Abstract
ObjectivesLiving arrangement has been reported to have a significant influence on feelings of loneliness in older adults, but their living preferences may confound the association. This study aimed to investigate whether the associations of living arrangements with loneliness differ in community-dwelling older adults according to different living preferences.MethodsIn the 2008/2009 (baseline) and 2011/2012 (follow-up) waves of the Chinese Longitudinal Healthy Longevity Survey, living arrangements [living with children mainly (LWC), living with spouse only (LWS), and living alone (LA)], living preferences [preferring living with children (PreLWC) and preferring living alone/only with spouse (PreLA)], and feelings of loneliness were assessed. The effect modifications of living preferences in the associations of living arrangements with loneliness were estimated using logistic regression models, and corresponding odds ratios (ORs) were calculated.ResultsLiving preferences significantly modified the associations of living arrangements with loneliness at baseline (p for interaction = 0.009 for LWS and = 0.015 for LA). Compared with LWC, LWS was protective for loneliness only in the PreLA older adults at baseline (OR = 0.53, 95% CI = 0.45–0.64, p < 0.001), and LA was significantly associated with loneliness especially in the PreLWC older adults, compared with their PreLA counterparts (at baseline, ORs = 2.89 vs. 2.15; at follow-up, ORs = 1.68 vs. 1.51).ConclusionLiving preference modifies the associations of living arrangements with loneliness, and those who prefer living with children but live alone are more likely to feel lonely. It is recommended that living preferences should be considered when managing loneliness in community-dwelling older adults.
Highlights
As filial piety of the Confucius culture prevails in China, coresidence is valued as the most desirable living arrangement for community-dwelling older adults [1]
Socioeconomic, physical, and cognitive factors related to living arrangements and living preferences, assessed the associations of living arrangements with loneliness, and determined whether living preference modifies these associations among community-dwelling older adults aged 65 years or above in China
LWC, living with children mainly; living with spouse only (LWS), live with spouse only; LA, living alone; PreLWC, preferring living with children; PreLA, preferring living alone/only with spouse. aMeasure of effect modification on multiplicative scale: LWS: odds ratios (ORs) = 0.68 (0.50–0.91), P = 0.009; LA: OR = 0.71 (0.54–0.94), P = 0.015
Summary
As filial piety of the Confucius culture prevails in China, coresidence is valued as the most desirable living arrangement for community-dwelling older adults [1]. With the development of our society and increasing preferences for individual privacy and independence, recognition of older adults on living alone, another kind of living arrangement, is changing. Living alone in older adults could be an initiative choice for socioeconomic advantaged older adults with younger age and better health status, who prefer a lifestyle of more freedom and privacy [2], or an involuntary choice for older adults who suffer from certain socioeconomic disadvantages (such as, being childless or in poverty) and need to live alone [3]. Previous studies have demonstrated that loneliness increased the risk of developing dementia among older adults especially in men [8], and was associated with mental disorders, such as depression, physical decline, and increased risk of death [9, 10]
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