An exploratory study of older people living alone in Chongming, Shanghai

443 Pages·2017·10.05 MB·English

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An exploratory study of older people living alone in Chongming, Shanghai
Chen, Yu
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King's College London
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Title:䅮⁥硰汯牡瑯特⁳瑵摹映潬摥爠灥潰汥楶楮朠慬潮攠楮⁃桯湧浩湧Ⱐ卨慮杨慩

A uthor:奵⁃桥渀
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derived from it may be published without proper acknowledgement.
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An exploratory study of older people living
alone in Chongming, Shanghai

Yu Chen

A thesis submitted in fulfilment of the requirements for the
degree of Doctor of Philosophy

Florence Nightingale School of Nursing & Midwifery
King’s College London

November 2013
ABSTRACT
Background
The number of older people living alone is increasing due to dramatic
population ageing and changes in living arrangements. Little is known about
older people living alone in Mainland China and their quality of life (QoL)
where collectivism and filial responsibility are emphasised.
Aims
This study aimed to explore the health status, life circumstances and QoL of
older people living alone in Chongming, Shanghai.
Methods
A cross-sectional survey of a stratified random cluster sample of 521
community-dwelling older people aged 60 years and above and living alone
was conducted in Chongming, Shanghai. The structured questionnaire
included validated measures to assess the health status, loneliness, social
support, physical activity, health services utilisation and satisfaction, housing
and QoL.
Results
Over two fifths of the participants rated their health as good despite 44.5%
reporting chronic diseases and 47.6% reporting being depressed. Most
participants reported a high level of functional ability and were satisfied with
their health services and overall dwelling conditions. However, over four fifths
of the participants reported moderate/moderately high levels of loneliness.
The social support mean score was 30.5, lower than the Chinese population
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norm. The participants’ health status, loneliness, social support, physical
activity, health services satisfaction and satisfaction with overall dwelling
conditions varied across the sample.

Over two fifths of the participants perceived their QoL as good. Satisfaction
with overall dwelling conditions, self-rated health, functional ability,
depression, economic level, social support, loneliness, occupation and
satisfaction with health services were predictors of QoL accounting for 68.8%
of the variance. Additionally, depression and occupation had an interaction
effect upon QoL.
Conclusions
Older people living alone in Chongming, Shanghai are a disadvantaged
heterogeneous group who need special attention. The proposed QoL model
provides the basis for further enquiry regarding the needs of different
sub-groups and future policy interventions.
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ACKNOWLEDGEMENTS
I would like to express my sincere gratitude to all those people who made this
thesis possible.

First, I would like to thank my supervisors, Professor Alison While and Dr.
Allan Hicks, for their insightful and valuable advice and guidance, full support
and continuous encouragement.

I am deeply grateful to all older people who agreed to participate in this study
and shared their experiences of living alone. Many thanks to all the data
collectors and the leaders of selected towns and communities for their
support and help during the data collection phase.

I would like to record many thanks to Mr. Peter Milligan for his statistical
consultations throughout the study process. Sincere thanks to Professor Ann
Bowling for her permission to use the copyrighted questionnaire. I also thank
Professor Yan Hu and Professor Haiou Xia from Fudan Unversity for their
assistance with the development of the Chinese version of the instruments.

Special thanks to the China Scholarship Council, King’s College London and
Fudan University for their financial assistance. I am also very grateful to
School of Nursing, Fudan University for the opportunity for me to pursue a
doctoral degree at King’s College London.

I would like to thank all my friends for their precious friendship and support.

