Impact of Social Changes and Birth Cohort on Subjective Well-Being in Chinese Older Adults: A Cross-Temporal Meta-analysis, 1990–2010

Over the past several decades, the proportion of older adults in the Chinese population has steadily increased during a period of substantial social change; the effect of these changes on older adults warrants examination. The present study explored changes in subjective well-being (SWB) in older adults by birth cohort and the social factors influential in these changes. We performed a cross-temporal meta-analysis using data from 20,713 adults over 60 years of age; data were obtained from 61 studies that used the Memorial University of Newfoundland Scale of Happiness. The dynamics of SWB in older adults were evaluated as a function of time. The mean SWB score decreased by 4.98 over the measured period, indicating a decrease of .52 standard deviations between 1990 and 2010. In addition, SWB in older adults was significantly correlated with high social connectedness and low overall threat. Specifically, urbanization level, Gini coefficient, personal medical expenditure, and birth rate were strong predictors of SWB. Our research demonstrates that social connectedness and overall threat contribute to SWB in Chinese older adults. As SWB is significantly related to the mental and physical health of older adults, the present study may serve as a useful reference for health care agencies and policy-makers.     

The Demography of Mental Health Among Mature Adults in a Low-Income,High-HIV-Prevalence Context

Very few studies have investigated mental health in sub-Saharan Africa (SSA). Using data from Malawi, this article provides a first picture of the demography of depression and anxiety (DA) among mature adults (aged 45 or older) in a low-income country with high HIV prevalence. DA are more frequent among women than men, and individuals affected by one are often affected by the other. DA are associated with adverse outcomes, such as poorer nutrition intake and reduced work efforts. DA also increase substantially with age, and mature adults can expect to spend a substantial fraction of their remaining lifetime—for instance, 52 % for a 55-year-old woman—affected by DA. The positive age gradients of DA are not due to cohort effects, and they are in sharp contrast to the age pattern of mental health that has been shown in high-income contexts, where older individuals often experience lower levels of DA. Although socioeconomic and risk- or uncertainty-related stressors are strongly associated with DA, they do not explain the positive age gradients and gender gap in DA. Stressors related to physical health, however, do. Hence, our analyses suggest that the general decline of physical health with age is the key driver of the rise of DA with age in this low-income SSA context.     

Priorities in Global Assistance for Health,AIDS, and Population

This article makes three points regarding international assistance in health, AIDS, and population. First, despite growing attention in the development policy dialogue, the share of health (broadly considered) in total assistance is actually declining, not increasing, if assistance for the HIV/AIDS crisis is taken out of the picture. Second, interventions financed by international health assistance do not closely correspond to the burden of disease as conventionally calculated. HIV/AIDS receives a share of assistance in excess of its contribution to the global burden of disease, and reasons for this are adduced. Third, despite the emphasis on aligning international assistance to country priorities, a comparison of how health is treated in poverty‐reduction strategies and the nature of health assistance reveals no clear relationship between the two. This suggests that there may be room for improvement in the process of preparing such strategies, the allocation of health assistance, or both.     

Best friends: the role of confidantes in older women's health

This article explores personal, network, and community contexts in older women's friendships and health. Twenty-six older women (mean age, 67; range 55-85 years) in San Francisco were asked to choose the one individual to whom they felt the closest and then discuss how this individual contributed to their health. Their choices were numerous, diverse, contextual, and circumstantial. Other women were chosen most often; however, this belies the complexity of their choices. Confidants were chosen primarily for expressive reasons, but instrumental reasons proved important too, particularly for lower class women. Older women called upon their closest ties with physical, social, and emotional problems; they were less likely to call upon them with mental, financial, or spiritual concerns. Family members were preferred to friends for direct caregiving; however, some older women felt they would call upon their friends as well. Confidants kept older women healthy by offering advice and encouragement about diet and exercise; by providing meals and transportation; by laughing, talking, and joking with them; by keeping them happy and feeling good about themselves; and, on rare occasions, by offering spiritual guidance. Practical and policy considerations of their choices were discussed.     

