Abstract
BackgroundLiving arrangements of older adults have changed worldwide with increasing solitary and non-spouse households, which could affect social care systems. However, the relationship between these households and disability onset has remained unclear. We examined the relationship between living arrangements and the onset of basic activities of daily living disability in older adults, with a focus on gender differences and cohabitation status of those without a spouse.MethodsData from 6600 men and 6868 women aged 65 years or older without disability were obtained from the Aichi Gerontological Evaluation Study Project in Japan. Onset of disability was followed for 9.4 years. Disability was assessed based on Long-term Care Insurance System registration. A hierarchical Cox proportional hazards model was conducted to examine the risk of living alone and living only with non-spousal cohabitants compared to those living with spouses.ResultsMen living only with non-spousal cohabitants and those living alone were significantly more likely to develop disability after controlling for health and other covariates (hazard ratio = 1.38 and 1.45, respectively), while a significant difference was found only for women living alone (hazard ratio = 1.19). The risk of living with non-spousal cohabitants was marginally stronger in men, indicated by the interaction effect model (p = .08). A series of hierarchical analyses showed that social support exchange explained 24.4% and 15.8% of the excess risk of disability onset in men living alone and those living only with non-spousal cohabitants, respectively. A subsequent analysis also showed that support provision by older adults more greatly explained such excess risk than receiving support from others.ConclusionsOlder men without spouses were more likely to develop disability onset regardless of cohabitants. Health professionals should consider programs that enhance social support exchange, particularly support provision by older adults who are at risk of disability.
Highlights
Living arrangements of older adults have changed worldwide with increasing solitary and non-spouse households, which could affect social care systems
A self-administered questionnaire survey was conducted in October 2003 with 33,152 people aged 65 years or older who were not eligible to utilize Longterm Care Insurance (LTCI) system services and who were selected through simple randomization (6 municipalities) or complete enumeration (4 small-scale municipalities) in Aichi Prefecture, Central Japan
Under the premise of a relatively low rate of needs-driven cohabitation, this study showed a relationship between living arrangements and Basic activities of daily living (BADL) disability onset, taking into consideration gender differences and cohabitation status of those living without a spouse
Summary
Living arrangements of older adults have changed worldwide with increasing solitary and non-spouse households, which could affect social care systems. We examined the relationship between living arrangements and the onset of basic activities of daily living disability in older adults, with a focus on gender differences and cohabitation status of those without a spouse. The proportion of older adults living alone is increasing worldwide [5], which could affect care provision by the community [6] and necessitates more detailed focus on their health problems and needs. In the United States, about one third of baby boomers were unmarried [7] Such changes in living arrangements imply the growing importance of examining the role of non-spousal networks in older adults’ health
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