Does consistency between actual living arrangements and expectations (ALIVE) matter? A population-based longitudinal study of older adults

Evidence indicates that living arrangements significantly influence the well-being and health of older adults. However, the psychological needs of this population have increasingly emerged as important public health concerns, with preferences regarding living arrangements serving as a key determinant. Ignoring this issue can lead to incomplete or inaccurate assessments of how various living arrangements affect their health. To better understand this impact, this study investigates the relationship between living arrangements and survival outcomes among older adults, while considering the alignment between Actual Living Arrangements and Expectations (ALivE). Data for this study were sourced from the China Longitudinal Healthy Longevity Survey (CLHLS) covering the period from 2005 to 2018. Living arrangements were assessed based on participants’ self-reported expect living arrangement (indicating preference) and current situations in the questionnaire, categorized into “living alone (or with a spouse only)”, “co-residence with children”, or “living in an institution”. Survival status and date of death were determined through interviews with close family members during each survey round. Cox proportional hazards regression models were used for longitudinal analysis, and strategies for heterogeneity analysis were employed to identify vulnerable subgroups. The study included 4,272 older adults, of whom 2,188 (51.22%) died during the follow-up period (2008 to 2018). The median survival time was 5 years. Compared to individuals with consistent living arrangements, those with discrepancies between actual and preferred arrangements had a hazard ratio (HR) of 1.36 (95% CI: 1.20–1.53), indicating a 36% increased risk of death. Sensitivity to these inconsistencies was greater among males, individuals with fixed occupations before age 60, those with average or difficult economic conditions, individuals with unfavorable dietary patterns, and those who are not currently exercising. This study highlights the significance of aligning older adults’ living arrangements with their preferences. The association with health is more closely related to whether living arrangements match personal desires rather than the specific type of arrangement.