Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-26T12:00:36.678Z Has data issue: false hasContentIssue false
  • English
  • Français

Living alone, social cohesion, and quality of life among older adults in rural and urban China: a conditional process analysis

Published online by Cambridge University Press:  02 July 2020

Denise Burnette Open the ORCID record for Denise Burnette [Opens in a new window] ,
Xujingzi Ye ,
Zhaowen Cheng  and
Hangqing Ruan
Denise Burnette*
Affiliation:
Virginia Commonwealth University, School of Social Work, 1000 Floyd Avenue, Academic Learning Commons, Richmond, VA, USA
Xujingzi Ye
Affiliation:
Peking University Institute of Population Research/Institute of Ageing Studies, Beijing, China
Zhaowen Cheng
Affiliation:
China Development Research Foundation, Beijing, China
Hangqing Ruan
Affiliation:
Department of Sociology, University of Maryland, College Park, MA, USA
*
Correspondence should be addressed to: Denise Burnette, Virginia Commonwealth University, School of Social Work, 1000 Floyd Avenue, Academic Learning Commons, Richmond, VA, USA. Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

To test the independent and combined impact of social cohesion and geographic locale (urban/rural) on quality of life (QoL) for older adults in China. Using conditional process analysis, we tested three hypotheses: (1) QoL will be lower for persons living alone than those who live with family; (2) social cohesion will mediate the association of living arrangement and QoL; and (3) geographic locale will moderate direct and indirect pathways in the mediation model.

Design:

Cross-sectional data from WHO Study on Global Aging and Adult Health (SAGE) (China, Wave 1, 2007–2010).

Setting:

National probability sample of 74 primary sampling units in China, 32 in urban, and 32 in rural areas.

Participants:

A total of 9,663 adults aged 50 years and older.

Measurements:

We measured QOL with the 8-item version of the WHOQOL-Bref; living arrangement as alone versus with family; and social cohesion with an 9-item index of frequency of a range of social activities in the previous 12 months. We controlled for sociodemographic characteristics and health and mental health variables in multivariate analyses.

Results:

Data supported the first two hypotheses; however, the mediating effects of social cohesion held only in urban areas.

Conclusion:

This study advances the large body of work on living arrangements and well-being of older adults in China. Social cohesion contributed to better QoL regardless of living arrangement, and cohesion mediated the association of living arrangement and QOL in urban but not rural areas. Programs and policies that strengthen social cohesion through older adults’ community involvement, especially in urban areas, will help to enhance QoL.

