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Romero KRF, Yang Y, Green SH, Gutierrez S, Meza E, Torres JM. Adult child educational attainment and older parents' psychosocial outcomes during the COVID-19 pandemic. BMC Public Health 2024; 24:2056. [PMID: 39085832 PMCID: PMC11289967 DOI: 10.1186/s12889-024-19425-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/09/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Older adults' psychosocial outcomes during the COVID-19 pandemic have been inequitable by socio-economic status (SES). However, studies have focused solely on own SES, ignoring emerging evidence of the relationship between adult child SES and late-life health. We evaluated whether adult child educational attainment - a core marker of SES - is associated with older parents' psychosocial outcomes during the pandemic. METHODS We used data from the Survey of Health, Aging, and Retirement in Europe (SHARE) 2004-2018 and the SHARE Corona Surveys (SCS) 2020 and 2021. We included 40,392 respondents ≥ 65 years who had pre-pandemic information on adult child educational attainment and self-reported psychosocial outcomes during the pandemic, including self-assessments of worsened psychosocial outcomes compared to the pre-pandemic period. We used generalized estimating equations with a Poisson distribution and a log link, adjusted for respondent and family-level characteristics, including respondents' own educational attainment. RESULTS Older adults whose adult children averaged levels of educational attainment at or above (vs. below) their country-specific mean had a lower prevalence of feeling nervous (Prevalence Ratio [PR]: 0.94, 95% Confidence Interval [CI]: 0.90, 0.97), sad or depressed (PR: 0.94, 95% CI: 0.91, 0.98), and having sleep problems (PR: 0.94, 95% CI: 0.90, 0.97) during the pandemic. Additionally, higher adult child educational attainment was associated with a lower risk of perceiving worsened feelings of nervousness (PR: 0.95, 95% CI: 0.90, 1.01) and worsened sleep problems (PR: 0.91, 95% CI: 0.82, 1.01) as compared to the pre-pandemic. In stratified models, protective associations were observed only in countries experiencing "high" levels of COVID-19 intensity at the time of the survey. All of these results are derived from adjusted models. CONCLUSIONS Adult child SES may have "upward" spillover effects on the psychosocial wellbeing of older parents during periods of societal duress like the pandemic.
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Affiliation(s)
- Karla Renata Flores Romero
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Yulin Yang
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Sharon H Green
- Department of Demography, UC Berkeley, Berkeley, CA, USA
| | - Sirena Gutierrez
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Erika Meza
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Jacqueline M Torres
- Department of Epidemiology & Biostatistics, UC San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
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Gil-Moltó MJ, Hole AR. The impact of adult children living at home on the well-being of Spanish parents: Evidence from panel data. Soc Sci Med 2024; 340:116492. [PMID: 38086220 DOI: 10.1016/j.socscimed.2023.116492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 01/23/2024]
Abstract
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.
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Affiliation(s)
| | - Arne Risa Hole
- Department of Economics, Universitat Jaume I, Avenida Vicente Sos Baynat s/n, E-12071 Castellón de la Plana, Spain.
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Howard A, Li A, Bentley R. Parental co-residence and young adults' mental health. PLoS One 2023; 18:e0294248. [PMID: 38019735 PMCID: PMC10686488 DOI: 10.1371/journal.pone.0294248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
The growing trend towards young adults staying in the parental home has garnered much recent scholarly interest. However, less is known about which young adults are living at home, and the impacts this has over young adults' lives. Using The Household, Income and Labour Dynamics in Australia (HILDA) dataset, this study examines the profiles of co-residing young adults and how these have changed over the first two decades of the 21st century. It then analyses the associations between co-residence and young adults' mental health, applying a propensity score modelling approach to determine differences in mental health between young adults living at home and their counterparts living independently. Results indicate that rates of co-residence have increased over the 2000s, most steeply amongst those residing outside of major cities (by 46%), older adults (by 36%), females (by 28%), and low-income groups (by 10%). Findings show a significant negative association between co-residence and mental health (a 4-point difference on the 100-point scale, 95% CI -5.93, -2.14). However, the greatest differential in mental health between co-resident and independent young adults is observed amongst those for whom rates of co-residence have increased most dramatically, i.e., females and older adults (a 6-point difference in mental health) and residents of regional and rural areas (a 5-point difference in mental health). We situate this discussion in the context of intensifying housing market constraints, considering how the transformation of the Australian housing system into a vehicle for wealth accumulation has generated barriers to residential independence.
