IPA were socioeconomic factors as low educational level (own and parental) and financial difficulties (male: POR: 1.60: 95%-CI: 1.26–2.03; female: POR: 1.58; 95%-CI: 1.26–1.97) and health-related factors as e.g. number of chronic diseases (male: POR: 1.34: 95%-CI: 1.23–1.45; female: POR: 1.31; 95%-CI: 1.21–1.42). Interpersonal only the size of social network was associated with IPA (male and female: POR: 0.88, 95%-CI: 0.81–0.95). Longitudinally in a fully adjusted model, only grip strength (HR: 0.99; CI-95%: 0.98–0.99) and BMI (HR: 1.02; CI-95%: 1.00–1.04) were statistically significant risk factors for IPA.ConclusionsPA promotion programs for older adults should incorporate the heterogeneity of health status and physical condition that can typically occur in this age group.

BackgroundPatients with Alzheimer's disease or dementia are at increased risk for COVID-19 hospitalization and mortality. However, no study has examined whether memory function is associated with COVID-19 outcomes in general older adults.MethodsData were obtained from SHARE (the Survey of Health, Ageing and Retirement in Europe), HRS (the Health and Retirement Study), and ELSA (the English Longitudinal Study of Ageing), three prospective and representative cohorts of non-institutionalized adults aged 50 years and older in 25 European countries plus Israel, the United States, and the United Kingdom, respectively. Memory function was measured with immediate and delayed 10-words recall tests. Associations of 10-words recall with COVID-19 hospitalization and mortality were assessed using logistic models adjusted for age, sex, race, body mass index, smoking, physical activity, household income, education level, and chronic conditions.Figure 1.Determination of the study sample.COVID-19, coronavirus disease 2019; ELSA, the English Longitudinal Study of Ageing; HRS, the Health and Retirement Study; SHARE, the Survey of Health, Ageing and Retirement in Europe.ResultsA total of 4062 participants with COVID-19 infection from SHARE, 1349 from HRS, and 278 from ELSA were included in the analysis. 610 (15.0%) in SHARE, 142 (10.5%) in HRS, and 39 (14.0%) in ELSA were hospitalized, and 102 (2.5%) died of COVID-19 or related complications in SHARE. The adjusted odds ratios (aORs) for COVID-19 hospitalization were 1.15 (95% CI, 1.09-1.22) in SHARE, 1.07 (95% CI, 0.94-1.21) in HRS, and 1.34 (95% CI, 1.02-1.77) in ELSA, per word decrease in immediate 10-words recall. For delayed 10-words recall, the corresponding aORs were 1.11 (95% CI, 1.06-1.17), 1.12 (95% CI, 1.01-1.24), and 1.25 (95% CI, 1.01-1.55), respectively. The aORs for COVID-19 mortality were 1.07 (95% CI, 0.94-1.21) and 1.14 (95% CI, 1.01-1.28) per word decrease in immediate and delayed 10-words recall in SHARE, respectively. Results were relatively robust to missing data of covariates, exclusion of cases based on symptoms alone, or exclusion of cases with Alzheimer's disease or dementia.ConclusionThis study shows that low memory performance, as measured by 10-words recall, is independently associated with an increased risk of COVID-19 hospitalization and mortality in adults aged 50 years and older.DisclosuresAll Authors: No reported disclosures

A large variety of information of respondents’ physical and mental health has been collected within the context of the Survey of Health, Ageing and Retirement in Europe(SHARE) from its first wave in 2004 on. Despite their undisputable value, self-reported and subjective health indicators turned out not to be unproblematic in international comparative analyses. The collection of biometric data contributes to remedying such problems. This research paper presents analyses with measures of isometric grip-strength – one of the biometric measures already available in SHARE to date. Further, the authors discuss the inclusion of other biometric measures (especially via blood samples) into the investigational program of the longitudinally designed SHARE. Relevant sociological problems and questions (e. g. the importance of biomarkers for analyses of the correlation between socio-economic status and health) as well as experiences with biometric data in studies comparable to SHARE (especially from Anglo-Saxon countries) are described.

