1. 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

2. 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?

3. 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.

4. 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

5. 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.

6. Social Structure and Social Support Urban/Rural Difference Educational Attainment and Occupation Sources of Financial Support

7. 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

8. The Current Study Examine how different dimensions of social support affect quality of life for China’s oldest old.

9. 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.

10. Data China’s Longitudinal Healthy Longevity Survey 1998 Sample: aged 80-110 Weighted statistics for descriptive tables

11. 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”

12. 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

13. 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%)

14. 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

20. Odds from Logistic Regression Predicting Effects of Social Support, Health,and Demographic Characteristics on Quality of Life

21. Odds of Logistic Regression Predicting Whether an Elderly Person Lives in Nursing Homes

22. 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?

23. 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

24. Implications Social security and pension in place Create networks of friends and peers –Community centers –Retirement communities –More nursing homes, especially for rural China