Abstract
Objectives:
Adult children play a significant role in ageing parents’ health and well-being. However, the evidence is mixed regarding whether the parent-child relations will affect older adults’ longevity. This study aims to investigate the relationship between filial discrepancy and mortality risk.
Method:
Data were derived from a prospective cohort study from 2011 to 2017 of US Chinese older adults aged 60 and above in the greater Chicago area, with a median of follow-up of 5.28 years. Filial discrepancy was assessed by the gap between filial expectation and receipt, including six domains (discrepancy in respect, greet, care, obey, make happy, and financial support). Mortality ascertained during follow-up. Cox proportional hazards models were used.
Results:
Among 3,021 participants, care expectation was least fulfilled while financial expectation was better fulfilled compared with other filial discrepancy domains. Compared with no respect discrepancy, older adults with respect expectation above receipt had higher risk of mortality (HR, 1.44; 95%CI, 1.07-1.94). Older adults with higher greet expectation than receipt experienced greater risk of mortality (HR, 1.56; 95%CI, 1.16-2.09) than those with no greet discrepancy. Older adults with care receipt above expectation had lower risk of mortality (HR, 0.75; 95%CI, 0.56-1.00).
Conclusion:
This study extends the relative standards model to investigate mortality outcomes. The findings add new insights to the association between parent-child relations and mortality risk. It is suggested that educational programs should focus on fostering young immigrants’ attitude and behavior to provide more respect and greeting for aging parents to strengthen the family protection role.
Keywords: filial piety, intergenerational relations, survival rate
Introduction
Family provides an important context for aging and plays a key role in individuals’ health and mortality. According to Durkheim’s “family protection” thesis, family can protect individuals from death (Durkheim, 1951). This effect on mortality can vary based on the type of familial relationships as spouses and children had a greater effect on survival compared with other relatives (Birditt and Antonucci, 2008). Adult children are a source of satisfaction and pride as well as disappointment and anxiety for ageing parents providing further nuances to the effect of parent-child relationships (Birditt, Fingerman, & Zarit, 2010). Studies also suggested having a child may have an impact on longevity, such as an empirical study in Sweden which reported parents had lower mortality than childless individuals (Modig, Talbäck, Torssander, & Ahlbom, 2017).
Filial piety is the primary virtue in Confucianism and the backbone in the Chinese conception of family (Hwang, 1999; Simon, Chen, Chang, & Dong, 2014). It includes several obligations that the children owes their parents. For example, the child must obey and respect his or her parents, and support them in old age (Smith and Hung, 2012). The value of filial piety has greatly influenced the intergenerational relationship (Chaves, 2003). Chow (2001) indicated filial piety has three levels: The first level of filial piety includes providing parents with the necessary materials for the satisfaction of their physical needs and comforts. The second level of filial piety includes paying attention to parents’ wishes and obeying their preferences. The third level of filial piety includes behaving in such a way as to make parents happy and to bring them honor and the respect of the community. The intergenerational solidarity paradigm proposed six dimensions of intergenerational relations: structural, associational, functional, affectual, consensual and normative (Bengtson and Roberts, 1991; Guo, Stensland, Li, & Dong, 2019). Filial piety could be regarded as the normative aspect of intergenerational relationships.
Different aspects of intergenerational relationships were found to be associated with mortality risk of aging parents. A study in Los Angeles reported older adults who were widowed had reduced mortality risk when they had more affectionate relationships with adult children (Silverstein and Bengtson, 1991). Meanwhile, negative relations with children were also found to be associated with lower risk of mortality among older adults. Research indicated that individuals with chronic conditions who reported that their child is demanding had greater survival rates than individuals whose child is not demanding (Birditt and Antonucci, 2008). Some studies reported that greater negative relations with children were associated with improved survival of older adults while other studies found there was no significant association between parent-child relationship quality and mortality (Antonucci and Akiyama, 2007; Fingerman, Pitzer, Lefkowitz, Birditt, & Mroczek, 2008; Silverstein and Bengtson, 1991). However, less is known regarding whether the normative aspect of intergenerational solidarity will have an impact on mortality risk of older adults.
