Aging Alone? International Perspectives on Social Integration and Isolation

A Six Year Longitudinal Study of Older Korean Women with Functional Limitations, Chronic Pain, and Depressive Symptoms Who are Living Alone or in Multi-Person Households

OBJECTIVES

This study examines not only the effects of functional limitations and chronic pain on depressive symptoms in older South Korean women, but also the moderating effect of living arrangements on these relationships.

METHODS

This study employed a Correlated Random Effects model using panel data from Wave 5 to Wave 8 of the Korean Longitudinal Study of Ageing. The final sample included 2,443 individuals and 8,360 observations.

RESULTS

The more severe the degree of functional limitations and chronic pain, the higher the level of depressive symptoms in older Korean women. Furthermore, the results of the Correlated Random Effects model showed that the associations between functional limitations and depressive symptoms were more positive among women living alone.

CONCLUSIONS

Given the variation in depressive symptoms by living arrangement among older women with functional limitations, the findings underscore the potential importance of living arrangements in the quality of life of older adults in South Korea.

CLINICAL IMPLICATIONS

With an increase in the older population, the number of older women living alone is also growing. To enhance the quality of life in old age, interventions related to geriatric primary care or home care would be needed for older women living alone.

Social isolation and depressive symptoms among chinese older adults: Serial mediating roles of social support and resilience

BACKGROUND

Social isolation is a significant risk factor for depressive symptoms in older adults, with social support and resilience serving as protective factors. However, the mechanisms underlying this association are not well understood.

METHODS

A cross-sectional survey was performed of 1020 participants (aged ≥ 60years) in the northern, central and southern parts of Jiangsu Province, China. A general information questionnaire, the Lubben Social Network Scale-6, the Perceived Social Support Scale, the Connor-Davidson Resilience Scale-10, and the Geriatric Depression Scale-5 were used. This study investigated the complex interplay among social isolation, social support, resilience, and depressive symptoms. Using the bootstrapping approach, serial multiple mediation models were constructed to explore the potential serial mediating roles of social support and resilience in the link between social isolation and depression.

RESULTS

Lower level of social isolation scores (coefficient = -0.2441, p < 0.001), lower level of social support (coefficient = -0.2368, p < 0.001) and lower level of resilience (coefficient = -0.1594, p < 0.001), were significantly associated with higher level of depressive symptoms. Social support and resilience in serial, mediated the relationship between social isolation scores and depressive symptoms (total effect: coefficient = -0.4526, 95 % CI [-0.0351, -0.0219]; total direct effect: coefficient = -0.2441, 95 % CI [-0.0423, -0.0240]; total indirect effect: coefficient = -0.2085, 95 % CI [-0.2531, -0.1642]).

CONCLUSIONS

Greater attention should be devoted to enhancing social support for Chinese older adults facing social isolation, which could foster higher resilience to prevent the onset of depressive symptoms. It is critical in driving the progress of mental health among aging community.

"Successfully" Aging "Alone?": Unequal Global Opportunities and Rising Risks in Family-Based Models of Care Cross-Nationally

BACKGROUND AND OBJECTIVES

For the first time in human history, older adults will outnumber children and a substantial and growing proportion will live alone and lack one or more nuclear family ties. Such unprecedented shifts require a reevaluation of existing models of "successful aging," particularly in terms of long-term care policies.

RESEARCH DESIGN AND METHODS

This paper draws on country-level data from multiple publicly available sources (e.g., World Bank, Organization for Economic Cooperation and Development, Our World in Data, and the World Values Survey) to examine cross-national patterns of development, health, demography, resources and policies, and cultural values in low-, middle-, and high-income countries.

RESULTS

Although there exists substantial heterogeneity across countries, country-level patterns illustrate the economic privilege of living alone and the dominance of "successful aging" opportunities in high-income countries. Cultural values about family reflect standard patterns of economic development, yet friendship emerges as a particularly consistent global value. At the country-level, living alone and health are associated with higher-income countries with lower within-country inequality.

DISCUSSION AND IMPLICATIONS

Aging "alone" is a risk factor in some contexts, yet a marker of privilege in others. Models of "successful aging" are largely unobtainable in lower-income countries or high-inequality countries, and therefore require a thorough incorporation of global realities or final abandonment in favor of more nuanced structural perspectives. Long-term care policies that assume the presence of family will yield increasing risk over time across all global contexts and represent a key vulnerability in the future of healthy aging policy.

Psychosocial Well-Being Differences Between the Young Old, Old-Old, and Oldest Old: A Global Comparison

OBJECTIVES

We investigate global differences in psychosocial well-being between older adult age groups.

METHODS

Using multinomial logistic regression, we analyzed 2018 data (n = 93,663) from 9 countries/regions in the Health and Retirement Study international family of studies to compare age group differences in depression, loneliness, and happiness.

