The numbers of oldest-old aged 80 years and above who will most likely need care in daily life and health services will climb from nearly 20 million in 2010 to about 120 million in 2050 in China (1). However, little is known about the oldest-old in most developing countries including China (Supplementary Materials). To fill in this knowledge gap for scientific studies and policymaking, this paper presents easily understandable analyses of gender differentials in familial status, socioeconomics, activities of daily living (ADL), physical performance, cognitive functions, self-reported health, and life satisfaction among the oldest-old aged 80 years and above in China. The definitions of the measurements of the activities of daily living, physical performance, self-reported health, and life satisfaction are described in “measurements of the health statuses” of Supplementary Materials.
The Chinese Longitudinal Healthy Longevity Study (CLHLS) was conducted in 1998–2018 and purposefully over-sampled the oldest-old aged 80 years and above, plus a compatible sub-sample of younger-old aged 60–79. We use the datasets of oldest-old aged 80 years and above collected in 1998, 2008–2009, and 2017–2018 waves of CLHLS in the present study to perform meaningful comparative analyses on gender differences in the 3 periods (each roughly 10 years apart) from 1998 to 2018. The included sample sizes were 8,805 oldest-old in the 1998 wave, 12,281 oldest-old in the 2008–2009 wave, and 10,437 oldest-old in the 2017–2018 wave. P values vary among different 5-year-old age groups and periods. In total, there are 210 P values in Figures 1–4 that are available upon request to the author.Figure 1. Gender differences in familial status among the oldest-old in China, 1998–2018. (A) Percentage of marital statuses among the oldest-old; (B) Percentage of living arrangements among the oldest-old.Figure 2. Gender differences in socioeconomic statuses among the oldest-old in China, 1998–2018. (A) Percent of illiterate among the oldest-old. (B) Percent of pension receivers among the oldest-old. (C) Percent of the oldest-old who mainly rely on children for financial support. (D) Percent of the oldest-old whose primary caregivers were children.Figure 3. Gender differences in functional capacities among the oldest-old in China, 1998–2018. (A) Percent of the oldest-old who were active in activities of daily living (ADL). (B) Percent of the oldest-old who could stand-up from a chair without using their hands. (C) Percent of the oldest-old who could pick-up a book on the floor from standing position. (D) Percent of the oldest-old whose cognitive functional capacity is good.Figure 4. Gender differences in self-reported health and life satisfaction among the oldest-old in China, 1998–2018. (A) Percent of the oldest-old who self-reported “good health”. (B) Percent of the oldest-old who self-reported “good life satisfaction”.
As shown in Figure 1A, the proportion of female oldest-old who were married was lower than their male counterparts. However, the overwhelming majority were widowed, especially the oldest-old women: 66%–98% of female oldest-old were widows, which was much higher than male oldest-old. The proportions of never-married and divorced male and female oldest-old were extremely low.
Figure 1B presented sex-age-specific percentage distributions of living with spouse and/or children (including children, grandchildren, and other family members), and those living alone. The overwhelming majority of Chinese oldest-old lived with spouses and/or children: 68%–90% for females, 80%–89% for males. Female oldest-old were less likely live with spouse/children up to ages 90–94, and the proportion of oldest-old women who lived alone were higher than the oldest-old men up to ages 90–94.
Figure 2A indicated that about 66%–93% of female oldest-old were illiterate with no schooling, in contrast to 29%–58% of their male counterparts. Many Chinese oldest-old women were found to be illiterate, and females were significantly disadvantaged.
Figure 2B indicated that percent of pension receivers among Chinese female oldest-old were much lower than their male counterparts. The majority of the Chinese oldest-old rely mainly on their children for financial support, and the gender differentials in primary source of financial supports were enormous: oldest-old women rely on their children much more than oldest-old men (Figure 2C).
About 48%–89% of oldest-old men’s primary caregivers were their children, in contrast to 75%–92% of their female counterparts (Figure 2D). The female oldest-old in China relied more on their children as caregivers, as compared to male oldest-old whose primary caregivers were more likely their spouse. This was consistent with a much higher proportion of widowhood existing in female oldest-old than in male oldest-old. Children were often the primary resource of financial support of the oldest-old and also the primary resource of caregiving when the oldest-old were sick.
As shown in Figure 3A, percent of activities of ADL active status declined quickly after age 80, especially after age 85–89. The curve of females who were ADL active was substantially lower than the male curve after age 80–84. The oldest-old women were substantially less active than the oldest-old men in daily living.
Figure 3B indicated that about 80%–88% and 77%–85% of male and female oldest-old aged 80–85, respectively, could stand-up from a chair without using their hands; but the percent decreased quickly after age 85–89. About 38%–53% male centenarians could stand-up from a chair without using their hands, compared to 27%–37% female centenarians. Female oldest-old persons’ capacities to perform picking-up a book on the floor from standing position were significantly worse than their male counterparts (Figure 3C). Male oldest-old physically performed better than female oldest-old did, and the gender gap became larger after age 90–94.
Figure 3D demonstrates that percent of good cognitive function among the Chinese oldest-old declined quickly with increase of age. The Chinese female oldest-old persons’ cognitive capacity was much worse than their male counterparts, and the gender gaps were remarkably large.
As shown in Figure 4A, about 40%–62% of the male oldest-old reported “good health” in contrast to the corresponding percentages of 34%–59% of the female oldest-old. The percentages of self-reported good health among Chinese oldest-old declined slightly from age 80–84 to age 100–105, and even slightly increased from ages 95–99 to ages 100–105 in 2008–2009 and 2017–2018, respectively among females at these very advanced ages. Such pattern of age variations differed from the age patterns of ADL, physical performance, and mini-mental state examination (MMSE). Figure 4D presented the results of self-reported good life satisfaction, which showed that gender differences in self-reporting good life satisfaction among Chinese oldest-old were mostly negligible in 1998, 2008–2009, and 2017–2018.