Changes in functional limitation and survival among older Taiwanese, 1993, 1996, and 1999

Using data from the Survey of Health and Living Status of the Elderly in Taiwan, we investigate changes in difficulties in walking and climbing stairs, tasks that represent basic lower-body movements less likely to be influenced by changes in environment and social roles than are activities and instrumental activities of daily living. Results are shown for unadjusted prevalence rates and rates adjusted for changes in population composition. The findings indicate that Taiwan does not appear to be experiencing the improvements in functioning witnessed recently in the United States. Prevalence of functional limitation increased between 1993 and 1996 and between 1996 and 1999. One possible reason is the change in old-age survival, which appears to have benefited those who have functional limitations, especially in a severe form. The Universal Health Insurance programme, established in 1995, may have increased access to care and thus the survival of those in poorest health.     

Women are key players in the economies of East and Southeast Asia

In 1996, the East-West Center's Program on Population investigated the links between population change and economic growth in Japan, South Korea, Taiwan, Singapore, Thailand, and Indonesia. This document discusses the findings pertaining to women's changing marriage and childbearing patterns, education attainment, and labor force participation as well as changes in family life. In eastern and southeastern Asia, women are delaying marriage and having fewer children as a result of their overwhelming acceptance of modern contraception. Concurrently, women's secondary school enrollment has increased dramatically since 1960, and women have accounted for steadily increasing proportions of total labor force growth. Economic development has led to fewer women employed in agriculture and more in clerical positions. Women continue to be marginalized in low-paying manufacturing jobs and to lose these jobs more frequently than do men. Women's labor force participation continues to be dependent upon their child care responsibilities, but women are beginning to combine both activities with the help of live-in grandparents. Women have made an important contribution to economic growth in Asia. Policies should address job discrimination against married women, wage discrimination, the problems faced by young women who leave home for employment in the manufacturing and service sectors, and the lack of child care facilities.     

Educational attainment and transitions in functional status among older Taiwanese

Despite considerable research examining the influence of socioeconomic status on health, few studies have considered this relationship as it pertains to older adults in non-Western societies. We attempt to ascertain the influence of education on changes in physical functioning in a rapidly developing country. Data come from the 1989 Survey of Health and Living Status of the Elderly in Taiwan and a follow-up interview in 1993 (N = 4,049, age = 60+). Individuals are conceptualized to be in a state of functional independence or functional limitation at the time of origin, based on their ability to perform three physical functioning tasks. The outcome at the follow-up interview is categorized as functionally independent, limited, or dead, allowing for six probabilities, one from each state of origin to each outcome. These are calculated using a multinomial logit model, controlling for other factors often thought to be associated with health transitions. High levels of educational attainment result in a decreased incidence of functional limitation for those originating in a state of independence. Contrary to expectations, however, education has little influence on those who originate functionally limited. Thus, higher education plays a substantial role in primary prevention of morbidity, delaying the onset of disability, but other factors are more important once limitations begin. We speculate on the reasons behind these findings, including that the results may be culturally dependent.     

Income and “Outcomes” for Elderly: DO the Poor have A Poorer Life?

The objective of this paper is to analyze the relationship between income and living conditions and well-being of elderly. The best from two worlds is used for this purpose: a Danish survey covering 1440 elderly aged 72 and 77 from 1997, connected to reliable register information on income, 1988–1996. Indicators of physical activity, social and solitary activities, social contact, functional capability, loneliness and psychological well-being are constructed from the survey. Ordered logistic models are estimated controlling for demographics, education, previous occupation and whether the elderly are still working. It is found that elderly with low income levels have poorer functional capability, lower physical activity and poorer psychological well-being whereas social contact and social activities show no relationship with income. The relationship with income vanishes for solitary activities and loneliness when adding control variables. Having established that robust relations exist between income and some measures of well-being of elderly, we turn to an investigation of causality. Simultaneous models are estimated to assess whether the income relationship can be causally interpreted for functional capability and physical activity. The results show that it cannot be rejected that the income effects are causal, although care should be taken when interpreting results. We finally address our findings in the light of current and future changes regarding the size and economic well-being of the elderly population.     