Filial expectation and receipt are the belief and practice of filial piety (Li and Dong, 2018). Filial discrepancy refers to the gap between filial expectation and filial receipt (Cheng and Chan, 2006). The relative standards model indicates that objective conditions are weakly correlated with well-being. Instead, individuals’ well-being is determined by the comparison of their standing in certain domains to relevant standards (Diener and Lucas, 2000). A discrepancy that entails an upward comparison (when the comparison standard is higher) could generate lower well-being (Diener and Lucas, 2000). Michalos’ multiple discrepancy theory further suggests the gap between what one has and wants was the most influential and the strongest determinant of individuals’ psychological well-being among various comparisons (Michalos, 1985). A considerable body of empirical research has documented the negative role of filial discrepancy in psychological well-being (Dong, Li, & Hua, 2017), while the relationship between discrepancy and mortality has not been fully explored. The present study seeks to address the limitation of existing empirical studies on parent-child relations and mortality by examining the normative aspect of intergenerational solidarity, and extend the relative standards model to investigate the relationship between filial discrepancy and mortality risk.
The older population is becoming more racially and ethnically diverse as the overall minority population in the US grows. Chinese American constitutes the largest Asian population in the US. Filial piety, one of the core values embedded in Chinese culture, requires adult children to take care of their ageing parents (Guo, Xu, Liu, Mao, & Chi, 2016; Li and Dong, 2018). A prior study reported that US Chinese older immigrants kept high filial expectations toward their children, while they perceived less filial receipt from children (Dong, Zhang, & Simon, 2014). It is not known whether the gap between filial expectation and receipt would affect the survival rate of older adults. To fill the research gap, this study aims to investigate the relationship between filial discrepancy and mortality among US Chinese older immigrants. According to the relative standards model and the multiple discrepancy theory, we hypothesized that older adults with higher filial expectation than receipt would have higher risk of mortality than those with no filial discrepancy.
Methods
Sample
Data were derived from the Population Study of Chinese Elderly (PINE) in the Greater Chicago area. In Chicago, only approximately 1.6% households contain a Chinese individual. The research team implemented a targeted community-based recruitment strategy by first engaging community centers, where Chinese people congregate, as the main recruitment sites throughout the Greater Chicago area (Dong, Wong, & Simon, 2014). Interviewers were trained by the investigative team through an in-depth orientation and training sessions. They underwent training on the research protocol, survey content, framing culturally relevant questions, and other interview skills. The eligibility criteria is older adults aged 60 and above living in the Greater Chicago area, and self-identified as Chinese. Guided by community-based participatory research approach, the baseline cohort of 3,157 community-dwelling older adults were interviewed in person in their preferred language by bilingual and bicultural interviewers between 2011 and 2013, which was about 50% of the total Chinese older adults in Chicago (Simon, Chang, Rajan, Welch, & Dong, 2014). Written informed consent was obtained from all participants and the study was approved by the institutional review board at Rush University Medical Center in Chicago, Illinois.
In this study, we only included older adults with at least one child in this study for the purpose to understand filial discrepancy. The working sample consisted of 3,021 older adults with a median follow-up of 5.28 years and 328 participants passed away during follow-up. We have 232 potential lost follow-up participants, which consisted of two groups of participants. The first group could not be contacted. These participants changed their telephone number, did not answer the telephone, or moved. The second group was reluctant participants. They did not want to participate in this study any more, or a family member did not allow them to participate.
Measures
Mortality ascertained during six years follow-up.
We obtained data on vital status of participants from informants and family members at regular subsequent contact. Study personnel regularly searched local newspapers and websites for obituaries.
Filial Piety.
We assessed six domains (care, respect, greet, happiness, obedience, and financial support) and two dimensions (expectation and receipt) of filial piety. In filial expectation, participants were asked how much care, respect, greet, happiness, obedience, and financial support they expected their children to provide in general. Similarly, in filial receipt, participants were asked how much care, respect, greet, happiness, obedience, and financial support they have actually received from their adult children in general. Participants indicated their answers using a five-point scale (1 = very little, 2 = rather little, 3 = average, 4 = rather a lot, and 5 = very much). The six-domain filial piety measures operationalized the three-level filial piety and have been validated among Chinese populations in different countries and societies (Liu, Ng, Weatherall, & Loong, 2000; Yue and Ng, 1999). The Cronbach’s alpha of filial piety scale in the present study was 0.88.
