Associations and Impact Factors between Living Arrangements and Functional Disability among Older Chinese Adults

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.

The association of multimorbidity and disability in a community-based sample of elderly aged 80 or older in Shanghai, China

“…Living arrangement was associated with ADL/IADL disability in previous studies, this relationship also confirmed in this study [15]. Elderly people living alone appeared to have better functionality, and those living with other relatives/non-relatives have the highest risk of ADL/IADL disability.…”

“…Most of previous studies were conducted in high-income countries, but social demographic status has been found strongly associated with the prevalence of multimorbidity and disability, regardless of whether social demographic status is measured by age, race, or area-based deprivation [13, 15]. There is a lack of a better understanding of the relationship between multimorbidity and disability among Asian elderly populations, as Asian was more susceptive to ADL disability compared with other races [13].…”

Association between rural-to-urban migration and the cognitive aging trajectories of older Chinese adults: results from a prospective cohort analysis

“…From our data, older adults living with children at baseline reported lower cognitive function (mental status) at both baseline and follow up. Findings that living with children was associated with physical disabilities were reported in other studies [41][42][43]. This pattern may be attributed to the fact that older adults with physical or cognitive impairment tend to live with their children for support.…”

Risk factors of functional disability among community-dwelling elderly people by household in Japan: a prospective cohort study

“…In a cross-sectional analysis, Wang et al [37] found that living arrangements were significantly associated with activities of daily living. They also suggested that unmarried elderly people living only with their children had significantly greater disability than those in other living arrangements.…”