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Never-married childless women in Australia: Health and social circumstances in older age
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Social Science & Medicine 62 (2006) 1991–2001 www.elsevier.com/locate/socscimed
Never-married childless women in Australia: Health and social circumstances in older age Julie Cwikela,b, Helen Gramotnevc, Christina Leec, a
Center for Women’s Health Studies and Promotion, Ben Gurion University of the Negev, Israel b Key Centre for Women’s Health in Society, The University of Melbourne, Australia c School of Psychology and School of Population Health, University of Queensland, St Lucia, QLD 4072, Australia Available online 12 October 2005
Abstract A growing proportion of women reach older age without having married or having children. Assumptions that these older women are lonely, impoverished, and high users of social and health services are based on little evidence. This paper uses data from the Older cohort of the Australian Longitudinal Study on Women’s Health to describe self-reported demographics, physical and emotional health, and use of services among 10,108 women aged 73–78, of whom 2.7% are never-married and childless. The most striking characteristic of this group is their high levels of education, which are associated with fewer reported financial difficulties and higher rates of private health insurance. There are few differences in self-reported physical or emotional health or use of health services between these and other groups of older women. Compared with older married women with children, they make higher use of formal services such as home maintenance and meal services, and are also more likely to provide volunteer services and belong to social groups. Overall, there is no evidence to suggest that these women are a ‘‘problem’’ group. Rather, it seems that their life experiences and opportunities prepare them for a successful and productive older age. r 2005 Elsevier Ltd. All rights reserved. Keywords: Women; Aging; Childless; Never-married; Australia
Introduction Remaining unmarried throughout adult life is widely viewed as anomalous, despite the fact that many women never marry. In the USA, the percentage of women who had not married by age 35 remained steady at around 15% for the first half of the twentieth century, dropped to 7% between 1950 and 1970, and is now climbing again (Baldwin & Nord, 1984). In the 1990s, approximately 8% of Corresponding author.
E-mail address: [email protected] (C. Lee). 0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.09.006
women in their 70s or 80s had never married (Hess & Waring, 1983; Hooyman & Kiyak, 1991), and the proportion of women who never marry or have a child seems likely to increase in developed countries (Australian Bureau of Statistics, 2002; Hooyman & Kiyak, 1991; Wolf, Laditka, & Laditka, 2002). Being never-married does not necessarily mean being childless, and currently a significant number of mothers remain unmarried. In 1998, more than half the births in Norway and Sweden were to unmarried women, while the rate was one in three in the USA (National Center for Health Statistics, 2000). The aim of this paper is to describe the health
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and social circumstances of older never-married Australian women who are now in their 70s. For this cohort, unmarried mothers faced social and economic difficulties, and pressure to give the child for adoption (Jones, 2000), and a vast majority of never-married women of this age did not have children. Research on marriage and well-being among older people often focuses on current living arrangements, combining the never-married with the widowed or divorced. However, a lifecourse approach to human development assumes that childhood and early adult experience shape functioning in old age, and suggests that never-married people approach older age with a different set of skills and attitudes from those who lived in families for most of their adult lives (Caspi & Elder, 1986; Gatz, Harris, & Turk-Charles, 1995). Marriage and children continue to be viewed as normal and desirable for women. Australian data (Lee et al., 2005) show that 96% of young women want to be married or in stable de facto relationships, and 91% want children; 96% of middle-aged women are or have been married and 92% are mothers; and of older women, 94% are or have been married, and 91% are mothers. Older single women are often assumed to be in poor emotional health, and a social burden and drain on public resources (Wells & Freer, 1988); however, there is little empirical evidence for this claim. Based on traditional theories of development, early studies of unmarried, childless women assumed that they must be unfulfilled and unhappy (Spurlock, 1990). Contemporary research (Wolf et al., 2002) has shown that single women show considerable adaptability and well-being in old age. Data from several countries (e.g., Koropeckyj-Cox, 1998; Zhang & Hayward, 2001) suggest that nevermarried women, like the currently married, tend to have better adjustment in old age than the previously married. Despite assumptions that marriage and children are more central to emotional well-being for women than they are for men, never-married women show better adjustment than never-married men do. In a Welsh study of ageing (Wenger, 2001), nevermarried men tended to be solitary and rely on female relatives for care, while never-married women were more independent and socially connected. In the USA, Zhang and Hayward (2001) showed that never-married men had higher levels of depression and loneliness than did never-married
women, while a Dutch study found that older nevermarried men were three times as likely to use formal support services as older never-married women (Wister & Dykstra, 2000). The evidence on the physical health of nevermarried women is mixed. Unmarried women generally have higher all-cause mortality and worse physical health than the married (e.g., Cheung, 1998; Johnson, Backlund, Sorlie, & Loveless, 2000); longitudinal research with middle-aged women (e.g., Waldron, Hughes, & Brooks, 1996) indicates that this can be explained both by selection—healthy women are more likely to marry and to remain married—and protection—marriage tends to improve women’s health. These effects, however, are found only among women who do not have paid work, suggesting that marriage and paid work may provide similar benefits and can perhaps substitute for each other (Waldron et al., 1996). Furthermore, these results are based on women across the lifespan and the situation for women who have reached old age may be quite different. Living alone has been shown to reduce survival among older men, but has no independent effect on the survival of women (Davis, Neuhaus, Moritz, & Segal, 1992) despite the fact that women living alone are vulnerable to poverty, social isolation, and inadequate diet (Davis, Murphy, Neuhaus, Gee, & Quiroga, 2000). A Canadian study (Wu & Pollard, 1998) has shown that older childless never-married individuals may lack emotional and instrumental support, but women generally maintain better social networks than men. Analysis of data from the US 1984–1990 Longitudinal Study of Aging estimated remaining unimpaired years of life for different groups of older women. Never-married, more-educated White women lived the longest, healthiest lives (Wolf et al., 2002), indicating the interaction between such variables as ethnicity, economic status, and educational attainment in predicting well-being in old age. In this cohort, never-married women were most likely to have had continuous employment and career progression (Keating & Jeffrey, 1983). However, a cross-national study of 12 industrial countries showed that never-married women were still concentrated in lower-paying, lower-status occupations than men (Roos, 1983). The historical context of these findings is important: women who are now in their 70s have experienced legal and socially sanctioned restrictions on educational and employment opportunities, with additional restrictions for
ARTICLE IN PRESS J. Cwikel et al. / Social Science & Medicine 62 (2006) 1991–2001
married women. Never-married older women are thus likely to be better educated than those who have married (e.g., Hoeffer, 1987), and women with higher educational attainment and incomes tend to have more extensive social networks. Childlessness is important for planning an ageing society: without family to provide informal caregiving, policymakers assume that childless, nevermarried women may over-tax formal health and welfare services or require early institutionalization (e.g., Connidis, 1994; de Jong-Gierveld, Kamphuis, & Dykstra, 1987; Johnson & Troll, 1992). In Australia in 1996, 22% of childless women aged 75 and over were living in long-term care, compared with 14% of women who had children (Australian Bureau of Statistics, 1996). On the one hand, older never-married women demonstrate good emotional health, with strong social networks, and those with a history of education and employment are likely to cope with older age with resilience. On the other hand, there are suggestions that never-married women are in poor health and reliant on publicly funded services to provide care. This paper explores variables across several domains (demographics, physical health, health behaviours, mental health, and service use) through an analysis of data from a large and nationally representative sample of older women participating in the Australian Longitudinal Study on Women’s Health (ALSWH). Never-married women in their 70s are compared with four groups of their contemporaries: currently married women who have and who have not had children; and previously married women who have and who have not had children. The aim is to describe their lives and reflect on the extent to which health and welfare services may need to target this growing demographic group. Method Background The ALSWH examines the relationship between physical, psychological, social, and lifestyle factors and women’s physical health, emotional well-being, and use of health services. The project involves three nationally representative age cohorts of women, who were aged 18–23 (younger), 45–50 (mid-age) and 70–75 (older) when first surveyed in 1996, and who will be followed longitudinally for 20 years.
