Older parents enjoy better filial piety and care from daughters than sons in China

Validation of the Perceived Community Support Questionnaire for Older Chinese

BACKGROUND AND OBJECTIVES

Community support has a profound positive impact on older people's health and plays a crucial role in facilitating aging in place. This impact is particularly significant in the Chinese context, where community support can alleviate the pressure on traditional family caregiving. This study translated, adapted, and validated the perceived community support questionnaire (PCSQ) for use with older Chinese.

RESEARCH DESIGN AND METHODS

Data for this validation study were collected from a cross-sectional survey of 1,064 Chinese aged 65 years and above. Following the cultural adaptation of the PCSQ-14, confirmatory factor analysis (CFA) was conducted to examine its factor structure. Criterion validity, convergent and discriminant validity, internal consistency reliability, and test-retest reliability of the scale were also assessed.

RESULTS

Based on the CFA results, the adapted PCSQ-14 was found to have a 3-factor solution for community integration, community participation, and community organizations. The criterion-related validity was supported by its significant correlation with depression. Convergent and discriminant validity were established, with the internal consistency of the scale being 0.90. The test-retest reliability intraclass correlation coefficient for the scale was 0.78.

DISCUSSION AND IMPLICATIONS

The adapted version of the PCSQ-14 demonstrated promising psychometric properties in assessing perceived community support in older Chinese. The adapted PCSQ-14 could assist researchers in determining older Chinese adults' perceptions of community support, and could also assist practitioners and policymakers in developing targeted services for older people and allocating resources more effectively.

Expectations Regarding Reciprocity of Flows of Intergenerational Support in China: Does Gender or Birth Order Matter?

This study investigates the flows of downward intergenerational transfer to adult children of different gender and birth order, and their influence on parental expectations towards old-age care and financial support, using data from the 2015-2016 China Health and Retirement Longitudinal Study (CHARLS). Based on the analytic sample of 1218 parents and 3237 adult children, we found that in multi-child families, sons are more likely to be expected by their parents as future caregivers if both they and their siblings received parental housing support, while it is the case for daughters when only they themselves received parental housing support. Parents' downward housing support shows a stronger effect on care expectations than on expectations of future financial support. This study contributes to our understanding of intergenerational transfer norms and expectations from parents' perspective and has important implications for old-age care policies in contemporary China.

The transition of eldercare responsibility and traditional filial piety concepts and its urban-rural differences in China: an age-period-cohort analysis from 2006 to 2017

BACKGROUND

With rapid urbanization, massive migration, and non-family-based eldercare involvement, Chinese concepts of eldercare responsibility and filial piety are shifting. We performed age-period-cohort (APC) analyses to assess the transition of old-age pension coverage, eldercare responsibility, and filial piety concepts and its urban-rural differences among Chinese adults using data from the China General Social Survey (2006-2017).

METHODS

Old-age pension coverage (yes/no) and primary eldercare responsibility (government/offspring/self/sharing) were investigated in 2010, 2012, 2013, 2015, and 2017. Filial piety was evaluated using customized questionnaires in 2006 and 2017. The APC effects were estimated using mixed effects and generalized additive models.

RESULTS

Among 66,182 eligible participants (mean age: 48.8 years, females: 51.7%) in the six waves, APC analyses indicated that old-age pension coverage increased with aging and over time. Across cohort groups, it grew as the cohort was younger in urban residents but decreased in rural residents. The concept of offspring-based (> 50%) and government/self/offspring-shared eldercare (> 30%) predominated. APC analyses revealed that the offspring-based concept declined with aging (OR = 0.81, 95% CI: 0.79-0.84), whereas the government-based (OR = 1.37, 95% CI: 1.33-1.41) and self-based (OR = 1.55, 95% CI: 1.47-1.63) concepts increased with aging. People born around the 1940s have a comparatively higher possibility to perceive that the primary eldercare responsibility should be undertaken by the government and elder parents. In contrast, people born in the younger cohort were more likely to perceive that adult children are responsible for their parents' primary eldercare. Filial piety score slightly increased with aging (β = 0.18, SD: 0.05) but decreased as the birth cohort was younger. In addition, rural participants were more likely to perceive offspring-based eldercare and maintain filial piety, and the related urban-rural difference was intensified by aging.

CONCLUSIONS

The traditional concept that eldercare solely relies on offspring has changed to relying on multiple entities, including the government and self-reliance. Diluted filial piety in people born in the young cohort requires reinforcement. Moreover, future healthy aging policies need to focus more on urban-rural disparities to promote equity in social well-being.

