Examining the impact of Co-residence with a daughter-in-law on older adult health in China: Evidence from a frailty index-based study

Background

The increasing geriatric population and variation in the disease spectrum among older adults in China contribute to a growing demand for more aged adult care in Chinese society. Relevant studies have shown that living arrangements with various family members have variable impacts on the older adult's health. This study employs the Frailty Index as a unified measurement standard to assess the overall health levels, integrating the specific "in-law relationships" into the research on living arrangements and the health of older adults.

Methods

This study used data from the China Longitudinal Aging Social Survey 2016-2018. OLS and Quantile Regression were used to investigate the in-law relationship on older adult health and whether this impact is homogeneous across older individuals with varying infirmity levels. The study used a lag model and propensity score matching to compensate for potential endogeneity concerns.

Results

The study found that residing with a daughter-in-law (20.22%) had a significant positive correlation with the frailty index (β=0.0088, P＜0.001), indicating that the relationship between parents-in-law and daughters-in-law can influence the health of the older adult. This impact is nonlinear and non-homogeneous for older adult people with various levels of frailty, exhibiting an approximately decreasing and then increasing U-shaped distribution, which denotes that older adult people with different health conditions have distinct demands for intergenerational care. In addition, this impact varies among older adult groups of disparate genders, urban and rural areas, and age groups.

Conclusion

This study investigates the impact of "in-law relationships" within living arrangements on the health of older adults. It shows that co-residing with a daughter-in-law has adverse effects on the health of older adults. Therefore, the study suggests that when the health and economic conditions of the elderly permit, a "live-near-but-not-with" living arrangement with their children can be considered.

Nonkin Carers' Roles and Contributions to the Support of Older People Living Alone: An Analysis of Qualitative Data

OBJECTIVES

In the Global North, the number of older people living alone who have little or no support from family members is increasing. However, little is known about older people living alone who have basic needs for support but do not have kin living nearby or a sustainable relationship to a relative they can rely on. Thus, this paper focuses on the role of nonkin carers and their contribution to the support arrangements of older people living alone.

METHODS

We conducted semistructured interviews with 32 older people living alone aged between 67 and 99 (Ø 84.2 years) in Austria, 23 women, and 9 men. The interviews were analyzed by applying a coding strategy based on grounded theory. In addition, sociograms were created to illustrate relevant relations in each support arrangement.

RESULTS

We identified and characterized 3 groups of nonkins involved in the support arrangements of older people living alone based on the origins of the relationships: (1) friends, (2) neighbors, and (3) acquaintances like members of various communities. The arrangements were classified according to the amount and quality of involvement of nonkin carers, namely manifold, scattered, and little nonkin involvement.

DISCUSSION

Our study highlights the diversity of nonkin support in the support arrangements of older people living alone. This heterogeneity should be considered by policy-makers when promoting informal care and designing policy measures.

Socioeconomic status, loneliness, and depression among older adults: a cross-sectional study in Spain

BACKGROUND

The association between socioeconomic status and depression is weaker in older adults than in younger populations. Loneliness may play a significant role in this relationship, explaining (at least partially) the attenuation of the social gradient in depression. The current study examined the relationship between socioeconomic status and depression and whether the association was affected by loneliness.

METHODS

A cross-sectional design involving dwelling and nursing homes residents was used. A total of 887 Spanish residents aged over 64 years took part in the study. Measures of Depression (GDS-5 Scale), Loneliness (De Jong-Gierveld Loneliness Scale), Socioeconomic Status (Education and Economic Hardship), and sociodemographic parameters were used. The study employed bivariate association tests (chi-square and Pearson's r) and logistic regression analyses.

RESULTS

The percentage of participants at risk of suffering depression was significantly higher among those who had not completed primary education (45.5%) and significantly lower among those with university qualifications (16.4%) (X2 = 40.25;p <.001), and respondents who could not make ends meet in financial terms faced a higher risk of depression (X2 = 23.62;p <.001). In terms of the respondents who experienced loneliness, 57.5% were at risk of depression, compared to 19% of those who did not report loneliness (X2 = 120.04;p <.001). The logistic regression analyses showed that having university qualifications meant a 47% reduction in the risk of depression. This risk was 86% higher among respondents experiencing financial difficulties. However, when scores for the loneliness measure were incorporated, the coefficients relating to education and economic hardships ceased to be significant or were significantly reduced.

CONCLUSION

Loneliness can contribute to explaining the role played by socioeconomic inequalities in depression among older adults.

In-Person Social Interactions and Anxiety During the COVID-19 Pandemic: Exploring the Role of Household Size and Virtual Social Contact Among Midlife and Older Black South African Adults

OBJECTIVES

The current study investigates how physical distancing during the coronavirus disease 2019 (COVID-19) pandemic was associated with increased anxiety among a cohort of midlife older Black South African adults and the extent to which household size and virtual social contact modify this association for men and women.

METHODS

We analyze data from a phone survey conducted from July 2021 to March 2022 as part of Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (n = 2,080). We employ logistic regression to estimate the association between changes in in-person social interactions and anxiety symptoms and examine whether the association is modified by household size and changes in virtual social contact. We perform analyses separately for women and men.

RESULTS

Declines in in-person social interactions were associated with increased anxiety for women and men (odds ratios [OR] = 2.52, p < .001). For women only, declines were greater for those living in larger households (OR = 1.11, p = .032). Declines were buffered by increased virtual social contact for both women (OR = 0.55, p = .025) and men (OR = 0.45, p = .019).

DISCUSSION

Although the anxiety symptoms of women and men were similarly affected by declines in in-person social interaction, the modifying influence of household size is unique to women, likely due to gender-specific social roles. For women, living in larger households may mean greater caregiving burden, exacerbating the detrimental association between physical distancing and anxiety. On the other hand, both women and men may have used virtual means to connect with friends and family living outside their homes, buffering against increased anxiety.

The effects of living arrangements and leisure activities on depressive symptoms of Chinese older adults: Evidence from panel data analysis

BACKGROUND

Livable environment and ways, as the necessary conditions for the elderly to enjoy their old age, have a significant impact on their mental health and happiness. It's crucial to understand how living arrangements affect depressive symptoms in China. Studies on how various leisure activities modify this association are yet limited.

METHODS

This study relies on panel data derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), collected during waves spanning 2008/2009, 2011/2012, 2014, and 2018. The primary objective is to examine the relationship between living arrangements, leisure activities, and depressive symptoms of elderly individuals. Linear mixed-effects models were used to analyze the data.

RESULTS

A total of 26,342 observations aged 65 and over were included in this paper. Older adults living alone (β = 0.66, 95 % CI: 0.55, 0.76) or living in institutions (β = 0.69, 95 % CI: 0.40, 0.98) had more depressive symptoms than those living with family. Leisure activities were negatively associated with depressive symptoms (β = -0.16, 95 % CI: -0.18, -0.15). Moreover, there was significant interactions between living arrangements and leisure activities. No matter which kind of living arrangements, participating in physical, productive or social activity was associated with a lower risk of depressive symptoms.

LIMITATIONS

Study design might introduce bias, and it cannot establish causality between the tested variables.

CONCLUSIONS

Older adults living alone or in institutions have more possibility to develop depressive symptoms than those living with family, and such a relationship among Chinese older adults can be moderated by participating in leisure activities.

Non-family Living Arrangements Among Young Adults in the United States

The share of young adults living in married-couple family households in the USA has declined in recent decades. Research on alternative living arrangements focuses on cohabitation among unmarried couples and parent-adult child coresidence. Less is known about trends in non-family living arrangements and the characteristics of young adults living with non-relatives. This study documents trends over time in non-family living arrangements among young adults in the USA and examines the sociodemographic profile of those living with non-relatives. Using pooled US Census and American Community Survey microdata from 1990 to 2019, the authors document age patterns in non-family living arrangements over time and use logistic regression to estimate the likelihood of living with non-family based on individual-level characteristics. Results indicate that non-family living among young adults has increased over time, and that the arrangement is associated with markers of both advantage and disadvantage. Differences across age groups explain some of these mixed results. Trends among younger groups are linked to socioeconomic patterns around family formation. Among older groups, the demographic and labor force characteristics of the foreign born and constraints of their kin availability may be driving trends. The exploratory analysis provides relevant evidence around an increasingly common living arrangement in the USA and also identifies several areas for future research on living arrangements among young adults and the implications of these trends.