Filial Discrepancy.
We further constructed filial discrepancy by filial expectation and receipt. Filial discrepancy was a categorical variable with three categories: no filial discrepancy (i.e. filial expectation = receipt), filial expectation above receipt, and filial expectation below receipt. In line with the six domains in filial piety measure, filial discrepancy includes care discrepancy, respect discrepancy, greet discrepancy, make happy discrepancy, obey discrepancy, and financial support discrepancy.
Covariates.
Socio-demographic factors included age and sex (self-reported). Social economic status were measured by years of education and annual personal income. For annual personal income, we asked participants to include income from all sources such as wages, salaries, social security or retirement benefits, help from relative, rent from property, and so forth (1 = $0 - $4,999, 2 = $5,000 - $9,999, 3 = $10,000 - $14,999, 4 = $15,000 - $19,999, 5 = $20,000 - $24,999, 6 = $25,000 - $29,999, 7 = $30,000 - $34,999, 8 = $35,000 - $49,999, 9 = $50,000 - $74,999, and 10 = $75,000 and over).
Health-related factors consisted of physical and cognitive function, and mental health. A validated Chinese version of Mini-Mental State Examination (C-MMSE) was used to evaluate cognitive function (Yi and Vaupel, 2002). Physical function was assessed by Activities of Daily Living (ADL) (Katz and Akpom, 1976). We asked participants whether they need help with eating, dressing, bathing, walking, transferring, grooming, incontinence, and toileting (0 = None, 1 = Sometimes, 2 = A lot, and 3 = Most of the time). We summed up the eight items in ADL, with higher score indicating higher level of impairment. Depressive symptoms were measured by Patient Health Questionnaire-9 (PHQ-9) (American Psychiatric Association, 1994).
In Chinese families, spouse is the primary caregiver for older adults, even when the elderly couple lived with their adult children, and an adult child will assume the primary caregiver role when the spouse is not available (Li and Dai, 2019). In terms of social factors, we controlled marital status (1 = married, 0 = other status), living arrangement (the number of co-residents), years in the US and social support. Social support was assessed by asking the frequency of positive support (i.e. open up to and rely on) and negative strain (i.e. too much demand and being criticized) from partner, family, and friends. The answer was rated on a three-point Likert scale (1 = Hardly ever or never, 2 = Some of the time, and 3 = Often). We reversely coded negative strain, and summed up positive support and negative strain, with higher score in social support indicating higher frequency of positive support and lower frequency of negative strain from partner, family and friends.
Data Analysis
In this study, cox proportional hazard models were used to assess the relationship between filial discrepancy and mortality. In Model A, we included demographic variables (age and sex). Social economic variables (education and income) were added to Model B. In Model C, we added variables related to health (C-MMSE, ADL and depressive symptoms). In Model D, we added social factors (social support, marital status, living arrangement and years in the US). Hazard ratio (HR) and 95% confidence intervals (CIs) are reported. All analyses used 2-sided alternatives with a P value of less than 0.05 considered significant. All statistical analyses were conducted using the PROC PHREG procedure in SAS, version 9.4 (SAS Institute Inc., Cary, NC, USA).
Results
The baseline data shows the older adults in the study sample had a mean age of 72.86 years (SD = 8.29) and 58.0% were female. The majority of participants (79.3%) had equal or less than a high school education. Most of them (85.5%) had an annual income less than US $10,000. Participants had a mean ADL score of 0.38 (SD = 2.08), with scores ranging from 0–24. The mean of C-MMSE was 25.26 (SD = 4.70), ranging from 0 to 30. The mean of depressive symptoms was 2.60 (SD = 4.06), ranging from 0 to 27. The mean of social support was 30.79 (SD = 3.29), ranging from 18 to 36. 328 participants died within six years of follow-up.
