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Health and Living Arrangement TransitionsAmong China’s Oldest-old
Zachary ZimmerPopulation Council
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IntroductionOld age is often accompanied by chronic disease, functional difficulties,
and cognitive disorders
The oldest-old require high levels of support
Support is facilitated through coresidence
This makes household composition particularly important for the oldest-old
This paper examines living arrangements and transitions, comparing good versus poor health
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Perspective
Supporting the aged may also be a practical decision given lack of alternatives
This suggests altruism coupled with rational decision-making is behind living arrangements.
Filial piety plays an important function
“Whatever other insecurities they faced, most parents could rest secure in the knowledge that their children would place parental needs ahead of their own” (Whyte, 2003: p. 8).
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Hypotheses
1) The oldest-old with health problems are most likely living with others
2) Moving in and remaining with others is a function of poor health
3) Relationships are stronger for those not married
Testing requires the use of longitudinal data that can assess transitions in living arrangements.
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Measuring Living Arrangement
1) Lives with children
2) Lives with othersa
3a) Lives alone 3b) Lives with spouse
IF NO
IF NO
Those not married Those married
3) Lives independently
a Spouse not included as ‘other’
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Measuring Health
1. ADL functional limitation 1= yes 0=no
2. Health condition 1=yes 0=no
3. Mini-Mental State Exam (MMSE) Scored 0 to 19
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MODEL
Living Arrangement At Follow-Up
Not married AloneWith childrenWith Others
MarriedWith spouse onlyWith childrenWith Others
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MODEL
Living Arrangement At Follow-Up
HealthADL limitationsHealth conditionsMMSE score
CovariatesAge, Sex, Education, Occupation, Marital status at originRural/Urban residence, number living children, has a son
Not married AloneWith childrenWith Others
MarriedWith spouse onlyWith childrenWith Others
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MODEL
Living Arrangement At Follow-Up
HealthADL limitationsHealth conditionsMMSE score
CovariatesAge, Sex, Education, Occupation, Marital status at originRural/Urban residence, number living children, has a son
Not married AloneWith childrenWith Others
MarriedWith spouse onlyWith childrenWith Others
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MODEL
Living Arrangement At Follow-Up
HealthADL limitationsHealth conditionsMMSE score
CovariatesAge, Sex, Education, Occupation, Marital status at originRural/Urban residence, number living children, has a son
Living arrangement at origin
+
Not married AloneWith childrenWith Others
MarriedWith spouse onlyWith childrenWith Others
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MODEL
Living Arrangement At Follow-Up
HealthADL limitationsHealth conditionsMMSE score
CovariatesAge, Sex, Education, Occupation, Marital status at originRural/Urban residence, number living children, has a son
Living arrangement at origin
+
Not married AloneWith childrenWith Others
MarriedWith spouse onlyWith childrenWith Others
MenWomen
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0
20
40
60
80
100
Origin (1998) Follow-up (2000)
Perc
ent
Alone
Spouse only
With children
With others
Living Arrangement Distributions for Full Sample at Origin and Follow-Up
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0
20
40
60
80
100
Alone With spouse With children With others
Per
cent
With others
With Children
With spouse only
Alone at follow-up
Living Arrangement Distributions at Follow-up By Living Arrangement at Origin
Living arrangement at origin
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0 20 40 60 80 100
Total sample
Alone
With spouse
With children
With others
Liv
ing a
rrangem
ent at origin
Percent changing
Percent in Different Living Arrangement at Follow-up by Living Arrangement at Origin
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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Not Marriedb
Model 1 Model 2
THOSE NOT MARRIED With childrena
With othersa
With childrena
With othersa
Health
ADL Limitations .703*** .685***
Health Conditions .091 .202
MMSE Score .035** .012
Living Arrangement at Origin
- Alone
- With children
- With others
b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin
