Health and Living Arrangements Among Older Americans

Relationship between the Prevalence of Metabolic Disease and Impaired Mobility, Diet, Physical Activity, and Socio-Demographic Characteristics in the Polish Elderly-A Cross-Sectional Study

Maintaining good health for as long as possible presents a great challenge for the elderly. As the elderly population is growing, there is an ongoing need to identify health risk factors affecting older individuals. The study aimed to explore relationships between sociodemographic characteristics, diet, physical activity, and prevalence of metabolic diseases and impaired mobility in the Polish elderly. A cross-sectional study was carried out on 417 elderlies in May-July 2021. Cluster analysis was applied to separate four homogeneous clusters based on the prevalence of metabolic disease and impaired mobility. Logistic regression analysis was used to verify associations between variables. Being overweight or having obesity, as well as following a diet, increased the probability of being affected by metabolic disease. Being well educated, having a better financial situation, positive perception of own health, and having at least moderate physical activity decreased the probability of suffering from mobility impairments. Eating behaviors were not found to be predictors of the disease. However, they differentiated the selected clusters. The results confirmed the heterogeneity of factors that may impact healthy aging. Thus, they should be taken into account by public health authorities to develop health promotion actions adjusted to the needs of specific subgroups.

Living Alone and Suicide Risk in the United States, 2008‒2019

Objectives. To evaluate the association between living alone and suicide and how it varies across sociodemographic characteristics. Methods. A nationally representative sample of adults from the 2008 American Community Survey (n = 3 310 000) was followed through 2019 for mortality. Cox models estimated hazard ratios of suicide across living arrangements (living alone or with others) at the time of the survey. Total and sociodemographically stratified models compared hazards of suicide of people living alone to people living with others. Results. Annual suicide rates per 100 000 person-years were 23.0 among adults living alone and 13.2 among adults living with others. The age-, sex-, and race/ethnicity-adjusted hazard ratio of suicide for living alone was 1.75 (95% confidence interval = 1.64, 1.87). Adjusted hazards of suicide associated with living alone varied across sociodemographic groups and were highest for adults with 4-year college degrees and annual incomes greater than $125 000 and lowest for Black individuals. Conclusions. Living alone is a risk marker for suicide with the strongest associations for adults with the highest levels of income and education. Because these associations were not controlled for psychiatric disorders, they should be interpreted as noncausal. (Am J Public Health. 2022;112(12):1774-1782. https://doi.org/10.2105/AJPH.2022.307080).

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.

Experience of Elderly Korean Women with Diabetes and Multimorbidity in Elderly Couple Households: A Qualitative Study

Elderly women with multimorbidity in elderly couple households face the double burden of managing their diseases while fulfilling their gender roles. This study aimed to investigate the daily life experiences of elderly women with diabetes and multimorbidity living as part of couple households in Korea. Ten women aged 65 or more with diabetes and multimorbidity and living as part of elderly couple households participated in this phenomenological qualitative study. The data were analyzed with van Manen’s method of study of analytical phenomena. Four essential themes were identified. Participants regarded diabetes and multimorbidity as a part of the aging process and continued to function as caregivers for their husbands and themselves, avoiding becoming a burden to their adult children. The findings of this study could help healthcare providers better understand elderly women with diabetes and multimorbidity and assist in improving the health of such women.

Role of the Social Support and Health Status in Living Arrangement Preference of the Elderly in China—A Cross-Sectional Study

Background

Living arrangement of the elderly is one of the most important components that affect their quality of life in later years. The aging, with the phenomenon of low fertility rate and family structure transformation, has caused changes in the living arrangements of the elderly. This research aimed to find the elderly's living arrangement preferences and influencing factors.

Methods

The data were obtained from The Chinese Longitudinal Healthy Longevity Survey (CLHLS) in the 2018, and the sample was comprised of 9,638 individuals aged ≥ 60 years. Independent variables were divided into social support, health status and so-economic status. Chi-square test and binary logistic regression were used to analyze the relationship between the above variates and living arrangement preferences.