1993
Details of cohorts and methods are available elsewhere (Lee et al., 2005). Copies of all surveys, and details of measures and derived variables can be found on the web at http:// www.sph.uq.edu.au/alswh. Categories used for each of the categorical variables in this analysis appear in Table 1. Participants This analysis focuses on women who responded to Survey 1 of the Older cohort in 1996 (aged 70–75) and to Survey 2 in 1999 (aged 73–78). A total of 12,940 women, representative of the Australian female population aged 70–75, completed Survey 1 in 1996. Of these, 90.2% were sent Survey 2 in 1999 (the remainder were deceased, unable to respond, or had not provided adequate contact details) and 10,434 (89.3%) responded. Measures Criterion variable Women were divided into five categories: nevermarried women who have never given birth (Never Married); currently married or cohabiting women who have never given birth (Married, No Children); separated, widowed or divorced women who have never given birth (Previously Married, No Children); currently married or cohabiting women who have given birth at least once (Married, With Children), and previously married women who have given birth at least once (Previously Married, With Children). Demographics Demographic variables included level of education, country of birth, rurality of area of residence, private health insurance, ability to manage on income, provision of care to a family member, and receipt of care. Physical health and health behaviours The eight subscales of the Australian standard version of the SF-36 (McCallum, 1995) were used as continuous measures of health-related quality of life. Other, categorical, measures of physical health were number of common serious medical conditions diagnosed (e.g., heart disease, arthritis), hospital admission in the previous year, number of GP (family physician) visits in the previous year, number of surgical procedures in the previous 3
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Table 1 Distributions of categorical variables across groups defined by marital and childbearing status w2
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
13.1 35.9 13.5 37.5
24.4 41.3 15.6 18.7
28.6 33.9 19.0 18.6
30.3 41.0 12.5 16.2
35.7 38.7 12.4 13.3
171.07
90.4 7.7
73.1 13.8
79.5 7.8
78.5 13.6
78.5 12.6
47.14
1.9
13.1
12.7
8.0
8.9
51.7 11.1 37.3
45.0 11.6 43.5
42.7 12.0 45.4
38.8 12.1 49.2
40.4 13.5 46.1
30.51
Private health insurance Yes 68.6 No 31.4
57.4 42.6
58.0 42.0
56.6 43.4
52.4 47.6
34.94
34.7 48.6 12.8 4.0
22.8 57.8 15.3 4.1
27.0 46.1 20.8 6.2
25.3 54.3 16.6 3.9
19.6 49.2 23.8 7.4
174.67
Care provider Yes No
19.8 80.2
28.2 71.8
18.4 81.6
25.3 74.7
16.3 83.7
109.70
Care recipient Yes No
11.0 89.0
11.2 88.8
8.0 92.0
11.1 88.9
9.6 90.5
7.42
Physical health/health behaviours Number of major diagnoses 0 33.0 1–2 49.4 3+ 17.6
27.7 51.1 21.2
16.4 64.1 19.5
22.3 56.3 21.4
21.6 53.4 25.0
50.13
Admitted to hospital previous year No 72.8 Yes 27.2
72.9 27.1
75.1 24.9
73.5 26.5
70.6 29.4
10.09
GP visits previous year 0 3.4 1–2 14.5 3–4 32.0 5–8 25.7 9+ 24.5
3.1 14.4 27.5 29.1 26.0
0.8 14.1 30.9 28.1 26.2
1.8 12.9 28.2 27.9 29.3
2.0 13.0 25.9 28.0 31.1
25.07
Surgical procedures previous 3 years 0 57.9 1+ 42.1
57.1 42.9
52.3 47.7
54.7 45.3
56.2 43.8
4.21
Demographics Education 0–9 10 11–12 Post-secondary Country of birth Australia Other English speaking Non-English speaking Area of residence Urban Large rural Small rural/remote
Manage on income Easy Not bad Some difficulty Always difficult/ impossible
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Table 1 (continued ) w2
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
Fall requiring medical attention previous year Yes 22.3 15.9 No 77.7 84.1
17.9 82.1
17.5 82.5
18.5 81.5
5.98
Number of symptoms 0 1–2 3–4 5+
53.1 25.8 12.2 8.9
55.0 24.3 15.2 5.5
48.9 30.4 11.9 8.9
52.3 28.2 11.4 8.2
51.4 28.4 11.1 9.2
15.69
Body mass index category o20 (under) 11.5 20–o25 (healthy) 46.8 25–o30 (over) 31.4 30+ (obese) 10.3
9.4 47.7 30.2 12.8
9.9 49.4 30.0 10.7
7.0 47.3 32.7 13.0
8.1 43.3 33.6 15.1
32.56
Smoking Never Ex Current
69.2 27.3 3.5
58.2 36.4 5.4
55.1 36.2 8.7
67.1 29.1 3.8
61.9 32.2 5.9
55.19
Alcohol consumption Non-drinker Rarely Low risk Risky
42.2 21.7 30.9 5.2
30.8 20.4 44.3 4.5
36.9 25.0 35.6 2.5
32.8 26.2 36.5 4.5
35.9 28.9 32.3 3.0
59.78
Physical activity None Low Moderate High
27.7 38.6 15.3 18.5
35.9 29.2 16.9 18.0
23.2 36.1 11.6 29.2
34.0 29.2 16.1 20.8
31.9 30.0 16.6 21.5
35.50
Mental health Satisfaction with social support Satisfied 57.2 Dissatisfied 42.8
58.7 41.3
61.5 38.5
67.5 32.5
71.6 28.4
60.10
Service use Number of services used 0 61.6 1 27.7 2+ 10.7
77.5 16.4 6.1
53.5 30.0 16.5
62.2 24.2 13.6
75.8 15.7 8.6
249.64
Social group membership Yes 15.5 No 84.5
8.8 91.2
15.0 85.0
9.5 90.5
15.3 84.8
78.97
Provide volunteer services Yes 66.1 No 33.9
47.7 52.3
55.8 44.2
46.6 53.4
49.2 50.8
42.65
po0:005.
years, whether they had had a fall requiring medical treatment in the previous year, and number of common symptoms (from a list of 22, e.g., head-
aches, back pain) experienced ‘‘often’’ in the previous year. Body mass index (BMI) from selfreported height and weight, smoking status, alcohol
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consumption status (National Health and Medical Research Council, 2002), and physical activity (Brown & Bauman, 2000) were also assessed by self-report.
Mental health Standardized psychometric scales included the Perceived Stress Questionnaire for Older Women (see Bell & Lee, 2002, 2003), the Life Orientation Test—Revised (Scheier, Carver, & Bridges, 1994), which measures optimism, the control subscale of the Health-Related Hardiness Scale (Pollock & Duffy, 1990), a measure of neighbourhood satisfaction (Young, Russell, & Powers, 2004), and a 10item version of the Duke Social Support Index (DSSI) (Koenig et al., 1993), which provides a continuous score for social network size and a dichotomous variable for satisfaction with support.
Services Respondents indicated whether they had used various formal services (e.g., meal deliveries, home nursing) in the previous 6 months, whether they had participated in any formal social groups (e.g., Country Women’s Association) in the previous six months, and whether they provided volunteer services for community or social organizations. Analytic strategy The aim of the analysis was to provide a crosssectional description of the health and circumstances of the five categories of older women. Univariate analyses (w2 or one-way analysis of variance) with a ¼ 0:005 were used to determine which variables showed differences between the groups (Tables 1 and 2). For categorical variables, multinomial logistic regression was conducted with adjustment for level of education and for country of
Table 2 Distributions of continuous variables across groups defined by marital and childbearing status
SF36: bodily pain
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
65.1 [26.4] 66.3 [21.4] 61.5 [26.4] 56.9 [41.2] 78.5 [15.9] 80.7 [33.8] 81.1 [27.2] 58.5 [20.5] 0.38 [0.43] 8.7 [1.7] 3.13 [0.61] 4.01 [0.61] 27.69 [4.40]
66.1 [26.5] 66.7 [21.4] 63.5 [25.6] 56.4 [41.0] 77.7 [17.3] 77.8 [33.5] 82.4 [25.7] 59.5 [20.9] 0.33 [0.36] 9.1 [1.6] 3.16 [0.64] 4.06 [0.61] 28.02 [4.44]
65.6 [26.9] 67.0 [20.9] 63.9 [25.3] 56.6 [41.8] 79.6 [15.8] 79.4 [34.5] 83.3 [24.9] 59.0 [20.9] 0.38 [0.43] 8.9 [1.5] 3.16 [0.64] 4.05 [0.59] 27.59 [4.30]
66.0 [27.5] 66.8 [21.4] 61.9 [26.5] 56.8 [41.9] 78.7 [16.6] 77.6 [35.7] 82.3 [25.3] 58.8 [21.2] 0.36 [0.43] 9.2 [1.5] 3.12 [0.63] 4.04 [0.58] 27.63 [4.65]
67.6 [25.7] SF36: general health 67.0 [21.1] SF36: physical functioning 61.1 [26.1] SF36: role physical 56.5 [40.4] SF36: mental health 81.5 [14.5] SF36: role emotional 83.2 [30.4] SF36: social functioning 83.8 [24.1] SF36: vitality 59.2 [20.2] Stress 0.27 [0.31] Social networks 9.1 [1.7] Optimism 3.27 [0.61] Hardiness 4.05 [0.63] Neighbourhood satisfaction 27.89 [4.39] po0:005.
