Health and Living Arrangement Transitions Among China’s Oldest-old

Health and Living Arrangement TransitionsAmong China’s Oldest-old Zachary Zimmer Population Council

Introduction Old 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

Perspective • 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). • 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.

Hypotheses 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.

Measuring Living Arrangement • Lives with children IF NO 2) Lives with othersa IF NO 3) Lives independently Those married Those not married 3b) Lives with spouse 3a) Lives alone a Spouse not included as ‘other’

Measuring Health ADL functional limitation 1= yes 0=no 2. Health condition 1=yes 0=no 3. Mini-Mental State Exam (MMSE) Scored 0 to 19

MODEL Living Arrangement At Follow-Up Married With spouse only With children With Others Not married Alone With children With Others

MODEL Health ADL limitations Health conditions MMSE score Living Arrangement At Follow-Up Covariates Age, Sex, Education, Occupation, Marital status at origin Rural/Urban residence, number living children, has a son Married With spouse only With children With Others Not married Alone With children With Others

MODEL Health ADL limitations Health conditions MMSE score Living Arrangement At Follow-Up Covariates Age, Sex, Education, Occupation, Marital status at origin Rural/Urban residence, number living children, has a son Married With spouse only With children With Others Not married Alone With children With Others + Living arrangement at origin

MODEL Health ADL limitations Health conditions MMSE score Women Men Living Arrangement At Follow-Up Covariates Age, Sex, Education, Occupation, Marital status at origin Rural/Urban residence, number living children, has a son Married With spouse only With children With Others Not married Alone With children With Others + Living arrangement at origin

Living Arrangement Distributions for Full Sample at Origin and Follow-Up With others With children Spouse only Alone

Living Arrangement Distributions at Follow-up By Living Arrangement at Origin Living arrangement at origin

Percent in Different Living Arrangement at Follow-up by Living Arrangement at Origin

Log Odds Ratios for Living Arrangements, Showing Health Effects for Those Not Marriedb *** p < .01 ** p < .05 * p < .10 a Reference category is alone b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin

Log Odds Ratios for Living Arrangements, Showing Health Effects for Those Married *** p < .01 ** p < .05 * p < .10 a Reference category is living with spouse only b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin

Log Odds Ratios for Living Arrangements, Showing Health Effects for Those Marriedb *** p < .01 ** p < .05 * p < .10 a Reference category is living with spouse only b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin

Effects of Health for Men Versus Women Among Those Not Married, Derived from Interaction Models Note: Significant interactions only are shown

Effects of Health for Men Versus Women Among Those Married, Derived from Interaction Models Note: Significant interactions only are shown

Summary 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

Effects Differ By Gender 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

Thank you for your attention

Log Odds Ratios for Living Arrangements, Showing # Children Effects for Those Not Married a Reference category is alone 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

Log Odds Ratios for Living Arrangements, Showing # Children Effects for Those Married a Reference category is alone 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

Health and Living Arrangement Transitions Among China’s Oldest-old