Living arrangements and health status in later life: a review of recent literature

Household Composition Under Strain: Regional Unemployment Rates and the Older American Housing Decision

This research explored the relationship between regional unemployment rates and the community-based housing configuration of older Americans. The analysis used the American Community Survey from 2006 to 2016 to examine regions experiencing high unemployment for differences in the likelihood of older adults to live alone, with a spouse or partner, or in a multigenerational household. Findings demonstrated that under the strain of higher regional unemployment, older adults were less likely to live alone and more likely to live in a multigenerational household. Additionally, older adults with a difficulty that could signify a need for support were less likely to live with a spouse or partner, while those without a difficulty were more likely to live with a spouse or partner. Recession-related safety-net policy should target supports to community-dwelling older adults, particularly those living alone, those with more support needs, with lower income, and older renters, because their housing arrangements may become vulnerable during regional economic contraction. Implications during COVID-19 are discussed.

Care Needs and Arrangements of Aging Immigrants in the United States

OBJECTIVES

To examine the need for and arrangements pertaining to personal care assistance among individuals 65 and older, and how life stage at migration impacts nativity differences in aging-related care.

METHODS

Using data from the Survey of Income and Program Participation (2001, 2004, and 2008), I examine the odds of needing care assistance, who provides care assistance, and the duration of time care assistance is needed, comparing U.S.-born individuals to migrants who arrived before age 50 ("earlier-life migrants") and those who arrived after age 50 ("later-life migrants").

RESULTS

While earlier-life migrants showed similar patterns to U.S.-born, later-life migrants showed higher care needs, were more likely to receive care from an adult child, and were particularly likely to need care for longer durations compared to U.S.-born.

DISCUSSION

Aging later-life migrants have strikingly distinct care needs and arrangements, with implications for individual and family well-being, especially considering their barriers to public support.

Association Between Paid Work and Health-Related Quality of Life Among Community-Dwelling Older Adults: The Sukagawa Study

In this study, we aimed to determine whether paid work has an impact on health-related quality of life (HRQOL) among older adults. Over three years, we longitudinally collected data from 5,260 community-dwelling older adults aged 75 years or older from a city in Japan. We assessed HRQOL using the Short-Form-8. We estimated the mean difference between the physical component summary (PCS) and the mental component summary (MCS) scores, which were stratified based on gender using multivariate, generalized estimating equation models. We further conducted a subgroup analysis based on the participants' occupational backgrounds. Engagement in paid work was associated with increased MCS scores across both genders and with increased PCS scores among women. In the subgroup analysis, only women who had previously worked as managerial workers showed an inverse association with MCS scores. In this population, engagement in paid work may be a crucial factor associated with well-being.

Unmet needs for hypertension diagnosis among older adults in Myanmar: secondary analysis of a multistage sampling study

Background

Hypertension is a major cause of morbidity among older adults. We investigated older adults’ access to health services in Myanmar by focusing on unmet needs in diagnosing hypertension. This study aims to identify factors associated with the unmet needs for hypertension diagnosis in the study areas of Myanmar.

Methods

This is a secondary data analysis of the survey which is a cross-sectional study conducted with older adults (aged ≥ 60 years) in the Yangon and Bago regions of Myanmar. Objective indicators of health were collected, including blood pressure, height and weight. The diagnosis of hypertension was considered an unmet need when a participant’s blood pressure measurement met the diagnostic criteria for hypertension but the disease had not yet been diagnosed. Bivariate and multivariate analyses using logistic regression were performed to identify factors associated with the unmet need for hypertension diagnosis. Factors related to lifestyle habits and medical-seeking behaviour were selected and put into the multivariate model.

Results

Data from 1200 people, 600 from each of the two regions, were analysed. Altogether 483 (40.3%) participants were male, 530 (44.2%) were aged ≥ 70 years, and 857 were diagnosed with hypertension based on their measured blood pressure or diagnostic history, or both, which is a 71.4% prevalence of hypertension. Moreover, 240 (20.0%) participants had never been diagnosed with hypertension. In the multivariate analysis, these unmet needs for hypertension diagnosis were significantly associated with male sex (odds ratio [OR] 1.46, 95% confidence interval [CI] 1.05–2.05), residence in the Bago region (OR 1.64, 95% CI 1.09–2.45) and better self-rated health (OR 1.70, 95% CI 1.24–2.33), but not with education, category on the wealth index or living arrangement.

Conclusions

There are barriers to accessing health services for hypertension diagnosis, as evidenced by the regional disparities found in this study, and charitable clinics may decrease the financial barrier to this diagnosis.

Feeling about living arrangements and associated health outcomes among older adults in India: a cross-sectional study

INTRODUCTION

Advancement in the field of gerontology has been concerned with the well-being of older adults in a family setup that is associated with caregiving and support. While family life and well-being are defined by emotion, caregiving, and support activities, dissatisfaction/discontent with living arrangements is a public health concern, which is increasing with a rise in the proportion of the older population in the country. The study examines the association of dissatisfaction with living arrangements with health outcomes among older men and women in India.

METHODS

The present research used data from the 'Building a Knowledge Base on Population Aging in India'. The effective sample size for the analysis was 9181 older adults. Descriptive statistics and bivariate analysis were performed to present the preliminary estimates. For finding the association between various health outcomes over explanatory variables, binary logistic regression model was used separately for men and women.

