Living arrangements and dietary quality of older U.S. adults

The association between living arrangement and dietary quality of older U.S. adults was investigated in 4,402 adults aged 55 years or older who participated in the Nationwide Food Consumption Survey, 1977 to 1978. Dietary quality was based on percent of Recommended Dietary Allowances for 3-day intakes of nine nutrients. More men living alone consumed a poor-quality diet than did men living with a spouse, particularly those 75 years or older; for women, this effect was seen only in the 55- to 64-year-old group. In general, more women than men had poor-quality diets. A number of factors (economic, employment, health status, energy intake, body mass index, and nutrient supplement use) were examined for their importance in accounting for differences in dietary quality of older men and women living alone compared with those living with a spouse. Energy intake was the most important variable accounting for the association of living arrangement with dietary quality. Evidence indicated that older adults living alone did not make poorer food choices than those living with a spouse, but rather that they consumed fewer calories.     

Why older people living with a spouse are less likely to be institutionalized: the role of socioeconomic factors and health characteristics

AIMS: To examine whether the lower risk of institutionalization among older adults living with a spouse as compared with those living alone or with other persons could be explained by socioeconomic factors, housing, and chronic medical conditions. METHODS: We used population-based follow-up data on Finnish adults aged 65 years and over (N=280,722), covering the period from January 1998 to September 2003, to analyse the risk of entering into long-term institutional care by living arrangements. Kaplan-Meier estimates and Cox regression models were applied. RESULTS: Among men, those living alone had a 70% higher risk and those living with other persons a 56% higher risk of being institutionalized than those living with a spouse, independently of age, region, and urbanicity. The corresponding figures for women were 29% and 21%. Among men, the lower risk of institutionalization among those living with a spouse than among those living alone was partly explained by higher educational level, occupation-based social class, household income, home ownership, house type, better housing conditions, and lower likelihood of having depressive symptoms. Almost the same factors helped to explain the lower risk among women, except that those living with a spouse were not advantaged in terms of education or having fewer chronic diseases. CONCLUSIONS: As controlling for socioeconomic factors, housing and health characteristics explained only 35-43% of the lower risk of institutionalization among those living with a spouse as compared to those living alone, having a spouse seems to have a major independent role in preventing and delaying institutionalization among older men and women.     

Living arrangements, changes in living arrangements, and survival among community dwelling older adults.

OBJECTIVES: This study examines whether living arrangements and changes in living arrangements are associated with survival among older community-dwelling adults, and whether differences in health status account for observed differences in survival. METHODS: The sample consisted of 5085 persons aged 70 years or older who had participated in the Longitudinal Study of Aging in 1984 and 1986. Proportional hazards models were used to examine associations of survival time through 1990 with living arrangements in 1984 and with changes in living arrangements from 1984 to 1986. RESULTS: Women who lived with someone other than a spouse at baseline or who changed from living with a spouse to living with someone other than a spouse were at greater risk of dying than women in other living arrangements, independent of health status or functioning. Among men, survival time was not generally associated with baseline living arrangements. CONCLUSIONS: Older adults who live alone or who change from living with someone to living alone do not have an increased mortality risk. However, living with or changing to living with someone other than a spouse may be associated with increased mortality risk.     

Living arrangements and survival among middle-aged and older adults in the NHANES I epidemiologic follow-up study.

BACKGROUND. There is concern about but little information on how living alone affects the health and survival of older adults. METHODS. We examined the association between living arrangements (living alone, with a spouse, or with someone other than a spouse) and survival among 7651 adults, aged 45 to 74 years in the National Health and Nutrition Examination Survey (NHANES I) (1971-1975) and traced at the NHANES I Follow-up Study (1982-1984), to see whether certain sociodemographic factors (race, education, income, and employment), health behaviors (alcohol, smoking, physical activity, and obesity), or chronic medical conditions were influential in the association. RESULTS. We found a stronger association of living arrangements with survival for men than for women, and for middle-aged men than for older men. For men, those living alone and those living with someone other than a spouse were equally disadvantaged in terms of survival. Income, race, employment, and physical activity influenced the association of living arrangements and survival, but their impact varied by age, gender, and living arrangement. CONCLUSION. Living arrangements had a weak impact on survival among men, but had no effect among women.     

Health among the oldest-old in China: Which living arrangements make a difference?