Is living alone beneficial to older adults during the COVID-19 pandemic? Examining associations between living arrangements and life satisfaction by gender in Korea

OBJECTIVES

This study examines associations between living arrangements and life satisfaction and the associated effects of gender among Korean older adults during the pandemic.

METHOD

Data were drawn from the 2020 National Survey of Older Koreans-a nationally representative survey. Living arrangements were categorized into four groups: living alone; living with spouse only; living with family and spouse; and living with family without spouse. Logistic regression analyses were used to examine associations between living arrangements and life satisfaction measured as a binary outcome.

RESULTS

Older adults living alone were more likely to be satisfied with life compared with those who lived with a spouse only. However, living alone became nonsignificant after controlling for social contact with friends or neighbors and social participation. Interestingly, there was a significant interaction between living arrangements and gender, showing that living alone was beneficial to older women but not to men. Subsample analysis by gender confirmed that older women living alone had a greater likelihood of being satisfied with life than those living with a spouse only, whereas men living alone had lower life satisfaction.

CONCLUSION

Findings suggest that living alone is not always deleterious to older adults, particularly women. During the pandemic, older Korean women living with their spouse and/or family might be less satisfied with life due to the dual burden of family care and housework, associated with traditional gendered norms and social context.

Association between living arrangements and health risk behaviors among the Hakka older adults in Fujian, China

BACKGROUND

Behavioral lifestyles are important social determinants of health. The impact of changes in living arrangements on behavioral lifestyles is currently under-explored. This study aims to examine the association between living arrangements and health risk behaviors among the Hakka older adults.

METHODS

Data were extracted from China's Health-Related Quality of Life Survey for Older Adults 2018. Living arrangements were divided into five categories: living alone, living with spouse only, living with child, mixed habitation, and others. Five health risk behaviors, including unhealthy dietary patterns, drinking, smoking, irregular sleep practices, and physical inactivity were measured. Logistic regression analysis was used to assess the association between living arrangements and specific health risk behaviors, and generalized linear models were established to test the association between living arrangements and the number of health risk behaviors.

RESULTS

A total of 1,262 Hakka older adults were included in this study. Compared to those living alone, those living with spouse only were less likely to have unhealthy dietary patterns (OR = 0.45, P < 0.05) and drinking (OR = 0.50, P < 0.05), those living with the child were less likely to experience unhealthy dietary patterns (OR = 0.35, P < 0.001), drinking (OR = 0.32, P < 0.001), smoking (OR = 0.49, P < 0.05), and physical inactivity (OR = 0.13, P < 0.01). Moreover, those who were living with child (β = -0.78, P < 0.001) or mixed habitation (β = -0.33, P < 0.05) tended to engage in fewer health risk behaviors than those living alone.

CONCLUSIONS

This study suggests significant differences in health risk behaviors among the Hakka older adults with different living arrangements. Living with the child could reduce the occurrence of health risk behaviors in the Hakka older adults and thus maintain their health status.

Who returned home? The COVID-19 pandemic and young adults' residential transitions

The COVID-19 pandemic is thought to have led to an increase in the percentage of young adults living with their parents, but the relative contributions made by moves into and out of the parental home to this increase are unknown. Also unknown is whether changes in the likelihood of home leaving and returning were concentrated among privileged or disadvantaged youth. This study used data from the Panel Study of Income Dynamics Transition into Adulthood Supplement (2013-2021) and estimated logistic regression models to examine changes in the levels and correlates of moving into (n = 1872) and out of (n = 1852) the parental home before and after the onset of the COVID-19 pandemic in the U.S. Results show that relative to pre-pandemic trends, during the COVID-19 pandemic young adults were more likely to move back to the parental home and less likely to leave it. The increase in the likelihood of returning home was concentrated among young, white college students from advantaged families. The decline in leaving home was most pronounced among white and employed young adults.

Living arrangements, activity participation and depression among older Chinese adults

OBJECTIVES

We examined the relationship among living arrangements, activity participation and depression and the mediating effects of activity participation on the relationship between living arrangements and depression.

STUDY DESIGN

This was a cross-sectional study based on nationally representative data.

METHODS

9647 older adults aged 60 years and over were recruited from the 2018 Chinese Longitudinal Healthy Longevity Survey. Three-step regression and mediation analysis methods were used.

RESULTS

Compared with older adults living with family members, those living in institutions attended fewer activities and experienced higher depression rates, and those living alone attended more activities and experienced higher depression rates. In the group living with family members, living with a spouse was an important way to increase activity participation and reduce depression. Mediation analysis suggested that activity participation mediated the impact of living arrangements on depression. Attending more activities could alleviate depression for older adults who are living alone, living in institutions and living without a spouse.

CONCLUSION

Our findings suggest an emphasis on the role of spouses and activity participation during depression interventions among older adults.

Living Arrangements and Subjective Well-Being of Elderly Chinese Tibetan People: The Mediating Role of Religion

While previous studies have found that living arrangements and religiosity can influence the subjective well-being (SWB) of older adults, they have tended to investigate each of these aspects separately. Engaging with this gap, the current study examines the relationship between living arrangements, religious attendance, and the SWB of older adults, as well as the mediating effect of religious attendance on the relationship between the other two factors. A total of 875 older adults from 40 villages or communities in a Tibetan area in China (Gannan) were surveyed. An ordinary least square regression was used to evaluate the relationship between SWB and living arrangements and/or religious attendance. A structural equation model was then used to test the mediating role played by religious attendance in the association between living arrangements and SWB. The results showed that older adults in the selected study areas who were co-residing with their children and/or spouse had a higher level of SWB compared to those living alone. While religious attendance was positively associated with older adults' SWB, the findings showed that living with their spouse or children decreased their frequency of attendance at religious activities. In contrast, it was found that living alone directly decreased older adults' SWB, but increased the frequency of their participation in religious events, thus indirectly promoting their SWB. A key implication of this study is its confirmation that religious attendance plays an important mediating role in the relationship between living arrangements and SWB.

Living arrangements and depression of the older adults- evidence from the Chinese longitudinal healthy longevity survey

BACKGROUND

The mental health and living arrangements of older adults are worthy of attention. Previous studies have pointed out that the living arrangements may be related to older adults' depression. However, it has not been found that studies concern the relationship between actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality and depression in older adults, so we carried out this study.

METHODS

The data from the Chinese longitudinal healthy longevity survey were used in this study. With the older adults' depression as the dependent variable and the living arrangement related variables as the independent variable, we constructed three binary-logistic regression analysis models to explore the potential relationship between living arrangement related variables and depression in older adults.

RESULTS

We found that the actual living arrangements, living arrangement preferences, and the fit between living arrangement preferences and reality are significantly correlated with depression in older adults. Specifically, older adults living alone or only with the spouse are at greater risk of depression. Older adults who prefer living alone or only with the spouse are at relatively low risk of depression. Older adults whose living arrangement preferences do not match reality have a higher risk of depression.

CONCLUSION

The living arrangement related variables are significantly correlated with depression in older adults. In addition to the actual living arrangements, living arrangement preferences and whether the living arrangement preferences fit with reality are also related to the depression of older adults.

Association of living arrangements with all-cause mortality among older adults: a propensity score-matched cohort study

BACKGROUND

Many studies exist on the living arrangements and health status of older adults, but the findings have been inconsistent. Therefore, we examined the relationship between living arrangements and all-cause mortality in older adults.

METHODS

This perspective study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 2011 to 2018. We used a sample aged 65 years and over included in the study in 2011. Propensity score matching was performed to minimize bias and Cox proportional hazards regression models were conducted.

RESULTS

A total of 7,963 participants were included. Of these, 1,383 were living alone, 6,424 were living with families, and 156 were living in nursing homes. In the propensity score-matched cohort, older adults living alone had a significantly lower risk of all-cause mortality than those living with families (hazard ratio 0.85; 95% confidence intervals 0.76 to 0.95). Living alone was prominently associated with a decline in mortality compared with living in nursing homes (hazard ratio 0.61; 95% confidence intervals 0.44 to 0.84). There was no significant difference in mortality between living in nursing homes and living with families (hazard ratio 1.19; 95% confidence intervals 0.89 to 1.60). Subgroup analyses indicated that there was no significant interaction with age, sex, education, or residence.

CONCLUSIONS

The risk of all-cause mortality was significantly lower in older adults living alone than in those living with families or living in nursing homes. This article's findings suggest the need to adopt multiple approaches to meet the needs of senior care services.

