{"paper_id":"0bc89060-19c8-4dbe-b8c5-da2ab2ac4d97","body_text":"TProtective Factors for Sustaining Robustness in Older Adults: An 8-Year Multinational Longitudinal Study Using SHARE Data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article TProtective Factors for Sustaining Robustness in Older Adults: An 8-Year Multinational Longitudinal Study Using SHARE Data Khalil Iktilat, Debbie Rand, Netta Bentur, Aviad Tur-Sinai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9345466/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Frailty is a widely recognized clinical syndrome of ageing. While most studies emphasize risk factors for frailty, little is known about the protective mechanisms that sustain robustness in later life. This study addresses this gap by identifying longitudinal predictors of robustness among older adults. Methods We analyzed eight years of longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE; Waves 4–8, 2011–2020) across 27 countries, including 7,865 adults aged 65–84, stratified into younger-old (65–74) and older-old (75–84) groups. Logistic regression models estimated odds ratios for maintaining robustness, incorporating sociodemographic, health, lifestyle, functional factors. Results Robustness declined steadily over time, with 52% of younger-old adults and 26% of older-old adults remaining robust after eight years. Across all models, better self-rated health (OR ≈ 0.72, p < 0.001), fewer chronic conditions (OR ≈ 0.89, p < 0.001), and greater financial security (OR ≈ 1.11, p = 0.018) were the strongest and most consistent predictors of sustained robustness. Engagement in moderate physical activity and participation in social and cognitive activities further contributed to resilience, though their effects were stronger among younger-old adults compared with the older-old. Conclusions This study contributes to ageing research by examining sustained robustness, rather than frailty progression alone, as a longitudinal outcome in a large multinational cohort. By highlighting behavioral, psychosocial, and functional determinants of resilience, it frames robustness as a measurable and actionable outcome in ageing research and practice. These findings promote a more balanced and positive conceptualization of ageing-one that emphasizes not only preventing frailty, but actively maintaining robustness as a core scientific and clinical objective. Robustness ageing SHARE sustained robustness healthy ageing multidimensional resilience longitudinal ageing trajectories Figures Figure 1 Introduction Frailty is a common geriatric syndrome in older adults, characterized by diminished strength, endurance and physiologic function, which increases vulnerability to adverse health outcomes ( 1 – 3 ). Many studies examined frailty transitions over time ( 4 – 12 ). Although the negative consequences of frailty are well known clinical interventions are often too late for effective management ( 13 – 16 ). Therefore, it is important to identify factors that can help maintain the robustness of older adults. Robustness represents the opposite pole of frailty and refers to the capacity to maintain physiological reserve, adaptability, and functional integrity despite age-related challenges( 17 , 18 ). In the context of frailty research, robustness has traditionally been defined as being “non-frail” ( 19 ). However, recent conceptual frameworks propose that robustness should be viewed as an active and multidimensional state encompassing physical, cognitive, psychological, and social domains ( 13 , 20 ). This broader view positions robustness not merely as the absence of frailty but as a positive expression of intrinsic capacity and adaptive potential ( 21 , 22 ). Various modifiable behaviors and lifestyle characteristics have been identified to protect against frailty and maintain robustness. For example, physical activity is consistently associated with lower incidence of frailty in a dose dependent manner such that higher levels of activity are associated with lower odds of developing frailty ( 23 – 25 ). Social participation and social support have also repeatedly been associated with slower frailty progression and lower disability and mortality risk ( 10 , 26 ), whereas social isolation and loneliness show mixed but largely negative consequences for frailty progression ( 26 , 27 ). Effects of diet on robustness have been mixed ( 24 , 28 ) as has the effect of varying degrees of alcohol consumption ( 29 ), but there is consistent evidence showing that smoking cessation can promote robustness ( 27 , 30 ). These examples highlight that while some lifestyle domains show mixed or context-dependent effects on robustness, a core set of modifiable behaviours consistently emerge as protective factors that help older adults remain robust. However, large, longitudinal, multi-domain analyses which focus on sustained robustness are lacking ( 31 – 33 ). The added value of the present study lies in its design rather than in proposing a new biological construct. Using eight years of longitudinal SHARE data from 27 European countries, we examine sustained robustness among older adults who were robust at baseline and assess a broad set of demographic, socioeconomic, health, physical, social, and cognitive factors within a single analytic framework. In addition, by stratifying the sample into younger-old and older-old adults, the study allows comparison of whether the correlates of maintained robustness differ across stages of later life. Most studies focus on predicting frailty, worsening states, and adverse effects, whereas the determinants of sustained robustness are less studied ( 2 , 3 , 34 ) and warranted ( 2 , 3 , 34 ) Building on this foundation, the present study directly responds to these gaps by adopting a multidimensional and longitudinal approach that explicitly examines sustained robustness, rather than the development of frailty. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) - a comprehensive eight-year multinational dataset ( 35 ), we examined how demographic, health, and lifestyle characteristics interact over time to preserve robustness. Unlike previous longitudinal studies, our analysis identifies potential protective pathways and modifiable factors associated with sustained robustness, representing a conceptual and empirical shift from describing decline to understanding how robustness may be maintained in later life. This study operationalizes robustness as a dynamic and measurable construct, integrating behavioral, psychosocial, and health-related domains within a unified framework. By emphasizing the determinants of sustained robustness rather than the predictors of frailty, it introduces a conceptual and methodological shift in ageing research. This approach moves beyond risk reduction toward the proactive maintenance of function and independence, positioning robustness as an active and multidimensional outcome of protective factors. Together, these perspectives highlight the importance of modifiable behavioral and social pathways for promoting healthy ageing and provide an empirical foundation for targeted, preventive interventions. Although the present study does not examine biological mechanisms directly, it contributes to the gerontology literature by showing how readily measured clinical, behavioral, and socioeconomic factors are associated with sustained robustness over time. This population-level perspective is important because it identifies observable markers and potentially modifiable domains that may help distinguish older adults who maintain robustness from those who transition toward pre-frailty or frailty. Methods Study Design and Data Source This study is based on a longitudinal analysis using data from Waves 4–8 (2011–2020) of SHARE ( 35 – 43 ). SHARE is a multinational, population-based panel study designed to provide insights into aging, health, and socioeconomic factors across Europe. Since its inception in 2004, SHARE has collected data from over 140,000 participants across 27 countries, making it one of the most comprehensive datasets for aging research. Study Population Our study sample included adults who were classified as robust (non-frail) at Wave 4 of SHARE, which was used as the baseline reference point for tracking robustness Participants were included in the analysis only if they had frailty phenotype data at Wave 4 and at least one other wave, allowing for longitudinal assessment of robustness-frailty transitions. Participants were aged 65–84, stratified into two subgroups: 65–74 years (younger-old) and 75–84 years (older-old). The age stratification is based on previous research on ageing trajectories (e.g. ( 44 ), ( 45 ), and ( 46 ). Typically, three groups are defined (65–74, 75–84, and 85+); here we focus on the younger two groups. Frailty Phenotype Assessment Frailty status was determined using a modified frailty phenotype model based on the five criteria originally proposed by ( 19 ) and adapted for SHARE ( 47 ). In this model, robustness represents the opposite end of the frailty spectrum individuals classified as “robust” met none of the following frailty criteria based on the original phenotype proposed by ( 19 ), indicating preserved strength, energy, and functional reserve. Grip strength of both hands assessed using a handheld dynamometer (Smedley, TTM, Tokyo), with the maximum value across trials retained (Maxgrip, SHARE protocol). If grip strength fell below the 20th percentile (very weak), adjusted for sex and BMI, as recommended by ( 47 ), participants received a point, indicating frailty. Walking speed measured using a 2.5-meter walking test, with timing starting when the first foot crossed the start line. Participants in the lowest 20th percentile, adjusted for sex and height ( 47 ), received a point, indicating frailty. Unintentional weight loss, defined as self-reported weight loss of 10 lbs (4.5 kg) or more in the past year indicated frailty (1 point). If weight loss data were unavailable, responses to appetite-related survey questions were used as proxies, as previously suggested ( 47 ). Exhaustion, assessed using two items from the Center for Epidemiological Studies Depression (CES-D) scale: “I felt everything I did was an effort” and “I could not get going.” Participants reporting these symptoms for at least 3–4 days per week received a point, indicating frailty. Physical activity, based on self-report engagement in low or moderate-intensity activities such as walking, gardening, or household chores. Participants engaging in such activities less than once a week received a point in alignment with SHARE-based studies. Points of these five criteria were summed up and classified: 0 points - Robust (non-frail), 1–2 points - Pre-frail, 3 or more points - frail. Covariates and Control Variables To comprehensively examine factors predicting sustained robustness, demographic, socioeconomic, health, and lifestyle variables were included as covariates, selected for their relevance to robustness research and availability within the SHARE dataset. All variables included in the analysis were selected based on the factors identified in the literature as key determinants of frailty and robustness, as discussed in the Introduction. Specifically, demographic, socioeconomic, health, and lifestyle characteristics-such as age, sex, education, financial status, chronic diseases, self-rated health, physical activity, and social participation have consistently been linked to frailty progression or robustness maintenance in previous studies ( 2 , 3 , 10 , 24 , 26 – 30 , 34 , 48 ). Accordingly, these variables were extracted from the SHARE dataset for the present analysis. Demographic and Socioeconomic Factors Key demographic variables included sex and socioeconomic status, assessed using education level (years of formal schooling) and financial situation, measured through self-reported ability to “make ends meet” on a scale from financial difficulty to financial security. Marital status (married or single/widowed/divorced) was also examined. In addition, living arrangement was captured using a binary variable (“single”), defined as living alone regardless of formal marital status. Accordingly, individuals classified as “single” could be never married, divorced, widowed, or married, provided they lived alone. Health-Related Variables Health status was measured by the number of diagnosed chronic conditions reported, an indicator of multimorbidity widely used in ageing research ( 2 , 49 ). Perceived health status was assessed using a self-rated health scale ranging from 1 (excellent) to 5 (poor), a validated and widely recognized predictor of morbidity, mortality, and overall functional decline ( 50 – 52 ). Both indicators were included given their consistent associations with frailty progression and robustness maintenance in previous longitudinal studies. Physical Activity and Functional Status Physical activity was categorized into vigorous activity (e.g., participation in sports or heavy physical labor) and moderate activity (e.g., walking, gardening, or household chores). The frequency of each type of activity was rated from 1 = Hardly ever or never, 2 = One to three times a month, 3 = Once a week, and 4 = More than once a week. Higher ratings indicate greater engagement in physical activity, with “4” representing regularly active individuals and “1” representing those who rarely or never engage in such activities. Physical activity has been repeatedly shown to reduce frailty risk and promote robustness ( 24 , 25 , 48 ), therefore it was included as a core behavioral variable to capture its protective influence on maintaining robustness and functional independence. Social and Cognitive Engagement Social participation was evaluated through engagement in volunteer work, attendance at educational or training courses, and participation in community-related or recreational activities such as sports clubs, religious, or political organizations. Cognitive engagement was assessed through participation in activities such as reading, solving puzzles (e.g., crosswords, Sudoku), and playing strategy-based games (e.g., chess, card games). Religious engagement (e.g., prayer frequency) was also considered, given its potential association with social support and psychological well-being. These indicators were selected based on evidence linking social participation and cognitive stimulation to reduced frailty progression and improved functional outcomes in later life ( 10 , 26 , 53 – 55 ). Such activities have been shown to contribute to the maintenance of cognitive and psychosocial functioning, thereby supporting sustained robustness across ageing populations. Statistical Analysis We used a series of logistic regression models to identify baseline sociodemographic, health, behavioral, and engagement factors associated with remaining robust over time. Specifically, we examined the likelihood of transitioning from robust to pre-frailty or frailty (binary variable) across four follow-up intervals (every two years starting from 2011). Models were stratified by age groups (65–74 and 75–84) to enable age-sensitive interpretation. Odds ratios (OR) greater than 1 indicate higher odds of remaining robust, while values below 1 indicate reduced odds. For health-related variables, higher values in both chronic conditions (0–9) and self-perceived health (1 = excellent to 5 = poor) represent worse health, so ORs less than 1 reflect the expected negative association with robustness. Results Our sample included 7,865 adults; younger-old adults aged 65–74 (n = 5,811, 73.9% of the cohort; 49.9% female), and older-old adults, aged 75–84 (n = 2,054, 26.1% of the cohort; 53.4% women). Groups are characterized in Table 1 . There were significant differences in health parameters; the younger-old group was characterized by better health. Both groups participated in social activities, though the younger-old group was significantly more active. The older-old group participated in significantly more physical activity and had lower BMIs, on average, than the younger-old group (Table 1 ). Table 1 Descriptive statistics of the whole population and differences between groups as assessed at Wave 4 of SHARE Whole Population N = 7,865 Younger-old Age 65–74 N = 5,811 Older-old Age 75–84 N = 2,054 Differences between groups t-statistic 1 ; χ 2 -statistic 2 p-value Age 71.33 ± 4.92 68.90 ± 2.80 78.20 ± 2.58 -130 1 p = 0.001 Sex (female) 3,995 (50.79%) 2,898 (49.87%) 1097 (53.41%) 7.60 2 p = 0.006 Education (years) 10.84 ± 4.35 11.09 ± 4.30 10.12 ± 4.40 8.70 1 p = 0.001 Financial distress ( 1 – 4 ) 3.08 ± 0.86 3.09 ± 0.86 3.05 ± 0.86 1.88 1 p = 0.06 Chronic disease (number) 1.55 ± 1.31 1.47 ± 1.27 1.81 ± 1.40 -10.25 1 p = 0.001 Self-perceived health status ( 1 – 5 ) 2.84 ± 0.94 2.78 ± 0.95 3.00 ± 0.91 -8.82 1 p = 0.001 Performed voluntary or charity work 1886 (23.99%) 1494 (25.72%) 392 (19.10%) 36.43 2 p = 0.001 Attended an educational or training course 833 (10.60%) 703 (12.10%) 130 (6.34%) 53.26 2 p = 0.001 Belong to a sport, social or other club 2844 (36.18%) 