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Affiliation(s)
- Amber Howard
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Department of Human Geography, Planning and International Development, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Ang Li
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Rebecca Bentley
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Caputo J, Cagney KA. Under Different Roofs? Coresidence With Adult Children and Parents' Mental Health Across Race and Ethnicity Over Two Decades. Demography 2023; 60:461-492. [PMID: 36794767 PMCID: PMC10566343 DOI: 10.1215/00703370-10571923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Many U.S. parents share a household with an adult child in later life. However, the reasons parents and adult children coreside may vary over time and across family race/ethnicity, shaping relationships with parents' mental health. Using the Health and Retirement Study, this study investigates the determinants and mental health correlates of coresidence with adult children from 1998 to 2018 among White, Black, and Hispanic parents under age 65 and aged 65+. Findings show that the predictors of coresidence shifted with increasing odds that parents lived with an adult child, and several varied by parents' age group and race/ethnicity. Compared with White parents, Black and Hispanic parents were more likely to live with adult children, especially at older ages, and to indicate that they helped their children with household finances or functional limitations. Living with adult children was associated with higher depressive symptoms among White parents, and mental health was negatively related to living with adult children who were not working or were helping parents with functional limitations. The findings highlight increasing diversity among adult child-coresident parents and underscore persistent differences in the predictors and meaning of coresidence with adult children across race/ethnicity.
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Affiliation(s)
- Jennifer Caputo
- Westat, Rockville, MD, USA; Department of Sociology, University of Chicago, Chicago, IL, USA
| | - Kathleen A Cagney
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
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Romero KRF, Yang Y, Green SH, Gutierrez S, Meza E, Torres JM. Adult child socio-economic status and older parents' psychosocial outcomes during the COVID-19 pandemic. RESEARCH SQUARE 2023:rs.3.rs-2719897. [PMID: 37034779 PMCID: PMC10081373 DOI: 10.21203/rs.3.rs-2719897/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Purpose Older adults' psychosocial outcomes during the COVID-19 pandemic have been inequitable by socio-economic status (SES). However, studies have focused solely on own SES, ignoring emerging evidence of the relationship between adult child SES and late-life health. We evaluated whether adult child educational attainment - a core marker of SES - is associated with older parents' psychosocial outcomes during the pandemic. Methods We used data from the Survey of Health, Aging, and Retirement in Europe (SHARE; 2004-2018) and the SHARE Corona Surveys (2020 and 2021). We included 15,553 respondents > 65 years who had pre-pandemic information on adult child educational attainment, self-reported mental health, and worsened mental health compared to the pre-pandemic period. We used generalized estimating equations adjusted for respondent and family-level characteristics, including respondents' own SES. Results Older adults whose adult children averaged levels of educational attainment at or above (vs. below) their country-specific mean had a lower prevalence of nervousness (Prevalence Ratio [PR]: 0.95, 95% Confidence Interval [CI]: 0.91, 0.99), depression (PR: 0.96, 95% CI: 0.92, 1.00), and trouble sleeping (PR: 0.96, 95% CI: 0.92, 1.00) during the pandemic; associations with loneliness were null. Overall associations with worsened mental health as compared to the pre-pandemic period were null. Protective associations were stronger in countries experiencing "high" levels of COVID-19 intensity. Conclusions Adult child SES may be an important driver of inequities in older adults' mental health during the COVID-19 pandemic. Policies aimed at improving adult child SES may buffer the adverse psychosocial impacts of societal stressors.
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Reyes AM. Intergenerational support and retirement timing among older men and women by race/ethnicity. SOCIAL SCIENCE RESEARCH 2023; 109:102783. [PMID: 36470634 PMCID: PMC10084133 DOI: 10.1016/j.ssresearch.2022.102783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 05/18/2022] [Accepted: 08/08/2022] [Indexed: 05/05/2023]
Abstract
Retirement timing is associated with health and economic outcomes for older adults. However, it is unclear how the pressures of supporting older parents and young adult children are associated with retirement. This study uses a life course perspective to consider how the linked lives of working older adults and their support of adult children and parents are associated with retirement. Cox proportional hazard models are estimated using the Health and Retirement Study (1992-2014) to assess the relationship between intergenerational support exchanges and retirement timing by gender and race/ethnicity. Providing most types of intergenerational support and especially providing time support are associated with an increased risk of retirement. Unlike all other respondents, Hispanic women providing intergenerational time support have similar retirement risks as those not providing any intergenerational support. These differing patterns by race/ethnicity suggest that earlier life course trajectories may shape older adults' ability to respond to family needs.
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Affiliation(s)
- Adriana M Reyes
- Cornell University, School of Public Policy & Sociology, 2223 MVR Hall, Ithaca, NY, 14853, USA.