Adult children and older people's demand for community care services in urban China

OBJECTIVES

This paper has two objectives. First, it assesses whether the existing informal care provided by adult children has an impact on older people's propensity to demand community care services. Second, it compares the different statuses of sons and daughters in the formal/informal support trade-off.

METHODS

The paper is based on an analysis of data from the 2018 wave of the China Longitudinal Ageing Social Survey, within the framework of a revised version of Andersen's model, and applies multilevel models to analyse the effects of adult children's gender, numbers and the quality of their support, on older people's willingness to purchase community care services.

RESULTS

Older people who had sons as well as daughters demanded fewer services, while the number of sons increased service demand. Regarding sons, community care services compensated for economic support, daily life care and spiritual consolation, but did so only in respect of daily life care from daughters.

CONCLUSIONS

Many families have only one son or one daughter as a result of the one-child policy and therefore often require support from formal care services. Moreover, there is a distinct gender division and an influential filial culture governing the impact of services on the support provided by adult children. Because ageing in place depends on both informal family support and formal services, this key policy goal is at risk if the latter provides insufficient support to the former.

Happiness in Old Age: The Daughter Connection

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

The effect of perceived social support on frailty and depression: A multicategorical multiple mediation analysis

The mediating effects of three sources of perceived social support on frailty severity and depression were examined. Conducted in rural China, data on 570 frail older women were studied. Results showed that significant others' support (mainly daughters) (β = 0.177 for frailty score = 3) mediated the relationship between frailty severity and depression, and the 95 % bias-corrected bootstrap confidence intervals did not straddle zero (0.013-0.419), while the mediating effects of family support (mainly sons) and friends support were not observed. Support from daughters contributes to frail mothers' mental health.

Does informal care reduce health care utilisation in older age? Evidence from China

Studies in Western countries suggest that receiving informal care from family members may reduce utilisation of health care services. This hypothesis has not been examined in China, where the population is ageing rapidly. We assess the impact of informal care from offspring (children and grandchildren) on health care utilisation and expenditures among older people in China. Data are drawn from the 2011, 2014, and 2018 waves of the Chinese Longitudinal Healthy Longevity Survey. Using lagged model with the instrumental variable approach, we find that the impact of informal care is different by type of health care: More hours of informal care from offspring reduces overall health care utilisation, and in particular, outpatient care utilisation, but it increases inpatient care utilisation and expenditures. Our results suggest that informal care reduces the demand for outpatient care but increases the demand for inpatient care, possible reflecting the fact that the latter involves more advanced procedures for which informal care is not a substitute but a complement. Results highlight the need for incorporating health care impacts in the analysis and evaluation of policies that affect informal care provision.

The impact of son or daughter care on Chinese older adults' mental health

RATIONALE

The traditional cultural norm in China is that eldercare should be offered by a son and his family. However, several decades of family planning policies and rapid economic growth have led to low fertility rates, urbanisation, and cultural change, resulting in both reduced household size and the availability of sons. The traditional eldercare system is thus being challenged, especially in urban areas, with an increasing number of daughters supporting their parents, enabled by rising female empowerment, formal economic employment and improved financial capacities. Existing studies examine and compare the amount and types of support provided by sons and daughters, but very little is known about the differential health outcomes of parents experiencing eldercare offered by sons and by daughters.

OBJECTIVE

This study investigates the difference in mental health outcomes of parents who receive eldercare from their sons and from their daughters.

METHOD

We analyse waves 2013, 2015, and 2018 of the China Health and Retirement Longitudinal Study, with mental health measured by a 10-item Center for Epidemiological Studies-Depression (CES-D-10) score. We compare the CES-D-10 score between parents with different sources of care - son's family, daughter's family or other - with multivariate statistical analysis.

RESULTS

Receiving regular care from a son (or a daughter-in-law) is associated with a lower CES-D score than from a daughter (or a son-in-law). The difference mainly exists amongst those with a stronger son preference and those who are heavily deponent on their children, in particular rural parents, mothers, and those with less wealth.

CONCLUSION

Our study explores the evidence on mental health inequalities among parents with different sources of care, highlighting that lack of son care creates an apparent mental health disadvantage. Lowering older adults' dependency on their children may alleviate this inequality by improving their financial independence. We also suggest the development of a long-term care system and greater facilitation of older adults to take-up supplementary services for family care.

Son or Daughter Care in Relation to Self-Reported Health Outcomes for Older Adults in China

OBJECTIVES

Parental care in China is traditionally provided by sons. In recent decades-partly due to the One-Child Policy but also economic development and urbanization-significant changes have occurred with more and more parents receiving care from daughters. We investigate the disparities in outcomes of eldercare provided by son(s) and daughter(s).

