Health and social determinants of aging-in-place among low-income elderly Chinese city-dwellers

Abstract

OBJECTIVES: Discuss the connections between aging-in-place preferences and older adults’ health and social functioning in a low-income Chinese sample.; Discuss the differential links between physical and mental health, and between confidante relations and community participation, in shaping aging-in-place preferences among low-income Chinese older adults. ABSTRACT BODY: Promoting aging-in-place (AIP) is a WHO policy objective. The AIP decision is complex, involving evaluating environmental demands and individual competencies. Linking to psychology of aging, this study examined the health and social determinants of AIP preferences. Using cross-sectional data from 2082 low-income older city-dwellers in Hong Kong, China, we examined how AIP preference was correlated with health (i.e., frailty; depressive symptoms) and social relations (i.e., having confidantes; engaging in socially productive activities); and whether social relations predicted AIP preference above and beyond health. Mean age of the sample was 80 years (s.d.= 7.98). 48% was robust; most were pre-frail (40%) or frail (12%). Mean score on Geriatric Depression Scale was 2.93 (s.d.=3.34), indicating low depression. 73.6% preferred AIP if their health would deteriorate beyond independent living. Most had good confidantes (mean=4.63, s.d.=1.56) but few productive engagements (mean=.68, s.d.=1.17). A preference for AIP was associated with lower frailty (r=.055, p=.017), lower depression (r=.097, p<.001), less productive engagements (r=.048, p<.05), and better confidantes (r=.047, p<.05). Logistic regression analyses showed after adjusting for age and gender, when frailty and depression were added, the odds of preferring to move to a nursing home increased by 107% (OR=1.071, p<.001) for an one-unit increase in depression; frailty was non-significant. When confidants and productive engagements were added next, the odds of preferring to move to a nursing home increased by 116% (OR=1.159, p=.003) for an one-unit increase in engagement; confidantes was non-significant. Findings underscore the need to understand the health and social factors that shape AIP decisions.