Family structure and changes in living arrangements among elderly nonmarried parents

A Study of the Factors Influencing the Residential Preferences of the Elderly in China

The global aging problem has a serious impact on the sustainable development of society. China has become the country with the largest aging population in the world, 1.75 times that of the EU and 3.01 times that of the United States. Therefore, the question of how to develop elderly care services and institutions in China is critical. Based on data from the China Health and Retirement Longitudinal Study (CHARLS), this paper details the residential preferences of the elderly, and uses a multinomial logistic regression model to analyze the influence of education level, health status, and income level on the residential preferences of the elderly in China. The results of the study are as follows: (1) From a spatial point of view, the residential preference of “living together” gradually increases from the northeast to the southwest. As for the choice of “nursing home”, northerners prefer to live in nursing homes more than southerners, especially in the northeast. (2) There are many personal factors that significantly affect housing preferences, such as education level, health status, income level, etc. (3) The development of socialized elderly care institutions should fully consider the preferences of the elderly. There are big differences in residential preferences in different regions and different cities, so the development of elderly care services should be adapted to local conditions.

Elderly Parents and the Geographic Availability of their Adult Children

Using data from the 1987 National Survey of Families and Households, this study examines the distribution and determinants of the geographic distance between elderly parents and their adult children. The majority of elderly Americans have at least one adult child living within 10 miles of their residence; for those with two or more adult children, the second-closest child is usually within 30 miles. Compared with the urban elderly, rural elders live farther from their second closest-children. Daughters live no closer than sons to their parents. The analysis shows that education and number of children are the most important factors in predicting parent-child proximity. Other factors, such as age, health, and the family size of the closest adult child, are also important.

The Life-Course Trajectory toward Living Alone

Objectives: Dramatic increases in living alone in late life have been associated with higher incomes and better health, obscuring the risk to subgroups living alone with diminished health and socioeconomic resources. This study describes race differences in the stability and life-course antecedents of living alone. Method: The prospective cohort study used data from the Established Populations for Epidemiologic Studies of the Elderly at Duke University ( n = 4,132) to estimate 10-yearprevalence, incidence, and predictors of living alone among Black and White elders. Results: New episodes of living alone were equally likely. Black elders’lower prevalence of living alone was a function of their 80 percent greater probability of a new coresident episode. Home ownership, residential tenure, and perceived good health were lower among Blacks living alone, compared to Whites, who had fewer living children. Stressful life events had similar effects on household size. Discussion: Race differences in late life household size were primarily dependent on decisions embedded in midlife.

Coresidence between Unmarried Aging Parents and their Adult Children

Data from the 1993 to 1995 waves of the Asset and Health Dynamics among the Oldest Old were used to analyze unmarried elderly parents' and children's characteristics associated with their respective self-reported reasons for coresidence: always lived together, to help the child, to help the parent, or to help both. As compared to the parents in the always-lived-together pairs, parents as the help receivers were older, had more health problems, and were more likely to have moved in with an older, married child. Children as the help recipients were more likely to be sons than daughters and less likely to work or make a financial contribution to the household. Parents in the mutual-help group were more likely to have higher education and to have been divorced, separated, or never married than to be widowed, and the children were more likely to be married. Parental gender and race/ethnicity were not significant factors.

Health and Living Arrangements Among Older Americans

Objective: This research examines how physical and mental health influence living arrangements among older Americans and whether these effects differ for married and unmarried persons. Methods: Data came from the Asset and Health Dynamics Among the Oldest Old study. These two intervals were pooled, and hierarchical multinomial logistic regressions were used to analyze pooled time lags. Results: Functional status and cognitive functioning are significantly associated with living arrangements among those not married. Health conditions exert no significant effects among those married. Given the same functional status, unmarried elders are significantly more likely than their married counterparts to reside with their children or with others. Discussion: These results underscore the critical role of the spouse in influencing living arrangements, providing new evidence supporting the assertion that a spouse is the greatest guarantee of support in old age and the importance of the marriage institution.

Living arrangements, relationship to people in the household and admission to care homes for older people

OBJECTIVE

to assess the separate contributions of marital status, living arrangements and the presence of children to subsequent admission to a care home.

DESIGN AND METHODS

a longitudinal study derived from the health card registration system and linked to the 2001 Census, comprising 28% of the Northern Ireland population was analysed using Cox regression to assess the likelihood of admission for 51,619 older people in the 6 years following the census. Cohort members' age, sex, marital and health status and relationship to other household members were analysed.

RESULTS

there were 2,138 care home admissions; a rate of 7.4 admissions per thousand person years. Those living alone had the highest likelihood of admission [hazard ratio (HR) compared with living with partner 1.66 (95% CI 1.48, 1.87)] but there was little difference between the never-married and the previously married. Living with children offered similar protection as living with a partner (HR 0.97; 95% CI 0.81, 1.16). The presence of children reduced admissions especially for married couples (HR 0.67 95% CI 0.54, 0.83; models adjusting for age, gender and health). Women were more likely to be admitted, though there were no gender differences for people living alone or those co-habiting with siblings.

