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Urban and Rural Factors Associated with Life Satisfaction among Older Chinese Adults

2019-03-08 17:36:28     作者:博彩棋牌     

 

Chengbo. Li,a Iris Chi,b Xu. Zhang,c Zhaowen. Cheng,c Lei. Zhang,c and Gong. Chenc*

 

a School of Journalism and Communication, Chongqing University, Chongqing, China

bSchool of Social Work, University of Southern California, Los Angeles, USA

c Institute of PopulationResearch, Peking University, Beijing, China

From Aging and Mental Health, 19(10), 947-954. (Publication time:Oct.2015) [SCI&SSCI]

Objective: This study comparedurban and rural factors associated with life satisfaction among older adults in mainland China.

Method:Study data were extracted at random from 10% of the Sample Survey on Aged Population in Urban/Rural China in 2006for 1,980 participants aged 60 and older, including 997 from urban cities and 983 from rural villages.

Results: In this study, 54.6% of urban older adults and 44.1%of rural older adults reported satisfaction with their lives. Binary logistic regression analysis showed that financial strain, depressive symptoms, filial piety, and accessibility of health services were significantly associated with life satisfaction for both urban and rural participants, but age and financial exchange with children were only associated with life satisfaction among urban older adults.

Conclusion:Findings are consistent with some previous studiesthat indicated the importance of financial strain, depressive symptoms,filial piety, and accessibility of health services to life satisfaction among the older adults in both urban and rural areas.This study also demonstrated the importance of age and family financial exchange to the life satisfaction of urban older adults.

Keywords: life satisfaction, urban–rural comparison, older Chinese adults


 

Introduction

Life satisfaction is defined as an overall assessment of one’s life, including current status (Bowling, 1990; Chou & Chi, 1999; Neurgarten, Havighurst, & Tobin, 1961). Life satisfaction is of particular interest in the study of subjective well-being among older adults because it is an enduring component of subjective well-being (Gana et al., 2013), a central aspect of well-being, and a subjective expression of successful aging (Ghubach et al., 2010; NíMhaoláin et al., 2012).

Many studies have focused on factors associated with life satisfaction among older adults,with findings indicating six main factors: demographic characteristics, physical and psychological health, family support, family relations, health care factors, and participation in activities. Studies have found many demographic attributes of older adults are associated with life satisfaction. For instance, age negatively affects life satisfaction among older adults (Meléndez, Tomás, Oliver, & Navarro, 2009) and is particularly associated with life satisfaction among older Korean people(Kim &Sok, 2012).Aging andthe experience of older adulthood often results in a lower life satisfaction among individuals 75 years of age or older (Hermann, 2007; Mollaoğlu, Tuncay, &Fertelli, 2010); research also found a slightly higher life satisfaction for men(Ferring et al.,2004).Educational attainmentis positively and significantly related to life satisfaction (Heo& Cho, 2008; E.-K. O. Lee & Lee, 2011, 2013; H. Li, Chi, &Xu,2013; W. Zhang&Liu, 2007).Marital status is strongly related to life satisfaction;widowhood in particular is negatively associated with life satisfaction and married older adults typically have higher levels of life satisfaction than non-marriedindividuals (Hsu, 2012; Liu &Guo,2008;Mroczek&Spiro, 2005).Some studies have shown that living arrangements are consistently related to life satisfaction among the older adults; specifically, living alone is associated with lower life satisfaction(Liao,Chang, & Sun, 2012; Silverstein,Cong, & Li, 2006;W. Zhang & Liu, 2007).Research has alsodemonstrated that financial strain or financial adequacy is a strong predictor of life satisfaction (Bishop,Martin, Johnson, & Poon, 2003; Chen & Silverstein, 2000;Katz, 2009).Financial strain is consistently negatively related to life satisfaction among older adults in economically underdeveloped countries(Chen & Silverstein, 2000). Moreover, some research has shown that the direction of the relationship between financial strain and life satisfaction is unclear, although the relationship may be reciprocal (Y. Li, Aranda, & Chi, 2007).

