The impact of adult children living at home on the well-being of Spanish parents: Evidence from panel data

Despite the prevalence of co-residence of adult children and their parents across Europe, there is only limited empirical evidence on the impact of such living arrangements on well-being. This paper investigates the impact of adult children living in the household on the well-being of Spanish parents aged 50-75. Using three waves of panel data from the Spanish Survey of Household Finances we assess whether the impact on parental well-being differs depending on the age of the child, and whether the effect depends on the gender of the parent. We find that there is a negative impact on parents' well-being of older adult children (aged 30 or over) living in the household, while cohabitation with younger children (aged 18-29) is not found to affect parental well-being. When analysing the impact on mothers and fathers separately we find that the negative effect of older children living in the household is driven by a significant reduction in the well-being of mothers, with no evidence of a corresponding effect on fathers. The negative effect on mothers' well-being seems to be related to co-residence with older sons rather than older daughters.

Happiness in Old Age: The Daughter Connection

Family and intergenerational relationships are becoming increasingly important as sources of support and care for the elderly population in rapidly ageing Asian societies. However, this has also raised concerns over reinforcement of cultural preference for sons as a source of old-age security. This paper therefore revisits the question-what determines happiness in old age-by investigating the role of adult children's gender in the context of Thailand, an ageing Asian country with no legacy of sex-preference in fertility. We employ nationally representative data to examine the association between old-age happiness and presence of a co-residing child. Compared to living alone, living with at least one child is found to positively associate with older persons' happiness. However, this result is specific to daughters. Moreover, compared to older men, women systematically benefit from a "daughter effect". Co-residing daughters with university education and those who maintain a good relationship with their parents help explain the positive happiness effect on older persons. Co-residing daughters are also positively linked to  reduced loneliness; improved self-rated health; and improved economic conditions of older parents. Our findings suggest that policies that increase human capital of the girl child and enhance family solidarity are likely to have long term intergenerational wellbeing benefits.

Prevalence of and Factors Associated with Negative Psychological Symptoms among Elderly Widows Living Alone in a Chinese Remote Sample: A Cross-Sectional Study

(1) Background: Research indicates that most elderly widows are at a high risk of experiencing negative psychological symptoms. It is common for elderly women in rural and remote areas to live alone without family support to cope with stress due to the mass rural-to-urban migration of China’s youth labor force. Such a situation further worsens their psychological health and well-being. However, the prevalence of and risk factors associated with negative psychological symptoms (loneliness, depression, and anxiety) among remote elderly widows living alone in China are currently unclear; (2) Methods: A cross-sectional study was conducted in Hunan Province, China. The loneliness was assessed through the University of California at Los Angeles Loneliness Scale (ULS-8). The depression and anxiety were assessed with the Short Form Geriatric Depression Scale (GDS-15) and Generalized Anxiety Disorder Scale (GAD-7), respectively. The Chi-square test and correlation analysis were conducted to identify factors associated with negative psychological symptoms. Logistic regression was performed to predict risk and protective factors contributing to loneliness, depression, and anxiety symptoms. The significance level was set as p < 0.05; (3) Results: A total of 271 remote elderly widows living alone were enrolled in the present study. Additionally, 234 valid questionnaires were returned (valid response rate = 86.3%). The prevalence of loneliness, depression and anxiety was 8.1%, 44.0%, and 16.7%, respectively. Acute or chronic medical conditions, marital happiness, being the primary caregiver before widowhood and anticipating the death of the spouse differed significantly in the distribution of negative psychological symptoms. Logistic regression analysis predicted that participants who were satisfied with their marriage had a lower likelihood to experience loneliness, depression, and anxiety (p < 0.05). Being the spouse’s primary caregiver before widowhood was more likely to have symptoms of loneliness (p < 0.01). Those with various acute or chronic medical conditions were more likely to suffer from depression (p < 0.01); (4) Conclusions: Remote elderly widows living alone in China are prone to loneliness, depression, and anxiety symptoms. Being the primary caregiver before widowhood and having many acute or chronic medical conditions are risk factors for loneliness and depression, respectively. Marital happiness is the protective factor against negative psychological symptoms. To accomplish the goal of equitable access to mental health care in China, evidence-based policy and resource development to support psycho-social interventions that prevent and manage negative psychological symptoms for remote elderly widows living alone are urgently needed.