IMPLICATIONS

presence of potential caregivers within the home, rather than those living elsewhere, is a major factor determining admission to care home. Further research should concentrate on the health and needs of these co-residents.

Topography, Culture Areas, and Integration of Retired Migrants in a Coastal North Carolina County

The later life migration literature includes analyses of migration streams, examination of later life migration precursors, the economic impact of migration, and meta-analyses advocating methodological refinement. Missing are studies of later life migrants post relocation, including their social integration in receiving communities. The small area analysis presented here evolved in consultation with a local Planning Committee including older adults and service providers that guided development of an aging services plan for Dare County on the North Carolina Outer Banks. Multiple methods were applied, including secondary historical and contextual data, in-depth interviews, and a brief survey of older adults using services. Findings suggest difference among communities in the integration of later life migrants with older natives that provides context for service needs and delivery. Community difference stems from topographical land form characteristics, socioeconomic and cultural difference between later life migrants and older natives, and the course of residential development across communities.

[Living arrangements of elderly adults in Catalonia (Spain). The impact of health deterioration on residential independence]

OBJECTIVES

To identify the effect of health deterioration on residential dependency.

MATERIAL AND METHODS

We performed a cross-sectional analysis of the microdata from the Catalan Survey of Health (2006), which features a sample of 3566 individuals aged 65 and over. A set of socio-demographic (sex, age, marital status, educational level and municipality size), as well as health variables (self-rated health, BADL and IADL dependency) associated with residential dependency are analysed by bivariate and multivariate logistic regression.

RESULTS

Multivariate analysis shows that age, marital status and health are the variables that most affect living arrangements and cohabitation. Among men, being aged 80 or over (OR>4), being unmarried or widowed (OR=6.4) and having one or more IADL dependencies (OR>2.8) increases the risk of residential dependency. Whereas for women being aged 80 and over (OR>4), being unmarried (OR=6.8) or widowed (OR=11.8) and having three or more IADL dependencies (OR=2.7) is associated with residential dependency. Municipality size and the level of education (in the latter case only for men) are also significant determining factors (P<0.05).

CONCLUSION

Although health deterioration, and especially IADL dependency, affects residential dependency, its impact is lower than that of socio-demographic variables, such as marital status or age. What is more, health has a greater influence on men than women, who live independently until they experience great difficulty in coping with their activities of daily living. On the other hand, men seem to fall more easily into residential dependency once they experience any IADL dependency.

Living arrangements and health status in later life: a review of recent literature

The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well-being. Nurses engaged in primary care, discharge planning, and home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late-life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late-life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.

The family as provider of long-term care: efficiency, equity, and externalities

The passage of the baby-boom generation into old age raises the prospect of intense pressures on public programs benefiting the elderly, limiting any contemplated expansion of programs serving those needing sustained personal care. This necessitates consideration of comparative efficiency of alternative resources for elder care. I focus on two distinct aspects of such efficiency: productive--the relationship between inputs and outputs--and target--the coincidence of served and those viewed as needing services. I argue that for theoretical reasons family members, specifically children, may be more productive and efficient carers than paid helpers. Furthermore, even if no more efficient than formal providers, care provided by children reduces public expenditures on long-term care. In view of the value to society of children's caregiving activities, if a collective program of long-term care insurance were to be adopted, it should be configured to target its financing and benefits according to family composition.

Changes in household composition among the over sixties: a longitudinal analysis of the Health and Lifestyles Surveys

Analyses of longitudinal data from the Health and Lifestyles Surveys (HALS) were carried out in order to examine the household changes of older people. Respondents who were interviewed at both the first HALS survey in 1984/85 (HALS1) and the second survey 7 years later (HALS2) and were aged 60 or over in HALS1 were selected (1156). Changes in household composition between the two surveys were examined and the relationship of these changes to socio-demographic factors and to both cross-sectional and longitudinal health factors investigated. Results of the analysis showed there was great diversity of experience and a considerable amount of change in what is often considered a fairly stable and homogeneous section of the population. Almost one-third of respondents changed household type, the majority changing to live alone and only a small proportion changing to live in households with their child/children or with others. Household changes were associated with poor and declining health (both physical and mental) and the rate of change was found to increase with age. In the case of ill health the first source of practical support and care is generally from within the household. Where this is not available it is sought from the wider community or the state. An increase in the proportion of the population aged over 60 and in the numbers of the oldest people, coupled with a rate of household change that increases with age, means that demand on health and community services can only be expected to increase.

