Research Gaps

The preceding sections have reviewed relevant literature on factors associated with the health and well-being of older people. It has also provided the most relevant theoretical background on how different types of resources, including socioeconomic resources and various forms of social support. This section highlights the gaps in the literature and how they are addressed in this thesis.

1.13.1. The influence of children’s education on parental health

Although there are studies that examine the influence of children’s education on parental health, most of these studies focused on one or two components of the disablement process, particularly physical functioning, to demonstrate the impact of children’s education on parental health. For example, Zimmer et al. (2002a) and (Yahirun et al., 2016) used functional limitations to measure the health status of older people. Other studies used mortality which is the terminal outcome in the disablement process (e.g.

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Friedman & Mare, 2014; Torssander, 2013; Zimmer et al., 2016). Bao (2016) used a frailty index that captures several components of the disablement process, including chronic diseases, ADL difficulty, IADL difficulty, depressive symptoms, self-reported health, and obesity but does not include functional limitations. Bao (2016) did not distinguish the role of children’s education on each component of the disablement process.

The focus of previous research on functional limitations as a measure of health status could be due to its important role as mediator between impairment/pathology and disability (Fauth et al., 2008; Femia, Zarit, & Johansson, 2001; Lawrence & Jette, 1996; Lowry, 2010; Peek et al., 2003). While this approach provides insight into how children's education influences parental health, it is equally important to examine whether children's education also influences the two health outcomes that functional limitations are supposed to mediate, i.e., impairment/pathology and disability. Although some studies allude to the role of children’s education in preventing the onset of health problems, very few have examined children’s education in relation to older people’s experience of chronic disease, which is a precursor of other health limitations. This gap is addressed in this thesis by using a more comprehensive definition of health to capture indicators that correspond to different stages of the disablement process. Investigating the role of children’s education with all components of the disablement process could help us identify the exact mechanisms by which older people can benefit from the socioeconomic resources of their children. It can also help us understand whether the influence of children’s education on parental health is dependent on the stage in the disablement process in which the older parents are in.

1.13.2. The role of social support in the well-being of older people

Although many studies have addressed the effect of different aspects of social support on the well-being of older people, our understanding of the association of living arrangements and intergenerational support with well-being remains incomplete in three respects.

First, while there are extensive studies on the relationship between living arrangements and well-being of older adults the results remain inconsistent, due in part to the different classifications used to define living arrangements, which hamper comparability across

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studies. Another reason for the inconsistent results could be the omission of important variables in the analyses. Most studies assumed that older people’s actual living arrangements are also their preferred arrangements. However, research shows that the actual and preferred types of living arrangements of older people do not always converge. For example in urban China, more than a third of older people did not actualize their preferred living arrangements (Logan & Bian, 1999). Another study in China shows that about 16 percent of older adults have living arrangement discordance: 6 percent live independently but prefer coresidence with children while 10 percent coreside with children but prefer to live independently (Sereny, 2011). A recent study in China indicates that 46 percent of older Chinese have living arrangement discordance (Chen, 2018). In Orissa, India nearly 23 percent of older people are not living in their preferred type of living arrangement (Panigrahi, 2009). Research in the Philippines indicates that although the majority of older people coreside with their children, a significant proportion of them would prefer to live independently, either alone or with spouse only (Natividad & Cruz, 1997). Despite the presence of studies that show a lack of concordance between the actual and preferred living arrangements of older people, very few studies examine how this lack of concordance is associated with their well-being. Further, these studies are all conducted in societies characterized by a patrilineal kinship system, while parallel analysis in societies characterized by a bilateral family system, which is another dominant family system in Asia, is lacking. The differences in kinship systems that govern traditional living arrangements and exchange of support in Asian societies highlight the need to complement the studies based on patrilineal kinship systems with parallel studies in societies with bilateral family system, so as to add the “cultural nuances” needed to comprehensively theorize the relationship between coresidence and well-being in developing Asia (Teerawichitchainan et al., 2015, p. 107).