RESULTS

Compared to the young old, the old-old reported more depression in Southern Europe, while the oldest old had higher risk in India and Southern Europe but lower risk in the United States. The old-old reported less loneliness in the United States but more in Southern Europe, while the oldest old had greater risk in Southern Europe. The old-old reported less happiness in Korea, while the oldest old had lower reports in Korea but higher reports in the United States.

DISCUSSION

The psychosocial well-being of the oldest old is exceptionally good in the United States but exceptionally poor in Southern Europe.

Trends in the prevalence of social isolation among middle and older adults in China from 2011 to 2018: the China Health and Retirement Longitudinal Study

BACKGROUND

Epidemiological studies have shown that social isolation, which is prevalent in older adults, is associated with a range of adverse health outcomes, but the prevalence of and trends in regard to social isolation remain ambiguous in China. The aim of this study was to elucidate the trends regarding the prevalence of social isolation among middle-aged and older adults in China from 2011 to 2018 and to further identify associated risk factors.

METHODS

A repeated cross-sectional study, The data were derived from panel sample data of four waves conducted from May 2011 to August 2018 in the nationally representative China Health and Retirement Longitudinal Study (CHARLS) using multistage probability sampling. Social isolation was ascertained by the five item Steptoe Social Isolation Index. The potential covariates were demographic characteristics, lifestyle factors, and health status. Linear-by-linear association was used to assess the trends in regard to social isolation over time under the influence of the potential covariates. Linear-by-linear association and an age-period-cohort analysis were used to explore the trends, and two-level (time, individual) generalized estimating equation models (GEE) linked multivariate binary logistic regression were performed to identify risk factors.

RESULTS

A high prevalence of social isolation and a moderate upward trend from 2013 to 2018 were observed among a U-shaped trend prevalence of social isolation from 2011 to 2018 across China, with rates of 38.09% (95% CI = 36.73-39.45) in 2011, 33.66% (32.32-35.00) in 2013, 39.13% (37.59-40.67) in 2015, and 39.95% (38.59-41.31) in 2018 (p < 0.001). The prevalence of social isolation increased with age and educational attainment. Females had a higher prevalence than males. The prevalence of social isolation was found to be significantly lower in pensioners than in non-pensioners between 2011 and 2018 (p < 0.001). The prevalence of social isolation was 38.9%, 34.9%, 38.5%, and 44.08% about three times higher among those who doid not use the Internet and 13.44%, 11.64%, 12.93%, and 16.73% than among those who doid in 2011, 2013, 2015 and 2018 respectively. The participants with short (0-5 h) and long sleep (9 or more hours), and poor self-rated health had a higher prevalence of social isolation than the others. Older age, lower educational attainment, living in a rural region, lack of medical insurance or pension, lack of internet use and poor health were risk factors (p < 0.05).

CONCLUSIONS

We found a U-shaped prevalence of social isolation trends from 2011 to 2018 and revealed increasing trends from 2013 to 2018 among middle-aged and older adults in China. The findings of the study highlight the urgent need for interventions to reduce social isolation including improving sleep quality and internet skills. Disadvantaged groups in terms of age, economic status, and health status should be the focus of such interventions, especially in the era of COVID-19.

Physical and mental health among older parents: Does offspring migration and living arrangement matter? Findings from Longitudinal Aging Survey in India (2017-18)

The migration of adult children can have beneficial and adverse effects on the health outcomes of elderly parents left behind. This study examines the effects of adult children's migration on self-rated health and depression among older parents using Longitudinal Ageing Study in India (LASI) 2017-18 with 19,401 individuals aged 60 years or older. Binary logistic regression models were performed to determine the association of self-rated health and depression with adult-child migration status while adjusting for living arrangements and socioeconomic factors. Results show that 36 percent of older parents have at least one migrant child, and 35 percent are empty nesters. Older adults living with their children experience positive impacts on their physical and mental health. Our study reveals that empty-nested elderly have a higher prevalence of poor self-rated health and depression. Irrespective of migrant children, the availability of children in the household matters most regarding parents' health care, as our study suggests no significant difference in physical and mental health among left-behind and non-left-behind older parents. This study aims to draw policymakers' attention to the impact of adult children or youth migration on older parents' physical and mental health. To address this issue, policies should prioritize raising awareness among migrant children of older adults about the importance of maintaining frequent contact and visiting their aging parents.

Reconfiguring Social Disconnectedness and Its Link to Psychological Well-Being among Older Adults in Rural China

Using data from 2015 to 2018 waves of the Longitudinal Study of Older Adults in Anhui Province, China, this study investigated associations between different forms of social disconnectedness (social isolation, loneliness, living alone) and psychological well-being of older adults longitudinally. The results showed that social isolation and loneliness were independently associated with psychological well-being, whereas living alone was not. Different forms of social disconnectedness had additive and interactive effects on psychological well-being of older adults. Those who were exposed to all three forms of social disconnectedness suffered from the lowest level of psychological well-being. Moreover, the adverse effects of social disconnectedness on psychological well-being were found to be stronger for older women than for older men. The results underscore the necessity to consider multiple forms of social disconnectedness as well as their different combinations in explaining psychological well-being in later life.

