The willingness and influencing factors to choose institutional elder care among rural elderly: an empirical analysis based on the survey data of Shandong Province

BACKGROUND

The ageing of the population has become an escalating problem in China, which has led to an increasing demand for healthcare throughout society. The care services of elderly institutions, as a more mature way of aging, can alleviate various social problems brought about by ageing to a certain extent. The aim of this paper is to explore the degree of acceptance of institutional care by rural elderly people in Shandong Province and the factors that influence whether rural elderly people accept institutional care services.

METHODOLOGY

Based on the theory of planned behavior, an analytical framework was constructed for the willingness of rural elderly people to receive nursing services from elderly care institutions. Using survey data from 192 rural elderly people in Shandong Province, descriptive statistics, binary logistic regression, and horizontal comparative analysis methods were used to analyze the willingness of rural elderly people to provide for the elderly and its influencing factors.

RESULT

Only 17.71% of respondents expressed willingness to receive services from elderly care institutions. Among them, education level, trust in elderly care institutions, and support from adult children have a significant positive impact on whether rural elderly people receive nursing services from elderly care institutions; The number of children, the level of understanding of elderly care institutions, neighbors' choices of elderly care methods, and their ability to contribute to the family have a significant negative impact on whether rural elderly people receive nursing services from elderly care institutions. There are significant differences in the willingness and influencing factors of rural elderly people to provide for the elderly among different regions.

CONCLUSION

The non-acceptance of institutional care by rural older people is a general phenomenon rather than a sample characteristic, thus justifying the supplementary status of institutional care services. The pension intention of the rural elderly in Shandong Province is obviously affected by personal will factors, and the influencing factors are various. The traditional concept of old-age care in Shandong province has a strong path-dependent effect on the choice of the rural elderly. There is heterogeneity in the willingness and influencing factors of the rural elderly in different regions and countries. Based on this, this paper puts forward the following suggestions: strengthen the spiritual and cultural construction of residents; The government should pay attention to the correct guidance of public opinion; And increase pension subsidies. It is hoped that reduce the burden of national elderly care through these suggestions.

Young adults' intention to encourage COVID-19 vaccination among their grandparents: A nationwide cross-sectional survey of college students in China

Background

During a vaccination plateau phase, traditional vaccination promotion strategies such as the mobilization of government and community appear to have limited impact on expanding the coverage. New strategies to promote vaccination are needed especially in older adults. Our study aimed to assess college students' intention to encourage coronavirus disease 2019 (COVID-19) vaccination among their grandparents and its correlates.

Methods

A cross-sectional survey was conducted in China from May to June 2022. We collected information on socio-demographics of college students and their grandparents, constructs of health belief model (HBM) and theory of planned behavior (TPB) for college students, and college students' intention to encourage COVID-19 vaccination among their grandparents. Multilevel logistic regression models were performed to assess correlates of intention.

Results

We enrolled 2681 college students who reported information for 6302 grandparents. 2272 students (84.7 %) intended to encourage COVID-19 vaccination for 4744 (75.3 %) grandparents. Intention was associated with having received a booster dose of COVID-19 vaccine (AOR 3.28, 95 % CI 1.68-6.42), having ever lived with their grandparents (2.07, 1.46-2.93), and having grandparents who regularly went outdoors (2.85, 1.70-4.76). HBM and TPB models showed that college students who had higher levels of perceived susceptibility (1.79, 1.12-2.87), perceived severity (1.52, 1.12-2.06) of COVID-19 among their grandparents, and higher levels of subjective norms (2.88, 1.61-5.15) were more likely to have the intention.

Conclusion

College students' intention to encourage COVID-19 vaccination among their grandparents was high. It may be potentially viable to engage college students in promoting COVID-19 and other routine vaccination among older adults.

Existing Datasets to Study the Impact of Internal Migration on Caregiving Arrangements among Older Adults in China

Massive rural-to-urban migration in China has a significant impact on informal caregiving arrangements among Chinese older adults. To stimulate research on the intersection of migration and caregiving, we conducted an inventory of longitudinal aging survey datasets from mainland China. Large publicly available datasets that included measures related to migration and caregiving were searched and reviewed for eligibility. Key characteristics of each dataset, including study design, sample size, and measures, were extracted. Seven eligible datasets were identified, and five included nationally representative samples. Measures for migration varied across datasets. Some datasets included information on the migration history of older adults, whereas others focused on the migration of adult children. Similarly, caregiving was measured using different questions in each dataset. Caregiving activities were assessed with regard to their type, source, and amount. High-quality datasets exist to support research on migration and caregiving arrangements among Chinese older adults.

An assessment of self-rated life satisfaction and its correlates with physical, mental and social health status among older adults in India

Life satisfaction refers to the assessment of one's own life in terms of self-perceived favourable qualities. It is an integral part of healthy and successful course of ageing. It is widely associated with the health status and social well-being. The present study attempted to determine the constructing factors of self-rated life satisfaction, such as socio-demographic, physical, social, and mental well-being of older adults. We analysed information from the Longitudinal Ageing Study in India (LASI-1), the initial phase conducted during 2017-18 for the population of older adults in India. We applied descriptive statistics for prevalence assessment and association was checked using chi-square test. Further, to determine the adjusted outcome of predictor covariates on the likelihood of an individual being satisfied from life estimated by applying hierarchical multiple logistic regression models. Several noteworthy affirmations on the relationship between the socio-demographic variables and health risk behaviours with life satisfaction were observed. The results were consistent with studies showing change in life satisfaction subject to the state of physical and mental health, presence of chronic diseases, friends and family relations, dependency, and events of trauma or abuse. While comparing respondents, we found varying degrees of life satisfaction by gender, education, marital status, expenditure and other socio-economic features. We also found that besides physical and mental health, social support and well-being play a pivotal role in achieving higher life satisfaction among older adults. Overall, this work contributes to the study of the subjective well-being of older adults in India based on self-reported levels of life satisfaction and further narrows the gap in knowledge about associated behaviour. Hence, with on-going ageing scenario, there is need for multi-sectorial policy-oriented approaches at individual, family, and community level, which helps to take care of older-adults' physical, social, and mental health for the betterment of healthy ageing.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

DISCUSSION

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

Association between living arrangements and cognitive decline in older adults: A nationally representative longitudinal study in China

Background

Living arrangements are critical to the survival and well-being of older people, especially in China where the filial piety culture demands adult children care for and serve their parents. The study aimed to explore the association between living arrangements and cognitive decline among older people in China.

