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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The value of children to older Thais

Children are highly valued in Thailand. Having children is considered a marker of adulthood and, for married couples, children fulfill the ideal of a complete family (Whittaker, 2004). Research has shown that older Thais, and especially women, not only rely on children for income, health and other social support, but they also prefer to live with or near their children (Knodel, Prachuabmoh & Chayovan, 2013). Older Thais, however, are increasingly living longer with fewer children overall, who, on top of that, frequently live far away.

Thailand’s total fertility rate declined from 6.13 in 1960 to 1.46 in 2015 (UN, 2017). On the family level, the number of children available to older adults is also declining. Among individuals aged 60-64, for example, the average number of living children declined from 5.0 in 1994 to 2.5 in 2011 (Basten, Muttarak, & Pothisiri, 2014). Additionally, drawing from the national surveys of older persons, the share of childless older adults (aged 50 years and older) has increased steadily from 3.5% in 1994 to 8.5% in 2014 (own calculations).

Furthermore, due to increasing internal migration, the share and number of older adults living separately from their children is also increasing. Recent assessments of intergenerational living arrangements show that between 1995 and 2011, the percentage of children living outside their parents’ province increased from 28% to 39% (Knodel, 2014). Such geographic separation can have possible negative consequences on the psychological wellbeing of older adults even if their migrant children support them economically and maintain social contacts (Teerawichitchainan, Pothisiri, & Long, 2015).

Although Thais may prepare for longer lives without the availability of support from children, it is still uncertain whether childless older adults are more vulnerable to poor psychological well-being relative to older adults who are parents.

While childless older Thais may rely on friends as a substitute source of support in the absence of children, research suggests that family support is more important than friends’ support for later life wellbeing in Thailand (Thanakwang, Ingersoll-Dayton, & Soonthorndhada, 2012). Although parents who live separately from their adult children may continue to have positive relationships with their children, these parents are currently in a non-traditional living arrangement that they may not have expected over their life course. This may contribute to lower psychological wellbeing compared to parents who live with their children.

In a recent publication, using data from the 2011 Survey of Older Persons in Thailand, we examined whether childless older adults were more likely to experience psychological distress compared to parents (Quashie & Pothisiri 2018). In our study, childless refers to those without any living children (i.e., biological, adopted or stepchildren) at the time of the survey and, we distinguished parents based on their living arrangements with their children: coresident (living with or near their children) and non-coresident (living separately). Given that marriage is near universal, the majority of never-married are childless, and the reasons for lifelong singlehood can strongly influence childlessness and psychological distress, we excluded never-married older Thais (5.4%). Our sample is thus restricted to ever-married older adults aged 50 years and over who completed the survey independently. Psychological distress was derived from self-reported experience of feelings such as loss of appetite, worry, distress/moodiness/irritability, hopelessness, feeling that life is not worth living, sadness, and loneliness, in the month prior to the survey.

The psychological well–being of parents and childless older Thais

As shown in Figure 1, the results of our regression models showed that, all other things being equal, childless older adults and non-coresident parents experience more symptoms of psychological distress than coresident parents.

We also examined whether the gender and marital status of parents moderated the relationship between parental status and psychological distress. We did not find statistically significant gender differences in the relationship between parental status and the psychological distress of older Thais. This challenges assumptions of traditional gender norms, which assume that children may be more critical to the well-being of women, relative to men, given women’s greater involvement in domestic life over the life course and their greater reliance on their children for social support.

In Figure 2, we show that the association between parenthood and psychological wellbeing is compounded by marital status for ever-married older Thais. Being widowed and childless as well as a widowed and non-coresident parent is associated with experiencing more symptoms of psychological distress compared to married older adults.

Although we do not know the duration of widowhood nor the precise reasons for childlessness or geographic separation, the strength of the moderating effect suggests that the absence of spouse and children increases the risks of psychological distress of older Thais, particularly for the childless.

Implications

Thailand is ageing rapidly. In 2015 older adults (aged 50 years and over) represented 30% of the total population and will account for approximately 42% by 2030 (UN, 2017). Thailand’s social welfare policies place most responsibility for the wellbeing of older adults upon individuals and families. Demographic changes suggest a need to strengthen current formal social welfare systems for older adults, regardless of the availability of kin.

Income security is one of the most critical challenges for older Thais. In 2011 the government established a National Pension Fund Scheme to encourage financial retirement planning among the working-age population, particularly informal workers, whereby the government will match individuals’ contributions to a saving scheme. Still, there is an assumption that family members will supplement the retirement income (Sasat & Bowers, 2013). Those with few or no familial resources may be more vulnerable to financial strain in later life. Our study shows that childless older Thais are more likely than parents to report economic insecurity.

There needs to be greater investment in long-term care facilities, home care programs, mental health services and training to meet the increasing demands of an ageing population. These services will be vital to the quality of life and overall wellbeing of older Thais, particularly those with few kin-based sources of support.

References

Basten, S., Muttarak, R., Pothisiri, W. (2014). “The persistence of parent repayment and the anticipation of filial obligations of care in two Thai Provinces.” Asian Social Work and Policy Review, 8(2), 109-122.

Knodel, J. (2014). “Is intergenerational solidarity really on the decline? Cautionary evidence from Thailand.” Asian Population Studies, 10(2), 176-194.

Knodel, J., Prachuabmoh, V., Chayovan, N. (2013). “The changing well-being of Thai Elderly: An update from the 2011 Survey of Older Persons in Thailand.” HelpAge International, Chiang Mai, Thailand.

Quashie N.T., Pothisiri, W. (2018). “Parental status and psychological distress among older Thais.” Asian Social Work and Policy Review DOI: 10.1111/aswp.12145

Sasat, S., Bowers, B. J. (2013). “Spotlight Thailand.” The Gerontologist, 53(5), 711-717.

Teerawichitchainan, B., Pothisiri, W., Long, G. T. (2015). “How do living arrangements and intergenerational support matter for the psychological health of elderly parents? Evidence from Myanmar, Vietnam, and Thailand.” Social Science & Medicine, 136–137, 106-116.

Thanakwang, K., Ingersoll-Dayton, B., Soonthorndhada, K. (2012). “The relationships among family, friends, and pscyhological well-being for Thai elderly.” Aging & Mental Health, 16(8), 993-1003.

UN (2017) United Nations, Department of Economic and Social Affairs, Population Division, World Population Prospects: The 2017 Revision.

Whittaker, A. (2004). Abortion, sin and the state in Thailand. Routledge.

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