Keywords

ruralquality of life (QoL)loneliness
Type
Original Research Article
Information
International Psychogeriatrics , Volume 33 , Special Issue 5: Issue Theme: Loneliness and Social Connectedness , May 2021 , pp. 469 - 479
Copyright
© International Psychogeriatric Association 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Berger-Schmitt, R. (2002). Considering social cohesion in quality of life assessments: concept and measurement. Social Indicators Research, 58, 403–428. doi: 10.1023/A:1015752320935 CrossRefGoogle Scholar
Bhatti, A. B. and Haq, A. U. (2017). The pathophysiology of perceived social isolation: effects on health and mortality. Cureus, 9(1), e994. doi: 10.7759/cureus.994.Google ScholarPubMed
Bongaarts, J. and Zimmer, Z. (2002). Living arrangements of older adults in the developing world: an analysis of demographic and health survey household surveys. Journals of Gerontology, Social Sciences, 57B (3), S145–S157 doi: 10.1093/geronb/57.3.S145 CrossRefGoogle Scholar
Bromell, L. and Cagney, K. A. (2014). Companionship in the neighborhood context: older adults’ living arrangements and perceptions of social cohesion. Research on Aging, 36(2), 228–243. doi: 10.1177/0164027512475096 CrossRefGoogle ScholarPubMed
Bruhn, J. (2009). The Group Effect: Social Cohesion and Health Outcomes. New York: Springer.CrossRefGoogle Scholar
Carroll, B. A., Kowal, P., Naidoo, N. and Chatterji, S. (2012). Measuring cognitive status in older age in lower income countries: results from a pilot of the study on global AG Eingand Adult Health (SAGE). SAGE Working Paper No. 3.Google Scholar
Chen, Y., Hicks, A. and While, A. E. (2014). Quality of life and related factors: a questionnaire survey of older people living alone in Mainland China. Quality of Life Research, 23(5), 1593–1602. doi: 10.1007/s11136-013-0587-2 CrossRefGoogle ScholarPubMed
Chen, S., Conwell, Y. and Chiu, H. F. K. (2014). Loneliness and aging in China–a public health problem in need of solutions. International Psychogeriatrics, 26 (11), 1771–1772. doi: 10.1017/S104161021400177X CrossRefGoogle ScholarPubMed
Engel, A. M., Chudyk, M. C., Ashe, H. A., McKay, D. G. T. and Whitehurst, S. B. (2016). Older adults’ quality of life – exploring the role of the built environment and social cohesion in community-dwelling seniors on low income. Social Science & Medicine, 164, 1–11. doi: 10.1016/j.socscimed.2016.07.008 CrossRefGoogle ScholarPubMed
Fei, H.-T. N., Hamilton, G. G. and Wang, Z. (1992). From the Soil: The Foundations of Chinesesociety. Berkeley, CA: University of California Press.CrossRefGoogle Scholar
Feng, Z., Falkingham, J., Liu, X. and Vlachantoni, A. (2017). Changes in living arrangements and mortality among older people in China. Social Science & Medicine, Population Health, 3, 9–19. doi: 10.1016/j.ssmph.2016.11.009 CrossRefGoogle ScholarPubMed
Gu, D., Dupre, M. and Liu, G. (2007). Characteristics of the institutionalized and community residing oldest-old in China. Social Science & Medicine, 64(4), 871–883. doi: 10.1016/j.socscimed.2006.10.026 CrossRefGoogle ScholarPubMed
Hayes, A. F. (2018). Introduction to Mediation, Moderation, and Conditional Process Analysis: a regression-based Approach (2nd Edition) (Chapter 11, pp. 393–430). New York: The Guilford Press.Google Scholar
Hayes, A. F. and Rockwood, N. J. (2019). Conditional process analysis: concepts, computation and advances in the modeling of the contingencies of mechanisms. American Behavioral Scientist, 64 (1), 19–54. doi: 10.1177/0002764219859633 CrossRefGoogle Scholar
He, C. and Ye, J. (2014). Lonely sunsets: impacts of rural-urban migration on the left-behindelderly in rural China. Population, Space and Place, 20(4), 352–369.CrossRefGoogle Scholar
Huang, X., Liu, J. and Bo, A. (2019). Living arrangements and quality of life among older adults in China: does social cohesion matter? Aging and Mental Health, doi: 10.1080/13607863.2019.1660856 Google ScholarPubMed
Kahneman, D., Krueger, A. B., Schkade, D. A., Schwarz, N. and Stone, A. A. (2004). A survey method for characterizing daily life experience. The Day Reconstruction Method, Science, 306 (5702), 1776–1780. doi: 10.1126/science.1103572 Google ScholarPubMed
Kincannon, C. L., He, W. and West, L. A. (2005). Demography of aging in China and the United States and the economic well-being of their older populations. Journal of Cross-Cultural Gerontology, 20(3), 243–255. doi: 10.1007/s10823-006-9015-1 CrossRefGoogle ScholarPubMed