Methods

Participants included 6,074 older adults over 60 years old (49.65% male, mean age 67.2 years [range 60–98]) from four waves (2011–2018) of the China Health and Retirement Longitudinal Study. Two to four assessments were conducted over a follow-up of an average of 5.3 years (range, 2–7). Cognitive function was assessed using an adapted Chinese version of Mini-Mental State Examination (MMSE). Living arrangements were classified as follows: living alone, living with spouse, living with adult children, living with spouse and adult children and living with others. Multilevel models were used to investigate the relationship between living arrangements and cognitive decline, as well as the gender difference.

Results

As the main type of living arrangements of the study participants (44.91%), living with spouse was taken as the reference group. Compared to the reference group, living alone (β=-0.126, P < 0.001), living with adult children (β=-0.136, P < 0.001), living with spouse and adult children (β=-0.040, P < 0.05) and living with others (β=-0.155, P < 0.05) were all related to a faster rate of cognitive decline. Further, the association between living arrangements and cognitive decline varied by gender. Living alone (β=-0.192, P < 0.001) was associated with a faster cognitive decline only in older men. Living with spouse and adult children (β=-0.053, P < 0.05) and living with others (β=-0.179, P < 0.05) were associated with faster cognitive decline only in older women.

Conclusion

This study suggests that living arrangements in older people in China were associated with cognitive decline, and these associations varied by gender. Greater attention to living arrangements might yield practical implications for preserving the cognitive function of the older population.

State containment measures, living arrangements, and mental health of U.S. older adults during the COVID-19 pandemic

OBJECTIVES

Early in the coronavirus pandemic, U.S. states implemented several different types of containment measures to slow the disease's spread. Early evidence indicates containment measures were associated with changes in individuals' mental health. This study explores the associations between U.S. state containment measures and older adults' mental health and importantly, whether the associations vary by living arrangement and gender.

METHODS

The study analyzed national sample of adults aged 50 or older from 12 waves (April-July 2020) of the U.S. Household Pulse Survey (N = 394,934). State fixed-effects models linked four state containment measures (stay-at-home order, restaurant closure, bar closure, and movie theater closure) to levels of depression and anxiety across different types of living arrangements, net of controls. Men and women were analyzed separately.

RESULTS

Stay-at-home order and restaurant and bar closure, but not movie theater closure, were associated with higher levels of depression and anxiety in older adults. Living arrangements moderated the associations for women but not men. For women, compared to living alone, living with a spouse or intergenerational family was associated with higher levels of anxiety and depression during stay-at-home order and restaurant closure.

CONCLUSION

The associations between containment measures and mental health vary by type of living arrangement and were gendered, likely because household situations create different demands and supports that men and woman experience differently. Although containment measures are necessary to protect public health, paying attention to these underlying dynamics can inform policymakers' efforts to implement policies that balance harms and benefits for older adults.

Structural equation model of the relationship between functional ability, mental health, and quality of life in older adults living alone

Aims

Living alone, a reality in an increasing number of older adults recently, is a risk factor for low quality of life. This study identified the predictors of quality of life in older adults living alone based on mental health and the International Classification of Functioning, Disability, and Health.

Methods

This secondary data analysis used information from the 2018 Assessing the Requirements of Customized Health Care and Daily Living Support Services survey (N = 1,022), collected from adults aged ≥ 65 living alone in Siheung City, South Korea, from August to October 2018. The exogenous variables were body functions (hand grip strength, timed “up and go” test score, and body mass index), daily living activities (Korean Instrumental Activities of the Daily Living Scale), social activity participation (social activity engagement, neighbor contacts, and family contacts), and participation in economic activity (frequency). The endogenous variables were mental health (Geriatric Depression Scale Short Form—Korean Version and UCLA Loneliness Scale) and quality of life (EuroQoL-5 Dimension-3 Level and EuroQoL-Visual Analog Scale).

Results

After modifying the hypothetical model, which had failed to satisfy the recommended fitness level, the (modified) model had good fitness indices Q (CMIN / df) 2.90, GFI 1, AGFI 1, RMSEA 0.04, CFI 0.90 and PCFI 0.53. Of the nine pathways of the modified model, five were statistically significant. Quality of life was affected by body functions, daily living activities, social activity participation, and mental health. These variables explained 68.2% of the factors affecting quality of life.

Conclusions

By highlighting the role of mental health, this model provides a useful framework for improving the quality of life of older adults who live alone and function at various levels in the community. Focusing on advancing mental health through body functions, daily living activities, and social activity participation can improve quality of life.

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

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

Social exclusion and health outcomes among empty nest and non-empty nest older people in China

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.

Gender and family structures affecting intergenerational support from adult children to older parents: A cross-national study in a developing country

In Latin America, informal support from adult children to their older parents ("upward support") is crucial with an aging population and insufficient coverage of social protection systems. This article examines variables associated with upward support, distinguishing by gender of parents and their children. The research design is quantitative, correlational, and cross-sectional. It is based on primary survey data collected by the authors for the study. The authors hypothesized that upward support depends on children's opportunities to provide support and on the needs of parents. The results show that upward support depends more on children's opportunities than on parents' needs, although upward support is higher for parents with poorer health. Daughters are more supportive than sons, but sibling characteristics do not moderate associations between children's gender and receipt of support. Cohabiting with the parent, receiving support from the parent, and having a good relationship were also associated with greater upward support. Therefore, policies should consider the gender of adult children when allocating resources to older people.

Circumstances Precipitating Rural Older Adults for Co-Residential Family Care Arrangements in Central Ethiopia

This study aims to explore circumstances that precipitate rural older adults for co-residential family care arrangements employing a phenomenological study method. Data from in-depth interviews with 12 rural older adults were inductively coded and developed into themes. Physical limitations and health problems, separation and divorce, death of a spouse, economic problem, neglect, inheritance dispute, and inaccessible locations are the circumstances that precipitate older adults to give up their independent living and start living with their children in the study area. The study points out to policymakers and other concerned bodies that actions must be geared toward maintaining a positive living environment for rural older adults and tackling challenges that are decisive in co-residential family care setting. Increasing health care accessibility, expanding senior/adult care centers and community health insurance programs, training geriatric social workers, enhancing collaboration between family caregivers and formal services, and provision of assistive devices for debilitating health conditions and subsequent disability will enhance the quality of life of rural older adults in co-residential family care arrangement.

