Abstract
ObjectivesTo examine the association of living arrangements with functional disability among older persons and explore the mediation of impact factors on the relationship.DesignCross-sectional analysis using data from Healthy Aging study in Zhejiang Province.ParticipantsAnalyzed sample was drawn from a representative rural population of older persons in Wuyi County, Zhejiang Province, including 1542 participants aged 60 and over in the second wave of the study.MeasurementsLiving arrangements, background, functional disability, self-rated health, number of diseases, along with contemporaneous circumstances including income, social support (physical assistance and emotional support). Instrument was Activities of Daily Living (ADL) scale, including Basic Activities Daily Living (BADL) and Instrumental Activities of Daily Living (IADL).ResultsLiving arrangements were significantly associated with BADL, IADL and ADL disability. Married persons living with or without children were more advantaged on all three dimensions of functional disability. Unmarried older adults living with children only had the worst functional status, even after controlling for background, social support, income and health status variables (compared with the unmarried living alone, ß for BADL: −1.262, ß for IADL: −2.112, ß for ADL: −3.388; compared with the married living with children only, ß for BADL: −1.166, ß for IADL: −2.723, ß for ADL: −3.902). In addition, older adults without difficulty in receiving emotional support, in excellent health and with advanced age had significantly better BADL, IADL and ADL function. However, a statistically significant association between physical assistance and functional disability was not found.ConclusionFunctional disabilities vary by living arrangements with different patterns and other factors. Our results highlight the association of unmarried elders living with children only and functioning decline comparing with other types. Our study implies policy makers should pay closer attention to unmarried elders living with children in community. Community service especially emotional support such as psychological counseling is important social support and should be improved.
Highlights
Living arrangements are defined by household composition or the number and identity of the cohabitants
Unmarried older adults living with children only had the worst functional status, even after controlling for background, social support, income and health status variables
Fewer older adults living with spouse and children (37.8%) than unmarried persons living with children only (67.3%) perceived their health as fair or poor, and 82.9% of married persons living with children only had no chronic diseases compared to 50.0% of unmarried persons living with children only
Summary
Living arrangements are defined by household composition or the number and identity of the cohabitants. Living arrangement concordance based on the family household is closely connected with cohabitation status, living with/without a partner and marital status. Many studies separately use cohabitation status and marital status as predictors in the analyses of the association between living arrangements and health outcomes, but at present, findings are conflicting [13,14,15,16,17,18,19,20]. We argue that households with different structures for the number and identity of members make very different demands on the older adults in them and offer very different resources. Following our theoretical emphasis on the qualitative differences in resources and demands among households of different structures, we compared health among persons living in different types of households in various combinations of cohabitation and marital status
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