Attempts to understand factors influential to the quality of life of older populations have long been a focus in gerontology literature. Recent efforts have expanded beyond age and health factors and prioritize social determinates to the quality of life among older adults. Burnette and her colleagues’ article (Reference Burnette, Ye, Cheng and Ruan2020) represents an effort to dissect the effect of living alone on the quality of life among older Chinese adults, by examining one proposed underlying mechanism – social cohesion within different residential settings (i.e. urban or rural areas).
Like most countries that went through industrialization and modernization, China witnessed remarkable changes in family size, structure, and dynamics (Yeung and Cheung, Reference Yeung and Cheung2015; Zhao and Guo, Reference Zhao and Guo2010). Such changes challenge traditional norms and values toward elder care derived from Confucius’ thoughts of filial piety. Filial piety simply refers to expectations of adult children to respect and support older parents by providing physical, emotional, and financial means (Ikels, Reference Ikels2004). In traditional Chinese culture, adult children who lived with their parents was common. However, in contemporary Chinese culture, adult children are unlikely to live with their parents for reasons other than employment opportunities and career development. The geographic and social distances between generations, along with increased life expectancy, have contributed to rising numbers of older Chinese adults who live alone. Recognizing this cultural shift, Burnette et al.’s paper is meaningful by focusing on the effect of living alone on the quality of life of older Chinese adults. It is even inspirational as it attempts to detect and test an underlying mechanism via which living alone affects quality of life in rural and urban settings.
This commentary aims to help readers better comprehend the implications of Burnette et al.’s study by highlighting their contributions to the literature, setting parameters for interpretation of their findings, and alluding to a direction for future studies in this regard.
Challenges to status quo about the effect of living alone
One of the key findings of Burnette et al.’s paper is that living alone had a positive effect on quality of life, after ruling out covariate effects such as health and mental health differences between those living alone and those living with families. Partially, this positive effect can be attributed to those who lived alone had high levels of social participation in community. This finding challenges a common belief that living alone negatively affects quality of life (Chen and Short, Reference Chen and Short2008). It begs for a scrutiny of a research question: What is the distinctive effect of living alone on quality of life? If we equalize differences in health, mental health, and social demographics, will those who live alone have better quality of life than those living with families?
If that holds true, what is a possible explanation? The authors identified social cohesion as a mediating factor between living alone and quality of life. It challenges the assumptions of people who live alone to engage in social interaction or participation. Rather, in their study, those who lived alone were found to engage in higher levels of social interaction and community participation, in the authors’ term, higher levels of social cohesion. Partially because of higher levels of social cohesion, those who lived alone had a better quality of life than those who lived with families. Burnette et al.’s explanation offers a new perspective, though not a definitive answer, given a cross-sectional study design that prevents a causal inference.
One way to help interpret the above finding is to contextualize it in the study sample. The age group in this study was 50 years and older, which differs from a common definition of older adults as 65 years or older. In particular, about half (46.3%) of the total participants in this study were aged 50–59 years, who are typically regarded as adults in middle adulthood. Individuals in middle adulthood (i.e. 50–64 years old) have different socioeconomic status (SES) and lifestyles compared to their counterparts aged 65 years and older. As those in their 50s are typically not retired, they are more likely to have a large social network and social events related to employment than are their older counterparts. Even when they live alone, they tend to enjoy an active lifestyle with social interactions and community participation, but this level of social participation may diminish as they advance to older age. Thus, jumping to the conclusion that living alone is beneficial to older adults’ quality of life and contributing its positive effect to social participation can be premature. The findings hold true because this study example included a large proportion of adults under 60. It is worth dichotomizing the sample using age 65 as a cutoff value and testing the same hypotheses on both age groups. Or three groups, such as 50–59, 60–69, and not, can be used to identify the effect of age on the relationship between living arrangement and quality of life.
Reinforcing urban and rural differences in Chinese society
The other key finding of this study is that the positive effect of living alone on social cohesion is more salient in urban areas than in rural areas. In other words, those who lived alone tended to have more social interactions and social participation than those who lived with families in urban areas. China has a split social welfare system in that urban retirees have better access to social security and medical services. Likewise, urban older adults have more access to social services and opportunities for community activities and social interactions (Sun et al., Reference Sun, Li, Jiang and Lee2020). Those who are bound to families may have less freedom to join these events as compared to those who live alone. In rural China, where community events geared toward seniors are rare, the difference between those who lived alone and with families tend to be small. This finding itself largely reflects an urban rural disparity on social engagement resources and opportunities for adults aged 50 years or older.
