Intergenerational Instrumental Support and Health Among Older Adults in Rural China: Trajectories and Correlated Change over a Decade

Background and Purpose: Understanding the developmental nature of the relationship between social support and health over time in later life has important theoretical and practical implications. Social support and health are not static but change over time. Despite there is increasing evidence that social support is associated with health in later life, however, there is much unknown regarding the social support process and how this process is associated with changes of late-life health over time. Changes in social support in later life have indicated different yet sometimes inconsistent trajectories for different types of support. Different sources of support also serve different functions in later life. In rural China, where there are scarce public resources, instrumental support exchange between older adults and their adult children is common and normative practice. This study aims to understand the dynamic relationship between multidimensional intergenerational instrumental support, both received and provided, and health over time in terms of their trajectories and correlated change.

Methods: Data came from the five waves of a longitudinal study titled The Well-Being of Older People in Anhui Province in the year 2001, 2003, 2006, 2009, and 2012, collected jointly by the Schools of Gerontology and Social Work at the University of Southern California and the Population Research Institute of Xi’an Jiaotong University, China. Older adults aged 60 and older in rural Chaohu, Anhui Province were randomly selected using stratified multi-stage sampling. There initially were 1,636 respondents who had at least one child and 567 of them were successfully followed up over 11 years. Attrition rate was comparable to other longitudinal aging studies. Self-rated health was measured by how you assess your current health status with a 4-point response set. Higher scores indicate better health. Intergenerational instrumental support was comprised of household chore help received (range = 0-16), personal care help received (range = 0-16), household chore help provided (range = 0-20), and personal care help provided (range = 0-20). Higher scores indicate higher levels of intergenerational instrumental support. Latent growth curve models using Mplus 6.12 were conducted to study change over time. A standard linear latent growth curve model was fitted for each construct. Nonlinear models were tested when appropriate. Four parallel process latent growth curve models were then conducted. Maximum likelihood estimation was used to deal with missing data.

Results: Model fit was acceptable for each dimension of support and health. Received household chore help decreased over time, whereas received personal care help increased over time. Provided household chore help and personal care help increased and then decreased over time. Self-rated health decreased over time. An increase in received household chore and personal care help was associated with a slower increase in health among older adults over time. A similar pattern did not hold for the other two dimensions.

Conclusions and Implications: Providers must assess for support provision; having support from children does not necessarily indicate stable support over time. Interventions should focus on encouraging and maintaining intergenerational instrumental support for health maintenance function in later life.