空巢真的是影响城镇老年人健康的危险因素吗?
|
摘要
随着老龄化程度的加剧、人口流动的日益频繁以及城镇青年注重隐私、倾向于独立居住,传统的家庭养老模式发生了变动,城镇老年人独自居住将成为未来城镇居住模式的主流。基于2011年中国老年健康影响因素跟踪调查数据,本文选取"老人有心事时是否与家人倾诉"与"住房来源"变量作为有效工具变量解决内生性问题,通过有限信息极大似然法估计空巢对老年人健康可能产生的影响,并采用两阶段最小二乘法回归作为对比。结果显示,空巢对于城镇老年人的生活自理能力、认知能力以及心理健康均存在显著的负向影响,空巢老人缺少家庭的支持与帮助,在生活自理能力、认知能力以及心理健康方面明显欠缺;同时由于自身健康、生活等条件处于劣势,空巢对于弱势城镇老年人(女性、高龄以及无配偶的老人)的健康水平影响更为显著。研究进一步发现缺乏物质生活保障、难以获得及时的医疗救助机会使得城镇空巢老人的自理能力和认知能力产生变化;参与社会活动的减少对空巢城镇老人的身心健康也存在显著的损害作用。基于以上结论,研究通过重点关注空巢对于城镇老年人健康的影响,从居住模式角度研究中国老年人健康问题,为探究居住模式和老年人健康之间的关系提供了新的证据。
With the increasing aging and urban youth tend to live independently,urban elderly live independently will become the mainstream of living pattern.Based on 2011 Chinese Longitudinal Healthy Longevity Survey data,we choose"whether talk to families or not when elder lies are upset"and"house owner"variables as effective instrumental variables to solve endogenous problem.This study used Limited Information Maximum Likelihood method to estimate the relationship between dependent variable and independent variable,and compared with results of two-stage least squares method.The results show that empty nest has a significant negative effect on urban elderly ADL,cognitive ability and mental health,especially for disadvantaged groups(female,advanced-age,without spouse).Furthermore,we have explored that lacking of material life support and inaccessible to timely medical resource will influence rural empty nesters'ADL and cognitive ability,and lacing of social activities also will damage to rural empty nesters'physical and mental health.
With the increasing aging and urban youth tend to live independently,urban elderly live independently will become the mainstream of living pattern.Based on 2011 Chinese Longitudinal Healthy Longevity Survey data,we choose"whether talk to families or not when elder lies are upset"and"house owner"variables as effective instrumental variables to solve endogenous problem.This study used Limited Information Maximum Likelihood method to estimate the relationship between dependent variable and independent variable,and compared with results of two-stage least squares method.The results show that empty nest has a significant negative effect on urban elderly ADL,cognitive ability and mental health,especially for disadvantaged groups(female,advanced-age,without spouse).Furthermore,we have explored that lacking of material life support and inaccessible to timely medical resource will influence rural empty nesters'ADL and cognitive ability,and lacing of social activities also will damage to rural empty nesters'physical and mental health.
引文
[1]Logan J R,Bian F,Bian Y.Tradition and Change in the Urban Chinese Family:The Case of Living Arrangements[J].Social Forces,1998,76(3):851-882.
[2]吴玉韶,郭平.2010年中国城乡老年人口状况追踪调查数据分析[M].北京:中国社会出版社,2014:2.
[3]吴玉韶,党俊武.老龄蓝皮书——中国老龄产业发展报告(2014)[M].北京:社会科学文献出版社,2014:33-39.
[4]曾毅,王正联.中国家庭与老年人居住安排的变化[J].中国人口科学,2004,(5):2-8.
[5]谷琳,乔晓春.我国老年人健康自评影响因素分析[J].人口学刊,2007,(6):25-29.
[6]曲嘉瑶,杜鹏.中国城镇老年人的居住意愿对空巢居住的影响[J].人口与发展,2014,20(2):87-94.
