Living arrangements and marital status: a register-based study of survival of older adults in Belgium at the beginning of the 21st century

A Brief Report on Living Arrangements Following Gray Divorce

OBJECTIVES

We offer new insights on how older adults in the United States navigate the aftermath of gray divorce (i.e., divorce that occurs among adults aged 50+) by describing their living arrangements upon divorce and tracking the stability of these configurations over time. Living arrangements are important to decipher because they are linked to health, well-being, and longevity.

METHODS

Using data from the 1998-2014 Health and Retirement Study, we uncovered patterns of U.S. older adult living arrangements upon divorce (N = 1,057), distinguishing among those who lived alone, lived with others, and lived with a new partner. Multinomial logistic regression models were estimated to assess how individual characteristics (demographics, marital biography, economic resources, health, and social ties) were associated with these configurations. Cumulative survival probabilities gauged the relative stability of these 3 living arrangements.

RESULTS

About half of U.S. adults lived alone upon gray divorce, another one-third lived with others, and the remaining 14% lived with a new partner. Adults living with a new partner tended to exhibit the most advantaged sociodemographic profiles, whereas those living solo or with others were largely comparable. More than 70% of adults experienced a subsequent living arrangement transition if they lived with others upon divorce, versus just 50% of those living alone and only 30% of those with a new partner.

DISCUSSION

After divorce, older adults reside in a range of living arrangements, some of which are more stable than others. Future work should address whether and how these arrangements and their durability are related to postdivorce adjustment.

Marital Status, Living Arrangements and Mortality at Older Ages in Chile, 2004-2016

The risk of mortality in old age is associated with marital status and living arrangements. There is still little knowledge about this in Latin America. Our objectives are to examine the association between marital status, living arrangements and mortality of older adults (>60 years) in Chile, and to test whether this association varies when demographic, socioeconomic and health factors are included. We used data from the Social Protection Survey, and mortality data were linked to the Civil Registry. We estimate a series of Poisson regression models. Our results show a clear association between marriage and longevity, since even controlling for demographic, socioeconomic and health factors, we found that separated or divorced, widowed, and unmarried people showed higher relative mortality compared to married people (IRR1.24, IRR1.33, IRR1.35, respectively). Considering only living arrangements, the results show that living alone, alone with children, with children and other relatives or in other arrangements is associated with higher mortality (IRR1.22, IRR1.27, IRR1.35, IRR1.35, respectively) compared to those living with their partners and children. However, considering marital status and living arrangements together, we find that survival among older adults was strongly associated with marital status. Marital status continues to be a direct measure of living arrangements among older adults in Chile.

Household and area determinants of emergency department attendance and hospitalisation in people with multimorbidity: a systematic review

OBJECTIVES

Multimorbidity is one of the greatest challenges facing healthcare internationally. Emergency department (ED) attendance and hospitalisation rates are higher in people with multimorbidity, but most research focuses on associations with individual characteristics, ignoring household or area mediators of service use.

DESIGN

Systematic review reported using the synthesis without meta-analysis framework.

DATA SOURCES

Twelve electronic databases (1 January 2000-21 September 2021): MEDLINE/OVID, Embase, Global Health, PsycINFO, ASSIA, CAB Abstracts, Science Citation Index Expanded/ISI Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, the Cochrane Library, and OpenGrey.

ELIGIBILITY CRITERIA

Adults aged ≥16 years, with multimorbidity. Exposure(s) were household and/or area determinants of health. Outcomes were ED attendance and/or hospitalisation. The literature search was limited to publications in English.

DATA EXTRACTION AND SYNTHESIS

Independent double screening of titles and abstracts to select relevant full-text studies. Methodological quality was assessed using an adaptation of the Newcastle-Ottawa Quality Assessment Scale tool. Given high study heterogeneity, narrative synthesis was performed.

RESULTS

After deduplication, 10 721 titles and abstracts were screened, and 142 full-text articles were reviewed, of which 10 were eligible for inclusion. In people with multimorbidity, household food insecurity was associated with hospitalisation (OR 1.58 (95% CI 1.06 to 2.36) in concordant multimorbidity). People with multimorbidity living in the most versus least deprived areas attended ED more frequently (8.9% (95% CI 8.6 to 9.1) in most versus 6.3% (95% CI 6.1 to 6.6) in least), had higher rates of hospitalisation (26% in most versus 22% in least), and higher probability of hospitalisation (6.4% (95% CI 5.8 to 7.2) in most versus 4.2% (95% CI 3.8 to 4.7) in least). There was non-conclusive evidence that household income is associated with ED attendance and hospitalisation. No statistically significant relationships were found between marital status, living with others with multimorbidity, or rurality with ED attendance or hospitalisation.