The Negative Impact of Adult Children's Marital Dissolution on Older Parents' Mental Health in South Korea

OBJECTIVE

Little is known about whether and the extent children's marital dissolution deteriorates older parents' mental health. This study examines the association of children's marital dissolution with parents' mental health, and whether children's gender and intergenerational contact and support moderate such an association in South Korea, where family lives are strongly linked under the Confucian collectivistic legacy.

METHODS

We apply fixed effects models on 15,584 parent-child dyads nested in 5,673 older parents (45-97 years in Wave 1) participating in the four waves of the Korean Longitudinal Study of Aging (KLoSA), conducted from 2006 to 2012.

RESULTS

In South Korea, a son's transition to marital dissolution is associated with higher levels of parents' depressive symptoms. Frequent parent-son contacts of at least once a week, living with a son, and increasing financial transfers from parents to a son tend to reduce the negative association of the son's marital dissolution with parents' depressive symptoms.

DISCUSSION

The findings imply that a son's transition to marital dissolution, as a later-life stressor, is detrimental to parents' mental health in a patrilineal Asian cultural context. The study also highlights the importance of intergenerational bonding in mitigating the negative impact of children's marital dissolution upwardly transmitted to their older parents.

Negative Life Events, Social Ties, and Depressive Symptoms for Older Adults in China

Although it is widely acknowledged that older adults who have gone through negative life events are more likely to develop depression, there is limited evidence on whether and which type of social ties moderate this perceived relationship. Based on 2016 and 2018 waves of Chinese Longitudinal Aging Social Survey (4,466 individuals, 8,932 observations), we apply linear fixed effects models and confirm that negative life events are associated with depressive symptoms for older adults (Coef. = 0.35; 95% CIs 0.11–0.61), and social ties are negatively associated with depression (Coef. = −0.08; 95% CIs −0.10 to −0.07). Our study further suggests that the association between negative life events and depressive symptoms is significantly moderated by friendship ties (Coef. = −0.18, 95% CIs −0.30 to −0.07), rather than family ties (Coef. = −0.03, 95% CIs −0.09 to 0.15). Moreover, the buffering effects of friendship ties are more prominent for the less resilient and less privileged groups, namely male, rural, and less educated older adults. Our findings point to the importance of expanding and strengthening social networks for Chinese older adults in promoting their psychological health.

Migration of adult male children and associated depression among community-dwelling older parents: A cross-sectional gender analysis from Longitudinal Ageing Study in India, 2017-2018

OBJECTIVES

This study empirically examines the association of migration of an adult male child (ren) on the mental health of the older parents left behind. It also examines the interaction effects of sex of older parents and male child migration on major depression to explore whether there is a gender differential in the possible association.

METHODS

The data for this study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). The total sample size for the present study was 27,248 older adults aged 60 years and above (male-12,624; female-14,624). Descriptive statistics along with cross-tabulation were presented. Proportion test was used to evaluate the significance level of differences in depression by sex. Additionally, binary logistic regression analysis was used to find out the associations. Major depression with symptoms of dysphoria, was calculated using the Short-Form Composite International Diagnostic Interview (CIDI-SF).

RESULTS

About 10.5% and 9.0% of older males and females had migrant sons. It was found that there was significant gender differential in depression in older age (male: 7.5% and female: 9.7%; p < 0.001). It was further found that the prevalence of depression was found among older men (9.3% vs. 7.3%) and women (12.5% vs. 9.4%) with migrant son. Older adults with migrant son had 26% significantly higher likelihood to be depressed in reference to older adults with non-migrant son (AOR: 1.26; CI: 1.02-1.56). Further, older women with a migrant son had 76% significantly higher likelihood to be depressed in reference to older men with migrant son (AOR: 1.76; CI: 1.32-2.39).