[7]Sibai A M,Yount K M,Fletcher A.Marital Status,Intergenerational Co-residence and Cardiovascular and All-cause Mortality among Middle-aged and Older Men and Women during Wartime in Beirut:Gains and Liabilities[J].Social Science&Medicine,2007,64(1):64-76.
[8]刘宏,高松,王俊.养老模式对健康的影响[J].经济研究,2011,(4):80-93.
[9]Rahman O,Menken J,Kuhn R.The Impact of Family Members on the Self-reported Health of Older Men and Women in a Rural Area of Bangladesh[J].Ageing and Society,2004,24(6):903-920.
[10]Kharicha K,Iliffe S,Harari D,et al.Health Risk Appraisal in Older People 1:Are Older People Living Alone an‘At-risk’Group?[J].British Journal of General Practice,2007,57(537):271-276.
[11]沈可.中国老年人居住模式之变迁[M].北京:社会科学文献出版社,2013:87-89.
[12]Waite L J,Hughes M E.At Risk on the Cusp of Old Age:Living Arrangements and Functional Status among Black,White and Hispanic Adults[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,1999,54(3):136-144.
[13]Walter-Ginzburg A,Blumstein T,Chetrit A,et al.Social Factors and Mortality in the Old-old in Israel the CALAS Study[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2002,57(5):308-318.
[14]Li L W,Zhang J,Liang J.Health among the Oldest-old in China:Which Living Arrangements Make a Difference?[J].Social Science&Medicine,2009,68(2):220-227.
[15]李建新,李嘉羽.城市空巢老人生活质量研究[J].人口学刊,2012,(3):31-41.
[16]Davis M A,Neuhaus J M,Moritz D J,et al.Living Arrangements and Survival among Middle-aged and Older Adults in the NHANES I Epidemiologic Follow-up Study[J].American Journal of Public Health,1992,82(3):401-406.
[17]Davis M A,Moritz D J,Neuhaus J M,et al.Living Arrangements,Changes in Living Arrangements,and Survival among Community Dwelling Older Adults[J].American Journal of Public Health,1997,87(3):371-377.
[18]Sarwari A R,Fredman L,Langenberg P,et al.Prospective Study on the Relation between Living Arrangement and Change in Functional Health Status of Elderly Women[J].American Journal of Epidemiology,1998,147(4):370-378.
[19]封婷,陈茗.厦门市城区空巢老年人生活质量综合评析[J].南方人口,2008,23(2):37-43.
[20]Magaziner J,Cadigan D A,Hebel J R,et al.Health and Living Arrangements among Older Women:Does Living Alone Increase the Risk of Illness[J].Journal of Gerontology,1988,43(5):127-133.
[21]Iliffe S,Tai S S,Haines A,et al.Are Elderly People Living Alone an at Risk Group?[J].Bmj,1992,305(6860):1001-1004.
[22]Mui A C,Burnette J D.A Comparative Profile of Frail Elderly Persons Living Alone and Those Living with Others[J].Journal of Gerontological Social Work,1994,21(3-4):5-26.
[23]Van Gelder B M,Tijhuis M,Kalmijn S,et al.Marital Status and Living Situation during a 5-year Period are Associated with a Subsequent 10-year Cognitive Decline in Older Men:The FINE Study[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2006,61(4):213-219.
[24]Stevens F C,Kaplan C D,Ponds R W,et al.How Ageing and Social Factors Affect Memory[J].Age and Ageing,1999,28(4):379-384.
[25]张卫华,赵贵芳.城市老年人认知功能的相关因素分析[J].中国心理卫生杂志,2001,15(5):327-330.
[26]Sibley A,Mac Knight C,Rockwood K,et al.The Effect of the Living Situation on the Severity of Dementia at Diagnosis[J].Dementia and Geriatric Cognitive Disorders,2002,13(1):40-45.