RESULTS

About 22.8% of men and 30.8% of women who were living alone were dissatisfied with their present living arrangement. It was revealed that both men and women who were dissatisfied with their present living arrangements had significantly higher odds of experiencing poor self-rated health [OR:4.45, 3.25 ~ 6.09 and OR:3.32, 2.54 ~ 4.34], low psychological health [OR: 2.15, 1.61 ~ 2.86 and OR: 1.99, 1.57 ~ 2.53], low subjective well-being [OR: 3.37, 2.54 ~ 4.45 and OR: 3.03, 2.36 ~ 3.38], low ADL [OR: 1.77, 1.2 ~ 2.62 and OR: 1.59, 1.17 ~ 2.18, low IADL] [OR: 1.32, 1.03 ~ 1.69 and OR: 1.57, 1.24 ~ 1.98] and low cognitive ability [OR: 1.26, 0.98 ~ 1.61 and OR:1.44, 1.13 ~ 1.82] in comparison to their counterpart from men and women respectively.

CONCLUSION

It is found that dissatisfaction with the living arrangement of older men and women is negatively associated with major health outcomes. Hence, appropriate policies and programs must be developed to promote increased family care and support and an improved residential environment that would create a feeling of comfort and happiness among older individuals.

Differences in Caregiving Intensity Among Distinct Sociodemographic Subgroups of Informal Caregivers: Joint Effects of Race/Ethnicity, Gender, and Employment

More than 40 million informal caregivers in the United States provide essential care to older adults. Recent research has identified substantial differences in caregiving intensity by gender, race/ethnicity, and employment status. Using intersectionality theory, the current study extends the existing literature by exploring the relationship between caregiving intensity and the unique experiences of individuals with different intersections of gender, ethnicity, and employment. We used generalized linear models to estimate multivariate associations between caregiving intensity assessed by three different measures (hours of caregiving per month and number of activities of daily living and instrumental activities of daily living [IADLs] assisted with) and the three sociodemographic factors of interest (race/ethnicity, gender, and employment status). Unemployed White males provided, on average, 77 fewer hours per month of care (p < 0.001) and assisted with 1.9 fewer IADLs (p = 0.004) than unemployed Black males. Employed White females provided 42.6 fewer hours per month of care (p = 0.002) than employed Black females and 49.2 fewer hours per month (p = 0.036) than employed females of other races. Study findings suggest that examining racial/ethnic or gender differences in isolation does not provide a true picture of differences in caregiving intensity. There is a critical need to understand how the intersections of race/ethnicity, gender, employment, and other sociodemographic factors shape the experiences of caregiver subgroups. [Journal of Gerontological Nursing, 47(7), 23-32.].

Experiences in the Decision-Making Regarding the Place of Care of the Elderly: A Systematic Review

The objective of this review was to understand how participants experience the decision-making process regarding the place of care for the elderly. Therefore, we conducted a systematic review of qualitative studies. The articles were included if they were original studies with qualitative/mixed methodology, written in English/Spanish, and that approached the decision-making process regarding the place of care for the elderly, already experienced by the participants. Forty-four articles were included, identifying experiences, both negative and positive. Negative experiences have been the most frequently reported experiences by all population groups; fear was the most relevant experience for the elderly, whereas concern was the most relevant for family members and professionals. This review has not only found a great variability of experiences, but also, it has deepened the differences between groups and the situations motivating/generating these experiences. This review highlights a wide range of experiences of those directly involved in the entire decision-making process on the place of care for the elderly. In future research it would be interesting to carry out qualitative primary studies conducted with professionals and other relevant people involved in this decision-making process, in order to know first-hand how they experience this process.

Do multigenerational living arrangements influence depressive symptoms in mid-late life? Cross-national findings from China and England

BACKGROUND

While living alone predicts depression in diverse ageing populations, the impact of multigenerational living is unclear. This study compared mid-late life depressive symptoms by living arrangements between societies with distinct kinship ties.

METHODS

Repeated data on depressive symptoms and living arrangements over 4 years from 16,229 Chinese (age≥45) and 10,403 English adults (age≥50) were analyzed using multilevel mixed-effects logistic regression. Elevated depressive symptoms were identified using the Center for Epidemiological Depression Scale criteria in each study.

RESULTS

Higher odds ratios (ORs) of elevated depressive symptoms were found in both Chinese and English adults aged<60 living with no partner but with children/grandchildren, compared to those living with a partner only. These ORs were greater for men (Chinese men: 3.09, 95% confidence interval: 2.00-4.78; English men: 3.44, 1.36-8.72) than for women (Chinese women: 1.77, 1.23-2.56; English women: 2.88, 1.41-3.67), after controlling for socioeconomic position, health behaviors, and health status. This male disadvantage was also observed for English, but not for Chinese, adults aged<60 living alone. For adults aged 60+, the increased odds among those living with no partner but with children/grandchildren and those living alone were smaller in both countries.

LIMITATIONS

Bias may exist because depressed participants are more likely to experience divorce or separation prior to baseline.

CONCLUSIONS

The relationship between living arrangements and depressive symptoms appears robust and consistent across social contexts, although the mechanisms differ. The protective role of partners in both China and England supports targeting those who do not live with partners to reduce depression.

The health and well-being of older women living alone in the United Kingdom and beyond: a scoping review

In the United Kingdom (UK), women are more likely to live alone in later life. Social factors such as household composition have been shown to affect health and wellbeing as we age. The health and well-being of older women who live alone are of interest to researchers, care providers, health organizations, and policymakers. This article contributes to the literature by detailing a scoping review, establishing the current evidence in this field. The purpose and context of the review are given. The methodology and resulting data are described. Gaps in the literature and implications for practice and research are given.

Reciprocal Dynamics of Solo-Living and Health Among Older Adults in Contemporary China

OBJECTIVES

Solo-living has far-reaching implications for older adults' well-being. The causal impacts and the pathways of solo-living on health and well-being of older adults are still unclear. This study examines the correlates of solo-living and subsequent health outcomes of solo-living among older adults in mainland China.

METHODS

We draw data from four waves of a nationwide survey with a total of 9,714 older adults aged 65 or older who had at least three interviews in 2005-2014. A generalized structural equation modeling approach was applied to examine what factors are associated with solo-living status and whether and how the antecedent of solo-living status subsequently affects well-being and health.