Transition of Living Arrangement and Cognitive Impairment Status among Chinese Older Adults: Are They Associated?

Background and Objectives: Living arrangement is a crucial factor for older adults' health. It is even more critical for Chinese older adults due to the tradition of filial piety. With the aging of China's population, the prevalence of cognitive impairment among older adults has increased. This study examines the association between living arrangement transition and cognitive function among Chinese older adults. Materials and Methods: Using three waves of the Chinese Longitudinal Healthy Longevity Survey (CLHLS; 2008-2009, 2011-2012, and 2014), we analyzed data for older adults (age ≥ 65) who lived with other household members and reported good cognitive function or mild cognitive impairment when they participated in the survey. Multistate Cox regression was employed to study changes in cognitive function. Results: Older adults who transitioned to living alone had lower risk of cognitive impairment (hazard ratio (HR) = 0.66, 95% CI: 0.52, 0.83; p < 0.01), compared with those who continued to live with other household members. Moving into an institution was also not associated with cognitive impairment. Conclusions: With older adults' transition to living alone, public health practitioners or social workers might educate them on the benefits of such a living arrangement for cognitive function.

“My Last Husband and Marriage:” The Impact of Inheritance Disputes on Chinese Immigrants’ Widowhood in the United States

This study explores the unique experiences of the emotional processing of the widowhood of individuals of the Chinese seniors, and immigrant background in the United States. By interviewing eight Chinese immigrant widows living in Phoenix, the United States, this study focuses on the comparison of social relations and lifestyles before and after their spousal loss, as well as the unique forces of their Chinese backgrounds and the transnational remarriages in their bereavement process, and then widow status. The narrative accounts of the participants therein illustrate that transnational marriage and blended families generate a series of practical challenges, including unexpected severed friendships and inheritance disputes between stepmother and stepchildren. The consequences are reflected in the increase of self-loathing and low self-esteem, the refusal to remarry, the rising anger at the betrayal of friends, as well as the rapid formation of a high level of independence and self-determination in such circumstances. These findings increase knowledge of widowhood of Chinese women with immigrant background, therein enrich ethno-cultural diversity in the widowhood studies.This study concludes with the implications of providing bilingual legal aid and counseling to Chinese-origin, US-based, and widows.

Health Behaviors and Self-Reported Oral Health among Centenarians in Nanjing, China: A Cross-Sectional Study

The role of health behaviors in oral health conditions in individuals of extremely old age remains understudied. This study included 185 participants aged 100 years or older from the Nanjing Centenarians Study (NCS) to examine the associations between health behaviors and oral health and investigate the potential moderating role of education and living arrangements in such relationships. The oral health status as an outcome included the self-reported oral health status and edentulous status. Health behavior variables included smoking, eating fruits, eating vegetables, participating in leisure activities, and practicing oral hygiene behaviors. Sociodemographic characteristics and health status were considered as confounders. Descriptive statistics, ordinal regression, and logistic regression models were used to address the research questions. Results showed that better oral health was reported by centenarians who were non-smokers, participated in more leisure activities, and practiced higher frequency of oral hygiene behaviors. Those who ate fruits daily and practiced more frequently oral hygiene behaviors were more likely to be dentate. The positive association of oral hygiene behaviors was stronger for centenarians who were formally educated and co-resided with family members. The results suggest that effective interventions should consider health behaviors and living arrangements in this growing population to improve their oral health status.

Rural-Urban Inequalities in Poor Self-Rated Health, Self-Reported Functional Disabilities, and Depression among Chinese Older Adults: Evidence from the China Health and Retirement Longitudinal Study 2011 and 2015

The household registration system (Hukou) in China classifies persons into rural or urban citizens and determines eligibility for state-provided services and welfare. Not taking actual residence into account may underestimate rural–urban differences. This study investigates rural–urban inequalities in self-reported health outcomes among older adults aged 60+, taking into account both Hukou and actual residence, adjusting for sociodemographic determinants, based on the China Health and Retirement Longitudinal Study (CHARLS) in 2011 and 2015. Self-Rated Health (SRH) was assessed with a single question, functional abilities were assessed with the Basic Activities of Daily Living (BADLs) and Instrumental Activities of Daily Living (IADLs) scales, and depression was assessed with the 10-item version of the Center for Epidemiologic Studies Depression Scale. Rural respondents had poorer socioeconomic status and higher prevalence of poor SRH, functional disabilities, and depression than urban respondents in both years, which were closely related to rural–urban differences in educational level and income. Impairments appeared at a younger age among rural respondents. Analyses using only Hukou registration and not actual residence resulted in underestimation of rural–urban differences. This study may serve as a basis for interventions to address rural–urban differences in health and social services and reduce health inequalities among Chinese older adults.

Living alone, social cohesion, and quality of life among older adults in rural and urban China: a conditional process analysis

OBJECTIVES

To test the independent and combined impact of social cohesion and geographic locale (urban/rural) on quality of life (QoL) for older adults in China. Using conditional process analysis, we tested three hypotheses: (1) QoL will be lower for persons living alone than those who live with family; (2) social cohesion will mediate the association of living arrangement and QoL; and (3) geographic locale will moderate direct and indirect pathways in the mediation model.

DESIGN

Cross-sectional data from WHO Study on Global Aging and Adult Health (SAGE) (China, Wave 1, 2007-2010).

SETTING

National probability sample of 74 primary sampling units in China, 32 in urban, and 32 in rural areas.

PARTICIPANTS

A total of 9,663 adults aged 50 years and older.

MEASUREMENTS

We measured QOL with the 8-item version of the WHOQOL-Bref; living arrangement as alone versus with family; and social cohesion with an 9-item index of frequency of a range of social activities in the previous 12 months. We controlled for sociodemographic characteristics and health and mental health variables in multivariate analyses.