F-statistic
F ¼ 0:46 F ¼ 0:16 F ¼ 4:09 F ¼ 0:01 F ¼ 3:55 F ¼ 2:87 F ¼ 1:47 F ¼ 0:12 F ¼ 4:01 F ¼ 26:38 F ¼ 6:20 F ¼ 0:48 F ¼ 0:74
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Table 3 Odds ratios [95% confidence intervals], with adjustment for education and country of birth, from multinomial logistic regression, with Married With Children as the reference group. Significant odds ratios are shown in bold type. Reference categories are indicated with asterisks Variable
Area of residence Urban* Large rural Small rural/remote Private hospital insurance Yes* No Manage on income Easy* Not bad Some difficulty Always difficult/impossible Care provider Yes No* Number of major diagnoses 0* 1–2 3–17 Body mass index category o20 (under) 20–o25 (healthy)* 25–o30 (over) 30+ (obese) Smoking Never* Ex Current Alcohol consumption Non-drinker* Low risk Rarely
Never Married N ¼ 271
Married, No Children N ¼ 329
Previously Married, No Children N ¼ 260
Previously Married, With Children N ¼ 4375
1.0 0.70 [0.46–1.07] 0.55 [0.42–0.73]
1.0 0.90 [0.61–1.32] 0.85 [0.66–1.09]
1.0 0.91 [0.59–1.41] 0.92 [0.69–1.21]
1.0 1.08 [0.94–1.24] 0.88 [0.80–0.96]
1.0 0.73 [0.55–0.97]
1.0 0.95 [0.73–1.22]
1.0 0.98 [0.74–1.31]
1.0 1.15 [1.05–1.27]
1.0 0.71 [0.53–0.96] 0.67 [0.44–1.02] 0.91 [0.46–1.81]
1.0 1.17 [0.86–1.57] 1.03 [0.69–1.54] 1.17 [0.60–2.26]
1.0 0.79 [0.57–1.09] 1.18 [0.79–1.76] 1.41 [0.76–2.63]
1.0 1.16 [1.03–1.30] 1.85 [1.61–2.13] 2.33 [1.87–2.91]
0.70 [0.51–0.97] 1.0
1.12 [0.86–1.47] 1.0
0.66 [0.47–0.94] 1.0
0.60 [0.54–0.67] 1.0
1.0 0.63 [0.47–0.85] 0.65 [0.44–0.94]
1.0 0.73 [0.55–0.96] 0.84 [0.60–1.17]
1.0 1.54 [1.07–2.22] 1.38 [0.90–2.13]
1.0 0.97 [0.87–1.08] 1.20 [1.06–1.37]
1.50 [0.98–2.30] 1.0 0.87 [0.63–1.21] 0.91 [0.58–1.42]
1.53 [1.03–2.27] 1.0 0.85 [0.64–1.14] 1.02 [0.70–1.48]
1.56 [1.01–2.42] 1.0 0.94 [0.68–1.30] 0.72 [0.44–1.16]
1.23 [1.04–1.46] 1.0 1.10 [0.99–1.23] 1.13 [0.98–1.30]
1.0 0.91 [0.67–1.22] 0.95 [0.46–1.97]
1.0 1.38 [1.07–1.78] 1.65 [0.96–2.83]
1.0 1.54 [1.15–2.06] 3.02 [1.83–5.00]
1.0 1.23 [1.11–1.36] 1.71 [1.38–2.13]
1.0 0.53 [0.38–0.72] 0.58 [0.41–0.82]
1.0 1.28 [0.96–1.72] 0.80 [0.56–1.14]
1.0 0.83 [0.60–1.15] 0.85 [0.59–1.21]
1.0 0.85 [0.76–0.95] 1.03 [0.92–1.16]
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Table 3 (continued ) Variable
Never Married
Risky Physical activity None* Low Moderate High Satisfaction with social support Satisfied* Dissatisfied Service use 0* 1 2+ Social group membership Yes No* Provide volunteer services Yes No*
N ¼ 271
Married, No Children N ¼ 329
Previously Married, No Children N ¼ 260
Previously Married, With Children N ¼ 4375
0.62 [0.31–1.21]
1.08 [0.58–2.03]
0.57 [0.24–1.32]
0.68 [0.53–0.88]
1.0 1.40 [1.00–1.95] 1.00 [0.65–1.52] 0.89 [0.60–1.34]
1.0 0.83 [0.61–1.13] 0.90 [0.62–1.29] 0.71 [0.49–1.01]
1.0 1.69 [1.17–2.43] 0.87 [0.52–1.45] 2.05 [1.40–3.00]
1.0 1.13 [1.01–1.27] 1.15 [1.00–1.32] 1.16 [1.02–1.32]
1.0 2.18 [1.68–2.83]
1.0 1.86 [1.47–2.36]
1.0 1.67 [1.27–2.19]
1.0 1.19 [1.08–1.30]
1.0 2.17 [1.62–2.91] 1.51 [0.98–2.31]
1.0 1.03 [0.75–1.41] 0.68 [0.41–1.10]
1.0 2.70 [1.99–3.65] 2.72 [1.87–3.96]
1.0 1.95 [1.74–2.17] 2.06 [1.79–2.38]
1.51 [1.05–2.18] 1.0
0.93 [0.62–1.40] 1.0
1.77 [1.23–2.55] 1.0
1.78 [1.56–2.03] 1.0
1.72 [1.30–2.28] 1.0
1.06 [0.82–1.36] 1.0
1.43 [1.08–1.91] 1.0
1.15 [1.05–1.27] 1.0
Table 4 Means and F ratios, adjusted for education and country of birth, for continuous variables significant at univariate level at 0.005
SF36: physical functioning Stress Social networks Optimism
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
59.26 0.27 8.88 2.66
61.21 0.37 8.64 2.60
62.77 0.33 9.08 2.58
63.95 0.38 8.85 2.63
62.33 0.36 9.20 2.58
F-statistic
3.67 3.46 26.58 7.42
po0:005.
birth (Table 3), in order to control for the effects of these early life influences on older adult well-being and functioning. For continuous variables, analysis of variance was conducted, again adjusting for the
effects of level of education and country of birth (Table 4). Analysis of data from Survey 1 was also conducted. Results at Surveys 1 and 2 were very
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similar, except that several additional variables had been included at Survey 2; thus, only results of Survey 2 are reported here. Results Criterion variable Overall, 10,108 (96.9%) of the respondents could be categorized. Fourteen women who indicated that they had never married but were mothers were excluded from analysis. The categories were Never Married (N ¼ 271, 2.7%); Married, No Children (N ¼ 329, 3.3%); Previously Married, No Children (N ¼ 260, 2.6%); Married, With Children (N ¼ 4375, 43.3%); and Previously Married, With Children (N ¼ 4859, 48.1%). The two Previously Married groups were mainly widows (89%), 8% divorced and 3% separated. Univariate analyses Univariate analyses showed significant differences for 19 of the 34 selected variables, at po0:005. Table 1 shows distributions and w2 for all categorical variables. As expected, never-married childless women had significantly higher levels of education, and were significantly more likely to be Australian born, than other women, supporting the decision to adjust for these variables. Table 2 presents means and F-statistics for continuous variables. Effects following adjustment for education and country of birth Thirteen significant categorical variables were entered into multinomial logistic regression, with adjustment for education and country of birth (see Table 3). Four significant continuous variables were analysed using three-factor analysis of variance with interaction effects suppressed. Table 4 shows the main effect for the criterion variable, and means adjusted for the other two factors (education and country of birth). Discussion This paper uses survey data from a large, nationally representative group of Australian women to examine the demographics, physical health, emotional well-being, and use of services of older, childless, never-married women, by comparison
1999
with others. The data show a strong difference in levels of education: almost 40% of never-married women have post-secondary qualifications, compared with 13–19% of the other groups. The data indicate that older never-married women are more active as members of social groups than other older women are. They make higher use of formal services than do currently married women, but so too do the previously married groups. Overall, there is no evidence from this self-report survey to suggest that older never-married childless women are in poor physical or emotional health, or that they are high users of medical services. While they are less likely to be providing family caregiving, they are considerably more likely to provide volunteer services. They make greater use of formal services—presumably because needs are not met by family—yet are coping financially and likely to have private health insurance. Thus, the view that these women constitute a social burden is not supported. It should be noted that, in this analysis, categorization was on the basis of a single question about marriage status, and many women who are classified as never-married may be, or have been, partnered. Women who reported currently living in de facto relationships were included as ‘‘married’’, but others—for example, those who had previously lived in de facto relationships or are in long-term same-sex relationships—were not included. A further limitation is the reliance on selfreport, which may have introduced some biases into the analysis. When these older women were making decisions about their adult lives, marriage and motherhood interfered with education and employment in a way which is no longer the case. For this cohort, it is not clear whether any particular woman gained education by default, because she was unable to follow her preferred path of marriage and motherhood, or chose not to marry because she did not want to forego education and employment. The data suggest that older never-married women in Australia do not constitute a social burden or ‘‘problem’’ group. Rather, it seems that their life experiences and opportunities prepare them for a successful and productive old age; as a wellfunctioning cohort, they appear able to make a significant contribution to society and to their similar-aged peers who may not have developed the same coping strategies over the years.