The relationship between living alone or not and depressive symptoms in older adults: a parallel mediation effect of sleep quality and anxiety

BACKGROUND

With modernization and ageing in China, the population of older adults living alone is increasing. Living alone may be a potential risk factor for depressive symptoms. However, no parallel mediation model analysis has investigated the mediating factors for living alone or not (living arrangements) and depressive symptoms.

METHODS

This cross-sectional study included a total number of 10,980 participants from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), 1699 of whom lived alone and 9281 of whom did not live alone. Binary logistic regression and parallel mediation effect model were used to explore the relationship between living alone or not and depressive symptoms and possible mediation effects. Bootstrap analysis was used to examine the mediation effect of living alone or not on depressive symptoms.

RESULTS

Compared to the participants who were not living alone, the living alone group had a higher rate of depressive symptoms. The binary logistic regression showed that after adjusting for other covariates, the risk of depressive symptoms was approximately 0.21 times higher for living alone compared to not living alone (OR = 1.21, 95% CI: 1.06, 1.37). Further, the results of the bootstrap analysis supported the partial mediating role of sleep quality and anxiety. Mediation analysis revealed that sleep quality and anxiety partially mediate the relationship between living alone and depressive symptoms (β = 0.008, 95% CI [0.003, 0.014]; β = 0.015, 95% CI [0.008, 0.024], respectively).

CONCLUSIONS

Sleep quality and anxiety were identified as partially parallel mediators between living alone or not and depressive symptoms. Older adults living alone with poorer sleep quality and more pronounced anxiety were positively associated with higher levels of depressive symptoms. Older adults living alone should be encouraged to engage in social activities that may improve sleep quality, relieve anxiety, and improve feelings of loneliness caused by living alone. Meanwhile, older adults living alone should receive attention and support to alleviate their depressive symptoms.

Family structure and living arrangements as indicators of social isolation, and prostate cancer risk

Social isolation has been linked to a poorer prostate cancer prognosis. Little is known about how it could also influence its incidence. We investigated the association between family structure and living arrangements as potential indicators of social isolation, and prostate cancer risk, globally and according to disease aggressiveness. Data from the Prostate Cancer & Environment Study (PROtEuS), a case-control population-based study conducted between 2005 and 2012 in Montreal, Canada, were used. The study population comprised 1931 incident cases of prostate cancer, aged ≤75 years, and 1994 age-matched (±5 years) population controls. In-person interviews collected information on family composition and living arrangements recently and at age 40. Logistic regression estimated odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders. Single men had an increased risk of high-grade prostate cancer at diagnosis (OR 1.80; 95% CI 1.29-2.51), compared to men currently married or with a partner. Having at least one daughter was associated with a lower risk of aggressive cancer (OR 0.76; 95% CI 0.61-0.96) while no association was found with having son(s). An inverse dose-response relationship was observed between the number of people living with the subject 2 years before diagnosis/interview and prostate cancer risk (p-trend<0.001). These results suggest a protective role of a rich personal environment on the risk of developing prostate cancer. As several of the associations studied here are novel, replication is required.

Preference to Age in Place in Low-Income Senior Housing

Low-income senior housing provided through the Section 202 Supportive Housing for the Elderly program is a critical site for aging in place, and many of these properties have hired service coordinators to monitor residents' quality of life, provide access to services, and promote their ability to age in place. To address gaps in the limited literature on Section 202 buildings, this study examined the association between service coordination and low-income senior housing residents' preference to age in place with particular attention to the most economically vulnerable. We analyzed data from 255 older adults living in eight Section 202 buildings in Southeastern Michigan using logistic regression. Self-perceived economic vulnerability moderated the relationship between service coordination and preference to age in place. Among those who had not received service coordination, the high economic vulnerability group was more likely to prefer to age in place compared to more economically secure residents. Among those who received assistance from a service coordinator, economically vulnerable residents were less likely to express a preference to age in place compared to other residents. Findings indicate a complex relationship between service coordination, economic resources, and preference to age in place in senior housing, and suggest areas for future research.

Under Different Roofs? Coresidence With Adult Children and Parents' Mental Health Across Race and Ethnicity Over Two Decades

Many U.S. parents share a household with an adult child in later life. However, the reasons parents and adult children coreside may vary over time and across family race/ethnicity, shaping relationships with parents' mental health. Using the Health and Retirement Study, this study investigates the determinants and mental health correlates of coresidence with adult children from 1998 to 2018 among White, Black, and Hispanic parents under age 65 and aged 65+. Findings show that the predictors of coresidence shifted with increasing odds that parents lived with an adult child, and several varied by parents' age group and race/ethnicity. Compared with White parents, Black and Hispanic parents were more likely to live with adult children, especially at older ages, and to indicate that they helped their children with household finances or functional limitations. Living with adult children was associated with higher depressive symptoms among White parents, and mental health was negatively related to living with adult children who were not working or were helping parents with functional limitations. The findings highlight increasing diversity among adult child-coresident parents and underscore persistent differences in the predictors and meaning of coresidence with adult children across race/ethnicity.

Intergenerational Ties and COVID-19 Contagion: A Study on European Adults Aged 50 Years and Older Using SHARE Data

OBJECTIVES

Intergenerational coresidence and interdependence among family members are salient forms of family support. However, they can also likely increase social and physical contact and thus potential coronavirus disease 2019 (COVID-19) transmission, especially among older adults. This study makes an original contribution to the literature by investigating which individual and household characteristics are associated with the risk of COVID-19 contagion among community-dwelling adults aged 50 years or older living in 27 European countries. We accounted for multiple indicators of intergenerational relationships and conducted a gendered analysis.

METHODS

The data came from the Survey of Health, Ageing and Retirement in Europe (SHARE), including 2 waves of the SHARE Corona Survey. Using linear probability models, the risk of experiencing COVID-19 outcomes was predicted by different family structures and intergenerational relationship indicators.

RESULTS

While intergenerational coresidence was not associated with the risk of COVID-19, a higher frequency of face-to-face contact with adult children was associated with a lower risk of COVID-19 among mothers. This result stresses the importance of social support from adult children during the COVID-19 pandemic. However, we also showed that grandparents who took care of grandchildren were at a higher risk of COVID-19. Additionally, childless individuals had a lower risk of COVID-19 during the second wave of the pandemic.

DISCUSSION

This study highlights the importance of intergenerational relationships in pandemic studies and underscores the need to examine how intergenerational ties might be a source of social support. Implications for policy interventions are discussed in the final section.

Living Alone During Old Age and the Risk of Dementia: Assessing the Cumulative Risk of Living Alone

OBJECTIVES

This study examines the association between living alone during old age and dementia. Whereas most previous studies on this topic utilize measures of living alone status that were obtained at a single point in time, we compare this typical approach to one that measures long-term exposure to living alone among older adults and assesses whether dementia is more likely to occur within individuals with more accumulated time living alone.

METHODS

Data come from the Health and Retirement Study, with a follow-up period of 2000-2018. A total of 18,171 older adults were followed during this period, resulting in 78,490 person-waves analyzed in a series of multi-level logistic models. Contemporaneous living alone was recorded when a respondent's household size was equal to 1 in a given wave. Cumulative living alone was calculated by adding the number of living alone statuses up to a given wave.

RESULTS

Contemporaneous living alone was either not associated (male-only subsample), or inversely associated (female-only subsample) with dementia. By contrast, a one-unit (i.e., one wave) increase in cumulative living alone was associated with about a 10% increase in the odds of dementia for both men (odds ratio [OR] = 1.111) and women (OR = 1.088), net of several covariates, including marital status, age, social activities, and social support.

DISCUSSION

Living alone during late life is an important risk factor for dementia, but the cognitive effects of solitary living probably do not take hold immediately for most older adults and potentially demonstrate a dose-response relationship.

Is Transition in Living Arrangements Associated With Older Adults' Life Satisfaction When Preference Is Considered?

OBJECTIVES

In a longitudinal design, the objective is to investigate the association between transitions in living arrangements and life satisfaction with special consideration for preferred living arrangement, and to assess whether such associations are moderated by age among Chinese older adults.

METHODS

Data were from 4 waves of the Chinese Longitudinal Healthy Longevity Survey, 2005-2014. Living arrangement transitions (N = 12,654) distinguished coresidence with children and non-coresidence and matched preference. Random effect ordinal logistic models predicted life satisfaction by transitions in living arrangements between baseline and follow-up, transitions in matched living arrangement preferences between baseline and follow-up, and these transitions interacted with age at baseline, adjusting for life satisfaction at baseline. Predicted probabilities for the highest level of life satisfaction for several transition combinations were calculated and the difference was tested for significance.