Family relationships of older, rural women: stability and change

The purpose of the study was to examine stability and change in family interaction patterns (availability, interaction, and assistance) of older, rural women as they moved from young-old to late old age. Women (N = 96) were interviewed at two times, twelve years apart. Although there were family network losses, most notably loss of spouse and siblings, family availability and contact showed more stability than change. By late old age, the women were receiving significantly more help from adult children relative to what they gave. Proximity of the adult child was most salient as a predictor of help received from children at both Times 1 and 2. Quality of the adult child relationship was higher for women who received more types of help from adult children at Time 2. The findings suggest that with loss of family members, proximate kin may take up the slack in providing support to rural women of advanced age.

DEPRESSION, LONELINESS, AND HEALTH IN AN ADVERSE LIVING ENVIRONMENT: A STUDY OF BEDSPACE RESIDENTS IN HONG KONG

Issues concerning deleterious effects of an adverse living environment, characterized by crowded, noisy, and dirty conditions, have been debatable. One way out of this debate is delineating paths through which the living environment affects outcome variables. The resident's perception of the environment and social relation may lead to such paths. While past studies tended to demonstrate the mediating role of social support, they employed samples of college students only. By contrast, the present study investigates the mediating processes with a sample of 122 bedspace residents in Hong Kong. Results of hierarchical modeling illustrate that the adverse living environment affected the resident's psychosocial well-being indirectly. Notably, the objective living environment was related to the resident's perception of the environment, which in turn was related to social relations, characterized by social problems and social support. The perception and social relations were then related to the resident's depressive affect and loneliness. However, the adverse living environment did not have significant direct and mediated effects on the resident's self-assessed health. Besides, this study reveals that stressful status, including having a criminal record, being divorced, and the duration of unemployment, tended to be deleterious to the resident's psychosocial and physical well-being.

Trends in, and transitions to, institutional residence among older people in England and Wales, 1971-91

OBJECTIVES

To compare transitions from private households to institutions between 1971-81 and 1981-91 among elderly people and see whether (1) differentials in the risk of institutionalisation changed and (2) whether the risk was higher in the second period.

DESIGN

Cross sequential analysis of data from the Office of National Statistics longitudinal study, a record linkage study which included individual level data from three national censuses, (1971, 1981, and 1991) and linked vital registration data.

SUBJECTS

Altogether 26,400 people aged 65 and over in 1971-81 and 32,500 persons aged 65 and over in 1981-91. These samples represent 1% of the population of England and Wales.

RESULTS

In both periods models including age, housing tenure, and marital status or household/family type terms fitted the data reasonably well. The effect of age was stronger in the second decade, while that of marital status was reduced. The risk of transition to an institution was nearly 33-52% higher in the second decade after controlling for these factors.

CONCLUSIONS

During the 1980s the availability of state financed institutional care increased substantially; a growth which the 1990 NHS and Community Care Act was designed to reverse. Increased access to institutional care undoubtedly is one factor underlying the higher transition rate to institutions observed in 1981-91 than for the previous decade. During 1981-91, transitions to live with relatives also declined substantially. It is not clear whether this simply represents the continuation of a previous trend or whether the increased availability of institutional care led to some substitution for family care. Either interpretation has worrying implications for policy makers keen to promote care in the community.

Living arrangements, changes in living arrangements, and survival among community dwelling older adults

OBJECTIVES

This study examines whether living arrangements and changes in living arrangements are associated with survival among older community-dwelling adults, and whether differences in health status account for observed differences in survival.

METHODS

The sample consisted of 5085 persons aged 70 years or older who had participated in the Longitudinal Study of Aging in 1984 and 1986. Proportional hazards models were used to examine associations of survival time through 1990 with living arrangements in 1984 and with changes in living arrangements from 1984 to 1986.

RESULTS

Women who lived with someone other than a spouse at baseline or who changed from living with a spouse to living with someone other than a spouse were at greater risk of dying than women in other living arrangements, independent of health status or functioning. Among men, survival time was not generally associated with baseline living arrangements.

CONCLUSIONS

Older adults who live alone or who change from living with someone to living alone do not have an increased mortality risk. However, living with or changing to living with someone other than a spouse may be associated with increased mortality risk.

Stability and Change in Temporal Distance between the Elderly and Their Children

Drawing on a developmental model of late-life migration, this paper investigates how older people’s health and social characteristics influence stability and change in their temporal distance from their children. Data from the Longitudinal Study of Aging are used to examine both discrete transitions and continuous change in distance over a four-year period. Decline in older parents’ physical health increased the propensity of parents and children to become temporally closer to each other. Among those parent-child pairs who had become closer, the conjunction of declining health and widowhood increased both the degree of non-coresident proximity and the likelihood of transition to coresidence. The findings portray a geographically resilient family that adjusts to the changing needs of its older members.