Figure 1 shows care expectation was least fulfilled among the six filial piety domains, and 648 (21.7%) of older adults had care expectation above receipt, followed by make happy (expectation > receipt: n = 617, 20.5%), respect (expectation > receipt: n = 560, 18.6%), greet (expectation > receipt: n = 554, 18.4%), and obey (expectation > receipt: n = 546, 18.2%). Financial expectation was better fulfilled compared with other filial discrepancy domains. There were 1,240 (41.3%) older adults with financial receipt above expectation and 1,399 (46.6%) of older adults with financial receipt meeting their expectation.
Figure 1.
Distribution of Filial Discrepancy. Shown are the filial discrepancy distribution in respect, greet, care, obey, make happy and financial support at the baseline.
The association between filial discrepancy in respect, greet and care and mortality is shown in Table 1. Older adults with respect expectation above receipt had higher risk of mortality compared with those with no respect discrepancy (HR, 1.44; 95%CI, 1.07-1.94). Older adults with higher greet expectation than receipt had greater risk of mortality than those with no greet discrepancy (HR, 1.56; 95%CI, 1.16-2.09). Older adults with care expectation below receipt had lower risk of mortality than those with no care discrepancy (HR, 0.75; 95%CI, 0.56-1.00). The relationships between filial discrepancy in obey, make happy, and financial support and mortality are shown in Table 2.
Table 1.
Association of Discrepancy in Respect, Greet and Care and Overall Mortality.1
| HR (95% CI) | ||||
|---|---|---|---|---|
| Respect discrepancy | Model A | Model B | Mode C | Model D |
| Age | 1.13 (1.12-1.15)*** | 1.13 (1.11-1.15)*** | 1.12 (1.10-1.13)*** | 1.11 (1.09-1.13)*** |
| Female | 0.52 (0.42-0.65)*** | 0.48 (0.38-0.61)*** | 0.43 (0.33-0.55)*** | 0.45 (0.34-0.59)*** |
| Education | — | 0.98 (0.96-1.00) | 1.00 (0.97-1.02) | 1.00 (0.97-1.03) |
| Income | — | 1.00 (0.87-1.14) | 0.98 (0.86-1.13) | 0.88 (0.75-1.03) |
| C-MMSE | — | — | 0.87 (0.77-0.97)* | 0.83 (0.73-0.94)** |
| ADL | — | — | 1.08 (1.04-1.11)*** | 1.07 (1.04-1.11)*** |
| Depressive symptoms | — | — | 1.01 (0.99-1.04) | 1.02 (0.99-1.05) |
| Social support | — | — | — | 1.00 (0.96-1.04) |
| Marital status | — | — | — | 1.18 (0.85-1.63) |
| Living Arrangement | — | — | — | 1.00 (0.93-1.08) |
| Years in the US | — | — | — | 1.02 (1.01-1.03)*** |
| Respect expectation = receipt | Reference | Reference | Reference | Reference |
| Respect expectation < receipt | 0.85 (0.63-1.14) | 0.85 (0.63-1.15) | 0.76 (0.55-1.04) | 0.78 (0.57-1.07) |
