Summary of main findings

Results in chapters 4 to 7 support the proposition of the fundamental cause theory that inequality in different types of resources, including education, social support, and macro-level socioeconomic factors, can explain, at least in part, the differences in the health and well-being of older people. Chapter 4 shows that the health benefits of education can be transferred from children to parents through various pathways including children’s influence on changing their parents’ unhealthy behaviour. Chapter 5 demonstrates that the social environment where the exchange of intergenerational support takes place and the fit of this environment with older people’s preference also contributes to better subjective well-being of older people. Additionally, chapter 6 indicates that the different types of support and the direction of the flow of this support (unidirectional or bidirectional) also have implications for the well-being of older people. The role of these different types of resources found at the micro-level also extends to the macro-level analysis. Chapter 7 shows that macro-level socioeconomic factors such as poverty incidence and level of education are associated with DFLE of older men and older women.

8.2.1 The role of children’s education in parental health

This study shows an important role of children’ education in parental health, which is over and above that of the parents’ level of education. This finding supports previous findings that education is not only an individual resource but it also represents a household or family resource that can be mobilized to benefit the health and well-being of other family members (Torssander, 2013; Yang et al., 2016; Zimmer et al., 2007).

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Unlike previous research that used a single indicator of physical health, the current research employed different health indicators corresponding to the different stages of the disablement process, to assess whether the influence of children’s education on parental health is dependent on the stage of the parental disablement process. These indicators include the presence of chronic disease (early stage), functional limitations (intermediate stage), and IADL and ADL disability (advanced stage). Findings show that of the four health indicators, only IADL and ADL difficulty are associated with children’s education. These disability indicators correspond to the advanced stage of the disablement process and indicate a more severe condition compared with the presence of chronic condition and functional limitations because these forms of disability restrict an older person’s ability to live an independent life. It is likely that it is only when older people experience a severe health condition that children’s support is called upon since it is common for older Filipinos to consider minor pain resulting from chronic conditions or functional limitations as part of their daily life.

However, the effect of children’s education it is only statistically significant among older women. One reason for this could be older women’s greater dependence on their children in terms of social support compared with men. Another reason could be the greater emotional attachments between older women and their children due to the roles that women perform over the life course. Maternal investments made over the life course make children more responsive to the health needs of their mothers than of their fathers (Zimmer, 2005).

This study shows that the health benefits of children’s education are generally the same for high and low-educated older people. It also shows that one of the pathways by which children’s education can influence parental health is through changing parental health behaviour. Findings show that older men with highly educated children are less likely to smoke than their counterparts with low educated children. Similarly, older women with highly educated children are more likely to engage in daily exercise than women with low educated children. These results are supportive of earlier findings that children’s education may positively influence parental health directly by encouraging their parents to change their health behaviours or indirectly through ‘spill-over’ effects by sharing with their parents their norms regarding lifestyle, health care services and conformance with medical treatment (Bao, 2016; Friedman & Mare, 2014; Torssander, 2014).

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8.2.2 Living arrangement concordance and well-being of older people

This study has shown that the majority of older Filipinos live with their children, but a significant proportion also prefer to live independently from their children. Older Filipinos are also open to the idea of living in ‘homes for the aged’, despite the stigma associated with living in institutions in the Philippines. There are several factors associated with living arrangement preference of older people, including their number of children, marital status, actual living arrangement, and health conditions. The influence of these factors on living arrangement preference is generally similar for older men and women, except for health conditions. Having ADL difficulty is associated with lower odds of independent living preference among women, and higher odds among men, although the relationship is significant only among women. This sex difference could be explained by demographic factors. Women are more likely to marry older men, and they tend to live longer than men (Mujahid, 2006; Reiss & Lee, 1988). Thus, husbands tend to need care earlier in their married life and have wives available to provide it. By the time the wives fall ill and need care, they are more likely to be widowed (Lee et al., 1993), and are more dependent on their children for caregiving. Since older men are more dependent on their spouse for caregiving, they are more likely to prefer to live independently with their spouse, whereas women are less likely to prefer to live away from their children because they are more dependent on them for social support.