Having better physical and psychological health is a predictor of greater life satisfaction (Hsu, 2012), as are self-rated health and physical functional impairment (Deeg& Bath, 2003; Gutiérrez,Tomás, Galiana, Sancho, &Cebrià, 2013; Katz, 2009; Kim &Sok, 2012; H. Li et al., 2013; L. W. Li & Liang, 2007; Silversteinet al., 2006; Wilhelmson, Fritzell, Eklund, &Dahlin-Ivanoff,2013).Having a depressive disorder is more strongly associated with less life satisfaction than physical frailty (Ghubach et al., 2010; Meléndez et al.,2009;NíMhaoláin et al., 2012).Family support ispositively associated with life satisfaction among older adults(Kim &Sok, 2012).Research found that financial support from children contributes to life satisfaction among rural older adults in China (H. Li et al.,2013; Silversteinet al., 2006). Providing support to adult children and capacity to provide support can enhance self-esteem and life satisfaction among older adults, whereasfilial norms and being mainly a recipient of help from adult children are related to a lower level of life satisfaction(Katz, 2009; G. R. Lee,Netzer, & Coward, 1995; Lowenstein,Katz, &Gur-Yaish, 2007).Relationships with adult children are also an important determinant of life satisfaction among older adults (Katz, 2009).Family harmony and filial piety are strongly associated with life satisfaction in East Asia (Huang,2012; Jung, Muntaner, & Choi, 2010;A. Y. Zhang & Yu,1998).

A national health insurance program has enhanced life satisfaction among older adults in Taiwan (Liao et al., 2012). Access to medical services has been consistently related to life satisfaction among older adults in China (W. Zhang & Liu, 2007).In addition, some studies indicated that regular activities including physical and leisure activitiesare significantly related to life satisfaction among older adults, whereas not participating in activities is associated with life dissatisfaction (Helvik,Engedal, Krokstad, &Selbæk, 2011;Inal, Subasi, Ay, &Hayran, 2007).

Amongstudies on factors associated with older adults’ life satisfaction, there is a large volume of literature regarding differences from various perspective, such as gender, age, education, marital status, and living arrangements (Oshio,2012). However, few studies have examined regional differences. One study conducted in Halifax, Canada,found that life satisfaction varied significantly by urban–rural zones,includingthe inner city, suburbs, inner commuter belt, and outer commuter belt (Millward& Spinney, 2013).Researchers found physical health was associated with life satisfaction among older adults in the inner city and suburbs, feeling unsafe after dark was only associated with life satisfaction in the suburbs, and travel-related (i.e., travel time, travel by car) variables were associated with older adults’ life satisfaction in the inner commuter belt (Millward& Spinney, 2013).

We identified 12 articles involving life satisfaction among older Chinese adults: 8 from mainland China, 2 from Taiwan, and two from Hong Kong. Of those conducted in mainland China, three articles focused on rural communities(H. Liet al., 2013; Liu &Guo, 2008; Silverstein et al., 2006) and only one article examineddifferences in the association between family relationships and life satisfactionbased on agricultural versus nonagricultural hukou, a household registration system overseen by the Chinese government that identifies individuals as official residents of a particularregion. In mainland China, having agricultural hukou is equivalent to living in rural areas and having nonagricultural hukou indicates urban status. This study found that filial support was associated with life satisfaction among older adults with both agricultural and nonagricultural hukou, satisfaction with family support and filial discrepancy was associated with life satisfaction among older adults with agricultural hukou, and family harmony was associated with life satisfaction among those with nonagricultural hukou (Huang, 2012). Few studies have examinedurban–rural differences in the association between family relationships and life satisfaction, much less other factors that may influence life satisfaction. However, in most countries, the proportion of older individuals is higher in rural areas than in urban areas, access to basic social and health services tends to be more limited in rural areas, and poverty rates are generally higher compared to urban locations (United Nations, 2009).These disparities highlight the importance of comparing factors associated with life satisfaction among older adults in rural and urban areas.

Moreover, in addition to the scarcity of research on regional differencesassociated with life satisfaction among older adults, previous studies have had other notable limitations. Some studies were conducted in certain communities, such as Halifax, Canada (Millward& Spinney, 2013), Putian, China (Huang, 2012), Taiwan (Hsu,2012; Liao et al.,2012), Hong Kong (Chou &Chi,1999;Yeung & Fung, 2007), and Beijing, China (A. Y. Zhang & Yu,1998).Other studies were limited to specific regionssuch as rural areas in mainland China (H. Liet al.,2013; Liu &Guo, 2008; Silverstein et al.,2006) or certain populations in particular communitiessuch as ethnic minority older adults in Yunnan, China (Y. Liet al.,2007).All of these studies relied on samples from local areas. In addition, the study sample sizes were typically too small to represent the overall population in China.

