Research prior to the COVID-19 outbreak identified being unpartnered or childless as risk factors for loneliness among older adults (Dahlberg et al. 2022; Fokkema et al. 2012). The COVID-19 pandemic might have affected loneliness among kinless older adults differently from the rest of the older population. With the aim of fighting the spread of the virus, several mitigation policies and recommendations were implemented at national, regional, and local levels. These mitigation strategies, which were especially stringent during the first phases of the pandemic and varied across countries, included avoidance of public social spaces, minimizing physical contact with others, “stay-at-home” orders, and full physical isolation, especially for older adults, and those with health issues in particular.

Kinlessness, loneliness and the COVID-19 pandemic

The “physical distancing” imposed by these strategies also produced “social distancing”, i.e. reduced social contacts, at least face-to-face (Arpino et al. 2021). Thus, anti-COVID policies may have exacerbated risks of loneliness, among older adults especially (Dahlberg 2021; van Tilburg et al. 2021). These consequences may have been more serious for those lacking close kin, such as unpartnered or childless older adults. For example, the types of contacts that are more common in networks of kinless older adults, such as extended family and non-family ties, may have been more vulnerable to disruption during the pandemic compared to partner and child ties. 

On the other hand, linkages between parenthood, partnership, and loneliness are complex and may have been particularly nuanced during the pandemic. For example, older parents who are accustomed to frequent in-person contact with their children may have experienced an uptick in loneliness when child contact was disrupted. Childless older adults, on the other hand, might be more accustomed to less contact and may therefore have experienced less disruption. 

Loneliness before and during the pandemic in Europe

In a recent study (Arpino et al. 2022), we examined whether unpartnered and childless older adults (aged 50 years and over) were more likely to report loneliness compared to those with these family ties, and whether the gap in loneliness between those with and without these ties increased during the COVID-19 pandemic. Our analyses are based on data from the Survey of Health, Ageing and Retirement in Europe (SHARE). We used pre-COVID data from wave 8, which started in October 2019 but was suspended in all countries in March 2020 due to the COVID-19 outbreak. We also used data from the SHARE Corona Survey 1 (SCS1) implemented between June and August 2020 to collect information on individuals’ behaviours and conditions during the pandemic.

Our analyses show that before the pandemic, when asked “Have you felt lonely recently?”, unpartnered and childless older adults were more likely to report loneliness compared to those with these family ties (Table 1, M1a-M2a). This remained true even when both factors were considered together, although the effect of childlessness on loneliness was smaller (Table 1, M3a). Older adults lacking one tie only (unpartnered parents or partnered childless) were at greater risk of loneliness compared to those who had both ties (Table 1, M4a).

During the pandemic, the associations between family ties and loneliness remained stable, with no notable change in the effects of being childless or unpartnered on loneliness before versus during the pandemic (Table 1, M1b-M3b). However, in contrast to the pre-COVID period, considering the combination of being childless and unpartnered made no difference (Table 1, M4b): In fact, in this case, the average marginal effect (AME) of parenthood is very similar for partnered and unpartnered individuals; similarly, the AME of partnership does not change significantly by parenthood. As a result, the effects of being unpartnered and childless on loneliness became more independent during the pandemic.

Feeling more lonely during the pandemic

Our second outcome examines whether people reported feeling more lonely during the pandemic. We found that unpartnered individuals were more likely to report feeling lonelier during the COVID-19 pandemic compared to those in a partnership. Childless individuals, on the other hand, were not at higher risk of reporting feeling lonelier compared to parents (Table 1, M1c-M3c). The effect of being unpartnered was slightly stronger among childless individuals, but the difference in the impact of being unpartnered on loneliness between childless and parent individuals was not statistically significant (Table 1, M4c).

Changes and stability in feeling lonely compared to before the pandemic

Our third outcome was obtained by combining the answers to the question “Have you felt lonely recently?” asked of respondents who participated in both the regular SHARE wave 8 and the SCS1. This analysis (not presented in Table 1) highlights that unpartnered individuals were more likely to “have become lonely” during the pandemic, while childless and unpartnered individuals were less likely to “exit” loneliness if they felt lonely before the pandemic.

