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Which Aspects of Elderly Living Conditions are Important to Predict Mortality? The Complex Role of Family Ties at Home and in Institutions

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Abstract

Besides health and socio-economic status, the social relationships maintained during elderly play an important role in shaping the living conditions at older ages. In this part of life, the family represents the major framework in which interpersonal relationships are experienced. With population ageing, the family increasingly ensures elderly care, especially where targeted public policies are lacking, and its protective effect on survival is foreseen. In this paper we investigate the complex role of family in mortality and contribute to the debate on the ideal living condition for elderly people, exploiting a nationwide integrated survey on private and collective households in France. Following a cohort of 16,263 individuals aged 55, we investigate the effect of family relations on survival. We question whether the lack of family care connected with the absence of active relationships with family members may be at least partly compensated by institutional settings. Estimates of life expectancy show that at the age of 60, people living in institutions live on average 10 years less that those living in private households, the gap decreasing with age. Cox proportional hazards models show a protective role of children on mortality. Having no children seems to be associated with a lower risk of death, but the effect is significant only for those declaring rare or no contacts with their children. Survival analysis also suggests that institutional living arrangement may be protective for the most fragile individuals, namely the severely disabled, isolated persons.

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Notes

  1. Institutions for elderly people, long-stay care facilities attached to hospitals, psychiatric establishments and institutions for adults. The survey also includes institutions for children, that are obviously excluded from our study.

  2. IMaCh is a publicly available computer program introduced by Brouard and Lievre (2002) and mostly used for the estimation of Health Expectancy from longitudinal surveys. It allows to estimate transition probabilities using a discrete time embedded Markov chain approach. Transitions are supposed to occur at any time and death is always an additional competing risk. See for example (Andrade 2010; Crimmins et al. 2009; Molla and Madans 2008) for some interesting applications.

  3. For detailed documentation on the new release of the software IMaCh see http://euroreves.ined.fr/imach/wiki/index.php/Documentation.

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  1. Dipartimento MEMOTEF, Università degli Studi di Roma La Sapienza, Via del Castro Laurenziano, 9, 00161, Rome, Italy

    Cristina Giudici & Alessandra de Rose

  2. Dipartimento di Scienze Sociali ed Economiche, Università degli Studi di Roma La Sapienza, P.le Aldo Moro, 5, 00185, Rome, Italy

    Silvia Polettini

  3. Unité Mortalité, santé, Epidemiologie, Institut National d’Etudes Démographiques–INED, 133, boulevard Davout, 75020, Paris, France

    Nicolas Brouard

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  1. Cristina Giudici
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Correspondence to Cristina Giudici.

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Giudici, C., Polettini, S., de Rose, A. et al. Which Aspects of Elderly Living Conditions are Important to Predict Mortality? The Complex Role of Family Ties at Home and in Institutions. Soc Indic Res 142, 1255–1283 (2019). https://doi.org/10.1007/s11205-018-1945-9

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