Tác động của sắp xếp cuộc sống đến sức khỏe và tình trạng làm việc của người cao tuổi việt nam TT TIENG ANH

THE UNIVERSITY OF DANANG UNIVERSITY OF ECONOMICS - - IMPACT OF LIVING ARRANGEMENTS ON HEALTH AND WORKING STATUS OF THE VIETMAMESE OLDER PERSONS MAJOR: DEVELOPMENT ECONOMICS CODE: 62.31.01.05 SUMMARY OF DOCTORAL DISSERTATION Danang - 2021 The dissertation was completed at UNIVERSITY OF ECONOMICS, THE UNIVERSITY OF DANANG Supervisors: Reviewer 1: Reviewer 2: Reviewer 3: The dissertation will be defended at the doctoral defence committee from University of Economics, The University of Danang on 2021 The dissertation can be found at: - National Library of Vietnam - Center for Learning Information Resources and Communication The University of Danang INTRODUCTION Necessity Vietnam is one of the countries with the fastest population aging, particularly when comparing with other middle-income countries According to the results of the 2019 Population and Housing Census, the proportion of older people (those aged 60 and over) was about 11.9% of the total population (equivalent to 11.4 million people) The population projections by GSO (2016) showed that the proportion of older people would increase to 26.1% by 2050 (equivalent to 27 million people) Co-residence has been traditionally common in Vietnam, and therefore older people are cared by family members To date, family remains the main security source for older persons – in which they receive support both physically and mentally However, the rapid socio-economic transition and migration have strongly affected households, turning them from multiple-generation families to nuclear families, particularly families where older person lives with his/her spouse Besides, living alone is not desirable arrangement but it has become an increasingly popular trend among older people Such changes in living arrangements (residential arrangements) provide both opportunities and challenges for care for and promote role of older people At the same time, most of the older people in Vietnam are still living in rural areas without pensions and having little saving, and many of them not receive any social protection benefits (UNFPA 2011, Giang Thanh Long and Phi Manh Phong, 2016) and thus many older people are working longer than expected to finance themselves and their families With these, changes in living arrangements where older people not live with their children will have a significant impact on income security for older people, especially in the Vietnamese socio-economic context As such, in the context of an aging population under middle- income status, exploration of how living arrangements impact on health and working status of older persons is very important To date, however, at the best of my knowledge, there have been no studies discussing the impact of living arrangements on health (physically and mentally) and working status of older people Therefore, these reasons provide a great motivation for me to pursue the topic “Impact of living arrangements on health and working status of the Vietnamese older persons” for my Ph.D research Objectives of the study 2.1 Specific objectives i) Systematize theories about living arrangements and the impact of living arrangements on health and working status of the Vietnamese older persons; ii) Analyze the current situation of the living arrangements of older persons in Vietnam; iii) Analyze the impact of living arrangements on the health and working status of older persons; iv) Based on the analysis results, propose some policies to improve health and working status of older persons 2.2 Research questions The research questions to be addressed are: i) What theories could be used to clarify the relationship between living arrangements and health and working of older people? ii) What is the situation of living arrangements of older people in Vietnam? iii) In the context of Vietnam, how does living arrangements factor affect the health and working status of older people? iv) Based on empirical research results, what policies are needed to improve the health of older people and promote older people to work? 3 Object and scope of the research 3.1 Object of the research: The objects of this research were living arrangements (residential arrangements) of older people in Vietnam, health and working status of older people, and the impact of living arrangements on health and working status of the Vietnamese older persons 3.2 The scope of the research: - Content: The author focused on building quantitative models to analyze the impact of older people’s living arrangements on their health (both physical and mental health) and working status - Space: Over Vietnam with a nationally representative dataset - Period: + Changes in living arrangements of older people from 2002 to 2016 based on the Vietnam Household Living Standards Survey (VHLSS) data of the General Statistics Office + Impact of living arrangements on health and working status of older people based on the data of the Vietnam Aging Survey 2011 (VNAS 2011) since at the time that this dissertation was completed, VNAS 2011 was the only nationally representative database on older persons with the most comprehensive data which could be fully used to pursue research questions of this dissertation New contributions to the research - This dissertation analyzed various research methods and respective results from a number of literatures in Vietnam and other countries From which, the research