RESULTS

Owning a home, having no living child, and a preference to live independently are positively correlated with living alone, whereas living in a city, having economic independence, being educated, and having poor physical and cognitive functions are associated with lower odds of solo-living. Older Chinese adults who live alone are more likely to feel lonely and have a lower life satisfaction, yet they are more likely to be involved in social/leisure activities, and have fewer physical disabilities and a lower mortality risk.

DISCUSSION

There is a bi-directional relationship between solo-living and well-being/health among the Chinese older adults. Solo-living is a conditioned choice of a set of critical factors among older Chinese. The greater involvement in social/leisure activities is likely a key for Chinese solo-living older adults to mitigate the negative impact of their lower psychological well-being on subsequent mortality.

Older people and home ownership: the intention to relocate

Purpose

The purpose of this paper is to explore older people’s intention to relocate from their primary homes. The study also seeks to understand the policy implications that such intentions may have.

Design/methodology/approach

This study employs a survey-based design via computer-aided telephone interviews (CATI). The CATI survey was employed to gather information on the behaviour of older people and whether differences exist by gender, age, health immigration status and financial knowledge. The survey-based design is triangulated with the literature on this topic area and policy issues.

Findings

The findings of the study suggest amongst others, that older South Australians overwhelmingly and significantly do not intend to move from their primary home and are content to age in place. This is particularly true as people reach the older stages of life.

Originality/value

The study enhances the understanding of the decision-making environment that older people are exposed to in contemplating relocation from the primary home. More specifically, it shows that factors stated in the literature that deemed to be of importance in the decision to relocate, has no significance in this study and that ageing in place should be used as a policy base.

The relationship between living arrangements and higher use of hospital care at middle and older ages: to what extent do observed and unobserved individual characteristics explain this association?

BACKGROUND

Previous research has shown that certain living arrangements, such as living alone, are associated with worse health at older ages. We assessed the association between living arrangements and hospital care use among middle-aged and older adults, and investigated to what extent observed and unobserved individual characteristics explain this association.

METHODS

Longitudinal Finnish registry data for men and women aged 50-89 years were used for the period 1987-2007. The relationship between living arrangements (based on whether an individual lived with a partner, other adults or alone, and whether they lived with minor/adult children) and heavy hospital care use (i.e., having been in hospital for 8 or more days in a year) was studied. First, we applied logistic regression models and linear probability models controlling for observed time-invariant factors (socioeconomic status measured by education, labour force status, and household income; and marital status), and then individual linear probability models with fixed-effects to further account for unobserved time-invariant individual characteristics in the measurement period. Analyses were done separately for 10 year age-groups.

RESULTS

In the logistic regression models, men and women who lived alone had higher crude odds of heavy hospital care use than those living only with their partner. These odds ratios were highest for men and women in the youngest age category (50-59 years, 1.72 and 1.36 respectively) and decreased with age. Adjusting for observed time-invariant socioeconomic status attenuated these odds by 14-40%, but adjusting for marital status did not affect the results. Lower odds were observed among adults aged 50-59 years who lived with their partner and (minor or adult) children. But odds were higher for individuals aged 60-79 years who co-resided with their adult children, regardless of whether they lived with a partner. Adjusting for observed time-invariant factors generally did not change these results. After further adjusting for unobserved time-invariant individual characteristics in the individual fixed-effects models, most of these associations largely attenuated or disappeared, particularly for ages 80-89 years.

CONCLUSIONS

The association between living arrangements and higher use of hospital care at middle and older ages is largely explained by socioeconomic disadvantage and unobserved time-invariant individual characteristics.

Bare necessities? How the need for care modulates the acceptance of ambient assisted living technologies

BACKGROUND

Steadily increasing numbers of older people and people in need of care represent critical challenges for today's society. In the last years, diverse (health-related) technologies have been developed to facilitate living at home for older people but also to support (professional) care personnel in their daily care efforts. Ambient Assisted Living (AAL) technologies have the potential to enhance safety, support medical therapy, or facilitate everyday chores and social life. With the huge range and variety of technical opportunities, the question arises what influences (potential) users' decisions for the right technology in their individual conditions and situations. In particular with regard to the fragility of the care situation, it is unknown which technologies are desired for different care needs and diverse situations.

OBJECTIVES

The present study investigates (1) personal care needs as a potential influencing parameter for technology acceptance and (2) the selection of specific technologies.

METHOD

In an online questionnaire (including n = 162 people of all ages), technology acceptance and the selection of specific technologies was assessed, using two scenarios differing in their personal care needs (low care needs vs. moderate care needs) in two situational contexts (emergency detection vs. medical reminders).

RESULTS

Personal care needs influence the perception of benefits, barriers, and general acceptance of assisting technologies, independent from situational context. Higher needs for care lead to higher acknowledgements of the technology's benefits, lower agreements or, in parts, higher rejections of potential barriers and higher acceptance. The two care situations differ regarding the participants' preferences for technologies: For emergency detection, smart watches and emergency buttons are clearly accepted. In contrast, cameras are consistently rejected. For situations in which medical reminders are used, smartphone and smartwatches are most wanted, whereas audio assistants and smart TV were rather rejected.

CONCLUSIONS

The results provide insights into users' preferences for specific technologies for the purpose of emergency detection and medical reminders as well as for the important influence of personal care needs. These insights can be used to derive user-tailored solutions of technology configurations for specific care needs and situations.