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Acknowledgements The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health, The University of Newcastle and The University of Queensland. We are grateful to the Commonwealth Department of Health and Ageing for funding, and the women who provided the survey data.
References Australian Bureau of Statistics. (1996). Census of population and housing: Ageing in Australia. Canberra: Australia Bureau of Statistics. Australian Bureau of Statistics. (2002). Australian social trends 2002—Family formation—trends in childlessness (pp. 1–5). Canberra: Australian Bureau of Statistics. Baldwin, W. H., & Nord, C. W. (1984). Delayed childbearing in the US: Facts and fictions. Population Bulletin, 39(4), 1–42. Bell, S., & Lee, C. (2002). Development of the perceived stress questionnaire for young women. Psychology, Health and Medicine, 7, 189–201. Bell, S., & Lee, C. (2003). Perceived stress revisited: The Women’s Health Australia project Young cohort. Psychology, Health and Medicine, 8, 343–353. Brown, W. J., & Bauman, A. E. (2000). Comparison of estimates of population levels of physical activity using two measures. Australian and New Zealand Journal of Public Health, 24, 520–525. Caspi, A., & Elder, G. H. (1986). Life satisfaction in old age: Linking social psychology and history. Psychology and Aging, 1, 18–26. Cheung, Y. B. (1998). Can marital selection explain the differences in health between married and divorced people? From a longitudinal study of a British birth cohort. Public Health, 112, 113–117. Connidis, I. A. (1994). Sibling support in older age. Journals of Gerontology B, 49(6), S309–S317. Davis, M., Neuhaus, J., Moritz, D., & Segal, M. (1992). Living arrangements and survival among middle-aged and older adults in the NHANES I epidemiologic follow-up study. American Journal of Public Health, 82(3), 401–406. Davis, M., Murphy, S. P., Neuhaus, J., Gee, L., & Quiroga, S. S. (2000). Living arrangements affect dietary quality for U.S. adults aged 50 years and older: NHANES III 1988–1994. Journal of Nutrition, 130, 2256–2264. de Jong-Gierveld, J., Kamphuis, F., & Dykstra, P. (1987). Old and lonely? Comprehensive Gerontology B, 1(1), 13–17. Gatz, M., Harris, J. R., & Turk-Charles, S. (1995). The meaning of health for older women. In A. L. Stanton, & S. J. Gallant (Eds.), The psychology of women’s health: Progress and challenges in research and application (pp. 491–529). Washington, DC: American Psychological Association. Hess, B., & Waring, J. (1983). Family relationships of older women: A women’s issue. In E. Markson (Ed.), Older women. Lexington, MA: Lexington Books.
Hoeffer, B. (1987). Predictors of life outlook of older single women. Research in Nursing & Health, 10(2), 111–117. Hooyman, N. R., & Kiyak, H. A. (1991). Social gerontology: A multidisciplinary perspective. Boston: Allyn and Bacon. Johnson, C. L., & Troll, L. (1992). Family functioning in late late life. Journals of Gerontology B, 47(2), S66–S72. Johnson, N. J., Backlund, E., Sorlie, P. D., & Loveless, C. A. (2000). Marital status and mortality: The national longitudinal mortality study. Annals of Epidemiology, 10(4), 224–238. Jones, C. (2000). Adoption: A study of post-war child removal in New South Wales. Journal of the Royal Australian Historical Society, 86, 51–64. Keating, N., & Jeffrey, B. (1983). Work careers of ever married and never married retired women. Gerontologist, 23(4), 416–421. Koenig, H. G., Westlund, R. E., George, L. K., Hughes, D. C., Blazer, D. G., & Hybels, C. (1993). Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics, 34(1), 61–69. Koropeckyj-Cox, T. (1998). Loneliness and depression in middle and old age: Are the childless more vulnerable? Journal of Gerontology B Psychological Science and Social Science, 53(6), S303–S312. Lee, C., Dobson, A. J., Brown, W. J., Bryson, L., Byles, J., Warner-Smith, P., & Young, A. F. (2005). Cohort Profile: The Australian Longitudinal Study on Women’s Health. International Journal of Epidemiology, 34, 1093–1098. McCallum, J. (1995). The SF-36 in an Australian sample: Validating a new generic health status measure. Australian Journal of Public Health, 19, 160–166. National Center for Health Statistics. (2000). Nonmarital childbearing in the United States, 1940–99. NVSR, 48(16), 2001–2011. National Health and Medical Research Council. (2002). Australian alcohol guidelines: Health risks and benefits. Canberra, Australia: National Health and Medical Research Council. Pollock, S., & Duffy, M. (1990). The Health-Related Hardiness Scale: Development and psychometric analysis. Nursing Research, 39, 218–222. Roos, P. A. (1983). Marriage and women’s occupational attainment in cross-cultural perspective. American Sociological Review, 48(6), 852–864. Scheier, M., Carver, C., & Bridges, M. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the life orientation test. Journal of Personality and Social Psychology, 67, 1063–1078. Spurlock, J. (1990). Single women. In J. R. Spurlock, & C. B. Robinowitz (Eds.), Women in context: Development and stresses (pp. 23–33). NY: Plenum Press. Waldron, I., Hughes, M. E., & Brooks, T. L. (1996). Marriage protection and marriage selection: Prospective evidence for reciprocal effects of marital status and health. Social Science & Medicine, 43, 113–123. Wells, N., & Freer, C. (1988). Introduction. In N. Wells, & C. Freer (Eds.), The ageing population: Burden or challenge? (pp. xiii–xviii). Basingstoke, UK: Macmillan. Wenger, G. C. (2001). Ageing without children: Rural Wales. Journal of Cross-Cultural Gerontology, 16(1), 79–109. Wister, A. V., & Dykstra, P. A. (2000). Formal assistance among Dutch older adults: An examination of the gendered
ARTICLE IN PRESS J. Cwikel et al. / Social Science & Medicine 62 (2006) 1991–2001 nature of marital history. Canadian Journal on Aging, 19(4), 508–535. Wolf, D. A., Laditka, S. B., & Laditka, J. N. (2002). Patterns of active life among older women: Differences within and between groups. Journal of Women and Aging, 14(1–2), 9–26. Wu, Z., & Pollard, M. (1998). Social support among unmarried childless elderly persons. Journal of Gerontology B, 53, S324–S335.
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Young, A. F., Russell, A., & Powers, J. R. (2004). The sense of belonging to a neighbourhood: Can it be measured and is it related to health and well-being in older women? Social Science & Medicine, 59, 2627–2637. Zhang, Z., & Hayward, M. (2001). Childlessness and the psychological well-being of older persons. Journal of Gerontology B, 56, S311–S320.