[27]Koller K,Gosden S.On Living Alone,Social Isolation and Psychological Disorder[J].Journal of Sociology,1984,20(1):81-92.
[28]李德明,陈天勇,吴振云,等.城市空巢与非空巢老人生活和心理状况的比较[J].中国老年学杂志,2006,26(3):294-296.
[29]Sun X,Lucas H,Meng Q,et al.Associations between Living Arrangements and Health-related Quality of Life of Urban Elderly People:A Study from China[J].Quality of Life Research,2011,20(3):359-369.
[30]Liu L J,Guo Q.Life Satisfaction in a Sample of Empty-nest Elderly:A Survey in the Rural Area of a Mountainous County in China[J].Quality of Life Research,2008,17(6):823-830.
[31]You K S,Lee H O.The Physical,Mental,and Emotional Health of Older People Who are Living Alone or with Relatives[J].Archives of Psychiatric Nursing,2006,20(4):193-201.
[32]Van Tilburg T,de Jong Gierveld J,Lecchini L,et al.Social Integration and Loneliness:A Comparative Study among Older Adults in the Netherlands and Tuscany,Italy[J].Journal of Social and Personal Relationships,1998,15(6):740-754.
[33]Stroebe W,Stroebe M S.Bereavement and Health:The Psychological and Physical Consequences of Partner Loss[M].Cambridge:Cambridge University Press,1987:133-143.
[34]周建芳,薛志强,方芳,等.独居老人抑郁症状和抑郁症的调查[J].上海精神医学,2008,20(3):136-138.
[35]张河川,张晓芬,郭思智.独居老年人心理健康状况与社会支持关系[J].中国公共卫生,2010,26(4):466-467.
[36]Durkheim E.Suicide:A Study in Sociology[M].Routledge&K Paul,1952:359.
[37]Lubben J E.Gender Differences in the Relationship of Widowhood and Psychological Well-being among Low Income Elderly[J].Women&Health,1989,14(3-4):161-189.
[38]Wenger G C,Dykstra P A,Melkas T,et al.Social Embeddedness and Late-life Parenthood Community Activity,Close Ties,and Support Networks[J].Journal of Family Issues,2007,28(11):1419-1456.
[39]沈可,程令国.空巢是否损害了老年健康?[J].世界经济文汇,2012,(2):89-103.
[40]Wen M,Gu D.The Effects of Childhood,Adult,and Community Socioeconomic Conditions on Health and Mortality among Older Adults in China[J].Demography,2011,48(1):153-181.
[41]Crimmins E M,Hayward M D,Saito Y.Differentials in Active Life Expectancy in the Older Population of the United States[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,1996,51(3):111-120.
[42]Jia Yunzhu.Daily Life of the Elderly Care Resources and Community Support Services Development[J].Sociology Studies,2002,(5):119-122.
[43]Zhang Z,Gu D,Hayward M D.Early Life Influences on Cognitive Impairment among Oldest Old Chinese[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2008,63(1):25-33.
[44]Zhang Z.Gender Differentials in Cognitive Impairment and Decline of the Oldest Old in China[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2006,61(2):107-115.
[45]Smith J,Gerstorf D,Li Q.Psychological Resources for Well-being among Octogenarians,Nonagenarians,and Centenarians:Differential Effects of Age and Selective Mortality[J].Healthy Longevity in China,2008,20:329-346.
[46]Li D,Wu T C Z.An Exploration of the Subjective Well-being of the Chinese Oldest-old[J].Healthy Longevity in China,2008,20:347-356.
[47]Hausman J A.Specification Tests in Econometrics[J].Econometrica:Journal of the Econometric Society,1978,46(6):1251-1271.
[48]Amemiya T.The Nonlinear Two-stage Least-squares Estimator[J].Journal of Econometrics,1974,2(2):105-110.
[49]福克斯.社会科学中的数理基础及应用[M].上海:格致出版社,2011:137-147.