Some roots of preference: Roles,activities and familial values

This paper examines some of the connecting links between modernization in a developing society, particularly urbanization and increased education for women, and preferences for number of children. Using 1973 Taiwan data, preferences for smaller families are found to be consistently related to modern attitudes and behavior in the three domains examined: intrafamilial husband-wife role relationships, extrafamilial activities of the wife, and familial and religious values relating the family to the larger institutional setting. Modernization of these attitudes, behaviors, and values has an impact on reproductive goals independent of their association with structural variables. The wife's outside activities and exposure to modern influences through the mass media are especially important linkages, having a particularly strong mediating effect in the education effect on preferences. Intrafamilial relations appear to be of less importance. Modernization of familial and religious values mediates between urbanization and family size preferences. The measure of preference used is a scale value which has been found in other research to be more predictive of reproductive behavior than the conventional single-valued statement of number of children wanted. As the level of contraceptive use rises in developing societies, family size preferences increasingly become a factor in birth rates, and understanding the sources of change in these preferences takes on added importance. The policy implications of these findings are discussed.     

Obesity, disease, and functional limitation in later life

Little is known about the effects of obesity late in life. Using data from the Longitudinal Study of Aging and the Assets and Health Dynamics of the Oldest Old Survey, this study finds an increased prevalence of obesity, over time, among those 70 and older. Obesity is related most strongly to limitations in activities of daily living (ADLs) for women and to activities related to mobility. One ADL, eating, has a negative association to obesity. Obesity is associated with an increased prevalence of arthritis, diabetes, and hypertension. These results are cross-sectional and are based on self-reports of height and weight; they must be interpreted cautiously.     

Trends in late-life disability in Taiwan, 1989-2007: the roles of education, environment, and technology

This analysis offers the first strong evidence of trends in late-life disability in an emerging economy. For the population of Taiwan aged 65 and older, consistent measures of limitations in seeing, hearing, physical functions, instrumental activities of daily living (IADLs), and activities of daily living (ADLs) were available for three to six survey waves, depending on the outcome, from 1989 to 2007. Limitations in seeing, hearing, and IADLs declined substantially, but trends were mixed for physical functions and flat for ADLs. The remarkable reduction in difficulty telephoning, an IADL, may reflect changes in telecommunications infrastructure and highlights the roles of environment and technology in disability outcomes. Trends for urban residents were more advantageous than those for rural residents for seeing and hearing, but less so for physical functions and IADLs. Were it not for the substantial increase in educational attainment, trends in all outcomes would have been less favourable.     

The roles of child support enforcement and welfare in non-marital childbearing

This paper examines the effects of stronger child support enforcement and declines in welfare benefits on changes in non-marital childbearing between 1980 and 1996. Economic theory suggests that stricter child support enforcement will increase the costs of children for unwed fathers, making them less likely to have a child outside marriage. Reductions in welfare benefits also are expected to increase the costs of non-marital childbearing for both mothers and fathers. We examine these hypotheses, using aggregate state-level data and fixed effects regression models to identify the effects of policies on non-marital birth rates. We find that both stricter child support enforcement and declines in welfare benefits deter non-marital births. However, the estimated effects of child support enforcement are more robust and larger than those of welfare. The estimates imply that in the 1980–1996 period, increases in child support enforcement led to a decline in non-marital birth rates in the range of 6% to 9%, whereas decreases in welfare benefits led to a decline in the range of 2% to 4%. Received: 28 June 2000/Accepted: 17 September 2001     

Fertility trends in Taiwan: Tradition and change

Fertility rates have been falling In Taiwan for several years. The declines appear to be general throughout the island, and are occurring mainly in the age groups above 50, as would be expected if there are beginnings of family limitation. There are indications that the fertility rates are negatively correlated with indices of modernization In local areas. Several pilot studies indicate a consensus in the population on the desirability of a moderate number of children, the desirability of the Idea of family planning, a positive valuation of such traditional Chinese values as the joint family and support of parents by their children In old age. In one urban area studied, a substantial minority of wives 25–29 years old have used a family planning method already. The “pre-pregnancy health program” of the Provincial Health Department has been quite successful in providing service to interested couples, and among these couples the programme is demonstrably effective in reducing birth rates. Data from the various sources are consistent with the speculation that Taiwanese couples want to use modern family planning methods to maintain elements of the traditional Chinese family in a modern setting.     