Objectively-Measured Neighbourhood Attributes as Correlates and Moderators of Quality of Life in Older Adults with Different Living Arrangements: The ALECS Cross-Sectional Study

With an ageing world population, preservation of older adults’ health and quality of life (QoL) is paramount. Due to lower levels of physical functionality, older adults are particularly susceptible to local environment influences, especially those living alone and lacking family support. Using generalised additive mixed models, we examined associations and confounder-adjusted associations between objectively-measured neighbourhood attributes and QoL domains in 909 Hong Kong Chinese elderly community dwellers. Most examined neighbourhood attributes were not associated with QoL in the whole sample. Neighbourhood residential and entertainment density was curvilinearly and/or linearly related to specific QoL domains. Number of parks was negatively associated with social QoL and having well-treed parks with higher levels of social QoL. Older adults living alone in neighbourhoods with poor access to destinations and few activities in parks showed lower environmental and/or social QoL than their counterparts. Neighbourhood built environment characteristics do not seem to impact Hong Kong older adults’ physical and psychological QoL. Medium-to-high density, well-ordered neighbourhoods with optimal mixes of well-treed public open spaces and services meeting their daily needs may significantly contribute to social and environmental QoL in this population and appear particularly important to those living alone.

Living arrangements and disability-free life expectancy in the United States

No studies have investigated the association between living arrangements and disability-free life expectancy in the United States, nor worldwide. This study aims to examine the differences in total and disability-free life expectancy among older Americans according to living arrangements. Data from the Health and Retirement Study (1998 to 2014) for non-Hispanic whites aged 50 and over (N = 21,612). Disability-free life expectancy by gender, living arrangement, and education are obtained from incidence-based multistate life tables. Overall, those who live only with their spouses/partners live 1-19 years longer with 3-25 more years without disability and 1-7 fewer years with disability than do those with other living arrangements. Among those with the same living arrangement, the higher educated live up to 6 years longer with up to 8 more years in a disability-free state and up to 2 fewer years in a disabled state. The study shows strong association between living arrangement and disability-free life expectancy by gender and education. Long-term care policy should take into account the length of life with/without disability by living arrangements and socioeconomic status and make use of the potential family resources.

Just Like in Their Home Country? A Multinational Perspective on Living Arrangements of Older Immigrants in the United States

Older immigrants are more likely to share residence with their adult children and other family members than are U.S.-born older adults. Because socioeconomic factors only partially explain these differences and direct measures of cultural preferences are seldom available, the persistently high rates of intergenerational coresidence among the older foreign-born are often interpreted as driven by cultural preferences and/or a lack of assimilation. To challenge this interpretation, this study investigates the extent to which older immigrants' living arrangements deviate from those of older adults in their home countries. The analysis combines data on immigrants from the 2008-2012 American Community Survey (ACS) with census data from three major immigrant-sending countries: Mexico, the Dominican Republic, and Vietnam. Despite persistent differences from U.S.-born whites, coresidence in later life is significantly less common than in the sending countries among the older foreign-born who migrated as young adults, and especially among those who migrated as children. The older foreign-born who migrated after age 50, however, are more likely to coreside and less likely to live independently than the older adults in their home countries. The similarity of these patterns across the three immigrant subgroups suggests that the unusually high coresidence among late-life immigrants is driven by U.S. family reunification policy and not simply by cultural influences.

Perceived quality of life and living arrangements among older rural South Africans: do all households fare the same?

This study explores how living arrangements influence perceived quality of life in an elderly population in rural South Africa. We use data from the longitudinal World Health Organization Study of Global Ageing and Adult Health Survey (WHO-SAGE) and from the Agincourt Health and Socio-Demographic Surveillance System (HDSS). On average, older men and women who reside in single-generation and complex-linked multigenerational households report worse quality of life than those in two-generation and linear-linked multigenerational households. However, after controlling for prior wellbeing status, we find living arrangements to have a significant impact on women's perceived quality of life only, and that it is moderated by age. We conclude that not all multigenerational arrangements are protective of older adults’ wellbeing and highlight the gendered impact of living arrangements on quality of life. These results suggest the necessity to understand how living arrangements influence the social roles of older adults and change with age.

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

This article investigates the determinants of preference for intergenerational co-residence and examines the effects of living arrangement concordance (i.e.having a match between preference and reality) on the subjective wellbeing (SWB) of older Chinese. Data were derived from the China Health and Retirement Longitudinal Study (CHARLS) national baseline conducted in 2011. This allows for two different measures of the affective approach to SWB: depression and happiness. This article found living arrangement preference is indicative of need, cultural norms and current living arrangement experiences. The results support the hypothesis of discrepancy theories that having living arrangement concordance improves older parents’ SWB (i.e.depressive symptoms and happiness). In addition, the previously predictive effects of the actual living arrangement on SWB lost significance when actual living arrangement and concordance were added simultaneously. Living in a preferred arrangement appears to be more important than living in a traditional arrangement from the point of view of older adults’ SWB. Programmes designed to improve wellbeing in later life should not assume that there is a one-size-fits-all model for all; instead, older people should be given more choices of living arrangements.

Choosing between staying at home or moving: A systematic review of factors influencing housing decisions among frail older adults

Background

Most older adults wish to stay at home during their late life years, but physical disabilities and cognitive impairment may force them to face a housing decision. However, they lack relevant information to make informed value-based housing decisions. Consequently, we sought to identify the sets of factors influencing the housing decision-making of older adults.

Methods

We performed a systematic literature search for studies evaluating any factors influencing the housing decisions among older adults over 65 years old without cognitive disabilities. Primary research from any study design reported after 1990 in a peer-reviewed journal, a book chapter or an evaluated doctoral thesis and written in English, French or Spanish were eligible. We extracted the main study characteristics, the participant characteristics and any factors reported as associated with the housing decision. We conducted a qualitative thematic analysis from the perspective of the meaning and experience of home.