2195 (37.79%) 649 (31.63%) 24.96 2 p = 0.001 Participate in religious activities (church, synagogue, mosque, etc.) 1235 (15.71%) 846 (14.57%) 389 (18.96%) 22.08 2 p = 0.001 Belong to a political or community-related organization 537 (6.83%) 425 (7.32%) 112 (5.46%) 8.24 2 p = 0.004 Read books, magazines or newspapers 6601 (83.98%) 4909 (84.52%) 1692 (82.46%) 4.81 2 p = 0.028 Did word or number games such as crossword puzzles or Sudoku 3993 (50.80%) 3031 (52.19%) 962 (46.88%) 17.08 2 p = 0.001 Played cards or board games (chess) 2655 (33.78%) 2045 (35.21%) 610 (29.73%) 20.38 2 p = 0.000 Attend social activities (0–7) 2.46 ± 1.41 2.54 ± 1.43 2.21 ± 1.34 9.18 1 p = 0.001 Vigorous physical activity 2.35 ± 1.30 2.27 ± 1.28 2.60 ± 1.31 -9.83 1 p = 0.001 Moderate physical activity 1.13 ± 0.34 1.13 ± 0.33 1.14 ± 0.35 -2.16 1 p = 0.031 Daily smoking (yes) 5,419 (68.90%) 4067 (69.99%) 1352 (65.82%) 12.29 2 p = 0.001 Alcohol consumption (> 2 glasses almost every day) 1,378 (17.52%) 1,140 (19.62%) 238 (11.59%) 67.73 2 p = 0.001 Marital status (single) 2,202 (28%) 1,399 (24.08%) 803 (39.09%) 169.82 2 p = 0.001 BMI 26.56 ± 4.01 26.65 ± 4.06 26.29 ± 3.82 3.47 1 p = 0.0005 Table 1 -Note: Significant differences between the two age groups (65–74 vs. 75–84) are in bold. Values are means ± SD. Age is continuous (years). Sex = male/female. Education ranges 0–25 years. Financial distress coded 1 = with great difficulty to 4 = easily, where higher values indicate better financial situation. Chronic diseases: range 0–9. Self-perceived health: coded 1 = excellent to 5 = poor. Activities are dichotomous (0 = no, 1 = yes) for volunteering, courses, clubs, religious and political organizations, reading, puzzles, and games; “Activities” (0–7) is the summed count. Vigorous and moderate physical activity coded 1–4 (1 = hardly ever or never, 2 = one to three times a month, 3 = once a week, 4 = more than once a week). Daily smoking and alcohol use (> 2 glasses almost every day) coded 0 = no, 1 = yes. Marital status = married coded 0, single/divorced/widowed coded 1. BMI is continuous (kg/m²). Variables analyzed using independent-samples t-tests¹; categorical variables analyzed using chi-square tests². Table 2 The percentage of participants who remained robust or transitioned to pre-frail and frail in Waves 5, 6, 7, 8 for the whole SHARE study population and for each age-group. Baseline is Wave 4, in which all participants were robust. Age 65–74 Age 75–84 Robust Pre-Frail Frail Robust Pre-Frail Frail Wave 4–5 (65.02%) (32.74%) (2.24%) (49.03%) (45.71%) (5.26%) Wave 4–6 (60.66%) (36.25%) (3.09%) (40.11%) (49.70%) (10.19%) Wave 4–7 (58.77%) (36.71%) (4.53%) (36.00%) (52.00%) (12.00%) Wave 4–8 (52.22%) (42.15%) (5.63%) (26.46%) (53.36%) (20.18) We followed each participant’s robustness over time and assessed changes in the distribution of health states across subsequent waves (see Table 2 ). At baseline, all participants were classified as robust. Over the eight-year follow-up, the younger-old group declined from 100% robustness at baseline to 52.2% remaining robust, 42.2% transitioning to pre-frailty, and 5.6% to frailty by Wave 8. The older-old group showed a steeper decline, with only 26.5% remaining robust, 53.4% classified as pre-frail, and 20.2% as frail at the end of the study period. These patterns indicate a progressive loss of robustness with age, with faster transitions toward pre-frailty and frailty among the older-old cohort. As illustrated in Fig. 1 , these longitudinal transitions demonstrate a clear age-stratified shift from robustness toward pre-frailty and frailty across successive SHARE waves. Table 3 Logistic regression to identify factors associated with robustness over time, stratified by age group and Wave. Odds ratio ± SD are reported, and significant ratios (p < 0.05) are denoted by grey shading. A full table of model statistics (including z-scores and exact p-values) can be found in Supp Table 1 . WAVE 4–5 WAVE 4–6 WAVE 4–7 WAVE 4–8 Age 65–74 Age 75–84 Age 65–74 Age 75–84 Age 65–74 Age 75–84 Age 65–74 Age 75–84 N = 5,753 N = 2,015 N = 5,011 N = 1,666 N = 2,074 N = 646 N = 3,264 N = 906 Age 0.951 ± 0.009 0.950 ± 0.017 0.934 ± 0.010 0.928 ± 0.019 0.924 ± 0.0155 0.960 ± 0.034 0.936 ± 0.012 0.876 ± 0.029 Sex (Female: 0, Male: 1) 1.232 ± 0.078 1.200 ± 0.127 1.237 ± 0.082 1.140 ± 0.137 1.171 ± 0.118 1.300 ± 0.256 1.300 ± 0.105 0.855 ± 0.158 Education 1.007 ± 0.007 1.006 ± 0.011 1.008 ± 0.007 1.009 ± 0.012 0.996 ± 0.012 0.994 ± 0.020 1.000 ± 0.008 1.011 ± 0.018 Single (No: 0, Yes: 1) 1.041 ± 0.071 0.922 ± 0.096 0.957 ± 0.068 0.936 ± 0.110 1.012 ± 0.117 0.951 ± 0.191 0.959 ± 0.083 1.023 ± 0.181 Financial distress 1.167 ± 0.040 1.161 ± 0.065 1.150 ± 0.041 1.102 ± 0.070 1.098 ± 0.062 1.115 ± 0.130 1.109 ± 0.048 1.250 ± 0.126 Chronic diseases 0.904 ± 0.021 0.939 ± 0.033 0.890 ± 0.022 0.904 ± 0.037 0.924 ± 0.039 0.849 ± 0.065 0.893 ± 0.028 0.906 ± 0.058 Self-reported health status 0.719 ± 0.024 0.714 ± 0.040 0.720 ± 0.026 0.721 ± 0.045 0.728 ± 0.041 0.723 ± 0.074 0.764 ± 0.033 0.717 ± 0.067 Performed voluntary or charity work 0.970 ± 0.070 1.092 ± 0.137 1.076 ± 0.085 0.888 ± 0.129 1.028 ± 0.119 1.135 ± 0.243 1.002 ± 0.091 1.032 ± 0.212 Attended an educational or training course 1.062 ± 0.101 0.977 ± 0.192 0.974 ± 0.097 1.725 ± 0.376 1.326 ± 0.201 2.288 ± 0.753 1.141 ± 0.131 1.279 ± 0.382 Belong to a sport, social or other club 1.259 ± 0.079 1.210 ± 0.126 1.330 ± 0.090 0.893 ± 0.107 1.107 ± 0.114 1.104 ± 0.214 1.107 ± 0.088 1.195 ± 0.211 Participate in religious activities (church, synagogue, mosque, etc.) 1.180 ± 0.102 0.965 ± 0.120 1.057 ± 0.091 0.948 ± 0.129 1.198 ± 0.155 1.487 ± 0.308 0.901 ± 0.090 0.943 ± 0.187 Belong to a political or community-related organization 1.192 ± 0.145 1.371 ± 0.293 0.989 ± 0.125 1.669 ± 0.395 0.897 ± 0.170 0.898 ± 0.314 0.965 ± 0.138 0.900 ± 0.304 Read books, magazines or newspapers 1.001 ± 0.084 1.126 ± 0.149 1.060 ± 0.090 1.553 ± 0.235 1.396 ± 0.182 1.002 ± 0.240 1.340 ± 0.146 0.551 ± 0.124 Did word or number games such as crossword puzzles or Sudoku 1.112 ± 0.069 1.177 ± 0.118 1.143 ± 0.075 1.165 ± 0.133 1.040 ± 0.109 1.316 ± 0.253 1.067 ± 0.085 1.352 ± 0.231 Played cards or board games (chess) 1.065 ± 0.067 0.858 ± 0.091 1.067 ± 0.071 1.039 ± 0.125 0.882 ± 0.090 1.076 ± 0.212 1.033 ± 0.082 1.020 ± 0.184 Vigorous physical activity 1.052 ± 0.024 1.116 ± 0.040 1.042 ± 0.025 1.049 ± 0.043 1.113 ± 0.042 1.095 ± 0.738 1.095 ± 0.032 0.982 ± 0.060 Moderate physical activity 1.454 ± 0.121 1.245 ± 0.165 1.231 ± 0.107 1.192 ± 0.188 1.413 ± 0.197 1.274 ± 0.367 1.136 ± 0.124 1.825 ± 0.501 Smoking 1.001 ± 0.064 0.991 ± 0.102 0.952 ± 0.063 1.313 ± 0.151 0.427 ± 0.347 N/A 0.957 ± 0.079 1.035 ± 0.182 Drinking 0.991 ± 0.074 0.811 ± 0.119 0.922 ± 0.073 0.891 ± 0.149 0.806 ± 0.096 0.883 ± 0.237 0.960 ± 0.093 0.929 ± 0.237 BMI 0.994 ± 0.007 0.967 ± 0.012 0.993 ± 0.007 1.002 ± 0.014 0.975 ± 0.012 0.983 ± 0.245 0.982 ± 0.009 0.996 ± 0.021 As shown in Table 3 , logistic regression analyses identified baseline sociodemographic, health, behavioral, and engagement factors associated with sustained robustness across waves and age groups. Several variables were associated with robustness across cohorts. Engagement in social, cognitive, and physical activities emerged as partially protective, though patterns varied by age group and wave. For example, participation in sporting or social clubs was strongly associated with remaining robust among younger-old adults (e.g., OR = 1.259, p < 0.001 in Wave 4–5). Among older-old adults, participation in educational courses or trainings (OR = 2.288, p = 0.012 in Wave 4–7) and involvement in community organizations (OR = 1.67, p = 0.030 in Wave 4–6) were also linked to sustained robustness. Cognitive activities, such as reading, were associated with greater robustness across the study period for younger-old adults (OR = 1.34, p = 0.008), though interestingly, the association was inverse among older-old adults (OR = 0.551, p = 0.008). Physical activity contributed in complementary ways. Moderate activities such as walking or gardening consistently predicted higher robustness (e.g., OR = 1.231, p = 0.017 in Wave 4–6), while vigorous activity was beneficial primarily during earlier follow-ups and among younger-old (OR = 1.052, p = 0.025 at Wave 4–5) and older-old adults (OR = 1.116, p = 0.003 at Wave 4–5). However, the protective effect of physical activity appeared to weaken slightly over time, particularly for vigorous activity, which lost significance in later waves. In contrast, moderate activity remained consistently associated with robustness, suggesting that sustainable, age-appropriate physical engagement plays a more enduring role in maintaining robustness in later life. Lifestyle behaviors showed less consistent associations. Smoking and alcohol use did not demonstrate stable relationships with robustness, apart from baseline smoking among older-old adults between Waves 4 and 6, which unexpectedly predicted higher robustness (OR = 1.31, p = 0.018). BMI displayed weak and inconsistent effects, with lower values marginally associated with robustness in shorter follow-ups (e.g., OR = 0.967, p < 0.001 in Wave 4–5 for older-old; OR = 0.975, p = 0.044 in Wave 4–7 for younger-old) but no significant impact by Wave 4–8. Self-rated health emerged as the strongest determinant of sustained robustness across all follow-up waves. Participants who perceived their health more favorably (“1” on the scale, indicating better health) had significantly higher odds of remaining robust regardless of age or wave (e.g., younger-old: OR = 0.719, p < 0.001; older-old: OR = 0.714, p < 0.001 in Wave 4–5). In contrast, each additional chronic condition reported at baseline reduced the likelihood of maintaining robustness across both age groups (e.g., younger-old: OR = 0.890, p < 0.001; older-old: OR = 0.905, p = 0.015 in Wave 4–6). Finally, financial distress emerged as an important but distinct predictor of robustness. Participants reporting lower financial distress (greater financial security) had higher odds of remaining robust, particularly among younger-old adults (e.g., OR = 1.109, p = 0.018 in Wave 4–8). Although this factor is less modifiable than behavioral or health-related variables, it underscores that both objective indicators (such as multimorbidity) and subjective perceptions (self-rated health) jointly influence the likelihood of maintaining robustness. Discussion Using the SHARE data, robustness declined steadily over the eight-year follow-up, with 52% of younger-old adults ( 65 – 74 ) and 26% of older-old adults (75–84) remaining robust by the final wave. Better self-rated health, fewer chronic conditions, greater participation in physical, cognitive, and social activities, and lower financial distress were all associated with a higher likelihood of maintaining robustness over time. Moderate physical activity and social engagement showed the most consistent protective effects, while traditional clinical risk factors such as BMI, smoking, and alcohol consumption were not significantly related to sustained robustness. These findings and the multidimensional nature of robustness are discussed below. Robustness, increasingly recognized as the counterpart to frailty, reflects preserved physical, cognitive, and psychosocial function in later life ( 17 – 19 ). Drawing on eight years of longitudinal follow-up data from the SHARE study (Waves 4–8), this research examined trajectories of robustness and frailty among adults aged 65–84, divided into two age classes, across four observation intervals. By following individuals who remained robust over time, we were able to identify the factors most strongly associated with maintaining robustness in later life. This research addresses a key gap in the literature, where most studies have focused primarily on the onset and progression of frailty. It advances the field by identifying modifiable protective factors, such as perceived health, financial security, and social or cognitive engagement, that help sustain robustness over time ( 3 , 56 ). The main contribution of this study is empirical and comparative. Whereas much of the frailty literature emphasizes deterioration, transition to frailty, or adverse outcomes, the present analysis begins with older adults who were robust at baseline and asks which factors are associated with preserving that state over an extended follow-up. By doing so across 27 countries and in two age strata, the study provides evidence that sustained robustness is shaped by multiple domains simultaneously and that the relative importance of these domains may differ between younger-old and older-old adults. The baseline cohort data collected at Wave 4 of older adults who are robust reflects a relatively well-educated and active sample of adults aged 65–74 (younger-old) and 75–84 (older-old). Previous longitudinal studies on ageing and frailty have typically focused on narrower or more specific age groups-such as younger participants aged 60–75 years (e.g.,( 57 )) or older cohorts aged 70–90 years (e.g.,( 7 , 8 , 58 )) limiting their ability to generalize findings across different stages of ageing. Our cohort, by contrast, bridges this gap by simultaneously examining younger-old and older-old adults within the same long-term framework. To contextualize these findings within the broader ageing literature, several large-scale longitudinal studies have examined frailty transitions and health trajectories among older adults, providing comparative insights into robustness maintenance across different populations. In the Newcastle 85 + Study ( 8 ), which followed 845 individuals aged 85 to 90, only 28% remained robust after five years-highlighting frailty progression but providing little insight into the protective mechanisms sustaining robustness. Similarly, ( 7 ), analyzing 25,446 Europeans aged 65 + in SHARE, demonstrated that frailty indices increased sharply beyond age 75, particularly among those with lower education levels, confirming a European “tipping point” for health deterioration. However, this study focused primarily on frailty progression rather than robustness maintenance. Chen ( 59 ), using data from 37,264 participants in the Chinese Longitudinal Healthy Longevity Survey, found that higher childhood and adult socioeconomic status predicted 4–6 additional years of healthy longevity, yet the study did not distinguish between robust and pre-frail trajectories. Similarly, ( 11 ), analyzing over 2.1 million English adults aged 50+, showed that frailty prevalence rose from 26.5% to 38.9% between 2006 and 2017, but the study’s design was cross-sectional in nature, limiting causal inference regarding long-term robustness maintenance. Despite age-related health declines, participants in our study demonstrated substantial engagement in physical and social activities. This pattern is consistent with findings from the DO-HEALTH trial, where 23% of 1,889 participants aged ≥ 70 was classified as “healthy agers” at baseline and 65% maintained or improved their status after four years ( 60 ). However, DO-HEALTH was a four-year interventional trial, limiting its ability to assess naturalistic long-term ageing trajectories. Likewise, ( 5 ) reported that 61.8% of robust adults in SHARE remained robust after two years and that loneliness predicted deterioration-important insights, but within a short timeframe. By leveraging eight years of continuous SHARE data across 27 countries, our study provides one of the most extended and comprehensive assessments of robustness maintenance, offering a proactive perspective that complements these shorter-term or frailty-focused investigations. While ( 4 ) reported that 69.1% of adults > 50 remained robust over eight years in the Taiwanese TLSA cohort, their sample was considerably young (mean 63.4 years). Similarly, ( 9 ) observed 69.2% robustness retention over 5.2 years (mean age 75.9), but their shorter follow-up and regional Spanish cohort likely account for higher stability rates. Our SHARE-based study included older adults aged 65–84 and applied a multidimensional framework integrating physical, cognitive, and psychosocial factors to explain sustained robustness. Our findings also reveal engagement in cognitive activities (e.g., reading, puzzles, games) and social participation (e.g., clubs, volunteering) were linked to higher odds of robustness, especially in earlier waves and among younger-old adults. These associations support theories of cognitive reserve and social buffering and align with previous findings showing that mental activity promotes functional health ( 2 , 53 – 55 , 61 , 62 ). However, their effects declined with age, perhaps suggesting the importance of early and sustained engagement. Physical activity also emerged as an important determinant of sustained robustness. Consistent with prior evidence, moderate activity (e.g., walking, gardening) was strongly associated with remaining robust across waves, while vigorous activity showed benefits primarily among younger-old adults ( 23 , 63 – 66 ). These findings support the notion