Korinek, K., Zimmer, Z. and Gu, D. (2011). Transitions in marital status and functional health and patterns of intergenerational co-residence among China’s elderly population. Journals of Gerontology: Social Science, 66B (2), 260–270. doi: 10.1093/geronb/gbq107 CrossRefGoogle Scholar
Kowal, P. et al. (2012) Data resource profile: the World Health Organization study on global Ageing and adult health (AGE). International Journal of Epidemiology, 41, 1639–1649. doi: 10.1093/ije/dys210 CrossRefGoogle Scholar
Lee, Y.-J. and Xiao, Z. (1998). Children’s support for elderly parents in urban and rural China: results from a national survey. Journal of Cross-Cultural Gerontology, 13(1), 39–62.doi: 10.1023/a:1006591608724 CrossRefGoogle Scholar
Lei, P., Xu, L., Nwaru, B. I., Long, Q. and Wu, Z. (2016). Social networks and health-related quality of life among old adults in urban areas: results from 4th National Household Survey. Public Health, 131, 27–39. doi: 10.1016/j.puhe.2015.10.009.CrossRefGoogle Scholar
Li, B. and Chen, S. (2011). Aging, living arrangements, and housing in China. Ageing International, 36(4), 463–474. doi: 10.1007/s12126-010-9094-8 CrossRefGoogle Scholar
Logan, J. R., Bian, F. and Bian, Y. (1998). Tradition and change in the urban Chinese family: the case of living arrangements. Social Forces, 76(3), 851–882. doi: 10.1093/sf/76.3.851 CrossRefGoogle Scholar
Li, X., Strauss, J., Tian, M. and Zhao, Y. (2015). Living arrangement of the elderly in China: evidence from the CHARLS national baseline. China Economics Journal, 8 (3), 191–214. doi: 10.1080/17538963.2015.1102473 CrossRefGoogle Scholar
Lou, V. W. and Ng, J. W. (2012). Chinese older adults’ resilience to the loneliness of living alone: a qualitative study. Aging & Mental Health, 16(8), 1039–1046. doi: 10722/186262 CrossRefGoogle ScholarPubMed
Marmot, M. and Wilkinson, R. (Eds.) (2006). Social Determinants of Health (2nd edition). Oxford: Oxford University Press.Google Scholar
Mcneill, L. H., Kreuter, M. W. and Subramanian, S. V. (2006). Social environment and physical activity: a review of concepts and evidence. Social Science & Medicine, 63(4), 1011–1022. doi: 10.1016/j.socscimed.2006.03.012.CrossRefGoogle ScholarPubMed
Meng, D., Xu, G., He, L., Zhang, M. and Lin, D. (2017). What determines the preference for future living arrangements of middle-aged and older people in urban China? PLoS ONE, 12(7), e0180764. doi: 10.1371/journal.pone.0180764 CrossRefGoogle ScholarPubMed
Miao, S. J., Wua, X. and Sun, X. (2019). Neighborhood, social cohesion, and the elderly’s depression in Shanghai. Social Science & Medicine, 229, 134–143, doi: 10.1016/j.socscimed.2018.08.022 CrossRefGoogle ScholarPubMed
Michael, Y., Berkman, L. F., Colditz, G. A. and Kawachi, I. et al (2001). Living arrangements, social integration, and change in functional health status. American Journal of Epidemiology, 153(2), 123–131. doi: 10.1093/aje/153.2.123 CrossRefGoogle ScholarPubMed
Miret, M. et al. (2012). Validation of a measure of subjective well-being: an abbreviated version of the day reconstruction method. PLoS ONE, 7(8), e43887. doi: 10.1371/journal.pone.0043887 CrossRefGoogle ScholarPubMed
Norstrand, J. A. and Xu, Q. (2012). Social capital and health outcomes among older adults in China: the urban–rural dimension. The Gerontologist, 52(3), 325–334. doi: 10.1093/geront/gnr072 CrossRefGoogle ScholarPubMed
Pantell, M., Rehkopf, D., Jutte, D., Syme, S. L., Balmes, J. and Adler, N. (2013). Social isolation: a predictor of mortality comparable to traditional clinical risk factors. American Journal of Public Health, 103, 2056–2062. doi: 10.2105/AJPH.2013.301261 CrossRefGoogle ScholarPubMed
Phillips, D. R. and Feng, Z. (2015). Challenges for the aging family in the People’s Republic of China. Canadian Journal of Aging, 34(3), 290–304. doi: 10.1017/S0714980815000203 CrossRefGoogle ScholarPubMed
Power, M. (2003). Development of a common instrument for quality of life. In: Nosikov, A. and Gudex, C. (Eds.), EUROHIS: Developing Common Instruments for Health Surveys (pp. 145–163). Amsterdam: IOS Press.Google Scholar
Ramlagan, S., Peltzer, K. and Phaswana-Mafuyal, N. (2014). Hand grip strength and associated factors in non-institutionalised men and women 50 years and older in South Africa. BMC Research Notes, 7, 8. http://www.biomedcentral.com/1756-0500/7/8 Google Scholar
Ren, Q. and Treiman, D. J. (2015). Living arrangements of the elderly in China and consequences for their emotional well-being. Chinese Sociological Review, 47(3), 255–286. doi: 10.1080/21620555.2015.1032162 CrossRefGoogle Scholar