Domestic Harm and Neglect Among Lesbian,Gay, and Bisexual Older Adults

This study examined harm, hurt, and neglect by caregivers as well as self-neglect and physical and mental health status among 113 lesbian, gay, and bisexual (LGB) older adults aged 60–88 years, who attended community-based social and recreation programs or groups in the United States. Reporting on their experiences with caregivers, 22.1% of the participants experienced at least one type of harm, including physical, emotional, verbal, sexual, financial, and neglectful; additionally, 25.7% of the participants reported they knew LGB older adults who experienced at least one type of harm from his or her caregiver. With regard to self-neglect, 62.8% reported experiencing it; those indicating positive psychological health reported fewer experiences with self-neglect.     

A Changing Nexus Between Unemployment and Suicide in Taiwan: Before and After Labor Welfare Improvement in the Late 1990s

The 2009 economic crisis in Greece had harsh implications on the Greek society. The crisis led to high and increasing unemployment rates, which previously found to relate to increases in suicide rates, health risking behaviors and increased risk of mental health problems. The public’s perceptions regarding the consequences of the crisis are crucial to their recovery. In order to get a comprehensive and thorough view of the public’s perceptions, which will allow to draw conclusions and recommendations for a possible effective intervention program, the current study assessed the perceptions of a representative sample of the Greek adult population (N = 3002) in three sampling waves: December 2011, March 2011 and November 2012. These assessments included questionnaires designed to evaluate perceptions of current quality of life, economic decline, coping with economic and occupational commitments, physical and psychological health, wellbeing, health related behaviors, attitudes towards emigration, sources of support and political and social trust. Findings showed significantly higher perceptions of financial uncertainty and difficulties coping with economic commitments. Participants generally rated their psychological health lower than their physical health. Trust ratings were also found to be generally low, especially for younger populations. Younger populations also showed a more willing attitude towards emigrating out of Greece, compared to older populations. Coping measurements revealed a strong possible tendency to go back to the traditional ties of confidence and trust in family and friends as sources of support. In light of the results, we recommend to build programs that see the family and the local community as a resources of resilience and coping.     

Introduction: the need to address older women's mental health issues

Women are the primary consumers of mental health services. Ironically, research addressing their unique needs lags behind that of men's issues. The aging process introduces an important variable that accentuates the relative lack of information and specific treatment guidelines for older women who are confronted by mental health problems. This volume offers a comprehensive overview for the health professional who is seeking a greater depth of understanding with respect to the study of mental health problems in general, and how these issues pertain specifically to women and the aging process. A second goal of this project is to provide the practicing therapist and counselor with a research update and a broad clinical perspective offered by seasoned clinicians. Using current psychiatric diagnosis as a framework, the contributions address the range of mental health problems, including dementia and cognitive impairment, schizophrenia, alcohol abuse, mood and anxiety disorders, traumatic and dissociative conditions, sexual and eating disorders, and personality disorders. It is hoped that this book will inform, inspire and encourage students and health professionals in their work with middle aged and older women who are facing mental health challenges.     

Self-perceived health status,gender, and work status

ABSTRACT

This study analyzes the relationship between gender and self-perceived health status in Spanish retirees and housewives from a sample of 1,106 community-dwelling older adults. A multivariate linear regression model was used in which self-perceived health status was measured by the EQ-5D visual analogue scale and gender according to work status (retired men and women and housewives). Retired males reported a significantly better health status than housewives. Self-perceived health status was closely associated with physical, mental, and functional health and leisure activities. Finally, being a woman with complete dedication to domestic work is associated with a worse state of self-perceived health.     

Caregiving and Care-Receiving:

Many aspects of aging are women's issues. Yet research on aging has, until recently, focussed little attention of gender differences in the experience of growing old. Older women are more likely than older men to be poor, widowed, living alone in poor health, receiving assistance from both formal and informal supports, as well as being institutionalized in long-term care facilities. This secondary analysis of data from the 1982 Survey of the Elderly in the Waterloo Region attempts to address a gap in our knowledge concerning gender differences in the giving and receiving of social support in later years. Gender differences in (1) need for social support, (2) turning to formal assistance, (3) amount of formal assistance used, and (4) amount of informal assistance received were examined using analysis of variance and logistic regression procedures. The profile of social support that emerged suggests both similarities and differences in the way elderly men and women experience the giving and receiving of social support. Older women in this sample were found to be disadvantaged in the areas of income, health, years lived alone, and loneliness, relative to older men. Low-income was related to formal service use for older women, but not for older     

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.     