CONCLUSIONS

This study invites policymakers' attention towards migration of adult children and its potential effects on mental health of left-behind older parents in community-settings and in women in particular. Policies should focus on spreading awareness to migrant children of older adults on maintaining frequent contacts and visits to their ageing parents.

The association of widowhood and living alone with depression among older adults in India

Widowhood is a catastrophic event at any stage of life for the surviving partner particularly in old age, with serious repercussions on their physical, economic, and emotional well-being. This study investigates the association of marital status and living arrangement with depression among older adults. Additionally, the study aims to evaluate the effects of factors such as socio-economic conditions and other health problems contributing to the risk of depression among older adults in India. This study utilizes data from the nationally representative Longitudinal Ageing Study in India (LASI-2017-18). The effective sample size was 30,639 older adults aged 60 years and above. Descriptive statistics and bivariate analysis have been performed to determine the prevalence of depression. Further, binary logistic regression analysis was conducted to study the association between marital status and living arrangement on depression among older adults in India. Overall, around nine percent of the older adults suffered from depression. 10.3% of the widowed (currently married: 7.8%) and 13.6% of the older adults who were living alone suffered from depression. Further, 8.4% of the respondents who were co-residing with someone were suffering from depression. Widowed older adults were 34% more likely to be depressed than currently married counterparts [AOR: 1.34, CI 1.2-1.49]. Similarly, respondents who lived alone were 16% more likely to be depressed compared to their counterparts [AOR: 1.16; CI 1.02, 1.40]. Older adults who were widowed and living alone were 56% more likely to suffer from depression [AOR: 1.56; CI 1.28, 1.91] in reference to older adults who were currently married and co-residing. The study shows vulnerability of widowed older adults who are living alone and among those who had lack of socio-economic resources and face poor health status. The study can be used to target outreach programs and service delivery for the older adults who are living alone or widowed and suffering from depression.

The mixed blessing of living together or close by: Parent-child relationship quality and life satisfaction of older adults in China

BACKGROUND

Geographic proximity between parents and children is increasingly recognized as an alternative measure to coresidence as a gauge for intergenerational support in China. The quality of intergenerational relationships is another important dimension of intergenerational ties that is often underexplored.

OBJECTIVE

We examine the association between parent-child proximity and life satisfaction of older adults and how it interacts with the quality of intergenerational relationships, particularly for vulnerable subpopulations.

METHODS

We use data from the China Longitudinal Aging Social Survey (CLASS 2014). We use ordered logit models to predict life satisfaction scores (ranged 1 to 4).

RESULTS

Our analyses show that parent-child relationship quality is strongly associated with life satisfaction, regardless of living proximity, in our full sample analysis. For those who have a lower-quality relationship with their children, coresidence or close-distance living does not enhance life satisfaction and they indeed have lower life satisfaction than those parents who have all children living farther away but maintain a high-quality relationship with them. At the same time, for those who have a high-quality relationship with their children, we find that close proximity provides added benefits for the subpopulations who are socioeconomically or physically disadvantaged, that is, female, urban, unmarried, and disabled (in terms of being capable of activities of daily living, or ADL) older adults.

CONCLUSIONS

We recognize the interdependence of the quality of the intergenerational ties and parent-child proximity in promoting life satisfaction, particularly for subpopulations who are in stronger need of support from adult children.

CONTRIBUTION

Our study clearly points to the importance of extending the research on intergenerational relationship beyond the boundary of the household and of paying close attention to the affective dimension of intergenerational ties.

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.

Moving beyond living arrangements: the role of family and friendship ties in promoting mental health for urban and rural older adults in China

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0-18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0-15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = -0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = -0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults' social networks, and these moderating effects vary between rural and urban China.

A longitudinal analysis of the association between the living arrangements and psychological well-being of older Chinese adults: the role of income sources

Background

Understanding how living arrangements may affect psychological well-being (PWB) is critical in China, a society with the largest older population in the world. However, few studies have examined the moderating effect of income sources on the relationship between living arrangements and PWB. Our aim was to examine whether living arrangements are associated with PWB and whether income sources moderate this association.

