Living arrangement preferences and realities for elderly Chinese: implications for subjective wellbeing

China's aging population: A review of living arrangement, intergenerational support, and wellbeing

China's rapid population aging and remarkable family-level changes have raised concerns about the weakening of its family-based elderly care. The last decade indeed has seen a clear departure from multigenerational living to alternative living arrangements such as living with spouse only and solo living. However, ample evidence suggests that Chinese families have demonstrated considerable resilience amidst profound sociodemographic changes. This review article highlights the importance of government-society cooperation in meeting the social challenges of population aging. A key factor is the persistient filial piety norms, which enable children living far or close, migrant or nonmigrant, to rearrange financial, instrumental, and emotional support to aging parents. Equally important is the step-in of the government to share elderly care responsibilities, provide support through deepening pension and healthcare reforms, and implement the active and healthy aging agenda. How the two factors play out over the next decade and beyond will have profound implications on the living arrangement, intergenerational support, and wellbeing of older adults in China.

Living arrangements and depression of the older adults- evidence from the Chinese longitudinal healthy longevity survey

BACKGROUND

The mental health and living arrangements of older adults are worthy of attention. Previous studies have pointed out that the living arrangements may be related to older adults' depression. However, it has not been found that studies concern the relationship between actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality and depression in older adults, so we carried out this study.

METHODS

The data from the Chinese longitudinal healthy longevity survey were used in this study. With the older adults' depression as the dependent variable and the living arrangement related variables as the independent variable, we constructed three binary-logistic regression analysis models to explore the potential relationship between living arrangement related variables and depression in older adults.

RESULTS

We found that the actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality are significantly correlated with depression in older adults. Specifically, older adults living alone or only with the spouse are at greater risk of depression. Older adults who prefer living alone or only with the spouse are at relatively low risk of depression. Older adults whose living arrangement preferences do not match reality have a higher risk of depression.

CONCLUSION

The living arrangement related variables are significantly correlated with depression in older adults. In addition to the actual living arrangements, living arrangement preferences and whether the living arrangement preferences fit with reality are also related to the depression of older adults.

Depressive symptoms among older empty nesters in China: the moderating effects of social contact and contact with one's children

OBJECTIVES

Mental health for older people has become a major social concern. Literature has shown that older people, especially when they become empty nesters-when a parent lives alone or lives with his/her spouse after the youngest child leaves home-may start to develop various mental health problems due to reduced contacts with their children.

Using fixed-effects, multivariate regression with a difference-in-differences approach and propensity score matching, this paper examines the relationship between being an empty nester and mental health among older people in China, and the moderating effects of social contact and contact with one's children in terms of mental health. Our data come from the China Health and Retirement Longitudinal Study of 2011, 2013, 2015 and 2018.

RESULTS

We found that, in the short term, the mental health of older people may not be affected after they became empty nesters. But in the longer term, if they did not have regular contact with their children, their mental health would deteriorate with time. Social contact, especially cognitive activities, was beneficial to the mental health of the older empty nesters. We also found that for older empty nesters with disabilities, frequent social contact and contact with their children were more important.

CONCLUSION

We urge the government to promote community-based social activities for older people, especially for those with functional limitations.

Is Transition in Living Arrangements Associated With Older Adults' Life Satisfaction When Preference Is Considered?

OBJECTIVES

In a longitudinal design, the objective is to investigate the association between transitions in living arrangements and life satisfaction with special consideration for preferred living arrangement, and to assess whether such associations are moderated by age among Chinese older adults.

METHODS

Data were from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, 2005-2014. Living arrangement transitions (N = 12,654) distinguished coresidence with children and non-coresidence and matched preference. Random effect ordinal logistic models predicted life satisfaction by transitions in living arrangements between baseline and follow-up, transitions in matched living arrangement preferences between baseline and follow-up, and these transitions interacted with age at baseline, adjusting for life satisfaction at baseline. Predicted probabilities for the highest level of life satisfaction for several transition combinations were calculated and the difference was tested for significance.

RESULTS

Although matching actual and preferred living arrangement transition is an important factor in determining life satisfaction, actual coresidence with children remains positively significant. Moreover, results show significant interaction effects of the two transitions with age: while the association of life satisfaction with consistent matching gradually declines into older ages, the association of life satisfaction with consistent coresidence increases with age.

DISCUSSION

While preference-matched living arrangement is critical for life satisfaction, especially for the young-old, the role of coresidence becomes more prominent at very old ages when various needs are likely to arise. It is too early to dismiss the role of coresidence with children in the Chinese context.