RESULTS

Data supported the first two hypotheses; however, the mediating effects of social cohesion held only in urban areas.

CONCLUSION

This study advances the large body of work on living arrangements and well-being of older adults in China. Social cohesion contributed to better QoL regardless of living arrangement, and cohesion mediated the association of living arrangement and QOL in urban but not rural areas. Programs and policies that strengthen social cohesion through older adults' community involvement, especially in urban areas, will help to enhance QoL.

Spillover effects of adult children's schooling on parents' smoking cessation: evidence from China's compulsory schooling reform

OBJECTIVE

As elderly parents today will share a longer life with their children than ever before, the spillover effects of children's human capital on parents' well-being become increasingly important. This study investigated whether children's schooling leads parents to give up smoking and whether the effects were moderated by their education or child-parent contact frequency.

METHODS

Using data from the China Health and Retirement Longitudinal Study, we conducted an instrumental variable (IV) analysis using China's compulsory schooling reform in the 1980s as a natural experiment.

RESULTS

The IV estimates suggest that elderly parents of more highly educated children are more likely to quit smoking. Moreover, the effects are more significant among parents who had not finished primary school and also slightly stronger among parents who live close to their children or meet their children frequently.

DISCUSSION

Our findings add to current evidence regarding spillover effects of education on smoking cessation. A child's education may exert an impact through the spillover of health knowledge.

Are Older Persons in China Living More Years in an Independent Living Arrangement? Estimates Using Multistate Life Tables

Adopting a multistate life table approach, this study estimates number of years the very old in China expect to live in an independent living arrangement (alone or with spouse only)-an estimate we term "independent living life expectancy" (ILLE)-as opposed to in coresidence with adult children or others. We also estimate how ILLE and proportion of total life expectancy (TLE) residing independently has changed over time. The backdrop for this study is a society experiencing both increasing longevity and social changes that influence the tendency to live in an independent living arrangement. The study concentrates on assessing whether changes in ILLE match or surpass gains in TLE experienced by oldest-old Chinese adults. Data are from the 2002-2014 Chinese Longitudinal Healthy Longevity Survey, and estimation is conducted using the Stochastic Population Analysis for Complex Events software. Results suggest that on balance, gains in ILLE are proportionately greater than gains in TLE, indicating an expansion of ILLE for most Chinese elders. Males, septuagenarian females, and disabled septuagenarians are the most likely to be living proportionately longer lives in an independent living arrangement. In contrast, extremely old (nonagenarian and centenarian) females and extremely old disabled individuals are least likely to have experienced dramatic changes in proportion of life residing independently. The findings imply some support for the hypothesis that given the maintenance of family solidarity in China, those in greatest need are least likely to encounter the most extreme changes toward independent living arrangements.

Inequalities in cognitive impairment among older adults in China and the associated social determinants: a decomposition approach

Background

Despite there is growing evidence focusing on health inequalities in China, socioeconomic inequalities in cognitive impairment among older adults have received little attention. This study aims to measure socioeconomic inequalities in cognitive impairment among Chinese older adults, and determine the contributing social factors to the inequalities.

Methods

A cross-sectional analysis was performed using data from the 2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 10,556 older adults aged 65 and over were included in the study. The prevalence of cognitive impairment was measured by using the Chinese version of the Mini-Mental State Examination. The socioeconomic inequalities in cognitive impairment were illustrated and quantified by the concentration curve and normalized concentration index. Multivariate logistic regression was conducted to identify the associated factors of cognitive impairment. And decomposition analysis was further applied to decompose the contribution of each determinant to the observed inequalities in cognitive impairment.

Results

The study indicated that the prevalence of cognitive impairment among Chinese older adults was 18.95%. The overall concentration index for cognitive impairment was − 0.046, which suggested a higher concentration of cognitive impairment among socioeconomically disadvantaged older adults. The results showed the prevalence of cognitive impairment was associated with sex, age, marital status, education level, occupation, economic status, emotional support, financial support, living arrangement, and participation in informal activities. Decomposition results further revealed the contributions of the determinants to the inequalities in cognitive impairment. Specifically, age (131.61%), marital status (85.68%), emotional support (84.85%), education level (39.73%), occupation (21.24%), sex (17.25%), financial support (− 4.19%), economic status (1.02%), living arrangement (0.88%), and informal activities (0.30%) have varying degrees of contributions to the inequality in cognitive impairment.

Conclusion

This study sheds light on the pro-rich inequality in cognitive impairment among older adults in China. It suggests that policymakers should pay more attention to older adults who are female, old-old, widowed, illiterate, economically disadvantaged, with no social support, and less socially involved. Also, more targeted interventions should be undertaken to improve the socioeconomic conditions of these vulnerable individuals and strengthen their ability to cope with the risk of cognitive impairment.

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.

Parental cohabitation and mental well-being amongst young adults in the world's densest population with least affordable housing: Evidence from the FAMILY cohort

BACKGROUND

Owing to rapidly raising property prices, living with parents is the most common living arrangement among young adults in urban areas. Studies for "full nest syndrome" or "boomerang children" have demonstrated that moving back in with parents was associated with more depressive symptoms. On the other hand, studies have suggested that living with parents was not associated with mental health in several countries where inter-generational households could potentially provide more social support among household members. We examined whether delayed residential independence might adversely impact mental health of young adults.

METHODS

The cross-sectional study was conducted from 2009 to 2011 in Hong Kong SAR, China - a highly urbanized city with the least affordable housing in the world. The analytic samples were 3612 young adults. Outcomes of interest were depressive symptoms and mental well-being.

RESULTS

Co-residence with parents under self headship was associated with young adults' fewer depressive symptoms (β = -0.157, 95% confidence interval [CI] = -0.311 to -0.003) and better mental well-being (β = 1.342, 95% CI = 0.522 to 2.162).

LIMITATIONS

This is susceptible to reverse causation, whereby young adults with poorer mental health may be more likely to stay or move back into their parental home.

CONCLUSIONS

Our findings showed that young adults co-residing with parents as the household head were associated with fewer depressive symptoms and better mental well-being compared to living with parents under their parental headship.

