1. Which socio-demographic living arrangement helps to reach 100? Michel POULAIN & Anne HERM Orlando 8 January 2014

2. Question addressed Which living arrangement trajectories are associated with longer life span? More specifically we would like to investigate if centenarians experienced different living arrangement trajectories and if it differs for men and women.

3. Three complementary investigations  Classical Life Table by single living arrangement  Multistate Life Table involving different living arrangements  Special investigation of living arrangements of a representative sample of centenarians

4. Data sets used (1)  More than 3 millions persons born before 1941 are followed on a continuous way through the population registration system from 1.1.1991 to 31.12.2009.  All demographic events are recorded with exact data of occurrence and the living arrangements are observed on 1 st January of each year. In total more than 1.3 million deaths are considered and more than 6 millions changes of living arrangements.

5. Data sets used (2)  The second database includes a random sample of 2.806 centenarians observed in Belgium and born during the years 1893-1902.  For each of them the living arrangements are observed from 60 years up to death.  This sample includes 606 male centenarians selected randomly in a total of 844 (71.8%) and 2,198 females centenarians in a total of 4,818 (45.6 %).

6. Definition of living arrangements ‘Living arrangement’ is an individual characteristic that describes with whom a person lives and what are the relationships of that person to all the other people with whom he/she lives. A combined variable derived from the three variables :  marital status,  household type and  the relationship of the person with other members of the household.

7. First investigation: life table by living arrangements The following types of living arrangements are compared:  Living with spouse versus living without spouse  Living alone versus living with others in a private household  Living with others in a private household versus living in a collective household

8. S urvival curve (left) and the mortality risk (right) above age 60 by gender Living with spouse versus living without spouse

9. S urvival curve (left) and the mortality risk (right) above age 60 by gender Living alone versus living with others in a private household

10. S urvival curve (left) and the mortality risk (right) above age 60 by gender Living in private household versus living in collective household

11. Second investigation: Multistate Life Table Never married persons living alone at age 60 who could later possibly live with others in a private household or in a collective household and die in one of these three living arrangements (64 percent of those who were never married). Ever married living in married couple at age 60 who could thereafter possibly be widowed living alone, then living with others in a private household or in a collective household and die in one of these four living arrangements (90 percent of married persons).

12. Living arrangement trajectories for never married persons at 60

13. Living arrangement trajectories for ever married persons living with spouse at 60

14. Third investigation: Living arrangements of centenarians  It considers longitudinal data on a representative sample of centenarians followed from age 60 till death.  Some aspects of their living arrangement trajectory will be compared with the ones of the same birth cohorts in the total population observed in past censuses in 1961, 1970, 1981 and 1991.

15. Lexis diagram Survival rates from censuses to 100 years

16. Survival rates between censuses and the 100th birthday for men Census dates Age range at census Never married MarriedWidowedDivorcedTotal 196158-67 years8.720.513.83.418.8 197067-76 years14.031.824.64.928.7 198178-87 years39.888.273.116.678.1 1991 88-97 years 290.7551.9580.6129.4548.7

17. Survival rates for men and women living with or without spouse at different censuses till their 100 th birthday.

18. Survival rates for men and women living alone or with others at different censuses till their 100 th birthday.

19. Survival rates for men and women living with others in private or collective household at different censuses till their 100 th birthday.

20. Discussion (1)  Our contribution shows that living arrangements is an important factor to consider when analyzing the survival among the oldest olds. It confirms that beside the impact of marital status the living arrangements is also associated with differences in mortality risks by age and gender among the elderly as stated by Lund et al. (2002) and Staehelin et al. (2012).

21. Discussion (2)  Confirming previous studies our results demonstrate the role of marital status for survival of the elderly. Nevertheless for a given marital status the distinction by living arrangements brings large variations in the survival. A distinction should be made between those living alone, living with others or living in collective household.

22. Discussion (3)  The advantage from living with spouse confirms the protective role of marriage. However that positive association diminishes with age.  Globally, from age 70 till 100 years, the survival rate of ever married men is higher compared to the one of never married men, but it is lower for ever married compared to never married women.

23. Discussion (4)  When comparing the survival of those living alone with those living with others in a private household we found that living alone is unfavorable in relatively younger ages, up to 72 years for women and 83 years for men. Globally, we found that a bigger proportion of men and women living alone at the time of censuses than those living with others became centenarians, especially women.

24. Discussion (5)  For both men and women living in collective household is largely unfavorable for survival compared to living with others in private household, particularly for men in younger ages. These results confirm previous findings where over-mortality in collective household was demonstrated (Grundy 2010), even if the mortality risk was controlled by health status (Herm et al. in press).

25. Why living arrangements are associated with varying levels of mortality risk in old ages? If the person in need of care is living in a married couple the first caregiver will be the spouse (Chappell 1991). For a widowed person living alone the potential caregivers are the children or other close relatives. Such situation may result in change of living arrangements from living alone to living with children or living with others. If nobody can provide such care in private living arrangements, the only option is institutionalization.

26. How to explain the age and gender variation of the association between living arrangements and mortality risks? (1) As far as the gender is concerned, we have to consider the difference in life expectancy between men and women and more specifically of that of healthy life expectancy, as health is a key factor for the change in living arrangements.

27. How to explain the age and gender variation of the association between living arrangements and mortality risks? (2) For ever-married persons two other aspects, age difference between spouses and the shock of widowhood, have to be considered. Tentatively we may divide the life span of ever married men and women in oldest ages in three phases.

28. The life span of ever married men and women  A first period where both are relatively healthy and benefit from being married due to psychological reasons and positive aspect of the mutual support.  The second period would be when (more often) the husband becomes dependent while his wife is still healthy and takes care of him as first caregiver.  The third period follows the death of the spouse. The very late widowhood observed among male centenarians could be an important factor explaining their extreme survival.

29. The living arrangement trajectory is as important as the marital history to live longer and to reach 100. Considering that the choice of living arrangements is related to health, availability of spouse or children as potential caregiver and socio- economic living conditions, all aspects being closely concerned by social policies, the new evidences presented here are useful for the debate of the future needs for the elderly within the context of population aging. 

30. Thanks for your attention