Social Science & Medicine 62 (2006) 1991–2001 www.elsevier.com/locate/socscimed
Never-married childless women in Australia: Health and social circumstances in older age Julie Cwikela,b, Helen Gramotnevc, Christina Leec, a
Center for Women’s Health Studies and Promotion, Ben Gurion University of the Negev, Israel b Key Centre for Women’s Health in Society, The University of Melbourne, Australia c School of Psychology and School of Population Health, University of Queensland, St Lucia, QLD 4072, Australia Available online 12 October 2005
Abstract A growing proportion of women reach older age without having married or having children. Assumptions that these older women are lonely, impoverished, and high users of social and health services are based on little evidence. This paper uses data from the Older cohort of the Australian Longitudinal Study on Women’s Health to describe self-reported demographics, physical and emotional health, and use of services among 10,108 women aged 73–78, of whom 2.7% are never-married and childless. The most striking characteristic of this group is their high levels of education, which are associated with fewer reported financial difficulties and higher rates of private health insurance. There are few differences in self-reported physical or emotional health or use of health services between these and other groups of older women. Compared with older married women with children, they make higher use of formal services such as home maintenance and meal services, and are also more likely to provide volunteer services and belong to social groups. Overall, there is no evidence to suggest that these women are a ‘‘problem’’ group. Rather, it seems that their life experiences and opportunities prepare them for a successful and productive older age. r 2005 Elsevier Ltd. All rights reserved. Keywords: Women; Aging; Childless; Never-married; Australia
Introduction Remaining unmarried throughout adult life is widely viewed as anomalous, despite the fact that many women never marry. In the USA, the percentage of women who had not married by age 35 remained steady at around 15% for the first half of the twentieth century, dropped to 7% between 1950 and 1970, and is now climbing again (Baldwin & Nord, 1984). In the 1990s, approximately 8% of Corresponding author.
E-mail address: [email protected] (C. Lee). 0277-9536/$ - see front matter r 2005 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2005.09.006
women in their 70s or 80s had never married (Hess & Waring, 1983; Hooyman & Kiyak, 1991), and the proportion of women who never marry or have a child seems likely to increase in developed countries (Australian Bureau of Statistics, 2002; Hooyman & Kiyak, 1991; Wolf, Laditka, & Laditka, 2002). Being never-married does not necessarily mean being childless, and currently a significant number of mothers remain unmarried. In 1998, more than half the births in Norway and Sweden were to unmarried women, while the rate was one in three in the USA (National Center for Health Statistics, 2000). The aim of this paper is to describe the health
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and social circumstances of older never-married Australian women who are now in their 70s. For this cohort, unmarried mothers faced social and economic difficulties, and pressure to give the child for adoption (Jones, 2000), and a vast majority of never-married women of this age did not have children. Research on marriage and well-being among older people often focuses on current living arrangements, combining the never-married with the widowed or divorced. However, a lifecourse approach to human development assumes that childhood and early adult experience shape functioning in old age, and suggests that never-married people approach older age with a different set of skills and attitudes from those who lived in families for most of their adult lives (Caspi & Elder, 1986; Gatz, Harris, & Turk-Charles, 1995). Marriage and children continue to be viewed as normal and desirable for women. Australian data (Lee et al., 2005) show that 96% of young women want to be married or in stable de facto relationships, and 91% want children; 96% of middle-aged women are or have been married and 92% are mothers; and of older women, 94% are or have been married, and 91% are mothers. Older single women are often assumed to be in poor emotional health, and a social burden and drain on public resources (Wells & Freer, 1988); however, there is little empirical evidence for this claim. Based on traditional theories of development, early studies of unmarried, childless women assumed that they must be unfulfilled and unhappy (Spurlock, 1990). Contemporary research (Wolf et al., 2002) has shown that single women show considerable adaptability and well-being in old age. Data from several countries (e.g., Koropeckyj-Cox, 1998; Zhang & Hayward, 2001) suggest that nevermarried women, like the currently married, tend to have better adjustment in old age than the previously married. Despite assumptions that marriage and children are more central to emotional well-being for women than they are for men, never-married women show better adjustment than never-married men do. In a Welsh study of ageing (Wenger, 2001), nevermarried men tended to be solitary and rely on female relatives for care, while never-married women were more independent and socially connected. In the USA, Zhang and Hayward (2001) showed that never-married men had higher levels of depression and loneliness than did never-married
women, while a Dutch study found that older nevermarried men were three times as likely to use formal support services as older never-married women (Wister & Dykstra, 2000). The evidence on the physical health of nevermarried women is mixed. Unmarried women generally have higher all-cause mortality and worse physical health than the married (e.g., Cheung, 1998; Johnson, Backlund, Sorlie, & Loveless, 2000); longitudinal research with middle-aged women (e.g., Waldron, Hughes, & Brooks, 1996) indicates that this can be explained both by selection—healthy women are more likely to marry and to remain married—and protection—marriage tends to improve women’s health. These effects, however, are found only among women who do not have paid work, suggesting that marriage and paid work may provide similar benefits and can perhaps substitute for each other (Waldron et al., 1996). Furthermore, these results are based on women across the lifespan and the situation for women who have reached old age may be quite different. Living alone has been shown to reduce survival among older men, but has no independent effect on the survival of women (Davis, Neuhaus, Moritz, & Segal, 1992) despite the fact that women living alone are vulnerable to poverty, social isolation, and inadequate diet (Davis, Murphy, Neuhaus, Gee, & Quiroga, 2000). A Canadian study (Wu & Pollard, 1998) has shown that older childless never-married individuals may lack emotional and instrumental support, but women generally maintain better social networks than men. Analysis of data from the US 1984–1990 Longitudinal Study of Aging estimated remaining unimpaired years of life for different groups of older women. Never-married, more-educated White women lived the longest, healthiest lives (Wolf et al., 2002), indicating the interaction between such variables as ethnicity, economic status, and educational attainment in predicting well-being in old age. In this cohort, never-married women were most likely to have had continuous employment and career progression (Keating & Jeffrey, 1983). However, a cross-national study of 12 industrial countries showed that never-married women were still concentrated in lower-paying, lower-status occupations than men (Roos, 1983). The historical context of these findings is important: women who are now in their 70s have experienced legal and socially sanctioned restrictions on educational and employment opportunities, with additional restrictions for
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married women. Never-married older women are thus likely to be better educated than those who have married (e.g., Hoeffer, 1987), and women with higher educational attainment and incomes tend to have more extensive social networks. Childlessness is important for planning an ageing society: without family to provide informal caregiving, policymakers assume that childless, nevermarried women may over-tax formal health and welfare services or require early institutionalization (e.g., Connidis, 1994; de Jong-Gierveld, Kamphuis, & Dykstra, 1987; Johnson & Troll, 1992). In Australia in 1996, 22% of childless women aged 75 and over were living in long-term care, compared with 14% of women who had children (Australian Bureau of Statistics, 1996). On the one hand, older never-married women demonstrate good emotional health, with strong social networks, and those with a history of education and employment are likely to cope with older age with resilience. On the other hand, there are suggestions that never-married women are in poor health and reliant on publicly funded services to provide care. This paper explores variables across several domains (demographics, physical health, health behaviours, mental health, and service use) through an analysis of data from a large and nationally representative sample of older women participating in the Australian Longitudinal Study on Women’s Health (ALSWH). Never-married women in their 70s are compared with four groups of their contemporaries: currently married women who have and who have not had children; and previously married women who have and who have not had children. The aim is to describe their lives and reflect on the extent to which health and welfare services may need to target this growing demographic group. Method Background The ALSWH examines the relationship between physical, psychological, social, and lifestyle factors and women’s physical health, emotional well-being, and use of health services. The project involves three nationally representative age cohorts of women, who were aged 18–23 (younger), 45–50 (mid-age) and 70–75 (older) when first surveyed in 1996, and who will be followed longitudinally for 20 years.