that even moderate, routine physical activity helps preserve functional reserve and delays frailty onset, particularly when from early old age. The differential impact of vigorous activity suggests that age-appropriate and sustainable forms of exercise may be more strongly associated with maintaining robustness in ageing populations. In contrast, traditional clinical risk factors - such as smoking and BMI - showed only limited or inconsistent associations with remaining robust across waves. Smoking was found to be protective in the older-old participants, seemingly in contrast to common sense, as well as the body of literature, which links smoking and frailty ( 67 , 68 ). This relationship was significant only when looking at the Wave 4–6 transition; on the one hand it could represent increased social encounters (social smoking), but more likely, it is an anomaly, as the association was not observed in any other models. We did not observe an effect of alcohol consumption (2 + drinks almost every day) on robustness in any waves; previous research found 1–7 alcoholic drinks per week to be associated with reduced frailty ( 69 ), suggesting that a more granular examination of alcohol consumption may be required. Taken together, these findings suggest that the maintenance of robustness in later life is driven by the interplay of physical, cognitive, and social pathways rather than by any single behavioral domain. Moderate physical activity may enhance cardiovascular and neuromuscular efficiency, supporting the energy and mobility required for social participation and cognitive engagement. Similarly, participation in social clubs and community activities can reinforce motivation for sustained physical activity and provide emotional support that buffers stress and inflammation. Cognitive engagement, in turn, contributes to self-regulation, executive functioning, and planning-facilitating adherence to active and socially connected lifestyles. This synergy between physical, cognitive, and social mechanisms forms a multidomain protective model of ageing, in which regular movement, meaningful interaction, and continuous mental stimulation jointly sustain functional independence and robustness. While clinical risk factors were not associated with robustness here, self-rated health consistently emerged as the strongest protective factor for maintaining robustness across waves and age groups. Older adults who perceived their health more favorably at baseline were more likely to remain robust throughout follow-ups, echoing previous work on the predictive value of subjective health assessments on ageing trajectories. Beyond its subjective nature, self-rated health may function as an integrative signal of underlying biological ageing processes. Previous research suggests that this measure captures multisystem dysregulation, cumulative inflammatory burden, and functional reserve that are not fully reflected by diagnosed conditions alone. From a geroscience standpoint, self-rated health may therefore approximate system-level resilience and adaptive capacity, offering a pragmatic population-level indicator of ageing trajectories. Its strong and consistent association with sustained robustness in the present study reinforces its value as a low-cost yet theoretically meaningful marker of long-term resilience in older adults. A significant, negative correlation between frailty and subjective life expectancy was reported in a study of > 1000 older adults (> 50 yrs) in Sub-Saharan Africa ( 70 ). Significant correlations between self-rated health and mortality ( 52 ) were also found among older adults, 70-year-olds (n = 1008) from Finland. The capacity of this single, easily attained health rating to predict long-term robustness underscores its validity as a pragmatic indicator of resilience in ageing populations. Unlike clinical biomarkers, determining self-rated health requires minimal resources, yet it reliably identifies individuals at elevated risk of maintaining robustness. Incorporating this question into routine primary care, particularly for adults over 75, could help flag those less likely to remain robust and guide earlier monitoring and intervention ( 50 , 51 , 71 ). Alongside subjective health, economic security represents another critical pillar of sustained robustness in older age. Financial distress was associated with increased frailty risk in nearly all models, particularly among younger-old adults (ages 65–74). Economic insecurity has been linked to stress, reduced access to care, and increased frailty in a number of cohorts studied longitudinally ( 72 , 73 ) and also in a study on previous waves of the SHARE cohort (Waves 1–5,( 74 )). Overall, these findings underscore the multidimensional nature of robustness and point to several practical implications for promoting healthy ageing. Beyond individual behaviors, targeted community-based programs that encourage regular physical and social activity could play a key role in maintaining robustness at the population level. Likewise, financial security interventions such as pension stability, access to affordable healthcare, and social assistance may reduce stress and health vulnerability, thereby reinforcing long-term wellbeing. In clinical settings, the integration of primary-care screening tools that include brief self-rated health assessments and questions on social participation could help identify individuals at risk of decline earlier and enable preventive strategies. Although several SHARE-based studies have examined frailty trajectories, inequalities, and transitions, fewer analyses have focused specifically on the maintenance of robustness among individuals who were robust at baseline. The present study contributes to this literature by combining four elements within a single framework: extended follow-up, broad cross-national coverage, multidomain predictors, and age-stratified analyses. Its uniqueness therefore lies less in identifying new mechanisms than in bringing these elements together to characterize sustained robustness as a measurable population-health outcome in later life. Limitations Frailty and robustness were classified according to slightly stricter operational criteria ( 47 ) based on the data collected in SHARE, thereby reducing the likelihood of misclassification and strengthening the robustness of observed associations. The reliance on some self-reported variables introduces potential recall and reporting bias, though valid and reliable tools were used. In addition, although the study spans multiple waves, its longitudinal structure is based on repeated cross-sectional comparisons, limiting causal inference. Additional variables, such as independence in IADL, caregiving support, nutritional status, or environmental barriers, may have influenced frailty outcomes, but were not included in this analysis. Despite these limitations, our findings highlight modifiable protective factors that are easily identifiable in clinical and community settings, making them valuable targets for early interventions to sustain robustness. The stratification by age groups provided nuanced insights into age-specific dynamics, and the inclusion of functional, psychosocial, and cognitive variables enriched the multidimensional assessment of frailty. Conclusions This study identifies financial security, physical activity, cognitive engagement, and self-rated health as key determinants of sustained robustness among older adults. By shifting the focus from delaying frailty to maintaining robustness, our findings emphasize a multidomain model of healthy ageing, in which behavioral, psychosocial, and economic factors interact to preserve function and independence .These insights highlight the value of community-based programs that foster active and social lifestyles, policies supporting financial stability in later life, and simple primary-care screening tools that assess health perception and participation. Strengthening these modifiable domains can help extend the years lived in good health. Although SHARE encompasses 27 countries with diverse welfare and healthcare systems, the consistency of our results across contexts underscores the generalizability and robustness of these findings. Declarations Statements and Declarations - Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The analyses were conducted using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), whose funding sources are detailed in the Acknowledgements section. Ethics approval and consent to participate This study is based on secondary analysis of anonymized data from the Survey of Health, Ageing and Retirement in Europe (SHARE). The SHARE study has been reviewed and approved by the Ethics Committee of the University of Mannheim and later by the Ethics Council of the Max Planck Society. All participants provided informed consent prior to participation. Clinical trial number: not applicable. Consent for publication Not applicable. Data Availability The datasets analysed during the current study are available from the SHARE Research Data Center (https://www.share-project.org) and can be accessed by registered researchers upon application in accordance with SHARE data access procedures. Author Contributions: All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Aviad Tur-Sinai. The first draft of the manuscript was written by Khalil Iktilat, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Acknowledgement This paper uses data from SHARE Waves 1, 2, 3, 4, 5, 6, 7, 8 and 9 (DOIs: 10.6103/SHARE.w4.900, 10.6103/SHARE.w5.900, 10.6103/SHARE.w6.900, 10.6103/SHARE.w7.900, 10.6103/SHARE.w8.900) see (35) for methodological details.The SHARE data collection has been funded by the European Commission, DG RTD through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N°227822, SHARE M4: GA N°261982, DASISH: GA N°283646) and Horizon 2020 (SHARE-DEV3: GA N°676536, SHARE-COHESION: GA N°870628, SERISS: GA N°654221, SSHOC: GA N°823782, SHARE-COVID19: GA N°101015924) and by DG Employment, Social Affairs & Inclusion through VS 2015/0195, VS 2016/0135, VS 2018/0285, VS 2019/0332, VS 2020/0313, SHARE-EUCOV: GA N°101052589 and EUCOVII: GA N°101102412. Additional funding from the German Federal Ministry of Research, Technology and Space (01UW1301, 01UW1801, 01UW2202), the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, BSR12-04, R01_AG052527-02, R01_AG056329-02, R01_AG063944, HHSN271201300071C, RAG052527A) and from various national funding sources is gratefully acknowledged (see www.share-eric.eu ). References Abyad A, Hammami SO. Frailty: Update on Diagnosis Evaluation and Management Part 2. Middle East J. 2021;14(1):27–33. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365–75. Morley JE, Vellas B, Van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392–7. 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Health and lifestyle factors include chronic conditions involving the heart, lungs, kidneys, and brain; cognitive and psychosocial components such as mental functioning, social participation, and community engagement; and lifestyle behaviors including balanced nutrition, moderate and vigorous physical activity, and mentally stimulating activities like reading and learning. Demographic influences-financial security, education, age, gender, and marital status-shape opportunities and resources across the ageing process. Together, these interconnected factors promote resilience, functional independence, and the maintenance of a robust and healthy state in older adulthood. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-9345466\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":641480386,\"identity\":\"571c5a3a-da5d-4e0d-9b8f-e498049d70b1\",\"order_by\":0,\"name\":\"Khalil Iktilat\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACNh4GBsbGBgYZNnbmA0C+hAwRWpjBWnjYmNkSQFp4CFsD08LAzGMA5hPUwcdz/gDjzB12PHzMPJ9f3aix4GFgP3x0A16H8TYzMG48kwx0GO8265xjQIfxpKXdwKuFH+iwh23MYC3GOWxALRI8ZsRoqQdq4XlmnPOPGC1gh7UdBmlhfpzbRowWnsMGB2e2HQcFshlzbp8EDxshv8j3JD582NtWLSff3vz4c863Ojl+9sPH8GoBgQMwGyXAJCHlyID5AymqR8EoGAWjYOQAAIJCOcPORPVgAAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Tel Aviv University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Khalil\",\"middleName\":\"\",\"lastName\":\"Iktilat\",\"suffix\":\"\"},{\"id\":641480387,\"identity\":\"039ee84a-a9e2-4945-b66f-1596d5d79288\",\"order_by\":1,\"name\":\"Debbie Rand\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Tel Aviv University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Debbie\",\"middleName\":\"\",\"lastName\":\"Rand\",\"suffix\":\"\"},{\"id\":641480388,\"identity\":\"57483236-0508-470e-b48f-b789ab4f3c3c\",\"order_by\":2,\"name\":\"Netta Bentur\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Tel Aviv University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Netta\",\"middleName\":\"\",\"lastName\":\"Bentur\",\"suffix\":\"\"},{\"id\":641480389,\"identity\":\"d4e82d13-6079-4ffe-9400-14c154c5facf\",\"order_by\":3,\"name\":\"Aviad Tur-Sinai\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"University of Haifa\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Aviad\",\"middleName\":\"\",\"lastName\":\"Tur-Sinai\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2026-04-07 12:56:52\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-9345466/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-9345466/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":109465139,\"identity\":\"76125640-cabc-49fc-8aa0-f491dcda2210\",\"added_by\":\"auto\",\"created_at\":\"2026-05-18 11:55:56\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":172740,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFigure 1: Transition from robustness to frailty across the study period, stratified by age group.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9345466/v1/553235114b6ea3a0c2190f8d.png\"},{\"id\":109465505,\"identity\":\"9542388e-3ca4-41ff-8259-4cc8c4938fe7\",\"added_by\":\"auto\",\"created_at\":\"2026-05-18 11:56:50\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":593996,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9345466/v1/f35dfc26-c618-4e25-89f6-7bb5498ba5a6.pdf\"},{\"id\":109465201,\"identity\":\"12056852-e3b6-4b8c-bb12-e06a0e61dced\",\"added_by\":\"auto\",\"created_at\":\"2026-05-18 11:56:02\",\"extension\":\"xlsx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":28895,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"SuppTable1.xlsx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9345466/v1/a83d1a55e92e4e4a1df5d846.xlsx\"},{\"id\":109465501,\"identity\":\"1a286683-f580-4571-9e70-eba14edcbfb7\",\"added_by\":\"auto\",\"created_at\":\"2026-05-18 11:56:46\",\"extension\":\"png\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":127910,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eThe figure illustrates the multidimensional factors contributing to sustained robustness in later life. Health and lifestyle factors include chronic conditions involving the heart, lungs, kidneys, and brain; cognitive and psychosocial components such as mental functioning, social participation, and community engagement; and lifestyle behaviors including balanced nutrition, moderate and vigorous physical activity, and mentally stimulating activities like reading and learning. Demographic influences-financial security, education, age, gender, and marital status-shape opportunities and resources across the ageing process. Together, these interconnected factors promote resilience, functional independence, and the maintenance of a robust and healthy state in older adulthood.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Graphicalabstract.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-9345466/v1/0812ed5a69e4cc321e80e0c9.png\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"TProtective Factors for Sustaining Robustness in Older Adults: An 8-Year Multinational Longitudinal Study Using SHARE Data\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eFrailty is a common geriatric syndrome in older adults, characterized by diminished strength, endurance and physiologic function, which increases vulnerability to adverse health outcomes (\\u003cspan additionalcitationids=\\\"CR2\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). Many studies examined frailty transitions over time (\\u003cspan additionalcitationids=\\\"CR5 CR6 CR7 CR8 CR9 CR10 CR11\\\" citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). Although the negative consequences of frailty are well known clinical interventions are often too late for effective management (\\u003cspan additionalcitationids=\\\"CR14 CR15\\\" citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). Therefore, it is important to identify factors that can help maintain the robustness of older adults.