METHODS

Our study compares the self-reported health (SRH) status of parents who receive eldercare from daughters and sons in China, analyzing the harmonized 2013, 2015, and 2018 waves of CHARLS with random-effects logistic estimates.

RESULTS

Our results show that the SRH status of parents who receive care from their sons is greater than those cared for by their daughters. This disparity is greater in rural areas, for mothers, and poorer families.

DISCUSSION

The One-Child Policy was more effective in urban areas, reducing both the availability of sons and cultural son preference. Higher levels of education received by girls in urban settings increases their employability and thus their ability to materially care for their parents. However, traditional norms and gender differences in social economic statuses still persist in rural areas, leading to higher SRH status of those cared for by sons, especially amongst those who are heavily dependent on their children: mothers or parents with less wealth.

Longitudinal Associations Between Expectations of Receiving Care in the Future and Life Satisfaction Among Older Adults in Korea

OBJECTIVES

Uncertainty about receiving care and assistance in the future has been increasing among older adults in Korea. This study examines whether expectations about receiving care from various sources (i.e., formal and/or filial caregivers) are related to life satisfaction among older adults in Korea.

METHODS

Using data from the Korean Longitudinal Study of Ageing (N = 3,607, aged 65 or older), this study estimated fixed effects regression models to investigate longitudinal within-person associations between future care expectations and life satisfaction.

RESULTS

The results of this study revealed that developing expectations of care from family caregivers is positively associated with life satisfaction. Beginning to expect care from non-family caregivers, however, is not associated with life satisfaction. When disaggregating different sources of care by family member type, expecting care from a spouse or daughter(s), but not son(s), is associated with higher life satisfaction. Gender-specific analyses showed that expecting care from daughter(s) is positively associated with life satisfaction among both men and women, whereas expectations of spousal care are associated with only men's life satisfaction. This study also found suggestive but not conclusive evidence that an association between care expectations from family caregivers and life satisfaction is stronger among older adults with lower education.

DISCUSSION

Reducing uncertainty about future care may improve older adults' subjective well-being. Policymakers may consider policies and programs that support family care of the aged, and more fundamentally, encourage family involvement in the lives of older people.

Protective effect of adult children's education on parental survival in China: Gender differences and underlying mechanisms

This study investigates whether adult children's education has a protective effect on parental survival, using data from all waves (2010-2018) of the China Family Panel Studies. We exploited the exogenous temporal and geographical variations in the enforcement of the 1986 compulsory schooling laws in China to construct an instrumental variable (IV) for adult children's education. The IV estimates indicated that the law-induced higher education of adult children led to sizeable improvements in the likelihood of paternal survival, although it had no significant effect on maternal survival. The protective effect on paternal survival was mainly driven by better-educated daughters, while sons' education had only a modest positive effect on maternal survival. Further evidence suggested that such heterogeneity by the gender of adult children might mainly come through more informal caregiving from better-educated daughters to older fathers with a limited role played by financial support from adult children.

The Role of Filial Piety in the Relationships between Work Stress, Job Satisfaction, and Turnover Intention: A Moderated Mediation Model

In China, filial piety, which usually refers to showing respect and obedience to parents, has exerted an important effect in the relationship between work stress and turnover intention. However, the mechanism behind this effect is still unclear. To address this gap in the existing literature, we developed and tested a moderated mediation model of the relationship that work stress shares with job satisfaction and turnover intention. In accordance with the dual filial piety model and the stress-moderation model, our hypothesized model predicted that the mediating effect of job satisfaction on the relationship between work stress and turnover intention would be moderated by reciprocal filial piety (RFP) and authoritarian filial piety (AFP). The analytic results of data that were obtained from 506 employees of manufacturing industries in China supported this model. Specifically, RFP and AFP, as a contextualized personality construct, positively moderated the direct relationship between work stress and turnover intention as well as the corresponding indirect effect through job satisfaction. In particular, RFP and AFP strengthened the positive effect of work stress on turnover intention. Based on these findings, recommendations to help employees fulfill their filial duties and reduce the effect of work stress on turnover intention among employees of Chinese manufacturing industries are delineated.

The Relevance of Gender in the Care of Elders: Assumptions and Realities

An examination of the common belief that gender determines a closer emotional bond between adult daughters and elderly parents than adult sons results in five paradoxes. By employing sociological and psychological theories, this paper looks at discriminatory socialisation that sets sons and daughters apart in childhood and argues that the performance of daily routine chores, rather than gender, lies at the core of how intergenerational bonds are shaped.