| Respect expectation > receipt | 1.57 (1.20-2.04)*** | 1.52 (1.16-1.99)** | 1.47 (1.11-1.96)** | 1.44 (1.07-1.94)* |
| Greet discrepancy | Model A | Model B | Mode C | Model D |
| Age | 1.14 (1.12-1.15)*** | 1.13 (1.11-1.15)*** | 1.12 (1.10-1.14)*** | 1.11 (1.09-1.13)*** |
| Female | 0.51 (0.41-0.64)*** | 0.47 (0.38-0.60)*** | 0.43 (0.34-0.55)*** | 0.45 (0.34-0.60)*** |
| Education | — | 0.98 (0.96-1.00) | 1.00 (0.97-1.02) | 1.00 (0.97-1.03) |
| Income | — | 1.00 (0.87-1.14) | 0.99 (0.86-1.13) | 0.88 (0.75-1.04) |
| C-MMSE | — | — | 0.87 (0.77-0.98)* | 0.83 (0.74-0.94)** |
| ADL | — | — | 1.08 (1.04-1.11)*** | 1.07 (1.04-1.11)*** |
| Depressive symptoms | — | — | 1.01 (0.98-1.04) | 1.02 (0.99-1.04) |
| Social support | — | — | — | 1.00 (0.96-1.04) |
| Marital status | — | — | — | 1.19 (0.86-1.65) |
| Living Arrangement | — | — | — | 1.01 (0.93-1.09) |
| Years in the US | — | — | — | 1.02 (1.01-1.03)*** |
| Greet expectation = receipt | Reference | Reference | Reference | Reference |
| Greet expectation < receipt | 0.76 (0.57-1.02) | 0.81 (0.61-1.09) | 0.77 (0.56-1.04) | 0.78 (0.58-1.07) |
| Greet expectation > receipt | 1.63 (1.25-2.11)*** | 1.71 (1.31-2.23)*** | 1.64 (1.23-2.17)*** | 1.56 (1.16-2.09)** |
| Care discrepancy | Model A | Model B | Model C | Model D |
| Age | 1.13 (1.12-1.15)*** | 1.13 (1.11-1.15)*** | 1.11 (1.10-1.13)*** | 1.11 (1.09-1.13)*** |
| Female | 0.50 (0.40-0.63)*** | 0.47 (0.37-0.60)*** | 0.42 (0.32-0.54)*** | 0.44 (0.33-0.58)*** |
| Education | — | 0.98 (0.96-1.01) | 1.00 (0.97-1.02) | 1.00 (0.97-1.03) |
| Income | — | 1.00 (0.88-1.14) | 0.99 (0.86-1.13) | 0.88 (0.75-1.03) |
| C-MMSE | — | — | 0.87 (0.77-0.98)* | 0.83 (0.74-0.94)** |
| ADL | — | — | 1.08 (1.04-1.12)*** | 1.07 (1.04-1.11)*** |
| Depressive symptoms | — | — | 1.02 (0.99-1.05) | 1.02 (0.99-1.05) |
| Social support | — | — | — | 0.99 (0.95-1.03) |
| Marital status | — | — | — | 1.22 (0.88-1.69) |
| Living Arrangement | — | — | — | 1.00 (0.93-1.08) |
| Years in the US | — | — | — | 1.02 (1.01-1.03)*** |
| Care expectation = receipt | Reference | Reference | Reference | Reference |
| Care expectation < receipt | 0.72 (0.55-0.95)* | 0.76 (0.57-1.00)* | 0.73 (0.55-0.98)* | 0.75 (0.56-1.00)* |
| Care expectation > receipt | 1.10 (0.84-1.44) | 1.11 (0.84-1.45) | 1.05 (0.79-1.40) | 0.98 (0.73-1.32) |
Note. 1Association between discrepancy in respect, greet and care and mortality risk occurs during the six years of follow-up, with no filial discrepancy as reference. HR = Hazard ratio; CI = Confidence interval.
p<.05,
p<.01,
p<.001
Table 2.