Conclusions

We found that both before and during the pandemic, lacking close kin (especially a partner) was associated with a higher risk of feeling lonely among older Europeans. However, “kinless” older adults (unpartnered and childless) were not lonelier than those who lacked only one of these ties. This may signal that kinless individuals have developed a range of resources and different coping strategies to manage the lack of close kinship ties, such as a rich network of friends (Mair, 2019).

While “physical distancing,” “lockdown,” and “stay-at-home” mitigation measures provided protection from COVID-19, the restrictions on face-to-face interactions and public spaces for socializing also removed key sources of social integration for those who were already more likely to spend time alone (e.g., the unpartnered). As the population of unpartnered and childless older adults grows globally, future public health strategies should seek a balanced mitigation approach that also considers the consequences of isolation, particularly for those who are already at higher risk for loneliness.

References

Arpino, B., Pasqualini, M., and Bordone, V. (2021) Physically distant but socially close? Changes in non-physical intergenerational contacts at the onset of the COVID-19 pandemic among older people in France, Italy and Spain. European Journal of Ageing, 18, 185–194.

Arpino B., Mair C. Quashie N., and Antczak R. (2022) Loneliness Before and During the COVID-19 Pandemic: Are Unpartnered and Childless Older Adults at Higher Risk? European Journal of Ageing. 19, 1327–1338.

Dahlberg L (2021) Loneliness during the COVID-19 pandemic. Aging & Mental Health, 25(7): 1161–1164.

Dahlberg L, McKee KJ, Frank A, Naseer M (2022) A systematic review of longitudinal risk factors for loneliness in older adults. Aging & Mental Health, 26(2): 225–249.

Fokkema, T., De Jong Gierveld, J., & Dykstra, P.A. (2012). Cross-national differences in older adult loneliness. The Journal of Psychology, 146(1-2), 201-228.

Mair, Christine A. (2019). “Alternatives to Aging Alone?: ‘Kinlessness’ and the Importance of Friends across European Contexts.” Journal of Gerontology: Social Sciences 74(8):1416-1428.

Van Tilburg, T.G., Steinmetz, S., Stolte, E., van der Roest, H., & de Vries, D.H. (2020). Loneliness and Mental Health During the COVID-19 Pandemic: A Study Among Dutch Older Adults. Journal of Gerontology: Social Sciences, 76(7), e249-e255

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Background

Children are the primary source of support for a majority of aging individuals across the globe. Thus, childless older adults are often assumed to have higher risks of poor health compared to parents due to lower social support, weakened sense of meaning, and greater social isolation (Hansen 2012). Children may, however, also be a source of social and/or economic strain at earlier life stages (Umberson, Pudrovska, & Reczek, 2010), which may contribute to health vulnerability at older ages. Research also shows that the health of older adults, with or without children, depends on the health dimension examined (Keenan & Grundy, 2019).

The health gap between parents and non-parents in later life depends also on several contextual factors including cultural norms about the meaning of family and children in the lives of older adults, the availability of public support for them, and income inequality, which shapes older adults’ access to quality health care (Albertini & Mencarini, 2014; Dickman, Himmelstein, & Woolhandler, 2017; Hansen, 2012).

However, prior cross-national research on the health of older adults with and without children has focused on comparisons within one global region or on small samples of countries from different global regions; it has examined associations for one or few health outcomes, and has applied different conceptualizations of childlessness. This makes it difficult to determine whether childless older adults are indeed at risk of poorer health than parents across different social contexts.

In a recent study, using harmonized cross-sectional data from the Health Retirement Study (HRS) global family of aging surveys provided by the Gateway to Global Aging repository (Lee, 2015), we examined the association between childlessness and health among adults aged 50 years and older (Quashie et al., 2019). We used data for comparable years (2011-2013) from four global regions: Europe (SHARE), North America (HRS), Latin America and the Caribbean (Mexico, MHAS), and Asia (China, CHARLS), 20 countries overall. In our study, older adults with no living children at the time of the survey were compared with older parents with one or more living children including biological, step or adopted children.

We adopted a multidimensional approach to health by examining physical, functional, and mental health:

• self-rated health (poor versus good),
• difficulties with activities of daily living (ADL, at least one among bathing, dressing and eating),
• difficulties with instrumental activities of daily living (IADL, at least one among managing money, taking medications, shopping, preparing meals),
• doctor diagnosed chronic conditions (at least one among high blood pressure, diabetes, cancer, stroke, lung disease, and heart disease), and
• depression (self-reported feelings of depression in the week prior to the interview).

