Social Cohesion and Quality of Life Among Older Adults Who Live Alone in China: A Conditional Process Analysis

Background and Purpose

Following classic theories of modernization and the family, industrialization and urbanization are leading to a convergence in family systems to a conjugal family type worldwide. Nowhere is this shift more evident or more challenging than in China, where the scope and pace of population aging and rural-to-urban migration are magnified by the size of the population and variant policies and services in rural and urban areas. Older adults who live alone occupy a critical juncture in this social demographic transition. By 2050, the percentage of persons aged 65 years or over who live alone is projected to increase 304% in rural areas and 286% in urban areas. The complex array of factors that influences living arrangements includes marital, financial and health statuses; family size and structure; cultural traditions and value placed on living independently; availability of social services and social supports; and features of housing stock and local communities. Risks associated with living alone in later life include health and functioning, mental health, mortality, risk of institutionalization and quality of life; but supportive social environments have been shown to buffer these negative outcomes. Using data from a nationally representative sample of older adults in China, we conducted a conditional process analysis to test the association of living arrangement and quality of life via social cohesion and to determine whether rural vs. urban residency moderates pathways in this mediation model.

Methods

Data are from the WHO longitudinal SAGE study of the health and well-being of adults aged 50 years or over in six developing countries (Wave 1, 2007-2010). In China, a probability sampling design and five-stage cluster sampling strategy were used to select 13,177 respondents (response rate >98%). Deletion of cases with missing values on relevant study variables and cases and those who reported living arrangements other than those examined yielded a final sample of 9,663. 

Measures are adapted from the WHO World Health Survey (WHS). Major study variables were Quality of Life (QOL) (8-item version WHOQOL-Bref; a = 0.87); living arrangement (alone = 0, with family =1); social cohesion (9-item scale of community involvement, past 12 months; a=0.61); and residency locale (rural = 0, urban =1). Controls were sex, age, education, marital status, household wealth quintile, and WHS measures of health, functional, and cognitive status, depression, anxiety, loneliness and subjective well-being.

Results

Compared to respondents living alone, those living with family had higher levels of well-being on all study variables, including QOL and social cohesion. QOL was higher in urban areas, as was social cohesion in rural areas. Social cohesion mediated the significant negative relationship between living arrangement and QOL. Of the three pathways in the mediation model, residency locale moderated only the association of living arrangement and social cohesion.

Conclusions and Implications

As industrialization and urbanization continue to impel growing numbers of older adults to live alone in China, programs and policies that strengthen social cohesion through their community involvement, especially in urban areas, can help ensure their quality of life.