Well-Being of Community-Dwelling Older Adults in China: A Multilevel Modeling Perspective

Background and Purpose. A growing body of research has suggested that physical and social environment play an important role in influencing older adults’ well-being, yet few studies investigate cultural-specific environmental determinants of well-being in later life. Drawing on the active ageing and the age-friendly environment framework, this study examined the effects of economic security and health, and physical/social environment on well-being in later life. Specifically, we examined how depression and life satisfaction among Chinese community-dwelling older adults were influenced by the individual level-level factors and community-level factors through a multilevel approach.

Methods. Using the 2011 baseline and 2013 wave of the China Health and Retirement Longitudinal Survey (CHARLS), multilevel linear regression analyses were performed with a sample of 7,688 older adults aged 60 and above in 446 communities. The well-being outcome, depression, was measured by 10-item CES-D; life satisfaction was measured a five-point rating overall satisfaction. Individual-level predictors include economic security and self-rated health. Cultural-specific community-level predictors include transportation (road passing though, degree of road tidiness), housing (sewer system, toilet type), social services (employment center, senior association), and health services (health centers, health posts). Covariates included age, gender, marital status, and education. Specifically, this study aimed to explore the relationship between individual- and community-level predictors (in 2011) and well-being outcomes (in 2013), after controlling the covariates and well-being preconditions in 2011. This longitudinal design allows a stronger test of causal relationship. Two hierarchical linear regression models (HLM) were constructed using SAS 9.3 to handle the cluster effects in well-being outcomes. Further, random slope analyses of health and economic security were performed to test whether these factors vary by communities.

Results. The intraclass correlation coefficient (ICC) from the null models indicated that 9% variance in depression and 7% variance in life satisfaction could be explained at community level. Results of the depression model showed that, on individual level, economic security (b = −.61, t = −5.37) and health status (b = −0.64, t = −6.42) were negatively associated with depressive symptoms. On community level, having sewer system in “housing” domain (b = −.61, t = −2.52) and having health center in “health services” domain (b = −0.69, t = −2.54) predicted fewer depressive symptoms. Results of the life satisfaction model showed that only economic security (b = .10, t = 5.67) in the individual level was significantly associated with life satisfaction. On community level, having sewer system (b = .08, t = 2.53) in “housing” domain predicted better life satisfaction.    

Conclusions and Implications. This study highlights the importance of examining the effects of physical/social environment in a different culture context. Further, this study suggests that both individual and community characteristics have impacts on reducing depression and improving life satisfaction in later life. On individual level, improving older adult's economic security and increasing health status are recommended. On community level, improving the basic living conditions, making the built environment more age-friendly, and providing more health services will benefit overall well-being among community-dwelling older adults in the developing countries like China.