This study aims to (1) examine the association of living arrangements and health among oldest-old Chinese, and (2) investigate gender differences in the association of living arrangements and health. Data were from the first two waves of the Chinese Longitudinal Healthy Longevity Survey, which included 9093 Chinese averaging 92 years old. Living arrangements had six mutually exclusive categories: living alone, with spouse, with children, with spouse and children, with others and in institutions. Using multinomial logistic regression, we found that baseline living arrangements are significantly associated with mortality, activities of daily living (ADL) disability, and self-rated health at Wave 2, controlling for baseline health, sociodemographic characteristics and availability of children. Further, the linkages between living arrangements and mortality vary by gender. Among the different living arrangements, having a spouse in the household (either with a spouse only or with both a spouse and children) provides the best health protection. Living alone and living with children are associated with both health advantages and disadvantages. Institutional living lowers mortality risk for men but not women. Living with others provides the least health benefits. Our study has extended the research on living arrangements and health to a unique population—the oldest-old in China—and clarified the health advantages and disadvantages of different living arrangements. Future research should examine the mechanisms linking living arrangements and health, and the experience of institutional living for men and women in China.     

Living arrangements, social integration, and change in functional health status

Limited prospective data have examined the association between living arrangements and emotional wellbeing. The authors assessed whether older women living with a spouse were less likely to experience a decline in mental health, vitality, or physical function compared with women living alone or with nonspouse others. The association between living arrangement and 4-year change in functional health status was examined prospectively among 28,324 women aged 60-72 years in the Nurses' Health Study. After adjustment for age, baseline function, comorbid conditions, and health behaviors, women living alone had lower risk of decline in mental health (relative risk (RR) = 0.73, 95 percent confidence interval (CI): 0.65, 0.81) and vitality (RR = 0.72, 95 percent CI: 0.65, 0.80) compared with those living with a spouse. Contact with friends and relatives and level of social engagement were significantly protective against a decline in mental health among women living alone but not among women living with a spouse. These results suggest that women living independently are neither socially isolated nor at increased risk for decline in functional health status. In fact, these women actually fare better on measures of psychologic function than do women living with a spouse.     

Doctors' age at domestic partnership and parenthood: cohort studies

Objective To report on doctors' family formation. Design Cohort studies using structured questionnaires. Setting UK. Participants Doctors who qualified in 1988, 1993, 1996, 1999, 2000 and 2002 were followed up. Main Outcome Measures Living with spouse or partner; and doctors' age when first child was born. Results The response to surveys including questions about domestic circumstances was 89.8% (20,717/23,077 doctors). The main outcomes - living with spouse or partner, and parenthood - varied according to age at qualification. Using the modal ages of 23-24 years at qualification, by the age of 24-25 (i.e. in their first year of medical work) a much smaller percentage of doctors than the general population was living with spouse or partner. By the age of 33, 75% of both women and men doctors were living with spouse or partner, compared with 68% of women and 61% of men aged 33 in the general population. By the age of 24-25, 2% of women doctors and 41% of women in the general population had a child; but women doctors caught up with the general population, in this respect, in their 30s. The specialty with the highest percentage of women doctors who, aged 35, had children was general practice (74%); the lowest was surgery (41%). Conclusions Doctors are more likely than other people to live with a spouse or partner, and to have children, albeit typically at later ages. Differences between specialties in rates of motherhood may indicate sacrifice by some women of family in favour of career.     

Living with loss: middle-aged men face spousal bereavement

Spousal bereavement is one of the most profoundly disturbing events encountered in the human life span. Research has shown that conjugal bereavement has significant physical and psychological consequences for the surviving spouse. In American culture, men and women experience bereavement in different ways. The author used in-depth interviews in the tradition of phenomenology to collect data from 8 men aged 41 to 54 years who had experienced the death of their spouse within the previous 8 months to 6 years. The research revealed the lived experience of spousal bereavement to be a journey from the realization of irreconcilable loss through themes of responding to the loss and living through the loss toward reclamation and reconstruction of a life.     

Marriage and diet in elderly Australians: results from a large random survey

Living arrangement, marital status and dietary patterns were examined for a representative sample of 2195 people aged 65 years and over residing in Adelaide, South Australia. Several indicators of food consumption patterns, dietary variety, and energy and nutrient intake from a self-completed semiquantitative food-frequency questionnaire were analysed. Elderly men living with a spouse generally had more favourable dietary patterns than those living alone. Women living alone, on the other hand, had largely similar dietary patterns, and nutrient intakes equal to or greater than those of women living with a spouse.     