gaps were explored to have further studies - Clarify the concepts and classify different types of living arrangements in order to adapt with the research contexts - Quantify the impact of living arrangements on health (both physical health and mental health) and working status of older people - This has been the first study in Vietnam analyzing such impact - The dissertation’s results showed that living arrangements of the Vietnamese older people have changed Among different types, living with children was the best for health and wellbeing of older people - The dissertation provide various recommendations to policy makers in formulating appropriate policies to improve health and wellbeing for older people Structure of the dissertation Include the opening, the conclusion and chapters as follows: Chapter Literature review Chapter Theoretical foundations of the effect of living arrangements on the health and working of older people Chapter Research design Chapter Research results Chapter Policy implications CHAPTER LITERATURE REVIEW 1.1 Studies on living arrangements of older people 1.1.1 Research situation in the world 1.1.2 Research situation in Vietnam Studies of the world and Vietnam on living arrangements of older people show that the living arrangements model of older people in different countries and regions is different Living alone or living with a spouse is the most common form of living arrangements found in developed countries, and living with children is the most common form in developing countries However, empirical evidence shows that, in developing countries like Vietnam, along with socioeconomic changes, the traditional living arrangements model is also changing rapidly The percentage of older persons living with children has decreased while living alone or with wife/husband has increased 1.2 Studies on the impact of living arrangements on health of older people * Living arrangements positively affect the health of older people * Living arrangements negatively affect the health of older people From the review of the above studies, some important results can be drawn as follows: - Living arrangements of older people is one of the important factors determining the health of older people There is ample evidence, including in developed and developing countries, that living arrangements are likely to affect older people's health represented by various measures such as self-assessment health, difficulty in daily activities, depression, cognitive impairment, disease situation, and risk of death - In general, studies have shown that living in a multigenerational family will contribute to improving physical and mental health due to the material and non-physical benefits it brings (such as supporting internal family transfer, health care, a healthy lifestyle, help with daily activities, pride, and emotional support, etc.) - Older people living alone often have poor health and are at higher risk for depression as well as less satisfied with life - Several studies have found the opposite effect that living together does not improve the health of older people but makes the health of them worse Due to the sharing of resources from parents to children, or living together makes older people too dependent on others, leading to a decline in some motor functions, and further, the generation gap leads to conflicts about ideological values These are the causes that make a living together between parents and children lead to health deterioration of older people 1.3 The research on the impact of living arrangements on working status of older people From the review of the above studies, some significant results can be drawn as follows: - The majority of older people still work, and this participation is very different for each type of living arrangement - Living arrangements of older persons are one of the important factors determining older people's work In both developed and developing countries, there is much research evidence showing that living arrangements may affect the working status of older people - The research results are heterogeneous, in which some studies affirm that the working probability of older people living with spouses and children is higher than in other older people groups (for example, Croda and Gonzalez 2005, Paul and Verma 2016, Raymo et al 2018) In contrast, there is a study revealing that older people living with their children have a lower probability of working than other older people groups (for example, Tong, Chen and Su 2018) 1.4 Scientific gaps - In the studies on the relationship between living arrangements and health, and working of older people, the research results are not apparent Hence, in the context of Vietnam, it is necessary to examine this relationship - Vietnam is a developing country, but the aging process is happening very fast The studies on aging, in general, are quite large, but the research on the current situation of living arrangements, health, work as well as the effect between these factors of older people in Vietnam has not been studied - Research on the effect of living arrangements on the health, and working of older people in Vietnam as a basis for social policy planning CHAPTER THEORETICAL BASIS OF THE IMPACT OF LIVING ARRANGEMENTS ON HEALTH AND WORKING STATUS OF OLDER PEOPLE 2.1 General issues about older people and living arrangements of older people 2.1.1 Some related concepts 2.1.1.1 Population aging Population aging also called the "aging population" period: When the proportion of people aged 65 and older accounts for 7% to 9.9% of the total population or more (According to the classification of Cowgill and Holmes (1970), cited by (Tsuya and Martin, 1992) 2.1.1.2 Definition of older people In Vietnam, according to Article 2, the Law on the older people 2009 stipulates: Older people are citizens of the Socialist Republic of Vietnam aged 60 and over In this dissertation, the author will use the term older people under this regulation 2.1.2 Definition of “Living arrangements” 2.1.2.1 Definition of living arrangements 2.1.2.2 Living arrangements of older persons The term ‘living arrangements’ or ‘co-residential arrangements’ (Palloni, 2000) is used to refer to the household structure of older people 2.2 Classifying living arrangements of older people From the above analysis, it is suitable for the basic characteristics of Vietnam in terms of demographics, socio-economic situation, and the availability of research data as well as to assess the relationship between living arrangements and health, and working of older people clearly, this dissertation defines living arrangements and classifies living arrangements as follows: Living arrangements of older people is to show whom the elderly live with and the living arrangements can be divided into the following groups: i) Living alone: consisting of households with only older persons living alone; ii) Living with a spouse only ( households with only elderly spouses living together); iii) Living with at least a child (that is, the elderly living with at least one child, including natural and/or adopted children; and iv) Other (including other ways of living arrangements of older persons not belong to the above groups) 2.4 Living arrangements and health of older persons 2.4.1 Definition and measurement of health 2.4.1.1 Physical health 2.4.1.2 Mental health 2.4.2 Impact of living arrangements on health The impact of living arrangements on the health of older persons is explained by convoy theory, social support theory, and cultural theory 2.4.2.1 The convoy model of social relations Living arrangements can be seen as a kind of social convoy of intergenerational relationships because it provides support throughout an individual's life, including both physically and physically support (physical help, financial support, etc.) and emotional support Individuals in this social convoy are closely related within the family, thus the living arrangements of individuals and the change in their living arrangements affect the overall health and well-being of all individuals in the convoy 2.4.2.2 Social support theory Living arrangements between generations are a kind of social support because living arrangements form the closest and most direct social environment in providing physical and mental social support to individuals The different types of living arrangements are associated with diverse family relationships and different exchange models because the different types of living arrangements will determine the role of individuals in a household and the number and type of various 11 + β: is coefficient; and + ε: shows the measurement error term 3.2.3 Describe and measure research variables 3.2.3.1 Dependent variable (Health outcomes) - Self- rated health (SHR) represents for physical health - Depression represents for mental health 3.2.3.2 Independent variables ❖ Independent variables in SRH logistic regression model - Living arrangements were main independent variable This study included four types of living arrangements, respectively: (i) living alone; (ii) living only with a spouse; (iii) living with at least child; (iv) other Other independent variables are divided into the following three groups: - Sociodemographic variables: age; gender; marriage status; education; urban/rural residence; religion; ethnicity - Environment factors were measured by lighting energy; drinking water; toilet - Health behaviors The environment assessed included tobacco-smoking; alcohol-drinking ❖ Independent variables in depression logistic regression model - Living arrangements of older people: This is the main independent variable in this study, the living arrangements is described above Other independent variables are divided into the following three groups: - Individual characteristics include: age; sex; marital status; education level; working status; had difficulties with activities of daily living (ADLs), had functional limitations - Household-related characteristics include financial status; 12 area of living; ever experienced domestic violence; had a role in the family decision; received help from child(ren) for housework; received monetary support from child(ren); provided monetary support to child(ren); and took care of (great) grandchild(ren) or other family members; and - Community-related characteristics include participated in social organizations and community activities; and had respect from community as an older person 3.3 Conceptual framework and research model for studying the effect of living arrangements and working status of older people 3.3.1 Conceptual framework 3.3.2 Research Model 3.3.3 Describe and measure research variables 3.3.3.1 Dependent variable: is work status of older persons, the variable “work status” was a binary variable: it was code (showing older people with current working), while it was coded (showing older people without current working) 3.3.3.2 Independent variables - Living arrangements Control