China is a typical dual urban–rural division society, which has a macro effect on rural and urban older adults. In the present study, we compared factors associated with life satisfaction among older Chinese adults living in urban and rural areas.

Method

Data

Studydata were extracted from the Sample Survey on Aged Population in Urban/Rural China (SSAPUR)conducted by the China Research Center on Aging in December 2006. Using a stratified multistage quota sample design, researchers randomly selected 19,947 adults aged 60 orolder who lived in urban (n = 10,016) and rural (n = 9,931) areas of mainland China. First, to ensure all geographical regions (north, northeast,east, south central, southwest, and northwest) were appropriately represented, the Chinese Research Center on Aging randomly selected 20 administrative divisions from all provinces or municipalities throughout China.Second, within each province or municipality, four urban areas and four rural areas were randomly selected according to the size of the older population. Third, 16 blocks in urban areas and 16 rural townships in rural areas were randomly selected within each province or municipality. Fourth, 50 urban residential communities and 50 rural residential communities were randomly selected within each province or municipality. Fifth, 10 households were randomly selected within each urban and rural residential community. In the case of households with more than one person aged 60 years or older, one individual was selected at random using the Kish table. Therefore, approximately 500 urban and 500 rural households were selected in each province(Chinese Research Center on Aging, 2010).

For this study, a 10% subsample was extracted at random from the SSAPUR in2006, resulting in data for 1,980 adults aged 60 orolder, including 997 urban participants and 983rural participants. No significant differencesemerged between the study subsampleand the SSAPUR sample in terms of gender, age, marital status, education level, living environment (urban vs. rural), and living arrangements;therefore, the study sample had the same level of national representativeness as the SSAPUR.

Measures

Based on previous studies, we explored potentially predictive factors including socio-demographic variables (gender, age, education, marital status, living arrangements, financial strain), physical and psychological health (self-rated health, functional impairment, depressive symptoms), family support (financial support, instrumental support), family relations(family harmony, filial piety), health care factors (health care coverage, accessibility of health services), and participation in activities. These attributes were selected because they were found to be associated with life satisfaction among older adults in a substantial number of studies. We used a representative sample of older Chinese adultsto contribute to the understanding of various predictive factors associated with life satisfaction among older adults in urban and rural areas.

Demographic Variables

Demographic information consisted of gender(0=male,1=female), age(in years), education (years of education completed), marital status(0= not married,1= married), living alone (0= no,1= yes), and financial strain, which was measured by a single item: ‘How do you assess your economic condition?’ Respondents rated their financial status on a 5-point Likert scale (1= more than enough, 2= good enough, 3=approximately enough, 4=somewhat difficult, 5=very difficult).

Life Satisfaction

Life satisfaction was measured by a single item: ‘Overall, how satisfied are you with your present life?’ Respondents were asked to rate this item on a 5-point Likert scale (1=very unsatisfied, 2=fairly unsatisfied, 3=fair, 4=fairly satisfied, and 5=very satisfied). To produce more meaningful results, we collapsed this variable into two categories: unsatisfied(unsatisfied, fairly unsatisfied, and fair) and satisfied (fairly satisfied and very satisfied).

Physical Health and Psychological Health

Self-rated health was measured by a single item: ‘How do you think of your health situation now?’ Respondents rated their health on a 5-point Likert scale (1= very bad, 2= bad, 3=fair, 4=good, and 5=very good). Functional impairment was measured using two well-established instruments of functional status: activities of daily living(ADLs; Mahoney &Barthel,1965)and instrumental activities of daily living (IADLs; Lawton & Brody, 1969). ADL items in the present sample were bathing, dressing, going to the toilet, transferring from bed to chair, and eating. IADL items wereusing a telephone, traveling via car or public transportation, shopping for food or clothes, preparing meal, performing housework, and managing money. All ADL and IADL items were rated on a 3-point Likert scale(1= not difficult at all, 2= a little bit difficult, and 3=unable to perform the task). Scores were summed to create total ADL and IADL scores. The internal consistencies of the ADL and IADL measures were .89 and .88respectively. An overall score of functional impairment (combining ADLs and IADLs) was calculated, with a range of 11–33. Higher cumulative scores indicated more limited functional ability.