RESULTS

Although matching actual and preferred living arrangement transition is an important factor in determining life satisfaction, actual coresidence with children remains positively significant. Moreover, results show significant interaction effects of the two transitions with age: while the association of life satisfaction with consistent matching gradually declines into older ages, the association of life satisfaction with consistent coresidence increases with age.

DISCUSSION

While preference-matched living arrangement is critical for life satisfaction, especially for the young-old, the role of coresidence becomes more prominent at very old ages when various needs are likely to arise. It is too early to dismiss the role of coresidence with children in the Chinese context.

The Impact of the COVID-19 Pandemic on Older Women in the Women's Health Initiative

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is a health crisis of which older adults are a high-risk group for severe illness and mortality. The objectives of this article are to describe the methods and responses to a COVID-19 survey administered by the Women's Health Initiative (WHI) to assess the impact of the pandemic on older women.

METHODS

WHI is an ongoing prospective cohort study that recruited 161 808 postmenopausal women from 1993 to 1998. From June 2020 to October 2020, participants in active follow-up were surveyed by mail, phone, or online to assess health and well-being, living situations, lifestyle, health care, and self-reported COVID-19 testing, treatment, and preventive behaviors.

RESULTS

Of 64 061 eligible participants, 49 695 (average age 83.6 years ± 5.6) completed the COVID-19 survey (response rate 77.6%). Many participants reported very good or good well-being (75.6%). Respondents reported being very concerned about the pandemic (51.1%; more common in urban compared to rural areas), with 6.9% reporting disruptions in living arrangements and 9.7% reporting changes in medication access. Participants (54.4%) reported physical activity levels were much less or somewhat less compared to levels before the pandemic, and this was more pronounced in urban areas versus rural areas (55.3% vs 44.4%). Participants engaged in preventive behaviors including wearing a face mask (93.2%). A total of 18.9% reported testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among whom 3.5% (n = 311) reported testing positive.

CONCLUSIONS

In this nationwide survey of older U.S. women, the COVID-19 pandemic was associated with impacts on health and well-being, living situations, lifestyle, health care access, and SARS-CoV-2 testing and preventive behaviors.

Rural urban differences in self-rated health among older adults: examining the role of marital status and living arrangements

BACKGROUND

The rural-urban gap in socioeconomic and morbidity status among older adults is prevalent in India. These disparities may impact the levels and factors of self-rated health (SRH). The objective of the study is to compare the levels and determinants of SRH between rural and urban areas by considering the moderating effects of marital status and living arrangements.

SUBJECTS AND METHODS

The present study used data from the Longitudinal Ageing Study in India (LASI) wave 1 (2017-18). A total sample of 30,633 older adults aged 60 years and above were selected for the study. Descriptive statistics, bivariate chi-square test, the interaction effect of living arrangements and marital status, and logistic estimation were applied to accomplish the study objectives.

RESULTS

The prevalence of poor SRH was found 7% higher in rural areas compared to urban counterparts. A substantial rural-urban disparity in the patterns of poor SRH was also observed. The interaction effect of marital status and living arrangement on self-rated health suggested that older adults who were currently unmarried and living alone were 38% more likely to report poor SRH than those who were currently married and co-residing in rural India. In addition to marital status and living situation, other factors that significantly influenced SRH include age, socio-cultural background (educational attainment and religion), economic background (employment status), health status (ADLs, IADLs, multi-morbidities), and geographic background (region).

CONCLUSION

The present study's findings demonstrated that, notwithstanding local variations, marital status and living circumstances significantly influenced SRH in India. In the present study, unmarried older people living alone were more susceptible to poor SRH in rural areas. The present study supports the importance of reinforcing the concepts of care and support for older individuals. There is a need for special policy attention to older individuals, particularly those unmarried and living alone. Although older individuals had difficulty performing ADLs and IADLs and had multi-morbidities, they reported poorer health. Therefore, offering them social support and top-notch medical assistance is crucial.

Rising living alone among the elderly in Iran: prevalence and associated factors

Background

This study first examines the pattern and trend of elderly living alone during the last five censuses in Iran. Then, after describing the characteristics of the elderly who live alone, it determines how social, economic, and demographic characteristics relate to the solo living of the elderly.

Methods

The data for people aged 60 and above are from two sources, including the aggregate data from five successive Iranian censuses and the individual data of 2% of the 2016 Iranian census. To determine the relative importance of variables such as sex, age, education, and activity status of the elderly, a set of logistic regression models using STATA software has been used for individual data analysis of the 2016 census.

Results

The proportion of older people living alone in 1986, 1996, 2006, 2011, and 2016 was 9.1, 9.0, 10.9, 14.5, and 14.9%, respectively. City residents are less likely to live alone than villagers, and women are more likely to live alone than men. The odds of living solo among Illiterate, Primary school, Secondary & High school and Holding a high school diploma elderly higher than those with university education. Being a student and homemaker increases solo living relative to employees, but pensioners reduce solo living relative to employees. Moreover, the odds of solo living of the elderly in the early and middle stages of old age is less than in late old age. Also, the variables included in the analysis explained 16% of the variation in solo living.

Conclusion

The prevalence of elderly solo living is increasing. And this increase continues due to the fundamental decline in childbearing, changes in family structure, and the effects of culture and tradition. Also, due to the rise in life expectancy, which increases the number of years of life with the disease, and disability, the lack of relief organizations will create more difficult conditions for the older people living alone.

Defining Childlessness Among Middle-Aged and Older Americans: A Research Note

Measuring childlessness is complicated by the increasing complexity of family structure. Using data from the 2014 Health and Retirement Study, in this research note we compared three definitions of childlessness: (1) respondent never fathered/gave birth to a child, (2) respondent had no children who were living and in contact, and (3) respondent and spouse/partner had no children or stepchildren who were living and in contact. Results showed that the prevalence of childlessness among Americans aged 55 or older ranged from 9.2% to 13.6% depending on which definition was used. The association between select individual characteristics (gender and marital status) and the likelihood of childlessness, as well as the association between childlessness and loneliness and living arrangements, also varied depending on how childlessness was defined. Therefore, how we define childlessness can affect our understanding of its prevalence, correlates, and relationships with well-being. Future research on childlessness should carefully consider the choice of definition and its implications for research and policy discussions.

Living arrangements and community participation among autistic adults: Exploring the possible influences of living alone or with others

BACKGROUND

With the increasing prevalence of autistic individuals, it is greatly needed to examine the factors impacting their community participation experiences. Where autistic adults live and how that may be related to their participation and quality of life is one environmental factor that has received little attention.

AIMS

This study explored the association between living arrangements in the community and community participation for autistic adults.

METHOD

This study used data from a statewide survey of autistic adults (N = 744) to investigate the relationship between living arrangements (live alone with or without support, live with roommate/spouse, or live with family) and the amount, breadth, and sufficiency of community participation.

RESULTS

After controlling for sociodemographic and clinical factors known to be associated with community participation, autistic adults living with family members participated less frequently in community activities over 30 days than those living with a roommate/spouse. However, they experienced similar levels of sufficiency with their participation. Autistic adults living alone with support reported the lowest levels of sufficiency with their participation, although the amount and breadth of their participation were no different from other adults.

CONCLUSION

These findings have several implications for providing support to enable autistic adults to participate in the areas that are important to them and to the extent they desire. Future research is needed to gain a better understanding of how interests and expectations for participation may be influenced by living situations.

Cohort matters: The relationships between living arrangements and psychological health from the Korean Longitudinal Study of Aging (KLoSA)

BACKGROUND

Little is known about cohort variations in the relationships between living arrangements and psychological health among older adults. The current study evaluated whether cohort differences in the intergenerational support affect the differences in the mental health benefits of multigenerational living arrangements, and how they do so.

METHODS

Using panel regression models with lagged variables based on South Korean data, we compared the shape of the relationships between living arrangements and psychological conditions of two cohorts of older adults.

RESULTS

The study found birth cohort differences in older adults' psychological well-being. Among older adults in recent cohorts, living in a multigenerational household was positively associated with depression and negatively linked with life satisfaction. The cohort variations were partly explained by children's marital status and home ownership.

