Effects Of Living Arrangements On Health-related Quality Of Life Among Chinese Older People:Propensity Score Weighting Analysis

ObjectiveTo explore the predictors of living arrangements among the elderly based on Andersen's behavioral model of health service use.To explore the effect of livingarrangements on health-related quality of life using propensity score weighting analysis.MethodsA total of 917 community-dwelling elderly and 249 institutionalized elderly were recruited from July 2015 to March 2016 in Jinan City.Our questionnaireincludingsocio-demographic characteristics,social support rating scale(SSRS),Activity of Daily Living(ADL),Instrumental Activity of Daily Living(IADL),Short Portable Mental Status Questionnaire(SPMSQ),5-item Geriatric Depression Scale(GDS-5),12-Item Short-Form Health Survey Questionnaire(SF-12).Descriptive analysis,bivariate analysis,logistic regression and multivariate liner regression were conducted using SPSS22.0,and propensity score for every case was calculated using logistic regression.Weighting liner regression analysis was conducted using STATA12.0.Results1.The institutionalized elderly were significantly more likely to be older,have less education,have no spouse,have religious beliefs,have more children,have children living far from the elderly residence place,have lower income,have hospitalization history,have less social support,cognitive function impairment,ADL and IADL impairment and depression(P<0.05).2.Logistic regression analysis showed that advanced age(OR==1.111,P<0.001),children living far from the elderly residence place(OR=2.674,P<0.001),cognitive function impairment(OR=1.951,P=0.018),ADL(OR=1.815,P=0.011)and IADL(OR=4.096,P<0.001)impairment were significant risk factors of institutionalization.The female elderly(0R=0.440,P=0.001),and those who had spouse(OR=0.210,P<0.001),more children(OR=0.494,P=0.020),higher income(OR=0.444,P=0.011),and more social support(OR=0.945,P=0.002)had less probability to be institutionalized.3.The effects of living arrangements on physical component summary,physical functioning,role-physical were significant in t test,multivariate linear regression and weighting linear regression(P<0.05),respectively;and institutionalized elderly performed worse in these dimensions.The effects of living arrangements on general health,role-emotional,social function were only significant in t test(P<0.05),respectively;and institutionalized elderly scored lower than the community residents.In multivariatelinear regression and weighting linear regression,general health,role-emotional,social function were not predicted by living arrangements significantly(P>0.05),respectively.The effects of living arrangements on bodily pain,and mental health were not significant in t test,multivariate linear regression or weighting linear regression(P>0.05),respectively.The significant effects of living arrangements on mental component summary and vitality were only showed in multivariate liner regression(P<0.05),not in t test or weighting linear regression(P>0.05).Conclusion1.There are heterogeneous socio-demographic and health characteristics between the community-dwelling elderly and the institutionalized elderly.2.Advanced age,male,having no spouse,having less children,having children living far from the elderly residence place,low income,less social support,cognitive function impairment,ADL and IADL impairment were risk predictors of institutionalization.3.Propensity Score Weighting analysis with control for selection bias provides an accurate estimation for the effects of living arrangements on health-related quality of life among the elderly.Institutionalization has detrimental effects on physical quality of life including physical functioning,role-physical,and physical component summary,not on psychological quality of life as well as body pain and general health.Therefore,it is key to maintain the physical functioning and role-physical of the institutionalized elderly for improving their health-related quality of life.