Association of Discrepancy in Obey, Make Happy and Financial Support and Overall Mortality.1
| HR (95% CI) | ||||
|---|---|---|---|---|
| Obey discrepancy | Model A | Model B | Model C | Model D |
| Age | 1.13 (1.12-1.15)*** | 1.13 (1.11-1.14)*** | 1.11 (1.09-1.13)*** | 1.10 (1.08-1.12)*** |
| Female | 0.50 (0.40-0.63)*** | 0.46 (0.37-0.59)*** | 0.41 (0.32-0.53)*** | 0.43 (0.33-0.58)*** |
| Education | — | 0.98 (0.96-1.00) | 1.00 (0.97-1.02) | 1.00 (0.97-1.03) |
| Income | — | 1.00 (0.88-1.14) | 0.99 (0.86-1.13) | 0.88 (0.75-1.03) |
| C-MMSE | — | — | 0.86 (0.76-0.97)** | 0.83 (0.73-0.93)** |
| ADL | — | — | 1.08 (1.04-1.11)*** | 1.07 (1.03-1.11)*** |
| Depressive symptoms | — | — | 1.02 (0.99-1.05) | 1.02 (0.99-1.05) |
| Social support | — | — | — | 0.99 (0.95-1.03) |
| Marital status | — | — | — | 1.24 (0.89-1.71) |
| Living Arrangement | — | — | — | 1.00 (0.93-1.08) |
| Years in the US | — | — | — | 1.02 (1.01-1.03)*** |
| Obey expectation = receipt | Reference | Reference | Reference | Reference |
| Obey expectation < receipt | 0.86 (0.65-1.13) | 0.91 (0.69-1.21) | 0.91 (0.67-1.22) | 0.90 (0.67-1.21) |
| Obey expectation > receipt | 1.04 (0.77-1.40) | 1.08 (0.80-1.46) | 1.04 (0.75-1.43) | 1.00 (0.72-1.38) |
| Make happy discrepancy | Model A | Model B | Model C | Model D |
| Age | 1.13 (1.12-1.15)*** | 1.13 (1.11-1.15)*** | 1.11 (1.10-1.13)*** | 1.11 (1.09-1.13)*** |
| Female | 0.51 (0.41-0.64)*** | 0.47 (0.37-0.60)*** | 0.42 (0.33-0.54)*** | 0.44 (0.33-0.59)*** |
| Education | — | 0.98 (0.96-1.00) | 1.00 (0.97-1.02) | 1.00 (0.97-1.03) |
| Income | — | 1.00 (0.88-1.14) | 0.98 (0.86-1.13) | 0.88 (0.75-1.03) |
| C-MMSE | — | — | 0.86 (0.77-0.97)* | 0.83 (0.73-0.93)** |
| ADL | — | — | 1.08 (1.04-1.11)*** | 1.07 (1.04-1.11)*** |
| Depressive symptoms | — | — | 1.02 (0.99-1.04) | 1.02 (0.99-1.05) |
| Social support | — | — | — | 0.99 (0.95-1.03) |
| Marital status | — | — | — | 1.21 (0.88-1.68) |
| Living Arrangement | — | — | — | 1.00 (0.93-1.08) |
| Years in the US | — | — | — | 1.02 (1.01-1.03)*** |
| Make happy expectation = receipt | Reference | Reference | Reference | Reference |
| Make happy expectation < receipt | 0.87 (0.64-1.17) | 0.92 (0.67-1.24) | 0.82 (0.59-1.14) | 0.84 (0.61-1.16) |
| Make happy expectation > receipt | 1.27 (0.97-1.65) | 1.30 (0.99-1.70) | 1.22 (0.92-1.62) | 1.16 (0.86-1.56) |
| Financial support discrepancy | Model A | Model B | Model C | Model D |
| Age | 1.13 (1.12-1.15)*** | 1.13 (1.11-1.15)*** | 1.11 (1.10-1.13)*** | 1.11 (1.09-1.13)*** |
| Female | 0.52 (0.41-0.64)*** | 0.48 (0.38-0.60)*** | 0.42 (0.33-0.54)*** | 0.44 (0.33-0.59)*** |
| Education | — | 0.98 (0.96-1.00) | 1.00 (0.97-1.02) | 1.00 (0.97-1.03) |
| Income | — | 1.00 (0.88-1.14) | 0.99 (0.86-1.14) | 0.89 (0.76-1.04) |
| C-MMSE | — | — | 0.87 (0.77-0.98)* | 0.83 (0.73-0.93)** |
| ADL | — | — | 1.08 (1.04-1.11)*** | 1.07 (1.03-1.11)*** |
| Depressive symptoms | — | — | — | 1.02 (0.99-1.05) |
| Social support | — | — | — | 0.99 (0.95-1.03) |
| Marital status | — | — | — | 1.22 (0.88-1.69) |
| Living Arrangement | — | — | — | 1.00 (0.93-1.08) |
| Years in the US | — | — | — | 1.02 (1.01-1.03)*** |
| Financial support expectation = receipt | Reference | Reference | Reference | Reference |
| Financial support expectation < receipt | 0.91 (0.72-1.15) | 0.92 (0.72-1.17) | 0.92 (0.71-1.19) | 0.96 (0.74-1.24) |
| Financial support expectation > receipt | 1.29 (0.91-1.81) | 1.31 (0.93-1.85) | 1.29 (0.90-1.85) | 1.25 (0.87-1.81) |
Note. 1Association between discrepancy in obey, make happy and financial support and mortality occurs during the six years of follow-up, with no filial discrepancy as reference. HR = Hazard ratio; CI = Confidence interval.
