Greater Risk of Negative Health Outcomes of Older Adults Living Alone in Vietnam: A Community Survey

In modern Asian societies, there has been a shift in the living arrangements of older adults away from living with others. Knowing the health characteristics of individuals living alone can help identify high-risk groups. This cross-sectional study aimed to describe characteristics of the Vietnamese older adults and to investigate the association between living alone and their reported health outcomes by utilizing survey data of individuals aged ≥60 years in Vietnam in 2018. The community survey included questions about sociodemographic factors, living arrangement, and self-reported physical functional status. Multivariate logistic regression was used to examine whether or not living alone was a predictor of health outcomes. Of 725 study participants, 8.9% lived alone. These participants were more likely to be female, aged 70–79 years, living in rural areas, and currently single or previously married. After adjusting for covariates, older adults who were living alone were more likely to have arthritis (adjusted odds ratio [AOR] = 1.95, 95% confidence interval [CI]: 1.10–3.45), a history of falling (AOR = 2.44, 95% CI: 1.02–5.82), visual difficulties (AOR = 1.89, 95% CI: 1.04–3.41), feelings of loneliness (AOR = 1.95, 95% CI: 1.10–3.47), and high fear of falling (AOR = 1.88, 95% CI: 1.02–3.46). Older adults living alone in Vietnam were at greater risk of negative health consequences than those living with others. Screening and providing adequate social support for this specific population is important in preventing the adverse effects of solitary living among these older adults.

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Living Arrangement Modifies the Associations of Loneliness with Adverse Health Outcomes in Older Adults: Evidence From the CLHLS

10.21203/rs.3.rs-669199/v1 ◽

2021 ◽

Author(s):

Kai Wei ◽

Yong Liu ◽

Junjie Yang ◽

Nannan Gu ◽

Xinyi Cao ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Living Arrangements ◽

Living Arrangement ◽

Community Dwelling ◽

Living Alone ◽

Adverse Health ◽

Adverse Health Outcomes ◽

Physical Functions ◽

Community Dwelling Older Adults

Abstract Background: Although it has been suggested that loneliness is a risk factor for adverse health outcomes, living arrangement may confound the association. This study aimed to investigate whether the associations of loneliness with adverse health outcomes differ in community-dwelling older adults according to different living arrangements.Methods: In the 2008/2009 wave of Chinese Longitudinal Healthy Longevity Survey, 16255 community-dwelling older adults (≥65 years) were recruited. Living arrangements and feelings of loneliness were assessed. Health outcomes including cognitive and physical functions were assessed using MMSE, ADL/IADL scales and Frailty Index in the 2008/2009 and 2011/2012 waves; mortality was assessed in the 3-year follow-up from 2008/2009 to 2011/2012. The associations of loneliness with adverse health outcomes accroding to different living arrangements were estimated using logistic regression or Cox proportional hazards regression models. Interactions between living arrangement and loneliness on adverse health outcomes were also investigated.Results: Older adults who were lonely (47.8% of those living alone and 25% of those living with others) had higher prevalence of cognitive impairment, frailty and 3-year mortality than older adults without loneliness, especially among those who lived with others (OR=1.31, 95% CI=1.15-1.51; OR=1.42, 95% CI=1.26-1.60; HR=1.16, 95% CI=1.07-1.26, respecitvely). In contrast, among the living alone older adults, loneliness was only associated with higher prevalence of frailty (OR=1.41, 95% CI=1.06-1.88). Living arrangement modified the associations of loneliness with prevalent cognitive impairment and mortality (P values for interactions=0.006 and 0.015, respectively).Conclusions: Living arrangement modifies the associations of loneliness with adverse health outcomes in community-dwelling older adults, and those who lived with others but felt lonely had worse cognitive and physical functions as well as higher mortality. Special attention should be paid to this population to reduce adverse health outcomes.

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Educational Differences in Self-Rated Health Trends Among Middle-Aged and Older Adults Living Alone, 1972–2018

Journal of Aging and Health ◽

10.1177/08982643211052718 ◽

2022 ◽

pp. 089826432110527

Author(s):

Esther O. Lamidi

Keyword(s):

Older Adults ◽

Living Arrangements ◽

Living Arrangement ◽

Living Alone ◽

Middle Aged ◽

Older Americans ◽

Health Trends ◽

Self Rated Health ◽

Educational Differences ◽

Middle Aged Adults

Objectives: This study examines educational differences in living alone and in self-rated health trends among middle-aged and older adults. Methods: We used logistic regression to analyze data from the 1972–2018 National Health Interview Survey ( n = 795,239 aged 40–64; n = 357,974 aged 65–84). Results: Between 1972–1974 and 2015–2018, living alone became more prevalent, particularly among men and at lower levels of education. Self-rated health trends varied by living arrangement and education. We found self-rated health declines among middle-aged adults having no college degree and living alone, but trends in self-rated health were mostly stable or even improved among middle-aged adults living with others. Among older adults, self-rated health improved over time, but for the least-educated older Americans living alone, the probability of reporting fair or poor health increased between 1972–1974 and 2015–2018. Discussion: The findings suggest growing disparities by social class, in living arrangements and in self-rated health.