1993
Details of cohorts and methods are available elsewhere (Lee et al., 2005). Copies of all surveys, and details of measures and derived variables can be found on the web at http:// www.sph.uq.edu.au/alswh. Categories used for each of the categorical variables in this analysis appear in Table 1. Participants This analysis focuses on women who responded to Survey 1 of the Older cohort in 1996 (aged 70–75) and to Survey 2 in 1999 (aged 73–78). A total of 12,940 women, representative of the Australian female population aged 70–75, completed Survey 1 in 1996. Of these, 90.2% were sent Survey 2 in 1999 (the remainder were deceased, unable to respond, or had not provided adequate contact details) and 10,434 (89.3%) responded. Measures Criterion variable Women were divided into five categories: nevermarried women who have never given birth (Never Married); currently married or cohabiting women who have never given birth (Married, No Children); separated, widowed or divorced women who have never given birth (Previously Married, No Children); currently married or cohabiting women who have given birth at least once (Married, With Children), and previously married women who have given birth at least once (Previously Married, With Children). Demographics Demographic variables included level of education, country of birth, rurality of area of residence, private health insurance, ability to manage on income, provision of care to a family member, and receipt of care. Physical health and health behaviours The eight subscales of the Australian standard version of the SF-36 (McCallum, 1995) were used as continuous measures of health-related quality of life. Other, categorical, measures of physical health were number of common serious medical conditions diagnosed (e.g., heart disease, arthritis), hospital admission in the previous year, number of GP (family physician) visits in the previous year, number of surgical procedures in the previous 3
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1994
Table 1 Distributions of categorical variables across groups defined by marital and childbearing status w2
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
13.1 35.9 13.5 37.5
24.4 41.3 15.6 18.7
28.6 33.9 19.0 18.6
30.3 41.0 12.5 16.2
35.7 38.7 12.4 13.3
171.07
90.4 7.7
73.1 13.8
79.5 7.8
78.5 13.6
78.5 12.6
47.14
1.9
13.1
12.7
8.0
8.9
51.7 11.1 37.3
45.0 11.6 43.5
42.7 12.0 45.4
38.8 12.1 49.2
40.4 13.5 46.1
30.51
Private health insurance Yes 68.6 No 31.4
57.4 42.6
58.0 42.0
56.6 43.4
52.4 47.6
34.94
34.7 48.6 12.8 4.0
22.8 57.8 15.3 4.1
27.0 46.1 20.8 6.2
25.3 54.3 16.6 3.9
19.6 49.2 23.8 7.4
174.67
Care provider Yes No
19.8 80.2
28.2 71.8
18.4 81.6
25.3 74.7
16.3 83.7
109.70
Care recipient Yes No
11.0 89.0
11.2 88.8
8.0 92.0
11.1 88.9
9.6 90.5
7.42
Physical health/health behaviours Number of major diagnoses 0 33.0 1–2 49.4 3+ 17.6
27.7 51.1 21.2
16.4 64.1 19.5
22.3 56.3 21.4
21.6 53.4 25.0
50.13
Admitted to hospital previous year No 72.8 Yes 27.2
72.9 27.1
75.1 24.9
73.5 26.5
70.6 29.4
10.09
GP visits previous year 0 3.4 1–2 14.5 3–4 32.0 5–8 25.7 9+ 24.5
3.1 14.4 27.5 29.1 26.0
0.8 14.1 30.9 28.1 26.2
1.8 12.9 28.2 27.9 29.3
2.0 13.0 25.9 28.0 31.1
25.07
Surgical procedures previous 3 years 0 57.9 1+ 42.1
57.1 42.9
52.3 47.7
54.7 45.3
56.2 43.8
4.21
Demographics Education 0–9 10 11–12 Post-secondary Country of birth Australia Other English speaking Non-English speaking Area of residence Urban Large rural Small rural/remote
Manage on income Easy Not bad Some difficulty Always difficult/ impossible
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1995
Table 1 (continued ) w2
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
Fall requiring medical attention previous year Yes 22.3 15.9 No 77.7 84.1
17.9 82.1
17.5 82.5
18.5 81.5
5.98
Number of symptoms 0 1–2 3–4 5+
53.1 25.8 12.2 8.9
55.0 24.3 15.2 5.5
48.9 30.4 11.9 8.9
52.3 28.2 11.4 8.2
51.4 28.4 11.1 9.2
15.69
Body mass index category o20 (under) 11.5 20–o25 (healthy) 46.8 25–o30 (over) 31.4 30+ (obese) 10.3
9.4 47.7 30.2 12.8
9.9 49.4 30.0 10.7
7.0 47.3 32.7 13.0
8.1 43.3 33.6 15.1
32.56
Smoking Never Ex Current
69.2 27.3 3.5
58.2 36.4 5.4
55.1 36.2 8.7
67.1 29.1 3.8
61.9 32.2 5.9
55.19
Alcohol consumption Non-drinker Rarely Low risk Risky
42.2 21.7 30.9 5.2
30.8 20.4 44.3 4.5
36.9 25.0 35.6 2.5
32.8 26.2 36.5 4.5
35.9 28.9 32.3 3.0
59.78
Physical activity None Low Moderate High
27.7 38.6 15.3 18.5
35.9 29.2 16.9 18.0
23.2 36.1 11.6 29.2
34.0 29.2 16.1 20.8
31.9 30.0 16.6 21.5
35.50
Mental health Satisfaction with social support Satisfied 57.2 Dissatisfied 42.8
58.7 41.3
61.5 38.5
67.5 32.5
71.6 28.4
60.10
Service use Number of services used 0 61.6 1 27.7 2+ 10.7
77.5 16.4 6.1
53.5 30.0 16.5
62.2 24.2 13.6
75.8 15.7 8.6
249.64
Social group membership Yes 15.5 No 84.5
8.8 91.2
15.0 85.0
9.5 90.5
15.3 84.8
78.97
Provide volunteer services Yes 66.1 No 33.9
47.7 52.3
55.8 44.2
46.6 53.4
49.2 50.8
42.65
po0:005.
years, whether they had had a fall requiring medical treatment in the previous year, and number of common symptoms (from a list of 22, e.g., head-
aches, back pain) experienced ‘‘often’’ in the previous year. Body mass index (BMI) from selfreported height and weight, smoking status, alcohol
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consumption status (National Health and Medical Research Council, 2002), and physical activity (Brown & Bauman, 2000) were also assessed by self-report.
Mental health Standardized psychometric scales included the Perceived Stress Questionnaire for Older Women (see Bell & Lee, 2002, 2003), the Life Orientation Test—Revised (Scheier, Carver, & Bridges, 1994), which measures optimism, the control subscale of the Health-Related Hardiness Scale (Pollock & Duffy, 1990), a measure of neighbourhood satisfaction (Young, Russell, & Powers, 2004), and a 10item version of the Duke Social Support Index (DSSI) (Koenig et al., 1993), which provides a continuous score for social network size and a dichotomous variable for satisfaction with support.
Services Respondents indicated whether they had used various formal services (e.g., meal deliveries, home nursing) in the previous 6 months, whether they had participated in any formal social groups (e.g., Country Women’s Association) in the previous six months, and whether they provided volunteer services for community or social organizations. Analytic strategy The aim of the analysis was to provide a crosssectional description of the health and circumstances of the five categories of older women. Univariate analyses (w2 or one-way analysis of variance) with a ¼ 0:005 were used to determine which variables showed differences between the groups (Tables 1 and 2). For categorical variables, multinomial logistic regression was conducted with adjustment for level of education and for country of
Table 2 Distributions of continuous variables across groups defined by marital and childbearing status
SF36: bodily pain
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
65.1 [26.4] 66.3 [21.4] 61.5 [26.4] 56.9 [41.2] 78.5 [15.9] 80.7 [33.8] 81.1 [27.2] 58.5 [20.5] 0.38 [0.43] 8.7 [1.7] 3.13 [0.61] 4.01 [0.61] 27.69 [4.40]
66.1 [26.5] 66.7 [21.4] 63.5 [25.6] 56.4 [41.0] 77.7 [17.3] 77.8 [33.5] 82.4 [25.7] 59.5 [20.9] 0.33 [0.36] 9.1 [1.6] 3.16 [0.64] 4.06 [0.61] 28.02 [4.44]
65.6 [26.9] 67.0 [20.9] 63.9 [25.3] 56.6 [41.8] 79.6 [15.8] 79.4 [34.5] 83.3 [24.9] 59.0 [20.9] 0.38 [0.43] 8.9 [1.5] 3.16 [0.64] 4.05 [0.59] 27.59 [4.30]
66.0 [27.5] 66.8 [21.4] 61.9 [26.5] 56.8 [41.9] 78.7 [16.6] 77.6 [35.7] 82.3 [25.3] 58.8 [21.2] 0.36 [0.43] 9.2 [1.5] 3.12 [0.63] 4.04 [0.58] 27.63 [4.65]
67.6 [25.7] SF36: general health 67.0 [21.1] SF36: physical functioning 61.1 [26.1] SF36: role physical 56.5 [40.4] SF36: mental health 81.5 [14.5] SF36: role emotional 83.2 [30.4] SF36: social functioning 83.8 [24.1] SF36: vitality 59.2 [20.2] Stress 0.27 [0.31] Social networks 9.1 [1.7] Optimism 3.27 [0.61] Hardiness 4.05 [0.63] Neighbourhood satisfaction 27.89 [4.39] po0:005.