CONCLUSION

The birth cohort variations in psychological health implications of living arrangements may reflect the changing patterns of intergenerational support and family values.

Living arrangement modifies the associations of loneliness with adverse health outcomes in older adults: evidence from the CLHLS

Background

Although it has been suggested that loneliness is a risk factor for adverse health outcomes, living arrangement may confound the association. This study aimed to investigate whether the associations of loneliness with adverse health outcomes differ in community-dwelling older adults according to different living arrangements.

Methods

In the 2008/2009 wave of Chinese Longitudinal Healthy Longevity Survey, 13,738 community-dwelling older adults (≥65 years) were included for analyses. Living arrangements and loneliness were assessed. Health outcomes including cognitive and physical functions were assessed using MMSE, ADL/IADL scales and Frailty Index in the 2008/2009 and 2011/2012 waves; mortality was assessed in the 3-year follow-up from 2008/2009 to 2011/2012. The effect modificaitons of loneliness on adverse health outcomes by living arrangements were estimated using logistic regression or Cox proportional hazards regression models.

Results

Living alone older adults were significantly more likely to be lonely at baseline (52% vs 29.5%, OR = 1.90, 95% CI = 1.67–2.16, P < 0.001), compared with those living with others. Loneliness in older adults was a significant risk factor for prevalent cognitive impairment and frailty, and 3-year mortality, especially among those who lived with others (OR = 1.32, 95% CI = 1.15–1.52, P < 0.001; OR = 1.39, 95% CI = 1.24–1.57, P < 0.001; HR = 1.14, 95% CI = 1.05–1.24, P = 0.002, respectively). In contrast, among the living alone older adults, loneliness was only significantly associated with higher prevalence of frailty (OR = 1.42, 95% CI = 1.07–1.90, P = 0.017). Living arrangement significantly modified the associations of loneliness with prevalent cognitive impairment and 3-year mortality (P values for interaction = 0.005 and 0.026, respectively).

Conclusions

Living arrangement modifies the associations of loneliness with adverse health outcomes in community-dwelling older adults, and those who lived with others but felt lonely had worse cognitive and physical functions as well as higher mortality. Special attention should be paid to this population and more social services should be developed to reduce adverse health outcomes, in order to improve their quality of life and promote successful aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-021-02742-5.

Sex and Relationships Pre- and Early- COVID-19 Pandemic: Findings from a Probability Sample of U.S. Undergraduate Students

In the wake of the COVID-19 pandemic, most U.S. colleges closed their campuses-including residence halls-causing significant disruption to students' lives. Two waves of data were collected from undergraduate students enrolled at a large U.S. Midwestern university: Wave 1 was a confidential online survey of 4989 randomly sampled undergraduate students collected in January/February 2020; Wave 2 was collected in April/May 2020 following campus closure. Our research aimed to: (1) assess how the COVID-19 related campus closure affected college students' romantic/sexual relationships, (2) examine students' past month sexual behaviors prior to the pandemic in comparison with their sexual behaviors during campus closure, and (3) compare participants' pre-pandemic event-level sexual behaviors with those occurring during campus closure. Of 2137 participants who completed both waves (49.8% women, mean age = 20.9), 2.6% were living at home in Wave 1 compared to 71.0% at Wave 2. Of those in relationships, 14.5% experienced a breakup and 25.3% stayed in their relationship but returned home to different cities. There were no statistically significant differences in participants' prior month reports of solo masturbation or sending/receiving nude/sexy images between Waves 1 and 2; however, participation in oral, vaginal, and anal sex significantly decreased across waves. Examining participants' most recent sexual events, Wave 2 sex more often occurred with a cohabiting or relationship partner and was rated as more wanted, emotionally intimate, and orgasmic. Implications for sexual health professionals are discussed.

The Effects of Social Activities and Living Arrangements on Cognitive Functions in Middle-aged and Elderly Adults: A Panel Study Using the 2006-2018 Korean Longitudinal Study of Aging

OBJECTIVES

Previous studies have shown that participation in social activities (SA) can prevent cognitive decline (CD) and that living arrangements (LA) can affect cognitive function. This study aimed to evaluate the effects of SA and LA on CD, as well as their interactions, using longitudinal data.

METHODS

Data were used from the 2006-2018 Korean Longitudinal Study for Aging, which followed 10 254 adults older than 45 years over a 12-year period. CD was defined as a ≥4-point score decrease in the Mini-Mental Status Exam over 2 years. We developed an extended Cox proportional hazards model for time-dependent covariates to estimate the hazard ratio (HR) of CD in 4 groups: (1) socially active and living with others, (2) socially active and living alone, (3) socially inactive and living with others (SILO), and (4) socially inactive and living alone (SILA). The model was stratified by gender and adjusted for important confounders.

RESULTS

The HR of CD was significantly higher in the SILO group in men (HR,1.36; 95% confidence interval [CI], 1.08 to 1.78) and in the SILA group in women (HR, 1.72; 95% CI, 1.08 to 2.75). However, the interaction term for gender was not significant.

CONCLUSIONS

Among socially inactive elderly adults, the HR of CD was elevated in men who lived with others and in women who lived alone, although the interaction term for gender was not significant. Socially inactive men who live with others and socially inactive women who live alone are particularly encouraged to participate in SA to prevent CD.

Gender differences in years of remaining life by living arrangement among older Singaporeans

Living arrangements of older adults have often been studied as a measure of the support available to them. Given the rapidly ageing and low fertility context of Singapore where the prevalence of older adults living alone and without children is expected to increase, we construct multistate life tables to estimate the number of years that older persons can expect to live in different living arrangements at a population level (population-based) as well as based on their initial living arrangement (status-based). We focus particularly on whether there are gender differences in the expected years of life in different living arrangement states. We use the Panel on Health and Ageing of Singaporean Elderly, a 2009 nationally representative survey of 4990 Singaporeans aged 60 years and older, with follow-up surveys in 2011 and 2015. In calculating the probabilities of transition between different states, we control for number of children, housing type, and time-varying ADL limitations. We find that at age 60, women can expect to spend more than twice the proportion (18%) of their remaining lives living alone compared to men (7%). Status-based estimates indicate that the proportion of remaining years living with a child is higher for women initially living alone, with a spouse only or already with a child, compared to males. Our results indicate that while older women are more likely to live alone compared to their male counterparts, older women living alone are also more likely to transition to living with children. Our research sheds light on the importance of expanding research on life expectancy beyond health, to consider analysis using other forms of social stratification, particularly gender differences in states of living arrangement.

Supplementary Information

The online version of this article contains supplementary material available at 10.1007/s10433-020-00594-3.

The Persistence of High Levels of Living Alone Among Adults with Disabilities in Sweden, 1993-2011

This study investigates how the probability to live alone has developed among working age individuals with and without disabilities in Sweden during the period 1993-2011 when extensive political reforms to improve the integration of disabled individuals in society were implemented. The results show that individuals with disabilities are approximately twice as likely to be living alone when compared to individuals without disabilities. People with disabilities were also more likely to report low life satisfaction, and this was especially true among individuals with disabilities living alone. Men and women with disabilities also tend to experience longer periods of living as a one-person household than non-disabled people. Over time we find no indications of reduced differences in family outcomes between disabled and non-disabled individuals but rather evidence to the contrary. These differences are interpreted as being the result of the disadvantage disabled individual's experience in the partner market and that people with disabilities are less successful in forming partnerships that can lead to cohabitation and family formation. The results thus show how disabled individuals still face societal barriers that limit their possibilities to find and sustain relationships that result in stable cohabitation despite increased efforts to improve their inclusion in Swedish society.

Caring as curing: Grandparenting and depressive symptoms in China

Research on grandparenting (i.e., caring for grandchildren) and mental health in Asian contexts has been limited, despite the rapid growth of older adults who take care of grandchildren. This study aims to investigate how grandparenting influences depressive symptoms in China. Using the China Health and Retirement Longitudinal Study (2011-2015, N = 4354), we conducted fixed effects regression models to examine the association between various types of grandparenting and depressive symptoms among older adults between the ages of 45 and 80. The results show that for grandparents, providing care to their grandchildren in skipped-generation households (i.e., grandparent-grandchildren families without adult children) is associated with a lower level of depressive symptoms compared to providing no care, after controlling for socioeconomic status, health behaviors, social support, and basic demographic characteristics. Other types of care (i.e., multigenerational household grandparenting, and part-time and full-time noncoresident grandparenting) are not significantly linked to caregiving grandparents' depressive symptoms. Overall, our findings suggest that sociocultural contexts need to be considered in explaining the different mental health implications of grandparenting.