\\u003c/p\\u003e \\u003cp\\u003eRobustness represents the opposite pole of frailty and refers to the capacity to maintain physiological reserve, adaptability, and functional integrity despite age-related challenges(\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). In the context of frailty research, robustness has traditionally been defined as being \\u0026ldquo;non-frail\\u0026rdquo; (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). However, recent conceptual frameworks propose that robustness should be viewed as an active and multidimensional state encompassing physical, cognitive, psychological, and social domains (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). This broader view positions robustness not merely as the absence of frailty but as a positive expression of intrinsic capacity and adaptive potential (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eVarious modifiable behaviors and lifestyle characteristics have been identified to protect against frailty and maintain robustness. For example, physical activity is consistently associated with lower incidence of frailty in a dose dependent manner such that higher levels of activity are associated with lower odds of developing frailty (\\u003cspan additionalcitationids=\\\"CR24\\\" citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e). Social participation and social support have also repeatedly been associated with slower frailty progression and lower disability and mortality risk (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e), whereas social isolation and loneliness show mixed but largely negative consequences for frailty progression (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). Effects of diet on robustness have been mixed (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e) as has the effect of varying degrees of alcohol consumption (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e), but there is consistent evidence showing that smoking cessation can promote robustness (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). These examples highlight that while some lifestyle domains show mixed or context-dependent effects on robustness, a core set of modifiable behaviours consistently emerge as protective factors that help older adults remain robust. However, large, longitudinal, multi-domain analyses which focus on sustained robustness are lacking (\\u003cspan additionalcitationids=\\\"CR32\\\" citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe added value of the present study lies in its design rather than in proposing a new biological construct. Using eight years of longitudinal SHARE data from 27 European countries, we examine sustained robustness among older adults who were robust at baseline and assess a broad set of demographic, socioeconomic, health, physical, social, and cognitive factors within a single analytic framework. In addition, by stratifying the sample into younger-old and older-old adults, the study allows comparison of whether the correlates of maintained robustness differ across stages of later life.\\u003c/p\\u003e \\u003cp\\u003eMost studies focus on predicting frailty, worsening states, and adverse effects, whereas the determinants of sustained robustness are less studied (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e) and warranted (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e) Building on this foundation, the present study directly responds to these gaps by adopting a multidimensional and longitudinal approach that explicitly examines sustained robustness, rather than the development of frailty. Using data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) - a comprehensive eight-year multinational dataset (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e), we examined how demographic, health, and lifestyle characteristics interact over time to preserve robustness. Unlike previous longitudinal studies, our analysis identifies potential protective pathways and modifiable factors associated with sustained robustness, representing a conceptual and empirical shift from describing decline to understanding how robustness may be maintained in later life.\\u003c/p\\u003e \\u003cp\\u003eThis study operationalizes robustness as a dynamic and measurable construct, integrating behavioral, psychosocial, and health-related domains within a unified framework. By emphasizing the determinants of sustained robustness rather than the predictors of frailty, it introduces a conceptual and methodological shift in ageing research. This approach moves beyond risk reduction toward the proactive maintenance of function and independence, positioning robustness as an active and multidimensional outcome of protective factors. Together, these perspectives highlight the importance of modifiable behavioral and social pathways for promoting healthy ageing and provide an empirical foundation for targeted, preventive interventions.\\u003c/p\\u003e \\u003cp\\u003eAlthough the present study does not examine biological mechanisms directly, it contributes to the gerontology literature by showing how readily measured clinical, behavioral, and socioeconomic factors are associated with sustained robustness over time. This population-level perspective is important because it identifies observable markers and potentially modifiable domains that may help distinguish older adults who maintain robustness from those who transition toward pre-frailty or frailty.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy Design and Data Source\\u003c/h2\\u003e \\u003cp\\u003eThis study is based on a longitudinal analysis using data from Waves 4\\u0026ndash;8 (2011\\u0026ndash;2020) of SHARE (\\u003cspan additionalcitationids=\\\"CR36 CR37 CR38 CR39 CR40 CR41 CR42\\\" citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e). SHARE is a multinational, population-based panel study designed to provide insights into aging, health, and socioeconomic factors across Europe. Since its inception in 2004, SHARE has collected data from over 140,000 participants across 27 countries, making it one of the most comprehensive datasets for aging research.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eStudy Population\\u003c/h3\\u003e\\n\\u003cp\\u003eOur study sample included adults who were classified as robust (non-frail) at Wave 4 of SHARE, which was used as the baseline reference point for tracking robustness Participants were included in the analysis only if they had frailty phenotype data at Wave 4 and at least one other wave, allowing for longitudinal assessment of robustness-frailty transitions. Participants were aged 65\\u0026ndash;84, stratified into two subgroups: 65\\u0026ndash;74 years (younger-old) and 75\\u0026ndash;84 years (older-old). The age stratification is based on previous research on ageing trajectories (e.g. (\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e), (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e), and (\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e). Typically, three groups are defined (65\\u0026ndash;74, 75\\u0026ndash;84, and 85+); here we focus on the younger two groups.\\u003c/p\\u003e\\n\\u003ch3\\u003eFrailty Phenotype Assessment\\u003c/h3\\u003e\\n\\u003cp\\u003eFrailty status was determined using a modified frailty phenotype model based on the five criteria originally proposed by (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e) and adapted for SHARE (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e). In this model, robustness represents the opposite end of the frailty spectrum individuals classified as \\u0026ldquo;robust\\u0026rdquo; met none of the following frailty criteria based on the original phenotype proposed by (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e), indicating preserved strength, energy, and functional reserve.\\u003c/p\\u003e \\u003cp\\u003e \\u003col\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eGrip strength of both hands assessed using a handheld dynamometer (Smedley, TTM, Tokyo), with the maximum value across trials retained (Maxgrip, SHARE protocol). If grip strength fell below the 20th percentile (very weak), adjusted for sex and BMI, as recommended by (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e), participants received a point, indicating frailty.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eWalking speed measured using a 2.5-meter walking test, with timing starting when the first foot crossed the start line. Participants in the lowest 20th percentile, adjusted for sex and height (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e), received a point, indicating frailty.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eUnintentional weight loss, defined as self-reported weight loss of 10 lbs (4.5 kg) or more in the past year indicated frailty (1 point). If weight loss data were unavailable, responses to appetite-related survey questions were used as proxies, as previously suggested (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003eExhaustion, assessed using two items from the Center for Epidemiological Studies Depression (CES-D) scale: \\u0026ldquo;I felt everything I did was an effort\\u0026rdquo; and \\u0026ldquo;I could not get going.\\u0026rdquo; Participants reporting these symptoms for at least 3\\u0026ndash;4 days per week received a point, indicating frailty.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003cspan\\u003e \\u003cli\\u003e \\u003cp\\u003ePhysical activity, based on self-report engagement in low or moderate-intensity activities such as walking, gardening, or household chores. Participants engaging in such activities less than once a week received a point in alignment with SHARE-based studies.\\u003c/p\\u003e \\u003c/li\\u003e \\u003c/span\\u003e \\u003c/ol\\u003e \\u003c/p\\u003e \\u003cp\\u003ePoints of these five criteria were summed up and classified: 0 points - Robust (non-frail), 1\\u0026ndash;2 points - Pre-frail, 3 or more points - frail.\\u003c/p\\u003e\\n\\u003ch3\\u003eCovariates and Control Variables\\u003c/h3\\u003e\\n\\u003cp\\u003eTo comprehensively examine factors predicting sustained robustness, demographic, socioeconomic, health, and lifestyle variables were included as covariates, selected for their relevance to robustness research and availability within the SHARE dataset. All variables included in the analysis were selected based on the factors identified in the literature as key determinants of frailty and robustness, as discussed in the Introduction. Specifically, demographic, socioeconomic, health, and lifestyle characteristics-such as age, sex, education, financial status, chronic diseases, self-rated health, physical activity, and social participation have consistently been linked to frailty progression or robustness maintenance in previous studies (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR27 CR28 CR29\\\" citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e). Accordingly, these variables were extracted from the SHARE dataset for the present analysis.\\u003c/p\\u003e\\n\\u003ch3\\u003eDemographic and Socioeconomic Factors\\u003c/h3\\u003e\\n\\u003cp\\u003eKey demographic variables included sex and socioeconomic status, assessed using education level (years of formal schooling) and financial situation, measured through self-reported ability to \\u0026ldquo;make ends meet\\u0026rdquo; on a scale from financial difficulty to financial security. Marital status (married or single/widowed/divorced) was also examined. In addition, living arrangement was captured using a binary variable (\\u0026ldquo;single\\u0026rdquo;), defined as living alone regardless of formal marital status. Accordingly, individuals classified as \\u0026ldquo;single\\u0026rdquo; could be never married, divorced, widowed, or married, provided they lived alone.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eHealth-Related Variables\\u003c/h2\\u003e \\u003cp\\u003eHealth status was measured by the number of diagnosed chronic conditions reported, an indicator of multimorbidity widely used in ageing research (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e). Perceived health status was assessed using a self-rated health scale ranging from 1 (excellent) to 5 (poor), a validated and widely recognized predictor of morbidity, mortality, and overall functional decline (\\u003cspan additionalcitationids=\\\"CR51\\\" citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e). Both indicators were included given their consistent associations with frailty progression and robustness maintenance in previous longitudinal studies.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003ePhysical Activity and Functional Status\\u003c/h3\\u003e\\n\\u003cp\\u003ePhysical activity was categorized into vigorous activity (e.g., participation in sports or heavy physical labor) and moderate activity (e.g., walking, gardening, or household chores). The frequency of each type of activity was rated from 1\\u0026thinsp;=\\u0026thinsp;Hardly ever or never, 2\\u0026thinsp;=\\u0026thinsp;One to three times a month, 3\\u0026thinsp;=\\u0026thinsp;Once a week, and 4\\u0026thinsp;=\\u0026thinsp;More than once a week. Higher ratings indicate greater engagement in physical activity, with \\u0026ldquo;4\\u0026rdquo; representing regularly active individuals and \\u0026ldquo;1\\u0026rdquo; representing those who rarely or never engage in such activities.\\u003c/p\\u003e \\u003cp\\u003ePhysical activity has been repeatedly shown to reduce frailty risk and promote robustness (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e), therefore it was included as a core behavioral variable to capture its protective influence on maintaining robustness and functional independence.\\u003c/p\\u003e\\n\\u003ch3\\u003eSocial and Cognitive Engagement\\u003c/h3\\u003e\\n\\u003cp\\u003eSocial participation was evaluated through engagement in volunteer work, attendance at educational or training courses, and participation in community-related or recreational activities such as sports clubs, religious, or political organizations. Cognitive engagement was assessed through participation in activities such as reading, solving puzzles (e.g., crosswords, Sudoku), and playing strategy-based games (e.g., chess, card games). Religious engagement (e.g., prayer frequency) was also considered, given its potential association with social support and psychological well-being.\\u003c/p\\u003e \\u003cp\\u003eThese indicators were selected based on evidence linking social participation and cognitive stimulation to reduced frailty progression and improved functional outcomes in later life (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR54\\\" citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e). Such activities have been shown to contribute to the maintenance of cognitive and psychosocial functioning, thereby supporting sustained robustness across ageing populations.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Analysis\\u003c/h2\\u003e \\u003cp\\u003eWe used a series of logistic regression models to identify baseline sociodemographic, health, behavioral, and engagement factors associated with remaining robust over time. Specifically, we examined the likelihood of transitioning from robust to pre-frailty or frailty (binary variable) across four follow-up intervals (every two years starting from 2011). Models were stratified by age groups (65\\u0026ndash;74 and 75\\u0026ndash;84) to enable age-sensitive interpretation. Odds ratios (OR) greater than 1 indicate higher odds of remaining robust, while values below 1 indicate reduced odds. For health-related variables, higher values in both chronic conditions (0\\u0026ndash;9) and self-perceived health (1\\u0026thinsp;=\\u0026thinsp;excellent to 5\\u0026thinsp;=\\u0026thinsp;poor) represent worse health, so ORs less than 1 reflect the expected negative association with robustness.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eOur sample included 7,865 adults; younger-old adults aged 65\\u0026ndash;74 (n\\u0026thinsp;=\\u0026thinsp;5,811, 73.9% of the cohort; 49.9% female), and older-old adults, aged 75\\u0026ndash;84 (n\\u0026thinsp;=\\u0026thinsp;2,054, 26.1% of the cohort; 53.4% women). Groups are characterized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. There were significant differences in health parameters; the younger-old group was characterized by better health. Both groups participated in social activities, though the younger-old group was significantly more active. The older-old group participated in significantly more physical activity and had lower BMIs, on average, than the younger-old group (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDescriptive statistics of the whole population and differences between groups as assessed at Wave 4 of SHARE\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eWhole Population\\u003c/p\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;7,865\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eYounger-old\\u003c/p\\u003e \\u003cp\\u003eAge 65\\u0026ndash;74\\u003c/p\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;5,811\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eOlder-old\\u003c/p\\u003e \\u003cp\\u003eAge 75\\u0026ndash;84\\u003c/p\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;2,054\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c6\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eDifferences between groups\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003et-statistic\\u003csup\\u003e1\\u003c/sup\\u003e; χ\\u003csup\\u003e2\\u003c/sup\\u003e-statistic\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ep-value\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e71.33\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.92\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e68.90\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.80\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e78.20\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;2.