[50]Andrews D W K,Soares G,Andrews D W K,et al.Instrumental Variables Regression with Weak Instruments[J].Cowles Foundation Discussion Papers,2004,23(6):1033-1082.
(1)西方不存在户籍制度分割,因此不存在城镇老年人与农村老年人的分别;而且由于西方国家经济发达,在整体上可以将全体老年人与中国城镇老年人进行对比。
(1)方差分析结果显示,以空巢与否作为分组标准对总体样本进行分组对比,F检验结果显示P值为0.000,说明空巢老人和与子女同住老人在健康方面存在显著差异。
(2)本研究遵循的是中国在西部大开发后对东中西部的重新划分,东部包括北京、天津、河北、辽宁、上海、江苏、浙江、福建、山东、广东、海南;中部包括山西、吉林、黑龙江、安徽、江西、河南、湖北、湖南;西部包括内蒙古自治区、广西壮族自治区、重庆、四川、贵州、云南、西藏自治区、陕西、甘肃、青海、宁夏回族自治区、新疆维吾尔自治区。
(1)一阶段回归的F值是否大于10可作为弱工具变量的评判标准。如果存在弱工具问题,则二阶段最小二乘法的估计结果可能会产生偏误。
(1)在变量处理的过程中,对于空巢影响的三个机制变量,研究将物质生活缺乏保障和医疗服务利用率不足变量进行负向处理,取值越高说明物质生活保障和医疗服务利用率越低,而社会活动参与变量则采用正向处理,取值越高说明老年人参与社会活动的程度越高。
[2]吴玉韶,郭平.2010年中国城乡老年人口状况追踪调查数据分析[M].北京:中国社会出版社,2014:2.
[3]吴玉韶,党俊武.老龄蓝皮书——中国老龄产业发展报告(2014)[M].北京:社会科学文献出版社,2014:33-39.
[4]曾毅,王正联.中国家庭与老年人居住安排的变化[J].中国人口科学,2004,(5):2-8.
[5]谷琳,乔晓春.我国老年人健康自评影响因素分析[J].人口学刊,2007,(6):25-29.
[6]曲嘉瑶,杜鹏.中国城镇老年人的居住意愿对空巢居住的影响[J].人口与发展,2014,20(2):87-94.
[7]Sibai A M,Yount K M,Fletcher A.Marital Status,Intergenerational Co-residence and Cardiovascular and All-cause Mortality among Middle-aged and Older Men and Women during Wartime in Beirut:Gains and Liabilities[J].Social Science&Medicine,2007,64(1):64-76.
[8]刘宏,高松,王俊.养老模式对健康的影响[J].经济研究,2011,(4):80-93.
[9]Rahman O,Menken J,Kuhn R.The Impact of Family Members on the Self-reported Health of Older Men and Women in a Rural Area of Bangladesh[J].Ageing and Society,2004,24(6):903-920.
[10]Kharicha K,Iliffe S,Harari D,et al.Health Risk Appraisal in Older People 1:Are Older People Living Alone an‘At-risk’Group?[J].British Journal of General Practice,2007,57(537):271-276.
[11]沈可.中国老年人居住模式之变迁[M].北京:社会科学文献出版社,2013:87-89.
[12]Waite L J,Hughes M E.At Risk on the Cusp of Old Age:Living Arrangements and Functional Status among Black,White and Hispanic Adults[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,1999,54(3):136-144.
[13]Walter-Ginzburg A,Blumstein T,Chetrit A,et al.Social Factors and Mortality in the Old-old in Israel the CALAS Study[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2002,57(5):308-318.
[14]Li L W,Zhang J,Liang J.Health among the Oldest-old in China:Which Living Arrangements Make a Difference?[J].Social Science&Medicine,2009,68(2):220-227.
[15]李建新,李嘉羽.城市空巢老人生活质量研究[J].人口学刊,2012,(3):31-41.