Living arrangements affect dietary quality for U.S. adults aged 50 years and older: NHANES III 1988-1994

The number and proportion of older U.S. adults who live alone have increased dramatically in the past three decades, and there is concern that these individuals may have particularly poor dietary quality. We examined the association of four living arrangements (living with a spouse only, with a spouse plus someone else, with someone other than a spouse or living alone) with dietary quality (the number of low nutrients out of a possible 15, with low defined as <67% of the recommended dietary allowance) among 6525 U.S. adults aged 50-64 y and those >/=65 y in the third National Health and Nutrition Examination Survey (NHANES III 1988-1994). Among non-Hispanic Caucasian adults, those who lived with a spouse only had better dietary quality, with significant differences ranging from 0.8 to 1.5 fewer low nutrients compared with those with other living arrangements. Effects of living arrangements on dietary quality were also seen among non-Hispanic African-Americans, Mexican-Americans, and those of "other" races, but differences were significant only for African-American men aged >65 y living with a spouse plus others (1.6 additional low nutrients compared with those living with a spouse only). Energy intake was strongly associated with dietary quality, but did not account for the associations between living arrangements and dietary quality. Although middle-aged and older adults with living arrangements other than living with a spouse only (including those living alone) tended to have poorer dietary quality, the effects varied substantially across age, gender and ethnic categories.     

Living arrangements and health behaviors in adolescence and young adulthood

This paper discusses the significance of living arrangementsfor the adoption of health behaviors in a national sample of1458 adolescents and young adults in the age group 16–25years in Norway. Living arrangements were operationalized interms of living with spouse or partner, living with parents/siblingsor living alone. Results from multiple logistic regression analysesshowed that the effect of living arrangements was most significantfor health compromising behaviors, i.e. smoking and alcoholconsumption. Results from discriminant analyses indicated thatadolescent men and women constituted two separate systems ofengagement in health behaviors but that living arrangementsfunctioned in the same manner within each system.     

The Effects of Social Activities and Living Arrangements on Cognitive Functions in Middle-aged and Elderly Adults: A Panel Study Using the 2006-2018 Korean Longitudinal Study of Aging

ObjectivesPrevious studies have shown that participation in social activities (SA) can prevent cognitive decline (CD) and that living arrangements (LA) can affect cognitive function. This study aimed to evaluate the effects of SA and LA on CD, as well as their interactions, using longitudinal data.MethodsData were used from the 2006-2018 Korean Longitudinal Study for Aging, which followed 10 254 adults older than 45 years over a 12-year period. CD was defined as a ≥4-point score decrease in the Mini-Mental Status Exam over 2 years. We developed an extended Cox proportional hazards model for time-dependent covariates to estimate the hazard ratio (HR) of CD in 4 groups: (1) socially active and living with others, (2) socially active and living alone, (3) socially inactive and living with others (SILO), and (4) socially inactive and living alone (SILA). The model was stratified by gender and adjusted for important confounders.ResultsThe HR of CD was significantly higher in the SILO group in men (HR,1.36; 95% confidence interval [CI], 1.08 to 1.78) and in the SILA group in women (HR, 1.72; 95% CI, 1.08 to 2.75). However, the interaction term for gender was not significant.ConclusionsAmong socially inactive elderly adults, the HR of CD was elevated in men who lived with others and in women who lived alone, although the interaction term for gender was not significant. Socially inactive men who live with others and socially inactive women who live alone are particularly encouraged to participate in SA to prevent CD.     

Living arrangements, heavy drinking and alcohol dependence

AIMS: To assess the variation in heavy drinking and alcohol dependence by living arrangements, and the contribution of social and behavioural factors to this variation. DESIGN: The Health 2000 survey is a nationally representative cross-sectional survey conducted in Finland in 2000-2001 (N = 4589 in the age-range of 30-54 years, response rate 81%). MEASUREMENTS: Living arrangements; married, cohabiting, living with other(s) than a partner, and living alone. Consumption of beer, wine and spirits in the past month was converted into grams of alcohol/week, and heavy drinking was classified as > or =280 (men) and > or =140 (women) grams/week. Twelve-month prevalence of alcohol dependence was diagnosed by a mental health interview (CIDI). FINDINGS: As compared to the married, cohabiting and living alone associated with heavy drinking (age-adjusted OR; 95% CI: 1.71;1.17-2.49 and OR 2.15;1.55-3.00 in men; OR 1.54;0.96-2.46 and OR 1.67;1.07-2.63 in women) and alcohol dependence (OR 2.29;1.44-3.64 and OR 3.66;2.39-5.59 in men; OR 2.56;1.10-5.94 and OR 4.43;2.03-9.64 in women). Living with other(s) than a partner associated with heavy drinking. Those who cohabited without children or lived alone had the highest odds for alcohol dependence. Among both genders, adjusting for main activity and financial difficulties attenuated the odds for heavy drinking and alcohol dependence by approximately 5-30% each, and additionally among women adjusting for urbanisation attenuated the odds for heavy drinking by approximately 15-45%. CONCLUSIONS: Cohabiting and living alone are associated with heavy drinking and alcohol dependence. Unemployment, financial difficulties and low social support, and among women also living in an urban area, seem to contribute to the excess risk.     