CONCLUSIONS

There is some evidence that household and area contexts mediate associations of multimorbidity with ED attendance and hospitalisation, but firm conclusions are constrained by the small number of studies published and study design heterogeneity. Further research is required on large population samples using robust analytical methods.

PROSPERO REGISTRATION NUMBER

CRD42021283515.

Lessons Learned From Blue Zones, Lifestyle Medicine Pillars and Beyond: An Update on the Contributions of Behavior and Genetics to Wellbeing and Longevity

Blue Zones are regions of the world that have a higher number of individuals who live longer than the expected average. The current paper revisits principles previously identified to be common in Blue Zones and to be contributing to longevity ( move naturally, eat wisely, improve resilience to stress, get adequate sleep, keep strong family ties, stimulate strong community support, respect for the planet and having a purpose in life’), compares these to the 6 pillars of Lifestyle Medicine ( healthy eating, exercising, avoidance of smoking and other risky substances, stress management, restorative sleep, and forming and maintaining relationships) and reviews new studies investigating the association between behavioral factors and longevity. In addition to the role of behavior, the review also discusses the important role of genetics and emphasizes the importance of conducting further research to understand how behavioral and genetic factors may affect molecular pathways with consequent effects on wellbeing and longevity.

Specific features of the oldest old from the Longevity Blue Zones in Ikaria and Sardinia

Human longevity may be found in single individuals as well as in the population as a whole ("population longevity"). Longevity Blue Zones (LBZs), which are areas with an unusually high number of oldest old, have been identified in Sardinia and the Greek island of Ikaria. We compared the lifestyle, health status and some genetic markers of the LBZ populations with those of reference populations from Italy and Greece; the data were extracted from the GEHA database. In the LBZs, the proportion of individuals who never married or were married and still living with their spouse was significantly greater. Nonagenarians males and females with a high self‒perception of optimism and/or a high score for self-rated health were also found in larger proportions in LBZs. Among the variables with lower frequency were the proportion of the widowed, the percentage of subjects who had suffered a stroke and the frequency of Apoε4 and Apoε2 and the TT genotype of FOXO3A gene. Compared to behavioral and health indicators, the impact of genetic factors might be relatively less important in the LBZs. Nevertheless, further research is needed to identify potential epigenetic traits that might play a predominant role due to the interaction between genetics and the human and physical environments.

Health and health-care utilisation in old age: the case of older men living alone

A growing number of older men are living alone. They are often referred to as an at-risk group in health-care systems. The purpose of this article is to establish an overview of these men's health and health-care utilisation. We do so by drawing on three sources: an online survey with health-care professionals, data from a national self-report health study and register-based data on health-care utilisation. The results show that older men living alone generally have lower health scores than older men co-habiting and that, among older men living alone, lower educational level is associated with lower health scores but also a greater use of free-of-charge health-care services. Health-care professionals conducting preventive home visits consider older men's social needs the most pronounced problem for the men's wellbeing and call for new services to be custom made for them. In this article, we discuss differences between older men living in rural and urban areas and between those who are single, divorced or widowed. We conclude that health and social care systems must differentiate between sub-groups of older men living alone when developing new services and that free-of-charge services, such as general practitioners and home care, should be considered as vehicles for addressing health inequities.

Receipt of Emotional Support among Rural South African Adults

As the world undergoes rapid ageing, informal support from friends and relatives is becoming especially important among older adults in middle and low income countries, where formalized social protections may be limited. We use new data from a cohort of adults ages 40 and older in rural South Africa to explore how receipt of emotional support differs by gender and marital status. Our findings suggest that women are more likely to get emotional support than men and have more sources of support. Moreover, women are more likely to get emotional support from relatives, whereas men are more likely to get support from friends. In regard to marital status, married people are more likely to get emotional support and have more sources of support than people who are not married. However, separated/divorced and widowed people are more likely to get emotional support from relatives and have more sources of non-spousal support than married people. These findings point toward gaps in informal systems of support, and the particular importance of considering men and unmarried (especially never married) people when designing policies to offer social protections to older populations.