For each health outcome, responses were coded to indicate poor, as opposed to good, health.

To compare the strength of the association between childlessness and health across countries, we computed the average marginal effect of childlessness, which can be interpreted as the percentage point difference between childless older adults and parents in the probability of experiencing a given “bad” health outcome.

Cross-national variation in childless older adults.

The prevalence of childlessness among older adults varies widely across the 20 countries in our study (Figure 1). China shows the lowest percentage of childless older adults (2%) followed by Mexico (4.1%). Within Europe, prevalence also varies widely, with the lowest in Czechia (4.4%) and Poland (4.8%), and the highest in Switzerland (16.3%). In other European countries, the prevalence ranges between 6% and 12%.

Are childless older adults at higher risk of poor health than parents?

Overall, childlessness was not significantly associated with older adults’ health, and this is probably our most important conclusion. When significant associations were observed, net of controls, there was no consistent relationship between childlessness and poor health across countries and health outcomes (Figure 2). In four countries (Czechia, Poland, Austria and the Netherlands), childlessness was associated with worse health for one or more outcomes. In five countries, (Mexico, Hungary, United States, Germany, and Belgium), childlessness was associated with better health. Childless older adults in Hungary and Mexico reported better health than parents across all indicators (except IADL in Hungary).

We found marked regional variations within Europe. For instance, Italy was the only Southern European country where childlessness was associated with health, but in an ambiguous way, as childless older adults are more likely to report poor overall self-rated health but less likely to report having a chronic condition. Among Eastern European countries, Hungary was the only country where childlessness was associated with health advantages; the opposite was found in Poland and Czechia.

Finally, childless older adults’ risk of poor health varies across health outcomes. Childlessness was associated with lower risk of chronic conditions in some countries (Italy, Germany, United States, Hungary and Mexico) but higher risk of having difficulty with at least one IADL in a few countries (Czechia, Austria, the Netherlands). In several countries, mixed patterns emerged for self-rated health, depression, and difficulty with at least one ADL.

Implications

Declining fertility and increasing life expectancy across the globe suggest that many people will age without children, one of the most traditional sources of support in later life, which may lead to health vulnerabilities. Our results, however, suggest that childless older adults are not an overall “at risk” segment of the older adult population in an international perspective: in some contexts, they even enjoy better health. Current and future social policies to protect the health of older adults should pay closer attention to individuals’ family resources. In some countries (e.g. Mexico and Hungary), social policies should also focus on protecting the health of older parents. In others (e.g. Czechia), policies need to address the multidimensional health vulnerability (e.g. mental and functional health) of childless older adults.

References

Albertini, M., & Mencarini, L. (2014). Childlessness and support networks in later life: New pressures on familistic welfare states? Journal of Family Issues, 35, 331–357. doi:10.1177/0192513X12462537

Dickman, S. L., Himmelstein, D. U., & Woolhandler, S. (2017). Inequality and the health-care system in the USA. Lancet (London, England), 389, 1431–1441. doi:10.1016/S0140-6736(17)30398-7

Hansen, T. 2012. Parenthood and happiness: A review of folk theories versus empirical evidence. Social Indicators Research, 108, 29–64. doi:10.1007/s11205-011-9865-y

Keenan, K., & Grundy, E. (2019). Fertility history and physical and mental health changes in European older adults. European Journal of Population, 35, 459–485. doi:10.1007/s10680-018-9489-x

Lee, J. 2015. Study descriptions: Health and retirement studies around the World. University of Southern California.

Quashie, N. T., Arpino, B., Antczak, R., & Mair, C. A. (2019). Childlessness and Health Among Older Adults: Variation Across Five Outcomes and 20 Countries. The Journals of Gerontology: Series B. doi: 10.1093/geronb/gbz153

Umberson, D., Pudrovska, T., & Reczek, C. (2010). Parenthood, childlessness, and well-being: A life course perspective. Journal of Marriage and the Family, 72, 612–629. doi:10.1111/j.1741-3737.2010.00721.x

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