Health and Living Arrangement Transitions Among China’s Oldest-old

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Health and Living Arrangement TransitionsAmong China’s Oldest-old

Zachary ZimmerPopulation Council

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IntroductionOld age is often accompanied by chronic disease, functional difficulties,

and cognitive disorders

The oldest-old require high levels of support

Support is facilitated through coresidence

This makes household composition particularly important for the oldest-old

This paper examines living arrangements and transitions, comparing good versus poor health

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Perspective

Supporting the aged may also be a practical decision given lack of alternatives

This suggests altruism coupled with rational decision-making is behind living arrangements.

Filial piety plays an important function

“Whatever other insecurities they faced, most parents could rest secure in the knowledge that their children would place parental needs ahead of their own” (Whyte, 2003: p. 8).

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Hypotheses

1) The oldest-old with health problems are most likely living with others

2) Moving in and remaining with others is a function of poor health

3) Relationships are stronger for those not married

Testing requires the use of longitudinal data that can assess transitions in living arrangements.

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Measuring Living Arrangement

1) Lives with children

2) Lives with othersa

3a) Lives alone 3b) Lives with spouse

IF NO

IF NO

Those not married Those married

3) Lives independently

a Spouse not included as ‘other’

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Measuring Health

1. ADL functional limitation 1= yes 0=no

2. Health condition 1=yes 0=no

3. Mini-Mental State Exam (MMSE) Scored 0 to 19

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MODEL

Living Arrangement At Follow-Up

Not married AloneWith childrenWith Others

MarriedWith spouse onlyWith childrenWith Others

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MODEL


HealthADL limitationsHealth conditionsMMSE score

CovariatesAge, Sex, Education, Occupation, Marital status at originRural/Urban residence, number living children, has a son



9

MODEL






10

MODEL




Living arrangement at origin

+



11

MODEL





+



MenWomen

12

0

20

40

60

80

100

Origin (1998) Follow-up (2000)

Perc

ent

Alone

Spouse only

With children

With others

Living Arrangement Distributions for Full Sample at Origin and Follow-Up

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0

20

40

60

80

100

Alone With spouse With children With others

Per

cent

With others

With Children

With spouse only

Alone at follow-up

Living Arrangement Distributions at Follow-up By Living Arrangement at Origin


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0 20 40 60 80 100

Total sample

Alone

With spouse

With children

With others

Liv

ing a

rrangem

ent at origin

Percent changing

Percent in Different Living Arrangement at Follow-up by Living Arrangement at Origin

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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Not Marriedb

Model 1 Model 2

THOSE NOT MARRIED With childrena

With othersa

With childrena

With othersa

Health

ADL Limitations .703*** .685***

Health Conditions .091 .202

MMSE Score .035** .012

Living Arrangement at Origin

- Alone

- With children

- With others

b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin

a Reference category is alone *** p < .01 ** p < .05 * p < .10

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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Not Marriedb

Model 1 Model 2


With othersa

With childrena

With othersa

Health

ADL Limitations .703*** .685*** .380** .450*

Health Conditions .091 .202 -.026 .215

MMSE Score .035** .012 .009 -.013


- Alone

- With children

---

3.325***

---

1.606***

- With others 1.683*** 2.686***


a Reference category is alone *** p < .01 ** p < .05 * p < .10

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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Married

Model 1 Model 2

THOSE MARRIED With childrena

With othersa

With childrena

With othersa

Health

ADL Limitations -.477** -.886*

Health Conditions -.197 .371

MMSE Score .019 .028


- Alone

- With children

- With others


a Reference category is living with spouse only *** p < .01 ** p < .05 * p < .10

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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Marriedb

Model 1 Model 2


With othersa

With childrena

With othersa

Health

ADL Limitations -.477** -.886* -.316 -.955*

Health Conditions -.197 .371 -.203 .560*

MMSE Score .019 .028 .034 .024


- Alone

- With children

---

2.774***

---

1.580***

- With others .969*** 3.428***


a Reference category is living with spouse only *** p < .01 ** p < .05 * p < .10

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Effects of Health for Men Versus Women Among Those Not Married, Derived from Interaction Models

Model 1 Model 2


With othersa

With childrena

With othersa

ADL Limitations

- Men

- Women

Health Conditions

- Men

- Women

MMSE Scores

- Men

-Women

-.167

+.985

---

---

+.006

+.042

-.547

+1.014

---

---

---

---

-.391

+.630

---

---

---

---

-.946

+.846

---

---

---

---

Note: Significant interactions only are shown

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Effects of Health for Men Versus Women Among Those Married, Derived from Interaction Models

Model 1 Model 2


With othersa

With childrena

With othersa

ADL Limitations

- Men

- Women

Health Conditions

- Men

- Women

MMSE Scores

- Men

-Women

---

---

-.303

+.122

-.002

+.076

---

---

-262

+2.955

-.030

+.195

-.741

+.608

-.406

+.229

+.007

+.106

-.782

-.975

-.049

+2.882

-.067

+.192

Note: Significant interactions only are shown

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There is some movement in and out of living arrangements over a two-year period

Changes in living arrangements respond to health

Effects are more likely in expected direction for those not married

ADL limitations are most strongly related to living arrangement outcomes

Summary

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Possible explanations:

- Wives are expected to care for husbands, but husbands are not expected to care for wives

- Older men are more likely to be living with others even when their health is good

- Men are more likely to receive help from non-coresident family

- May be important to consider the health of both spouses

Effects Differ By Gender

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Thank you for your attention

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Log Odds Ratios for Living Arrangements,Showing # Children Effects for Those Not Married

Model 1 Model 2


With othersa

With childrena

With othersa

Number of children

One --- --- --- ---

Two .014 -.159 .347* .109

Three -.223 -.731*** .040 -.405

Four .129 -.155 .443** .156

Five or more -.178 -.933*** .202 -.515**

Note: Controls for health, age, sex, education, occupation, rural/urban residence, having a son, marital status at origin. Model 2 also controls for living arrangement at origin

a Reference category is alone

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Log Odds Ratios for Living Arrangements,Showing # Children Effects for Those Married

Model 1 Model 2


With othersa

With childrena

With othersa

Number of children

One --- --- --- ---

Two -.015 -.359 -.141 -1.051*

Three -.701** -.364 -.370 -.910

Four -1.397*** -.764 -1.338*** -1.128**

Five or more -1.065*** -1.446*** -.769** -1.997***

Note: Controls for health, age, sex, education, occupation, rural/urban residence, having a son, marital status at origin. Model 2 also controls for living arrangement at origin

a Reference category is alone

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Health and Living Arrangement Transitions Among China’s Oldest-old