Background: Multidimensional vulnerability among older adults, characterized by low levels of individual resources in different life domains, has been insufficiently studied. This phenomenon is considered to be associated with a marked decrease in overall life satisfaction. Social support is supposed to buffer the negative effect of multidimensional vulnerability on life satisfaction. Methods: Analyses are based on the German Health Update dataset (GEDA 2014/2015-EHIS). The analytic sample includes respondents ≥ 65 years (N = 5826). Confirmatory factor analyses were performed to construct a latent variable from the indicators income poverty, activities of daily living (ADL) limitations, multimorbidity, mental problems, and living alone. Multivariate linear regression models estimate the relationship between vulnerability and life satisfaction with a special focus on the interaction between vulnerability and social support. Results: The analyses supports the multidimensional construct of vulnerability. Social support considerably moderates the negative relationship between vulnerability and life satisfaction. As the degree of vulnerability increases, the influence of social support becomes more pronounced. Conclusion: The assessment of vulnerability as a multidimensional construct helps to depict the life situation of older people in a more differentiated way. Vulnerable older adults with a small or unreliable social network while finding it difficult to access practical help need additional external social support to achieve a high level of life satisfaction.
Zusammenfassung: Hintergrund: Multidimensionale Vulnerabilität älterer Erwachsener, die durch ein geringes Maß an individuellen Ressourcen in verschiedenen Lebensbereichen gekennzeichnet ist, wurde bislang unzureichend untersucht. Dieses Phänomen kann mit einem deutlichen Rückgang der allgemeinen Lebenszufriedenheit einhergehen. Es wird vermutet, dass soziale Unterstützung die negativen Auswirkungen multidimensionaler Vulnerabilität auf die Lebenszufriedenheit abpuffert. Methoden: Die Analysen basieren auf dem Datensatz „Gesundheit in Deutschland aktuell" (GEDA 2014/2015-EHIS). Die analytische Stichprobe umfasst Befragte ≥ 65 Jahre (n = 5826). Mit Hilfe von konfirmatorischen Faktorenanalysen wird eine latente Variable aus den Indikatoren Einkommensarmut, Einschränkungen in den Aktivitäten des täglichen Lebens (ADL), Multimorbidität, mentale Probleme und Alleinleben konstruiert. Multivariate lineare Regressionsmodelle schätzen den Zusammenhang zwischen Vulnerabilität und Lebenszufriedenheit mit besonderem Augenmerk auf die Interaktion zwischen Vulnerabilität und sozialer Unterstützung. Ergebnisse: Die Analyse bestätigt das multidimensionale Konstrukt der Vulnerabilität. Soziale Unterstützung moderiert die negative Beziehung zwischen Vulnerabilität und Lebenszufriedenheit erheblich. Mit zunehmendem Grad der Vulnerabilität wird der Einfluss der sozialen Unterstützung deutlicher. Diskussion: Die Betrachtung von Vulnerabilität als multidimensionales Konstrukt hilft, die Lebenssituation älterer Menschen differenzierter darzustellen. Vulnerable ältere Erwachsene mit einem kleinen oder unzuverlässigen sozialen Netzwerk und mit Schwierigkeiten beim Zugang zu praktischer Hilfe benötigen zusätzliche externe soziale Unterstützung, um ein hohes Maß an Lebenszufriedenheit zu erreichen.
Keywords: Cumulative risk factors; Life satisfaction; Social support; Confirmatory factor analysis; GEDA 2014/2015-EHIS; Kumulative Risikofaktoren; Soziale Unterstützung; Konfirmatorische Faktorenanalyse
Supplementary Information The online version of this article (https://doi.org/10.1007/s00391-022-02142-3) contains supplementary material, which is available to authorized users.
Overall life satisfaction among older adults is a central indicator in aging research representing a cognitive evaluation process of the subjectively perceived quality of life [[
The association of risk factors with adverse outcomes—in this case a marked decrease in life satisfaction—comes into full force when the individual cannot draw on protective reserves. The presence of individual risk factors therefore acts as a disposition for vulnerability. The absence of corresponding protective factors subsequently manifests the individual's vulnerable state. According to Grundy [[
Advantages and disadvantages in old age with regard to health, social relations and financial situation on the individual level are described to emerge within a cumulating process over the life course [[
Recent research takes up the idea of heterogeneity in old age and has criticized the empirical implementation of the different dimensions of vulnerability to decreased life satisfaction as merely isolated influencing factors. The simultaneous occurrence of risks in different life domains is usually ignored [[
Despite the existence of risk factors that challenge the coping process, the negative impact of stressful events on life satisfaction does not necessarily have to occur if the individual draws on protective reserves that can buffer the negative impact of risk factors on perceived quality of life. Protective factors generally reduce the likelihood of disorders occurring in the presence of stress [[
Based on the critical interrogations mentioned above, we propose the basic hypothesis that vulnerability acts as a composite measure including risk factors from different dimensions. The aim of this study is twofold: first, we take up the idea of multidimensional vulnerability among older adults and use data from Germany to construct a latent variable reflecting the material, physical, mental and social dimension of vulnerability. Second, we apply this construct in relation to overall life satisfaction. Referring to external coping resources, we expect that the negative direct effect of vulnerability on life satisfaction is moderated by social support.