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Objectively-Measured Neighbourhood Attributes as Correlates and Moderators of Quality of Life in Older Adults with Different Living Arrangements: The ALECS Cross-Sectional Study

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16050876 ◽

2019 ◽

Vol 16 (5) ◽

pp. 876 ◽

Cited By ~ 4

Author(s):

Casper Zhang ◽

Anthony Barnett ◽

Janice Johnston ◽

Poh-chin Lai ◽

Ruby Lee ◽

...

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Hong Kong ◽

Living Arrangements ◽

Local Environment ◽

Living Alone ◽

World Population ◽

Cross Sectional ◽

Objectively Measured

With an ageing world population, preservation of older adults’ health and quality of life (QoL) is paramount. Due to lower levels of physical functionality, older adults are particularly susceptible to local environment influences, especially those living alone and lacking family support. Using generalised additive mixed models, we examined associations and confounder-adjusted associations between objectively-measured neighbourhood attributes and QoL domains in 909 Hong Kong Chinese elderly community dwellers. Most examined neighbourhood attributes were not associated with QoL in the whole sample. Neighbourhood residential and entertainment density was curvilinearly and/or linearly related to specific QoL domains. Number of parks was negatively associated with social QoL and having well-treed parks with higher levels of social QoL. Older adults living alone in neighbourhoods with poor access to destinations and few activities in parks showed lower environmental and/or social QoL than their counterparts. Neighbourhood built environment characteristics do not seem to impact Hong Kong older adults’ physical and psychological QoL. Medium-to-high density, well-ordered neighbourhoods with optimal mixes of well-treed public open spaces and services meeting their daily needs may significantly contribute to social and environmental QoL in this population and appear particularly important to those living alone.

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THE BURDEN OF ENGAGING IN VOLUNTEER ATTENUATE THE RELATIONSHIP BETWEEN VOLUNTEER ENGAGEMENT AND HEALTH OUTCOMES

Innovation in Aging ◽

10.1093/geroni/igz038.524 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S145-S146

Author(s):

Yuta Nemoto ◽

Ryota Sakurai ◽

Masami Hasebe ◽

Kumiko Nonaka ◽

Hiroko Mtsunaga ◽

...

Keyword(s):

Older Adults ◽

Health Outcomes ◽

Economic Status ◽

Living Arrangement ◽

Well Being ◽

Cross Sectional Study ◽

World Health ◽

Cross Sectional ◽

Volunteer Activity ◽

Volunteer Engagement

Abstract This study examined the interaction of participating in volunteer activity and its burden on health outcomes. A community-based cross-sectional study was conducted in 2018. Of 8426 older adults aged 65 and over, 5232 individuals were included in the analyses (response rate: 62.1%). Health outcomes included self-rated health (SRH), mental health (The World Health Organization Five Well-Being Index: WHO-5), and Instrumental Activities of Daily Living (Tokyo Metropolitan Institute of Gerontology Index of Competence: TMIG-IC) as dependent variables. Independent variables included engagement in volunteer activity and its burden. These variables were combined and classified into three groups: non-participants; participants with burden; and participants without burden. Covariates included age, gender, educational attainments, economic status, and living arrangement. Logistic regression analysis and analysis of covariates were conducted to examine the interaction of volunteer activity and its burden on health outcomes. Of 5232 older adults, 76.3% of subjects were non-participants, 3.4% were participants with burden, and 20.3% were participants without burden. Multivariate analysis showed that non-participants were more likely to have poor health outcomes compared with participants with burden. Moreover, participants without burden were more likely to have better health outcomes (SRH: Odds Ratio [OR] = 1.92, 95% Confidence Interval [CI] = 1.70 to 2.17, WHO-5: OR = 1.69, 95% CI = 1.51 to 1.88, TMIG-IC: Coefficient = 0.36, 95% CI = 0.10 to 0.62). Our findings suggest that volunteer activity is related to better health regardless of their burden. However, burden of volunteer engagement might attenuate the relationships between volunteer activity and health outcomes.