Results

The search resulted in 660 titles (after duplicate removal) from which 86 studies were kept for analysis. One study out of five reported exclusively on frail older adults (n = 17) and two on adults over 75 years old. Overall, a total of 88 factors were identified, of which 71 seem to have an influence on the housing decision-making of older adults, although the influence of 19 of them remains uncertain due to discrepancies between research methodologies. No conclusion was made regarding 12 additional factors due to lack of evidence.

Conclusion

A wealth of factors were found to influence housing decisions among older adults. However, very few of them have been studied extensively. Our results highlight the importance of interdisciplinary teamwork to study the influence of a broader range of factors as a whole. These results will help older adults make the best possible housing decision based on their unique situation and values.

Deciding How to Stay Independent at Home in Later Years: Development and Acceptability Testing of an Informative Web-Based Module

Background

Seniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible.

Objective

The study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home.

Methods

The approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics.

Results

In phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by participants. In phase II, after 4 days in a studio with 15 bilingual actors, 30 videos were made of various experts (eg, family doctor, home care nurse, and social worker) presenting options and guidance for the decision-making process. These were integrated into an interactive website, which included a comments tool for visitors to add information. In phase III (n=21), 8 seniors (7 women, mean age 75 years), 7 caregivers, and 6 professionals evaluated the acceptability of the module and suggested improvements. Clarity of the videos scored 3.6 out of 4, length was considered right by 17 (separate videos) and 13 participants (all videos together), and 18 participants considered the module acceptable. They suggested that information should be tailored more, and that seniors may need someone to help navigate it.

Conclusions

Our interactive website with interlinked videos presenting information about options for staying independent at home was deemed acceptable and potentially helpful by a diverse group of stakeholders.

Changes in living arrangements and mortality among older people in China

Living arrangements in later life are dynamic, with changes associated with life events such as widowhood or moves into an institution. Previous research has found particular changes in living arrangements to be associated with an elevated risk of mortality. However, research in this area within the context of China is limited, despite China being home to the world's largest population of older people. This study investigates the impact of changes in living arrangements on older persons' survival using the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2011. The original sample was 16,064 in 2002, and this study includes 6191 individuals who survived in 2005 and had complete information of track record in later waves. Changes in living arrangements are examined between 2002 and 2005. Cox-proportional hazards models are then used to investigate the association between the dynamics of living arrangements and respondents' survival status from 2005 to 2011 . Results show that men and women who lived in an institution in both 2002 and 2005, or who moved into an institution from living with family faced a greater risk of dying compared to those continuing to live with family. By contrast, continuing to live with family or alone, or moving between living with family and living alone, were not associated with an increased mortality risk, although there were some differences by gender. The institutional care sector in China is still in its infancy, with provision based on ability to pay market fees rather than need associated with age-related function impairment. The findings show that living in, or moving into, an institution is associated with a high mortality risk therefore requires further investigation in the context of a rapidly changing Chinese society.

Impact of home care versus alternative locations of care on elder health outcomes: an overview of systematic reviews

Background

Many elders struggle with the decision to remain at home or to move to an alternative location of care. A person’s location of care can influence health and wellbeing. Healthcare organizations and policy makers are increasingly challenged to better support elders’ dwelling and health care needs. A summary of the evidence that examines home care compared to other care locations can inform decision making. We surveyed and summarized the evidence evaluating the impact of home care versus alternative locations of care on elder health outcomes.

Methods

We conducted an overview of systematic reviews. Data sources included MEDLINE, the Cochrane Library, EMBASE, and CINAHL. Eligible reviews included adults 65+ years, elder home care, alternative care locations, and elder health outcomes. Two independent reviewers screened citations. We extracted data and appraised review quality using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) checklist. Results were synthesized narratively.

Results

The search yielded 2575 citations, of which 19 systematic reviews were eligible. Three hundred and forty studies with 271,660 participants were synthesized across the systematic reviews. The categories of comparisons included: home with support versus independent living at home (n = 11 reviews), home care versus institutional care (n = 3 reviews), and rehabilitation at home versus conventional rehabilitation services (n = 7 reviews). Two reviews had data relevant to two categories. Most reviews favoured home with support to independent living at home. Findings comparing home care to institutional care were mixed. Most reviews found no differences in health outcomes between rehabilitation at home versus conventional rehabilitation services. Systematic review quality was moderate, with a median AMSTAR score of 6 (range 4 - 10 out of 11).

Conclusions

The evidence on the impact of home care compared to alternative care locations on elder health outcomes is heterogeneous. Our findings support positive health impacts of home support interventions for community dwelling elders compared to independent living at home. There is insufficient evidence to determine the impact of alternative care locations on elders’ health. Additional research targeting housing and care options for the elderly is needed.

Electronic supplementary material

The online version of this article (doi:10.1186/s12877-016-0395-y) contains supplementary material, which is available to authorized users.

Functioning, Forgetting, or Failing Health: Which Factors Are Associated With a Community-Based Move Among Older Adults?

OBJECTIVE

To examine whether the health and functioning of middle-aged and older adults are associated with an increased likelihood of community-based moves.

METHOD

Biennial data from adults aged 51 and older in the Health and Retirement Study (HRS) and discrete-time survival models were used to assess the likelihood of community-based moves from 2000 to 2010 as a function of 11 measures of health and functioning.

RESULTS

Respondents diagnosed with heart disease, stroke, hypertension, lung disease, and psychiatric problems were more likely to move during the study period than those with no such diagnosis. Changes in activities of daily living and instrumental activities of daily living functioning, cognitive impairment, and falls were also related to a greater likelihood of moving during the study period. Cancer and diabetes were not related to overall moves, although diabetes was associated with an increased likelihood of local moves. For the most part, it was longstanding not recent diagnoses that were significantly related to the likelihood of moving.

DISCUSSION

Although some health conditions precipitate moves among middle-aged and older adults, others do not. This work has important implications for understanding the role of different aspects of health and functioning in the likelihood of migration among older adults.