Depressive symptoms were assessed using the 15-item Geriatric Depression Short Form Scale(GDS-15;Sheikh &Yesavage,1986).Participants were asked whether they had experienced certain feelings or behaviors (basic satisfaction with life; dropping many activities and hobbies; feeling that life is empty; often getting bored; in good mood most of time; afraid that something bad is going to happen; feeling happy most of time; often feeling helpless; preferring to stay at home rather than going out and trying something new; feeling that their memory is worse than other old people; thinking it is wonderful to be alive now; feeling not helpful; feeling full of energy; feeling that their situation is hopeless; thinking that most people are better off) during the 1-week period preceding the interview. The15 items were scored on a 2-point scale and summed to create an overall score with a range of 0–15. Cronbach’s alpha for the GDS-15 in the present sample was .79.

Family Support

Family support was defined as financial and instrumental support exchange between older adults and their children. Financial support exchangewas assessed by asking whether participants received financial support from their children (0=no, 1=yes) and provided financial support to their children (0=no,1=yes) during the previous 12 months.

Receiving instrumental support from children was measured by asking respondents whether their children accompaniedthem when they needed to visit the doctor and whether their children helped them with shopping when needed. Each item was measured dichotomously (0=no, 1=yes).Providing instrumental support to children was measured by asking respondents whether they helped their children with house sitting, household chores, child care. Each item was measured dichotomously (0=no, 1=yes).

Family Relationships

Family relationshipswere measured in terms of family harmony and filial piety. Family harmony was assessed by asking the respondents to indicate whether their family was harmonious, using a single item with twocategories(0= disharmonious, 1= harmonious). Filial piety was measured by asking the respondents to indicate whether their children followed filial norms, using a single item with fivecategories (1= not at all, 2= not very much, 3=fair, 4=fairly, 5=very much).

Health Care Factors

Health care factors included health insurance coverage and accessibility of health services.Health insurance coverage was measured by a single question: ‘Are you entitled to receive health insurance?’ (0= no, 1= yes). Accessibility of health services was measured by a single item: ‘Do you think it’s convenient for you to see a doctor?’ Respondents were asked to rate this item on a 3-point scale (0=not convenient, 1=fair, 2=convenient).

Participation in Activities

Engagement in various activities was measured by asking participants ‘Do you often take part in the following activities?’ The activities weretaiji (or tai chi), physical exercise, listening to broadcast radio, watching television, reading, playing majiang (or mah-jongg), playing cards or chess, playing ball, watching a movie or opera, gardening or caring for household plants or pets, painting or calligraphy, traveling, singing or dancing, collecting stamps or other items, visiting the park, learning about computers, andtaking a walk.

Analysis

The first stage of the analysis consisted of calculating detailed descriptive (means and standard deviations or percentages) and t-test or chi-square tests results for all measures of life satisfaction and their potential predictors. A t-test or chi–square test was used to compare means or percentages between rural and urban populations.Second, inter-correlation analysis was conducted between life satisfaction and all predictive variables for rural and urban respondents, separately. Third, because the dependent variable of life satisfaction was a two-category variable, a binary logistic regression modeling approach was applied to analyze the relationship and direction of the association between life satisfaction and all predictive factors. Statistical significance was set at .05. All analyses were performed using SPSS 16.0.

Results

Table 1 displays descriptive statistics of the sample(means and standard deviations or percentage distributions andt-test or chi-square test results for all variables);54.6% of urban older adults and 44.1% of rural older adults reported satisfaction with their lives.There were statistically significant rural–urban differences in 16 variables:life satisfaction, gender, years of education, marital status, living alone, self-rated health, functional impairment, depressive symptoms, financial strain, receiving financial support, providing financial support, providing instrumental support, filial piety, health insurance coverage, accessibility of health services, and participation in activities.

