Social Support and Quality of Life: China’s Oldest Old

Zhenchao Qian

Min Zhou

The Ohio State University

qian.26@osu.edu

Presented at the workshop on “Determinants of Healthy Longevity in China” at Max Planck Institute for Demographic Research, Rostock, Germany, August 2-4, 2004

Research Questions

• What is the quality of life like among China’s oldest old?

• How objective and subjective dimensions of social support affect quality of life?

• Whether social support from families or peers leads to better quality of life?

Social Support and Quality of Life

• Reciprocity – the normative obligation of a help recipient to assist people who have provided help to them.

• The elderly with children expect support from their children.

• The elderly with children are expected to have higher quality of life than the childless elderly.

Objective Social Support

• Living Arrangement – living with children, living alone, and living in nursing homes– Voluntary interpersonal attachments such as

friendships are more positively associated with quality of life than involuntary kinship ties (Ellison 1990).

• Regular Visits by Non-Resident Children– Family care and cohesion

Subjective Social Support

• Perceived support is more important than received support in buffering the effect of stressful events (Wethington and Kessler 1986).

• The thoughts of being cared for when they are sick affects quality of life more than the actual care.

Social Structure and Social Support

• Urban/Rural Difference

• Educational Attainment and Occupation

• Sources of Financial Support

China’s Oldest Old

• The elderly population has increased rapidly in China…– Decline in fertility and increase in life expectancy

• The percentage of the elderly residing with children is declining.

• Less likely for all the elderly to live with children changes in social norm

• Alternative living arrangement

The Current Study

• Examine how different dimensions of social support affect quality of life for China’s oldest old.

Hypotheses

• The elderly who live in nursing homes should report better quality of life than the elderly who live elsewhere

• The elderly who receive children’s regular visits should report better quality of life than the elderly who don’t receive children’s regular visits.

• Those with perceived support are more likely to report better quality of life than those without perceived support.

Data

• China’s Longitudinal Healthy Longevity Survey 1998

• Sample: aged 80-110

• Weighted statistics for descriptive tables

Quality of Life

• How would you rate your self-report quality of life– Good (72%)

• Good and very good

– Not good (28%)• So so, bad, and very bad

• Logistic regression predicting “good”

Measuring Social Support

• Objective behavior– Living arrangement: with children (67%), with

spouse (13%), nursing homes (7%), alone (13%)

– Whether non-resident children pay regular visits to elderly parents (75% yes)

• Subjective behavior– Sources of support if sick: 90% by family, 8%

by non-family, 2% by nobody

Measuring Sources of Financial Support

• Combine primary and secondary sources of financial support– From own or spouse (11%)– From children or relatives (59%)– From government or other sources (5%)– Form own, spouses, children, and relatives

(17%)– From all sources (8%)

Other Variables

• Social structure– Urban/rural residence– Educational attainment– Occupation

• Health status: ADL (active, mildly disable, and severely disable)

• Age, gender, children ever born, children still alive

Figure 1. Percentage of the Elderly Reporting Good Quality of Life by Living Arrangement

74.7 73.7

52.0

87.3

0

20

40

60

80

100

Children Spouse only Alone Nursing Home

Living Arrangement

Per

cent

Figure 2. Percentage of the Elderly Reporting Good Quality of Life by Whether Non-Resident Children Visit

70.273.0

0

20

40

60

80

100

No Yes

Whether Visited by Non-Resident Children

Per

cen

t

Figure 3. Percentage of the Elderly Reporting Good Quality of Lifeby Sources of Percieved Support

72.8

77.2

31.3

0

20

40

60

80

100

Family Non-Family Nobody

Sources of Perceived Support When They Become Sick

Per

cen

t

Financial Support*** % Reporting Good Quality of Life Own and Spouse 77.6 Child and Relatives 71.3 Government and Others 68.8 Own, Spouse and Kins 73.6 All Sources 71.5ADL Status*** Active 72.9 Mild Disability 72.7 Severe Disability 63.1Place of Residence*** Rural 69.7 Urban 76.8

Education*** No Education 71.0 1-6 Years 73.0 6+ Years 78.5Occupation at Retirement*** Professional or Governmental 82.4 Industrial or Agricultural 70.6 Housework or Others 73.8Age* 80 - 89 years 72.0 90 - 99 years 75.5 100 -110 years 77.1Having Child*** No 66.8 Yes 72.6Child Alive No 71.2 Yes 72.6Sex Male 72.3 Female 72.3

Odds from Logistic Regression Predicting Effects of Social

Support, Health,and Demographic Characteristics on

Quality of Life

Living Arrangement (Reference= Childiren) Spouse Only .70*** Nursing Home 2.41*** Alone .44***No Children Ever Born (Yes) .87At least one child alive (Yes) .90Regular Visit of Children (Yes) 1.48***Caretaker When Sick (Reference= Nobody) Family Members 3.48*** Nonfamily Members 2.68***Financial Support (Reference= Own) Children .76** Government .67** Own and Children .81** All sources .81ADL (Reference= Severe disability) Active 1.48*** Mild Disability 1.45***

Urban (Yes) 1.27***Age (Reference = 80-89)90-99 1.19***100 and higher 1.32***Female (Yes) 1.14**Education (Reference = no schooling)1-6 years of schooling 1.14*6 and more years of schooling 1.33**Occupation (Reference=worker or farmer)Professional 1.30**Housework 1.22***

Odds of Logistic Regression Predicting Whether an Elderly

Person Lives in Nursing Homes

No Child 2.24***Child Alive 1.37

Child and Relatives 1.22 Government and Others 7.18*** Own, Spouse and Kins 1.42 All 2.24*Visit 1.63

Active .60* Mild Disability 1.20Caretaker When Sick (Reference= Nobody) Family Members .48 Nonfamily Members 98.19***Urban 5.25***90-99 .42***100-110 .32***Female 1.101-6 yrs Education 1.49*6+ yrs Education .96Professional .46*Housework or Others .51**

Financial Support (Reference= Own and Spouse)

ADL (Reference= Severe disability)

Discussion

• Why do the elderly living in nursing homes most likely report good quality of life?– Peers and friends, community– Personality…– Many of them are childless elderly persons who

rely on government support

• Would the elderly with children report the same levels of quality of life if they were in nursing homes?

• The elderly living alone are similar to the elderly living in nursing homes in many ways except they – don’t get as much financial support from

government – perceive support from nobody when they are

sick– tend to be rural residents

Implications

• Social security and pension in place

• Create networks of friends and peers– Community centers– Retirement communities – More nursing homes, especially for rural China