Second, although there are also extensive studies on the relationship between intergenerational support and well-being in old age, the results are far from consistent. Aside from contextual differences, one factor that could explain these inconsistent results is the fact that the indicator used to measure the pattern of intergenerational exchange neglects the distinctions between different types of support (Peng et al., 2018). Most research on intergenerational support usually distinguish three types of support: emotional, financial and instrumental (e.g.,Chao, 2011; Chen & Silverstein, 2000) but existing studies that relate the exchange of support to well-being focus only on one or two types of support (e.g., Chen & Jordan, 2018; Lee et al., 2014) or combine different types

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of support into one variable (Davey & Eggebeen, 1998; Kim & Kim, 2003; Lowenstein et al., 2007). Respondents are then classified into over-benefited, under-benefited, reciprocal or no exchange of support by comparing how many types of support they receive and provide (Peng et al., 2018). For example, the respondent is classified as over- benefited when the number of types of support he or she receives exceed what he or she provides. A respondent is also considered as over-benefited when he or she received any form of support but did not provide any form of support.

This existing operationalization of exchange of support suffers from two weaknesses. First, focusing only on one aspect of support does not capture the diversity of support that flows across generations and may underestimate the important role played familial support in the well-being of older people. Second, previous research assumes that the different types of support are tradable and substitutable, but in reality, the importance of different types of support may be perceived differently by older people (Peng et al., 2018). For example, previous research shows that Chinese adult children are compensating for the inadequacy of emotional support by increasingly using financial support (Lee & Kwok, 2005). However, studies also show that elderly Chinese least expect financial support from their children but ascribe more importance to emotional support than material support (Dong, Chang, Wong, & Simon, 2012). Different types of support also have different impacts on the well-being of older people. For example, emotional support, which reflects belongingness to a caring network, may have more profound effects on psychological well-being than instrumental support because the former is dependent on having close family members or friends whereas the latter can be obtained from far less personal sources (Wu & Schimmele, 2008).

Third, previous research also shows that intergenerational support is not only dependent on the characteristics of the older persons, but also conditioned by the characteristics of their children (Cunningham, Yount, Engelman, & Agree, 2013; Logan, Bian, & Bian, 1998; Quashie, 2015). While previous studies have recognized the importance of looking at the needs of both actors in the exchange process (Lowenstein et al., 2007) and how the characteristics of children could also impact parental well-being (Peng et al., 2018), most existing research that examines the relationship between exchange of support and parental well-being ignores the characteristics of children.

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While some research has examined children's characteristics in relation to the exchange of support and parental well-being, these characteristics are mostly limited to the sex or migration status of the child (Hoang, 2015). Other important characteristics of children such as age, education and marital status, which have been shown to be associated with the intergenerational exchange of support are largely unexplored in relation to their impact on parental well-being. For example, highly educated children tend to have more resources and can provide more financial and material support to their parents, while low educated children may require help from their parents. Compared with married children, unmarried, separated and divorced children are less likely to give material support to their parents (Quashie, 2015).

The foregoing research gaps are addressed in this thesis in three ways. First, instead of relying mainly on the actual living arrangements of older people as an indicator of social support, this research also examines their living arrangement concordance and how it is related to their well-being. Second, in examining the relationship between the exchange of support and well-being of older people, this thesis distinguishes different types of support and how each type of support is related to older people's well-being. Third, in addition to the personal characteristics of older people, the characteristics of their children are also examined in relation to parental well-being.

1.13.3. The role of socioeconomic resources in explaining health expectancy

Overall, there is growing research documenting the role of socioeconomic, lifestyle and social support factors in explaining geographic variation in health expectancy. However, most of this research is conducted in developed countries, where structural factors and cultural context are different from developing countries. Existing studies examining geographic variation in health expectancy in developing countries (Apinonkul, Soonthorndhada, Vapattanawong, Jagger, & Aekplakorn, 2016; Nguyen, Saito, Phan, & Nguyen, 2012; Reyes-Beaman et al., 2005) are mostly descriptive. Very few studies have empirically examined the correlates of geographic variation in health expectancy in developing countries. To date, no study has examined the factors associated with regional variation in the health status of older people in the Philippines, despite the increasing availability of data and the growing number and proportion of older Filipinos. Except for the life tables published at the regional and provincial level and the annual reports of the

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Department of Health on the top causes of morbidity and mortality, there is no detailed analysis that focuses on the health of the adult population. Existing analyses on health at the subnational level heavily focus on maternal and child health (Collas-Monsod, Monsod, & Ducanes, 2004; Quintos, 2016). This focus on maternal and child health is understandable given the relatively high fertility and high maternal mortality in the country. To address this gap, this thesis describes regional variation in DFLE among older people in the Philippines and examines the factors associated with this regional variation. This research complements existing research on the role of socioeconomic resources in the health expectancy of older people in developed countries by providing evidence from the perspective of a developing country.