Methods

The data were drawn from the third (2002) to sixth (2011/2012) waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Six questions reflecting older adults’ well-being were used to measure PWB. Living arrangements were classified as follows: living alone, living with family and living in an institution. Income sources were categorized into financially independent, supported by children, and governmental support. We performed random-effects ordinal probit models to examine the association of living arrangements with PWB and the moderating effect of income sources on this relationship.

Results

We included a total sample of 30,899 observations for 16,020 respondents aged 65 and over during 9-year follow-up. Older adults living with family (β = .29, p < .001) and those living in an institution (β = .34, p < .001) had stronger PWB than those living alone; moreover, support from children (β= −.24, p < .001) or from the government (β= −.08, p < .05) has a negative effect on PWB compared to the effect of financial self-support. Living in an institution with support from children (β= −.22, p < .05) led to lower PWB than living alone with financial self-support. The opposite result was observed for older adults living with their family and supported by the government (β = .16, p < .05).

Conclusions

Our analysis provides a significant contribution to the existing literature on the relationship between living arrangements and PWB in China. We recognize that living with family or in an institution leads to better PWB than does living alone. In addition, financial support from the government can moderate this association.

Subjective wellbeing of Chinese elderly: a comparative analysis among Hong Kong, Urban China and Taiwan

This study investigates the relative importance of living with adult children and social participation for the elderly's subjective wellbeing (happiness) in three Chinese societies (Hong Kong, urban China and Taiwan). We use data from the 2011 wave of the Hong Kong Panel Study of Social Dynamics (N = 1,658), the 2010 China Family Panel Studies in mainland China (N = 3,198) and the 2010 wave of the Taiwan Social Change Survey (N = 790). The ordinary least squares regression shows that, as the family value of society moves forward on a traditional–modern continuum, the elderly benefit more psychologically from social participation and less from living with children. The older people in Hong Kong who live independently with a spouse are in a significantly better emotional state than those living with adult children. Social participation is positively associated with subjective wellbeing among the aged in Hong Kong but not among those in urban China and Taiwan. The findings suggest that encouraging social involvement is important for effective public policy to tackle rapid population ageing in Chinese societies.

Widowhood and Depression in a Cross-National Perspective: Evidence from the United States, Europe, Korea, and China

Objectives

We explore marital and depression trajectories over time for men and women, and distinguish between mood and somatic depression across contexts.

Method

We use longitudinal data from 2002 to 2013 from the United States, England, Europe, Korea, and China to explore depression among individuals married at baseline and follow their trajectories into widowhood with married as the reference group. We use random effects models to estimate these trajectories using the Center for Epidemiologic Studies Depression Scale (CES-D) or EURO-D scales for men and women.

Results

Depression peaks within the first year of widowhood for men and women, but women recover to levels comparable to married counterparts in all countries. Men sustain high levels of depression even 6-10 years post-widowhood everywhere except Europe. Widowed women have higher somatic depression compared to men, who have higher mood depression. Family plays differential roles in mediating depression across countries.

Discussion

Our research shows the complex global relationship between widowhood and depression. Studies that do not compare depression trajectories over time may make incorrect inferences about the persistence of depression by gender and country. Interventions should target different components of depression: mood-related symptoms for men and somatic-related symptoms for women for most effective recovery.

A Pilot Study to Test the Feasibility of a Home Mobility Monitoring System in Community-Dwelling Older Adults

Technology enables home-based personalized care through continuous, automated, real-time monitoring of a participant's health condition and remote communication between health care providers and participants. Technology has been implemented in a variety of nursing practices. However, little is known about the use of home mobility monitoring systems in visiting nursing practice. Therefore, the current study tested the feasibility of a home mobility monitoring system as a supportive tool for monitoring daily activities in community-dwelling older adults. Daily mobility data were collected for 15 months via home-based mobility monitoring sensors among eight older adults living alone. Indoor sensor outputs were categorized into sleeping, indoor activities, and going out. Atypical patterns were identified with reference to baseline activity. Daily indoor activities were clearly differentiated by sensor outputs and sensor outputs discriminated atypical activity patterns. During the year of monitoring, a health-related issue was identified in a participant. Our findings indicate the feasibility of a home mobility monitoring system for remote, continuous, and automated assessment of a participant's health-related mobility patterns. Such a system could be used as a supportive tool to detect and intervene in the case of problematic health issues.