Trust in Healthcare during COVID-19 in Europe: vulnerable groups trust the least

Aim

We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries.

Subjects and methods

We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted.

Results

We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic.

Conclusions

Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01705-3.

Transitions in Social Network Types over Time among Older Adults

OBJECTIVE

Network typology studies have identified heterogeneous types of older adults' social networks. However, little is known about stability and change in social network types over time. We investigate transitions in social network types among older adults, aged 60 years and older, and factors associated with such transitions.

METHODS

We used data on 1,305 older adults, participating in 2 waves of a national, longitudinal survey, conducted in 2016-2017 and 2019, in Singapore. Latent transition analysis identified the distinct types of social networks and their transition patterns between the waves. Multinomial logistic regression examined the association of baseline and change in physical, functional, and mental health and baseline sociodemographic characteristics with network transitions into more diverse or less diverse types.

RESULTS

We found 5 social network types at both waves, representing the most to the least diverse types - diverse, unmarried and diverse, extended family, immediate family, and restricted. Between waves, about 57% of respondents retained their social network type, whereas 24% transitioned into more diverse types and 19% into less diverse types. Those who were older and less educated and those with worsening functional and mental health were more likely to transition into less diverse types versus remaining in the same type.

DISCUSSION

The findings capture the dynamics in social network composition among older adults in the contemporary aging society. We highlight sociodemographic and health disparities contributing to later life social network diversity.

Migration of adult male children and associated depression among community-dwelling older parents: A cross-sectional gender analysis from Longitudinal Ageing Study in India, 2017-2018

OBJECTIVES

This study empirically examines the association of migration of an adult male child (ren) on the mental health of the older parents left behind. It also examines the interaction effects of sex of older parents and male child migration on major depression to explore whether there is a gender differential in the possible association.

METHODS

The data for this study were obtained from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). The total sample size for the present study was 27,248 older adults aged 60 years and above (male-12,624; female-14,624). Descriptive statistics along with cross-tabulation were presented. Proportion test was used to evaluate the significance level of differences in depression by sex. Additionally, binary logistic regression analysis was used to find out the associations. Major depression with symptoms of dysphoria, was calculated using the Short-Form Composite International Diagnostic Interview (CIDI-SF).

RESULTS

About 10.5% and 9.0% of older males and females had migrant sons. It was found that there was significant gender differential in depression in older age (male: 7.5% and female: 9.7%; p < 0.001). It was further found that the prevalence of depression was found among older men (9.3% vs. 7.3%) and women (12.5% vs. 9.4%) with migrant son. Older adults with migrant son had 26% significantly higher likelihood to be depressed in reference to older adults with non-migrant son (AOR: 1.26; CI: 1.02-1.56). Further, older women with a migrant son had 76% significantly higher likelihood to be depressed in reference to older men with migrant son (AOR: 1.76; CI: 1.32-2.39).

CONCLUSIONS

This study invites policymakers' attention towards migration of adult children and its potential effects on mental health of left-behind older parents in community-settings and in women in particular. Policies should focus on spreading awareness to migrant children of older adults on maintaining frequent contacts and visits to their ageing parents.

Families in Later Life: A Decade in Review

Later-life families encompass the legal, biological, romantic, and kin-like relationships of persons ages 65 and older. Research on older families has flourished over the past decade, as population aging has intensified concerns regarding the capacities of families to care for older adults and the adequacy of public pension systems to provide an acceptable standard of living. Shifting patterns of family formation over the past half-century have created a context in which contemporary older adults' family lives differ markedly from earlier generations. Decreasing numbers of adults are growing old with their first and only spouse, with rising numbers divorcing, remarrying, forming non-marital romantic partnerships, or living single by choice. Remarriage and the formation of stepfamilies pose challenges and opportunities as older adults negotiate complex decisions such as inheritance and caregiving. Family relationships are consequential for older adults' well-being, operating through both biological and psychosocial mechanisms. We synthesize research from the past decade, revealing how innovations in data and methods have refined our understanding of late-life families against a backdrop of demographic change. We show how contemporary research refines classic theoretical frameworks and tests emerging conceptual models. We organize the article around two main types of family relationships: (1) marriage and romantic partnerships and (2) intergenerational relationships. We discuss how family caregiving occurs within these relationships, and offer three promising avenues for future research: ethnic minority and immigrant families; older adults without close kin ("elder orphans"); and the potentials of rapidly evolving technologies for intergenerational relationships and caregiving.