Predictors of mortality in a disabled and elderly population receiving domiciliarly based services

Predictors of mortality were evaluated after a period of 26 months for 218 persons receiving domiciliary nursing and/or domiciliary assistance. They were living in Posio, a rural commune in northern Finland. Twenty-six (12%) persons died during the follow-up of 26 months. The prospects for survival were slightly poorer among the persons with a poor physical mobility and among those living together with their spouse, and slightly better for those persons who lived alone as compared with persons living with another person or persons. The predictions of mortality among long-term home-care patients seemed not to be the same as those of the institutionalized aged population. The findings warrant further research in this respect.     

Determinants of self-rated health among elderly persons in S?o Paulo, Brazil]

OBJECTIVES: To investigate the influence that demographic determinants, socioeconomic determinants, chronic diseases, and functional capacity have on self-rated health among elderly persons (60 years and older) living in the city of S?o Paulo, S?o Paulo, Brazil, and to investigate the existence of differences between men and women in terms of their self-rated health. METHODS: The study was carried out using data collected in the city of S?o Paulo as part of a project called Health, Well-being, and Aging in Latin America and the Caribbean (the "SABE project"). We analyzed data on 2,135 elderly individuals (58.6% women; mean age, 69.4 years; median age, 68.0 years). The dependent variable was self-rated health (good or poor). The following independent variables were considered: (1) demographic ones (age, sex, marital status, and living arrangements (whether the elderly person lived alone or with others)), (2) socioeconomic ones (schooling and income), (3) the number of chronic diseases (hypertension, arthritis or rheumatism, cardiovascular disease, diabetes, asthma, bronchitis or emphysema, embolism or stroke, and cancer), and (4) functional capacity. To estimate the association between self-rated health and the independent variables and to study gender differences, a multiple binary logistic regression analysis was performed. RESULTS: The presence of chronic diseases in association with gender was the strongest determinant of self-rated health among the elderly in S?o Paulo. Among men with four or more chronic diseases, they were 10.53 times as likely to characterize their health as poor; among women with four or more chronic diseases, the ratio was 8.31. Functional capacity, schooling, and income were also strongly associated with self-rated health, and the influence of age was significant. The elderly women were more likely to report good self-rated health than were men when the women or men either had no chronic diseases or had two or more. CONCLUSIONS: Our results indicate the need for simultaneous, comprehensive actions in the health sector, social services, and the economic sector to address the main determinants of self-rated health in order to promote well-being and quality of life among the elderly.     

Elderly men living alone: are they at high nutritional risk?

This review article investigates the influence of living arrangements on the dietary intake and nutritional status of elderly men. Elderly men living alone have been identified as a group particularly at risk of poor dietary habits, however available evidence is inconsistent. Data from the United States suggests that low income elderly men living alone are at high risk of an inadequate dietary intake, and that a low energy intake is the most important predictor of a poor quality diet in this group. In Australia, older men living with a spouse have a better quality diet (higher nutrient density) than those living alone or with a person or persons other than a spouse, particularly regarding fruit and vegetable intake; differences in nutrient intake are not explained by lower energy intakes. In contrast, older men in European countries who live alone appear to have a more favourable dietary intake as compared to their counterparts in other living arrangements. Information on the association between living arrangements and household food security in the elderly in developing countries is sparse, however single living among older men is rare and the ethos of the extended family appears to remain intact. The inconsistencies in the apparent level of nutritional risk associated with living alone in elderly men in different countries necessitates the development and validation of screening programmes and nutrition services which are country-specific.     

Social inequalities in the association between partner/marital status and health among workers in Spain

