Which Aspects of Elderly Living Conditions are Important to Predict Mortality? The Complex Role of Family Ties at Home and in Institutions

Abstract

Besides health and socio-economic status, the social relationships maintained during elderly play an important role in shaping the living conditions at older ages. In this part of life, the family represents the major framework in which interpersonal relationships are experienced. With population ageing, the family increasingly ensures elderly care, especially where targeted public policies are lacking, and its protective effect on survival is foreseen. In this paper we investigate the complex role of family in mortality and contribute to the debate on the ideal living condition for elderly people, exploiting a nationwide integrated survey on private and collective households in France. Following a cohort of 16,263 individuals aged 55, we investigate the effect of family relations on survival. We question whether the lack of family care connected with the absence of active relationships with family members may be at least partly compensated by institutional settings. Estimates of life expectancy show that at the age of 60, people living in institutions live on average 10 years less that those living in private households, the gap decreasing with age. Cox proportional hazards models show a protective role of children on mortality. Having no children seems to be associated with a lower risk of death, but the effect is significant only for those declaring rare or no contacts with their children. Survival analysis also suggests that institutional living arrangement may be protective for the most fragile individuals, namely the severely disabled, isolated persons.

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

“…Survival at adult and later ages is positively influenced by the quantity and the quality of both social relationships and support (Holt-Lunstad et al 2010 ; Shor et al 2013 ). Among the extended social net, family members, particularly partners and children, play a crucial role in this association (Giudici et al 2019 ; Modig et al 2017 ). Differential mortality by marital status has largely been investigated and has shown the benefits of being married.…”

Enhancing active ageing in later life: Can community networks enhance elderly health behaviours? Insights from a bracketing qualitative method

“…Previous studies on elderly living arrangements found that they increase health practice and behaviour changes daily in living activities (Wei et al, 2022). Similarly, as Ethisan et al (2017) and Giudici et al (2019) demonstrated, the elderly tend to seek the most appropriate living conditions, and in turn, exhibit behaviour in ways that show an increase in elderly health outcomes.…”

“…This finding is consistent with Simpson et al (2022), who found a connection between the elderly and community health based on strong ties, access to healthcare, and health communication. Giudici, Polettini, de Rose, and Brouard (2019) noted that strong network ties are necessary for accessing health information and living arrangements. This result is consistent with previous studies (Turnera et al, 2019; Whittaker & Gillespie, 2013), and our study demonstrated that strong network ties are more likely to enhance elderly health behaviours.…”

“…It was noted that the strength of living arrangements, living with family, receiving caregiver support, and engaging with public health volunteers are vital in enhancing health behaviours. Community health can directly support daily living activities (physical, mental, and psychosocial health) (Daovisan & Mamom, 2022; Ehsan, Sommet, Morselli, & Spini, 2021; Giudici et al, 2019). More effective responses are needed to enhance self‐rated health (health checks, self‐assessments, and health reports), which increases elderly health behaviours with active ageing in later life.…”

Nursing homes and mortality in Europe: Uncertain causality

“…There is relatively limited research on the specific issue of the role of the institutionalization on potential excess mortality. Based on longitudinal French data on people aged 60 and more, Giudici et al (2019) have estimated that people living in institutions live on average 10 years less that those living in private households. However, they did not take into account the potential issue of endogeneity, as people in nursing home differ from people staying at home.…”