The Happy Home: Ageing, Migration, and Housing in Relation to Older Migrants' Subjective Wellbeing

(1) Background: With an increasingly diversifying ageing population, it is important to understand what 'ageing well' means to older adults with a migration background. Given older adults' preference to age in place and declining mobility, housing is a significant place in later life. Therefore, this paper explores the influence of housing, migration, and age on older migrants' subjective wellbeing, with attention to immaterial aspects such as a sense of home as well. (2) Methods: In-depth interviews with older migrants from various ethnicities (N = 22) were conducted. The data collection and analysis were led by an inductive and deductive approach through thematic analysis. (3) Results: The results point to the dynamic nature of age(ing) and the role of migration background in the subjective wellbeing of older migrants. The need for preserving one's housing situation and environmental mastery in later life is highlighted. Furthermore, the relation and mutual influence of subjective wellbeing and sense of home is uncovered. (4) Conclusions: This study highlights the intersection of age, migration, and housing to the subjective wellbeing and sense of home of older migrants. In addition, influences on older migrants' subjective wellbeing concern both a material (i.e., housing) and immaterial (i.e., sense of home, age, migration) base.

Salutogenic Healthy Ageing Programme Embracement (SHAPE)- an upstream health resource intervention for older adults living alone and with their spouses only: complex intervention development and pilot randomized controlled trial

BACKGROUND

In view of age-related health concerns and resource vulnerabilities challenging older adults to age in place, upstream health resource interventions can inform older adults about the availability, accessibility, and utility of resources and equip them with better coping behaviours to maintain health and independence. This paper described the development process and evaluated the feasibility of an upstream health resource intervention, titled Salutogenic Healthy Ageing Programme Embracement (SHAPE), for older adults living alone or with spouses only.

METHODS

A pilot randomised controlled trial design was adopted. SHAPE was designed to equip older adults with resource information and personal conviction to cope with stressors of healthy aging. This 12-week intervention comprised 12 weekly structured group sessions, at least two individual home visits and a resource book. Both the intervention and control groups received usual care provided in the community. Feasibility of SHAPE intervention was evaluated using recruitment rate, intervention adherence, data collection completion rate, satisfaction survey and post-intervention interview. Outcome measures (sense of coherence, health-promoting lifestyle behaviours, quality of life, self-efficacy, and self-rated health) were assessed at baseline and post-intervention. Paired t-tests were used to examine within-group changes in outcome measures. Content analysis was used to analysed qualitative data.

RESULTS

Thirty-four participants were recruited and randomised. While recruitment rate was low (8.9%), intervention adherence (93.75%) and data collection completion (100%) were high. Participants expressed high satisfaction towards SHAPE intervention and found it useful. Participants experienced mindset growth towards personal and ageing experiences, and they were more proactive in adopting healthful behaviours. Although the programme was tailored according to needs of older adults, it required refinement. Intention-to-treat analysis showed significant increase in overall health-promoting lifestyle behaviours, health responsibility, physical activity, spiritual growth, and stress management among intervention participants. However, they reported a significant drop in autonomy post-intervention.

CONCLUSION

Findings of this pilot trial suggested that with protocol modifications, SHAPE can be a feasible and beneficial health resource intervention for older adults. Modifications on recruitment strategies, eligibility criteria, selection of outcome measures, training of resource facilitators and strong collaboration bonds with community partners would be needed to increase feasibility robustness and scientific rigor of this complex intervention.

TRIAL REGISTRATION

This study has been registered with clinicaltrials.gov on 10/05/2017. The trial registration number is NCT03147625.

Will Downward Intergenerational Housing Support Increase Parents' Expectations for Old-Age Care from Adult Children? Evidence from China

Toward a background of young people's decreasing housing affordability and parents' increasing involvement in intergenerational housing support, this study investigates how such support influences parents' expectation of future care from adult children. Using data from the China Health and Retirement Longitudinal Study, we found that, in general, middle-aged/older adults who provided adult children financial housing support were more likely to expect old-age care from them. The help-receiving child was more likely to be an expected caregiver than the other children in multi-children families. Moreover, the reciprocal relationship was most prominent among the 1950s cohort, compared with the pre-1950s and the post-1950s cohorts. Our study broadly contributes to understanding how modernization reshapes intergenerational relationships and family members' expectations of commitments toward each other. It also informs the design of a comprehensive multi-level care system for older adults in China.

The Expected Demand for Elderly Care Services and Anticipated Living Arrangements Among the Oldest Old in China Based on the Andersen Model

Objective: The first aim of this study was to explore expected demands of the oldest old and their determinants for different types of elderly care services. The second aim was to investigate preferred choices of living arrangements among the oldest old and the influencing factors.