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

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

Intergenerational relationship, family social support, and depression among Chinese elderly: A structural equation modeling analysis

OBJECTIVE

This study aimed to investigate the association among intergenerational relationship, family social support, and elderly's depression symptoms.

METHOD

Data were obtained from China Longitudinal Aging Social Survey (CLASS) 2014, which is a continuous large-scale national social survey project conducted by the National Survey Research Center at Renmin University of China. Stratified multi-stage probability sampling method was used to collect the sample (N = 11,511). Structural equation modeling was adopted to analyze the association among intergenerational relationship, family social support, and elderly's depression.

RESULTS

Intergenerational relationship and family social support were negatively correlated with an elderly's depression level. Elderly who enjoyed positive intergenerational relationships with their children would experience adequate family social support and likely have few depression symptoms.

CONCLUSION

Intergenerational relationship directly affected the elderly's depression level. Family social support played a mediating role between intergenerational relationship and depression. Our findings could contribute to current theories and knowledge and provide implications in social policy, pension service, and social work intervention for the elderly in China.

Factors Related to the Institutionalization of Older Aged Individuals Using Home- and Community-Based Care Services: Data From the South Korea Long-Term Care Insurance Program, 2008-2013

South Korea introduced a public long-term care insurance (LTCI) program in response to its rapidly aging population. This study analyzed the association between living arrangement and caregiver type with institutionalization in LTCI grade 1 (very severe limitations), 2 (severe limitations), and 3 (moderate limitations) beneficiaries using data from the LTCI cohort, 2008 to 2013. The dependent variable was alteration status from home to institutional care within 1 year of receiving home service. Independent variables were living arrangement and primary caregiver type. The analysis was conducted using the generalized estimating equation model. Higher likelihoods of institutionalization were found in individuals living with a non-family member compared to individuals living with their spouses. Individuals without a caregiver or with a paid caregiver were also more likely to experience institutionalization than individuals with a spouse primary caregiver. Our findings underscore the importance of monitoring identified vulnerable groups of individuals to attain LTCI sustainability and enhance elderly quality of life.

Migration of adult children and mental health of older parents 'left behind': An integrative review

Background

Although a number of studies have examined the effect of the out-migration of children on the mental health of ‘left behind’ elderly parents, research on the consequences of children’s migration on the mental health and well-being of elderly parents left behind is inconclusive and a systematic review is warranted.

Objectives

To identify the association between the left behind or empty nest status and the mental health of older parents, and to identify common risk factors for poor mental health among those left behind.

Methods

Online databases CINAHL, PsycINFO, PubMed, Scopus and ProQuest were searched for research (2000-September 2017) that focused on the relationship between the migration of adult children and the mental health of the older parents (≥50 years) left behind. The JBI Checklist for Analytical Cross Sectional Studies was used to assess the methodological quality of the articles.

Results

25 articles met the inclusion criteria. The studies identified that left behind older parents had higher levels of mental health problems compared to non-left behind. Left behind parents had higher depressive symptoms, higher levels of loneliness, lower life satisfaction, lower cognitive ability and poorer psychological health. A number of risk factors were identified for mental health disorders among the left behind parents, which included living arrangements, gender, education, income, physical health status, physical activity, family and social support, age, rural residence and frequency of children’s visit.

Conclusions

This review synthesised the various studies related to the mental health of left behind parents, advancing the theoretical and empirical understanding of the implications of out-migration of adult children on the psychological health and well-being of older parents. More responsive preventive measures and effective management approaches are required for this vulnerable cohort.