For the empirical analyses, the fourth wave of the survey German Health Update (GEDA 2014/2015-EHIS) is used, which was carried out between November 2014 and July 2015. The dataset comprises a sample of 24,016 respondents aged 15 years and older in private households from the German resident population. The core questionnaire of the GEDA survey, based on the third wave of the European Health Interview Survey (EHIS), includes questions on subjective, functional and mental health, chronic diseases, potential causes of diseases, support and social networks, and the use of medical care and treatment. Questions are also asked on other health-related topics, such as care for diabetes mellitus, working conditions and issues related to disease prevention [[
Multidimensional vulnerability manifests in four dimensions: material, physical, mental and social [[
Life satisfaction as the outcome variable is measured using an 11-point scale from 0 ("not at all satisfied") to 10 ("completely satisfied") [[
In order to verify that the selected variables can estimate the latent construct of vulnerability on the basis of one dimension, an exploratory factor analysis was carried out in a first step using the principal component factor method. Subsequently, a confirmatory factor analysis (CFA) based on generalized structural equation modeling (GSEM) with probit link functions and including missing values was conducted [[
The results of CFA in Fig. 1 show a satisfactory overall fit to the data (log likelihood = −15,165.747, Akaike information criterion (AIC) = 30,351.490, Bayesian information criterion (BIC) = 30,418.200, RMSEA = 0.010, 90% confidence interval, CI [0.000, 0.023], CFI = 0.998) referring to multidimensional vulnerability indicated by material, physical, mental and social vulnerability. As vulnerability is a latent exogenous variable and needs a normalizing constraint, the association with income poverty is constrained to 1; however, within the measurement model, the ADL and multimorbidity scales as well as the PHQ mental health problems scale show the strongest associations with the latent variable vulnerability. The sub-dimensions of physical and mental health thus seem to play the most important role in measuring multidimensional vulnerability among older adults, while living alone shows comparatively lower associations.
Graph: Fig. 1Measurement component of multidimensional vulnerability. Note: unstandardized coefficients, unweighted data, probit link function, missing values included. AIC Akaike information criterion, BIC Bayesian information criterion, * p < 0.5, ** p < 0.01, *** p < 0.001, Bernoulli distribution refers to a discrete random variable which takes the value 1 with probability p and the value 0 with probability q = 1- p (source: GEDA 2014/2015-EHIS, own calculations)
The latent variable of the measurement model corresponds to a continuous factor score ranging from very low to very high levels of multidimensional vulnerability. About one in five respondents has no vulnerability in any of the dimensions, which corresponds to very low factor scores. Slightly more than half of the respondents have a rather low vulnerability with a prevalent risk in either one or two dimensions. Of the study participants 18% show high to very high vulnerability scores corresponding to the prevalence of risk factors in 3 or more dimensions. Thus, multidimensional vulnerability is characterized by a right-skewed distribution (M < 0.001, SD = 0.151, skewness = 0.707) as shown in Fig. 2. Overall, the factor scores reveal gradual trajectories of vulnerability in much greater detail than would be possible with categorical variables on different groups of vulnerability.
Graph: Fig. 2Distribution of vulnerability factor scores in the sample (in %). Note: the solid line shows the approximated normal distribution of the indicator (source: GEDA 2014/2015-EHIS, own calculations)
Vulnerability has a significant negative impact on life satisfaction (β = −0.437; p < 0.001; see Model I, Table 1). Adding social support to the regression model (Model II) shows that the effect of vulnerability changes, while social support also significantly influences life satisfaction. These effects persist under control for age, gender and self-efficacy.