Associations of living arrangements with symptoms and functioning in schizophrenia

BACKGROUND

Living arrangements and accommodation are closely related, but no study had concurrently investigated their associations with outcomes in schizophrenia. This study seeks to describe and compare socio-demographic, clinical and functioning profiles of people with schizophrenia in different living arrangements and accommodation, and to examine the associations of living arrangements and accommodation with symptomatic remission and functioning.

METHODS

Community dwelling outpatients with schizophrenia (n = 276) were inquired on living arrangements, accommodation, socio-demographics and assessed on the Positive and Negative Syndrome Scale (PANSS) and the Social and Occupational Functioning Scale (SOFAS). Socio-demographics, symptoms and functioning of outpatients in different living arrangements and accommodation were compared. Symptomatic remission was investigated using logistic regression with living arrangements, socio-demographics and clinical variables as independent variables. Functioning was investigated using multiple regression with the same set of independent variables and the addition of PANSS factors. The same analyses were conducted with accommodation as independent variable.

RESULTS

185 (67.03%) participants lived with family and 195 (70.65%) participants lived in owned accommodation. People living with their spouses had significantly higher SOFAS, lower PANSS Total and PANSS Positive than people living with family, independently, or in rehabilitation centres. They also had lower PANSS Negative than people living with family and a higher likelihood to have achieved symptomatic remission. Types of accommodation was not associated with symptoms, symptomatic remission, and functioning.

CONCLUSION

Living arrangements, but not types of accommodation, were associated with symptoms and functioning in schizophrenia. Family education and support is important to help maintain a conducive environment for people with schizophrenia. People living independently may need more support.

Community social networks, individual social participation and dietary behavior among older Japanese adults: Examining mediation using nonlinear structural equation models for three-wave longitudinal data

Community social networks positively affect older adults' dietary behavior, but the underlying mechanisms remain uncertain. This study investigated if the relationship between community social networks and dietary behavior is mediated by social participation, and whether the influence of community social networks differs across sociodemographic groups. We conducted a cross-lagged panel mediation analysis employing nonlinear structural equation modeling using panel data from the Japan Gerontological Evaluation Study (JAGES), a longitudinal study of Japanese older adults in 2010, 2013, and 2016, which included 11,347 men and 14,105 women aged over 65. Monodirectional relationships in community social networks, individual social participation, and fruit/vegetable intake were examined. Community social networks were associated with social participation regardless of sociodemographic conditions. Individual social participation was in turn, positively associated with fruit/vegetable intake, with this association being stronger among those living alone. Analyses further showed that individuals' social participation positively mediated the relationship between community social networks and fruit/vegetable intake. For both genders, the mediating effects were stronger among people living alone than in those living with someone. However, community networks could also directly and negatively affect fruit/vegetable intake among men who live alone unless they participated in community activities. Community social networks may promote social participation, thereby facilitating healthier dietary behavior regardless of sociodemographic status. Social participation in turn may positively contribute to the dietary health of people living alone. Community-based interventions to encourage people living alone to participate in social activities may help reduce inequality in dietary behavior related to cohabitation status.

Revisiting the Role of Gender and Marital Status as Risk Factors for Nursing Home Entry

OBJECTIVE

To study the role of gender and marital status as risk factors for nursing home entry in the United States.

METHOD

The paper uses data from the Health and Retirement Study, a nationally representative survey of the older population in the United States. Multivariate logit models of the risk of nursing home entry over a 2-year follow-up period were estimated for noninstitutionalized individuals over the age of 65. A multiple imputation procedure was used to explore the sensitivity of the results to alternative assumptions about the data-generating process of missing outcome values.

RESULTS

In an analysis based on complete observations, women exhibited the same risk of nursing home entry as men (risk ratio [RR] = 1.01; CI: 0.90, 1.13). However, after expanding the sample to include information on nursing home use for individuals who died during the follow-up period, women were found to have a statistically lower risk of nursing home entry (RR = 0.85; CI: 0.79, 0.92). The latter result was robust to alternative assumptions about the nature of missing data. The type of sample used in the analysis did not affect the conclusions regarding the role of marital status. Divorced and widowed individuals were found to be at higher risk of nursing home admissions than married individuals in all specifications.

DISCUSSION

The findings clarify the role of gender as a predictor of nursing home admissions and may provide useful prognostic information for clinicians and caregivers regarding nursing home entry risk. The study also sheds light on how conclusions about predictors of nursing home risk obtained from prospective studies with long follow-up periods can be affected by the treatment of missing outcomes due to death or attritions.

Socially-isolated neighborhoods and the risk of all-cause mortality among nursing home residents in the United States: A multilevel study

The total number of Americans age 65 and older is expected to nearly double by 2060, and the number of Americans admitted to nursing homes is likewise anticipated to escalate. Studies have found living alone to be an important risk factor for mortality. Yet little is known about possible spillover health effects of living in a community where many elderly residents live alone. Even less is known about whether these risks persist after entering nursing homes. Our study population consisted of 874,162 US elderly adults newly admitted to nursing homes in 2011, as identified from the 3.0 Minimum Data Set. Data on these individuals were linked to Medicare claims and 2010 Census data. In this cohort study, we estimated multivariable-adjusted hazard ratios for the associations between the quartiles of county-level percentage of households with those age 65 or older living alone and the individual-level risks of all-cause mortality until December 31, 2013, controlling for county-, nursing home facility-, and individual-level factors. Older adults in counties belonging to the highest quartile of elderly single-occupancy households had a 8% higher risk of dying (HR = 1.08; 95% CI = 1.04-1.12, p < 0.001) after entering nursing homes compared to those in counties belonging to the lowest quartile. There was evidence of a linear trend (p for trend < 0.001). Should these findings be confirmed in future studies, it would suggest that living arrangements in elderly communities may have spillover health effects onto their residents. Programs and interventions that modify such living arrangements may yield more favorable health trajectories among older Americans, who are increasingly aging in place and at growing risk of entering nursing homes.

Changing living arrangements and stress during Covid-19 lockdown: Evidence from four birth cohorts in the UK

Background

The outbreak of Covid-19 in the UK has seen many families unexpectedly brought back together. The circumstances and stories of individual families have been picked up in the press focussing on the difficulties of people adjusting to their changed living arrangements. Yet, there have been few empirical analyses on how such changes might influence people's health and wellbeing. Therefore, this study explored the changing patterns of perceived stress by living arrangements change during the first wave of the Covid-19 pandemic in 2020.

Methods

The data used relates to 12,532 cohort members in the special Covid-19 surveys conducted with the participants of the 1958, 1970, 2000-01 British birth cohorts and Next Steps (born in 1989-90) in May 2020. Probit regression models were used to assess the chance of reporting increased stress amongst those who had experienced changes in living arrangements during the pandemic compared to those who had not.

Results

The results provide strong evidence that those individuals whose living arrangements changed during the Covid-19 pandemic have a higher likelihood of reported increased stress than those whose living arrangements remained unchanged. This was most clearly seen for older cohorts. Increased interpersonal conflict plays a role in mediating the association, especially for the younger cohort.

Conclusions

The findings confirm that during the first lockdown, changing living arrangements were negatively associated with individuals' mental wellbeing. As prolonged periods of stress can lead to serious health problems and policymakers need to be mindful that services may need to take these new, albeit for many temporary, forms of living arrangements into account.

The Effects of the COVID-19 Pandemic on the Lived Experience of Diverse Older Adults Living Alone With Cognitive Impairment

BACKGROUND AND OBJECTIVES

Even before the COVID-19 pandemic, older adults with cognitive impairment living alone (an estimated 4.3 million individuals in the United States) were at high risk for negative health outcomes. There is an urgent need to learn how this population is managing during the pandemic.

RESEARCH DESIGN AND METHODS

This is a qualitative study of 24 adults aged 55 and older living alone with cognitive impairment from diverse racial/ethnic backgrounds. Participants' lived experiences during the pandemic were elicited via 59 ethnographic interviews conducted over the phone either in English, Spanish, or Cantonese. Using a qualitative content analysis approach, interview transcripts were analyzed to identify codes and themes.

RESULTS

Qualitative analysis of transcripts revealed 5 themes: (a) fear generated by the pandemic, (b) distress stemming from feeling extremely isolated, (c) belief in misinformation, (d) strategies for coping during the pandemic, and (e) the importance of access to essential services.