Living arrangements and cognitive abilities of community-dwelling older adults in Singapore

AIM

Dementia is a growing public health concern. It is necessary to focus on factors that may help preserve cognitive function in late life. Limited research has examined how living arrangements are associated with cognitive function in older adults. This study aims to further our understanding of this association in community-dwelling older adults in a multi-ethnic Asian population.

METHODS

Data were obtained from a cross-sectional population survey of 2548 adults aged 60 and older with standardized instruments. Living arrangements were classified as living with adult children and grandchildren, living with adult children only, living with a spouse/partner only, living alone, living with other relatives, and living with non-relatives.

RESULTS

Cognitive function was significantly predicted by living arrangements among community-dwelling older adults. Multivariate linear regression analyses revealed that older adults in multigenerational family households had significantly poorer cognitive function than those living with a spouse/partner (β = 0.54, P < 0.02) and those living with non-relatives (β = 1.08, P < 0.02). This association was independent of the influence of age, gender, ethnicity, education, employment status, marital status, depression, disability, chronic health conditions, and self-reported health.

CONCLUSION

Older adults living in multigenerational households seem to be disadvantaged in their cognitive function. However, we cannot conclude this based on the evidence because of the cross-sectional nature of the data. Further research is needed to reasonably determine the relationship between living arrangements and cognitive function. Regardless, these findings add to the growing understanding of the complex relationship between living arrangements and cognition in older adults and could provide a basis to design effective strategies to delay cognitive decline in community-dwelling older adults.

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.

The Association Between Loneliness and Cognitive Impairment among Older Men and Women in China: A Nationwide Longitudinal Study

We aimed to investigate the association between loneliness and cognitive impairment among older men and women in China. Data for 6898 eligible participants aged 65 years and older were derived from the latest two waves (2008/2009 and 2011/2012) of the Chinese Longitudinal Healthy Longevity Survey. A logistic regression analysis was performed to determine whether the association between loneliness at baseline and the risk of cognitive impairment at follow-up varied by sex, with adjustment for social-demographic variables, social isolation, lifestyles, and health status. The rates of baseline loneliness and follow-up cognitive impairment were both higher among women than men. Loneliness at baseline was significantly associated with cognitive impairment at follow-up among elderly men (OR = 1.30; 95% CI 1.01-1.69), even after adjusting for potential confounding variables; however, a similar association was not observed among elderly women (OR = 0.98; 95% CI 0.81-1.19). Multiple imputations were applied to address missing data. Although elderly women more frequently reported feelings of loneliness, the impact of loneliness on cognitive impairment was significant among elderly men but not elderly women. Interventions designed to decrease the incidence of loneliness may be particularly beneficial for the reduction of cognitive impairment among elderly Chinese men.

Changing Perception of the Rights and Responsibilities in Family Care for Older People in Urban China

As an ageing society, China has undergone various political and economic transitions since the 1980s, which has raised a series of social and policy concerns about the practicality of relying on family support in the care of older people. To understand the changing social expectations and the corresponding societal responses, the shifting perception of the rights and responsibilities associated with the family care of older people has to be comprehended first. Based on 39 qualitative interviews in two Chinese cities, Beijing and Guangzhou, this research contributes to an understanding of the pursuit of a "good life" by older people in contemporary urban China. It points to the argument that independence and autonomy in old age, as valued by the interviewees, will not be realised unless there is a shift in policy to recognise and respect the individuality of older people and facilitate their life choices.

Person-Centered Dementia Care in China: A Bilingual Literature Review

We conducted a bilingual literature review of the existing studies focusing on person-centered dementia care in China. We synthesized key findings from included articles according to three overarching themes: Chinese cultural relevance of person-centered care (PCC), perceived needs for PCC for older adults in China, implementation and measurement of PCC in China, and person-centered dementia care model. We also drew on frameworks, theories, and other contents from the examined articles to develop a person-centered dementia care model with specific relevance to China. The model is a good starting point to help us operationalize globally relevant core principles of PCC in the specific sociocultural context of China. The framework will be informed by more empirical studies and evolve with the ongoing operationalization of PCC. Although PCC is a new concept and has not been vigorously or systematically studied in China, it is attracting increasing attention from Chinese researchers. More empirical studies are needed to link PCC to measurable outcomes, enrich the framework for applying PCC, and construct assessment and evaluation systems to facilitate the provision of PCC across countries and cultures. Global consortia and collaborations with multidisciplinary expertise to develop a PCC common data infrastructure that is internationally relevant for data sharing and comparison are needed.

Old Age Support in Urban China: The Role of Pension Schemes, Self-Support Ability and Intergenerational Assistance

With the aim of probing into the life satisfaction of retired urban elderly in China with respect to old age support systems, this study examines the effect of pension reform with its existing inequalities across demographic and social groups on the life satisfaction of retired urban residents. The complementary role of intergenerational assistance and self-support on the life satisfaction of beneficiaries and non-beneficiaries of the pension scheme was analyzed using an ordered logit regression model with 2015 national representative data from China's Health and Retirement Longitudinal Survey. Our sample consists of a cross-sectional data set of 3815 retired urban elderly aged 60 and above. The empirical results depict that though enjoying benefits from the public pension scheme generally enhances life satisfaction, beneficiaries of the Government and Institution Pension and Enterprise Employee Basic Pension are more advantaged than beneficiaries under the Urban-Rural Social Pension Scheme. The pension inequalities existing at provincial levels and across social groups such as gender and residence registration status also affect life satisfaction adversely. Women and rural 'Hukou' registered retired urban residents are at an apparent disadvantage. Getting financial and emotional support from children broadly improves life satisfaction. Non-beneficiaries of the public pension benefit more from the financial support of children than public pension beneficiaries. There is also a positive effect of cohabiting with children on life satisfaction when retired urban residents are single as compared to being married. Financial and physical self-support ability in forms of good health, home ownership and wealth management enhance life satisfaction significantly. However, largely, retired urban elderly have a higher life satisfaction when they are financially independent of children and are supported by state pension schemes. Our findings indicate that self-support ability of the elderly together with pension benefits are more effective in enhancing the life satisfaction of retired urban elderly in China. It is recommended that government institute policies to promote personal finance initiatives by the elderly while improving the pension scheme and reducing pension inequality.

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.

Which Child Is Parents’ Preferred Caregiver/Listener in China?