Results

Currently, in terms of living arrangement preferences, nearly half (45.6%) of the respondents choose not to live with their children. The binary model results showed that elderly who were married (OR = 0.166, 95% CI: 0.147–0.187), experienced more than 6 years of education (OR = 0.600, 95% CI: 0.517–0.695), ability of daily living (ADL) impaired (OR = 0.810, 95% CI: 0.720–0.912), suffering from multiple chronic diseases (OR = 0.803, 95% CI: 0.720–0.912), and obtained community services (OR = 0.884, 95% CI: 0.803–0.972) incline to not live with their children. The elderly who living in rural areas (OR = 1.244, 95% CI: 1.129–1.371), with an income of more than 500,000 yuan per year (OR = 1.557, 95% CI: 1.380–1.757), having children visiting regularly (OR = 1.405, 95% CI: 1.161–1.707) and receiving children's financial support (OR = 1.194, 95% CI: 1.080–1.319) are more likely to choose to live with their children.

Conclusions

This study found that the living arrangement preferences of the elderly were affected by social support and health status, and living with children is no longer the only option for the elderly these days. The elderly care services provided by communities or professional care institutions may become the mainstream of taking care of the elderly citizens in the aging society. Improving the types and forms of community nursing services to increase the accessibility of these services; setting up elderly care institutions reasonably and equipping adequate professional nursing staff should be considered as priority measures.

The Relationship between Living Arrangements and Sleep Quality in Older Adults: Gender Differences

(1) Background: This study examined the effects of living arrangements on the quality of sleep among older adults and analyzed related gender differences; (2) Methods: A total of 4756 older adults in Seoul were included. After adjusting for socio-demographic factors, older adults living alone showed a poorer sleep quality compared with those living with others; (3) Results: When we analyzed the effects of living arrangements on sleep quality by gender, there was no difference in the risk of poor sleep quality between male older adults living alone and those living with others (OR = 1.089, 95% CI = 0.729–1.628), whereas the risk of poor sleep quality was higher for female older adults living alone than those living with others (OR = 1.359, 95% CI = 1.088–1.696); (4) Conclusions: In this study, we have confirmed that older women living alone had poor sleep quality compared to older men. Hence, gender-based approaches will be helpful when providing social support resources to older adults living alone.

Living Preference Modifies the Associations of Living Arrangements With Loneliness Among Community-Dwelling Older Adults

Objectives

Living arrangement has been reported to have a significant influence on feelings of loneliness in older adults, but their living preferences may confound the association. This study aimed to investigate whether the associations of living arrangements with loneliness differ in community-dwelling older adults according to different living preferences.

Methods

In the 2008/2009 (baseline) and 2011/2012 (follow-up) waves of the Chinese Longitudinal Healthy Longevity Survey, living arrangements [living with children mainly (LWC), living with spouse only (LWS), and living alone (LA)], living preferences [preferring living with children (PreLWC) and preferring living alone/only with spouse (PreLA)], and feelings of loneliness were assessed. The effect modifications of living preferences in the associations of living arrangements with loneliness were estimated using logistic regression models, and corresponding odds ratios (ORs) were calculated.

Results

Living preferences significantly modified the associations of living arrangements with loneliness at baseline (p for interaction = 0.009 for LWS and = 0.015 for LA). Compared with LWC, LWS was protective for loneliness only in the PreLA older adults at baseline (OR = 0.53, 95% CI = 0.45–0.64, p < 0.001), and LA was significantly associated with loneliness especially in the PreLWC older adults, compared with their PreLA counterparts (at baseline, ORs = 2.89 vs. 2.15; at follow-up, ORs = 1.68 vs. 1.51).

Conclusion

Living preference modifies the associations of living arrangements with loneliness, and those who prefer living with children but live alone are more likely to feel lonely. It is recommended that living preferences should be considered when managing loneliness in community-dwelling older adults.

Educational Differences in Self-Rated Health Trends Among Middle-Aged and Older Adults Living Alone, 1972-2018

Objectives: This study examines educational differences in living alone and in self-rated health trends among middle-aged and older adults. Methods: We used logistic regression to analyze data from the 1972-2018 National Health Interview Survey (n = 795,239 aged 40-64; n = 357,974 aged 65-84). Results: Between 1972-1974 and 2015-2018, living alone became more prevalent, particularly among men and at lower levels of education. Self-rated health trends varied by living arrangement and education. We found self-rated health declines among middle-aged adults having no college degree and living alone, but trends in self-rated health were mostly stable or even improved among middle-aged adults living with others. Among older adults, self-rated health improved over time, but for the least-educated older Americans living alone, the probability of reporting fair or poor health increased between 1972-1974 and 2015-2018. Discussion: The findings suggest growing disparities by social class, in living arrangements and in self-rated health.