Age structure,growth, attrition and accession: A new synthesis

This paper shows that each equation describing relationships among demographic parameters in a stable population is a special case of a similar and equally simple equation that applies to any closed population and demonstrates some implications of these new equations for demographic theory and practice. Much of formal demography deals with functions that pertain to individuals passing through life, or to a stationary population in which births of individuals are evenly distributed over time. These functions include life expectancy, probabilities of survival, net and gross reproduction rates, expected years spent in various states and the probability that certain events will occur in the course of life. The stable population model permits the translation of population structure or processes in a more general type of population, with constant growth rates, back into equivalent populations for a stationary population. The method for translation developed in this paper, requiring only a set of age-specific growth rates is even more general, applying to any population. Age specific growth rates may also be useful for performing reverse translations, between a population's life table and its birth rate or its age distribution. Tables of numbers of females by single years of age in Sweden are used to illustrate applications. Tables summarize the basic relations among certain functions in a stationary population, a stable population and any population. Applications of new equations, particularly to demographic estimation of mortality, fertility and migration, from incomplete data, are described. Some other applications include; the 2 sex problem, increment decrement tables, convergence of population to its stable form, and cyclical changes in vital rates. Stable population models will continue to demonstrate long term implications of changes in mortality and fertility. However, in demographic estimation and measurement, new procedures will support most of those based on stable assumptions.     

Estimates of Survival of Diabetics from Repeated, Independent Sample Surveys

Little is known about death rates among diabetic populations. The few prior estimates have used two data systems, usually a registry or a survey to identify diabetics and death certificates to identify deaths. In this research, the diabetic population aged 18–94 in 1996–1998 and those surviving in 2001–2003 were estimated from repeated cross-sectional surveys, the Behavioral Risk Factor Surveillance System of the Centers for Disease Control and Prevention. Forward survival ratios were computed using a method developed for successive censuses and these were used to compute death rates. Nonlinear regression models for age-sex specific survival ratios were used to estimate parametric rates and thereby increase the accuracy of estimates. About 81.4 % (SE = 1.3 %) of diabetics survived 5 years, for an annual death rate of 41.1 per thousand (SE = 3.2). Among men survival was 84.7 % (SE = 2.1 %) with an annual death rate of 33.8 (SE = 4.9) per thousand; among women survival was 78.5 % (SE = 2.2 %) with an annual death rate of 48.1 (SE = 4.1) per thousand. Model estimates of mortality rates showed an odds ratio of 3.17 (95 % CI 2.64, 3.82) for each 10 year age interval and of 1.35 (95 % CI 1.02, 1.79) for women compared with men. Pooled annual samples, longer time intervals for survival, and parametric estimates of rates all help overcome the small numbers and large sampling variation of survey estimates of survival and mortality. Useful estimates of survival rates can be made from a single data system, a sample survey of the general population. This can be done for any condition where a respondent’s status at the earlier survey time is obtained at the later survey time. It could also be used to make estimates from periodic surveys for nations with limited information systems.     

Mortality, fertility, education and capital accumulation in a simple OLG economy

We develop a simple OLG model to analytically show that aging leads to increased educational efforts through a general equilibrium effect. The mechanism is that scarcity of raw labor increases the return of human relative to physical capital. While a reduction in the birth rate is shown to unambiguously increase educational efforts, increases in the survival rate have ambiguous effects. Falling birth rates also increase capital per worker, but the effects of rising survival rates are again ambiguous. We conclude that our model is a useful laboratory to highlight potentially offsetting effects in models with endogenous education and overlapping generations.     

Gender Differences in the Relationship of Social Activity and Quality of Life in Community-Dwelling Taiwanese Elders

This study explores the gender differences in the relationship between social activity and quality of life (QOL). A cross-sectional survey of 220 community-dwelling elderly people was conducted in southern Taiwan. Social activity was classified into six categories. The brief version of the World Health Organization QOL (WHOQOL-BREF) was used to measure QOL. Findings revealed that the associations of six types of social activities with QOL were weaker among women than men. The regression analyses further showed that for women, only religious activity was positively related to total QOL, while for men only involvement in formal group activity was positively related to total QOL.     

Gender differences in the relationship of social activity and quality of life in community-dwelling Taiwanese elders

This study explores the gender differences in the relationship between social activity and quality of life (QOL). A cross-sectional survey of 220 community-dwelling elderly people was conducted in southern Taiwan. Social activity was classified into six categories. The brief version of the World Health Organization QOL (WHOQOL-BREF) was used to measure QOL. Findings revealed that the associations of six types of social activities with QOL were weaker among women than men. The regression analyses further showed that for women, only religious activity was positively related to total QOL, while for men only involvement in formal group activity was positively related to total QOL.     