In the Survey of Health, Ageing and Retirement in Europe (SHARE) (http://www.share-project.org), health measures were constructed based on a careful consultation process of health experts and previous health surveys. However, there have been limited efforts to examine the comparability of health data in SHARE. Therefore, we aim to compare self-reports of health based on incidence and prevalence of health outcomes in SHARE to estimates from parallel national and trans-national health surveys. Prevalence of health outcomes in SHARE measured at baseline (2004/2005) were compared to prevalence estimates from the European Health Interview Survey (EHIS) (2006-2009), national Health Interview Surveys (HIS) (1997-2003), the European Social Survey (ESS) (2004/2005), the EU Statistics on Income and Living Conditions (EU-SILC) (2005) and the disability ad hoc module added to the European Union Labour Force Survey (EU-LFS-disability) (2002). Components of each of these surveys provide an element of comparison for a particular health dimension in SHARE. Across countries, agreement between surveys was described for self-perceived health, long-standing illness, global activity limitations, diabetes, hypertension, asthma, lung diseases, depression and overweight by age group, gender and educational level. First results show substantial variation in the comparability of health prevalence assessed by SHARE with other health surveys, depending on the health indicator of interest. For instance, a good agreement with SHARE was found for self-reported diagnosed diseases assessed by EHIS and for overweight based on self-reported weight and height by EHIS and HIS. On the other hand, for self-perceived health, the agreement between SHARE and other surveys was poor. Furthermore, agreement varied across countries, making country-specific comparisons between surveys less reliable. Lack of agreement between surveys is studied in more detail concerning systematic differences in survey design, sampling strategies, responses and assessment modes. Investigating time trends will evaluate whether differences in prevalence of health indicators between surveys will also affect agreement among trends over time in prevalence of health measures across age, gender and education. These additional analyses will complete this first assessment of the quality of SHARE data on health. Besides, this research will highlight the overlap and complementarity between SHARE and other national and trans-national health surveys. By recognising health measures that could be harmonised between surveys and measures that are more exclusive, we could exploit the opportunities offered by having multiple measures of health in different surveys.

Although engagement in productive activities is associated with favourable outcomes with respect to the health and well-being of older individuals, the association between such activities and depression in older populations remains relatively unexplored. The purpose of this study was to evaluate the association among five productive activities (paid work, formal volunteering, caregiving, informal helping and caring for grandchildren) with depression in older adults in 14 European countries. This cross-sectional study used the first two waves of data collected by the Survey of Health, Ageing and Retirement in Europe and analysed a total sample of 7238 relatively healthy community residents aged 60 years and older from 14 European countries. The Survey of Health, Ageing and Retirement in Europe excluded potential participants with a past history of depression, cognitive impairment and physical limitations. Depression was categorised using the EURO-D instrument, and associations with participating in productive activities were investigated. Depression was less prevalent among those individuals who were employed or self-employed and those who participated in formal volunteering or informal helping, whereas caregiving was associated with a higher risk of depression. Caring for grandchildren was not associated positively or negatively with depression. Formal volunteering and caregiving remained associated with depression after adjustment for age, sex, marital status, education, economic status, country and presence of long-term illness. Availability of formal volunteering may be important in reducing depression risk, whereas caregiving is associated with a higher risk of depression in older European adults. Further research is required to clarify the direction of causation and evaluate interventions.