The Effect of a Reduced Statutory Workweek on Familial Long-Term Care in Korea

Objectives: We examine how statutory workweeks affect workers’ provision of long-term care for their non-coresident elderly parents. Method: The Korean government reduced its statutory workweek from 44 to 40 hr, gradually from larger to smaller establishments, between 2004 and 2011. Using multiple regressions, we assess how the reduction affected visits, financial transfers, and in-kind transfers to parents. Annual longitudinal data come from the 2005 to 2013 waves of the Korea Labor and Income Panel Study. Results: The reduction caused an increase in the frequency of visits and in-kind transfers among male workers, with no significant impact on their financial transfers. Among female workers, we found no impact on any outcomes. Discussion: We interpret the findings within the context of developed Asian countries with long work hours and Confucian traditions, and suggest regulating workweeks as a policy tool to encourage familial long-term care in the rapidly aging societies.

Impact of family characteristics by marital status of cohabitating adult children on depression among Korean older adults

AIM

To identify the association between different living arrangements of intergenerational household composition and depression in older adults.

METHODS

Data from the Korea Longitudinal Study of Aging, the first to fourth waves, were used. Using the first wave as baseline, our analysis included 5046 participants aged ≥60 years with at least one living child. Depression was measured using the 10-item Center for Epidemiological Studies Depression scale. Factors investigated included living arrangements according to household composition and the marital status of a cohabiting adult child. A generalized estimating equation with the logit link for binary outcomes was used to examine the association between living arrangements and depression.

RESULTS

Compared with the older adults living with a married child and grandchildren, those living alone, those living with an unmarried child, and those living with an unmarried child and grandchildren were more likely to have depression (OR 1.41, 95% CI 1.13-1.75; OR 1.40, 95% CI 1.18-1.66; OR 1.60, 95% CI 1.27-2.01). In particular, women were more likely to have depression than men in the association between living arrangements and depression.

CONCLUSIONS

Efforts should be made to provide social services for older adults living alone and those living with an unmarried child in a two-/three-generation family, in particular, for those who are female. Geriatr Gerontol Int 2017; 17: 2527-2536.

Implications of Changes in Family Structure and Composition for the Psychological Well-Being of Filipino Women in Middle and Later Years

The health implications of multigenerational coresidence for older adults is a well-researched topic in the aging literature. Much less is known of its impact for women in midlife. We used data from the Cebu Longitudinal Health and Nutrition Study (2002, 2005, 2007, and 2012) to study the influence of transitions in multigenerational household composition on depressive symptoms for women in midlife transitioning into old age. Our initial analysis showed little effect when we use the conventional classification of nuclear versus extended family and transition in and out of extended family. When we described shifts in the family environment by compositional changes, that is, change in the presence and absence of particular family members, we found significant association between depressive symptoms and two types of role transitions: the loss of a spouse in the household and the entry and exit of grandchildren in the household.

Changes in South Korean urbanicity and suicide rates, 1992 to 2012

OBJECTIVES

Studies have highlighted the association between the degree of urbanicity and spatial disparities in suicide, but few have evaluated its changes across time. We explored the geospatial trends of suicide in South Korea from 1992 to 2012, and their relationship to the nation's evolving urbanicity.

SETTING

South Korea.

PRIMARY OUTCOME MEASURES

Age-sex-specific suicide rate.

RESULTS

Suicide rates increased in all regions of South Korea during the study period. Controlling the effects of age and sex, there was an overall inverse relationship between the degree of urbanicity and regional suicide rates. These associations were, however, attenuated across the periods, as there were smaller increases in suicide rates in mid-sized urban regions as compared to larger cities and to rural areas. Increases over time in the suicide rates among youth and working-age adults were greater in large urban centres and in rural regions. For elders, the increase was far greater in rural regions.

CONCLUSIONS

The association of urbanicity and the geospatial pattern of suicide in South Korea was a dynamic process and varied by age groups across the course of two decades. Internal migration and related social processes most likely contributed to these changes.