variables was divided into three groups: - Variables representing individual characteristics include: age; sex; education level; health; and - Variables representing household characteristics include: financial status; living location; received monetary support from child(ren); provided monetary support to children; and took care of (great) grandchildren or other family members 3.4 Research data The data for the study comes from two secondary data include Vietnam Aging Survey (VNAS), which was the first nationally representative survey on older adults (aged 50 years and over) in Vietnam (Vietnam Women Union-VWU) and Vietnam Household 13 Living Standards Survey (VHLSS) data of the General Statistics Office (GSO) 3.5 Research method 3.5.1 Data processing 3.5.2 Analysis method 3.5.2.1 Qualitative analysis methods The syndissertation method is used through the syndissertation of related theories and systematizing the theoretical basis of the dissertation, the empirical research on the relationship between living arrangements and health, and working of older people Since then, selectively acquire to build theoretical frameworks and research models suitable for the actual conditions of Vietnam 3.5.2.2 Quantitative analysis methods ❖ Descriptive Statistic With the frequency indexes to analyze the current situation living arrangements of older persons in Vietnam, the health status of older people as well as their working status by each specific life arrangement, and by other variables ❖ Related tests - Correlation test - Variance Inflation Factor test - T-test - Chow test - Hosmer-Lemeshow test ❖ Regression Coefficient Estimate This research uses the logistic regression model The regression coefficients are expressed as the odds ratio (OR), a ratio above indicates that the associated variable has a higher probability (chance) of occurrence than the reference list and values less than indicates the opposite 14 CHAPTER RESEARCH RESULTS 4.1 The situation of living arrangements of older people in Vietnam 4.1.1 Overview of the elderly population in Vietnam 4.1.1.1 Number of older people in Vietnam The number and proportion of older persons in Vietnam have increased sharply over time In 1979, the elderly population of our country was 3.71 million people, accounting for 6.9% of the country's population By 2018, there were about 13.1 million Vietnamese people aged 60 and over, this figure accounted for 13.9% of the total population of the country The number of older persons has doubled compared to 1999 and tripled compared to 1979 And it is forecasted that by 2050 Vietnam will be a "super-old" population 4.1.1.2 Characteristics of Vietnam's elderly population 4.1.2 Living arrangements of older persons in Vietnam Table 4.3 Living arrangements of older persons in Vietnam Indicator Unit Living alone % Living with only spouse % Living with at least a child % Others % Total Total (unweighted) n Total (weighted) n 2002 5.29 13.28 72.80 8.63 100 11,946 2006 5.58 15.53 68.02 10.86 100 3,865 2012 7.44 19.43 60.85 12.28 100 3,978 2016 7.92 19.65 59.53 12.90 100 4,642 7,081,223 8,400,266 10,009,091 12,464,736 (Source: Adapted from VHLSS 2002, 2006, 2012 and 2016) The household living arrangements of older people have changed a lot, previously, 80% of older persons lived with their children, but now due to the changes in socio-economic life, only over 59% of older persons live with their children Clearly, with such changes in family living arrangements, it creates a challenge in support and cares for older persons based on the community and other factors instead of the family While the proportion of older 15 persons living with their children has decreased significantly, the proportion of older persons who have lived only with their spouses has increased over time 4.1.3 Living arrangements of older persons by age 4.1.4 Living arrangements of older persons by sex 4.1.5 Living arrangements of older persons by living area 4.2 Test results 4.3 Impact of living arrangements and self-rated health 4.3.1 The health condition is self-assessed by older people There were 36% of older people considered themselves in good health (SRH-Self-rated Health), in which the proportion of older men was 41.19% and older women were 32.11% In the form of living arrangements, there is a big difference in the assessment of SRH among different ways of living arrangements Only 18% of older persons living alone think that they have a good SHR, while such percentage of older persons living with spouses only is 36.07%; those who live with children are 36.62%, and older persons living with others with SRH was 41.94% 4.3.2 Living arrangements and factors impacting self-rated health of older persons Table 4.9 Logistic regression results for self-rated health of older persons Model OR Model OR Model OR Model OR Living arrangements Living alone (ref) With only spouse 2.57*** 1.488 1.50 1.40 With at least a child 2.63*** 1.78** 1.80** 1.76** Others 3.29*** 1.94* 1.99* 1.99** Notes: *, **, *** denote statistically significant Beta coefficient at the 10, and percent significance level respectively; (ref.) denotes the reference groups Source: By author, using VNAS 2011 The results of Model show that the relationship between 16 living arrangements and SRH is quite clear: compared to older persons living alone, older persons live with spouses; older people live with children; and older persons with different living arrangements have better SRH with 2.5 times higher (OR = 2,572, p