Association between internet exclusion and depressive symptoms among older adults: panel data analysis of five longitudinal cohort studies

The association between changes in frailty status and the prevalence of chronic lung diseases (CLD) is critical. This study aims to explore the relationship between variations in frailty status and incidence of CLD. This study utilized data from four national prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), Health and Retirement Study (HRS) and Survey of Health, Ageing and Retirement in Europe (SHARE). Changes in frailty status were assessed using the Rockwood Frailty Index. CLD was defined as self-reported physician-diagnosed chronic lung diseases, including chronic bronchitis, emphysema, cor pulmonale. Cox proportional hazards model was employed to examine the relationship between changes in frailty status and the incidence of CLD. The analysis included 38,122 participants from four cohorts. Participants who progressed to prefrail or frail status had a significantly higher risk of developing CLD compared to those who remained robust (CHARLS, HR: 1.85, 95% CI: 1.47–2.32; HRS, HR: 1.84, 95% CI: 1.34–2.51; ELSA, HR: 1.58, 95% CI: 1.08–2.31; SHARE, HR: 1.70, 95% CI: 1.40–2.07). Conversely, individuals who transitioned to robust status demonstrated a lower risk of incident CLD compared to those who remained in prefrail or frail status (CHARLS, HR: 0.59, 95% CI: 0.48–0.73; HRS, HR: 0.71, 95% CI: 0.49–1.01; ELSA, HR: 0.57, 95% CI: 0.36–0.89; SHARE, HR: 0.71, 95% CI: 0.55–0.92). Different changes in frailty status are associated with varying risks of developing CLD. Progression of frailty status is associated with the increasing risk of CLD, whereas recovery from frailty is associated with the decreased risk of CLD. The findings suggest that changes in frailty status can serve as important indicators for predicting the risk of developing CLD, where frailty progression elevates risk while recovery from frailty mitigates it. Question What are the associations of changes in frailty status with risks of incident chronic lung disease (CLD)? Finding Progression from robust to pre-frail or frail status increased risks of incident CLD, while recovery from pre-frail or frail statust to robust status, and decreased risks of incident CLD. Conclusions Changes in frailty status affect incident CLD risk. Abbreviations：CHARLS, China Health and Retirement Longitudinal Study ; HRS, Health and Retirement Study; ELSA, English Longitudinal Study of Ageing.; SHARE, Survey of Health, Ageing and Retirement in Europe

BackgroundLow dementia rates, reflecting underdiagnosis in representative cohort studies, limit statistical power of etiological and preventative research. Although several algorithms for automated classification of presence or absence of dementia have been validated in the Health and Retirement Study (HRS), no such algorithm has yet been applied to the Survey of Health, Ageing and Retirement in Europe (SHARE).MethodThe Langa‐Weir classification (LW) was adapted to readily available indicators in SHARE, including immediate and delayed recall. Adapted algorithms additionally included instrumental activities of daily living (IADL) and used cut‐offs defined by either sample‐ or population‐level distributions. Performance was compared to logistic and bayesian‐logistic regression models and a gradient boosting machine (XGBoost) with the same indicators, adjusting for age groups, gender and educational level. The bayesian‐logistic regression used priors for sociodemographic indicators and global dementia incidence. Accuracy, specificity and sensitivity were compared with a train‐test split approach in SHARE wave 7 (2017).ResultIn total, N = 72,329 participants (57% female) above age 50 had no missing data on self‐reported dementia diagnosis, immediate or delayed recall and IADLs. LW based on immediate and delayed recall with a score cutoff based on dementia population‐incidence performed best overall (Accuracy = .92, Balanced Accuracy = .75, Sensitivity = .58, Specificity = .92), and showed greatest similarities to participants with self‐reported dementia diagnosis regarding risk factors and comorbidities (i.e., gripstrength, numerical performance, verbal fluency). Results from XGBoost suggested comparable performance however with risk of overfitting.ConclusionLW adaptations outperformed regression models regarding sensitivity. Comparisons of risk factor and comorbidity distributions suggest meaningful differences in comorbidities and risk factors in participants classified with and without dementia. With a lack of proxy assessments in SHARE, a suspected healthy volunteer bias and the absence of standardized cognitive assessments, probable dementia detection in SHARE necessarily comes with less confidence compared to algorithms tested in HRS. Nonetheless, performance of LW adaptations in SHARE is in line with previous validation studies in HRS. Future research should validate the algorithms through more extensive cognitive assessments once available.