Table 1 Associations of life satisfaction and vulnerability by social support
Variables Model I Model II Model III β 95% CI β 95% CI β 95% CI 4.380*** 4.299 4.462 4.081*** 3.983 4.180 3.034*** 2.888 3.180 −0.437*** −0.457 −0.418 −0.553*** −0.625 −0.481 −0.468*** −0.539 −0.397 Moderate – – – 0.138*** 0.107 0.170 0.124*** 0.094 0.154 Strong – – – 0.256*** 0.225 0.286 0.228*** 0.198 0.258 80+ – – – – – – 0.107*** 0.084 0.130 Female – – – – – – 0.018n.s. −0.004 0.040 Self-efficacy – – – – – – 0.242*** 0.217 0.267 Vulnerability × Social support – – – 0.153*** 0.080 0.226 0.143*** 0.072 0.213 Log likelihood – −8236.497 – – −8995.333 – – −22,738.257 – AIC – 16,478.994 – – 18,030.667 – – 45,564.514 – BIC – 16,499.004 – – 18,164.069 – – 45,857.998 – CD – 0.191 – – 0.231 – – 0.281 –
β standardized coefficient, CI confidence interval, LL lower limit, UL upper limit, AIC Akaike information criterion, BIC Bayesian information criterion, CD coefficient of determination Models are based on unweighted data (N = 5826). n. s.: not significant, *p < 0.5, **p < 0.01, ***p < 0.001 Source. GEDA 2014/2015-EHIS, own calculations
The interaction coefficient vulnerability × social support is also found to be significant and points in the opposite direction: The negative effect of vulnerability on life satisfaction is moderated by social support and therefore becomes less pronounced when the level of social support increases. Controlling for age, gender and self-efficacy (Model III), for each unit of social support adds 0.143 to the main effect of vulnerability, reducing the negative coefficient. Accordingly, when social support is strong, the effect of vulnerability on life satisfaction is −0.039 instead of −0.468.
To validate these results, an additional model was calculated without social support and the interaction term, but with a group comparison for the social support categories. This model shows a significant χ
The older age group (≥ 80 years) reports higher life satisfaction compared to the younger respondents. Self-efficacy yields a positive coefficient (β = 0.242; p < 0.001), while gender does not show a significant correlation with life satisfaction (Table 1).
Figure 3 shows the predicted margins of life satisfaction by level of vulnerability moderated by social support. While there is a general gain in life satisfaction through social support, a stronger effect becomes visible for vulnerable people in particular. The relative difference in life satisfaction increases as the vulnerability level rises, depending on the degree of social support.
Graph: Fig. 3Trajectories of life satisfaction in relation to vulnerability moderated by social support (source. GEDA 2014/2015-EHIS, own calculations). Note: Overall life satisfaction is measured by the following item: ‚Asked in general terms, how satisfied are you with your life overall? 0 = not satisfied at all ... 10 = completely satisfied'.
The results of this study are twofold: First, by creating a continuous latent variable to represent different degrees of vulnerability, the concept of vulnerability becomes multidimensional and contributes to the current debate over the conceptualization and operationalization of vulnerability [[
Vulnerability theory argues that vulnerability can exist simultaneously in multiple life domains and affect perceived quality of life [[
Consistent with previous studies revealing a negative relationship between vulnerability and perceived quality of life on single dimensions [[
These findings have direct practical relevance, as they show that older adults facing multidimensional vulnerability particularly need special external support to achieve a higher level of life satisfaction. Identifying the multidimensionally vulnerable is a major task for actors in community work (e.g. social agencies or service providers) and could benefit from a standardized and generally accepted assessment and screening of vulnerability. Moreover, potential services of external social support are at least as broad as the composition of vulnerability in older adults. To create helpful measures, the federal and local governments should collaborate with scientific research on models of external interventions based on subsidiarity and solidarity. This call for a mix of tailored interventions addresses actors on different levels, such as public health (regarding physical and mental well-being), the welfare state (regarding financial provision) and the community (regarding support in everyday tasks).
In the light of this multidimensional perspective, aging describes a process that involves the accumulation of successive and time-variant changes in different domains within different settings. Essentially, this involves intra-individual and inter-individual differences in the process of development and adaptation and is based on life span psychology [[
Increasing the significance of the study results would entail the following changes in the study design:
- Use of longitudinal data in order to (
1 ) identify a baseline regarding overall life satisfaction and (2 ) investigate for cause and effect. - Oversampling older persons with multiple risk factors to gain a deeper understanding and a more differentiated picture of vulnerability in old age.
Our findings can be useful in suggesting approaches for practitioners:
- The focus of practical interventions should be on the individual situation of vulnerability, and thus a "one size fits all" approach should be avoided and replaced by tailored interventions.
- Interventions to promote social support and life satisfaction appear to be most effective among the most vulnerable. It follows that identifying individuals with high levels of vulnerability is essential and directing them to appropriate interventions promises the most positive outcomes.
- In order to increase life satisfaction of older vulnerable people living alone, social relations in the local environment (e.g. neighbors) should be strengthened.
- Targeted urban and social planning can promote support for vulnerable older people in their immediate social environment by enabling close links between individuals and their context.
- Developing measures to improve perceived life satisfaction can be more effective if older adults confronted with multidimensional vulnerability are already involved early in the planning process.
Open Access funding enabled and organized by Projekt DEAL.
V. Cihlar, F. Micheel and A. Mergenthaler declare that they have no competing interests.
For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.
Graph: Tab. S1: Correlations, means, standard deviations, minimum and maximum of the study variables
By Volker Cihlar; Frank Micheel and Andreas Mergenthaler
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