Findings from the study also show that less than half of older Filipinos have living arrangement concordance. Older people’s health status is associated with their living arrangement concordance, particularly among older women. This concordance plays an important role in their subjective well-being. Corroborating the predictions of the person-environment fit, cognitive dissonance, and self-discrepancy theories (Festinger, 1957; Higgins, 1987; Kahana, 1975; Kahana et al., 1980), this study shows that older people who have coresidence discordance have lower odds of reporting good self-rated health, and psychological well-being than those with coresidence concordance. These findings not only highlight the important role of their actual living arrangement in their subjective well-being but also show that whether or not this actual arrangement is consistent with their preferred arrangement matters when it comes to their well-being. Older people’s preference may indicate their underlying needs and meeting these needs will have important implications for their health and well-being. This study shows the role of health status in moderating the relationship between living arrangement concordance and subjective well-being, particularly among older women.

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The relationship between living arrangement concordance and the three indicators of subjective well-being is significant only among older women. Older women’s greater emotional connections with their children engendered by their much closer interactions during their performance of their roles as a mother may motivate older women to prefer to live with their children. Women who prefer to live with their children but are in different living arrangements are likely to experience cognitive dissonance that can trigger negative outcomes, such as poor self-rated health and lower psychological well-being.

8.2.3 Intergenerational exchange of support and well-being of older people

Although the type of household where older people live has important implications for their well-being, the household is not an adequate unit of analysis when it comes to social support because the flow of support extends beyond the household. This study finds that different types of support that are exchanged across generations, and the directions of this flow of support have different implications for the well-being of older people. Contrary to the predictions of the social and exchange theories, that giving support to children is not beneficial to their well- being, findings of the current study show that, compared with receiving support only (over- benefiting), giving support only (under-benefiting), particularly financial and emotional support, is positively associated with self-rated health and psychological well-being of older people in the Philippines. The positive impact of giving support among older people could be related to the role of giving in supporting well-being by externally validating their self-worth, making them feel useful, nourishing their identity, and giving them a sense of contentment or pride just by performing their role as givers of support (Chen & Silverstein, 2000; Gierveld et al., 2012; Schatz et al., 2018).

This study also finds partial support for the proposition of the equity perspective that being involved in an exchange flow of support is beneficial to the well-being of older people. Specifically, exchange of financial support with their children is associated with higher odds of life satisfaction among older women. Curiously, the exchange of financial support is negatively associated with life satisfaction among older men. This unexpected finding may be related to the amount and intensity of the financial support exchanged. Older people may be providing more financial support than they are receiving which may lead to negative subjective well-being.

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Lack of intergenerational support, particularly financial support, is negatively associated with life satisfaction among older men. Lack of exchange of support not only challenges the highly valued concept of reciprocity in Philippine society but can also reflect the financial difficulties of older people and their children. Older people’s own poor socioeconomic condition may lead to psychological distress, but the knowledge that their children also experiencing similar poor economic conditions may reduce their subjective well-being.

8.2.4 The role of socioeconomic resources in explaining regional differences in DFLE in the Philippines

This study finds wide regional variation in DFLE among older men and women in the Philippines. Consistent with the predictions of fundamental cause theory, regional differences in DFLE can be explained by socioeconomic resources. Specifically, this research found several socioeconomic indicators, namely poverty incidence, GDP per capita and education, to be significantly associated with regional differences in DFLE in the Philippines. Findings of the study show that poverty incidence is negatively associated with DFLE, while higher education of both younger and older people is positively associated with DFLE. Poverty may limit older people’s ability to access appropriate health care services, resulting in lower DFLE. Better education not only improves the socioeconomic condition and the ability to afford better health care, but it also enhances an individual’s cognitive skills and learning, factors that are critical in maintaining positive health status (Lynch & Kaplan, 2000). This study also shows that being in the labour force, particularly among older men, is negatively associated with DFLE. This could be related to the type of work that older men in the Philippines do. Most older Filipino men work in manual occupations that have negative impact on health. One common example of manual occupations among older men is farming. Since most older Filipinos do not have social security they continue to work in these types of occupation even if they fall ill, hence higher labour force participation of older men is associated with lower DFLE.

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