Methods: Data of 4,738 participants aged ≥80 years were extracted from the Chinese Longitudinal Health Longevity Survey carried out in 2014. Using the Andersen model as the analysis framework, a multiple logistic regression analysis was performed to analyze the relationship between the expected elderly care services and living arrangements and other influencing factors. The odds ratios were calculated to indicate the relationship between the influencing factors and the dependent variables.

Results: From the descriptive analysis results, we found that the oldest old showed high anticipated needs for home visits (83.5%) and health education (76.4%). Further, there existed a huge imbalance between the supply and demand of care services for the aged. Living with children is still the most important way of providing for the oldest old. The regression results showed that the expected demands for elderly care services and anticipated living arrangements among the oldest old in China are influenced by age, residence, housing property rights, economic status, loneliness, and activities of daily living (ADLs). The oldest old who are older without housing property rights, childless, and have restricted ADLs were more frequently observed to live in long-term care institutions.

Conclusions: There is an inequality of the supply and expected demand for elderly care services, and living with children is still a preferred choice of the Chinese oldest old. Our findings indicate that when planning how to promote elderly care services among the oldest old, it is important to consider their expectations, especially for the subgroup that is relatively disadvantaged. Related policies should be developed to offer incentives to family caregivers when they live with the oldest old.

A Study of the Factors Influencing the Residential Preferences of the Elderly in China

The global aging problem has a serious impact on the sustainable development of society. China has become the country with the largest aging population in the world, 1.75 times that of the EU and 3.01 times that of the United States. Therefore, the question of how to develop elderly care services and institutions in China is critical. Based on data from the China Health and Retirement Longitudinal Study (CHARLS), this paper details the residential preferences of the elderly, and uses a multinomial logistic regression model to analyze the influence of education level, health status, and income level on the residential preferences of the elderly in China. The results of the study are as follows: (1) From a spatial point of view, the residential preference of “living together” gradually increases from the northeast to the southwest. As for the choice of “nursing home”, northerners prefer to live in nursing homes more than southerners, especially in the northeast. (2) There are many personal factors that significantly affect housing preferences, such as education level, health status, income level, etc. (3) The development of socialized elderly care institutions should fully consider the preferences of the elderly. There are big differences in residential preferences in different regions and different cities, so the development of elderly care services should be adapted to local conditions.

Socio-economic and health determinants of preference for separate living among older adults: A cross-sectional study in India

INTRODUCTION

The living arrangements among the older population form a basic pointer to the care and support of older adults in India, and living with extended kin is clearly differentiated from living separately. This paper attempts to understand the associations between socio-economic and health-related variables with preference for the separate living among older adults in India.

MATERIALS AND METHODS

Using data from Building Knowledge Base on Population Ageing in India (BKPAI), we employed bivariate and probit regressions on a sample of 9540 older adults to fulfil the study objective.

RESULTS

Nearly 21% of older adults were living alone/with a spouse. Additionally, those older adults who lived alone/with spouse had specific reasons, i.e. about 14.6% reported that they had no children, 47.3% of older adults had their children away and 15.9% of older adults reported a family conflict. Availability of children is consistently found to be negatively associated with the preference of separate living. Besides, better self-rated health, independence in daily activities, and facing any type of violence were the strongest predictors of preference for separate living. In addition, the background characteristics, including age, sex, education, religion, and ethnicity, were found as significant predictors of living arrangement preference. Preference for co-residential arrangements emerges among older persons who have a feeling of importance within their family.

CONCLUSION

Physical proximity to kin and health conditions, in addition to economic conditions, substantially determine the swing towards separate living among older adults in India. This suggests that attention has to be paid to the demand for specialized care and health services among older adults living separately.

Who We Live With and How We Are Feeling: A Study of Household Living Arrangements and Subjective Well-Being Among Older Adults in China

Using a sample of Chinese adults over the age of 50 from wave 1 of the WHO Study on Global Ageing and Adult Health (n = 13,367), we investigated the relationship between living arrangements and subjective well-being (SWB) in regard to life satisfaction, happiness, and control. We also looked at the moderating role of resources, proxied by income and hukou status. Multivariate regression results indicate that living only with a spouse was significantly associated with better SWB. Multigenerational living arrangements may not always promote SWB, particularly when resources are constrained. Yet, results also underscore the importance of daughters and daughters-in-law in promoting SWB among older adults. Older adults in rural areas had better SWB, including greater life satisfaction if living with grandchildren only, compared to their urban peers living with a spouse only. Findings suggest that context matters in the association between living arrangements and older adults' SWB.