DISCUSSION AND IMPLICATIONS

This pandemic put a spotlight on the precarity and unmet needs of older adults living alone with cognitive impairment. Findings underscore the need to expand access to home care aides and mental health services for this population.

Association of living arrangements with happiness attributes among older adults

Background

In Korea, along with the rapid aging of the population, older adults’ living arrangements have changed in various ways. In particularly, the happiness of older adults living alone warrants attention because they are more vulnerable to unhappiness than those living with families are. This study reports on the level of happiness among older adults in Korean and examines the potential mediating roles of depressive symptoms, present health status, socio-physical environment, social support networks, and social activities, and happiness in three different living arrangements, older adults living alone, with their spouse, or with their family.

Method

Data for this study were extracted from the secondary data from the 2017 Korean Community Health Survey, a non-experimental, cross-sectional survey conducted among Korean individuals that were aged 65 and above (n = 14,687). The chi-square test, one-way ANOVA, and Logistic regression were used to explore the related factors of happiness among the three groups.

Results

Findings revealed a significant difference in the happiness index among older adults living alone (6.22 ± 2.11), older adults living with their spouse (6.76 ± 1.99), and older adults living with their family (6.46 ± 1.94) (F = 88.69, p < .001). As the result of logistic regression, older adults living alone (odds ratio (OR) = 0.75, 95% confidence interval (CI) = 0.57–0.99) and those living with their family (OR = 0.80, 95% CI = 0.65–0.99) demonstrated greater happiness as the frequency of contact with their family increased. Older adults living with their spouse indicated an increase in happiness when their contact with friends was higher (OR = 0.69, 95% CI = 0.56–0.84).

Conclusion

It was recognized that factors influencing happiness differed according to older adults’ living arrangements, thus suggesting that older adults’ happiness could be facilitated through interventions that consider their circumstances, including living arrangements.

The burden of loneliness: Implications of the social determinants of health during COVID-19

This study sought to examine if mental health issues, namely depression and anxiety symptoms, and loneliness were experienced differently according to various demographic groups during the COVID-19 pandemic (i.e., a societal stressor). An online survey, comprising demographic questions and questionnaires on depression, anxiety and loneliness symptoms, was distributed in Canada during the height of social distancing restrictions during the COVID-19 pandemic. Respondents (N=661) from lower income households experienced greater anxiety, depression and loneliness. Specifically, loneliness was greater in those with an annual income <$50,000/yr versus higher income brackets. Younger females (18-29yr) displayed greater anxiety, depressive symptoms and loneliness than their male counterparts; this difference did not exist among the other age groups (30-64yr, >65yr). Moreover, loneliness scores increased with increasing depression and anxiety symptom severity category. The relationship between loneliness and depression symptoms was moderated by gender, such that females experienced higher depressive symptoms when encountering greater loneliness. These data identify younger females, individuals with lower income, and those living alone as experiencing greater loneliness and mental health challenges during the height of the pandemic in Canada. We highlight the strong relationship between loneliness, depression and anxiety, and emphasize increased vulnerability among certain cohorts.

The impact of different patterns of home- and community-based services on nursing home admission: National data from Taiwan

BACKGROUND

This study had two aims: (a) to identify the different patterns of use of home- and community-based services (HCBS) among older adults in Taiwan, and (b) to examine the effects of the different use patterns on HCBS recipients' use of institutional long-term care services.

METHODS

The study analyzed cohort data from Taiwan's first National 10-Year Long-Term Care Plan database and from National Health Insurance Claim Data. We extracted baseline information on older adults who were first evaluated for and prescribed HCBS from 2010 through 2013 (N = 71,260). We used latent class analysis to specify the underlying subgroups of recipients with similar patterns of HCBS use. We used hierarchical multinomial logistic regression to examine the effect of the different use patterns on the risk of institutional (e.g., nursing home) placement from 4 to 15 months after initial HCBS evaluation.

RESULTS

Four subgroups of HCBS recipients were identified, with patterns of home-based personal care (PC), home-based personal care and medical care (PC/MC), home-based medical care (MC), and community care services. Compared to the home-based PC/MC group, people in the home-based MC group had lower risk (OR = 0.54) and people in the community care group had higher risk (OR = 1.76) of admission to a nursing home.

CONCLUSIONS

Study findings may provide insights for policy makers regarding the usefulness of integrating medical care and other types of long-term care services into adult day care.

Use of Services by People Living Alone With Cognitive Impairment: A Systematic Review

BACKGROUND AND OBJECTIVES

Formal supports and social services are essential to people living alone with cognitive impairment (PLACI) because they are at risk of negative health outcomes and lack cohabitants who may support them with cognitively demanding tasks. To further our understanding of this critical and worldwide issue, we conducted a systematic review to understand whether, and how, PLACI access and use essential formal supports and services.

RESEARCH DESIGN AND METHODS

We searched 6 databases (PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Sociological Abstracts) to identify quantitative and mixed-method literature on formal service use among PLACI. The initial search was conducted in 2018 and updated in 2020.

RESULTS

We identified 32 studies published between 1992 and 2019, representing 13 countries, that met our criteria: 16 reported on health services and 26 on social services. Most studies compared PLACI with people with cognitive impairment living with others. Health service use was lower or similar among PLACI, as opposed to counterparts living with others. Most studies reported a higher use of social services (e.g., home services) among PLACI than those living with others. Overall use of essential home service among PLACI was higher in Europe than in the United States, a country where large portions of PLACI were reported receiving no formal services.

DISCUSSION AND IMPLICATIONS

We identified wide variability among countries and major gaps in service use. Results for use of health services were mixed, although our findings suggest that PLACI may have fewer physician visits than counterparts living with others. Our findings suggest that varying policies and budgets for these services among countries may have affected our findings. We encourage researchers to evaluate and compare the influence of social policies in the well-being of PLACI. We also encourage policy makers to prioritize the needs of PLACI in national dementia strategies.

Living alone, loneliness and lack of emotional support as predictors of suicide and self-harm: A nine-year follow up of the UK Biobank cohort

BACKGROUND

The association between loneliness and suicide is poorly understood. We investigated how living alone, loneliness and emotional support were related to suicide and self-harm in a longitudinal design.

METHODS

Between 2006 and 2010 UK Biobank recruited and assessed in detail over 0.5 million people in middle age. Data were linked to prospective hospital admission and mortality records. Adjusted Cox regression models were used to investigate relationships between living arrangements, loneliness and emotional support, and both suicide and self-harm as outcomes.

RESULTS

For men, both living alone (Hazard Ratio (HR) 2.16, 95%CI 1.51-3.09) and living with non-partners (HR 1.80, 95%CI 1.08-3.00) were associated with death by suicide, independently of loneliness, which had a modest relationship with suicide (HR 1.43, 95%CI 0.1.01-2.03). For women, there was no evidence that living arrangements, loneliness or emotional support were associated with death by suicide. Associations between living alone and self-harm were explained by health for women, and by health, loneliness and emotional support for men. In fully adjusted models, loneliness was associated with hospital admissions for self-harm in both women (HR 1.89, 95%CI 1.57-2.28) and men (HR 1.74, 95%CI 1.40-2.16).

LIMITATIONS

Loneliness and emotional support were operationalized using single item measures.

CONCLUSIONS

For men - but not for women - living alone or living with a non-partner increased the risk of suicide, a finding not explained by subjective loneliness. Overall, loneliness may be more important as a risk factor for self-harm than for suicide. Loneliness also appears to lessen the protective associations of cohabitation.

Living alone, social networks in neighbourhoods, and daily fruit and vegetable consumption among middle-aged and older adults in the USA

OBJECTIVE

A social network is a valuable resource in later life. Therefore, the current study aims to investigate whether social networks within homes and neighbourhoods are associated with older adults' daily fruit and vegetable consumption.

DESIGN

Cross-sectional secondary data analysis.

SETTING

USA.

PARTICIPANTS

A nationally representative sample of 6865 community-dwelling older adults over age 53 in the Health and Retirement Study - Health Care and Nutrition Survey.

RESULTS

Older adults who lived alone with no children or friends nearby had the lowest fruit and vegetable consumption. However, the daily fruit and vegetable consumption of respondents who lived alone and had children or friends nearby or those who lived with someone and had no children or friends nearby was not statistically different from those who lived with someone and had children or friends nearby. This suggests that having a social network either at home or in the neighbourhood complements the absence of living with someone or having children or friends nearby and attenuates the negative association between limited social networks and daily fruit and vegetable consumption. A greater decrease in the number of fruits and vegetables consumed was observed among men when they lived alone with no children or friends nearby.