The two essential findings of this study presented new evidence that sheds new light on the links between living alone and social cohesion within the context of residential settings. Yet, this study did not seem to fully address the question it raised. That is, theoretically, why living alone would trigger more social participation/interaction? Supported by the data was the partial mediation due to social cohesion (setting aside the limitation of cross-section design for mediation analysis), but the theoretical ground is lacking. On the contrary, conceptually living alone would lead to social isolation, which is the lack of social participation, a risk factor for quality of life in later life (Wang et al., Reference Wang, Chen and Han2014). Additionally, are there possible other mediating mechanisms, such as social isolation, family conflict, or even loneliness, that can partial out the effects of living alone? Lack of a theoretical framework to support hypothesis testing weakens a conclusion. Goode’s convergency theory explains a tendency of family nuclearization and weak cohesion among extended family as individuals have improved SES (Goode, Reference Goode1983). Other theories (e.g. socio emotional selectivity theory) could also be embedded to guide this inquiry or help interpret results.
Limitations of the study and direction for future research
The interpretations of the findings of Burnette et al.’s article need to be understood within several limitations (noted below), which can be addressed in future studies.
The measure of social cohesion needs to be in line with its conceptualization. The authors cited McNeill et al.’s (Reference Mcneill, Kreuter and Subramanian2006) understanding of social cohesion as a community characteristic, but measured it as an individual-level social participation. The authors further adopted Marmot and Wilkinson’s definition (Reference Marmot and Wilkinson2006) of social cohesion, which appears to encompass frequency and quality of social participation. In the 9-item measure of social cohesion used in this study, the quality aspect of social participation such as feelings of closeness or sense of belonging was not captured. Strictly speaking, social cohesion in this study was operationalized as social interaction with others and community social participation. Given a secondary analysis that is inherently limited to available measures, future research needs to adopt a measure fully compatible with the conceptualization of social cohesion.
The effects of other important covariates to quality of life in late stage were not included. Quality of life and living arrangement can be influenced by life events such as loss of the loved one and declined cognitive function (Pocnet et al., Reference Pocnet, Antonietti, Strippoli, Glaus, Preisig and Rossier2016). Particularly, widowhood is one of the biggest events in later life leading older adults to be depressed and suffer from low quality of life (Jadhav and Weir, Reference Jadhav and Weir2018). Whether or not older adults have cohabiting partners should be considered, but this study did not address this issue. Further, there are differences between women living alone and men living alone in later life and different rates of older men and women that reside in urban and rural areas. The study used urban and rural residences as a moderator. Differences in rates of men and women living in urban or rural areas should be addressed, and multi-group analysis should be used to understand the disparities in urban and rural residences based on differences in older men and women.
Lastly, living arrangement can be fluid and may encompass more than two types: living alone and living with family. This study focused on community-dwelling adults, and therefore, those who live in government-subsidized housing, retirement communities, assisted living facilities, and nursing homes were not included. Even though researchers reported that they excluded older adults in other living arrangements, it may have left out those who had mixed living arrangements, which meant they shifted between living alone and with families. It is common that rural older Chinese women move to urban city to help take care of grandchild and leave their husbands at home alone. Or older Chinese in cities may split time between their own apartment and their adult child’s house. This population termed as migrant elders needs to be examined in future studies.
Conclusion
China has faced remarkable changes in traditional norms and values and a split urban and rural social welfare system since opening and reforming their economy (He and Ye, Reference He and Ye2014; Ye et al., Reference Ye, He, Liu, Wang and Chen2016). Such transformation has influenced the living arrangement, social participation, and quality of life for older adults in rural and urban areas, calling for scholars in gerontology and geriatric fields to develop new theoretical frameworks to guide empirical inquiries. Burnette et al.’s article shed some initial light in this direction, and still much more work needs to be done. In sum, a theoretical framework that postulates the relationship between living alone and social cohesion within urban and rural settings needs to be brought up, valid and reliable measures of key concepts like social cohesion are adopted, and longitudinal research design is needed for mediation analyses that imply causal inferences.