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Who Lives Alone During Old Age? Trends in the Social and Functional Disadvantages of Sweden’s Solitary Living Older Adults

Research on Aging ◽

10.1177/0164027517747120 ◽

2017 ◽

Vol 40 (9) ◽

pp. 815-838 ◽

Cited By ~ 8

Author(s):

Benjamin A. Shaw ◽

Stefan Fors ◽

Johan Fritzell ◽

Carin Lennartsoon ◽

Neda Agahi

Keyword(s):

Older Adults ◽

Old Age ◽

Policy Implications ◽

Living Alone ◽

Mobility Impairment ◽

Cross Sectional ◽

Never Married ◽

Solitary Living ◽

The Social ◽

Age Trends

This study identifies specific social and functional disadvantages associated with living alone during old age in Sweden and assesses whether these associations have changed during recent decades. Data came from repeated cross-sectional surveys of Swedish adults aged 77+ during 1992–2014. Findings indicate that several types of disadvantage are consistently associated with the probability of living alone including financial insecurity and having never married for women and having never married and mobility impairment for men. Also for older men, low education has become an increasing strong determinant of living alone. These findings suggest that older adults who live alone are a subgroup that is particularly, and in some cases increasingly, vulnerable with respect to social and functional status. This has important policy implications related to addressing the needs of this growing subgroup as well as methodological implications for studies on the health effects of living alone.

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Factors Contributing to Older Adults Living Alone and Thereby at Risk of Poor Health and Adverse Health Outcomes

10.35831/shipley2019 ◽

2019 ◽

Author(s):

Nikki Shipley

Keyword(s):

Older Adults ◽

At Risk ◽

Health Status ◽

Health Outcomes ◽

Older Adult ◽

Living Arrangements ◽

Age At Onset ◽

Poor Health ◽

Living Child ◽

Living Alone

Introduction: Extensive research demonstrates that older adults living alone tend to be less healthy, have poorer health outcomes and are at greater risk of dying. While many investigators have explored various aspects of aging, there has been limited work assessing factors that increase the chances of an older adult to live alone. This study examines the association between demographic characteristics; current health status; and social, cultural, and environmental factors among older adults (65 years of age and older) and the likelihood they will live alone Methods: Secondary analyses is conducted of survey data from the Americans' Changing Lives (ACL) cohort study initiated in 1986 (Wave 1) and continued through 2012, with four follow-up surveys conducted in 1989 (Wave II), 1994 (Wave III), 2001/02 (Wave IV), and 2011/12 (Wave V). All ACL participants 65 years and older at time of survey (Wave I – V) are included for this study (N=7,020). An analysis of variance (ANOVA) that included demographics, health status, and social support factors is employed to determine the relationship of these variables to an older adult reporting living alone. Additionally, the Cox proportional hazards model is used for survival analysis to predict the expected age at onset of living alone. Results: Four critical factors reduce the probability of an older adult living alone: 1) marital status (married), 2) gender (male), 3) presence of at least one living child, and 4) willingness to spend time in the garden (physical activity). An older female adult who is currently single and without a living child is most likely to report living alone (p<.001). Conclusions: Older adults living alone are at higher risk of poor health and health outcomes. The influx of baby boomers whose life expectancy is longer than the past, will cause a dramatic increase in senior adults living alone. This research suggests a guideline to public health professionals for identifying those at risk of being negatively impacted by living alone so that they can intervene and provide alternative living arrangements and support services, as necessary. Keywords: living alone, older adults, health outcomes

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Cross-sectional associations of objectively assessed neighbourhood attributes with depressive symptoms in older adults of an ultra-dense urban environment: the Hong Kong ALECS study

BMJ Open ◽

10.1136/bmjopen-2017-020480 ◽

2018 ◽

Vol 8 (3) ◽

pp. e020480 ◽

Cited By ~ 5

Author(s):

Casper J P Zhang ◽

Anthony Barnett ◽

Cindy H P Sit ◽

Poh-chin Lai ◽

Janice M Johnston ◽

...

Keyword(s):