Race Comparisons of the Household Dynamics of Older Adults

Longitudinal studies have suggested that households are much more fluid than was once believed. Yet our understanding of changes in household composition is based on limited sets of transitions occurring across relatively long intervals. Furthermore, we know relatively little about ethnoracial variation in household dynamics. Using data from a sample of older Floridians, the authors describe race differences in longitudinal patterns of household change that occurred during four 6-month intervals. Approximately one quarter of respondents experienced some change in composition during the 24-month study. Older African Americans lived in larger and more dynamic households and were more likely to form coresident relationships with grandchildren and nonrelatives. Age, gender, marital status, and disability were also associated with the likelihood of acquiring a new household member. Findings from this research provide additional insight into the processes through which race differences in the composition of households emerge and are maintained over time.

Correlates of Living Alone among Single Elderly Chinese Immigrants in Canada

According to traditional Chinese culture, families will care for their elderly. Therefore, it appears to be uncommon for elderly Chinese to live alone. This study examines the correlates for single elderly Chinese immigrants in Canada to live alone. Using a probability sample of single elderly Chinese immigrants ( N = 660) in seven urban centers, hierarchical logistic regression analysis was performed to analyze the effects of socio-demographic resource variables, health, and cultural variables. The findings show that 39.1% of single elderly Chinese immigrants reported to be living alone. Variables related to resources, functioning capacity, and acculturation related variables are the key correlates for the elderly Chinese immigrants to maintain independence in the community. The findings imply a need to develop culturally sensitive programs to strengthen the social support, financial stability, and functioning capacity of the elderly immigrants.

Health and Living Arrangements Among Older Americans

Objective: This research examines how physical and mental health influence living arrangements among older Americans and whether these effects differ for married and unmarried persons. Methods: Data came from the Asset and Health Dynamics Among the Oldest Old study. These two intervals were pooled, and hierarchical multinomial logistic regressions were used to analyze pooled time lags. Results: Functional status and cognitive functioning are significantly associated with living arrangements among those not married. Health conditions exert no significant effects among those married. Given the same functional status, unmarried elders are significantly more likely than their married counterparts to reside with their children or with others. Discussion: These results underscore the critical role of the spouse in influencing living arrangements, providing new evidence supporting the assertion that a spouse is the greatest guarantee of support in old age and the importance of the marriage institution.

Living arrangement and cognitive decline among older people in Europe

Family resources may play an important role in the wellbeing of older people. In this paper, we examine the association between living arrangement and cognitive decline among people over 65 living in different European countries. The underlined hypothesis is that living with others (i.e. spouse or/and children) vis-à-vis living alone may have a positive role in maintaining cognitive functioning, but also that such beneficial influence varies according to the circumstances. To this end, we used data from the first two waves of the Survey of Health, Ageing and Retirement in Europe (SHARE), which provides indicators of several cognitive functions: orientation, immediate recall, delayed recall, verbal fluency and numeracy. Net of both the potential biases due to the selective attrition and the re-test effects, the evidence shows that the association between living arrangement and cognitive decline depends on the geographical area and on the starting level of cognitive function.

Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study

BACKGROUND

Caring for people with dementia living in their own homes is a challenging care issue that raises ethical dilemmas of how to balance autonomy with their safety and well-being. The theoretical framework for this study consisted of the concepts of autonomy, beneficence, non-maleficence, paternalism and from the ethics of care. The aim of this study was to explore ethical dilemmas concerning autonomy that were identified when persons with dementia wished to live at home.

METHODS

This Norwegian study had a qualitative, hermeneutic design and was based on nine cases. Each case consisted of of a triad: the person with dementia, the family carer and the professional caregiver. Inclusion criteria for the persons with dementia were: (1) 67 years or older (2) diagnosed with dementia (3) Clinical Dementia Rating score 2 i.e. dementia of moderate degree (4) able to communicate verbally and (5) expressed a wish to live at home. The family carers and professional caregivers registered in the patients' records were included in the study. An interview guide was used in interviews with family carers and professional caregivers. Field notes were written after participant observation of interactions between persons with dementia and professional caregivers during morning care or activities at a day care centre. By means of deductive analysis, autonomy-related ethical dilemmas were identified. The final interpretation was based on perspectives from the theoretical framework.

RESULTS

The analysis revealed three main ethical dilemmas: When the autonomy of the person with dementia conflicted with (1) the family carer's and professional caregiver's need to prevent harm (non-maleficence) (2) the beneficence of family carers and professional caregivers (3) the autonomy of the family carer.

CONCLUSIONS

In order to remain living in their own homes, people with dementia accepted their dependence on others in order to uphold their actual autonomy and live in accordance with their identified values. Paternalism could be justified in light of beneficence and non-maleficence and within an ethics of care.

Making the Move: A Mixed Research Integrative Review

The purpose of this mixed research integrative review is to determine factors that influence relocation transitions for older adults who are considering a move from independent living to supervised housing, such as assisted living, using the Theory of Planned Behavior as a conceptual guide. PubMED, CINAHL, and PsychInfo databases were queried using key words: relocation, transition, older adults, and, elderly and time limited from 1992 to 2014. Sixteen articles were retained for review. The majority of articles, qualitative in design, reveal that older adults who comprehend the need to move and participate in the decision-making process of a relocation adjust to new living environments with fewer negative outcomes than older adults who experience a forced relocation. The few quantitative articles examined the elements of impending relocation using a variety of instruments but support the necessity for older adults to recognize the possibility of a future move and contribute to the relocation process. Additionally, the influence of family, friends, and health care providers provides the older adult with support and guidance throughout the process.