Determinants of Mortality at Older Ages: The Role of Biological Markers of Chronic Disease

Researchers have had a longstanding interest in understanding the determinants of mortality. This article examines the impact of a broad array of biological markers, together with self‐reports of physical and mental health status, on the probability of dying for older adults. The estimates are derived from logistic regression models based on data from a national survey in Taiwan. The analysis confirms previous studies demonstrating the effects of clinical measures related to metabolic syndrome on mortality and identifies detrimental effects of neuroendocrine and immune‐system markers. The results reveal that biomarkers provide independent explanatory power in the presence of self‐reported health measures. The associations between biomarkers and mortality found here provide new avenues for projecting future mortality and elucidating differences in longevity across populations.     

Care arrangement choices for older widows: decision participants' perspectives

This research examines how a wide range of care arrangement decisions for frail older women are made. Interviews were conducted with 11 older women (ten of whom are widows), nine of their family members, and six professional service providers. Maintaining the older woman's independence was identified as a major theme. While all decision participants identified it as an explicit or implicit decision-making goal, their meanings of independence were different. The older women's meanings were flexible, changing in response to changes in their physical condition and need for assistance. Adult children tended to identify their mothers as independent when they did not actually need assistance, or when they received help from other sources (e.g., home health care). Professional service providers were inclined to define independence narrowly, as avoiding nursing home placement. Minor themes associated with independence include responsibility, reciprocity, and the family's importance in maintaining independence. These themes help to clarify the complex dynamics that take place during care arrangement decisions and explain how care arrangement choices are made.     

Returns on Lifetime Investments in Children in Egypt

Parental expectations about the companionship and assistance they will receive in later life from their children are key considerations in family formation decisions. We explore patterns of parents’ investment and the support and contact they receive from adult children in Egypt, where fertility is falling and sources of support at all life stages are in flux. Using data from a survey of older adults in Ismailia governorate, we consider parents’ past investments in childbearing, child survival, and children’s education and marriage, as well as recent assistance to adult children via housing, care for grandchildren, gifts, and money. The returns from children considered include economic assistance, instrumental support, and visits. Most parental investments are associated with frequent visits from children. The assistance children provide to parents is gendered: sons tend to provide economic transfers, whereas daughters tend to provide instrumental help. A greater number of surviving children is most strongly associated with parents’ receipt of multiple types of later-life returns. Investments in children’s education and marriage are not associated with assistance, but recent assistance to children—especially economic transfers and provision of housing—is associated with receiving instrumental assistance from adult children.     

Discrimination Against Older Women in Health Care

Growing awareness of apparent gaps in health care received by women and men raises concern over possible discrimination. This literature review examines this issue for elderly women, whose health care is obtained in a system that also may be permeated with age discrimination. Physicians tend to spend more time with women and older patients, suggesting that discrimination may not be an issue in the physician-patient relationship or may work in favor of older women. However, this may simply reflect elderly women's poorer health. Gender and age disparities in medical treatments received provide a more compelling argument that the health care system is a source of discrimination against older women, who are less likely than others to receive available treatments for cardiac, renal, and other conditions. The history of medical treatment of menopause suggests that stereotypes of older women have been advantageous for segments of the health care system. Finally, in addition to discrimination that has its source within the health care system itself, societal-wide inequities, particularly economic, are extremely detrimental to older women's health care. As we respond to the health care crisis, we must be alert to the potential to rectify those structures and tendencies that can lead to discrimination against women and the aged. Health care reform presents a unique opportunity to ensure health care equity.     