[16]Davis M A,Neuhaus J M,Moritz D J,et al.Living Arrangements and Survival among Middle-aged and Older Adults in the NHANES I Epidemiologic Follow-up Study[J].American Journal of Public Health,1992,82(3):401-406.
[17]Davis M A,Moritz D J,Neuhaus J M,et al.Living Arrangements,Changes in Living Arrangements,and Survival among Community Dwelling Older Adults[J].American Journal of Public Health,1997,87(3):371-377.
[18]Sarwari A R,Fredman L,Langenberg P,et al.Prospective Study on the Relation between Living Arrangement and Change in Functional Health Status of Elderly Women[J].American Journal of Epidemiology,1998,147(4):370-378.
[19]封婷,陈茗.厦门市城区空巢老年人生活质量综合评析[J].南方人口,2008,23(2):37-43.
[20]Magaziner J,Cadigan D A,Hebel J R,et al.Health and Living Arrangements among Older Women:Does Living Alone Increase the Risk of Illness[J].Journal of Gerontology,1988,43(5):127-133.
[21]Iliffe S,Tai S S,Haines A,et al.Are Elderly People Living Alone an at Risk Group?[J].Bmj,1992,305(6860):1001-1004.
[22]Mui A C,Burnette J D.A Comparative Profile of Frail Elderly Persons Living Alone and Those Living with Others[J].Journal of Gerontological Social Work,1994,21(3-4):5-26.
[23]Van Gelder B M,Tijhuis M,Kalmijn S,et al.Marital Status and Living Situation during a 5-year Period are Associated with a Subsequent 10-year Cognitive Decline in Older Men:The FINE Study[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2006,61(4):213-219.
[24]Stevens F C,Kaplan C D,Ponds R W,et al.How Ageing and Social Factors Affect Memory[J].Age and Ageing,1999,28(4):379-384.
[25]张卫华,赵贵芳.城市老年人认知功能的相关因素分析[J].中国心理卫生杂志,2001,15(5):327-330.
[26]Sibley A,Mac Knight C,Rockwood K,et al.The Effect of the Living Situation on the Severity of Dementia at Diagnosis[J].Dementia and Geriatric Cognitive Disorders,2002,13(1):40-45.
[27]Koller K,Gosden S.On Living Alone,Social Isolation and Psychological Disorder[J].Journal of Sociology,1984,20(1):81-92.
[28]李德明,陈天勇,吴振云,等.城市空巢与非空巢老人生活和心理状况的比较[J].中国老年学杂志,2006,26(3):294-296.
[29]Sun X,Lucas H,Meng Q,et al.Associations between Living Arrangements and Health-related Quality of Life of Urban Elderly People:A Study from China[J].Quality of Life Research,2011,20(3):359-369.
[30]Liu L J,Guo Q.Life Satisfaction in a Sample of Empty-nest Elderly:A Survey in the Rural Area of a Mountainous County in China[J].Quality of Life Research,2008,17(6):823-830.
[31]You K S,Lee H O.The Physical,Mental,and Emotional Health of Older People Who are Living Alone or with Relatives[J].Archives of Psychiatric Nursing,2006,20(4):193-201.
[32]Van Tilburg T,de Jong Gierveld J,Lecchini L,et al.Social Integration and Loneliness:A Comparative Study among Older Adults in the Netherlands and Tuscany,Italy[J].Journal of Social and Personal Relationships,1998,15(6):740-754.
[33]Stroebe W,Stroebe M S.Bereavement and Health:The Psychological and Physical Consequences of Partner Loss[M].Cambridge:Cambridge University Press,1987:133-143.
[34]周建芳,薛志强,方芳,等.独居老人抑郁症状和抑郁症的调查[J].上海精神医学,2008,20(3):136-138.
[35]张河川,张晓芬,郭思智.独居老年人心理健康状况与社会支持关系[J].中国公共卫生,2010,26(4):466-467.