Table 1.  Characteristics of the sample by region.


Rural

Urban

Total



n = 983

n = 997

n = 1,980



% or M (SD)

χ2 or t

Life satisfaction   (satisfied)

44.1

54.6

49.4

21.55**

Gender (male)

54.2

48.4

51.3

6.61*

Age (range: 60–102   years)

71.44 (7.26)

71.02 (6.61)

71.23   (6.94)

1.35

Education (range:   1–24 years)

4.77 (2.55)

7.93 (3.98)

6.70   (3.81)

-15.74**

Married

58.6

68.7

63.7

21.89**

Living alone

45.4

53.5

49.4

12.33**

Financial strain   (range: 1–5)

3.37 (0.84)

3.15 (0.80)

3.26 (0.83)

5.89**

Self-rated health   (range: 1–5)

2.89 (0.93)

3.06 (0.88)

2.97   (0.91)

-0.47**

Functional impairment   (range: 11–33)

14.80 (4.89)

13.34 (4.61)

14.06   (4.80)

6.80**

Depressive symptoms   (range: 0–15)

6.25 (3.45)

4.83 (3.28)

5.54 (3.44)

62.10**

Received financial   support

63.5

38.6

51.0

123.60**

Provided financial   support

38.0

59.1

48.3

83.54**

Received instrumental   support

94.6

93.8

94.2

0.56

Provided instrumental   support

82.5

62.9

72.6

95.77**

Harmonious family

95.3

96.5

95.9

1.87

Filial piety (range:   1–5)

2.12 (0.80)

1.93 (0.87)

2.02 (0.84)

5.09**

Health insurance   coverage

96.1

51.9

73.8

32.75**

Accessibility of   health services




91.24**

Not convenient

18.2

12.0

15.1


Fair

18.1

17.1

17.6


Convenient

63.6

70.9

67.3


Participation in   activities

91.7

96.5

94.1

20.78**

*p< .05. **p< .01. ***p< .001.

Table 2 shows correlations between study variables and life satisfaction among rural and urban respondents. Among rural respondents, life satisfaction was significantly associated with all but four variables (gender, age, marital status, and living alone). Life satisfaction was highly associated with depressive symptoms, financial strain, filial piety, and self-rated health.

Among urban respondents, life satisfaction was significantly associated with all but two predictive variables (age and years of education). Moreover, similar to rural respondents, life satisfaction was highly associated with depressive symptoms, financial strain, filial piety, and self-rated health.

 

Table 2.   Correlations between life satisfaction and study variables by rural or urban status.


Rural

Urban

Gender

-.02

-.08**

Age

-.01

-.04

Education

.12**

.07

Marital status

.05

.08*

Living alone

.05

.07*

Financial strain

-.35**

-.32**

Self-rated health

.26**

.24**

Functional impairment

-.17**

-.15**

Depressive symptoms

-.38**

-.40**

Received financial   support

.07*

.08*

Provided financial   support

.17**

.22**

Received instrumental   support

.09**

.12**

Provided instrumental   support

.05

.01

Harmonious family

.12**

.12**

Filial piety

.28**

.26**

Health insurance   coverage

.02

.06

Accessibility of   health services

.21**

.17**

Participation in   activities

.04

.11**

*p< .05. **p< .01. ***p< .001.

The results of the logistic regression analysis for rural and urban respondents are presented in Table 3 and Table 4. Before conducting the regression models, we checked multicollinearity among all independent variables. The results showed that all of the tolerance values of the independent variables were greater than the common threshold of .1 (Hair, Tatham, Anderson, & Black, 1998), meaning that multicollinearity was at an acceptable level. In addition, the proportions of the independent information provided by all 18 selected variables weremore than 60% of the variance.

Table 3  Binary logistic regression model of factors associated with life satisfaction among rural older adults.


Rural


B

Exp(B)

95% CI

Gender

-0.04

0.96

0.56, 1.64

Age

-0.03

0.97

0.94, 1.01

Education

0.04

1.04

0.95, 1.15

Marital status

0.35

1.42

0.83, 2.45

Live alone

0.46

1.58

0.98, 2.57

Financial strain

-0.87***

0.42

0.29, 0.62

Self-rated health

0.13

1.14

0.83, 1.57