1 Health and Living Arrangement Transitions Among China’s Oldest-old Zachary Zimmer Population Council

2 Introduction Because of health problems, the oldest-old require high levels of support In China, support is often facilitated through coresidence So, household composition is particularly important for the oldest-old  This paper looks at household composition by comparing the living arrangement transitions of those in good versus poor health

3 Perspective  Coresidence may also be a practical decision given lack of alternative support structures  This suggests coresidence decisions are in part altruistic and in part rational.  Filial piety plays an important function in coresidence

4 Hypotheses 1)The oldest-old with health problems are most likely living with others 2) Moving in and remaining with others is a function of poor health 3) Relationships are stronger for those not married

5 Measuring Living Arrangement 1) Lives with children 2)Lives with others a 3a) Alone 3b) With spouse IF NO Those not married Those married 3)Lives independently a Spouse not included as ‘other’

6 Measuring Health 1.ADL functional limitation 1= yes 0=no 2. Health condition 1=yes 0=no 3. Mini-Mental State Exam (MMSE) Scored 0 to 19

7 Model Living Arrangement At Follow-Up Not married Alone With children With Others Married With spouse only With children With Others

8 Model Living Arrangement At Follow-Up Health ADL limitations Health conditions MMSE score Covariates Age, Sex, Education, Occupation, Marital status at origin Rural/Urban residence, number living children, has a son Not married Alone With children With Others Married With spouse only With children With Others

9 Model Living Arrangement At Follow-Up Health ADL limitations Health conditions MMSE score Covariates Age, Sex, Education, Occupation, Marital status at origin Rural/Urban residence, number living children, has a son Living arrangement at origin + Not married Alone With children With Others Married With spouse only With children With Others

10 Model Living Arrangement At Follow-Up Health ADL limitations Health conditions MMSE score Covariates Age, Sex, Education, Occupation, Marital status at origin Rural/Urban residence, number living children, has a son Living arrangement at origin + Not married Alone With children With Others Married With spouse only With children With Others Men Women

11 Alone Spouse only With children With others Living Arrangement Distributions at Origin and Follow-Up

12 Living Arrangement Distributions at Follow-up By Living Arrangement at Origin Living arrangement at origin At follow-up

13 Percent in Different Living Arrangement at Follow-up by Living Arrangement at Origin

14 Log Odds Ratios for Living Arrangement Transitions, Showing Health Effects by Marital Status b Those Not Married Health Indicator With children at follow-up a With others at follow-up a ADLs +.380**+.450* Health Conditions MMSE b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, marital status at origin and living arrangement at origin a Reference category is living with spouse only *** p <.01 ** p <.05 * p <.10

15 Log Odds Ratios for Living Arrangement Transitions, Showing Health Effects by Marital Status b Those Not MarriedThose Married Health Indicator With children at follow-up a With others at follow-up a With children at follow-up a With others at follow-up a ADLs +.380**+.450* * Health Conditions * MMSE b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, marital status at origin and living arrangement at origin a Reference category is living with spouse only *** p <.01 ** p <.05 * p <.10

16 Log-Odds for Men Versus Women Those not married With children a With others a ADL Limitations - Men - Women Health Conditions - Men - Women MMSE Scores - Men -Women

17 Log-Odds for Men Versus Women Those not marriedThose married With children a With others a With children a With others a ADL Limitations - Men - Women Health Conditions - Men - Women MMSE Scores - Men -Women

18 1. There is a fair degree of fluctuation in and out of living arrangements over a two-year period 2. Effects of health on living arrangements differ by gender For example: Married men with health problems are less likely to move in with others Married women with health problems are more likely to move in with others Summary

19 - Wives are expected to care for husbands - Older men are likely to be living with others even when their health is good - Men are likely to receive help from non-coresident family Some Possible Explanations