Understanding Household Dynamics From the Ground Up: A Longitudinal Study From a Rural South African Setting

Investigations into household structure in low- and middle-income countries (LMICs) provide important insight into how families manage domestic life in response to resource allocation and caregiving needs during periods of rapid sociopolitical and health-related challenges. Recent evidence on household structure in many LMICs contrasts with long-standing viewpoints of worldwide convergence to a Western nuclearized household model. Here, we adopt a household-centered theoretical and methodological framework to investigate longitudinal patterns and dynamics of household structure in a rural South African setting during a period of high AIDS-related mortality and socioeconomic change. Data come from the Agincourt Health and Socio-Demographic Surveillance System (2003-2015). Using latent transition models, we derived six distinct household types by examining conditional interdependency between household heads' characteristics, members' age composition, and migration status. More than half of households were characterized by their complex and multigenerational profiles, with considerable within-typology variation in household size and dependency structure. Transition analyses showed stability of household types under female headship, while higher proportions of nuclearized household types dissolved over time. Household dissolution was closely linked to prior mortality experiences-particularly, following death of a male head. Our findings highlight the need to better conceptualize and contextualize household changes across populations and over time.

Do the living arrangements of older people matter for the family transfers they receive? Evidence from Senegal

In the absence of broad-based formal health insurance and social protection systems in much of sub-Saharan Africa, the family acts as the key provider of support to older people. This paper furthers our understanding of family support mechanisms in the context of low-income countries by focusing on support from outside the household, which has been less studied so far. By using the data of 3,114 people aged ≥50 from the second round of the Senegalese Poverty and Family Structure Survey, the paper examines how the living arrangements of older people are associated with receiving transfers from non-coresident kin. Our findings highlight a net advantage of women receiving net positive family transfers compared to men for some living arrangements. Results also indicate that living without a husband or an adult significantly increases the likelihood of older women receiving support from non-resident family members compared to those who live with both spouse and a younger adult child. However, these differences are not significant among older men. These results suggest that in constrained settings, decision-makers should consider older people's living arrangements and potential external family support when designing public policies towards them, so as to optimise the impact of policy and interventions on their welfare.

Challenges and Assets of Older Adults in Sub-Saharan Africa: Perspectives of Gerontology Scholars

Life expectancy is increasing globally, with the biggest gains expected in sub-Saharan Africa. Using an online survey, we investigated the perspectives of gerontology scholars on the challenges of aging in sub-Saharan Africa as well as the assets of older adults. Respondents (n = 72) from 17 countries, primarily in Africa, and representing 16 disciplines, identified the top issues facing African older adults as: poverty, lack of trained geriatric professionals, food insecurity, disability/health issues, and long-term care. Older adults' unique strengths were noted as indigenous knowledge systems, being holders of cultural heritage, and their contributions to development. Respondents' biggest concerns about older adults in sub-Saharan Africa were the lack of government attention to aging issues (63%) and a lack of social services targeted to older adults' needs (57%). Government funding (77.8%) and international partnerships (38.9%) were noted as resources needed to support aging research in sub-Saharan Africa. The response or non-response of governments in sub-Saharan Africa will determine whether the growing number of older adults will increasingly experience unmet needs and whether their assets will be considered in development efforts. Establishing professional networks of gerontology scholars in the region will help to document the challenges faced by older adults, to plan for the coming demographic shift, and to empower older adults to thrive as valued community members.

Policy Shift: South Africa's Old Age Pensions' Influence on Perceived Quality of Life

Noncontributory pensions serve as an important resource for poverty-affected households in low- and middle-income countries. This study explores how a recent policy change to pension receipt influences perceived quality of life among older South Africans. We use survey data from the longitudinal World Health Organization Study on global AGEing and adult health and from the Agincourt Health and Socio-Demographic Surveillance System census. We find pension receipt to have a positive impact on both men's and women's perceived quality of life. These findings hold when controlling for prior well-being status. We find a significant moderating factor of physical limitations on the relationship between pension receipt and quality of life. Individuals reporting the highest levels of physical limitation report a larger increase in their quality of life upon pension receipt than those with less severe physical limitations. We conclude that despite the well-documented household income-pooling in this population, pension receipt still leads to a significant positive impact on pensioners' perceived quality of life.

Antiretroviral therapy coverage associated with increased co-residence between older and working-age adults in Africa

OBJECTIVES

To determine whether national antiretroviral therapy (ART) coverage is associated with changes in the living arrangements of older adults.

