Rethinking health in later life: A six-dimensional model based on the European SHARE survey

The accelerating global aging population requires updated conceptualizations and measurements of health in later life. While traditionally framed around physical, mental, and social dimensions, recent research suggests that additional dimensions may form part of the broader health construct in older adults. However, empirical validation of such multidimensional health constructs using population-based data remains limited. We analyzed data from 46,317 participants aged 50-104 years (M = 71.33, SD = 9.34; 42.6 % men, 57.4 % women) from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (SHARE). To examine the structure of health in later life, we applied a theory-informed data-driven psychometric approach. Candidate variables were first identified through a review of theoretical health frameworks and mapped onto SHARE indicators. We conducted Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and second-order Structural Equation Modeling (SEM). The second-order SEM model supported a multidimensional structure of health comprising six dimensions: Physical Health, Functional Ability, Cognitive Function, Psychological Wellbeing, Financial Autonomy, and Social Engagement. Standardized factor loadings ranged from 0.579 to 0.832. Model fit indices were: RMSEA = 0.054, 90 % CI [0.053, 0.054]; CFI = 0.904; SRMR = 0.050. These findings suggest that health in later life is best conceptualized as a multidimensional system of capacities and resources encompassing physical, functional, cognitive, psychological, social, and financial dimensions. By empirically deriving this structure from large-scale data, this study bridges theoretical frameworks of healthy aging with their operational measurement. Future research should examine longitudinal interplay among these dimensions and validate this structure beyond Europe.