Change in Elderly Living Arrangements in Rural South Africa 2000-2010

描述（由申请人提供）：南非提供了一个独特的背景下，审查老龄化，因为三个因素的汇合：（1）老年人在人口中的比例稳步上升;（2）艾滋病毒/艾滋病导致预期寿命下降和（3）存在国家资助的60岁及以上的非缴费养老金制度。2009年，南非60岁以上年龄组的人口比例为7%，预计到2050年将翻一番（联合国，2009年）。与此同时，预期寿命从1991年的61.5岁下降到2009年的51.6岁，主要原因是艾滋病毒/艾滋病（世界银行，2009年; Hontalez等人，2011年）。养老金已成为一种宝贵的家庭资源，特别是在农村地区，它相当于家庭平均收入的近50%，不仅受益于领取者，而且受益于整个家庭及其网络（Ardington等人，2010; Case & Menendez，2007; Schatz & Ogunmefun，2007）。所有这三个因素都可能反映在老年人的生活安排中。现有文献表明，在艾滋病毒流行率较高的非洲国家，老年人更有可能在没有照顾者的情况下生活（考茨、Bendavid、Bhattacharya和米勒，2010年），而为孤儿孙辈提供照顾导致隔代家庭的数量不断增加（Amaoteng等人，2007年; Cheng和Slankam，2009年）。然而，新出现的证据表明，养老金可能使老年人成为有吸引力的家庭成员，特别是在有失业成年人的家庭中，从而导致多代同堂的家庭（Schatz、Madhavan和威廉姆斯，2011年）。然而，大多数关于老年人生活安排的分析（Bongaarts and Zimmer 2002; Merli and Palloni 2004）使用的是横截面数据，这大大限制了我们了解老年人生活安排如何随时间变化的能力。此外，我们更不了解与艾滋病有关的死亡率和获得养恤金的机会如何影响老年人的生活安排。在本项目中，我们利用南非农村独特的纵向数据集的力量来解决这些差距。我们建议审查的变化，在生活安排的50岁以上的老年人在十年期间（2000-2010年），在南非东北部的农村，黑人社区，经历了艾滋病死亡人数的增加，并在人口中的养老金资格的人的比例也增加了10年的时间。我们将利用覆盖普马兰加省阿金库尔分区约14 000个家庭的阿金库尔卫生和人口监测系统的纵向数据进行以下分析：1）审查三个时间点老年人居住的家庭类型的分布情况（2）计算从2000年开始的两个五年期内老年人家庭从一种类型过渡到另一种类型的概率; 3）分析艾滋病相关死亡率和养老金获得率在推动老年人生活安排变化中的作用。 公共卫生相关性：该项目的研究结果将有助于对非洲老年人生活安排的小型但不断增长的研究，重点是：1）生活安排随时间的变化，2）长期家庭生活安排的稳定程度; 3）10年期间艾滋病相关死亡率与获得养恤金和生活安排之间的关系（2000-2010年）在南非农村。这一时期的特点是，与艾滋病有关的死亡人数以及有资格领取养恤金的人数（有资格领取的年龄为60岁）有所增加。这些结果将为改善老年人健康和福祉的干预工作和政策制定提供信息，因为生活安排是身体和心理社会健康的一个重要的直接决定因素。

DESCRIPTION (provided by applicant): South Africa provides a unique context in which to examine aging because of the confluence of three factors: (1) a steady increase in the proportion of older persons in the population; (2) a decrease in life expectancy brought on by HIV/AIDS and (3) the existence of a state-funded non-contributory pension system for persons aged 60 and over. The proportion of South Africans in the 60+ age group was 7% in 2009 and is projected to double by 2050 (UN 2009). At the same time, life expectancy has dropped from a high of 61.5 in 1991 to 51.6 in 2009, much of it attributable to HIV/AIDS (World Bank 2009; Hontalez et al. 2011). The old age pension has become an invaluable household resource, particularly in rural areas, where it is equal to nearly 50% of mean household income, and benefits not just the recipient but entire households and their networks (Ardington et al., 2010; Case & Menendez, 2007; Schatz & Ogunmefun, 2007). All three factors are likely to be reflected in the living arrangements of older persons. The extant literature suggests that elders in African countries with higher HIV-prevalence are more likely to be living without caregivers (Kautz, Bendavid, Bhattacharya, & Miller, 2010) and providing care to orphaned grandchildren is resulting in increasing numbers of skipped generation households (Amaoteng et al. 2007; Cheng & Slankam 2009). However, emerging evidence shows that pensions may make elders attractive as household members, particularly in households with unemployed adults, thus resulting in multiple generation households (Schatz, Madhavan & Williams 2011). Most analysis of living arrangements of the elderly (Bongaarts and Zimmer 2002; Merli and Palloni 2004), however, use cross-sectional data, greatly limiting our ability to understand how the living arrangements of older persons are changing over time. Moreover, we know even less about how AIDS-related mortality and access to pensions influence older persons living arrangements. In this project, we address these gaps leveraging the power of a unique longitudinal dataset in rural South Africa. We propose to examine changes in the living arrangements of older persons aged 50+ over a ten year period (2000-2010) in a rural, Black community in Northeastern South Africa, a setting that has experienced an increase in the number of deaths attributable to AIDS and where the proportion of pension eligible persons in the population has also increased over a 10-year period. Using longitudinal data from the Agincourt Health and Demographic Surveillance System which covers approximately 14,000 households in the Agincourt sub-district of Mpumalanga province, we will undertake the following analyses: 1) examine the distribution of household types in which older persons reside at three time points (2000, 2005 and 2010); 2) calculate the probabilities of older persons' households transitioning from one type to another over two 5-year periods starting in 2000; and 3) analyze the roles of AIDS-related mortality and access to pension in driving changes in older persons' living arrangements. PUBLIC HEALTH RELEVANCE: The findings from this project will contribute to the small but growing research on the living arrangements of the elderly in Africa by focusing on 1) the change over time in living arrangements, 2) the extent of stability in household living arrangements over time and 3) the relationship between AIDS related mortality and access to pensions and living arrangements over a 10 year period (2000-2010) in rural South Africa. This time period is characterized by an increase in the deaths related to AIDS as well the number of people eligible for pension receipt (eligible age - 60). These results will inform intervention efforts and policy development for improving the health and wellbeing of older adults given that living arrangements are one important proximate determinant of physical and psycho-social health.