DESIGN

Retrospective analysis using 103 nationally representative surveys from 28 African countries between 1991 and 2015.

METHODS

The sample consisted of individuals aged at least 60 years. We investigated how three measures of living arrangements of older adults have changed with ART coverage: the number of older individuals living without working-age adults, the number of older individuals living with only dependent children (i.e. 'missing generation' households), and the number of working-age adults per household where an older individual lives.

RESULTS

Our sample consisted of 297 331 older adults. An increase in ART coverage of 1% was associated with a 0.7 percentage point reduction (P < 0.001) in the probability of an older adult living without working-age adult and a 0.2 percentage point reduction (P = 0.005) in the probability of an older adult living in a 'missing generation' household. Increases in ART coverage were also associated with more working-age adults in households with at least one older adult. In our study countries, representing 75% (749 million) of the sub-Saharan population, an additional 103 000-358 000 older adults could be living with working-age adults as a result of increased ART coverage (1%).

CONCLUSION

The scale-up of ART has likely led to substantial increases in co-residence between older and working-age adults in Africa. Returns to investments in HIV treatment will be too low, if the social benefits from these changes in living arrangements of older adults are not taken into account.

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

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

Living Arrangements and Health at Older Ages in Rural Malawi

Sub-Saharan Africa's older population is projected to nearly double in size by 2030. At the same time, demographic changes have caused major shifts in the units primarily responsible for the care of older adults: the family and household. The purpose of this paper is to examine the relationship between household composition and health at older ages in rural Malawi. We use data from the Malawi Longitudinal Study of Families and Health (MLSFH), which contains detailed information on household and family structure, along with measures of mental and physical health (from the Short Form-12). We focus on several measures of living arrangements that are expected to be associated with health: overall household size, sex composition, and kin structure (based on co-residence with offspring and grandchildren). Results show that: (1) older women who co-reside with offspring have better mental and physical health compared to those living only with grandchildren; (2) older men who live in larger households or in households with a higher proportion of females have better physical health.

The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context

Very few studies have investigated mental health in sub-Saharan Africa (SSA). Using data from Malawi, this article provides a first picture of the demography of depression and anxiety (DA) among mature adults (aged 45 or older) in a low-income country with high HIV prevalence. DA are more frequent among women than men, and individuals affected by one are often affected by the other. DA are associated with adverse outcomes, such as poorer nutrition intake and reduced work efforts. DA also increase substantially with age, and mature adults can expect to spend a substantial fraction of their remaining lifetime-for instance, 52 % for a 55-year-old woman-affected by DA. The positive age gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that has been shown in high-income contexts, where older individuals often experience lower levels of DA. Although socioeconomic and risk- or uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical health with age is the key driver of the rise of DA with age in this low-income SSA context.

Number of Dependents, Community Support, and Mental Health in Later Life: Does Gender Make a Difference?

This study examined associations of number of dependents and community support with mental health and whether the nature of these associations differs for males and females. Data were obtained from 209 elderly Nigerians using self-report measures. Hierarchical multiple regression (stepwise method) and Hayes regression-based PROCESS approach for tests of moderation were employed in analyzing the data. Results of a hierarchical multiple regression showed that number of dependents predicted mental health for the total sample and for men, but not for women. For the subgroups of men and women, there were significant predictions of mental health by community integration, community participation, and use of community organization, even after controlling for the roles of sociodemographic variables. The hypothesis on the moderation effect of community support on the associations of number of dependents and mental health was also supported. Findings highlighted the importance of addressing gender differences in the role of social capital in mental health.

Who Benefits--Or Does not--From South Africa's Old Age Pension? Evidence from Characteristics of Rural Pensioners and Non-Pensioners

Social protection grants play a critical role in survival and livelihoods of elderly individuals in South Africa. Rarely is it possible to assess how well a social program reaches its target population. Using a 2010 survey and Agincourt Health Demographic Surveillance System census data we conduct multivariate logistic regression to predict pension receipt in rural South Africa. We find only 80% of age-eligible individuals report pension receipt. Pension non-recipients tend to be male, have poor socio-economic status, live in smaller households, be of Mozambican origin, and have poorer physical function; while older persons living in households receiving other grants are more likely to report pension receipt. We conclude that a reservoir of older persons exists who meet eligibility criteria but who are not yet receiving pensions. Ensuring that they and their households are properly linked to all available social services—whether for child or old-age social grants—is likely to have beneficial and synergistic effects.