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-130\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSex (female)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3,995 (50.79%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2,898 (49.87%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1097 (53.41%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7.60\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.006\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eEducation (years)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10.84\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11.09\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.12\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8.70\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eFinancial distress (\\u003cspan additionalcitationids=\\\"CR2 CR3\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3.08\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3.09\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.05\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.88\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ep\\u0026thinsp;=\\u0026thinsp;0.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eChronic disease (number)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.55\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.47\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.27\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.81\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-10.25\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eSelf-perceived health status (\\u003cspan additionalcitationids=\\\"CR2 CR3 CR4\\\" citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.84\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.94\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.78\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.95\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.00\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.91\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-8.82\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePerformed voluntary or charity work\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1886 (23.99%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1494 (25.72%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e392 (19.10%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e36.43\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAttended an educational or training course\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e833 (10.60%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e703 (12.10%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e130 (6.34%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e53.26\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBelong to a sport, social or other club\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2844 (36.18%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2195 (37.79%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e649 (31.63%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e24.96\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eParticipate in religious activities (church, synagogue, mosque, etc.)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1235 (15.71%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e846 (14.57%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e389 (18.96%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e22.08\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBelong to a political or community-related organization\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e537 (6.83%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e425 (7.32%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e112 (5.46%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8.24\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.004\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eRead books, magazines or newspapers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6601 (83.98%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4909 (84.52%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1692 (82.46%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.81\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.028\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDid word or number games such as crossword puzzles or Sudoku\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3993 (50.80%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3031 (52.19%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e962 (46.88%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17.08\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePlayed cards or board games (chess)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2655 (33.78%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2045 (35.21%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e610 (29.73%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e20.38\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.000\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAttend social activities (0\\u0026ndash;7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.46\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.41\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.54\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.43\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.21\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9.18\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVigorous physical activity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2.35\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2.27\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.60\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;1.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-9.83\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eModerate physical activity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.13\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.13\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.33\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.14\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e-2.16\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.031\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDaily smoking (yes)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5,419 (68.90%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4067 (69.99%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1352 (65.82%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12.29\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAlcohol consumption (\\u0026gt;\\u0026thinsp;2 glasses almost every day)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1,378 (17.52%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1,140 (19.62%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e238 (11.59%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e67.73\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eMarital status (single)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2,202 (28%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1,399 (24.08%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e803 (39.09%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e169.82\\u003csup\\u003e2\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26.56\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26.65\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;4.06\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26.29\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;3.82\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.47\\u003csup\\u003e1\\u003c/sup\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ep\\u0026thinsp;=\\u0026thinsp;0.0005\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e\\u003cem\\u003e-Note: Significant differences between the two age groups (65\\u0026ndash;74 vs. 75\\u0026ndash;84) are in bold. Values are means\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD. Age is continuous (years). Sex\\u0026thinsp;=\\u0026thinsp;male/female. Education ranges 0\\u0026ndash;25 years. Financial distress coded 1\\u0026thinsp;=\\u0026thinsp;with great difficulty to 4\\u0026thinsp;=\\u0026thinsp;easily, where higher values indicate better financial situation. Chronic diseases: range 0\\u0026ndash;9. Self-perceived health: coded 1\\u0026thinsp;=\\u0026thinsp;excellent to 5\\u0026thinsp;=\\u0026thinsp;poor. Activities are dichotomous (0\\u0026thinsp;=\\u0026thinsp;no, 1\\u0026thinsp;=\\u0026thinsp;yes) for volunteering, courses, clubs, religious and political organizations, reading, puzzles, and games; \\u0026ldquo;Activities\\u0026rdquo; (0\\u0026ndash;7) is the summed count. Vigorous and moderate physical activity coded 1\\u0026ndash;4 (1\\u0026thinsp;=\\u0026thinsp;hardly ever or never, 2\\u0026thinsp;=\\u0026thinsp;one to three times a month, 3\\u0026thinsp;=\\u0026thinsp;once a week, 4\\u0026thinsp;=\\u0026thinsp;more than once a week). Daily smoking and alcohol use (\\u0026gt;\\u0026thinsp;2 glasses almost every day) coded 0\\u0026thinsp;=\\u0026thinsp;no, 1\\u0026thinsp;=\\u0026thinsp;yes. Marital status\\u0026thinsp;=\\u0026thinsp;married coded 0, single/divorced/widowed coded 1. BMI is continuous (kg/m\\u0026sup2;).\\u003c/em\\u003e\\u003c/p\\u003e \\u003cp\\u003e \\u003cem\\u003eVariables analyzed using independent-samples t-tests\\u0026sup1;; categorical variables analyzed using chi-square tests\\u0026sup2;.\\u003c/em\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eThe percentage of participants who remained robust or transitioned to pre-frail and frail in Waves 5, 6, 7, 8 for the whole SHARE study population and for each age-group. Baseline is Wave 4, in which all participants were robust.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c4\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eAge 65\\u0026ndash;74\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"3\\\" nameend=\\\"c7\\\" namest=\\\"c5\\\"\\u003e \\u003cp\\u003eAge 75\\u0026ndash;84\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRobust\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePre-Frail\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eFrail\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eRobust\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003ePre-Frail\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eFrail\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWave 4\\u0026ndash;5\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(65.02%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(32.74%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e(2.24%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(49.03%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(45.71%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(5.26%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWave 4\\u0026ndash;6\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(60.66%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(36.25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e(3.09%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(40.11%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(49.70%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(10.19%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWave 4\\u0026ndash;7\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(58.77%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(36.71%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e(4.53%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(36.00%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(52.00%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(12.00%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWave 4\\u0026ndash;8\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(52.22%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e(42.15%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e(5.63%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e(26.46%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e(53.36%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e(20.18)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eWe followed each participant\\u0026rsquo;s robustness over time and assessed changes in the distribution of health states across subsequent waves (see Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e). At baseline, all participants were classified as robust. Over the eight-year follow-up, the younger-old group declined from 100% robustness at baseline to 52.2% remaining robust, 42.2% transitioning to pre-frailty, and 5.6% to frailty by Wave 8. The older-old group showed a steeper decline, with only 26.5% remaining robust, 53.4% classified as pre-frail, and 20.2% as frail at the end of the study period. These patterns indicate a progressive loss of robustness with age, with faster transitions toward pre-frailty and frailty among the older-old cohort. As illustrated in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e, these longitudinal transitions demonstrate a clear age-stratified shift from robustness toward pre-frailty and frailty across successive SHARE waves.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eLogistic regression to identify factors associated with robustness over time, stratified by age group and Wave.\\u003c/b\\u003e Odds ratio\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;SD are reported, and significant ratios (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05) are denoted by grey shading. A full table of model statistics (including z-scores and exact p-values) can be found in Supp Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"9\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c8\\\" colnum=\\\"8\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c9\\\" colnum=\\\"9\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c3\\\" namest=\\\"c2\\\"\\u003e \\u003cp\\u003eWAVE 4\\u0026ndash;5\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c5\\\" namest=\\\"c4\\\"\\u003e \\u003cp\\u003eWAVE 4\\u0026ndash;6\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c7\\\" namest=\\\"c6\\\"\\u003e \\u003cp\\u003eWAVE 4\\u0026ndash;7\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c9\\\" namest=\\\"c8\\\"\\u003e \\u003cp\\u003eWAVE 4\\u0026ndash;8\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAge 65\\u0026ndash;74\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eAge 75\\u0026ndash;84\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAge 65\\u0026ndash;74\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eAge 75\\u0026ndash;84\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eAge 65\\u0026ndash;74\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eAge 75\\u0026ndash;84\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eAge 65\\u0026ndash;74\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eAge 75\\u0026ndash;84\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;5,753\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;2,015\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;5,011\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;1,666\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;2,074\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;646\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;3,264\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003eN\\u0026thinsp;=\\u0026thinsp;906\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAge\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.951\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.009\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.950\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.017\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.934\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.010\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.928\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.019\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.924\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.0155\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.960\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.034\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.936\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.876\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.029\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSex\\u003c/b\\u003e (Female: 0, Male: 1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.232\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.078\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.200\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.127\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.237\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.082\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.140\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.137\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.171\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.118\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.300\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.256\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.300\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.105\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.855\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.158\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEducation\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.007\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.007\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.006\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.011\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.008\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.007\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.009\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.996\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.994\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.020\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.000\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.008\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.011\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.018\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSingle\\u003c/b\\u003e (No: 0, Yes: 1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.041\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.071\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.922\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.096\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.957\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.068\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.936\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.110\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.012\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.117\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.951\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.191\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.959\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.083\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.023\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.181\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eFinancial distress\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.167\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.040\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.161\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.065\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.150\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.041\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.102\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.070\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.098\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.062\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.115\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.130\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.109\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.048\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.250\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.126\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eChronic diseases\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.904\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.021\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.939\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.033\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.890\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.022\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.904\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.037\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.924\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.039\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.849\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.065\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.893\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.028\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.906\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.058\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSelf-reported health status\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.719\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.714\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.040\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.720\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.026\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.721\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.045\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.728\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.041\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.723\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.074\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.764\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.033\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.717\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.067\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePerformed voluntary or charity work\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.970\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.070\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.092\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.137\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.076\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.085\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.888\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.129\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.028\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.119\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.135\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.243\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.002\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.091\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.032\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.212\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eAttended an educational or training course\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.062\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.101\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.977\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.192\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.974\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.097\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.725\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.376\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.326\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.201\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e2.288\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.753\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.141\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.131\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.279\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.382\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eBelong to a sport, social or other club\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.259\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.079\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.210\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.126\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.330\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.090\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.893\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.107\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.107\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.114\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.104\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.214\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.107\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.088\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.195\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.211\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eParticipate in religious activities (church, synagogue, mosque, etc.)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.180\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.102\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.965\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.120\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.057\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.091\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.948\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.129\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.198\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.155\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.487\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.308\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.901\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.090\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.943\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.187\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eBelong to a political or community-related organization\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.192\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.145\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.371\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.293\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.989\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.125\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.669\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.395\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.897\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.170\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.898\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.314\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.965\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.138\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.900\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.304\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eRead books, magazines or newspapers\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.001\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.084\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.126\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.149\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.060\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.090\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.553\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.235\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.396\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.182\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.002\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.240\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.340\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.146\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.551\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.124\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDid word or number games such as crossword puzzles or Sudoku\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.112\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.069\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.177\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.118\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.143\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.075\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.165\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.133\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.040\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.109\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.316\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.253\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.067\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.085\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.352\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.231\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePlayed cards or board games (chess)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.065\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.067\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.858\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.091\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.067\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.071\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.039\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.125\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.882\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.090\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.076\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.212\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.033\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.082\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.020\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.184\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eVigorous physical activity\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.052\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.024\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.116\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.040\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.042\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.025\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.049\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.043\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.113\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.042\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.095\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.738\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.095\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.032\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.982\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.060\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eModerate physical activity\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.454\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.121\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e1.245\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.165\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.231\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.107\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.192\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.188\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.413\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.197\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e1.274\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.367\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e1.136\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.124\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.825\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.501\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSmoking\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1.001\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.064\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.991\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.102\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.952\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.063\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.313\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.151\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.427\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.347\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003eN/A\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.957\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.079\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e1.035\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.182\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eDrinking\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.991\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.074\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.811\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.119\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.922\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.073\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.891\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.149\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.806\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.096\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.883\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.237\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.960\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.093\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.929\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.237\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eBMI\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e0.994\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.007\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0.967\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.993\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.007\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.002\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.014\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.975\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.012\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.983\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.245\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c8\\\"\\u003e \\u003cp\\u003e0.982\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.009\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c9\\\"\\u003e \\u003cp\\u003e0.996\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;0.021\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eAs shown in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e, logistic regression analyses identified baseline sociodemographic, health, behavioral, and engagement factors associated with sustained robustness across waves and age groups.