Older Adults ◽

Hong Kong ◽

Depressive Symptoms ◽

Public Transport ◽

Living Arrangements ◽

Depression Scale ◽

Living Alone ◽

Hong Kong Chinese ◽

Cross Sectional ◽

Environmental Attributes

ObjectivesThis study aimed to examine the associations between objectively assessed neighbourhood environmental attributes and depressive symptoms in Hong Kong Chinese older adults and the moderating effects of neighbourhood environmental attributes on the associations between living arrangements and depressive symptoms.DesignCross-sectional observational study.SettingHong Kong.Participants909 Hong Kong Chinese community dwellers aged 65+ years residing in preselected areas stratified by walkability and socioeconomic status.Exposure and outcome measuresAttributes of participants’ neighbourhood environment were objectively assessed using geographic information systems and environmental audits. Depressive symptoms were measured using the Geriatric Depression Scale.ResultsOverall, pedestrian infrastructure (OR=1.025; P=0.008), connectivity (OR=1.039; P=0.002) and prevalence of public transport stops (OR=1.056; P=0.012) were positively associated with the odds of reporting depressive symptoms. Older adults living alone were at higher risk of reporting any depressive symptoms than those living with others (OR=1.497; P=0.039). This association was moderated by neighbourhood crowdedness, perceptible pollution, access to destinations and presence of people. Residing in neighbourhoods with lower levels of these attributes was associated with increased deleterious effects of living alone. Living in neighbourhoods with lower public transport density also increased the deleterious effects of living alone on the number of depressive symptoms. Those living alone and residing in neighbourhoods with higher levels of connectivity tended to report more depressive symptoms than their counterparts.ConclusionsThe level of access to destinations and social networks across Hong Kong may be sufficiently high to reduce the risk of depressive symptoms in older adults. Yet, exposure to extreme levels of public transport density and associated traffic volumes may increase the risk of depressive symptoms. The provision of good access to a variety of destinations, public transport and public open spaces for socialising in the neighbourhood may help reduce the risk of depressive symptoms in older adults who live alone.

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A Longitudinal Analysis of the Association Between Living Arrangements and Health Among Older Adults in China

Research on Aging ◽

10.1177/0164027516680854 ◽

2016 ◽

Vol 40 (1) ◽

pp. 72-97 ◽

Cited By ~ 14

Author(s):

Zi Zhou ◽

Fanzhen Mao ◽

Jiaping Ma ◽

Shichao Hao ◽

Zhengmin (Min) Qian ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Living Arrangements ◽

Living Arrangement ◽

Well Being ◽

Living Alone ◽

Psychological Well Being ◽

Self Rated Health ◽

Health Differences ◽

Adl Disability

This article used the nationally representative Chinese Longitudinal Healthy Longevity Survey to explore the associations between living arrangements and health among older adults. Living arrangements were stratified into six categories. Health was measured by self-rated health, activities of daily living (ADL) disability, and cognitive impairment. Random-effects ordered probit regressions were applied. The results indicated that coresidence had a positive effect on self-rated health compared with living alone. After introducing psychological well-being, the health differences observed in living with a spouse and living with both spouse and children were not significant. Participants with each of the living arrangement were more likely to have a higher rate of cognitive impairment and ADL disability than those living alone. Living arrangements were associated with older adults’ health. Psychological well-being was a key factor in this association, which may result from living with a spouse, and could contribute to the self-rated health of older adults.

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Difficulty in taking medication and stroke among older adults with systemic arterial hypertension: the Fibra Study

Ciência & Saúde Coletiva ◽

10.1590/1413-812320212611.3.29292019 ◽

2021 ◽

Vol 26 (suppl 3) ◽

pp. 5089-5098

Author(s):

Juliana Lustosa Torres ◽

Anita Liberalesso Neri ◽

Eduardo Ferrioli ◽

Roberto Alves Lourenço ◽

Lygia Paccini Lustosa

Keyword(s):

Older Adults ◽

Arterial Hypertension ◽

Living Arrangements ◽

Medical Diagnosis ◽

Cross Sectional Study ◽

Living Alone ◽

Financial Difficulty ◽

Sectional Study ◽

Cross Sectional ◽

Systemic Arterial Hypertension

Abstract This article aims to investigate whether difficulty in taking medication is associated with stroke among older adults with Systemic Arterial Hypertension (SAH) and to explore their association with living arrangements. Cross-sectional study was based on 3,502 older adults with SAH from the four universities pole of Frailty in Brazilian Older People (Fibra) Study, Brazil, including 14 municipalities of the five Brazilian regions. We used the medical diagnosis of stroke and difficulty in taking medications (self-reported difficulty and financial difficulty affording prescribed medications). Multivariate analysis was performed using logistic regression. Differently from women, older men with SAH, which report difficulty in taking medication (unintentional non-adherence), have higher odds of stroke. When stratified by living arrangements, those living with a partner have even higher odds of stroke compared to those without difficulty in taking medication and living alone. None association was found for difficulty affording prescribed medication for both men and women. Unintentional difficulty in taking medication plays a role in SAH treatment among men. Primary care strategies for controlling blood pressure should not be focus only on patients but targeting spouses as well.

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

International Psychogeriatrics ◽

10.1017/s1041610220001210 ◽

2020 ◽

pp. 1-11

Author(s):

Denise Burnette ◽

Xujingzi Ye ◽

Zhaowen Cheng ◽

Hangqing Ruan

Keyword(s):

Quality Of Life ◽

Older Adults ◽

Social Cohesion ◽

Rural Areas ◽

Urban Areas ◽

Process Analysis ◽

Living Arrangement ◽

Living Alone ◽

Conditional Process Analysis

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.

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