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

2. 2 Introduction Old age is often accompanied by chronic disease, functional difficulties, and cognitive disorders The oldest-old require high levels of support Support is facilitated through coresidence This makes household composition particularly important for the oldest-old  This paper examines living arrangements and transitions, comparing good versus poor health

3. 3 Perspective  Supporting the aged may also be a practical decision given lack of alternatives  This suggests altruism coupled with rational decision- making is behind living arrangements.  Filial piety plays an important function “Whatever other insecurities they faced, most parents could rest secure in the knowledge that their children would place parental needs ahead of their own” (Whyte, 2003: p. 8).

4. 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 Testing requires the use of longitudinal data that can assess transitions in living arrangements.

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

6. 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. 7 MODEL Living Arrangement At Follow-Up Not married Alone With children With Others Married With spouse only With children With Others

8. 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. 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 Not married Alone With children With Others Married With spouse only With children With Others

10. 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

11. 11 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

12. 12 Alone Spouse only With children With others Living Arrangement Distributions for Full Sample at Origin and Follow-Up

13. 13 Living Arrangement Distributions at Follow-up By Living Arrangement at Origin Living arrangement at origin

14. 14 Percent in Different Living Arrangement at Follow-up by Living Arrangement at Origin

15. 15 Log Odds Ratios for Living Arrangements, Showing Health Effects for Those Not Married b Model 1Model 2 THOSE NOT MARRIED With children a With others a With children a With others a Health ADL Limitations.703***.685*** Health Conditions.091.202 MMSE Score.035**.012 Living Arrangement at Origin - Alone - With children - With others b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin a Reference category is alone *** p <.01 ** p <.05 * p <.10

16. 16 Log Odds Ratios for Living Arrangements, Showing Health Effects for Those Not Married b Model 1Model 2 THOSE NOT MARRIED With children a With others a With children a With others a Health ADL Limitations.703***.685***.380**.450* Health Conditions.091.202-.026.215 MMSE Score.035**.012.009-.013 Living Arrangement at Origin - Alone - With children --- 3.325*** --- 1.606*** - With others1.683***2.686*** b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin a Reference category is alone *** p <.01 ** p <.05 * p <.10

17. 17 Log Odds Ratios for Living Arrangements, Showing Health Effects for Those Married Model 1Model 2 THOSE MARRIED With children a With others a With children a With others a Health ADL Limitations-.477**-.886* Health Conditions-.197.371 MMSE Score.019.028 Living Arrangement at Origin - Alone - With children - With others b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin a Reference category is living with spouse only *** p <.01 ** p <.05 * p <.10

18. 18 Log Odds Ratios for Living Arrangements, Showing Health Effects for Those Married b Model 1Model 2 THOSE MARRIED With children a With others a With children a With others a Health ADL Limitations-.477**-.886*-.316-.955* Health Conditions-.197.371-.203.560* MMSE Score.019.028.034.024 Living Arrangement at Origin - Alone - With children --- 2.774*** --- 1.580*** - With others.969***3.428*** b Controls for age, sex, education, occupation, rural/urban residence, number of children, having a son, and marital status at origin a Reference category is living with spouse only *** p <.01 ** p <.05 * p <.10

19. 19 Effects of Health for Men Versus Women Among Those Not Married, Derived from Interaction Models Model 1Model 2 THOSE NOT 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 -.167 +.985 --- +.006 +.042 -.547 +1.014 --- -.391 +.630 --- -.946 +.846 --- Note: Significant interactions only are shown

20. 20 Effects of Health for Men Versus Women Among Those Married, Derived from Interaction Models Model 1Model 2 THOSE 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 --- -.303 +.122 -.002 +.076 --- -262 +2.955 -.030 +.195 -.741 +.608 -.406 +.229 +.007 +.106 -.782 -.975 -.049 +2.882 -.067 +.192 Note: Significant interactions only are shown

21. 21 There is some movement in and out of living arrangements over a two-year period Changes in living arrangements respond to health Effects are more likely in expected direction for those not married ADL limitations are most strongly related to living arrangement outcomes Summary

22. 22 Possible explanations: - Wives are expected to care for husbands, but husbands are not expected to care for wives - Older men are more likely to be living with others even when their health is good - Men are more likely to receive help from non-coresident family - May be important to consider the health of both spouses Effects Differ By Gender

23. 23 Thank you for your attention

24. 24 Log Odds Ratios for Living Arrangements, Showing # Children Effects for Those Not Married Model 1Model 2 THOSE NOT MARRIED With children a With others a With children a With others a Number of children One--- Two.014-.159.347*.109 Three-.223-.731***.040-.405 Four.129-.155.443**.156 Five or more-.178-.933***.202-.515** Note: Controls for health, age, sex, education, occupation, rural/urban residence, having a son, marital status at origin. Model 2 also controls for living arrangement at origin a Reference category is alone

25. 25 Log Odds Ratios for Living Arrangements, Showing # Children Effects for Those Married Model 1Model 2 THOSE NOT MARRIED With children a With others a With children a With others a Number of children One--- Two-.015-.359-.141-1.051* Three-.701**-.364-.370-.910 Four-1.397***-.764-1.338***-1.128** Five or more-1.065***-1.446***-.769**-1.997*** Note: Controls for health, age, sex, education, occupation, rural/urban residence, having a son, marital status at origin. Model 2 also controls for living arrangement at origin a Reference category is alone