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Social exclusion and health outcomes among empty nest and non-empty nest older people in China. AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Many existing studies lack a comprehensive picture of the social exclusion statuses and health outcomes of empty nesters and those empty nesters living alone or with a spouse only. Cross-sectional analysis was conducted on representative national data from the 2014 China Longitudinal Aging Social Survey, focusing on respondents aged 60 and above (N = 7,923). Four dimensions of social exclusion (social relationships, subjective feeling of being excluded, social activities and financial products) and three health outcomes (self-reported health (SRH), activities of daily living (ADLs) and depression), were considered. Results show that ‘empty nest’ older people were more likely to be excluded from social relationships and to experience subjective feelings of being excluded, and were less likely to participate in social activities than non-empty nesters. Empty nesters were significantly less likely to report fair SRH and ADL difficulties than non-empty nesters, but they were more likely to report having depression than non-empty nesters. Among ‘empty nest’ older people, empty nesters who were living alone were associated with higher levels of being excluded from social relationships and to experience subjective feelings of being excluded than those who were living with a spouse only. Future research could focus on the development of age-friendly communities which act as health interventions to address relevant situations of social exclusion and depression among empty nesters.
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McMinn MA, Seaman R, Dundas R, Pell JP, Leyland AH. Socio-economic inequalities in rates of amenable mortality in Scotland: Analyses of the fundamental causes using the Scottish Longitudinal Study, 1991-2010. POPULATION, SPACE AND PLACE 2022; 28:psp.2385. [PMID: 35411206 PMCID: PMC7612592 DOI: 10.1002/psp.2385] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 09/02/2020] [Indexed: 05/29/2023]
Abstract
Socio-economic inequalities in amenable mortality rates are increasing across Europe, which is an affront to universal healthcare systems where the numbers of, and inequalities in, amenable deaths should be minimal and declining over time. However, the fundamental causes theory proposes that inequalities in health will be largest across preventable causes, where unequally distributed resources can be used to gain an advantage. Information on individual-level inequalities that may better reflect the fundamental causes remains limited. We used the Scottish Longitudinal Study, with follow-up to 2010 to examine trends in amenable mortality by a range of socioeconomic position measures. Large inequalities were found for all measures of socioeconomic position and were lowest for educational attainment, higher for social class and highest for social connection. To reduce inequalities, amenable mortality needs to be interpreted both as an indicator of healthcare quality and as a reflection of the unequal distribution of socio-economic resources.
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Affiliation(s)
- Megan A. McMinn
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Usher Institute, University of Edinburgh, Edinburgh,UK
| | - Rosie Seaman
- Faculty of Social Sciences, University of Stirling, Stirling, UK
| | - Ruth Dundas
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Jill P. Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alastair H. Leyland
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Song L, Pettis PJ, Chen Y, Goodson-Miller M. Social Cost and Health: The Downside of Social Relationships and Social Networks. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2021; 62:371-387. [PMID: 34309419 DOI: 10.1177/00221465211029353] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The research tradition on social relationships, social networks, and health dates back to the beginning of sociology. As exemplified in the classic work of Durkheim, Simmel, and Tönnies, social relationships and social networks play a double-edged-protective and detrimental-role for health. However, this double-edged role has been given unbalanced attention. In comparison to the salubrious role, the deleterious role has received less scrutiny and needs a focused review and conceptual integration. This article selectively reviews the post-2000 studies that demonstrate the harmful physical and mental health consequences of social relationships (intimate relationships and parenthood) and social networks. It uses a parsimonious three-category typology-structural forms, structural composition, and contents-to categorize relationship and network properties and proposes the social cost model, in contrast to the social resource model, to synthesize and integrate the adverse aspects of these properties. It concludes with future research directions.
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Affiliation(s)
- Lijun Song
- Vanderbilt University, Nashville, TN, USA
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Guerra O, Eboreime E. The Impact of Economic Recessions on Depression, Anxiety, and Trauma-Related Disorders and Illness Outcomes-A Scoping Review. Behav Sci (Basel) 2021; 11:119. [PMID: 34562956 PMCID: PMC8464685 DOI: 10.3390/bs11090119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/20/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
In the wake of a global economic recession secondary to the COVID-19 pandemic, this scoping review seeks to summarize the current quantitative research on the impact of economic recessions on depression, anxiety, traumatic disorders, self-harm, and suicide. Seven research databases (PsycINFO, MEDLINE, Embase, Web of Science: Core Collection, National Library of Medicine PubMed, PubMed Central, and Google Scholar) were searched for keywords returning 3412 preliminary results published since 2008 in Organisation for Economic Coordination and Development (OECD)nations. These were screened by both authors for inclusion/exclusion criteria resulting in 127 included articles. Articles included were quantitative studies in OECD countries assessing select mental disorders (depression, anxiety, and trauma-/stress-related disorders) and illness outcomes (self-harm and suicide) during periods of economic recession. Articles were limited to publication from 2008 to 2020, available online in English, and utilizing outcome measures specific to the disorders and outcomes specified above. A significant relationship was found between periods of economic recession and increased depressive symptoms, self-harming behaviour, and suicide during and following periods of recession. Results suggest that existing models for mental health support and strategies for suicide prevention may be less effective than they are in non-recession times. It may be prudent to focus public education and medical treatments on raising awareness and access to supports for populations at higher risk, including those vulnerable to the impacts of job or income loss due to low socioeconomic status preceding the recession or high levels of financial strain, those supporting others financially, approaching retirement, and those in countries with limited social safety nets. Policy makers should be aware of the potential protective nature of unemployment safeguards and labour program investment in mitigating these negative impacts. Limited or inconclusive data were found on the relationship with traumatic disorders and symptoms of anxiety. In addition, research has focused primarily on the working-age adult population with limited data available on children, adolescents, and older adults, leaving room for further research in these areas.