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Finally, I would like to express my heartfelt thanks to my family for their
endless care, support and encouragement, especially to my husband, lovely
daughter and parents for their perseverance and love.
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TABLE OF CONTENTS
ABSTRACT .................................................................................................. 1
ACKNOWLEDGEMENTS ............................................................................ 3
TABLE OF CONTENTS ............................................................................... 5
LIST OF TABLES ....................................................................................... 10
LIST OF FIGURES ..................................................................................... 13
LIST OF APPENDICES ............................................................................. 14

CHAPTER 1 INTRODUCTION
1.1 Background to the study ................................................................... 15
1.2 Aim, objectives and research questions ............................................ 17
1.3 Operational definition of terms .......................................................... 18
1.4 Structure of the thesis ....................................................................... 19
CHAPTER 2 LITERATURE REVIEW
2.1 Chapter introduction .......................................................................... 21
2.2 Population ageing and living arrangements change ......................... 21
2.2.1 Global population ageing ............................................................ 21
2.2.2 Population ageing in China ......................................................... 22
2.2.3 Population ageing in Shanghai ................................................... 23
2.2.4 Changes in living arrangements in China ................................... 26
2.2.5 A brief summary of population ageing ........................................ 27
2.3 Profile of older people living alone .................................................... 28
2.4 Quality of life ..................................................................................... 35
2.4.1 Definition and concepts of quality of life ..................................... 36
2.4.2 Related factors of quality of life of older people .......................... 38
2.4.2.1 Health status ........................................................................ 39
2.4.2.2 Loneliness ............................................................................ 51
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2.4.2.3 Social support ...................................................................... 53
2.4.2.4 Physical activity .................................................................... 56
2.4.2.5 Housing ................................................................................ 59
2.4.2.6 Socio-demographic factors .................................................. 62
2.4.3 A brief summary of the literature regarding quality of life ............ 70
2.5 Health status, life circumstances and quality of life of older people in
China ................................................................................................. 72
2.5.1 Health status ............................................................................... 72
2.5.2 Loneliness .................................................................................. 81
2.5.3 Social support ............................................................................. 83
2.5.4 Physical activity .......................................................................... 90
2.5.5 Health services ........................................................................... 92
2.5.6 Housing ...................................................................................... 95
2.5.7 Measurements of quality of life of older people in China ............ 96
2.5.8 A brief summary of the health status, life circumstances and quality
of life of older people in China ........................................................... 101
2.6 Conceptual framework for the study ................................................. 103
2.7 Chapter summary ........................................................................... 104
CHAPTER 3 METHOD
3.1 Chapter introduction ........................................................................ 107
3.2 Study aim and objectives ................................................................ 107
3.3 Study design ................................................................................... 108
3.3.1 Type of study ............................................................................ 108
3.3.2 Study site .................................................................................. 109
3.3.3 Subjects .................................................................................... 111
3.3.4 Sample size .............................................................................. 112
3.4 Questionnaire development ............................................................ 114
3.5 Ethical considerations ..................................................................... 124
3.6 Pilot study ....................................................................................... 125
3.7 Main study ...................................................................................... 128
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3.7.1 Sampling procedure ................................................................. 129
3.7.2 Data collectors training ............................................................. 130
3.7.3 Data collection .......................................................................... 131
3.8 Data analysis .................................................................................. 133
3.8.1 Validation of the scales in the main study ................................. 133
3.8.2 Statistical analysis to fulfil the research objectives ................... 134
3.9 Chapter summary ........................................................................... 136
CHAPTER 4 FINDINGS: STATUS OF HEALTH, LIFE CIRCUMSTANCES
AND QUALITY OF LIFE OF OLDER PEOPLE LIVING ALONE IN
CHONGMING
4.1 Chapter introduction ........................................................................ 137
4.2 Psychometric properties of the scales in the main study ................ 137
4.2.1 Psychometric properties of the Chinese OPQOL ..................... 137
4.2.2 The reliabilities of other scales ................................................. 146
4.3 Characteristics of the participants ................................................... 147
4.4 Health status ................................................................................... 149
4.4.1 Chronic and acute diseases ..................................................... 149
4.4.2 Cognitive function ..................................................................... 152
4.4.3 Depression ............................................................................... 154
4.4.4 Functional ability ....................................................................... 156
4.4.5 Self-rated health ....................................................................... 160
4.5 Loneliness ....................................................................................... 162
4.6 Social support ................................................................................. 164
4.7 Physical activity ............................................................................... 169
4.8 Health services ............................................................................... 172
4.9 Housing ........................................................................................... 175
4.10 Quality of life ................................................................................. 178
4.11 Additional information from the participants .................................. 181
4.12 Chapter summary ......................................................................... 182

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