Changes in living arrangements and mortality among older people in China

Abstract

Living arrangements in later life are dynamic, with changes associated with life events such as widowhood or moves into an institution. Previous research has found particular changes in living arrangements to be associated with an elevated risk of mortality. However, research in this area within the context of China is limited, despite China being home to the world's largest population of older people. This study investigates the impact of changes in living arrangements on older persons’ survival using the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2011. The original sample was 16,064 in 2002, and this study includes 6191 individuals who survived in 2005 and had complete information of track record in later waves. Changes in living arrangements are examined between 2002 and 2005. Cox-proportional hazards models are then used to investigate the association between the dynamics of living arrangements and respondents’ survival status from 2005 to 2011 . Results show that men and women who lived in an institution in both 2002 and 2005, or who moved into an institution from living with family faced a greater risk of dying compared to those continuing to live with family. By contrast, continuing to live with family or alone, or moving between living with family and living alone, were not associated with an increased mortality risk, although there were some differences by gender. The institutional care sector in China is still in its infancy, with provision based on ability to pay market fees rather than need associated with age-related function impairment. The findings show that living in, or moving into, an institution is associated with a high mortality risk therefore requires further investigation in the context of a rapidly changing Chinese society.

Trends in living arrangements and their impact on the mortality of older adults: Belgium 1991‒2012

“…The mechanisms by which mortality risks are associated with LA in old age are still not well known, and the findings contain some contradictions. This is partly because it is difficult to identify causal links between LA and mortality risk, as LAs in old age are quite dynamic (Feng et al 2017). For example, the presence of the spouse or partner, who is the closest and most available caregiver, supports survival and reduces the need for formal care, such as entry into a nursing home (Chappell 1991;Antonucci and Ajrouch 2007;Freedman, Cornman, and Carr 2014).…”

Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China—Evidence from Shaanxi province

“…An increasing number of cross-sectional studies and a few longitudinal studies conducted in China have indicated that living arrangements have an effect on mortality [ 18 , 13 ], functional disability [ 19 ], cognitive impairment [ 20 ], psychological health [ 21 – 23 ], and self-rated health [ 24 ] of the old-age adults. Health-Related Quality of Life ( HRQOL), which was defined as an individual’s or a group's perceived physical and mental health over time by the Center for Disease Control and Prevention (CDC) recently[ 25 ], has also been investigated as an important overall health outcome for the elderly with different living arrangements [ 24 , 26 ].…”

The effects of social support, social networks, and functional ability on life satisfaction among oldest old adults

“…Additionally, as Bromell and Cagney (2014) stated, living environments may provide varied opportunities for social integration, companionship, and engagement with others. Within the current study, living in a private home was related to better social sup port, which indicates that people living at home may have close family or friends nearby to maintain close connections, which is consistent with past studies (Ashida & Heaney, 2008;Feng et al, 2017). Ewen et al…”

“…Connidis and Davies (1992) posited that spouses and friends act as the primary companionships for older adults, and Bromell and Cagney (2014) identified the importance of receiving that companionship tied to the specific living arrangement in an older adult's life. Feng, Falkingham, Liu, and Vlachantoni (2017) underlined the importance of receiving social support in varying living environments for older adults. Ashida and Heaney (2008) (Ewen, Washington, Emerson, Carswell, & Smith;Paganini-Hill, 2013;Sarwari, Fredman, Langenberg, & Magaziner, 1998).…”