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Affiliation(s)
- Olivia Guerra
- Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
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Xie L, Qian Z, Xu J. Clinical intervention effect of TACE combined with 3DCRT in patients with primary liver cancer. Am J Transl Res 2021; 13:7960-7967. [PMID: 34377276 PMCID: PMC8340196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/19/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the clinical intervention effect of transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiotherapy (3DCRT) in patients with primary liver cancer (PLC). METHODS A total of 110 PLC patients admitted to our hospital were selected and divided into the study group (SG, n=60, treated with TACE combined with 3DCRT) and the control group (CG, n=50, treated with TACE alone) in accordance with the different clinical intervention measures. The clinical intervention effect and the changes of tumor factors and quality of life scores were compared between the two groups before and after intervention, and the three-year survival and the incidence of adverse reactions were evaluated. RESULTS The objective response rate (ORR) and disease control rate (DCR) in the SG (78.33% and 95.00%) were higher than those in the CG (38.00% and 80.00%), whereas the carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) levels in the SG were lower than those in the CG (P < 0.05). After intervention, the quality of life score in the SG was higher than that in the CG (P < 0.05). The SG was superior to the CG in follow-up survival (P < 0.05). CONCLUSION TACE combined with 3DCRT has a high safety and leads to remarkable clinical intervention effects, marked improvement of the serological indices, better quality of life, as well as satisfactory long-term survival.
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Affiliation(s)
- Lifeng Xie
- Affiliated Jiangnan Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine General Hospital Hangzhou 311200, Zhejiang Province, China
| | - Zhuliang Qian
- Affiliated Jiangnan Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine General Hospital Hangzhou 311200, Zhejiang Province, China
| | - Jianchang Xu
- Affiliated Jiangnan Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine, Hangzhou Xiaoshan District Hospital of Traditional Chinese Medicine General Hospital Hangzhou 311200, Zhejiang Province, China
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Phulkerd S, Gray RS, Chamratrithirong A. The influence of co-residential and non-co-residential living arrangements on sufficient fruit and vegetable consumption in the aging population in Thailand. BMC Geriatr 2020; 20:476. [PMID: 33198625 PMCID: PMC7670708 DOI: 10.1186/s12877-020-01884-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/09/2020] [Indexed: 11/13/2022] Open
Abstract
Background Living arrangements have an impact on a family’s health-related behaviors, especially its eating behaviors. However, studies that have examined the association between living arrangements and food intake, especially fruit and vegetable (FV) consumption of older adults, are rare. This study aimed to investigate the association between living arrangements and FV consumption in a population of older adults in Thailand from a national sample of households. Methods This study extracted data on 2048 persons age 60 years or older from a study of a nationally-representative sample of Thai households. The survey asked respondents about FV intake, living arrangements, household size, and socio-demographic characteristics. Binary logistic regression analysis was used to investigate the association between the variables and FV intake. Results The mean age of the respondents was 68.2 ± 6.5 years. Of the total sample, only 31.9% had sufficient FV intake. The group with the lowest possibility of sufficient FV intake was persons who lived alone. Those who lived with at least one child or lived in a skipped-generation household were 2.7 and 2.2 times as likely to have sufficient FV intake as those who lived alone (p < 0.001 and p < 0.01, respectively). Older adults living only with their spouse were 2.1 times as likely to have sufficient FV intake as those who lived alone. FV intake also differed significantly by socio-demographic characteristics (sex, place of residence, educational attainment, occupation and income), self-rated health, FV knowledge, and exposure to a FV promotion campaign in the community. Conclusions The findings from this study suggest that a different approach is required to improve FV consumption in the older population by taking into account their living arrangements, community context, level of FV knowledge, and socio-demographic characteristics. The older adults who live alone, as well as those living in a large household, are at particular risk of inadequate FV intake, and require special attention.
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Affiliation(s)
- Sirinya Phulkerd
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, 73170, Thailand.
| | - Rossarin Soottipong Gray
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom, 73170, Thailand
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