a Reference category is alone *** p < .01 ** p < .05 * p < .10
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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Not Marriedb
Model 1 Model 2
THOSE NOT MARRIED With childrena
With othersa
With childrena
With othersa
Health
ADL Limitations .703*** .685*** .380** .450*
Health Conditions .091 .202 -.026 .215
MMSE Score .035** .012 .009 -.013
Living Arrangement at Origin
- Alone
- With children
---
3.325***
---
1.606***
- With others 1.683*** 2.686***
b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin
a Reference category is alone *** p < .01 ** p < .05 * p < .10
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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Married
Model 1 Model 2
THOSE MARRIED With childrena
With othersa
With childrena
With othersa
Health
ADL Limitations -.477** -.886*
Health Conditions -.197 .371
MMSE Score .019 .028
Living Arrangement at Origin
- Alone
- With children
- With others
b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin
a Reference category is living with spouse only *** p < .01 ** p < .05 * p < .10
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Log Odds Ratios for Living Arrangements,Showing Health Effects for Those Marriedb
Model 1 Model 2
THOSE MARRIED With childrena
With othersa
With childrena
With othersa
Health
ADL Limitations -.477** -.886* -.316 -.955*
Health Conditions -.197 .371 -.203 .560*
MMSE Score .019 .028 .034 .024
Living Arrangement at Origin
- Alone
- With children
---
2.774***
---
1.580***
- With others .969*** 3.428***
b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin
a Reference category is living with spouse only *** p < .01 ** p < .05 * p < .10
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Effects of Health for Men Versus Women Among Those Not Married, Derived from Interaction Models
Model 1 Model 2
THOSE NOT MARRIED With childrena
With othersa
With childrena
With othersa
ADL Limitations
- Men
- Women
Health Conditions
- Men
- Women
MMSE Scores
- Men
-Women
-.167
+.985
---
---
+.006
+.042
-.547
+1.014
---
---
---
---
-.391
+.630
---
---
---
---
-.946
+.846
---
---
---
---
Note: Significant interactions only are shown
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Effects of Health for Men Versus Women Among Those Married, Derived from Interaction Models
Model 1 Model 2
THOSE MARRIED With childrena
With othersa
With childrena
With othersa
ADL Limitations
- Men
- Women
Health Conditions
- Men
- Women
MMSE Scores
- Men
-Women
---
---
-.303
+.122
-.002
+.076
---
---
-262
+2.955
-.030
+.195
-.741
+.608
-.406
+.229
+.007
+.106
-.782
-.975
-.049
+2.882
-.067
+.192
Note: Significant interactions only are shown
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There is some movement in and out of living arrangements over a two-year period
Changes in living arrangements respond to health
Effects are more likely in expected direction for those not married
ADL limitations are most strongly related to living arrangement outcomes
Summary
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Possible explanations:
- Wives are expected to care for husbands, but husbands are not expected to care for wives
- Older men are more likely to be living with others even when their health is good
- Men are more likely to receive help from non-coresident family
- May be important to consider the health of both spouses
Effects Differ By Gender
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Thank you for your attention
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Log Odds Ratios for Living Arrangements,Showing # Children Effects for Those Not Married
Model 1 Model 2
THOSE NOT MARRIED With childrena
With othersa
With childrena
With othersa
Number of children
One --- --- --- ---
Two .014 -.159 .347* .109
Three -.223 -.731*** .040 -.405
Four .129 -.155 .443** .156
Five or more -.178 -.933*** .202 -.515**
Note: Controls for health, age, sex, education, occupation, rural/urban residence, having a son, marital status at origin. Model 2 also controls for living arrangement at origin
a Reference category is alone
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Log Odds Ratios for Living Arrangements,Showing # Children Effects for Those Married
Model 1 Model 2
THOSE NOT MARRIED With childrena
With othersa
With childrena
With othersa
Number of children
One --- --- --- ---
Two -.015 -.359 -.141 -1.051*
Three -.701** -.364 -.370 -.910
Four -1.397*** -.764 -1.338*** -1.128**
Five or more -1.065*** -1.446*** -.769** -1.997***
Note: Controls for health, age, sex, education, occupation, rural/urban residence, having a son, marital status at origin. Model 2 also controls for living arrangement at origin
a Reference category is alone