Breakthrough research or false findings? New review of: Patterns of Frailty in Older Adults: Comparing Results from Higher and Lower Income Countries Using the Survey of Health, Ageing and Retirement in Europe (SHARE) and the Study on Global AGEing and Adult Health (SAGE) on Publons. Add your own expert review today.

Parkinson's disease (PD) significantly reduces quality of life (QoL), particularly due to its complex interplay of motor and nonmotor symptoms. While personality traits influence QoL in chronic diseases, their longitudinal effects in people with PD (PwPD) remain underexplored. This study evaluates the longitudinal predictive influence of neuroticism, conscientiousness, and openness on QoL in PwPD over two waves of the Survey of Health, Aging, and Retirement in Europe (SHARE). This study utilized longitudinal data from 100 PwPD participants in waves 7 and 8 of the Survey of Health, Aging, and Retirement in Europe (SHARE). QoL was assessed using the CASP-12 scale, while personality traits were measured with the Big Five Inventory (BFI-10). Linear regressions and generalized estimating equations (GEE) were used to examine cross-sectional and longitudinal associations between personality traits and QoL, controlling for sociodemographic, psychosocial, and health-related variables. Neuroticism was consistently associated with lower QoL across all analyses. Cross-sectional results showed neuroticism as the strongest predictor of QoL decline in wave 7 (beta = -0.33, p < 0.001), and longitudinal GEE analyses confirmed its predictive effect (beta = -0.03, p = 0.007). Conscientiousness and openness showed limited and inconsistent associations with QoL. Beyond personality traits, depressive symptoms and mobility limitations were found to substantially impact QoL, influencing the effects of neuroticism. Neuroticism plays a pivotal role in predicting QoL decline in PwPD, highlighting its utility as a target for psychological interventions aimed at emotional regulation and resilience building. While depressive symptoms and mobility limitations also contribute, integrating personality assessments into care strategies may improve outcomes. These findings advocate for a multidimensional approach to managing PD that addresses both clinical and psychological factors.

BackgroundSocial participation and digital use are associated with reduced depression risk among older adults, but most supporting evidence does not consider both time-invariant and time-varying confounders and is inconsistent. We aimed to evaluate the impact of social participation and digital use on the incidence of depressive symptoms among older adults by a multi-country cohort considering both time-invariant and time-varying counfounders.MethodsWe used data from four nationally representative observational studies across 18 countries (2008–2021): the Health and Retirement Study (HRS), the Survey of Health, Aging and Retirement in Europe (SHARE), the China Health and Retirement Longitudinal Study (CHARLS), and the Mexican Health and Aging Study (MHAS). Participants aged 50 years or older without depressive symptoms at baseline and without related behaviors pre-baseline were included. Interested exposure social participation and digital use were measured by specific questions. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D) and the European Depression Scale (EURO-D). Targeted maximum likelihood estimation method was applied to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the long-term impact of exposure on depressive symptoms onset.ResultsA total of 69,186 eligible participants were included. At baseline, 77.0%, 44.0%, 34.2%, and 49.8% of participants were exposed to social participation in HRS, SHARE, CHARLS, and MHAS, respectively, and these proportions were 55.7%, 55.9%, 4.5%, and 69.9% for digital use exposure. During follow-up, a total of 18,245 (26.4%) individuals developed depressive symptoms. The RRs (95% CI) of depression risk under social participation versus no social participation were 0.80 (0.68–0.93) in HRS, 0.80 (0.74–0.87) in SHARE, 0.86 (0.77–0.96) in CHARLS, and 0.93 (0.85–1.02) in MHAS. Compared with no digital use, the RRs (95% CI) of depression risk under digital use were 0.88 (0.72–1.08) in HRS, 0.85 (0.77–0.93) in SHARE, 0.75 (0.60–0.92) in CHARLS, and 0.88 (0.79–0.98) in MHAS.ConclusionsEngagement in social participation and digital use are associated with a reduced incidence of depressive symptoms in older adults. In the digital world, besides social participation, promoting digital use for social connection may be an effective strategy for depression prevention in ageing populations.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-026-04846-4.