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Attempts to understand factors influential to the quality of life of older populations have long been a focus in gerontology literature. Recent efforts have expanded beyond age and health factors and prioritize social determinates to the quality of life among older adults. Burnette and her colleagues’ article (Reference Burnette, Ye, Cheng and Ruan2020) represents an effort to dissect the effect of living alone on the quality of life among older Chinese adults, by examining one proposed underlying mechanism – social cohesion within different residential settings (i.e. urban or rural areas).
Like most countries that went through industrialization and modernization, China witnessed remarkable changes in family size, structure, and dynamics (Yeung and Cheung, Reference Yeung and Cheung2015; Zhao and Guo, Reference Zhao and Guo2010). Such changes challenge traditional norms and values toward elder care derived from Confucius’ thoughts of filial piety. Filial piety simply refers to expectations of adult children to respect and support older parents by providing physical, emotional, and financial means (Ikels, Reference Ikels2004). In traditional Chinese culture, adult children who lived with their parents was common. However, in contemporary Chinese culture, adult children are unlikely to live with their parents for reasons other than employment opportunities and career development. The geographic and social distances between generations, along with increased life expectancy, have contributed to rising numbers of older Chinese adults who live alone. Recognizing this cultural shift, Burnette et al.’s paper is meaningful by focusing on the effect of living alone on the quality of life of older Chinese adults. It is even inspirational as it attempts to detect and test an underlying mechanism via which living alone affects quality of life in rural and urban settings.
This commentary aims to help readers better comprehend the implications of Burnette et al.’s study by highlighting their contributions to the literature, setting parameters for interpretation of their findings, and alluding to a direction for future studies in this regard.
Challenges to status quo about the effect of living alone
One of the key findings of Burnette et al.’s paper is that living alone had a positive effect on quality of life, after ruling out covariate effects such as health and mental health differences between those living alone and those living with families. Partially, this positive effect can be attributed to those who lived alone had high levels of social participation in community. This finding challenges a common belief that living alone negatively affects quality of life (Chen and Short, Reference Chen and Short2008). It begs for a scrutiny of a research question: What is the distinctive effect of living alone on quality of life? If we equalize differences in health, mental health, and social demographics, will those who live alone have better quality of life than those living with families?
If that holds true, what is a possible explanation? The authors identified social cohesion as a mediating factor between living alone and quality of life. It challenges the assumptions of people who live alone to engage in social interaction or participation. Rather, in their study, those who lived alone were found to engage in higher levels of social interaction and community participation, in the authors’ term, higher levels of social cohesion. Partially because of higher levels of social cohesion, those who lived alone had a better quality of life than those who lived with families. Burnette et al.’s explanation offers a new perspective, though not a definitive answer, given a cross-sectional study design that prevents a causal inference.
One way to help interpret the above finding is to contextualize it in the study sample. The age group in this study was 50 years and older, which differs from a common definition of older adults as 65 years or older. In particular, about half (46.3%) of the total participants in this study were aged 50–59 years, who are typically regarded as adults in middle adulthood. Individuals in middle adulthood (i.e. 50–64 years old) have different socioeconomic status (SES) and lifestyles compared to their counterparts aged 65 years and older. As those in their 50s are typically not retired, they are more likely to have a large social network and social events related to employment than are their older counterparts. Even when they live alone, they tend to enjoy an active lifestyle with social interactions and community participation, but this level of social participation may diminish as they advance to older age. Thus, jumping to the conclusion that living alone is beneficial to older adults’ quality of life and contributing its positive effect to social participation can be premature. The findings hold true because this study example included a large proportion of adults under 60. It is worth dichotomizing the sample using age 65 as a cutoff value and testing the same hypotheses on both age groups. Or three groups, such as 50–59, 60–69, and not, can be used to identify the effect of age on the relationship between living arrangement and quality of life.
Reinforcing urban and rural differences in Chinese society
The other key finding of this study is that the positive effect of living alone on social cohesion is more salient in urban areas than in rural areas. In other words, those who lived alone tended to have more social interactions and social participation than those who lived with families in urban areas. China has a split social welfare system in that urban retirees have better access to social security and medical services. Likewise, urban older adults have more access to social services and opportunities for community activities and social interactions (Sun et al., Reference Sun, Li, Jiang and Lee2020). Those who are bound to families may have less freedom to join these events as compared to those who live alone. In rural China, where community events geared toward seniors are rare, the difference between those who lived alone and with families tend to be small. This finding itself largely reflects an urban rural disparity on social engagement resources and opportunities for adults aged 50 years or older.