The influence of domestic living arrangement and neighborhood identity on mental health among urban Chinese elders

OBJECTIVES

The primary purposes of the present study were (1) to assess the living arrangements among urban Chinese elders, (2) to examine the relationship between household living arrangement and elders' mental health, and (3) to investigate how individuals' neighborhood identity affects their mental health.

METHOD

The random sample was collected in 2011, including 939 respondents aged 60 and above who lived in the Jing'an district of Shanghai, China. The study examined well-being and depression of elders. The domestic living arrangements were assessed by a single item with five options: 'With whom are you living together?' The neighborhood identity was measured by four items: the sense of belonging, the sense of pride, volunteer work, and monetary donation for the neighborhood.

RESULTS

Urban Chinese elders' living arrangement had transited from a traditional intergenerational co-residence pattern to a more self-independent style. However, living with children was positively associated with elders' mental health after controlling for demographic variables. Although the neighborhood identity had no interaction with living arrangement, it also contributed to elders' mental health.

CONCLUSION

The study highlighted the importance of living with children and spouse, the sense of belonging, volunteer work, and the feelings of pride on elders' mental health. Results of the current study suggested implications for both government and non-governmental organizations to design family-based support for eldercare and improve neighborhood identity for elders.

Stigma and Discontinuity in Multilevel Senior Housing's Continuum of Care

PURPOSE OF THE STUDY

This article presents data from 2 qualitative studies, confirming what gerontologists observed 30 years ago. Multilevel senior housing residents experience stigma and distress in an environment where people are grouped by levels of functioning.

DESIGN AND METHODS

Qualitative, interview-based (N = 367) studies were conducted in senior housing settings offering multiple levels of care (N = 7). Analyses involved revisiting coded narrative data, ethnographers' field-based knowledge, and identification of pattern saturation.

RESULTS

Residents and places reflecting the highest levels of care are stigmatized in a context where people are monitored for health changes and required to relocate. Consequently, residents self-isolate, develop a diminished sense of self, and hide health and cognitive conditions out of fear of relocation.

IMPLICATIONS

Developers, operators, staff, and potential residents need to recognize the personal and social challenges typically experienced even in within-site relocation. It is important to rethink the predominant model of senior housing that requires residents with changing needs to move and adapt to the setting.

Living Arrangement and Loneliness Among Lesbian, Gay, and Bisexual Older Adults

PURPOSE OF THE STUDY

Loneliness is a key health risk for older adults. Utilizing the loneliness model, we examine the relationship between living arrangement and loneliness among lesbian, gay, and bisexual (LGB) older adults, taking into consideration potential correlates including social resources and personal constraints.

DESIGN AND METHODS

We use data from a national survey of LGB adults aged 50 and older (N = 2,444). Types of living arrangement include living with a partner or spouse, living alone, and living with someone other than a partner or spouse.

RESULTS

Compared with LGB older adults living with a partner or spouse, both those living alone and living with others reported higher degrees of loneliness, even after controlling for other correlates. The results of a multivariate regression analysis reveal that social support, social network size, and internalized stigma partially account for the relationship between living arrangement and loneliness.

IMPLICATIONS

Living arrangement was found to be an independent correlate of loneliness among LGB older adults. Targeted interventions are needed to reduce loneliness for those living alone and those living with someone other than a partner or spouse in part by enhancing social resources and reducing risks of internalized stigma. Eliminating discriminatory policies against same-sex partnerships and partnered living arrangements is recommended.

Bargaining Power, Parental Caregiving, and Intergenerational Coresidence

OBJECTIVE

To examine the effect of changes in parent-child coresidence on caregiving decisions of non-resident siblings over a 5-year period while controlling for characteristics of the elderly parent and adult children in the family network.

METHOD

We use difference-in-difference models applied to Health and Retirement Study-Assets and Health Dynamics of the Elderly data to test the hypothesis that the formation of a joint household between a parent and one of her children raises the bargaining power of non-resident siblings, who then reduce their care to the parent. Similarly, the dissolution of a parent-child household is expected to increase the bargaining power of the child who no longer coresides with the parent relative to her siblings.

RESULTS

We find that children whose parent and sibling begin coresiding during the study period are less likely to provide care and provide fewer hours of care than children whose parents never coresided with a child. Adult children whose parent cease coresiding with a sibling, on the other hand, have a higher likelihood of providing care and provide significantly more hours of care relative to children whose parents either coresided with a sibling in both time periods or never coresided with a child.

DISCUSSION

Meeting the needs of the growing elderly population while maintaining them in the community is a particular focus of long-term care policy. To the extent that shared living is an important component of such care, the observed sensitivity of non-resident children's caregiving efforts has implications for the well-being of both disabled parents and their coresiding adult children.

Residential relocation by older adults in response to incident cardiovascular health events: a case-crossover analysis

Objective. We use a case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new home address. Methods. We conducted an ambidirectional case-crossover analysis to explore the association between incident cardiovascular events and residential relocation to a new address using data from the Cardiovascular Health Study (CHS), a community-based prospective cohort study of 5,888 older adults from four U.S. sites beginning in 1989. Relocation was assessed twice a year during follow-up. Event occurrences were classified as present or absent for the period preceding the first reported move, as compared with an equal length of time immediately prior to and following this period. Results. Older adults (65+) that experience incident cardiovascular disease had an increased probability of reporting a change of residence during the following year (OR 1.6, 95% confidence interval (CI) = 1.2–2.1). Clinical conditions associated with relocation included stroke (OR: 2.0, 95% CI: 1.2–3.3), angina (OR: 1.6, 95% CI: 1.0–2.6), and congestive heart failure (OR: 1.5, 95% CI: 1.0–2.1). Conclusions. Major incident cardiovascular disease may increase the probability of residential relocation in older adults. Case-crossover analyses represent an opportunity to investigate triggering events, but finer temporal resolution would be crucial for future research on residential relocations.