The objectives of this study are to examine the association between partner/marital status and several health outcomes among workers and to assess whether it depends on gender and occupational social class. The sample was composed of all workers aged 21-64 years interviewed in the 2006 Spanish National Health Survey (8563 men and 5881 women). Partner/marital status had seven categories: married and living with the spouse (reference category), married and not living with the spouse, cohabiting, single and living with parents, single and not living with parents, separated/divorced and widowed. Four health outcomes were analysed: self-perceived health status, mental health, psychiatric drugs consumption and hypertension. Multiple logistic regression models stratified by sex and social class were fitted. Female manual workers who were cohabiting were more likely to report poor self-perceived health status, poor mental health status, psychiatric medication consumption and hypertension than their married and living with the spouse counterparts. In that group the prevalence of poor health outcomes was even higher when compared with single people. Among male non-manual workers, being married and not living with the spouse was associated with poor self-perceived health status, poor mental health status and hypertension. There were almost no differences in health between being married and the rest of partner/marital status categories for different combinations of gender and social class and, even, some groups of single people reported better health outcomes than people who were married. Our results show no evidence that being married and living with the spouse is unequivocally linked to better health status among Spanish workers. They emphasize the importance of not only considering marital status, but also partner status, as well as the role of gender, social class and the sociocultural context in the analysis of the association between family characteristics and health.     

Risk for disordered eating relates to both gender and ethnicity for college students

OBJECTIVE: To estimate the frequency of disordered eating behaviors among college students and associations by gender, ethnicity, participation in social organizations and college athletics and to determine whether responses to eight health behavior and attitude questions and body weight predicted a high score on the Eating Attitudes Test (EAT)-26, a screening instrument used to identify risks of developing an eating disorder. METHODS: Subjects were a convenience sample of 1,899 college students (cleaned to 1620) who attended four classes, were members of 14 sororities or lived in five residence halls. Students reported height and weight and responded to the EAT-26 and eight items regarding health behaviors and attitudes. RESULTS: Among women and men, 4.5% and 1.4%, respectively, reported previous treatment for an eating disorder, and 10.9% of women and 4.0% of men were at risk for eating disorders (scores > or = 20 on EAT). Among African-Americans, 8.3% of women were at risk. One group of women who lived separately in a social sorority had the highest risk of 15%. The frequency of "weight concerns interfering with academic performance" and "eliminating high fat foods" was moderately correlated to risk for disordered eating for both genders. Body mass only weakly related to risk for disordered eating and the association varied by subgroup. CONCLUSION: Students at risk for disordered eating report weight concerns interfering with their academic performance and include both men and African-Americans, as well as Caucasian American women. Sorority women living in separate residences might be at increased risk.     

Aspects of Quality of Life in Old Age: Studies on Life Events,Bereavement and Health

Psychological reactions and health-related quality of life were studied in relation to stressful life events, such as bereavement and ill health, among younger elderly persons (70–76 years) living in their own homes. The present studies are part of the gerontological and geriatric population studies in Göteborg, Sweden.

I. Grief reactions studied in 50 newly bereaved subjects were characterised by loneliness, low mood, fatigue, anxiety and perceived cognitive dysfunctioning, generally diminishing during the one-year follow-up. Post-bereavement hallucinations and illusions one month after death of the spouse were feeling presence (illusions) (52%), seeing, hearing and talking to the deceased (26%, 30%, 30%), and being touched (6%). There was no spontaneous disclosure of hallucinations/illusions, although almost all subjects found it comforting and helpful. The quality of life was significantly lower among the bereaved than among married people.

II. Stressful life events were experienced by 2/3 of the sample (n = 565) between 70 and 76 years of age, mostly related to health and bereavement. However, there was no relationship between life stresses and cognitive decline, except for the bereavement situation, especially in men.

III. Quality-of-life (QL) domains and health-related problems in daily areas were measured at 76 years of age with the Nottingham Health Profile (NHP). In the sample (n = 565) 97% were ambulant and lived independently. Although the majority (80%) had one or more diseases or disorders, they felt healthy and had good health-related QL. Impaired QL was related to observed and perceived illness, institutionalization, widowhood, lacking someone close and being financially discontent. Women had more pain, emotional, sleep and mobility problems than men. Generally, mobility problems had the most negative influence on daily activities.

IV. About half of the sample had more than one diagnosis and health-related QL was found to deteriorate in proportion to the number of diagnoses, especially in lack of energy, pain, sleep and mobility problems. Surprisingly, emotional reactions and social isolation withstood the influence of multiple morbidity. Anginal pain, urinary incontinence, locomotor and mental disorders were most closely associated with impaired QL.

V. Dizziness (34% in women and 23% in men), mostly reported as unsteadiness, was significantly associated with locomotor disorders, anginal pain, incontinence, stroke/paresis and mental disorders. Dizziness had a detrimental influence on health-related QL and was associated with anxiety, nervousness, depression and memory problems. It should be recognized as a serious complaint, especially when it is reported to interfere with daily life.

VI. Health-related QL was studied in a female group (n = 120) with urinary incontinence and compared with the age-matched IVEG sample (n = 313). QL was reduced in the incontinent group as regards emotional reactions and social isolation.