Reciprocal Dynamics of Solo-Living and Health Among Older Adults in Contemporary China

OBJECTIVES

Solo-living has far-reaching implications for older adults' well-being. The causal impacts and the pathways of solo-living on health and well-being of older adults are still unclear. This study examines the correlates of solo-living and subsequent health outcomes of solo-living among older adults in mainland China.

METHODS

We draw data from four waves of a nationwide survey with a total of 9,714 older adults aged 65 or older who had at least three interviews in 2005-2014. A generalized structural equation modeling approach was applied to examine what factors are associated with solo-living status and whether and how the antecedent of solo-living status subsequently affects well-being and health.

RESULTS

Owning a home, having no living child, and a preference to live independently are positively correlated with living alone, whereas living in a city, having economic independence, being educated, and having poor physical and cognitive functions are associated with lower odds of solo-living. Older Chinese adults who live alone are more likely to feel lonely and have a lower life satisfaction, yet they are more likely to be involved in social/leisure activities, and have fewer physical disabilities and a lower mortality risk.

DISCUSSION

There is a bi-directional relationship between solo-living and well-being/health among the Chinese older adults. Solo-living is a conditioned choice of a set of critical factors among older Chinese. The greater involvement in social/leisure activities is likely a key for Chinese solo-living older adults to mitigate the negative impact of their lower psychological well-being on subsequent mortality.

A New Look at the Living Arrangements of Older Americans Using Multistate Life Tables

OBJECTIVES

We extend existing research on the living arrangements of older Americans by focusing on geographic proximity to children, examining transitions in living arrangements across older ages, and describing differences by both race/ethnicity and educational attainment.

METHOD

We use data from the Health and Retirement Study (HRS) over a period of 10 years (2000-2010) to construct multistate life tables. These analyses allow us to describe the lives of older Americans between ages 65 and 90 in terms of the number of expected years of life in different living arrangements, reflecting both mortality and living arrangement transitions.

RESULTS

Americans spend a substantial proportion of later life living near, but not with, adult children. There is a good deal of change in living arrangements at older ages and living arrangement-specific life expectancy differs markedly by race/ethnicity and educational attainment. However, overall life expectancy is not strongly related to living arrangements at age 65.

DISCUSSION

Multistate life tables, constructed separately by sex, race/ethnicity, and educational attainment, provide a comprehensive description of sociodemographic differences in living arrangements across older ages in the United States. We discuss the potential implications of these differences for access to support and the exacerbation or mitigation of inequalities at older ages.

Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-Evidence from Shaanxi province

BACKGROUND

So far limited evidence exist comparing the difference between urban and rural elder residents in relation to how living arrangements correlates to health-related quality of life(HRQOL) of the elderly.

OBJECTIVE

This study aims to compare the HRQOL of the elderly with four living arrangements: living with spouse only (LS), living alone (LA), living with a spouse and adult children(LSC) and the single elderly living with adult children (SLC) in urban and rural areas of China.

METHODS

The data were drawn from the 2013 wave of Chinese National Health Service Survey in Shaanxi Province, which included 11,729 elderly people. The Chinese version of the EQ-5D-3L questionnaire was used to measure the HRQOL. Tobit regression model and logistic regression models were employed to estimate the associations between living arrangements and the HRQOL of the elderly.

RESULTS

The EQ-5D utility scores of the urban elderly with four different living arrangements (LS, LA,LSC and SLC) were 0.9141, 0.8392, 0.8176 and 0.9080, which were almost all higher than their rural counterparts. After controlling other confounding variables, tobit regression estimates showed that the EQ-5D utility scores of the single elderly either living alone or living with adult children were lower than the elderly living with a spouse in urban areas. In rural areas only the single elderly living with adult children were more disadvantaged. Additionally the logistic regression results showed living-alone elderly had worse psychological health and the single elderly living with adult children had worse physical health.

CONCLUSION

The findings suggest that the urban elderly have better HRQOL than the rural elderly and the elderly with different living arrangements in urban and rural area have different HRQOL. More attention should be given to the poor mental health of the elderly living alone and the worse physical health of the single elderly living with adult children.

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.

Demography of Living Arrangements Among Oldest-Old Mexican Americans: Evidence From the Hispanic Epidemiologic Study of the Elderly

OBJECTIVE

In this article, we examine the demographics of living arrangements and household headship status among Mexican-origin individuals aged 85+ years.