Senior caregivers in different housing arrangements: comparison of health and care profiles

OBJECTIVE

To compare the physical, cognitive and psychological health profile and care context of elder caregivers of the elderly in different home arrangements.

METHOD

Quantitative and transversal study with elderly caregivers. The sample consisted of 349 caregivers divided into mono-gerational, bi-gerational and multi-generational housing arrangements. Sociodemographic and care questionnaires and physical, cognitive and psychological health assessment instruments were used for evaluation. The Chi-square distribution and Mann Whitney's U were used for data analysis.

RESULTS

Elderly caregivers in mono-generational homes were significantly older and independent for instrumental activities of daily living. In multigenerational households there was a significantly greater proportion of caregivers who considered family income insufficient, received emotional help, and felt overwhelmed and stressed.

CONCLUSION

The differences identified between the groups can contribute to the elaboration of care policies and for the health promotion of elderly caregivers.

Widowhood and mortality risk of older people in rural China: do gender and living arrangement make a difference?

Increased mortality after spousal bereavement has been observed in many populations. Few studies have investigated the widowhood effect in a traditional culture where the economy is underdeveloped. The reasons for the widowhood effect and its gender dynamic are not well understood. In this study, we assessed whether the widowhood-associated excess mortality exists and differs by gender and living arrangement in rural China. We used a six-wave panel of data derived from rural people over 60 years old in the Chaohu region of China. Cox regression analyses suggest that there was a positive effect of spousal loss on mortality for older rural Chinese and this effect was gender different. Our findings also suggest that living with adult children after spousal loss played a protective role in reducing the risk of older men's death, though it tended to increase older men's mortality risk in general.

Association of providing/receiving support on the mortality of older adults with different living arrangements in Taiwan: a longitudinal study on ageing

This longitudinal study evaluated the direct effects of providing/receiving family support on mortality in older adults with different living arrangements in Taiwan. All data analysed were obtained from the Taiwan Longitudinal Study on Aging, 1996–2007, of residents aged ⩾67 years (1,492 men and 1,177 women) and Taiwan's National Death Register. Living arrangements were divided into living alone, living only with spouse, living with family and living with others. Support was mainly defined as family support divided into two categories: providing and receiving. The effect of providing/receiving family support on the mortality of older adults was evaluated using Cox regression analysed by living arrangement. Participants living with their families had lower educational levels (illiterate or elementary school) and more disability in both activities of daily living and instrumental activities of daily living. However, they provided more family support than those in other living arrangements. After adjusting for several potentially confounding variables, including background characteristics, economic status and various health status measures, results showed that older adults living with their families and providing support had an 11 per cent lower mortality rate (Hazard ratio = 0.89; 95 per cent confidence interval = 0.83–0.96; p = 0.0018). In conclusion, we found that, when living with family, the lives of older adults can be extended by providing support, clearly supporting the old adage ‘it is more blessing to give than to receive’. Older adults wanting to extend their lives can be encouraged to provide more help to their families.

Living arrangements of community-dwelling older Singaporeans: predictors and consequences

In this paper, we examine predictors and consequences of living arrangements among community-dwelling older Singaporeans. We take a holistic approach and consider a range of social and economic as well as emotional and physical wellbeing indicators. Two waves (2009, 2011) of the Panel on Health and Ageing of Singaporean Elderly (PHASE) are analysed to (a) provide an overview of living arrangements in 2009 and assess the extent to which living arrangements change by 2011; (b) examine the predictors of living arrangements in 2009; and (c) examine the consequences of living arrangements over a two-year period. The majority (88%) of older Singaporeans co-reside with either their spouse and/or children. A small yet growing proportion live with others (5%) or live alone (6%). Very little change in living arrangements is observed over the two years. Our results show that women, the oldest-old and older adults with fewer children are more likely to live alone. Older adults who live alone are not particularly disadvantaged compared to those who live with their spouse and children or spouse only in their social and economic wellbeing. It is, in fact, older adults who live with their children that are disadvantaged in many aspects of social, economic and mental wellbeing. Measures to engage older adults living with their families (along with those living alone and with others) in broader social activities are imperative.