\\u003c/p\\u003e \\u003cp\\u003eSeveral variables were associated with robustness across cohorts. Engagement in social, cognitive, and physical activities emerged as partially protective, though patterns varied by age group and wave. For example, participation in sporting or social clubs was strongly associated with remaining robust among younger-old adults (e.g., OR\\u0026thinsp;=\\u0026thinsp;1.259, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001 in Wave 4\\u0026ndash;5). Among older-old adults, participation in educational courses or trainings (OR\\u0026thinsp;=\\u0026thinsp;2.288, p\\u0026thinsp;=\\u0026thinsp;0.012 in Wave 4\\u0026ndash;7) and involvement in community organizations (OR\\u0026thinsp;=\\u0026thinsp;1.67, p\\u0026thinsp;=\\u0026thinsp;0.030 in Wave 4\\u0026ndash;6) were also linked to sustained robustness. Cognitive activities, such as reading, were associated with greater robustness across the study period for younger-old adults (OR\\u0026thinsp;=\\u0026thinsp;1.34, p\\u0026thinsp;=\\u0026thinsp;0.008), though interestingly, the association was inverse among older-old adults (OR\\u0026thinsp;=\\u0026thinsp;0.551, p\\u0026thinsp;=\\u0026thinsp;0.008).\\u003c/p\\u003e \\u003cp\\u003ePhysical activity contributed in complementary ways. Moderate activities such as walking or gardening consistently predicted higher robustness (e.g., OR\\u0026thinsp;=\\u0026thinsp;1.231, p\\u0026thinsp;=\\u0026thinsp;0.017 in Wave 4\\u0026ndash;6), while vigorous activity was beneficial primarily during earlier follow-ups and among younger-old (OR\\u0026thinsp;=\\u0026thinsp;1.052, p\\u0026thinsp;=\\u0026thinsp;0.025 at Wave 4\\u0026ndash;5) and older-old adults (OR\\u0026thinsp;=\\u0026thinsp;1.116, p\\u0026thinsp;=\\u0026thinsp;0.003 at Wave 4\\u0026ndash;5). However, the protective effect of physical activity appeared to weaken slightly over time, particularly for vigorous activity, which lost significance in later waves. In contrast, moderate activity remained consistently associated with robustness, suggesting that sustainable, age-appropriate physical engagement plays a more enduring role in maintaining robustness in later life.\\u003c/p\\u003e \\u003cp\\u003eLifestyle behaviors showed less consistent associations. Smoking and alcohol use did not demonstrate stable relationships with robustness, apart from baseline smoking among older-old adults between Waves 4 and 6, which unexpectedly predicted higher robustness (OR\\u0026thinsp;=\\u0026thinsp;1.31, p\\u0026thinsp;=\\u0026thinsp;0.018). BMI displayed weak and inconsistent effects, with lower values marginally associated with robustness in shorter follow-ups (e.g., OR\\u0026thinsp;=\\u0026thinsp;0.967, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001 in Wave 4\\u0026ndash;5 for older-old; OR\\u0026thinsp;=\\u0026thinsp;0.975, p\\u0026thinsp;=\\u0026thinsp;0.044 in Wave 4\\u0026ndash;7 for younger-old) but no significant impact by Wave 4\\u0026ndash;8.\\u003c/p\\u003e \\u003cp\\u003eSelf-rated health emerged as the strongest determinant of sustained robustness across all follow-up waves. Participants who perceived their health more favorably (\\u0026ldquo;1\\u0026rdquo; on the scale, indicating better health) had significantly higher odds of remaining robust regardless of age or wave (e.g., younger-old: OR\\u0026thinsp;=\\u0026thinsp;0.719, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001; older-old: OR\\u0026thinsp;=\\u0026thinsp;0.714, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001 in Wave 4\\u0026ndash;5). In contrast, each additional chronic condition reported at baseline reduced the likelihood of maintaining robustness across both age groups (e.g., younger-old: OR\\u0026thinsp;=\\u0026thinsp;0.890, p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001; older-old: OR\\u0026thinsp;=\\u0026thinsp;0.905, p\\u0026thinsp;=\\u0026thinsp;0.015 in Wave 4\\u0026ndash;6).\\u003c/p\\u003e \\u003cp\\u003eFinally, financial distress emerged as an important but distinct predictor of robustness. Participants reporting lower financial distress (greater financial security) had higher odds of remaining robust, particularly among younger-old adults (e.g., OR\\u0026thinsp;=\\u0026thinsp;1.109, p\\u0026thinsp;=\\u0026thinsp;0.018 in Wave 4\\u0026ndash;8). Although this factor is less modifiable than behavioral or health-related variables, it underscores that both objective indicators (such as multimorbidity) and subjective perceptions (self-rated health) jointly influence the likelihood of maintaining robustness.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eUsing the SHARE data, robustness declined steadily over the eight-year follow-up, with 52% of younger-old adults (\\u003cspan additionalcitationids=\\\"CR66 CR67 CR68 CR69 CR70 CR71 CR72 CR73\\\" citationid=\\\"CR65\\\" class=\\\"CitationRef\\\"\\u003e65\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR74\\\" class=\\\"CitationRef\\\"\\u003e74\\u003c/span\\u003e) and 26% of older-old adults (75\\u0026ndash;84) remaining robust by the final wave. Better self-rated health, fewer chronic conditions, greater participation in physical, cognitive, and social activities, and lower financial distress were all associated with a higher likelihood of maintaining robustness over time. Moderate physical activity and social engagement showed the most consistent protective effects, while traditional clinical risk factors such as BMI, smoking, and alcohol consumption were not significantly related to sustained robustness. These findings and the multidimensional nature of robustness are discussed below.\\u003c/p\\u003e \\u003cp\\u003eRobustness, increasingly recognized as the counterpart to frailty, reflects preserved physical, cognitive, and psychosocial function in later life (\\u003cspan additionalcitationids=\\\"CR18\\\" citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). Drawing on eight years of longitudinal follow-up data from the SHARE study (Waves 4\\u0026ndash;8), this research examined trajectories of robustness and frailty among adults aged 65\\u0026ndash;84, divided into two age classes, across four observation intervals. By following individuals who remained robust over time, we were able to identify the factors most strongly associated with maintaining robustness in later life. This research addresses a key gap in the literature, where most studies have focused primarily on the onset and progression of frailty. It advances the field by identifying modifiable protective factors, such as perceived health, financial security, and social or cognitive engagement, that help sustain robustness over time (\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR56\\\" class=\\\"CitationRef\\\"\\u003e56\\u003c/span\\u003e). The main contribution of this study is empirical and comparative. Whereas much of the frailty literature emphasizes deterioration, transition to frailty, or adverse outcomes, the present analysis begins with older adults who were robust at baseline and asks which factors are associated with preserving that state over an extended follow-up. By doing so across 27 countries and in two age strata, the study provides evidence that sustained robustness is shaped by multiple domains simultaneously and that the relative importance of these domains may differ between younger-old and older-old adults.\\u003c/p\\u003e \\u003cp\\u003eThe baseline cohort data collected at Wave 4 of older adults who are robust reflects a relatively well-educated and active sample of adults aged 65\\u0026ndash;74 (younger-old) and 75\\u0026ndash;84 (older-old). Previous longitudinal studies on ageing and frailty have typically focused on narrower or more specific age groups-such as younger participants aged 60\\u0026ndash;75 years (e.g.,(\\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e)) or older cohorts aged 70\\u0026ndash;90 years (e.g.,(\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR58\\\" class=\\\"CitationRef\\\"\\u003e58\\u003c/span\\u003e)) limiting their ability to generalize findings across different stages of ageing. Our cohort, by contrast, bridges this gap by simultaneously examining younger-old and older-old adults within the same long-term framework.\\u003c/p\\u003e \\u003cp\\u003eTo contextualize these findings within the broader ageing literature, several large-scale longitudinal studies have examined frailty transitions and health trajectories among older adults, providing comparative insights into robustness maintenance across different populations. In the Newcastle 85\\u0026thinsp;+\\u0026thinsp;Study (\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e), which followed 845 individuals aged 85 to 90, only 28% remained robust after five years-highlighting frailty progression but providing little insight into the protective mechanisms sustaining robustness. Similarly, (\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e), analyzing 25,446 Europeans aged 65\\u0026thinsp;+\\u0026thinsp;in SHARE, demonstrated that frailty indices increased sharply beyond age 75, particularly among those with lower education levels, confirming a European \\u0026ldquo;tipping point\\u0026rdquo; for health deterioration. However, this study focused primarily on frailty progression rather than robustness maintenance. Chen (\\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e), using data from 37,264 participants in the Chinese Longitudinal Healthy Longevity Survey, found that higher childhood and adult socioeconomic status predicted 4\\u0026ndash;6 additional years of healthy longevity, yet the study did not distinguish between robust and pre-frail trajectories. Similarly, (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e), analyzing over 2.1\\u0026nbsp;million English adults aged 50+, showed that frailty prevalence rose from 26.5% to 38.9% between 2006 and 2017, but the study\\u0026rsquo;s design was cross-sectional in nature, limiting causal inference regarding long-term robustness maintenance.\\u003c/p\\u003e \\u003cp\\u003eDespite age-related health declines, participants in our study demonstrated substantial engagement in physical and social activities. This pattern is consistent with findings from the DO-HEALTH trial, where 23% of 1,889 participants aged\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 was classified as \\u0026ldquo;healthy agers\\u0026rdquo; at baseline and 65% maintained or improved their status after four years (\\u003cspan citationid=\\\"CR60\\\" class=\\\"CitationRef\\\"\\u003e60\\u003c/span\\u003e). However, DO-HEALTH was a four-year interventional trial, limiting its ability to assess naturalistic long-term ageing trajectories. Likewise, (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e) reported that 61.8% of robust adults in SHARE remained robust after two years and that loneliness predicted deterioration-important insights, but within a short timeframe. By leveraging eight years of continuous SHARE data across 27 countries, our study provides one of the most extended and comprehensive assessments of robustness maintenance, offering a proactive perspective that complements these shorter-term or frailty-focused investigations.\\u003c/p\\u003e \\u003cp\\u003eWhile (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e) reported that 69.1% of adults\\u0026thinsp;\\u0026gt;\\u0026thinsp;50 remained robust over eight years in the Taiwanese TLSA cohort, their sample was considerably young (mean 63.4 years). Similarly, (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e) observed 69.2% robustness retention over 5.2 years (mean age 75.9), but their shorter follow-up and regional Spanish cohort likely account for higher stability rates. Our SHARE-based study included older adults aged 65\\u0026ndash;84 and applied a multidimensional framework integrating physical, cognitive, and psychosocial factors to explain sustained robustness. Our findings also reveal engagement in cognitive activities (e.g., reading, puzzles, games) and social participation (e.g., clubs, volunteering) were linked to higher odds of robustness, especially in earlier waves and among younger-old adults. These associations support theories of cognitive reserve and social buffering and align with previous findings showing that mental activity promotes functional health (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR54\\\" citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e). However, their effects declined with age, perhaps suggesting the importance of early and sustained engagement.\\u003c/p\\u003e \\u003cp\\u003ePhysical activity also emerged as an important determinant of sustained robustness. Consistent with prior evidence, moderate activity (e.g., walking, gardening) was strongly associated with remaining robust across waves, while vigorous activity showed benefits primarily among younger-old adults (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR64 CR65\\\" citationid=\\\"CR63\\\" class=\\\"CitationRef\\\"\\u003e63\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR66\\\" class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e). These findings support the notion that even moderate, routine physical activity helps preserve functional reserve and delays frailty onset, particularly when from early old age. The differential impact of vigorous activity suggests that age-appropriate and sustainable forms of exercise may be more strongly associated with maintaining robustness in ageing populations.\\u003c/p\\u003e \\u003cp\\u003eIn contrast, traditional clinical risk factors - such as smoking and BMI - showed only limited or inconsistent associations with remaining robust across waves. Smoking was found to be protective in the older-old participants, seemingly in contrast to common sense, as well as the body of literature, which links smoking and frailty (\\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR68\\\" class=\\\"CitationRef\\\"\\u003e68\\u003c/span\\u003e). This relationship was significant only when looking at the Wave 4\\u0026ndash;6 transition; on the one hand it could represent increased social encounters (social smoking), but more likely, it is an anomaly, as the association was not observed in any other models. We did not observe an effect of alcohol consumption (2\\u0026thinsp;+\\u0026thinsp;drinks almost every day) on robustness in any waves; previous research found 1\\u0026ndash;7 alcoholic drinks per week to be associated with reduced frailty (\\u003cspan citationid=\\\"CR69\\\" class=\\\"CitationRef\\\"\\u003e69\\u003c/span\\u003e), suggesting that a more granular examination of alcohol consumption may be required.