METHOD

Data come from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) caregiver and respondent surveys.

RESULTS

Finances of the elderly individual and their caregiver inform living arrangement decisions. Physical and cognitive disability differentiate among living arrangements: The most mentally and physically impaired are most likely to live with others and less likely to be the head of the household.

DISCUSSION

Motivations for living with others are clearly more complex than simple filial piety considerations might hold. Extended living arrangements provide concrete financial and instrumental benefits for both elderly parents and their adult child caregiver. Future research should address the question of the capacity of the Mexican American family to provide care for elderly parents in the face of major demographic and social changes.

Differences in Living Arrangements Among Older Adults Transitioning Into the Community: Examining the Impact of Race and Choice

The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examines the influence of these factors on living arrangements for 659 program participants age 65 or older. Unmarried Blacks and people with financial or legal challenges are less likely to live with a live-in caregiver or in supervised housing compared with unmarried Whites. Race did not determine living arrangements among married participants, but housing transition challenges did. Findings inform policies targeting nursing home rebalancing efforts by highlighting racial diversity in living arrangements and emphasizing the need for affordable, accessible housing options for older adults of any race seeking to live in the community rather than remain in an institutional setting.

Transitions in Living Arrangements Among Older Mexican Americans

This study examines the transition from independent living to a coresidential living arrangement across the late life course among older unmarried (i.e., widowed, divorced/separated, and single) Mexican Americans. Using 18 years' worth of panel data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly, event history analyses revealed that age at migration, physical disability, and cognitive impairment were strong predictors of the transition to a coresidential living arrangement. Importantly, a decline in physical and cognitive abilities heightened the risk of transition to a coresidential living arrangement, net of time-variant measures of disability and impairment. These findings provide evidence for incorporating a dynamic approach to examining living arrangements across the late life course for Mexican-origin Hispanics living in the United States, with implications for policy and service providers.

Predictors of ADL Disability Trajectories Among Low-Income Frail Elders in the Community

In this study, the author examined the effects of psychosocial and health factors on the ADL disability trajectory of low-income frail elders living in the community. She analyzed three-year longitudinal data with a maximum of 15 repeated observations from a cohort of elderly participants in Michigan’s Medicaid Waiver Program ( N=3,161), using the hierarchical linear modeling approach. Baseline data of this cohort were taken in 1999; a reassessment was conducted about every three months. The analysis shows that major risk factors for a poor activity of daily living (ADL) disability trajectory include being Black, older, living with nonspouse others, and no confidence in functional improvement. Presence of arthritis, cancer, and cognitive limitation had significant and modest effects on ADL disability trajectories. The findings have implications to community-based intervention programs for frail elderly persons in the community.

Aging in Place of Vulnerable Older Adults: Person-Environment Fit Perspective

Based on the premise that the experience of aging in place is different for vulnerable subgroups of older adults compared with less vulnerable subgroups, we focus on low-income older adults as a vulnerable subgroup and senior housing as an alternative to a conventional, private home environment. Using the 2008 and 2010 waves of the Health Retirement Study, regression models determined the impact of person-environment (P-E) fit between poverty status and residence in senior housing on self-rated health. Consistent with the environmental docility hypothesis, findings show that, among low-income individuals, the supportive environment of senior housing plays a pronounced compensating role and may be a key to successful adaptation in aging. As the first research effort to empirically demonstrate the positive health effects of senior housing among socioeconomically vulnerable elders, our findings provide a much-needed theoretical and practical underpinning for policy-making efforts regarding vulnerable elders.

Association between Living Arrangements and Influenza Vaccination Rates among Elderly South Korean People: The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2)

BACKGROUND

This study aimed to investigate the association between living arrangements and influenza vaccination among elderly South Korean subjects.

METHODS

We used data from the fifth Korean National Health and Nutrition Examination Survey. Participants older than 65 years were included and categorized into 4 groups according to the type of living arrangement as follows: (1) living alone group; (2) living with a spouse group; (3) living with offspring (without spouse) group; and (4) living with other family members group. A total of 1,435 participants were included in this cross-sectional analysis.