The power of culture: the gendered impact of family structures and living arrangements on social networks of Chinese older adults

Most of the extant literature on the fertility history and social networks of older adults has focused on advanced societies. Nevertheless, a limited number of studies have explored how culturally preferred family structures or living arrangements are related to older adults’ social networks in developing societies. This study examined these issues in the Chinese context and paid particular attention to the filial piety and preference for sons dominating Chinese society. Using nationally representative data of adults aged 60 and over from China Longitudinal Aging Social Survey in 2016, we constructed family and friend network scores following previous studies and developed linear models using multiple imputation for the missing data. The results suggested that childless older adults were the most disadvantaged in receiving support from family networks. Despite China's patrilineal culture, daughters were important sources of support. In terms of friend networks, older men who had no sons were least likely to receive support while co-residing with a partner and a son(s) might benefit them. Further analysis revealed that older rural women, but not older urban women, also had more support from friend networks if living with sons, implying urban–rural differences. Given the impact of social networks on older adults’ health and wellbeing, older Chinese people with no sons might need more support from other sources, such as aged-care programmes from public institutions, to achieve healthy ageing.

Measuring character strengths as possible protective factors against suicidal ideation in older Chinese adults: a cross-sectional study

BACKGROUND

Suicide is a global issue among the elderly. The number of older people committing suicide is proliferating, and the elderly suicide rate is the highest among all age groups in China. A better understanding of the possible protective factors against suicidal ideation is necessary to facilitate prevention and intervention efforts. The objectives of the present study are threefold. First, this study aims to examine the psychometric properties of the three-dimensional inventory of character strengths (TICS) with a sample of older adults. Second, this study intends to investigate correlations among suicide ideation, wellbeing, and character strengths. Third, the study seeks to explore the possible protective roles of the three character strengths and wellbeing in explaining suicidal ideation among older adults.

METHODS

A cross-sectional study comprising 308 older adults aged at least 50 years old from nursing homes was conducted. Four questionnaires, namely, the TICS, the Geriatric Suicide Ideation Scale-10 items, the Brief Inventory of Thriving, and the Satisfaction with Life Scale, were used. Exploratory structural equation modeling, intraclass correlation coefficients, partial correlations, and sets of hierarchical regressions were adopted to estimate and report the results.

RESULTS

TICS could be used to assess the character strengths (i.e., caring, inquisitiveness, and self-control) among older adults with an acceptable goodness-of-fit (chi square = 157.30, df = 63, p < 0.001, CFI = 0.94, TLI = 0.90, RMSEA = 0.07, 90% CI = [0.06, 0.08]). Wellbeing and character strengths exhibited a negative association with suicidal ideation among older adults. Moreover, character strengths showed an independently cross-sectional relationship with suicidal ideation, explaining 65.1% of the variance of suicidal ideation after controlling for the wellbeing and demographics.

CONCLUSION

This study indicated that character strengths were associated with low levels of suicidal ideation. Therefore, the protective factors against suicidal ideation among older adults should be given additional attention.

Rural-urban disparities in age trajectories of depression caseness in later life: The China Health and Retirement Longitudinal Study

BACKGROUND

No consensus has been reached on whether depression decreases or increases with age in later life. Majority of the evidence comes from Western societies, while little is known about this relationship and its rural-urban disparities in the Chinese context.

METHODS

Three waves of data from 15,501 Chinese adults aged 45-85 years from the China Health and Retirement Longitudinal Study, Chinese sister study of Health and Retirement Study, were used. Depression caseness was identified using the 10-item Center for Epidemiologic Studies Depression Scale (score ≥12). Urbanisation levels were determined by combining rural-urban residence and rural-urban Hukou (a household registration system). Odds ratios and predicted probabilities of depression caseness were estimated using generalised linear mixed models.

RESULTS

For both men and women and across all ages, the crude predicted probability of depression caseness was the highest in the rural group, followed by the semi-urban group, and the lowest in the urban group. The probability was stable over age among urban men (around 0.05), but it increased at an accelerated rate with age among semi-urban men (0.25 at age 85, 95% confidence interval [CI]: 0.13-0.44) and rural men (0.29 at age 85, 95% CI: 0.22-0.39). Among women the age pattern was similar between the urbanisation groups: the probability increased with age, reached a peak at ages 75-80 (urban women: 0.16, 95% CI: 0.13-0.20; semi-urban women: 0.28, 95% CI: 0.20-0.39; rural women: 0.41, 95% CI: 0.36-0.46), and decreased slightly afterwards. These differences were significantly attenuated when socio-demographic characteristics and physical disability, but not when behaviour-related factors, were controlled for.

CONCLUSION

The age trajectories of later-life depression caseness varied by gender and urbanisation levels, and were not U-shaped as in many Western societies. The increasing depression caseness with age and the large rural disadvantage were substantially driven by socio-demographic characteristics and physical disability.