\\u003c/p\\u003e \\u003cp\\u003eTaken together, these findings suggest that the maintenance of robustness in later life is driven by the interplay of physical, cognitive, and social pathways rather than by any single behavioral domain. Moderate physical activity may enhance cardiovascular and neuromuscular efficiency, supporting the energy and mobility required for social participation and cognitive engagement. Similarly, participation in social clubs and community activities can reinforce motivation for sustained physical activity and provide emotional support that buffers stress and inflammation. Cognitive engagement, in turn, contributes to self-regulation, executive functioning, and planning-facilitating adherence to active and socially connected lifestyles. This synergy between physical, cognitive, and social mechanisms forms a multidomain protective model of ageing, in which regular movement, meaningful interaction, and continuous mental stimulation jointly sustain functional independence and robustness.\\u003c/p\\u003e \\u003cp\\u003eWhile clinical risk factors were not associated with robustness here, self-rated health consistently emerged as the strongest protective factor for maintaining robustness across waves and age groups. Older adults who perceived their health more favorably at baseline were more likely to remain robust throughout follow-ups, echoing previous work on the predictive value of subjective health assessments on ageing trajectories. Beyond its subjective nature, self-rated health may function as an integrative signal of underlying biological ageing processes. Previous research suggests that this measure captures multisystem dysregulation, cumulative inflammatory burden, and functional reserve that are not fully reflected by diagnosed conditions alone. From a geroscience standpoint, self-rated health may therefore approximate system-level resilience and adaptive capacity, offering a pragmatic population-level indicator of ageing trajectories. Its strong and consistent association with sustained robustness in the present study reinforces its value as a low-cost yet theoretically meaningful marker of long-term resilience in older adults. A significant, negative correlation between frailty and subjective life expectancy was reported in a study of \\u0026gt;\\u0026thinsp;1000 older adults (\\u0026gt;\\u0026thinsp;50 yrs) in Sub-Saharan Africa (\\u003cspan citationid=\\\"CR70\\\" class=\\\"CitationRef\\\"\\u003e70\\u003c/span\\u003e). Significant correlations between self-rated health and mortality (\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e) were also found among older adults, 70-year-olds (n\\u0026thinsp;=\\u0026thinsp;1008) from Finland. The capacity of this single, easily attained health rating to predict long-term robustness underscores its validity as a pragmatic indicator of resilience in ageing populations. Unlike clinical biomarkers, determining self-rated health requires minimal resources, yet it reliably identifies individuals at elevated risk of maintaining robustness. Incorporating this question into routine primary care, particularly for adults over 75, could help flag those less likely to remain robust and guide earlier monitoring and intervention (\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAlongside subjective health, economic security represents another critical pillar of sustained robustness in older age. Financial distress was associated with increased frailty risk in nearly all models, particularly among younger-old adults (ages 65\\u0026ndash;74). Economic insecurity has been linked to stress, reduced access to care, and increased frailty in a number of cohorts studied longitudinally (\\u003cspan citationid=\\\"CR72\\\" class=\\\"CitationRef\\\"\\u003e72\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR73\\\" class=\\\"CitationRef\\\"\\u003e73\\u003c/span\\u003e) and also in a study on previous waves of the SHARE cohort (Waves 1\\u0026ndash;5,(\\u003cspan citationid=\\\"CR74\\\" class=\\\"CitationRef\\\"\\u003e74\\u003c/span\\u003e)).\\u003c/p\\u003e \\u003cp\\u003eOverall, these findings underscore the multidimensional nature of robustness and point to several practical implications for promoting healthy ageing. Beyond individual behaviors, targeted community-based programs that encourage regular physical and social activity could play a key role in maintaining robustness at the population level. Likewise, financial security interventions such as pension stability, access to affordable healthcare, and social assistance may reduce stress and health vulnerability, thereby reinforcing long-term wellbeing. In clinical settings, the integration of primary-care screening tools that include brief self-rated health assessments and questions on social participation could help identify individuals at risk of decline earlier and enable preventive strategies. Although several SHARE-based studies have examined frailty trajectories, inequalities, and transitions, fewer analyses have focused specifically on the maintenance of robustness among individuals who were robust at baseline. The present study contributes to this literature by combining four elements within a single framework: extended follow-up, broad cross-national coverage, multidomain predictors, and age-stratified analyses. Its uniqueness therefore lies less in identifying new mechanisms than in bringing these elements together to characterize sustained robustness as a measurable population-health outcome in later life.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eLimitations\\u003c/h2\\u003e \\u003cp\\u003eFrailty and robustness were classified according to slightly stricter operational criteria (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e) based on the data collected in SHARE, thereby reducing the likelihood of misclassification and strengthening the robustness of observed associations.\\u003c/p\\u003e \\u003cp\\u003eThe reliance on some self-reported variables introduces potential recall and reporting bias, though valid and reliable tools were used. In addition, although the study spans multiple waves, its longitudinal structure is based on repeated cross-sectional comparisons, limiting causal inference. Additional variables, such as independence in IADL, caregiving support, nutritional status, or environmental barriers, may have influenced frailty outcomes, but were not included in this analysis. Despite these limitations, our findings highlight modifiable protective factors that are easily identifiable in clinical and community settings, making them valuable targets for early interventions to sustain robustness. The stratification by age groups provided nuanced insights into age-specific dynamics, and the inclusion of functional, psychosocial, and cognitive variables enriched the multidimensional assessment of frailty.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Conclusions\",\"content\":\"\\u003cp\\u003eThis study identifies financial security, physical activity, cognitive engagement, and self-rated health as key determinants of sustained robustness among older adults. By shifting the focus from delaying frailty to maintaining robustness, our findings emphasize a multidomain model of healthy ageing, in which behavioral, psychosocial, and economic factors interact to preserve function and independence .These insights highlight the value of community-based programs that foster active and social lifestyles, policies supporting financial stability in later life, and simple primary-care screening tools that assess health perception and participation.\\u003c/p\\u003e \\u003cp\\u003eStrengthening these modifiable domains can help extend the years lived in good health. Although SHARE encompasses 27 countries with diverse welfare and healthcare systems, the consistency of our results across contexts underscores the generalizability and robustness of these findings.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eStatements and Declarations - Competing interests\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The analyses were conducted using data from the Survey of Health, Ageing and Retirement in Europe (SHARE), whose funding sources are detailed in the Acknowledgements section.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study is based on secondary analysis of anonymized data from the Survey of Health, Ageing and Retirement in Europe (SHARE). The SHARE study has been reviewed and approved by the Ethics Committee of the University of Mannheim and later by the Ethics Council of the Max Planck Society.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eAll participants provided informed consent prior to participation.\\u003cbr\\u003e\\u003cstrong\\u003eClinical trial number: not applicable.\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData Availability\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets analysed during the current study are available from the SHARE Research Data Center (https://www.share-project.org) and can be accessed by registered researchers upon application in accordance with SHARE data access procedures.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions:\\u003c/strong\\u003e\\u003cbr\\u003e\\u0026nbsp;All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Aviad Tur-Sinai. The first draft of the manuscript was written by Khalil Iktilat, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgement\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis paper uses data from SHARE Waves 1, 2, 3, 4, 5, 6, 7, 8 and 9 \\u0026nbsp;(DOIs: \\u0026nbsp;10.6103/SHARE.w4.900, 10.6103/SHARE.w5.900, 10.6103/SHARE.w6.900, 10.6103/SHARE.w7.900, 10.6103/SHARE.w8.900) see (35) for methodological details.The SHARE data collection has been funded by the European Commission, DG RTD through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N\\u0026deg;211909, SHARE-LEAP: GA N\\u0026deg;227822, SHARE M4: GA N\\u0026deg;261982, DASISH: GA N\\u0026deg;283646) and Horizon 2020 (SHARE-DEV3: GA N\\u0026deg;676536, SHARE-COHESION: GA N\\u0026deg;870628, SERISS: GA N\\u0026deg;654221, SSHOC: GA N\\u0026deg;823782, SHARE-COVID19: GA N\\u0026deg;101015924) and by DG Employment, Social Affairs \\u0026amp; Inclusion through VS 2015/0195, VS 2016/0135, VS 2018/0285, VS 2019/0332, VS 2020/0313, SHARE-EUCOV: GA N\\u0026deg;101052589 and EUCOVII: GA N\\u0026deg;101102412. Additional funding from the German Federal Ministry of Research, Technology and Space (01UW1301, 01UW1801, 01UW2202), the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, BSR12-04, R01_AG052527-02, R01_AG056329-02, R01_AG063944, HHSN271201300071C, RAG052527A) and from various national funding sources is gratefully acknowledged (see \\u003cstrong\\u003ewww.share-eric.eu\\u003c/strong\\u003e).\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eAbyad A, Hammami SO. Frailty: Update on Diagnosis Evaluation and Management Part 2. Middle East J. 2021;14(1):27\\u0026ndash;33.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365\\u0026ndash;75.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMorley JE, Vellas B, Van Kan GA, Anker SD, Bauer JM, Bernabei R, et al. Frailty consensus: a call to action. J Am Med Dir Assoc. 2013;14(6):392\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHwang A-C, Lee W-J, Huang N, Chen L-Y, Peng L-N, Lin M-H, et al. Longitudinal changes of frailty in 8 years: comparisons between physical frailty and frailty index. BMC Geriatr. 2021;21(1):726.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJarach CM, Tettamanti M, Nobili A, D'avanzo B. Social isolation and loneliness as related to progression and reversion of frailty in the Survey of Health Aging Retirement in Europe (SHARE). Age Ageing. 2021;50(1):258\\u0026ndash;62.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eJenkins ND, Hoogendijk EO, Armstrong JJ, Lewis NA, Ranson JM, Rijnhart JJ, et al. 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J Epidemiol Community Health. 2017;71(1):73\\u0026ndash;80.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-geriatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bgtc\",\"sideBox\":\"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bgtc/default.aspx\",\"title\":\"BMC Geriatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Robustness, ageing, SHARE, sustained robustness, healthy ageing, multidimensional resilience, longitudinal ageing trajectories\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-9345466/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-9345466/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFrailty is a widely recognized clinical syndrome of ageing. While most studies emphasize risk factors for frailty, little is known about the protective mechanisms that sustain robustness in later life. This study addresses this gap by identifying longitudinal predictors of robustness among older adults.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe analyzed eight years of longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE; Waves 4–8, 2011–2020) across 27 countries, including 7,865 adults aged 65–84, stratified into younger-old (65–74) and older-old (75–84) groups. Logistic regression models estimated odds ratios for maintaining robustness, incorporating sociodemographic, health, lifestyle, functional factors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eRobustness declined steadily over time, with 52% of younger-old adults and 26% of older-old adults remaining robust after eight years. Across all models, better self-rated health (OR ≈ 0.72, p \\u0026lt; 0.001), fewer chronic conditions (OR ≈ 0.89, p \\u0026lt; 0.001), and greater financial security (OR ≈ 1.11, p = 0.018) were the strongest and most consistent predictors of sustained robustness. Engagement in moderate physical activity and participation in social and cognitive activities further contributed to resilience, though their effects were stronger among younger-old adults compared with the older-old.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThis study contributes to ageing research by examining sustained robustness, rather than frailty progression alone, as a longitudinal outcome in a large multinational cohort. By highlighting behavioral, psychosocial, and functional determinants of resilience, it frames robustness as a measurable and actionable outcome in ageing research and practice. These findings promote a more balanced and positive conceptualization of ageing-one that emphasizes not only preventing frailty, but actively maintaining robustness as a core scientific and clinical objective.\\u003c/p\\u003e\",\"manuscriptTitle\":\"TProtective Factors for Sustaining Robustness in Older Adults: An 8-Year Multinational Longitudinal Study Using SHARE Data\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-05-18 11:54:56\",\"doi\":\"10.21203/rs.3.rs-9345466/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-18T07:59:28+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"336846112176024263597830728496207016638\",\"date\":\"2026-05-15T12:48:24+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"116370030241662841736650343547012732476\",\"date\":\"2026-05-15T07:42:30+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-15T02:58:09+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"64020802757633870734104946844478050941\",\"date\":\"2026-05-14T12:36:23+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"210625286614308126944405990815040451117\",\"date\":\"2026-05-07T11:28:48+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-05-07T09:27:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2026-04-13T07:19:42+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-04-11T05:16:35+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2026-04-11T05:15:52+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Geriatrics\",\"date\":\"2026-04-07T12:43:10+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-geriatrics\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bgtc\",\"sideBox\":\"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bgtc/default.aspx\",\"title\":\"BMC Geriatrics\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"60afb090-ed4b-4c19-b93b-a7712978e9ac\",\"owner\":[],\"postedDate\":\"May 18th, 2026\",\"published\":true,\"recentEditorialEvents\":[{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-18T07:59:28+00:00\",\"index\":63,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"336846112176024263597830728496207016638\",\"date\":\"2026-05-15T12:48:24+00:00\",\"index\":60,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"116370030241662841736650343547012732476\",\"date\":\"2026-05-15T07:42:30+00:00\",\"index\":58,\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-05-15T02:58:09+00:00\",\"index\":57,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"64020802757633870734104946844478050941\",\"date\":\"2026-05-14T12:36:23+00:00\",\"index\":53,\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"210625286614308126944405990815040451117\",\"date\":\"2026-05-07T11:28:48+00:00\",\"index\":33,\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"30\",\"date\":\"2026-05-07T09:27:48+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-18T11:54:56+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-05-18 11:54:56\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-9345466\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-9345466\",\"identity\":\"rs-9345466\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}