[36]Durkheim E.Suicide:A Study in Sociology[M].Routledge&K Paul,1952:359.
[37]Lubben J E.Gender Differences in the Relationship of Widowhood and Psychological Well-being among Low Income Elderly[J].Women&Health,1989,14(3-4):161-189.
[38]Wenger G C,Dykstra P A,Melkas T,et al.Social Embeddedness and Late-life Parenthood Community Activity,Close Ties,and Support Networks[J].Journal of Family Issues,2007,28(11):1419-1456.
[39]沈可,程令国.空巢是否损害了老年健康?[J].世界经济文汇,2012,(2):89-103.
[40]Wen M,Gu D.The Effects of Childhood,Adult,and Community Socioeconomic Conditions on Health and Mortality among Older Adults in China[J].Demography,2011,48(1):153-181.
[41]Crimmins E M,Hayward M D,Saito Y.Differentials in Active Life Expectancy in the Older Population of the United States[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,1996,51(3):111-120.
[42]Jia Yunzhu.Daily Life of the Elderly Care Resources and Community Support Services Development[J].Sociology Studies,2002,(5):119-122.
[43]Zhang Z,Gu D,Hayward M D.Early Life Influences on Cognitive Impairment among Oldest Old Chinese[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2008,63(1):25-33.
[44]Zhang Z.Gender Differentials in Cognitive Impairment and Decline of the Oldest Old in China[J].The Journals of Gerontology Series B:Psychological Sciences and Social Sciences,2006,61(2):107-115.
[45]Smith J,Gerstorf D,Li Q.Psychological Resources for Well-being among Octogenarians,Nonagenarians,and Centenarians:Differential Effects of Age and Selective Mortality[J].Healthy Longevity in China,2008,20:329-346.
[46]Li D,Wu T C Z.An Exploration of the Subjective Well-being of the Chinese Oldest-old[J].Healthy Longevity in China,2008,20:347-356.
[47]Hausman J A.Specification Tests in Econometrics[J].Econometrica:Journal of the Econometric Society,1978,46(6):1251-1271.
[48]Amemiya T.The Nonlinear Two-stage Least-squares Estimator[J].Journal of Econometrics,1974,2(2):105-110.
[49]福克斯.社会科学中的数理基础及应用[M].上海:格致出版社,2011:137-147.
[50]Andrews D W K,Soares G,Andrews D W K,et al.Instrumental Variables Regression with Weak Instruments[J].Cowles Foundation Discussion Papers,2004,23(6):1033-1082.
(1)西方不存在户籍制度分割,因此不存在城镇老年人与农村老年人的分别;而且由于西方国家经济发达,在整体上可以将全体老年人与中国城镇老年人进行对比。
(1)方差分析结果显示,以空巢与否作为分组标准对总体样本进行分组对比,F检验结果显示P值为0.000,说明空巢老人和与子女同住老人在健康方面存在显著差异。
(2)本研究遵循的是中国在西部大开发后对东中西部的重新划分,东部包括北京、天津、河北、辽宁、上海、江苏、浙江、福建、山东、广东、海南;中部包括山西、吉林、黑龙江、安徽、江西、河南、湖北、湖南;西部包括内蒙古自治区、广西壮族自治区、重庆、四川、贵州、云南、西藏自治区、陕西、甘肃、青海、宁夏回族自治区、新疆维吾尔自治区。
(1)一阶段回归的F值是否大于10可作为弱工具变量的评判标准。如果存在弱工具问题,则二阶段最小二乘法的估计结果可能会产生偏误。
(1)在变量处理的过程中,对于空巢影响的三个机制变量,研究将物质生活缺乏保障和医疗服务利用率不足变量进行负向处理,取值越高说明物质生活保障和医疗服务利用率越低,而社会活动参与变量则采用正向处理,取值越高说明老年人参与社会活动的程度越高。