ObjectivesThe burden of pain in middle‐aged and older adults is considerable and significantly increases healthcare expenditures. We aimed to investigate the roles of handgrip strength (HGS) weakness and asymmetry in predicting pain across four nationally representative cohorts.MethodsThis longitudinal study utilized data from four major surveys: the Health and Retirement Study (HRS); the English Longitudinal Study of Ageing (ELSA); the Survey of Health, Ageing and Retirement in Europe (SHARE); and the China Health and Retirement Longitudinal Study (CHARLS). Multivariable cubic regression splines were employed to visually explore the nonlinear associations between HGS and pain in each cohort. The Cox proportional hazard model was applied to analyze the independent and combined relationship between HGS weakness and asymmetry and pain risk.ResultsWe included 41,171 participants in the final analysis, with a mean follow‐up period of 4.68 ± 2.61 years (50.7% female, mean age 64.3 ± 9.3 years). No nonlinear relationship was found between HGS and pain incidence (nonlinear p < 0.05 in ELSA and SHARE; >0.05 in CHARLS and HRS). After adjustment, the highest quartile groups had a significantly reduced risk of pain compared to the lowest quartile groups across all cohorts, with hazard ratios of 0.81 (0.74, 0.89) in CHARLS, 0.86 (0.77, 0.97) in HRS, 0.88 (0.77, 0.98) in ELSA, and 0.78 (0.73, 0.84) in SHARE. Participants with normal HGS had approximately 20% lower risk of pain compared to those with weak HGS. Each 5 kg increase in HGS was associated with decreased hazard ratios for pain: 0.95 (0.93, 0.97) in CHARLS, 0.97 (0.94, 0.99) in HRS, 0.96 (0.94, 0.99) in ELSA, and 0.94 (0.92, 0.95) in SHARE. The association between HGS asymmetry and pain risk was significant only in a few cohorts (HRS at 10%, 1.10 (1.03, 1.18); SHARE at 30%, 1.12 (1.05, 1.21)). No interaction effect between HGS weakness and asymmetry on pain risk was observed (all p‐values for interaction >0.05).ConclusionsOur findings suggest that HGS can be used as an independent predictor of pain in middle‐aged and older European, American, and Chinese populations. However, our results do not support the use of HGS asymmetry as an independent predictor of pain risk. It is necessary to establish appropriate criteria for HGS asymmetry across different populations. The use of both weak HGS and asymmetry as predictors of health outcomes requires further validation in more diverse populations.

ObjectiveOur study prospectively assessed the relationship between cumulative handgrip strength and temporal changes in depressive symptoms among adults aged 50 years and over.MethodsThis study was conducted based on two longitudinal cohort studies: the English Longitudinal Study of Ageing (ELSA) and the Survey of Health, Ageing and Retirement in Europe (SHARE). Cumulative handgrip strength was derived from three repeated measurements taken over eight years (ELSA) or six years (SHARE). The mixed linear regression models and Cox regression models were employed to assess the associations between cumulative handgrip strength and temporal changes in depressive symptoms, as well as incident depression risk.ResultsParticipants in the lowest quartile of cumulative handgrip strength had higher depressive symptom scores compared to those in the highest quartile in ELSA (β: 0.191; 95% CI: 0.035, 0.348) and SHARE (β: 0.391; 95% CI: 0.267, 0.514), and experienced an accelerated increase in depressive symptoms of 0.040 point/y (95% CI: 0.009, 0.070) in ELSA, and 0.067 point/y (95% CI: 0.045, 0.089) in SHARE during follow-up. Regarding incident depression, the lowest quartile group faced a 55% (HR: 1.55; 95% CI: 1.13, 2.12) and 62% (HR: 1.62; 95% CI: 1.38, 1.90) increased risk of developing depression in ELSA and SHARE, relative to the highest quartile.ConclusionsReduced cumulative handgrip strength correlated with accelerated depressive symptom progression and increased depression incidence. Future interventional studies should further investigate if strength/muscular fitness can improve mental health, particularly in older adults.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-24223-9.