Living Alone and Subsequent Living Arrangement Transitions among Older Americans

262 Pages·2016·7.53 MB·English

University of Massachusetts Boston
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Graduate Doctoral Dissertations Doctoral Dissertations and Masters Theses
5-31-2016
Living Alone and Subsequent Living Arrangement
Transitions among Older Americans
Yao-Chi Shih
University of Massachusetts Boston
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Shih, Yao-Chi, "Living Alone and Subsequent Living Arrangement Transitions among Older Americans" (2016).Graduate Doctoral
Dissertations.Paper 246.
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LIVING ALONE AND SUBSEQUENT LIVING ARRANGEMENT TRANSITIONS
AMONG OLDER AMERICANS

A Dissertation Presented
by
YAO-CHI SHIH

Submitted to the Office of Graduate Studies,
University of Massachusetts Boston,
in partial fulfillment of the requirements for the degree of

DOCTOR OF PHILOSOPHY

May 2016

Gerontology Program
© 2016 by Yao-Chi Shih
All rights reserved

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LIVING ALONE AND SUBSEQUENT LIVING ARRANGEMENT TRANSITIONS
AMONG OLDER AMERICANS

A Dissertation Presented
by
YAO-CHI SHIH

Approved as to style and content by:

________________________________________________
Frank W. Porell, Professor
Chairperson of Committee

________________________________________________
Jeffrey A. Burr, Professor
Member

________________________________________________
Mark D. Hayward, Professor
University of Texas at Austin
Member

_________________________________________
Edward A. Miller, Program Director
Gerontology Program

_________________________________________
Jeffrey A. Burr, Chairperson
Gerontology Department

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ABSTRACT

LIVING ALONE AND SUBSEQUENT LIVING ARRANGEMENT TRANSITIONS
AMONG OLDER AMERICANS

May 2016

Yao-Chi Shih, B.A., National Chung Cheng University
M.A., National Chung Cheng University
M.S., University of Massachusetts Boston
Ph.D., University of Massachusetts Boston

Directed by Professor Frank W. Porell

Past research often considers living alone as a risk factor for older persons. In fact,
adverse health outcomes are associated with living arrangement transitions, suggesting a
need to consider the dynamic process of living arrangements. Using eight waves of the
Health and Retirement Study (1998-2012), this study examines three research questions:
(1) Do older Americans’ living arrangements exhibit a pattern of sequence? (2) What are
implications of living arrangements at particular older ages on life expectancy? (3) What
factors predict transitions out of a living alone arrangement?
The first analysis displays and classifies ordered patterns of living arrangements
over time. Baseline living arrangements have a substantial influence on subsequent
transitions. Major patterns of women’s living arrangement sequences are more diverse
than those for men. In particular, living alone is both the major living arrangements at

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baseline or intermediately after baseline. These results suggest the importance of the
living arrangement status at old ages in relation to subsequent living arrangements over
time.
Next, multistate life tables are estimated for calculating life expectancy in total
and among distinct living arrangements. While the expected percentage of time spent
living alone for men increases with age, about half of women’s total life expectancy at
any ages is spent living alone. Older persons living alone do not have shorter life
expectancies than those in co-residential living arrangements, particularly among women.
This suggests a selection process in which less robust older persons tend to transition to
other living arrangements or die at younger ages.
Lastly, discrete-time event history models are used to examine factors associated
with transitioning from living alone. Sentinel health events and poorer functional status
are associated with an increased risk of death, and, to a lesser extent, a subsequent
transition to co-residence or institutionalization. Analyses of transitions from living alone
measured concurrently with changes in functional status suggest that many transitions
may be immediate reactions to a recent health decline rather than adjustments following a
progressive health decline. In either case, subsequent co-residence does not appear to be a
common adaptation for many older adults who live alone with increased needs for care.

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ACAKNOWLEDGEMENTS

I am deeply indebted to many people who have contributed to the completion of
this dissertation. I give special thanks to Frank Porell for his steadfast guidance and
support in response for my countless struggles throughout the dissertation process. To
Jeff Burr and Mark Hayward I give my heartfelt thanks. Their thoughtful participation is
a constant source of encouragement for me to go on. I also thank Jan Mutchler and
Pamela Nadash who patiently lead me to embark on the course of social research. This
accomplishment would not have been possible without the wonderful members of the
Gerontology Program. For all the opportunities and support that I have been given, I am
beyond grateful.

