Ageing under unequal circumstances: a cross-sectional analysis of the gender and socioeconomic patterning of functional limitations among the Southern European elderly.

Background: In a context of population ageing, it is a priority for planning and prevention to understand the socioeconomic (SE) patterning of functional limitations and its consequences on healthcare needs. This paper aims at measuring the gender and SE inequalities in functional limitations and their age of onset among the Southern European elderly; then, we evaluate how functional status is linked to formal and informal care use.

Methods: We used Portuguese, Italian and Spanish data from the Survey of Health, Ageing and Retirement in Europe (SHARE) of 2011 (n = 9233). We constructed a summary functional limitation score as the sum of two variables: i) Activities of Daily Living (ADL) and ii) Instrumental Activities of Daily Living (IADL). We modelled the functional limitation as a function of age, gender, education, subjective poverty, employment and marital status using multinomial logit models. We then estimated how functional limitation affected informal and formal care demand using negative binomial and logistic models.

Results: Women were 2.3 percentage points (pp) more likely to experience severe functional limitation than men, and overcame a 10% probability threshold of suffering from severe limitation around 5 years earlier. Subjective poverty was associated with a 3.1 pp. higher probability of severe functional limitation. Having a university degree reduced the probability of severe functional limitation by 3.5 pp. as compared to none educational level. Discrepancies were wider for the oldest old: women aged 65-79 years old were 3.3 pp. more likely to suffer severe limitations, the excess risk increasing to 15.5 pp. among those older than 80. Similarly, educational inequalities in functional limitation were wider at older ages. Being severely limited was related with a 32.1 pp. higher probability of receiving any informal care, as compared to those moderately limited. Finally, those severely limited had on average 3.2 hospitalization days and 4.6 doctor consultations more, per year, than those without limitations.

Conclusion: Functional limitations are unequally distributed, hitting women and the worse-off earlier and more severely, with consequences on care needs. Considering the burden on healthcare systems and families, public health policies should seek to reduce current inequalities in functional limitations.