Effects of Childhood Mortality and Morbidity on the Fertility Transition in sub‐Saharan Africa

Child mortality rates have fallen substantially in developing countries since 1960. The expected fertility decline has followed only weakly in sub‐Saharan Africa compared to other recent and historic demographic transitions. Disease and anthropometric data suggest that morbidity remains prevalent in Africa despite child survival improvements. The uniquely high infectious disease burden among children in Africa reduces population health and diminishes the returns to human capital investment, thwarting the quantity–quality tradeoff for children that typically accompanies the mortality transition. Individual‐level data from the Demographic and Health Surveys are used to show that persistent morbidity has weakened the positive relationship between child mortality and total fertility rates throughout the region, slowing Africa's demographic transition.     

Education of adult children and mortality of their elderly parents in Taiwan

In societies in which families are highly integrated, the education of family members may be linked to survival. Such may be the case in Taiwan, where there are large gaps in levels of education across generations and high levels of resource transfers between family members. This study employs 14 years of longitudinal data from Taiwan to examine the combined effects of the education of older adults and their adult children on the mortality outcomes of older adults. We use nested Gompertz hazard models to evaluate the importance of the education of an older adult and his or her highest-educated child after controlling for socioeconomic, demographic, and health characteristics at baseline. To gain further insight, we fit additional models based on the sample stratified by whether older adults report serious diseases at baseline. The results indicate that the educational levels of both older adults and children are associated with older adult mortality, but children's education appears more important when we examine the mortality of only those older adults who already report a serious disease. This finding suggests that there may be different roles for education in the onset versus the progression of a health problem that may lead to death.     

Similarities and Differences Among the Taiwan,China, and Hong-Kong Versions of the WHOQOL Questionnaire

To facilitate comparison across cultures, the World Health Organization (WHO) has been developing a universal measure of quality of life (QOL) called the WHOQOL Questionnaire. This questionnaire contains 24 facets organized into six broad domains: physical, psychological, level of independence, social relationships, environment, and spirituality/religion/personal beliefs. The standard WHOQOL is designed for cross-cultural comparison. However, to obtain a valid QOL measure that can be applied in diverse populations, cultural adaptation of the WHOQOL has been encouraged. Each culture is permitted to add culture-specific questions, called national items, so that the questionnaire can also reflect cultural attributes. Three Chinese versions of the WHOQOL have been developed for China, Hong Kong, and Taiwan. National items were selected for each version according to the criteria proposed by the WHOQOL Group. The purpose of this paper is to compare the Taiwan version to the China and Hong Kong versions. The questionnaire development process, response scale generation, psychometric properties (reliability and validity), national items, and population means were all examined. Results indicated that not only is cultural adaptation of WHOQOL measures necessary for individual cultures, but also for sub-cultures, as these differences must be considered in order to provide effective health care and treatment.     

Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

This study assesses the effects of socio-economic conditions and the interaction between son preference and China's one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mother's education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.     

The Nonlinear Relationship Between Education and Mortality: An Examination of Cohort, Race/Ethnic, and Gender Differences

Researchers investigating the relationship between education and mortality in industrialized countries have consistently shown that higher levels of education are associated with decreased mortality risk. The shape of the education–mortality relationship and how it varies by demographic group have been examined less frequently. Using the U.S. National Health Interview Survey-Linked Mortality Files, which link the 1986 through 2004 NHIS to the National Death Index through 2006, we examine the shape of the education–mortality curve by cohort, race/ethnicity, and gender. Whereas traditional regression models assume a constrained functional form for the dependence of education and mortality, in most cases semiparametric models allow us to more accurately describe how the association varies by cohort, both between and within race/ethnic and gender subpopulations. Notably, we find significant changes over time in both the shape and the magnitude of the education–mortality gradient across cohorts of women and white men, but little change among younger cohorts of black men. Such insights into demographic patterns in education and mortality can ultimately help increase life expectancies.     

Economic motives for family limitation

Abstract Taiwan can boast one of the most rapid rates of economic development in the world over the past 20 years. Taiwan is also in the midst of the demographic transition. The nature of the connection between economic development and the onset and progress of the fertility decline is far from clear, however. Rather than explore the relation between income and fertility change, this paper will be concerned with some of the economic motivations which may be responsible for fertility decline during the demographic transition. Inquiries in this area have been handicapped by having to rely on aggregative or on household data which included only a very limited set of economic variables (other than income) along with demographic data. In order to re-examine the linkages between economic change and fertility change at the family level, a special survey was conducted in Taiwan in 1969. While recognizing that economic factors are not wholly, perhaps not even primarily, responsible for the lowering of the birth rate, the central interest of this paper is the complex of cost and benefit considerations which may contribute to a decline of the rate, using the new data for Taiwan.