RESULTS

A lower vaccination rate was observed in the living with offspring (without spouse) group, whereas the living with a spouse group had higher rates of both seasonal and H1N1 influenza vaccination. After adjusting for age, sex, region, education level, income level, and number of comorbidities, the living with offspring (without spouse) group had a higher H1N1 vaccination non-receipt rate than the living alone group (odds ratio, 2.03; 95% confidence interval, 1.08-3.82).

CONCLUSION

Influenza vaccination rates differed according to the type of living arrangement. Particularly, those living with offspring (without spouse) had the lowest H1N1 influenza vaccination rate compared to those with other living arrangements, and this difference was significant. Interventions to improve influenza vaccination coverage should target not only elderly persons who live alone, but also those living with offspring.

Preventive care service usage among Chinese older adults in the Greater Chicago area

BACKGROUND

Preventive care is important for reducing morbidity and mortality among the elderly, but racial/ethnic disparities exist in use of preventive care services. We aimed to develop a better understanding of preventive care service utilization among Chinese older adults in the Greater Chicago area.

METHODS

We used data collected from the Population Study of Chinese Elderly in Chicago study, a population-based survey of 3,159 community-dwelling Chinese older adults in the Greater Chicago area. Preventive care services assessed include use of flu, pneumonia, and hepatitis B vaccines as well as colon, breast, cervical and prostate cancer screening. We also examined sociodemographic, health and quality of life correlates for preventive care service use.

RESULTS

We found that although Chinese older adults had lower utilization rates for the pneumonia vaccine and cancer screening, their utilization of the flu shot was consistent with national utilization rates. No sociodemographic, self-reported health, or quality of life characteristics were associated with all nine of the preventive care services.

CONCLUSION

Use of preventive care services except flu vaccination was low among Chinese older adults in the Greater Chicago area. However, future longitudinal studies may be necessary to further elucidate preventive care service utilization patterns among Chinese older adults.

Influence of living arrangements on the management and control of hypertension: a mixed-methods study of Korean American elderly

Elders living alone may experience worse health outcomes than do those living with spouse and/or children. Using baseline data from a randomized trial to promote high blood pressure (HBP) control in Korean elders (N = 440), we examined the relationship between living arrangements and HBP control. We also interviewed a sub-sample to better understand the patterns of social interactions associated with different types of living arrangements. One in five reported living alone; this group tended to be older and female, and resided in senior group housing. Those living alone were twice as likely as those living with a spouse to have controlled BP (OR = 2.08; 95 % CI 1.09-3.97), even after controlling for study covariates. Those in senior group housing had frequent social interactions that involved conversations around health, encouragement concerning medication taking, and health information sharing. In conclusion, Korean elders living independently are neither socially-isolated nor at increased risk for poor BP control.

Identifying factors associated with changes in physical functioning in an older population

AIM

The present study evaluated the association between changes in physical functioning and a variety of factors in an older population in Taiwan.

METHODS

The data of 907 participants were derived from a three-wave cohort study of aging, the Functioning and Aging Study in Taipei, with a study period from 2005 to 2009. Functional status was assessed using activities of daily living, instrumental activities of daily living and mobility tasks, and classified as being normal, with mild disability, moderate disability, and severe disability. All potential factors were allocated into five groups including demography, chronic diseases, geriatric conditions, lifestyle and physical assessments. Generalized estimating equations and generalized linear mixed-effects models were used to identify factors responsible for changes in physical functioning across different waves of data.

RESULTS

The proportion of elderly participants with normal function decreased with time throughout the study period. The results of Generalized estimating equations and mixed effects models showed nearly identical sets of factors. These included age, living arrangements, social support, self-rated health, stroke, diabetes, Parkinson's disease, osteoporosis, depression, cognition, vision, history of fracture and falls, incontinence of urine and feces, physical activity, body mass index, and short physical performance battery.

CONCLUSIONS

Older persons with stroke, Parkinson's disease, diabetes, osteoporosis, geriatric conditions and poor short physical performance battery score should be considered as the target of prevention against functional decline. Those not living with spouses, with poor self-rated health, with low social support, being underweight or obese and with a sedentary lifestyle might also require major attention.