The two essential findings of this study presented new evidence that sheds new light on the links between living alone and social cohesion within the context of residential settings. Yet, this study did not seem to fully address the question it raised. That is, theoretically, why living alone would trigger more social participation/interaction? Supported by the data was the partial mediation due to social cohesion (setting aside the limitation of cross-section design for mediation analysis), but the theoretical ground is lacking. On the contrary, conceptually living alone would lead to social isolation, which is the lack of social participation, a risk factor for quality of life in later life (Wang et al., Reference Wang, Chen and Han2014). Additionally, are there possible other mediating mechanisms, such as social isolation, family conflict, or even loneliness, that can partial out the effects of living alone? Lack of a theoretical framework to support hypothesis testing weakens a conclusion. Goode’s convergency theory explains a tendency of family nuclearization and weak cohesion among extended family as individuals have improved SES (Goode, Reference Goode1983). Other theories (e.g. socio emotional selectivity theory) could also be embedded to guide this inquiry or help interpret results.
Limitations of the study and direction for future research
The interpretations of the findings of Burnette et al.’s article need to be understood within several limitations (noted below), which can be addressed in future studies.
The measure of social cohesion needs to be in line with its conceptualization. The authors cited McNeill et al.’s (Reference Mcneill, Kreuter and Subramanian2006) understanding of social cohesion as a community characteristic, but measured it as an individual-level social participation. The authors further adopted Marmot and Wilkinson’s definition (Reference Marmot and Wilkinson2006) of social cohesion, which appears to encompass frequency and quality of social participation. In the 9-item measure of social cohesion used in this study, the quality aspect of social participation such as feelings of closeness or sense of belonging was not captured. Strictly speaking, social cohesion in this study was operationalized as social interaction with others and community social participation. Given a secondary analysis that is inherently limited to available measures, future research needs to adopt a measure fully compatible with the conceptualization of social cohesion.
The effects of other important covariates to quality of life in late stage were not included. Quality of life and living arrangement can be influenced by life events such as loss of the loved one and declined cognitive function (Pocnet et al., Reference Pocnet, Antonietti, Strippoli, Glaus, Preisig and Rossier2016). Particularly, widowhood is one of the biggest events in later life leading older adults to be depressed and suffer from low quality of life (Jadhav and Weir, Reference Jadhav and Weir2018). Whether or not older adults have cohabiting partners should be considered, but this study did not address this issue. Further, there are differences between women living alone and men living alone in later life and different rates of older men and women that reside in urban and rural areas. The study used urban and rural residences as a moderator. Differences in rates of men and women living in urban or rural areas should be addressed, and multi-group analysis should be used to understand the disparities in urban and rural residences based on differences in older men and women.
Lastly, living arrangement can be fluid and may encompass more than two types: living alone and living with family. This study focused on community-dwelling adults, and therefore, those who live in government-subsidized housing, retirement communities, assisted living facilities, and nursing homes were not included. Even though researchers reported that they excluded older adults in other living arrangements, it may have left out those who had mixed living arrangements, which meant they shifted between living alone and with families. It is common that rural older Chinese women move to urban city to help take care of grandchild and leave their husbands at home alone. Or older Chinese in cities may split time between their own apartment and their adult child’s house. This population termed as migrant elders needs to be examined in future studies.
Conclusion
China has faced remarkable changes in traditional norms and values and a split urban and rural social welfare system since opening and reforming their economy (He and Ye, Reference He and Ye2014; Ye et al., Reference Ye, He, Liu, Wang and Chen2016). Such transformation has influenced the living arrangement, social participation, and quality of life for older adults in rural and urban areas, calling for scholars in gerontology and geriatric fields to develop new theoretical frameworks to guide empirical inquiries. Burnette et al.’s article shed some initial light in this direction, and still much more work needs to be done. In sum, a theoretical framework that postulates the relationship between living alone and social cohesion within urban and rural settings needs to be brought up, valid and reliable measures of key concepts like social cohesion are adopted, and longitudinal research design is needed for mediation analyses that imply causal inferences.