Cohort study on living arrangements of older men and women and risk for basic activities of daily living disability: findings from the AGES project

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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-017-0580-7) contains supplementary material, which is available to authorized users.

Social vulnerability underlying disability amongst older adults: A systematic review

“…Seventeen studies were considered of good quality, 42,47,53,57‐59,61,68,69,74,75,78,84,85,96,98,99 31 were fair quality, 15,37,38,40,41,44‐46,50,51,54,56,60,62‐67,72,76,77,79,81,83,86,88,91‐93,97 and 17 were poor quality 36,38,43,48,49,52,55,70,71,73,80,82,87,89,90,94,95 …”

“…In other studies, functional decline was assessed by means of access to public long‐term care services 37,41,60,63,64,67,68,71,81,87,88 . One study considered functional decline by means of years with active life 62 whilst in another study, a functional decline measurement was not described 59 (On‐line Appendix [Outcome Definition]).…”

“…Thirteen studies were performed in Japan: seven were part of the Aichi Gerontological Evaluation Study (AGES), 37,41,63,64,67,81,88 two were part of the Tokyo Metropolitan Institute of Gerontology Longitudinal Interdisciplinary Study on Aging (TMIG–LISA), 49,61 and the rest came from other studies 60,68,71,87 …”

“…The Japanese AGES study showed that being widowed, living in high‐income areas and higher social engagement positively mediated functional status, measured as access to public long‐term health care services 36,37,41,64,67,81,88,4363 …”

Combined Effect of Marriage and Education on Mortality: A Cross-national Study of Older Japanese and Finnish Men and Women

“…3,31,32 In addition, our findings showed a gender difference, with a stronger association between marriage and mortality in men than women in both countries. Other studies have found similar gender differences, 28 suggesting that husbands rely more on social support exchange with their wives, 33 who also take a larger role in controlling their husbands' health-related behaviors. 34 In particular, our additional analysis found a significantly higher risk in divorced men as compared to married men in both countries.…”