Living Arrangements and Psychological Well-Being of the Older Adults After the Economic Transition in Vietnam

OBJECTIVES

We examine the relationship between living arrangements and psychological well-being of the older adults in Vietnam, where there is an influence of Confucian values and a lack of close substitutes for family care of the older adults, by exploiting a great deal of regional variation in economic development. We also examine the role of living arrangements in well-being differentials across regions.

METHOD

We estimate a triangular simultaneous-equation discrete-response model, which accounts for the simultaneity between living arrangements and psychological well-being (happiness, depression, loneliness, poor appetite, and sleep disorder), using a nationally representative sample of 2,225 adults aged 60 and older drawn from the 2011 Vietnam Aging Survey.

RESULTS

Intergenerational coresidence significantly increases the psychological well-being of the older adults in Vietnam. The results are fairly robust, even after taking quasi-coresidence into account, decomposing the psychological well-being index into each affect and symptom, and splitting the sample by gender.

DISCUSSION

Changes in living arrangements induced by differences in labor market opportunities in neighboring regions have resulted in significant differences in psychological well-being among the older adults. The findings point to the need for attention to the mental health of elderly parents left behind in less economically developed regions.

Intergenerational financial exchange and the psychological well-being of older adults in the Republic of Korea

OBJECTIVES

This study examined whether the exchange of instrumental support (i.e., financial resources) among older adults and their children was related to the psychological well-being of older Koreans.

METHODS

Data from the Korean Longitudinal Study of Ageing were employed. Older adults who were aged 65 and older and who had at least one living child who did not live in the respondent's household were included (N = 3791). Well-being was measured with depressive symptoms (CES-D-10) and life satisfaction. For the direction model of exchange, giving and receiving support was assessed with financial aid (cash and non-cash). For the reciprocity model of exchange, four patterns of financial exchanges were identified: both giving and receiving, receiving only, giving only, and no exchange.

RESULTS

The results from the direction model showed that older adults who give financial support were less likely to be depressed and reported higher levels of life satisfaction. The effect of receiving support was not significant for depression but was related to higher levels of life satisfaction. The results from the reciprocity model showed that those who gave and received support had better psychological health compared to those who only received support.

CONCLUSIONS

Both giving and receiving were positively related to the psychological well-being of older adults. Our results provide support for identity theory and equity theory as frameworks for understanding intergenerational exchange and well-being of older Koreans.

How do living arrangements and intergenerational support matter for psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand

Living arrangements and family support for older persons have become an increasingly important policy concern in developing and rapidly aging Asia. Formulating a sound elderly care policy for the region will benefit from empirically examining how living arrangements, particularly coresidence, and intergenerational exchanges of financial, instrumental, and emotional support are associated with old-age psychological health. This study analyzes data from nationally representative aging surveys in Myanmar, Vietnam, and Thailand for 2011-2012 to offer a comparative perspective from Southeast Asia where various kinship systems coexist. Results suggest that coresidence with a child of culturally preferred gender significantly improves the emotional health of Vietnamese and Thai elders but with different implications. In Vietnam, living with a married son is more beneficial to parents' psychological wellbeing than living with other children. In Thailand, coresidence regardless of the child's gender improves old-age psychological wellbeing but living with a daughter brings greater benefits than living only with son. Evidence points to the importance of understanding the dominant kinship system that may shape normative filial expectations and gender role expectations within the family. In Vietnam and Thailand, the positive association holds even after intergenerational support is controlled, suggesting that the value of culturally preferred coresidence goes beyond practical functions. In Myanmar, there are almost no significant differences in psychological wellbeing among elderly across various living arrangements, except between coresidence and network living arrangements. For all settings, we do not find evidence in support of network family arrangements as a complete substitute for coresidence in terms of promoting old-age psychological wellbeing after filial support is controlled. Our study highlights important cultural nuances for theorizing the nature of the relationship between living arrangements and old-age psychological health, and presents the important need for more rigorous investigation of the causal links between these two phenomena in future research.