Adult children are an important source of care providers for parents in a rapidly aging Chinese society, but we know little of which particular child is preferred by parents in time of need. Using the China Longitudinal Aging Social Survey, we investigate the factors associated with parental preference of caregivers and listeners among all his or her children. With children nested within each parent, we fit the conditional (family) fixed-effect fractional logit model. The main results for both caregivers and listeners suggest a preference for the unmarried, the oldest or the youngest, and children who have provided them with support before. Coresident children are favored in rural but not urban China. We did not find preference for sons over daughters. Neither did we find any effect of prior transfers from parents to children. Our findings shed light on the changing norms of eldercare provision in a transitioning society.

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.

Spillover effects of children’s political status on elderly parents’ health in China

Background

Due to the sustained increases in life expectancy over the past half century, the elderly today will receive supports from their children for a longer period than ever before. Therefore, understanding the spillover effects of children’s socioeconomic status on parents’ health becomes increasingly important for both scholars and policy makers.

Methods

The Ordinary Least Squares regression is applied to the China Health and Retirement Longitudinal Study 2011, a national representative dataset including approximately 10 000 households and 17 600 middle-aged and elderly respondents. The Sobel test is used to examine the mediation role of social integration.

Results

The elderly who have a cadre child reported better health (coefficient=0.1347; 95% CI 0.067 to 0.202), had fewer activities of daily living (ADLs) limitations (coefficient=−0.1289; 95% CI −0.216 to −0.042) and were more socially integrated (coefficient=0.2321; 95% CI 0.103 to 0.361). Such effects are mainly driven by the parents of higher-ranking cadres. For the parents of higher ranking cadres, the Sobel test suggests that 12.6% of the total effects on self-reported health and 21.9% of the total effects on ADL limitations are mediated by the increase in parents’ social integration.

Conclusion

The findings suggest positive spillover effects of children’s political status on parents’ health. The benefits of having a cadre child are at least equivalent to the rural–urban gap in health and even stronger for the parents of higher ranking cadres. One potential explanation for such spillover effects is that a child’s political status can improve parents’ community involvement and social interactions.

Health in the Neighborhood and Household Contexts Among Older Chinese Americans

OBJECTIVE

This study examined the associations of neighborhood characteristics and living arrangements with physical and mental health among older Chinese Americans.

METHOD

A sample of 3,159 community-dwelling Chinese older adults in the Greater Chicago area provided reports of health, socio-demographic characteristics, living arrangements, social cohesion, and neighborhood disorder. We used multinomial logistic, Poisson, and negative binominal regression analyses.

RESULTS

Neighborhood disorder was consistently associated with negative health indicators, including poor self-reported health, more chronic conditions, depressive symptoms, and anxiety symptoms. Findings about the relationships between social cohesion and health indicators were mixed. Social cohesion was more salient to mental health for those living with spouse, children, and/or grandchildren relative to those living with spouse only.

DISCUSSION

Policies and interventions are needed to improve the physical and social environments of neighborhoods and to promote healthy aging among Chinese older adults and in the general population as well.

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.

Living Alone among Older Persons in Uganda: Prevalence and Associated Factors

This study aimed at investigating the prevalence and factors associated with living alone among older persons in Uganda. A secondary analysis of the 2010 Uganda National Household Survey (UNHS) data was conducted. A complementary log-log regression model was used to estimate the association between living alone and demographic, socio-economic and health factors. Nearly one out of ten (9%) older persons lived alone in Uganda. Living alone was associated with being divorced / separated (OR 18.5, 95% CI: 10.3–33.3), being widowed (OR 8.8, 95% CI: 5.1–15.2), advanced age (OR 2.1, 95% CI: 1.4–3.2), residence in western region (OR 0.6, 95% CI: 0.3–0.93), poor wealth status (OR 0.3, 95% CI: 0.2–06), receiving remittances (OR 1.6, 95% CI: 1.1–2.3) and being disabled (OR 1.6, 95% CI: 1.2–2.1). Living alone among older persons did not vary by gender.

The effect of health status and living arrangements on long term care models among older Chinese: A cross-sectional study

Background

Currently, there are many studies focusing on the influencing factors of the elderly people’s living arrangements or health status, but little is known about the relationship between living arrangements or health status and long-term care models for the old-age, especially the joint effects.

Objective

We aimed to assess the effects of health status and living arrangements on long-term care models (LTCM) among the elderly of Xiamen, China, especially their cumulative joint effects.

Methods

A total of 14,373 participants aged ≥ 60 years by multistage sampling in Xiamen of China were enrolled. Multinomial logistic regression was used to estimate the Odds ratios (ORs) regressing LTCM on health status and living arrangements using the Anderson model as theoretical framework.

Results

Totally, 14,292 valid questionnaires were obtained, of which 86.37% selected home care. With the increase of disability degree, older people are more likely to choose institutional care, compared to living alone (ORs = 1.75, 2.06, 4.00, 4.01 for the “relatively independent’, “mild disability’, “moderate disability’, and “total disability’, respectively, in comparison with “completely independent’). The elderly living with children and other family members preferred to choose home care. (ORs = 0.50, 0.39, 0.40, and 0.43 for the “living with children’, “living with spouse’, “living with children and spouse’, and “living with others’, respectively, in comparison with “alone’). Additionally, residence, number of children, education level, and feelings of loneliness were the determinants of the choice of social pension.

Conclusion

A multitude of older people are trended to choose home care in Xiamen of China. There was an interaction and joint effect between the degree of disability and the living arrangements on LTCM. Therefore, policymakers should pay close attention to care for those living alone, childless, and disabled elders to meet their care needs, especially in home care. In addition, the social construction of facilities for elders in rural areas should be strengthened.

Postmarital Living Arrangements in Historically Patrilocal Settings: Integrating Household Fission and Migration Perspectives

This study integrates theory and research on household fission (or partition) and migration to better understand living arrangements following marriage, especially in historically patrilocal and primarily agricultural settings. Using panel data from the Chitwan Valley Family Study to analyze the sequential decision-making process that influences men's living arrangements subsequent to first marriage, we demonstrate the importance of distinguishing among extended family living, temporary migration, and the establishment of an independent household. We find that community economic characteristics, such as access to markets or employment, as well as household wealth affect the initial decision to leave the natal home. Household resources and use of farmland, along with the young men's own education, media exposure, travel, and marital behavior, influence the decision to make the departure from the natal home permanent. Our findings explain why previous results regarding household fission and those focused on migration have provided such mixed results, and we establish a new framework for thinking about how families and individuals manage living situations.