The social side of accidental death

Mortality from unintentional injuries, or accidents, represents major and understudied causes of death in the United States. Epidemiological studies show social factors, such as socioeconomic and marital status, relate with accidental death. But social theories posit a central role for social statuses on mortality risk, stipulating greater relevance for causes of death that have been medically determined to be more preventable than others. These bodies of work are merged to examine deaths from unintentional injuries using 20years of nationally representative survey data, linked to prospective mortality. Results indicate that socially disadvantaged persons were significantly more likely to die from the most preventable and equally likely to die from the least preventable accidental deaths over the follow-up, compared to their more advantaged counterparts. This study extends our knowledge of the social contributors to a leading cause of death that may have substantial implications on overall disparities in length of life.

Instrumental Activities of Daily Living (I-ADL) trigger an urgent request for nursing home admission

Objective

Although disabled elderly people mostly prefer to receive care at home or in other community settings, many of them reside in nursing homes. That is why several researchers have tried to identify predictors of institutionalisation. Various different dependency factors seem to explain the request for residential care. The aim of this study is to discover the most important factor triggering an urgent request for nursing home admission.

Methods

On the basis of social field research, we analysed the profiles and motives of an admission cohort of 125 elderly (31 men and 94 women) who were admitted to four nursing homes in Antwerp (Belgium) between January 2000 and April 2001. The study used data of the 'intake conversation', performed by an experienced social worker of the nursing home, subsequent to the request for nursing home admission.

Gender, age, Katz category, marital status, disease, living conditions, Personal and Instrumental Activities of Daily Living (P-ADL and I-ADL) were the independent variables.

The variable 'time span' was introduced as dependent variable. This is the time between the onset of dependency and the request for institutionalisation. Nursing home carers have classified this time span in three periods: < 3, 3-12, and > 12 months. The statistical analysis focused on the characteristics of the two extremes, namely the earliest versus the latest applicants (n = 74). This was the best strategy to go about investigating the issue due to the vagueness and uncertain status of the data in the midrange.

Results

The applicants had an average age of 83 years. 31% of the elderly were defined as functioning good (needing assistance from another person in no to maximum two ADLs - washing and dressing) and 69% were classified as ill functioning (needing assistance in minimum three ADLs). Women were more likely to be widowed (83%) and to live alone and isolated (55%) and they had a lower degree of dependency (both P-ADL and I-ADL) when entering institutions. Of the women, 57% had a mental illness, compared with 48% of the men. Of the applicants, 34% were unwilling or unable to start home care and applied for an urgent request (within the first 3 months); 41% tried home care for a time and 26% applied after one year of home care.

The stepwise logistic regression analysis identified I-ADL as the decisive factor explaining the difference in 'decision speed' towards institutionalisation. An increase of one unit on the I-ADL score increased the chance of a request within the first three months by 63% (95%CI: 19 to135%, p = 0.006).

Conclusions

The only factor related to an urgent request for nursing home admission seems to be the I-ADL score. These results have important implications for targeting sheltered housing and further extension of home care services to postpone or prevent institutionalisation.

Living Arrangements of Older Adults in China: The Interplay Among Preferences, Realities, and Health

This article uses the Chinese Longitudinal Healthy Longevity Survey to examine the dynamics of living arrangements among the elderly in China. First, the author explores what factors are related to living arrangement preference. In addition, the author looks at a relatively unexplored measure— “living arrangement concordance”—having a match between preferred and actual living arrangements. This article also examines the relationship between concordance, self-rated health, and activities of daily living disability. Living arrangement concordance is high among community-residing elderly, but older Chinese and minority ethnicity are more likely to prefer coresidence with children, while people with higher socioeconomic status and greater family care resources are more likely to prefer living independently. This study gives evidence for person-environment fit theory—older adults with independent living concordance are more likely to have good self-rated health. Older adults who coreside with children, however, are more likely to be disabled, regardless of concordance status.

Decline in co-residence of parents and children among older Kuwaiti men and women: what are the significant correlates?

A trend towards decline in co-residence with children is apparent in several countries while it is absent in others. The objectives of this paper are to address the patterns of co-residence with children among older Kuwaiti men and women aged 60+ and to assess the determinants of such patterns within the context of rapid socioeconomic changes occurring in the country (n = 1588). The data for this paper were collected as part of a household survey on the psychosocial health and disability among 2487 older Kuwaitis aged 50+. Forward step-wise logistic regression was run to assess the significant socio-demographic and health related correlates of living without any co-resident children. We found that the percentage living without any co-resident children increased from 5% in 1999 to 24% in 2005/6. About 13% women and 1% men were living alone in 2005/6. In the multivariate analysis, older age, female gender, non-Bedouin cultural background, a smaller number of children, higher educational level, and the presence of one or more domestic helpers were positively associated with the absence of co-resident children. On the other hand, those who were not married were less likely to reside without co-resident children, as were those with higher family incomes. Except for self-rated health none of the health related variables, such as chronic illnesses or depressive symptom experience, emerged as significant. Modernization forces seem to be at the core of the observed decline in co-residence with children.