Depressive Symptoms Among Older Mexicans: The Role of Widowhood, Gender, and Social Integration

Widowhood is often associated with decreased mental health. In developing countries with low institutional support, such as Mexico, social integration can be particularly consequential for widowed older adults' psychological well-being. This study investigates the interplay among depressive symptoms, widowhood, gender, and social integration in a nationally representative sample of older Mexicans. Drawing on Waves 1 (2001) and 2 (2003) of the Mexican Health and Aging Study, we estimated the ordinary least squares regressions to examine the implications of widowhood, gender, social support, social network, and social engagement for changes in depressive symptoms between the waves among Mexicans aged 50 and older (N = 8,708). The findings indicate that social integration can mitigate as well as exacerbate depressive symptomatology among older Mexicans. Certain aspects of social integration can moderate marital status-gender differences in depressive symptoms among older Mexicans.

Living arrangements, chronic diseases, and prescription drug expenditures among Korean elderly: vulnerability to potential medication underuse

Background

Insufficient social security combined with family structure changes has resulted in a poverty of the elderly. The objective of this study was to examine an association of living arrangements of the elderly with chronic disease prevalence and prescription drug use.

Methods

2008 Korea Health Panel Survey (KHPS) data were used in this study. Information on living arrangements, socio-demographics, health behaviors, chronic disease prevalence and healthcare expenditures including out-of-pocket (OOP) prescription drug expenditures for elderly aged 65 or older were collected from self-reported diaries and receipts. OOP prescription drug expenditure as a total cost that subject paid to a pharmacy for prescription drugs was examined. Logistic regression was used to identify differences in major chronic disease prevalence by living arrangements. The association of living arrangements with prescription drug use was analyzed using generalized linear model with a log link and a gamma variance distribution.

Results

Proportions of elderly living alone, elderly living with a spouse only, and elderly living with adults aged 20–64 were 14.5%, 48.3%, and 37.2%, respectively. Elderly living alone showed 2.43 odds ratio (OR) (95% confidence interval (CI) = 1.66-3.56) for having major chronic diseases prevalence compared to elderly living with adults. Despite a higher major chronic disease prevalence, elderly living alone showed lower OOP prescription drug expenditures (Cost Ratio = 0.80, 95% CI = 0.67-0.97) after adjusting for the number of major chronic diseases. Total OOP prescription drug expenditures were significantly lower in patients with a low income level versus high income level.

Conclusions

Even though elderly living alone had a higher risk of chronic disease, they spent less on OOP prescription drug expenditures. Optimal drug use is important for elderly with chronic diseases to achieve good health outcomes and quality of life. Public health policies should be supplemented to optimize medical treatment for vulnerable elderly living alone.

The relationship of living arrangements and depressive symptoms among older adults in sub-Saharan Africa

BACKGROUND

Older adults in sub-Saharan Africa are increasingly facing the twin challenges of reduced support from their adult children and taking on new roles caring for orphans and vulnerable children. How these changes affect the mental health of older adults is largely unknown.

METHODS

We use data from the 2002-2003 World Health Surveys for 15 countries in sub-Saharan Africa to examine whether older adults who may be lacking adequate support through living alone or in skipped-generation households are at an increased risk of depressive symptoms compared to those living with at least one working-age adult. Using meta-regression, we also examine whether heterogeneity across countries in the prevalence of depressive symptoms or in the association between living arrangements and depressive symptoms is associated with HIV/AIDS prevalence and national economic status.

RESULTS

The pooled prevalence of depressive symptoms among older adults was 9.2%. Older adults living alone had a 2.3% point higher predicted prevalence of depressive symptoms compared to individuals living with at least one working-age adult (95% confidence interval: 0.2%, 4.4%). None of the country characteristics examined explained heterogeneity across countries in the relationship between living arrangements and depressive symptoms. However, there was some evidence suggesting a positive association between depressive symptom prevalence and the severity of a country's HIV/AIDS epidemic.

CONCLUSION

As depressive symptoms are known to be predictive of poor quality of life and increased mortality, it is important to address how health and social policies can be put in place to mitigate the potentially detrimental effects of solitary living on the mental health of older persons in sub-Saharan Africa.