What matters for life satisfaction among the oldest-old? Evidence from China

Objective

The world population is aging rapidly and the well-being of older people is of great interest. Therefore, this study investigates the determinants of life satisfaction among the oldest-old (i.e. individuals aged 80 or over) in China.

Materials and methods

We use the 2011/2012 Chinese Longitudinal Healthy Longevity Survey data (n = 6530) for this paper. Logistic regression is used to analyse the effects of socio-demographic, economic, health, instrumental activities of daily living, family and community factors on life satisfaction and depression among the oldest-old in China.

Results

Our analysis confirms the significance of many factors affecting life satisfaction among the oldest-old in China. Factors that are correlated with life satisfaction include respondent’s sex, education, place of residence, self-rated health status, cognitive ability (using mini mental state examination), regular physical examination, perceived relative economic status, access to social security provisions, commercialized insurances, living arrangements, and number of social services available in the community (p<0.05 for all these variables). Although life satisfaction is negatively associated with instrumental activities of daily living (β = -0.068, 95%CI = -.093—.043), and depression (β = -0.463, 95%CI = -.644—.282), the overall effect of self-rated health status is positive (p<0.001). This confirms the primacy of health as the determinant of well-being among the oldest-old.

Conclusions

Majority of the oldest-old in China rated their life satisfaction as good or very good. Our findings show that health and economic status are by far the most significant predictors of life satisfaction. Our finding on the primacy of health and relative income as determinants of well-being among the oldest-old, and the greater influence of self-rated health status over objective health measures is consistent with the findings of many past studies. Our results suggest that efforts should be directed at enhancing family support as well as health and social service provisions in the community to improve life satisfaction of older people.

Self-perceived uselessness and associated factors among older adults in China

Background

Self-perceived uselessness is associated with poor health and high mortality among older adults in China. However, it is unclear which demographic, psychosocial, behavioral and health factors are associated with self-perceived uselessness.

Methods

Data came from four waves (2005, 2008, 2011 and 2014) of the largest nationwide longitudinal survey of the population aged 65 and older in China (26,624 individuals contributed 48,476 observations). This study aimed to systematically investigate factors associated with self-perceived uselessness based on the proposed REHAB framework that includes resources (R), environments (E), health (H), fixed attributes (A) and behaviors (B). Self-perceived uselessness was measured by a single item: “with age, do you feel more useless?” and coded by frequency: high (always and often), moderate (sometimes) and low (seldom and never). Multinomial logistic regression models with low frequency as the reference category were employed to identify REHAB risk factors associated with self-perceived uselessness.

Results

Most factors in the REHAB framework were associated with self-perceived uselessness, although some social environmental factors in the full model were not significant. Specifically, more socioeconomic resources were associated with reduced relative risk ratio (RRR) of high or moderate frequency of self-perceived uselessness relative to low frequency. More environmental family/social support was associated with lower RRR of high frequency of self-perceived uselessness. Cultural factors such as coresidence with children and intergenerational transfer were associated with reduced RRR of high frequency of self-perceived uselessness. Indicators of poor health status such as disability and loneliness were associated with greater RRR of high or moderate frequency of self-perceived uselessness. Fixed attributes of older age and Han ethnicity were associated with increased RRR of high frequency of self-perceived uselessness; whereas optimism and self-control were associated with reduced RRR. Behaviors including regular consumption of alcohol, regular exercise, social participation and leisure activities were associated with reduced RRR of high frequency of self-perceived uselessness.

Conclusions

Self-perceived uselessness was associated with a wide range of factors in the REHAB framework. The findings could have important implications for China to develop and target community health programs to improve self-perceived usefulness among older adults.

A Longitudinal Analysis of the Association Between Living Arrangements and Health Among Older Adults in China

This article used the nationally representative Chinese Longitudinal Healthy Longevity Survey to explore the associations between living arrangements and health among older adults. Living arrangements were stratified into six categories. Health was measured by self-rated health, activities of daily living (ADL) disability, and cognitive impairment. Random-effects ordered probit regressions were applied. The results indicated that coresidence had a positive effect on self-rated health compared with living alone. After introducing psychological well-being, the health differences observed in living with a spouse and living with both spouse and children were not significant. Participants with each of the living arrangement were more likely to have a higher rate of cognitive impairment and ADL disability than those living alone. Living arrangements were associated with older adults’ health. Psychological well-being was a key factor in this association, which may result from living with a spouse, and could contribute to the self-rated health of older adults.

Socioeconomic status as a moderator between frailty and mortality at old ages

Background

Despite the well-established power of frailty to predict mortality, and the known associations of socioeconomic status (SES) with mortality, it is largely unknown whether the linkage between frailty and mortality varies across different SES groups. This study aims to investigate whether SES moderates the association between frailty and mortality.

Methods

We relied on the 2008/2009 and 2011/2012 waves of the Chinese Longitudinal Healthy Longevity Survey, a nationwide sample of 13,731 adults aged 65 or older in China. Frailty was constructed using a cumulative index of 38 items (with 39 deficits) reflecting different dimensions of health; the index or the proportion of deficits ranges from 0 to 1, with greater scores indicating poorer health condition. SES was measured by a socioeconomic vulnerability index (SEVI) also from a similar cumulative approach consisting of 6 deficits; the proportion of deficits ranges from 0 to 1 with higher scores indicating lower SES. Eight Weibull hazard regression models were performed to examine how SES moderates the linkage between frailty and mortality.

Results

We found that a one percentage point increase in the frailty index was associated with an increased hazard ratio (HR) by 2.7 % (HR = 1.027, 95 % CI: 1.025–1.027); a one percentage point increase in SEVI score was associated with an increased hazard ratio by 0.6 % (HR = 1.006, 95 % CI: 1.004–1.008) controlling for demographics. When interactions between SEVI and frailty index were modeled, the increased mortality risk associated with frailty was weaker among people with lower SES than among people with higher SES (HR = 0.983, 95 % CI: 0.967–0.992). However, the moderating role of SES was diminished when interactions between SES and age and between frailty and age were modeled. With increasing age, the increased mortality risks associated with frailty and socioeconomic vulnerability weakened.

