Living Alone and Depressive Symptoms Among Older Japanese: Do Urbanization and Time Period Matter?

Health-related quality of life of Korean older adults according to age, sex, and living arrangements: a cross-sectional study

Introduction

The number and proportion of older adults living alone is a significant issue. While the number of the oldest old people is also expected to increase, their health characteristics are poorly understood. This study aims to evaluate the health-related quality of life (HRQoL) of the oldest old people according to age, sex, and living arrangements.

Methods

This study is based on the Korea Community Health Survey 2021. Among the survey's 229,242 observations, 73,617 observations aged 65 or higher were used for the analysis. The study participants were divided into 5-year age intervals (from 65-69 to 90+), sex, and living arrangements. The outcome variables are the EuroQol 5 Dimensions (EQ-5D) index score and the problem reporting rates of the five dimensions of EQ-5D.

Results

The mean EQ-5D index scores were 0.896 at 65-69 and 0.741 at 90+. The mean EQ-5D index score decreased more rapidly as age increased. Women showed consistently lower mean EQ-5D index scores than men in all age intervals. The proportion of older adults living alone increased from 18.1% at 65-69 to 43.6% at 90+. The odds of reporting problems with anxiety/depression among older men living alone were estimated to be significantly higher than older men living with someone (aOR 1.22 95% CI 1.05-1.43). The odds of reporting problems in self-care and usual activity among older women living alone were estimated to be significantly lower than older women living with someone (aOR 0.88 95% CI 0.70-0.83 and aOR 0.88 95% CI 0.82-0.94).

Conclusion

This study showed that older adults' HRQoL deteriorates as their age increases. Moreover, living alone may lead to different effects on older adults' HRQoL according to sex. More comprehensive studies and collaborative attention are needed to identify and provide customized care for older adults.

Living alone and the risk of depressive symptoms: a cross-sectional and cohort analysis based on the China Health and Retirement Longitudinal Study

BACKGROUND

There were a few studies that examined the longitudinal association between living alone and depressive symptoms, and the vast majority of them were conducted in patients with certain diseases, such as heart failure, cancer, and glaucoma. This study aimed to examine the association between living alone and depressive symptoms in a large representative older Chinese population.

METHODS

The China Health and Retirement Longitudinal Study (CHARLS) data from 2015 to 2018 were used. Living alone was defined as participants who did not live with others ever or more than 11 months in the past year at baseline. Depressive symptoms were measured using the 10-item Center for Epidemiological Studies-Depression Scale (CES-D10). The multivariate logistic regression was used to estimate the relationship between living alone and depressive symptoms.

RESULTS

There were 5,311 and 2,696 participants ≥ 60 years old included in the cross-sectional and cohort analysis, respectively. The risk of depressive symptoms in participants who lived alone was significantly higher than those who lived with others in both cross-sectional (OR:1.33; 95%CI:1.14,1.54) and cohort analysis (OR:1.23; 95%CI:0.97,1.55). There was a significant interaction between financial support and living alone (Pinteraction = 0.008) on the risk of depressive symptoms. Stratified analyses showed that, compared to those who lived with others, the risk of depressive symptoms in participants who lived alone increased by 83% (OR:1.83; 95%CI:1.26,2.65) in participants receiving lower financial support. However, we did not find statistically significant associations in participants with medium (OR:1.10; 95%CI: 0.74,1.63) and higher financial support (OR: 0.87; 95%CI: 0.53,1.41).

CONCLUSION

Living alone was associated with a higher risk of depressive symptoms in the Chinese older population, and this association was moderated by the receipt of financial support. Living alone may be an effective and easy predictor for early identification of high-risk populations of depression in the older population.

Prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in living arrangements: a cross-sectional study

BACKGROUND

Older adults with different living arrangements may have different mental health statuses and different factors that influence their mental health. The aim of the present study is to investigate the prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in their living arrangements.

METHODS

Participants were 6,055 older adults from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms and their determinants were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale and multivariate logistic regression analysis, respectively.

RESULTS

The prevalence of depressive symptoms among older adults living alone, as a couple, and with children was 47.8%, 33.2%, and 39.5%, respectively. The common risk factors for depressive symptoms were shorter sleep duration, poorer activities of daily living, and poorer self-rated health. Women, those with lower educational levels, and those suffering from chronic diseases had a higher risk of depressive symptoms among older adults living as a couple and those living with children. Smoking and participation in economic activities were also risk factors of depressive symptoms among older adults living with children and those living alone, respectively.

CONCLUSIONS

The findings suggest that older adults living as couples had the lowest prevalence of depressive symptoms, while those living alone had the highest prevalence of depressive symptoms. The determinants of depressive symptoms differed by living arrangement; hence, they should be considered in future interventions.