F-statistic
F ¼ 0:46 F ¼ 0:16 F ¼ 4:09 F ¼ 0:01 F ¼ 3:55 F ¼ 2:87 F ¼ 1:47 F ¼ 0:12 F ¼ 4:01 F ¼ 26:38 F ¼ 6:20 F ¼ 0:48 F ¼ 0:74
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1997
Table 3 Odds ratios [95% confidence intervals], with adjustment for education and country of birth, from multinomial logistic regression, with Married With Children as the reference group. Significant odds ratios are shown in bold type. Reference categories are indicated with asterisks Variable
Area of residence Urban* Large rural Small rural/remote Private hospital insurance Yes* No Manage on income Easy* Not bad Some difficulty Always difficult/impossible Care provider Yes No* Number of major diagnoses 0* 1–2 3–17 Body mass index category o20 (under) 20–o25 (healthy)* 25–o30 (over) 30+ (obese) Smoking Never* Ex Current Alcohol consumption Non-drinker* Low risk Rarely
Never Married N ¼ 271
Married, No Children N ¼ 329
Previously Married, No Children N ¼ 260
Previously Married, With Children N ¼ 4375
1.0 0.70 [0.46–1.07] 0.55 [0.42–0.73]
1.0 0.90 [0.61–1.32] 0.85 [0.66–1.09]
1.0 0.91 [0.59–1.41] 0.92 [0.69–1.21]
1.0 1.08 [0.94–1.24] 0.88 [0.80–0.96]
1.0 0.73 [0.55–0.97]
1.0 0.95 [0.73–1.22]
1.0 0.98 [0.74–1.31]
1.0 1.15 [1.05–1.27]
1.0 0.71 [0.53–0.96] 0.67 [0.44–1.02] 0.91 [0.46–1.81]
1.0 1.17 [0.86–1.57] 1.03 [0.69–1.54] 1.17 [0.60–2.26]
1.0 0.79 [0.57–1.09] 1.18 [0.79–1.76] 1.41 [0.76–2.63]
1.0 1.16 [1.03–1.30] 1.85 [1.61–2.13] 2.33 [1.87–2.91]
0.70 [0.51–0.97] 1.0
1.12 [0.86–1.47] 1.0
0.66 [0.47–0.94] 1.0
0.60 [0.54–0.67] 1.0
1.0 0.63 [0.47–0.85] 0.65 [0.44–0.94]
1.0 0.73 [0.55–0.96] 0.84 [0.60–1.17]
1.0 1.54 [1.07–2.22] 1.38 [0.90–2.13]
1.0 0.97 [0.87–1.08] 1.20 [1.06–1.37]
1.50 [0.98–2.30] 1.0 0.87 [0.63–1.21] 0.91 [0.58–1.42]
1.53 [1.03–2.27] 1.0 0.85 [0.64–1.14] 1.02 [0.70–1.48]
1.56 [1.01–2.42] 1.0 0.94 [0.68–1.30] 0.72 [0.44–1.16]
1.23 [1.04–1.46] 1.0 1.10 [0.99–1.23] 1.13 [0.98–1.30]
1.0 0.91 [0.67–1.22] 0.95 [0.46–1.97]
1.0 1.38 [1.07–1.78] 1.65 [0.96–2.83]
1.0 1.54 [1.15–2.06] 3.02 [1.83–5.00]
1.0 1.23 [1.11–1.36] 1.71 [1.38–2.13]
1.0 0.53 [0.38–0.72] 0.58 [0.41–0.82]
1.0 1.28 [0.96–1.72] 0.80 [0.56–1.14]
1.0 0.83 [0.60–1.15] 0.85 [0.59–1.21]
1.0 0.85 [0.76–0.95] 1.03 [0.92–1.16]
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Table 3 (continued ) Variable
Never Married
Risky Physical activity None* Low Moderate High Satisfaction with social support Satisfied* Dissatisfied Service use 0* 1 2+ Social group membership Yes No* Provide volunteer services Yes No*
N ¼ 271
Married, No Children N ¼ 329
Previously Married, No Children N ¼ 260
Previously Married, With Children N ¼ 4375
0.62 [0.31–1.21]
1.08 [0.58–2.03]
0.57 [0.24–1.32]
0.68 [0.53–0.88]
1.0 1.40 [1.00–1.95] 1.00 [0.65–1.52] 0.89 [0.60–1.34]
1.0 0.83 [0.61–1.13] 0.90 [0.62–1.29] 0.71 [0.49–1.01]
1.0 1.69 [1.17–2.43] 0.87 [0.52–1.45] 2.05 [1.40–3.00]
1.0 1.13 [1.01–1.27] 1.15 [1.00–1.32] 1.16 [1.02–1.32]
1.0 2.18 [1.68–2.83]
1.0 1.86 [1.47–2.36]
1.0 1.67 [1.27–2.19]
1.0 1.19 [1.08–1.30]
1.0 2.17 [1.62–2.91] 1.51 [0.98–2.31]
1.0 1.03 [0.75–1.41] 0.68 [0.41–1.10]
1.0 2.70 [1.99–3.65] 2.72 [1.87–3.96]
1.0 1.95 [1.74–2.17] 2.06 [1.79–2.38]
1.51 [1.05–2.18] 1.0
0.93 [0.62–1.40] 1.0
1.77 [1.23–2.55] 1.0
1.78 [1.56–2.03] 1.0
1.72 [1.30–2.28] 1.0
1.06 [0.82–1.36] 1.0
1.43 [1.08–1.91] 1.0
1.15 [1.05–1.27] 1.0
Table 4 Means and F ratios, adjusted for education and country of birth, for continuous variables significant at univariate level at 0.005
SF36: physical functioning Stress Social networks Optimism
Never Married
Married, No Children
Previously Married, No Children
Married, With Children
Previously Married, With Children
N ¼ 271
N ¼ 329
N ¼ 260
N ¼ 4859
N ¼ 4375
59.26 0.27 8.88 2.66
61.21 0.37 8.64 2.60
62.77 0.33 9.08 2.58
63.95 0.38 8.85 2.63
62.33 0.36 9.20 2.58
F-statistic
3.67 3.46 26.58 7.42
po0:005.
birth (Table 3), in order to control for the effects of these early life influences on older adult well-being and functioning. For continuous variables, analysis of variance was conducted, again adjusting for the
effects of level of education and country of birth (Table 4). Analysis of data from Survey 1 was also conducted. Results at Surveys 1 and 2 were very
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similar, except that several additional variables had been included at Survey 2; thus, only results of Survey 2 are reported here. Results Criterion variable Overall, 10,108 (96.9%) of the respondents could be categorized. Fourteen women who indicated that they had never married but were mothers were excluded from analysis. The categories were Never Married (N ¼ 271, 2.7%); Married, No Children (N ¼ 329, 3.3%); Previously Married, No Children (N ¼ 260, 2.6%); Married, With Children (N ¼ 4375, 43.3%); and Previously Married, With Children (N ¼ 4859, 48.1%). The two Previously Married groups were mainly widows (89%), 8% divorced and 3% separated. Univariate analyses Univariate analyses showed significant differences for 19 of the 34 selected variables, at po0:005. Table 1 shows distributions and w2 for all categorical variables. As expected, never-married childless women had significantly higher levels of education, and were significantly more likely to be Australian born, than other women, supporting the decision to adjust for these variables. Table 2 presents means and F-statistics for continuous variables. Effects following adjustment for education and country of birth Thirteen significant categorical variables were entered into multinomial logistic regression, with adjustment for education and country of birth (see Table 3). Four significant continuous variables were analysed using three-factor analysis of variance with interaction effects suppressed. Table 4 shows the main effect for the criterion variable, and means adjusted for the other two factors (education and country of birth). Discussion This paper uses survey data from a large, nationally representative group of Australian women to examine the demographics, physical health, emotional well-being, and use of services of older, childless, never-married women, by comparison
1999
with others. The data show a strong difference in levels of education: almost 40% of never-married women have post-secondary qualifications, compared with 13–19% of the other groups. The data indicate that older never-married women are more active as members of social groups than other older women are. They make higher use of formal services than do currently married women, but so too do the previously married groups. Overall, there is no evidence from this self-report survey to suggest that older never-married childless women are in poor physical or emotional health, or that they are high users of medical services. While they are less likely to be providing family caregiving, they are considerably more likely to provide volunteer services. They make greater use of formal services—presumably because needs are not met by family—yet are coping financially and likely to have private health insurance. Thus, the view that these women constitute a social burden is not supported. It should be noted that, in this analysis, categorization was on the basis of a single question about marriage status, and many women who are classified as never-married may be, or have been, partnered. Women who reported currently living in de facto relationships were included as ‘‘married’’, but others—for example, those who had previously lived in de facto relationships or are in long-term same-sex relationships—were not included. A further limitation is the reliance on selfreport, which may have introduced some biases into the analysis. When these older women were making decisions about their adult lives, marriage and motherhood interfered with education and employment in a way which is no longer the case. For this cohort, it is not clear whether any particular woman gained education by default, because she was unable to follow her preferred path of marriage and motherhood, or chose not to marry because she did not want to forego education and employment. The data suggest that older never-married women in Australia do not constitute a social burden or ‘‘problem’’ group. Rather, it seems that their life experiences and opportunities prepare them for a successful and productive old age; as a wellfunctioning cohort, they appear able to make a significant contribution to society and to their similar-aged peers who may not have developed the same coping strategies over the years.