Living alone and psychological well-being in mid-life: does partnership history matter?

BACKGROUND

Previous studies have found that the duration since a union dissolution and the number of union dissolutions are associated with psychological well-being. However, these two aspects of partnership history have rarely been considered jointly in models of mental health. This study aims to investigate how the time since the most recent union dissolution and the number of union dissolutions are related to two indicators of psychological well-being-life satisfaction and the General Health Questionnaire-among middle-aged solo-living British men and women.

METHODS

Data from the United Kingdom Household Longitudinal Study from 2009 to 2010 are analysed for 1201 50-64 year olds who were living alone and have ever been in a co-resident union (472 men and 729 women). Logistic regression analysis is used to investigate how life satisfaction and General Health Questionnaire 12 (GHQ-12) caseness are associated with partnership characteristics.

RESULTS

GHQ-12 caseness is significantly and positively associated with the number of union dissolutions and negatively with the duration since the most recent union dissolution. This is the case among both genders, in models in which these partnership characteristics are entered separately and jointly, and in models controlling for parenthood status, socioeconomic status and physical health.

CONCLUSIONS

The results suggest that there is a short-term deterioration in mental health after a partnership break-up and that experiencing multiple union dissolutions is detrimental for psychological well-being. The association between partnership characteristics and the two measures of psychological well-being differs, which is in line with previous research showing that negative affect and life satisfaction are two separate constructs.

Pathways into living alone in mid-life: diversity and policy implications

This paper adopts a life course approach to investigate the pathways into living alone in mid-life in Britain and how these vary by gender and socio-economic status. The rise in the proportion of people living alone over the past three decades has been well documented. However, much of the focus of the existing literature has been on either people living solo in young adulthood or in later life. Mid-life has received surprising little scholarly attention, despite the fact that living arrangements in mid-life are changing rapidly, and that household composition and socio-economic circumstances in the period immediately prior to retirement are strongly associated with living arrangements and associated sources of support in later life. This paper therefore aims to fill this gap. We begin with a review of previous research on living alone and present a conceptual framework of the pathways into living alone in mid-life. Data from the United Kingdom Household Longitudinal Survey (UKHLS) are used to analyse the partnership and parenthood histories and socio-economic characteristics of those currently living alone in mid-life. The findings indicate that the dissolution of a marriage with children is the dominant pathway into mid-life solo-living, but that there is also a substantial group of never partnered men living alone. These never partnered men are split between those with low and high socio-economic status. Distinguishing between different groups of individuals living alone in mid-life is important for policy as these groups of men and women will have different social and financial resources as they enter later life. Mid-life men living alone who have not had children, have no educational qualifications, are not economically active and who live in rented housing are likely to be most at risk of needing a social and economic 'safety net' in old age.

Is self-rated health still sensitive for changes in disease and functioning among nonagenarians?

OBJECTIVES

With age, there is an increasing gap between relatively stable levels of self-rated health (SRH) and actual health status. This study investigates longitudinal changes in SRH and examines its sensitivity to changes in chronic conditions and functioning among people aged 90 and older.

METHODS

In the Vitality 90+ Study, questionnaires were sent to all people aged 90 years and older living in Tampere, Finland. Included were respondents who provided data on the 2001 measurement and at least one follow-up measurement in 2003, 2007, or 2010 (N = 334). Generalized Estimating Equations analyses examined longitudinal change in SRH and the predictive value of number of chronic conditions and a functioning score based on 5 activities.

RESULTS

Within 2 years, most people (56.3%) had unchanged SRH, but declined SRH (22.3%) was associated with worse baseline functioning and declined functioning. Clear declines in SRH after 6 and 9 years were associated with increased chronic conditions (odds ratio [OR] = 1.23) and decreased functioning (OR = 1.28). The impact of chronic conditions and functioning was smaller among institutionalized people (chronic conditions OR = 0.90; functioning OR = 1.18) than among people living independently (chronic conditions OR = 1.30; functioning OR = 1.44).

DISCUSSION

SRH among nonagenarians was sensitive to changes in the number of chronic conditions and functioning although more pronounced on the longer than on the shorter term.

Relocation remembered: perspectives on senior transitions in the living environment

The experience of aging may necessitate transitions in living environments, either through adaptations to current residences or through relocations to more supportive environments. For over a half century, the study of these transitions has informed the work of researchers, health and mental health providers, policymakers, and municipal planners. In the 1970s and 80s, knowledge about these transitions advanced through Lawton and Nahemow's ecological theory of competence and environmental press, Wiseman's behavioral model of relocation decision making, and Litwak and Longino's developmental perspective on senior migrations. This article revisits influential theoretical frameworks that contribute to our understanding of senior transitions in living environments. These seminal works are shown to inform recent studies of relocation and gerontology. This article concludes with a call for a view on housing transitions that reflects the contemporary context.

[Use of family resources in future need of care. Care preferences and expected willingness of providing care among relatives: a population-based study]

The family is an important resource in elderly care. It is of great interest if persons who might be in need of care in the future would use this resource. Our study assessed wishes and expectations regarding family care in a representative sample of the general population (≥ 45 years, N = 1,445) using questionnaires. Logistic regressions were performed to analyze the potential impact on the willingness to use or provide family care. One quarter of the participants reported experience in family care. In case of own need 62.9% of participants would prefer care provided by relatives and 56.7% would prefer professional care. Participants are more likely to use family care if they report having relatives, are experienced in care of relatives or do not associate old age with being a burden, e.g. report low values in the image of age "being a burden/demanding". Perceived willingness of the relatives to provide care is more likely if there is little regional distance to the relatives, in male participants and if participants talked about future care with their relatives. Besides structural factors, negative images of old age might have a negative influence on the willingness to use family care. Talking about care in old age seems to have a positive impact.