The Chinese Postreform Generation as Caregivers: The Caregiving Intentions Toward Parents and Parents-in-Law of the One-Child Generation

The problem of population aging in China has been widely documented. As a result of decreasing birth rates due to the Chinese one-child policy, birth rates have decreased dramatically, while life expectancy has increased. By 2040, it is expected that 24.6% of the Chinese population will be older than 65 years (United Nations, Department of Economic and Social Affairs, Population Division, 2015), with the majority of the elderly care likely to fall to their, often, singleton children. Little research has been conducted, however, with this future generation of caregivers. This article reports on a mixed-methods study comparing the attitudes of the one-child generation toward the future care of their parents and parents-in-law, in terms of gender, sibling status, and urban/rural providence. It includes the results of 26 in-depth interviews with students aged 18 to 22 years, and a survey among 351 first-year students of a semiprivate university in Zhuhai (China). No differences were found for gender, sibling status, or urban/rural providence for the intention to take care of the own parents in the future, although rural and nonsingleton participants were more likely to mention that they intended to live close to, or with their parents in the future than their urban and singleton counterparts. Concerning the care for future parents-in-law, male students in both the survey and the interviews were significantly less likely to accept responsibility for their care than female students, but no differences were found for urban/rural providence or for sibling status in this respect. Finally, female and rural students were found to be significantly much more likely to want to live in a separate house than their male and urban counterparts.

Adult Children's Perceptions of Maternal Favoritism During Caregiving: Comparisons Between Turkey and the United States

This study explores cross-cultural variations in adult children's perceptions of maternal favoritism during caregiving in Turkey and the United States. Qualitative analysis of interview data from two siblings in each of 14 Turkish and 14 American families revealed differences in adult children's perceptions of and explanations for maternal favoritism. Most Turkish children perceived that their mothers favored sons because of higher filial expectations from sons. Conversely, most American children perceived that their mothers favored daughters and explained mothers' preferences as based on socioemotional factors. Furthermore, perceptions of maternal favoritism had detrimental consequences for sibling relationships in both contexts but differently. Turkish daughters reported conflicts over their favored brothers' lack of cooperation. American daughters perceived themselves as favored and felt obligated to undertake most of the caregiving burden which fueled sibling conflict. Taken together, this study highlights the importance of cultural context for understanding the within-family differences in sibling relationships during caregiving.

Aging and separation from children: The health implications of adult migration for elderly parents in rural China

BACKGROUND

Massive rural-to-urban migration in China has profoundly altered the family life of rural older adults, as adult children remain the primary caretakers of their elderly parents. And yet little is known about the health and well-being of the parents of adult migrants in rural China whose main source of support has been displaced.

OBJECTIVE

This study takes a comprehensive view and compares the trajectories of self-rated health among the rural elderly and examines how these health trajectories are associated with adult children's migration.

METHODS

We analyze older adults aged 55 years and over in rural China, using four waves of data from the China Health and Nutrition Survey (1997, 2000, 2004, 2006) and multilevel growth curve models.

RESULTS

The results show that parents of migrants persistently scored worse self-rated health across ages than their counterparts whose children had not migrated. Long-term migration of adults takes a heavier toll on the health of their elderly parents than short-term migration. However, these associations with children's migration are driven by the migration of sons. The migration of daughters and of children of both genders may have disparate effects on the health trajectories of elderly men and women.

CONCLUSIONS

The findings suggest that the interplay of gendered family dynamics and migration processes affects the health outcomes of older adults.

CONTRIBUTION

The findings contribute to current debates on the health and well-being of family members left behind by migrants and call for further study of the relationship between migration and family processes in the well-being of migrant families.

The effects of China's universal two-child policy

In October, 2015, China's one-child policy was replaced by a universal two-child policy. The effects of the new policy are inevitably speculative, but predictions can be made based on recent trends. The population increase will be relatively small, peaking at 1·45 billion in 2029 (compared with a peak of 1·4 billion in 2023 if the one-child policy continued). The new policy will allow almost all Chinese people to have their preferred number of children. The benefits of the new policy include: a large reduction in abortions of unapproved pregnancies, virtual elimination of the problem of unregistered children, and a more normal sex ratio. All of these effects should improve health outcomes. Effects of the new policy on the shrinking workforce and rapid population ageing will not be evident for two decades. In the meantime, more sound policy actions are needed to meet the social, health, and care needs of the elderly population.