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Acknowledgements The research on which this paper is based was conducted as part of the Australian Longitudinal Study on Women’s Health, The University of Newcastle and The University of Queensland. We are grateful to the Commonwealth Department of Health and Ageing for funding, and the women who provided the survey data.
References Australian Bureau of Statistics. (1996). Census of population and housing: Ageing in Australia. Canberra: Australia Bureau of Statistics. Australian Bureau of Statistics. (2002). Australian social trends 2002—Family formation—trends in childlessness (pp. 1–5). Canberra: Australian Bureau of Statistics. Baldwin, W. H., & Nord, C. W. (1984). Delayed childbearing in the US: Facts and fictions. Population Bulletin, 39(4), 1–42. Bell, S., & Lee, C. (2002). Development of the perceived stress questionnaire for young women. Psychology, Health and Medicine, 7, 189–201. Bell, S., & Lee, C. (2003). Perceived stress revisited: The Women’s Health Australia project Young cohort. Psychology, Health and Medicine, 8, 343–353. Brown, W. J., & Bauman, A. E. (2000). Comparison of estimates of population levels of physical activity using two measures. Australian and New Zealand Journal of Public Health, 24, 520–525. Caspi, A., & Elder, G. H. (1986). Life satisfaction in old age: Linking social psychology and history. Psychology and Aging, 1, 18–26. Cheung, Y. B. (1998). Can marital selection explain the differences in health between married and divorced people? From a longitudinal study of a British birth cohort. Public Health, 112, 113–117. Connidis, I. A. (1994). Sibling support in older age. Journals of Gerontology B, 49(6), S309–S317. Davis, M., Neuhaus, J., Moritz, D., & Segal, M. (1992). Living arrangements and survival among middle-aged and older adults in the NHANES I epidemiologic follow-up study. American Journal of Public Health, 82(3), 401–406. Davis, M., Murphy, S. P., Neuhaus, J., Gee, L., & Quiroga, S. S. (2000). Living arrangements affect dietary quality for U.S. adults aged 50 years and older: NHANES III 1988–1994. Journal of Nutrition, 130, 2256–2264. de Jong-Gierveld, J., Kamphuis, F., & Dykstra, P. (1987). Old and lonely? Comprehensive Gerontology B, 1(1), 13–17. Gatz, M., Harris, J. R., & Turk-Charles, S. (1995). The meaning of health for older women. In A. L. Stanton, & S. J. Gallant (Eds.), The psychology of women’s health: Progress and challenges in research and application (pp. 491–529). Washington, DC: American Psychological Association. Hess, B., & Waring, J. (1983). Family relationships of older women: A women’s issue. In E. Markson (Ed.), Older women. Lexington, MA: Lexington Books.
Hoeffer, B. (1987). Predictors of life outlook of older single women. Research in Nursing & Health, 10(2), 111–117. Hooyman, N. R., & Kiyak, H. A. (1991). Social gerontology: A multidisciplinary perspective. Boston: Allyn and Bacon. Johnson, C. L., & Troll, L. (1992). Family functioning in late late life. Journals of Gerontology B, 47(2), S66–S72. Johnson, N. J., Backlund, E., Sorlie, P. D., & Loveless, C. A. (2000). Marital status and mortality: The national longitudinal mortality study. Annals of Epidemiology, 10(4), 224–238. Jones, C. (2000). Adoption: A study of post-war child removal in New South Wales. Journal of the Royal Australian Historical Society, 86, 51–64. Keating, N., & Jeffrey, B. (1983). Work careers of ever married and never married retired women. Gerontologist, 23(4), 416–421. Koenig, H. G., Westlund, R. E., George, L. K., Hughes, D. C., Blazer, D. G., & Hybels, C. (1993). Abbreviating the Duke Social Support Index for use in chronically ill elderly individuals. Psychosomatics, 34(1), 61–69. Koropeckyj-Cox, T. (1998). Loneliness and depression in middle and old age: Are the childless more vulnerable? Journal of Gerontology B Psychological Science and Social Science, 53(6), S303–S312. Lee, C., Dobson, A. J., Brown, W. J., Bryson, L., Byles, J., Warner-Smith, P., & Young, A. F. (2005). Cohort Profile: The Australian Longitudinal Study on Women’s Health. International Journal of Epidemiology, 34, 1093–1098. McCallum, J. (1995). The SF-36 in an Australian sample: Validating a new generic health status measure. Australian Journal of Public Health, 19, 160–166. National Center for Health Statistics. (2000). Nonmarital childbearing in the United States, 1940–99. NVSR, 48(16), 2001–2011. National Health and Medical Research Council. (2002). Australian alcohol guidelines: Health risks and benefits. Canberra, Australia: National Health and Medical Research Council. Pollock, S., & Duffy, M. (1990). The Health-Related Hardiness Scale: Development and psychometric analysis. Nursing Research, 39, 218–222. Roos, P. A. (1983). Marriage and women’s occupational attainment in cross-cultural perspective. American Sociological Review, 48(6), 852–864. Scheier, M., Carver, C., & Bridges, M. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the life orientation test. Journal of Personality and Social Psychology, 67, 1063–1078. Spurlock, J. (1990). Single women. In J. R. Spurlock, & C. B. Robinowitz (Eds.), Women in context: Development and stresses (pp. 23–33). NY: Plenum Press. Waldron, I., Hughes, M. E., & Brooks, T. L. (1996). Marriage protection and marriage selection: Prospective evidence for reciprocal effects of marital status and health. Social Science & Medicine, 43, 113–123. Wells, N., & Freer, C. (1988). Introduction. In N. Wells, & C. Freer (Eds.), The ageing population: Burden or challenge? (pp. xiii–xviii). Basingstoke, UK: Macmillan. Wenger, G. C. (2001). Ageing without children: Rural Wales. Journal of Cross-Cultural Gerontology, 16(1), 79–109. Wister, A. V., & Dykstra, P. A. (2000). Formal assistance among Dutch older adults: An examination of the gendered
ARTICLE IN PRESS J. Cwikel et al. / Social Science & Medicine 62 (2006) 1991–2001 nature of marital history. Canadian Journal on Aging, 19(4), 508–535. Wolf, D. A., Laditka, S. B., & Laditka, J. N. (2002). Patterns of active life among older women: Differences within and between groups. Journal of Women and Aging, 14(1–2), 9–26. Wu, Z., & Pollard, M. (1998). Social support among unmarried childless elderly persons. Journal of Gerontology B, 53, S324–S335.
2001
Young, A. F., Russell, A., & Powers, J. R. (2004). The sense of belonging to a neighbourhood: Can it be measured and is it related to health and well-being in older women? Social Science & Medicine, 59, 2627–2637. Zhang, Z., & Hayward, M. (2001). Childlessness and the psychological well-being of older persons. Journal of Gerontology B, 56, S311–S320.