p<.05,
p<.01,
p<.001
Discussion
This study shed light on the relationship between intergenerational relations and mortality risk of older adults by understanding the impact of the gap between filial expectation and receipt of older adults. We compared the morality risk of US Chinese older adults in three groups (no filial discrepancy, filial expectation above receipt, and filial expectation below receipt) over six years, and our hypothesis was partially supported.
More filial expectation than receipt in respect and greet was associated with higher mortality risk, while more filial receipt than expectation in care was associated with lower mortality risk. Filial discrepancy in obey, make happy, and financial support had no significant relationships with mortality risk. The findings showed that US Chinese older adults emphasized filial obligation in respect, greet and care. According to Chow’s three levels of filial piety framework (Chow, 2001), the first and second levels of filial piety play an important role in US Chinese older immigrants.
Greeting was a typical practice of filial piety and a way of expressing gratitude to ageing parents (Mao and Chi, 2011). Respect for parents is concerned with both inner disposition and external behavior (Sung, 2001). Listening to parents when they talk is regarded as a traditional form of elder respect while consulting ageing parents has become a more prevalent form of elder respect (Ingersoll-Dayton and Saengtienchai, 1999; Sung, 2001). The educational programs should focus on fostering children’s filial belief and behavior in intergenerational interactions, such as greeting, listening, and seeking advice from parents to improve the protection role of family for vulnerable members.
This study found that the normative aspect of intergenerational solidarity could influence mortality risk. In addition, the relative standards model and empirical studies indicated an upward comparison (when the comparison standard is higher) would generate lower level of psychological well-being (Diener and Lucas, 2000; Dong, et al., 2017). The present study extended the relative standards model by exploring the impact of the discrepancy in what one has and wants on mortality outcomes. It is suggested that social service on promoting US Chinese older immigrants’ health could be aware of older adults with higher expectation than receipt in respect and greet.
The findings of this study should be interpreted with cautious. First, our study examined a representative sample of Chinese older immigrants living in the greater Chicago area. The findings may not be generalizable to Chinese elderly in other geographic areas. Second, this study used time-invariant covariates in cox proportional hazards models. However, physical, mental and cognitive health of participants could change during follow-up. Future study could use time-varying covariates in cox proportional hazards models to strengthen the causal relationship between filial discrepancy and mortality. Third, quantitative data were limited in providing information on filial discrepancy experiences of older adults. Future qualitative study is needed to comprehensively understand the filial discrepancy experiences and explore how filial discrepancy impacts mortality risk of older immigrants.
Despite these limitations, our study advanced knowledge regarding the relationship between intergenerational solidarity and mortality risk by investigating the normative aspect, and extended the relative standards model and multiple discrepancy theory by examining mortality outcomes. Through comparing the trajectories of survival rate among three filial discrepancy groups in respect, greet, care, obey, make happy and financial support, our study depicted a more complete picture of how the gap between filial expectation and receipt would affect the longevity of US Chinese older adults. Although this study targeted Chinese older immigrants in Chicago, the findings are relevant to immigrant older adults and families from East Asian countries who share the value of filial piety.
This study has important practical implications for social and health care services/policies focusing on US Chinese older adults. It is suggested that social service agency could take a culturally relevant approach to provide services for US Chinese older immigrants. Understanding the negative impact of filial discrepancy, particularly filial expectation above receipt in respect and greet, on mortality outcome might be of special importance for adult children and should be taken into account by service providers and program planners. The findings may inform social services on US Chinese older adults to reduce mortality risk through reducing filial discrepancy. On the other hand, higher filial receipt than expect in care was a protective factor showing intergenerational care still matters for aging parents, which suggest Chinese immigrant families should maintain filial piety belief and practice, and continue providing care to protect older family members to promote their health and well-being.
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