Elsevier

Social Science & Medicine

Volume 68, Issue 2, January 2009, Pages 220-227
Social Science & Medicine

Health among the oldest-old in China: Which living arrangements make a difference?

https://doi.org/10.1016/j.socscimed.2008.10.013Get rights and content

Abstract

This study aims to (1) examine the association of living arrangements and health among oldest-old Chinese, and (2) investigate gender differences in the association of living arrangements and health. Data were from the first two waves of the Chinese Longitudinal Healthy Longevity Survey, which included 9093 Chinese averaging 92 years old. Living arrangements had six mutually exclusive categories: living alone, with spouse, with children, with spouse and children, with others and in institutions. Using multinomial logistic regression, we found that baseline living arrangements are significantly associated with mortality, activities of daily living (ADL) disability, and self-rated health at Wave 2, controlling for baseline health, sociodemographic characteristics and availability of children. Further, the linkages between living arrangements and mortality vary by gender. Among the different living arrangements, having a spouse in the household (either with a spouse only or with both a spouse and children) provides the best health protection. Living alone and living with children are associated with both health advantages and disadvantages. Institutional living lowers mortality risk for men but not women. Living with others provides the least health benefits. Our study has extended the research on living arrangements and health to a unique population—the oldest-old in China—and clarified the health advantages and disadvantages of different living arrangements. Future research should examine the mechanisms linking living arrangements and health, and the experience of institutional living for men and women in China.

Section snippets

Hypotheses

Fig. 1 depicts our conceptualization of the linkages between living arrangements and health. We hypothesize that baseline living arrangements have significant effects on current health (i.e., that measured at Wave 2), independent of baseline health status, sociodemographic characteristics and children's availability. Among the different living arrangements being investigated, we expect oldest-old Chinese living with both a spouse and children to have the best health outcomes, because of the

Data and sample

This study was a secondary data analysis that was reviewed and approved by the Health Science Institutional Review Board at the University of Michigan. It was based on the first two waves of data, which had been de-identified, from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The survey had a randomly selected sample of oldest-old Chinese from almost half of the total number of counties and cities of the 22 provinces in China. The survey areas covered 985 million persons, or 85%

Description of the sample

Characteristics of the sample at baseline are shown in Table 1. The sample averaged 92.10 years old (range = 77–122). The majority was women (60.0%), had low education (a mean of 1.80 years of schooling), resided in rural areas (61.8%), had low occupational status (92.4%), and was Han Chinese (92.8%). The respondents had 2.39 living children on average and most (82.8%) had at least one child living nearby. At baseline, about 37.1% of the sample had ADL disability, 44.9% reported poor self-rated

Discussion

Using two waves of penal data derived from a large sample of oldest-old persons in China, this study found that living arrangements predict physical health, indicated by mortality, ADL disability and self-rated health; and that men and women differ in the association of living arrangements and mortality. Consistent findings were obtained when the analyses were repeated in a sub-sample of ‘healthy’ respondents who had no ADL disability, chronic conditions and cognitive impairment at baseline.

The

Acknowledgments

This study was supported by the Center for Chinese Studies at the University of Michigan and the National Institute on Aging (R01-AG154124). The authors wish to thank Tanya Emley for her editorial assistance. Data used for this research was provided by the longitudinal study entitled “Determinants of Healthy Longevity in China” (DHLC) managed by the Center for Healthy Aging and Family Studies, Peking University. DHLC is supported in part by funds from Duke University under an award from the

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