Cultural Preferences and Economic Constraints: The Living Arrangements of Elderly Canadians

Utilisant les donnés du recensement canadien de 2001, nous examinons le rôle des préférences culturelles et des contraintes économiques sur la situation domestique des personnes âgées (vivre avec son enfant et/ou une personne apparentée versus vivre de façon autonome). Nos analyses révèlent que les membres de groupes ethniques partageant des valeurs familialistes (italien, chinois, sud-asiatique, et indien d’Asie) sont plus susceptibles que leur homologues individualistes (britannique, allemand, et néerlandais) de vivre avec un proche parent. Toutefois, l’importance des préférences culturelles et des contraintes économiques dépendent en grande partie de l’état matrimonial. Pour les personnes mariées, les préférences culturelles expliquent une grande proportion de la variation des situations domestiques. Pour ce qui est des personnes célibataires, les contraintes économiques sont plus importantes. En comparaison avec les études antérieures, où celles-ci négligent le rôle de l’état matrimonial, cette recherche contribue à une compréhension plus nuancée de la situation domestique des personnes âgées.

Intergenerational support and subjective health of older people in rural China: a gender-based longitudinal study

AIM

To examine gender differences in the effect of intergenerational exchanges on subjective health of Chinese rural elderly.

METHODS

Using the data from three waves of the survey 'Well-being of Elderly in Anhui Province, China' conducted in 2001, 2003 and 2006, respectively, this study uses random effect logit models for men and women separately.

RESULTS

While an increase in instrumental support from children to older people is associated with deterioration in the subjective health of older men, financial support from older people to children is associated with improvement in the formers' subjective health. Although an increase in instrumental support from older people to children, and mutual emotional support is associated with improved subjective health of older women, financial support from children to older women has a negative effect on the latter's subjective health.

CONCLUSIONS

Reciprocal intergenerational transfers contribute to improvement in subjective health of older people, while increased support through demand-based transfers appears to result in deterioration of their health.

The relationship between living arrangement and preventive care use among community-dwelling elderly persons

OBJECTIVES

We sought to examine the relationship between living arrangements and obtaining preventive care among the elderly population.

METHODS

We obtained data on 13,038 community-dwelling elderly persons from the 2002 to 2005 Medical Expenditure Panel Survey and used multivariate logistic regression models to estimate the likelihood of preventive care use among elderly persons in 4 living arrangements: living alone (38%), living with one's spouse only (52%), living with one's spouse and with one's adult offspring (5%), and living with one's adult offspring only (5%). Preventive care services included influenza vaccination, physical and dental checkup, and screenings for hypertension, cholesterol, and colorectal cancer.

RESULTS

After we controlled for age, gender, race, education, income, health insurance, comorbidities, self-reported health, physical function status, and residence location, we found that elderly persons living with a spouse only were more likely than were those living alone to obtain all preventive care services, except for hypertension screening. However, those living with their adult offspring were not more likely to obtain recommended preventive care compared with those living alone. These results did not change when the employment status and functional status of adult offspring were considered.

CONCLUSIONS

Interventions to improve preventive care use should target not only those elderly persons who live alone but also those living with adult offspring.

Sociodemographic Effects on the Dynamics of Task-specific ADL Functioning at the Oldest-old Ages: The Case of China

Studies that systematically examine the dynamics of task-specific ADL functioning and its associates are very rare. Using the first three waves of the Chinese Longitudinal Healthy Longevity Survey, this study examines the dynamics of each of the six ADL tasks (bathing, dressing, toileting, indoor transferring, eating, and continence) and their sociodemographic correlates among the oldest-old by including the ADL information both at the follow-up wave for survivors and at the time prior to death for those who died during survey intervals. Effects of age, gender, urban/rural residence, ethnicity, education, primary lifetime occupation, primary source of daily expenses, living alone, and marital status are examined in both the absence and presence of other various confounders. Our results show that each sociodemographic factor still plays some limited role in the dynamics of ADL functioning across tasks.