Conclusions

Frailty was a stronger predictor of mortality among individuals with higher SES than those with lower SES. The increased mortality risks associated with socioeconomic vulnerability and frailty weakened with age. Public health programs aimed at improving SES and promoting healthy longevity should start early in old age, or even earlier, and target poor and frail older adults for maximum impact.

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.

Facing “Double Jeopardy”? Depressive Symptoms in Left-Behind Elderly in Rural China

Objective: When examining the depressive symptoms of left-behind elderly, this article goes beyond a focus on disruption to traditional patterns of living arrangements and investigates the heterogeneities in the patterns of migration distance, as well as the role of community contexts in buffering the loss of migrant children’s support. Method: This study uses the first wave of the China Health and Retirement Longitudinal Survey, and employs random effects multi-level modeling. Results: Having migrant children is associated with increased depressive symptoms among older adults, above and beyond living arrangements. Having their migrant children all live outside the province further puts older adults in disadvantaged mental conditions. This disadvantage can be further compounded by residence in impoverished communities. Discussion: In assessing depression among rural older adults in China, examination of living arrangements may be insufficient. It may be necessary to reference to children’s migration status as well as community poverty levels.

Village senior centres and the living arrangements of older people in rural China: considerations of health, land, migration and intergenerational support

China is experiencing rapid urbanisation and population ageing, alongside sometimes contentious rural land consolidation. These on-going social, economic, political and demographic changes are especially problematic for older people in rural areas. In these regions, social and institutional support arrangements are less developed than in urban areas; older people have few options for re-settlement but are resistant to or incapable of adjusting to high-rise apartment living. In 2012–13, we gathered rich qualitative and quantitative data on over 600 older residents in 12 villages under the jurisdiction of City L in north-east coastal China to analyse residents’ living arrangement choices during the village renovation process. We compared villages with and without senior centres to shed light on the correlates of co-residence and independent living. Senior centres play a role in balancing the burden on rural Chinese families resulting from population ageing, smaller families, widespread migration for work, and the rapid urbanisation that is restructuring land rights and social support arrangements.

Care Needs and Caregivers: Associations and Effects of Living Arrangements on Caregiving to Older Adults in India

As the ageing phenomenon continues in India, we explore the care needs of older adults and identify caregivers for specific care needs across living arrangements. Using the United Nations Population Fund (UNFPA) conducted Building Knowledge Base on Population Ageing in India (BKPAI 2011) data comprising 9850 older adults, we employed statistical methods to analyze the data, find associations and used binary logistic regression to model the adjusted and unadjusted effects of living arrangements on caregiving to older adults for specific care needs. Care-requiring situations considered were acute sickness, sickness requiring hospitalization, chronic morbidity, functional disability represented by ADL and IADL limitations, and locomotor disability. Results indicate that living arrangements of older adults were significantly associated with health, functional status and disability as well as caregiving patterns. Our results suggest that co-residence with children and all others was beneficial to older adults in obtaining care from a family caregiver for their hospitalization and chronic morbidity needs while living with spouse or living with a partner was advantageous for older adults in receiving care for their ADL limitations and during hospitalizations. Mean number of children was also significantly associated with the availability of a caregiver during hospitalization, locomotor disability, chronic morbidity and acute sickness. The study also highlights a little known phenomenon, that there was familial help available to older adults who lived alone. Notably, non-family sources of caregiving were steadily becoming visible (as high as 8–10 % of the caregiving component) especially among older adults living alone.

The impact of a discrepancy between actual and preferred living arrangements on life satisfaction among the elderly in China

OBJECTIVES

To explore the effects of a discrepancy between actual and preferred living arrangements on the relationship between living arrangements and life satisfaction among the elderly in China.

METHODS

Secondary analysis of the 2005 dataset of the Chinese Longitudinal Healthy Longevity Survey was performed. A binary logistic regression model was used to analyze the relationship between life satisfaction and living arrangements.

RESULTS

Among those with concordant actual and preferred living arrangements, living in a nursing home increased the likelihood of life satisfaction, whereas living alone and living with a spouse decreased the likelihood of life satisfaction compared to living with the next generation and a spouse. Among those with discordant living arrangements, there were no differences in life satisfaction between the various living arrangements, except that living with a spouse increased life satisfaction compared to living with the next generation and a spouse.

CONCLUSIONS

A discrepancy between actual and preferred living arrangements modifies the relationship between life satisfaction and actual living arrangement. Living in a nursing home is a good option for Chinese elder care only if the older individual emotionally accepts it. Living alone or with a spouse is not a good arrangement for elder care, even though it is often preferred by the elderly. Those with discordant living arrangements are more satisfied living with their spouses.

Offspring caregivers' depression affected by intergenerational disagreements on preferred living arrangement for the elderly: A phenomena with Chinese characteristic

OBJECTIVE

This study aimed to explore whether the depression of offspring caregivers can be affected by the intergenerational disagreements on preferred living arrangements for the elderly, and the extent of this influence.

METHODS

A total of 875 participants from five urban neighborhoods were investigated in a cross-sectional survey in Jinan, China. Depressive symptoms were assessed by the Self-rating Depression Scale (SDS). Multiple stratification was performed based on participants' characteristics, then generalized linear models (GLM) were used to adjust confounding factor and analyze the effect of the intergenerational disagreements on depressive symptoms among participants with different characteristics.

RESULTS

The intergenerational disagreements on preferred living arrangements for the elderly greatly impact on offspring caregivers' depressive symptoms. Especially in the following two situations: (1) in the case of older adults were relatively independent and offspring caregivers had to co-reside with older adults against their own will, the max mean difference on the depression measures was up to 10.603 (p<0.001), in comparison with both parties were willing to co-reside. (2) In the case of older adults were fully dependent and offspring caregivers had not to hire a maid to care older adults against their own will, the max mean difference on the depression measures was up to 8.937 (p<0.001), in comparison with both parties were willing not to hire a maid.

CONCLUSION

Intergenerational disagreements on preferred living arrangement for the elderly have negative effect on offspring caregivers' depressive symptoms.