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TABLE OF CONTENTS

ACKNOWLEDGMENTS ......................................................................................... vi

LIST OF FIGURES ................................................................................................... xi

LIST OF TABLES ..................................................................................................... xiii

CHAPTER Page

1. INTRODUCTION ............................................................................................ 1
Organization of the Dissertation ............................................................... 5
Living Arrangement Sequences among Older Americans ................... 6
Multistate Life Tables of Older Americans’ Living Arrangements ..... 7
Subsequent Living Arrangements of Older Americans are Living Alone 8
Data ........................................................................................................... 9
Closing Remarks ....................................................................................... 10
References ................................................................................................. 12

2. LIVING ARRANGEMENT SEQUENCES AMONG OLDER AMERICANS 16
Introduction ............................................................................................... 16
Methodology ............................................................................................. 18
Data ...................................................................................................... 18
Living Arrangement States ................................................................... 20
Analytic Plan ........................................................................................ 22
Missing Data ........................................................................................ 30
Results ....................................................................................................... 31
Descriptive Analysis of Baseline Living Arrangements and Subsequent
Living Arrangement Episodes ......................................................... 32
Baseline living arrangements by Gender and Age .......................... 32
Subsequent Transitions in Baseline Living Arrangements by Gender
and Age Group ............................................................................ 36
Intermediate Living Arrangements by Gender and Age Group ...... 38
Sequence Index Plots by Intermediate Living Arrangements over
Time ........................................................................................... 41
Sequence Analysis of Living Arrangements ........................................ 45
Sequences of Living Arrangement Episodes ................................... 46
Sequences of Annual Living Arrangement States ........................... 48
Sequence Analysis of Annual Living Arrangement Sequences ...... 50
Subsequent Analysis Methodology ............................................ 51
Cluster Description ..................................................................... 52
Discussion of Sequence Analysis Results .................................. 59
Discussion ................................................................................................. 61
References ................................................................................................. 66

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CHAPTER Page

3. MULTISTATE LIFE TABLES OF OLDER AMERICANS’ LIVING
ARRANGEMENTS .................................................................................. 69
Introduction ............................................................................................... 69
Prior Studies of Living Arrangement Transitions ................................ 70
Life expectancy of Living Arrangements ............................................. 72
Multistate Life Tables .......................................................................... 74
Multistate Life Tables for Living Arrangements Transitions .............. 76
Methodology ............................................................................................. 78
Data ...................................................................................................... 78
Living arrangement states .................................................................... 79
Markov chains and interpolated Markov chain (IMaCh) approach ..... 81
Discrete-time Markov Chain ........................................................... 81
Interpolating Markov Chain (IMaCh) ............................................. 82
Multistate Life Table Functions Calculated by IMaCh ................... 87
Analytic Plan ............................................................................................. 90
Descriptive Statistics Observed from Sample Data ............................. 92
Multinomial Logit Empirical Results ................................................... 95
Multistate Life Table Results .................................................................... 98
Annual Incidence Rates of Transitions ................................................ 99
Implied Prevalence ............................................................................... 104
Population-based Life Expectancy ....................................................... 107
Status-based Life Expectancy .............................................................. 109
Discussion ................................................................................................. 117
Age-specific prevalence rates of living arrangements ......................... 117
Population-based life expectancies of living alone and in institutions 118
Status-based life expectancies and selection process ........................... 119
Limitations ........................................................................................... 121
References ................................................................................................. 125

4. SUBSEQUENT TRANSITIONS IN LIVING ARRANGEMENTS AMONG
OLDER AMERICANS WHO ARE LIVING ALONE ............................ 130
Introduction ............................................................................................... 130
Literature Review ...................................................................................... 133
Rational Choice Model ......................................................................... 133
Cultural Influences .......................................................................... 134
Economic Resources ....................................................................... 134
Kin Availability ............................................................................... 136
Health .............................................................................................. 138
Health and Living Arrangement Transitions ........................................ 141
Conceptual Model ..................................................................................... 146
Methodology ............................................................................................. 151
Data ...................................................................................................... 151

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CHAPTER Page

Defining Risk Set ................................................................................. 153
Study Sample ........................................................................................ 155
Analytic plan ........................................................................................ 156
Left Truncation ................................................................................ 159
Measures ............................................................................................... 162
Results ....................................................................................................... 166
Descriptive Analysis ............................................................................ 166
Discrete-time Survival Model .............................................................. 170
Sentinel Health Events, Functional Status and Relative Risks of
Subsequent Transitions ............................................................... 170
Men’s Transitions from Living Alone ............................................. 171
Women’s Transitions from Living Alone ....................................... 177
Concurrent Changes in Functional Status and Living Arrangements
......................................................................................................... 184
Discussion ................................................................................................. 197
Limitations ........................................................................................... 202
References ................................................................................................. 205

5. CONCLUSION ................................................................................................. 213
Summary of Findings ................................................................................ 214
Contributions to the Literature .................................................................. 218
Future Directions ....................................................................................... 219
Policy Implication ..................................................................................... 221
References ................................................................................................. 224

APPENDIX

A. CONSTRUCTING BETWEEN-WAVE LIVING ARRANGEMENT STATUS
................................................................................................................... 225
Introduction ............................................................................................... 225
Methodology ............................................................................................. 227
Construction of Between-Wave Living Arrangement Status ............... 227
The Midpoint of Two HRS Waves as the Pseudo Interview Date ....... 228
Constructing Transition Indicators Between Two Biennial Interviews
......................................................................................................... 229
Missing Data Screening ....................................................................... 230
Living Arrangement Indicator at the Pseudo Between-wave Date ...... 232
Longitudinal Merge .............................................................................. 232
Streamline the Annual Living Arrangement Status ............................. 233
Data ......................................................................................................... 234
Limitations ................................................................................................ 236

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