Perceived availability of future care and depressive symptoms among older adults in China: evidence from CHARLS

Abstract

Background: Major concerns have arisen about the challenges facing China in providing sufficient care to its older population in light of rapid population ageing, changing family structure, and considerable rates of internal migration. At the family level, these societal changes may produce care uncertainty which may adversely influence the psychological wellbeing of older individuals. This paper applies social support and control theories to examine the relationship between perceived availability of future care and psychological wellbeing of older adults in China, and how this relationship is moderated by economic insufficiency, health vulnerability, and urban/rural context. Methods: Analyses are based on data from the China Health and Retirement Longitudinal Study, a multi-panel nationally representative household survey of the Chinese population aged 45 years and older. Data are taken from 2013 and 2011 waves of the study, with an initial sample size around 17,000, in which around 11,000-14,000 respondents are used for our final regression model. The score of depressive symptoms was measured in both waves with the Center for Epidemiologic Studies Depression Scale (CES-D10), and perceived availability of future care was measured in 2013 by asking respondents the question "Suppose that in the future, you need help with basic daily activities like eating or dressing, do you have relatives or friends (besides your spouse/partner) who would be willing and able to help you over a long period of time (yes/no)?" Results: Multivariate regression analysis revealed that uncertainty regarding future care support was associated with greater depressive symptoms even after controlling for factors confounded with care uncertainty such as family structure, socio-economic status, and a lagged measure of depression. Further, older adults without an anticipated source of care faced double jeopardy in their depressive symptoms if they also experienced functional limitations. Conclusions: Considering rapid aging of the Chinese population, anticipated increases in chronic disease burden, and possible attenuation of filial care, this analysis suggests that older adults in China may increasingly face health and social conditions detrimental to their mental health. Polices that remedy these concerns should be discussed, developed and implemented.

Depressive Symptoms and ADL/IADL Disabilities Among Older Adults from Low-Income Families in Dalian, Liaoning

“…Scarce family emotional support can be an important reason for the poor mental health of elderly people, especially for Chinese older adults who place great emphasis on traditional family values and family ties formed by mutual attachment. 50 This finding also corresponds to prior studies indicating that good family relations moderate the impact of stressful events on health and motivate elderly individuals to engage in more health promotion behaviors, subsequently reducing the risk of depressive symptoms. 51 , 52 …”

Hypothetical Interventions for Falls Among Older Adults: An Application of the Parametric G-Formula

“…Data were taken from the CHARLS, which targeted middle-aged and older populations aged 45 years and older, selected through a multistage probability proportional to size sampling. The first baseline survey carried out in 2011 involved 17,705 respondents, covering 150 county-level units and 450 village-level units from 28 provinces ( 16 ). It was a longitudinal study, and performed every 2 years for a total of three waves from 2011 to 2015.…”

Future expectations of receiving care and all‐cause mortality among older adults in Korea

“…• The link between future care expectations and mortality risk is more pronounced among women. family members rather than from paid caregivers (Gondodiputro et al, 2019;Silverstein et al, 2020). Among family caregivers, we further differentiate between spouses, sons and daughters to investigate whether who individuals expect care from matters.…”

“…Older adults may engage in unhealthy behaviours such as smoking and binge drinking as a coping mechanism to reduce stress and anxiety associated with lack of an expected care provider. These unhealthy behavioural responses to low expectations for support and care in the future may increase mortality risk (Silverstein et al., 2020). Based on these arguments, future care expectations are likely an important but understudied predictor of health and mortality among older adults.…”

“…In doing so, we distinguish between formal and informal family caregivers. Expectations that a family member will provide care/assistance in the future may have a stronger impact on health because older adults often prefer to receive care from family members rather than from paid caregivers (Gondodiputro et al., 2019; Silverstein et al., 2020). Among family caregivers, we further differentiate between spouses, sons and daughters to investigate whether who individuals expect care from matters.…”