Background: The number of older people living alone is increasing due to dramatic population ageing and changes in living arrangements. Little is known about older people living alone in Mainland China and their quality of life (QoL) where collectivism and filial responsibility are emphasised. Aims: This study aimed to explore the health status, life circumstances and QoL of older people living alone in Chongming, Shanghai. Methods: A cross-sectional survey of a stratified random cluster sample of 521 community-dwelling older people aged 60 years and above and living alone was conducted in Chongming, Shanghai. The structured questionnaire included validated measures to assess the health status, loneliness, social support, physical activity, health services utilisation and satisfaction, housing and QoL. Results: Over two fifths of the participants rated their health as good despite 44.5% reporting chronic diseases and 47.6% reporting being depressed. Most participants reported a high level of functional ability and were satisfied with their health services and overall dwelling conditions. However, over four fifths of the participants reported moderate/moderately high levels of loneliness. The social support mean score was 30.5, lower than the Chinese population norm. The participants’ health status, loneliness, social support, physical activity, health services satisfaction and satisfaction with overall dwelling conditions varied across the sample. Over two fifths of the participants perceived their QoL as good. Satisfaction with overall dwelling conditions, self-rated health, functional ability, depression, economic level, social support, loneliness, occupation and satisfaction with health services were predictors of QoL accounting for 68.8% of the variance. Additionally, depression and occupation had an interaction effect upon QoL. Conclusions: Older people living alone in Chongming, Shanghai are a disadvantaged heterogeneous group who need special attention. The proposed QoL model provides the basis for further enquiry regarding the needs of different sub-groups and future policy interventions.

As China has the largest and one of the fastest growing aging populations, health status and its disparity among the elderly has become one of the most challenging issues in the coming decade. The traditional family care system for the elder! y has been weakened since the 1980s and at the same time the current social security provision for the elderly remains extremely underfunded, underdeveloped and unevenly distributed geographically. This study seeks to understand to what extent different demographic, socioeconomic factors, social security provision and access, social contexts and geography effects are responsible to explain differential health outcomes and mortality among the elderly. The results of the study have great policy implications for the well-being of the vulnerable elderly population and China's on-going social security reforms. The empirical analysis mainly uses the Chinese Longitudinal Healthy Longevity Survey (2008/2002-2008) and employs multilevel statistical approaches to analyse variations of Self-Rated Health (SRH) and mortality for the elderly at both the individual and province levels simultaneously. Results indicate that individual characteristics (demographic and socioeconomic status), social security sources and social context (income inequality) bring out different consequences on the health outcome and mortality of the elderly. To be more specific, males have better health than females, but a lower survival rate than females; family and state play different roles on the SRH and mortality of the elderly in the form of financial resources and as medical expense bearers; income inequality has a positive effect on the elderly with poor health, but a negative effect on the risk of mortality of the elderly with poor health. No significant differences are found for urban-rural residence and schooling in this study. Substantial province level differences exist on the health outcomes of the elderly.

China is fast becoming an ageing society and this is raising important issues for public health. This study employs nationally representative datasets, the China General Social Surveys and the China Health and Retirement Longitudinal Study, to investigate the relationship between different health outcomes and social capital among older people in China (45 and over). First, the analysis uses binary logistic regression to confirm a significant positive association between subjective measures of individual health and wellbeing and individual-level social capital (measured by social trust, social interaction and membership of organisations and social groups). Second, the analysis combines Difference-In-Difference and Propensity Score Matching to simulate a quasi-experiment designed to identify the causal relationship between social capital and objective health (measured by cognitive function, mental health and physical health). Third, the analysis uses a multilevel modelling strategy to investigate the interrelationships between income inequality, community-level social capital, individual-level social capital and health outcomes. This part of the analysis finds evidence that social capital at the community-level can reduce to some extent the negative association between income inequality and health. Together, the results provide new evidence of the relationship between health, social capital and the distribution of household wealth among older people in China.