Care Arrangement Choices for Older Widows: Decision Participants' Perspectives

SUMMARY

This research examines how a wide range of care arrangement decisions for frail older women are made. Interviews were conducted with 11 older women (ten of whom are widows), nine of their family members, and six professional service providers. Maintaining the older woman's independence was identified as a major theme. While all decision participants identified it as an explicit or implicit decision-making goal, their meanings of independence were different. The older women's meanings were flexible, changing in response to changes in their physical condition and need for assistance. Adult children tended to identify their mothers as independent when they did not actually need assistance, or when they received help from other sources (e.g., home health care). Professional service providers were inclined to define independence narrowly, as avoiding nursing home placement. Minor themes associated with independence include responsibility, reciprocity, and the family's importance in maintaining independence. These themes help to clarify the complex dynamics that take place during care arrangement decisions and explain how care arrangement choices are made.     

Home Front: Post-Deployment Mental Health and Divorces

Since 2003, about 14 % of U.S. Army soldiers have reported symptoms of posttraumatic stress disorder (PTSD) following deployments. In this article, we examine how post-deployment symptoms of PTSD and of other mental health conditions are related to the probability of divorce among married active-duty U.S. Army soldiers. For this purpose, we combine Army administrative individual-level longitudinal data on soldiers’ deployments, marital history, and sociodemographic characteristics with their self-reported post-deployment health information. Our estimates indicate that time spent in deployment increases the divorce risk among Army enlisted personnel and that PTSD symptoms are associated with further increases in the odds of divorce. Although officers are generally less likely to screen positive for PTSD than enlisted personnel, we find a stronger relationship between PTSD symptoms and divorces among Army officers who are PTSD-symptomatic than among enlisted personnel. We estimate a larger impact of deployments on the divorce risk among female soldiers, but we do not find a differential impact of PTSD symptoms by gender. Also, we find that most of the effect of PTSD symptoms occurs early in the career of soldiers who deploy multiple times.     

Quality of Life in Older Adults: Benefits from Caring Services in Hong Kong

Many older adults are in need of care. Therefore, older people would generally benefit from the use of caring services, notably including home care, residential care, nursing, and medical services. The contributory factors underlying caring services tend to be a caring perspective that aspires to sustain older people’s social relationships and real-life involvement. To gauge the benefits from various social and health services, the present study relies on a large-scale survey of 3000 older adults in Hong Kong, using quality of life as a criterion. Results showed that an older adult who had used (ordinary or enhanced) home care services for a longer time turned out to have appreciably more improvement in quality of life. Besides, those who joined an interest group more frequently were higher in quality of life, including the health domain. On the other hand, frequent use of medical and meal-to-home services were signals that reflected problems detrimental to the older user’s quality of life. Despite this, the quality of clinics or hospitals, as perceived by the older adult, was the most beneficial. As such, caring services that foster older adults’ interests, cater to their health care needs, and embody quality can have principal contribution to their users’ quality of life.     

Older Women Caring for Older Women: The Rewards and Challenges of the Home Care Aide Job

As our population ages, the need for personal assistance services increases. Paid personal care is predominantly provided by women, often older women, and has been considered low-status, low-wage work. This article reports on a mixed-method, longitudinal study of 261 home care aides; study participants were 46 years old, on average. Predictors of termination included younger age and lack of health insurance. Study participants reported more rewarding than challenging aspects to the job, though low and inconsistent compensation often forced them to leave the work they loved. Implications of the study with regard to older women caring for older women are explored.     

Children and the Mental Health of Older Adults in China: What Matters?

China is witnessing several major demographic, socioeconomic, and cultural trends that likely intersect in unique and significant ways to influence the health and well-being of its older adult population. Concerns that such trends may be eroding traditional family structures and values raise questions about the continued importance and impact of children on the lives of their older parents. Do children matter and, if so, what is it about having children that makes a difference to the mental health of their parents? This study addressed these issues using baseline data drawn from the Chinese Longitudinal Aging Social Survey, conducted in 2014. Multivariate OLS regression analyses revealed the importance of having children for parental mental health. This relationship was found to be mediated by economic/utilitarian factors (co-residence, the receipt of financial, and instrumental support) as well as psychological/emotional factors (companionship, emotional support), and social/traditional factors (children’s socioeconomic status achievements). These findings support the view that children continue to be important to the mental health of their older parents in contemporary China. Further, what matters most when it comes to understanding the influence that children have on parents’ mental health are their perceived accomplishments in life and their meaningful presence in the day-to-day lives of their parents.