Rios, R., Aiken, L. S. and Zautra, A. J. (2012). Neighborhood contexts and the mediating role of neighborhood social cohesion on health and psychological distress among Hispanic and non-Hispanic residents. Annals of Behavioral Medicine, 43 (1), 50–61. doi: 10.1007/s12160-011-9306-9 CrossRefGoogle ScholarPubMed
Salomon, J. A., Mathers, C. D., Chatterji, S., Sadana, R., Ustun, T. B. and Murray, C. J. L. (2003).Quantifying individual levels of health: definitions, concepts and measurement issues. In Murray, C. J. L. and Evans, D. (Eds.), Health Systems Performance Assessment: Debates, Methods and Empiricism. Geneva: World Health Organization.Google Scholar
Sereny, M. (2011). Living arrangements of older adults in China: the interplay among preferences, realities, and health. Research on Aging, 33(2), 172–204. doi: 10.1177/0164027510392387 CrossRefGoogle Scholar
Silverstein, M., Cong, Z. and Li, S. (2006). Intergenerational transfers and living arrangements of older people in rural China: consequences for psychological well-being. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(5), S256–S266. doi: 10.1093/geronb/61.5.S256 CrossRefGoogle ScholarPubMed
Song, X. and Xie, Y. (2014). Market transition theory revisited: changing regimes of housing in equality in China, 1988–2002. Sociological Science, 1, 277–291. doi: 10.15195/v.1.a18 CrossRefGoogle Scholar
Sun, X., Lucas, H., Meng, Q. and Zhang, Y. (2011). Associations between living arrangements and health-related quality of life of urban elderly people: a study from China. Quality of Life Research, 20(3), 359–369. doi: 10.1007/s11136-010-9752-z CrossRefGoogle ScholarPubMed
Tang, D., Lin, Z. and Chen, F. (2019). Moving beyond living arrangements: the role of family andfriendship ties in promoting mental health in urban and rural older adults in China. Aging & Mental Health, 1–10. doi: 10.1080/13607863.2019.1602589.Google Scholar
Ustün, T. B., Ayuso-Mateos, J. L., Chatterji, S., Mathers, C. and Murray, C. J. (2004). Global burden of depressive disorders in the year 2000. British Journal of Psychiatry, 184, 386–392. doi: 10.1192/bjp.184.5.386 CrossRefGoogle ScholarPubMed
Ustün, T. B., Kostanjsek, N., Chatterji, S. and Rehm, J. (2010). Measuring Health and Disability: Manual for WHO Disability Assessment Schedule (WHODAS 2.0). Geneva: World Health Organization.Google Scholar
Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S. and Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational data. Heart, 102, 1009–1016. doi: 10.1136/heartjnl-2015-309242 CrossRefGoogle Scholar
Wang, D. (2006). China’s urban and rural old age security system: challenges and options. China & World Economy, 14(1), 102–116. doi: 10.1111/j.1749-124X.2006.00001.x CrossRefGoogle Scholar
World Health Organization Quality of Life Group (WHOQOL). (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558.CrossRefGoogle Scholar
World Health Organization. (1993). The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (DCR-10). Geneva, Switzerland: World Health Organization.Google Scholar
World Health Organization. (2007). Global Age-friendly Cities: A Guide. Geneva: World Health Organization. http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf Google Scholar
Xiangming, C. (1985). The one-child population policy, modernization, and the extended Chinese family. Journal of Marriage & Family, 47(1), 193–202. doi: 10.2307/352082 Google Scholar
Ye, J., He, C., Liu, J., Wang, W. and Chen, S. (2016). Left-behind elderly: shouldering a disproportionate share of production and reproduction in supporting China’s industrial development. The Journal of Peasant Studies, 1–29. doi: 10.1080/03066150.2016.1186651 Google Scholar
Yeung, W-J. J. and Cheung, A. K-L. (2015). Living alone: one-person households in Asia. Demographic Research, 32(40), 1099–1112. doi: 10.4054/DemRes.2015.32.40 CrossRefGoogle Scholar
York, E. Y. and Waite, L. J. (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 31–48. doi: 10.1177/002214650905000103 Google Scholar
Zeng, Y. and Wang, Z. (2003). Dynamics of family and elderly living arrangements in China: New lessons learned from the 2000 Census. China Review, 3(2), 95–119.Google Scholar
Zhou, Z. et al. (2018a). A longitudinal analysis of the association between living arrangements and health among older adults in China. Research on Aging, 40(1), 72–97. doi: 10.1177/0164027516680854.CrossRefGoogle ScholarPubMed
Zhou, Z., Zhou, Z., Gao, J., Lai, S. and Chen, G. (2018b). Urban-rural difference in the associations between living arrangements and the health-related quality of life (HRQOL) of the elderly in China-evidence from Shaanxi province. PloS ONE, 13(9), e0204118. doi: 10.1371/journal.pone.0204118 CrossRefGoogle ScholarPubMed