CONCLUSIONS

Special attention should be given to older adults with limited social networks, especially older adults living alone with no children or friends nearby. Provision of help with grocery shopping and meal preparation as well as social support networks and more opportunities that can improve social engagement appear to be necessary.

Decomposition Analyses of the Trend in Poverty Among Older Adults: The Case of South Korea

OBJECTIVES

We examine the sharp increase in poverty among older adults since the mid-1990s in South Korea.

METHOD

We apply decomposition analyses to quantify the contributions of demographic and household characteristics, as well as income sources, to the rise in poverty among older adults.

RESULTS

A rapid increase in the number of older adults living independently, combined with an increase in the number of old older adults, largely explains the rising poverty rate among Korean older adults. At the same time, market incomes and private transfers are no longer dominant sources of income for older adults. Gradually rising public transfer incomes offset most of the decline in market and private transfer incomes. Public transfer could not counteract the formidable consequences of changing living arrangements and other changes related to a rapidly aging population.

DISCUSSION

The Korean experience shows what would have happened to older adults in rich welfare states if mature old-age income security programs had not been in place. It may also provide some lessons for lower-income countries where poverty among older adults is set to become a larger problem in the coming decades.

The influence of co-residential and non-co-residential living arrangements on sufficient fruit and vegetable consumption in the aging population in Thailand

Background

Living arrangements have an impact on a family’s health-related behaviors, especially its eating behaviors. However, studies that have examined the association between living arrangements and food intake, especially fruit and vegetable (FV) consumption of older adults, are rare. This study aimed to investigate the association between living arrangements and FV consumption in a population of older adults in Thailand from a national sample of households.

Methods

This study extracted data on 2048 persons age 60 years or older from a study of a nationally-representative sample of Thai households. The survey asked respondents about FV intake, living arrangements, household size, and socio-demographic characteristics. Binary logistic regression analysis was used to investigate the association between the variables and FV intake.

Results

The mean age of the respondents was 68.2 ± 6.5 years. Of the total sample, only 31.9% had sufficient FV intake. The group with the lowest possibility of sufficient FV intake was persons who lived alone. Those who lived with at least one child or lived in a skipped-generation household were 2.7 and 2.2 times as likely to have sufficient FV intake as those who lived alone (p < 0.001 and p < 0.01, respectively). Older adults living only with their spouse were 2.1 times as likely to have sufficient FV intake as those who lived alone. FV intake also differed significantly by socio-demographic characteristics (sex, place of residence, educational attainment, occupation and income), self-rated health, FV knowledge, and exposure to a FV promotion campaign in the community.

Conclusions

The findings from this study suggest that a different approach is required to improve FV consumption in the older population by taking into account their living arrangements, community context, level of FV knowledge, and socio-demographic characteristics. The older adults who live alone, as well as those living in a large household, are at particular risk of inadequate FV intake, and require special attention.

Immigrants: Assessing the Role of Living Arrangements and English Proficiency

OBJECTIVES

To identify diverse pathways to linguistic isolation (LI) and explain the differences in LI for older immigrants from different countries.

METHOD

A demographic decomposition of LI was applied to 18 largest origin subgroups of foreign-born, ages 65 and older, in the 2010-2014 American Community Survey data.

RESULTS

LI varied from 12% for older Indians to 68% for older Ukrainians. Decomposition analysis identified 3 components: (a) Limited English proficiency (LEP); (b) Solitary living; and (c) Limited English of co-resident others. The relative contribution of components differed by country of origin, pointing to different pathways to LI. Older Mexicans have the highest LEP, but moderate LI due to infrequent solitary living and the English proficiency of co-resident others. Many Chinese and Vietnamese older adults are LI because they live with other LEP adults. Older Europeans' common pathway to LI is solitary living.

DISCUSSION

Components of LI in ethnic communities can inform communication strategies for older LEP lacking access to critical information.

Moving beyond living arrangements: the role of family and friendship ties in promoting mental health for urban and rural older adults in China

Objective: This study examines the interplay among living arrangements, social networks, and depressive symptoms among Chinese older adults.Methods: Data are derived from the 2014 baseline survey of the China Longitudinal Aging Social Survey (CLASS), which provides a sample of older Chinese who had been married and had children (N = 7,662). This study examines the association between living arrangements and depressive symptoms (measured as CES-D scale, 0-18) of older adults, and addresses the moderating role of social networks (measured as family ties and friendship ties, 0-15) on this perceived association.Results: Our results show that older adults who live both with a spouse and adult children report superior mental health than those living alone (β = 1.240, p < 0.001), but no differences are seen from those living only with a spouse or children. Older adults living alone in rural areas are also more disadvantaged in comparison to those living alone in urban places (β = 0.535, p < 0.05). However, we find that the undesirable consequences associated with depression of older adults living alone can be reduced or even eliminated when older adults have strong friendship ties in rural China (β = -0.145, p < 0.01). We also find that for rural older adults living only with children, their mental health is highly contingent on their family ties, that is, they are extremely disadvantaged when having weak family ties, but benefit most significantly from strong family ties (β = -0.137, p < 0.05).Conclusions: Associations between living arrangements and mental health in later life are contingent on older adults' social networks, and these moderating effects vary between rural and urban China.

Factors associated with different numbers of health behaviors by living arrangements

BACKGROUND

As the number of individuals living alone increases, it becomes clear that health disparities vary according to a person's living arrangement. However, very few studies have investigated the characteristics of individuals who improve or maintain multiple healthy behaviors based on their living arrangements. This study aimed to explore the differing individual characteristics and multiple health behaviors in Korean adults living alone compared to those living with others and to identify the factors significantly associated with these behaviors.

METHODS

This study utilized a secondary analysis, using 2013-2015 Korea National Health and Nutrition Examination Survey data, with a cross-sectional and descriptive correlational design (N = 15,934). Multiple health behaviors, based on the comparison of past and present behaviors, included smoking, alcohol consumption, and weight control. The total number of health behaviors was calculated as the sum of each single health behavior. The different numbers of health behaviors were categorized into four levels: from 0, none of the three health behaviors to 3, all three health behaviors. Descriptive statistics and generalized ordinal logistic regression analysis were used.

RESULTS

People living alone engaged in fewer healthy behaviors (p <  0.05) and reported lower rates of maintenance of abstinence from smoking and weight control compared to those living with others, but they maintained a status of abstaining from alcohol consumption more than those living with others (p ≤ 0.001). In particular, higher self-rated health statuses (Adjusted Odds Ratio [aOR] = 2.03, 95% Confidence Interval [CI] = 1.04-3.97), being overweight (aOR = 1.46, 95% CI = 1.11-1.92), and having shorter sleep durations per day (aOR = 0.74, 95% CI = 0.55-0.99) were significantly associated with 0, 1 versus 2, 3 levels of healthy behaviors in those living alone.

CONCLUSIONS

Korean adults who lived alone had different factors associated with different combinations of multiple healthy behaviors compared to those living with others. Therefore, we need to manage healthy behaviors by considering associated factors for those living alone. Specifically, clinicians should consider the vulnerability of health behaviors in people living alone and provide customized approaches and multidimensional interventions based on their living arrangements.

Marital status, living arrangements, and mortality in middle and older age in Europe

OBJECTIVES

We study the role of marital status and living arrangements in mortality among a 50+ population living in Europe by gender and welfare states.

METHODS

Using data from waves 4, 5, and 6 of the Survey of Health Age and Retirement in Europe (n = 54,171), we implemented Cox proportional hazard models by gender and age groups (50-64 and 65-84). We estimated pooled models and separated models for two regions representing different welfare states (South-East and North-West).

RESULTS

Among people aged 50-64, nonpartnered individuals (except never-married women) showed a higher mortality risk as compared with those partnered. Among the older population (65-84), divorce was associated with higher mortality among men, but not among women, and living with someone other than a partner was associated with higher mortality risk as compared to those partnered. In the South-East region living with a partner at ages 50-64 was associated with lower mortality.

CONCLUSIONS

Partnership and residential status are complementary for understanding the role of family dimensions in mortality. The presence of a partner is mortality protective, especially among 50-64-year-old men in South-East Europe.