The Association between Intergenerational Support and Self-Rated Health among Chinese Older Adults: Do Resilience and Gender Matter?

Abstract

This study aims to examine the association between intergenerational support and self-rated health (SRH) levels using data collected from Chinese older adults residing in Honolulu, United States (N = 329). We also investigated the mediating role of resilience and the moderating role of gender in the association. We found that receiving emotional support was significantly and positively associated with better SRH for the whole sample. The positive effect of receiving emotional support on health was significant among older women only. In contrast, the beneficial effect of providing economic support on health was significant among older men only. We found that resilience significantly mediated the positive effect of received emotional support on SRH, and this effect was found for the whole sample and among older women. However, resilience did not mediate the positive effect of the economic support provided on SRH among older men.

Keywords

intergenerational support resilience self-rated health Chinese older adults

Introduction and Background

Approximately 5.4 million Chinese live in the U.S. in 2020, with more than 13% above 65 years old (U.S. Census Bureau, 2021). With an increase in life expectancy and the aging population, it is important to examine whether older Chinese individuals can live healthy lives in the U.S. It is essential to consider the impact of psychosocial factors, such as intergenerational support, which is closely related to Chinese family-oriented values and the filial piety culture, when examining the health status of Chinese older adults (Chen & Silverstein, 2000).

Intergenerational Support and Self-Rated Health

Chinese families are greatly influenced by the filial piety culture. The traditional filial piety norm emphasized that adult children should support and care for their aging parents to fulfill their filial duties (Dong & Zhang, 2016). In the modern era, the filial piety norm also emphasizes the interdependence among generations (Smith & Hung, 2012). Empirical studies have found that intergenerational support benefits the health and well-being of Chinese older adults, although the effects might vary among the types of support (Chen & Silverstein, 2000; Liu et al., 2019; Silverstein et al., 2006).

Although many Chinese older adults in the U.S. still follow the traditional family-oriented culture and filial piety norms, they are also strongly influenced by the U.S. culture when acculturated to American society (Wu et al., 2005). The cultural norm in the U.S. emphasizes independence, especially economic independence among generations (Zhang et al., 2018), which largely contradicts the Chinese cultural norm that emphasizes the interdependence among family members. Apart from the cultural norm, a fully-developed pension system and health care coverage in the U.S. has enabled older adults to become “self-sufficient” (Wu et al., 2005). Consequently, older family members in the U.S. are self-reliant or depend on their spouses to take care of daily activities instead of receiving support from adult children. However, many Chinese older adults tend to immigrate to the U.S. in their later life and have never been employed by the U.S. labor market (Dong, Chen, et al., 2014). These older adults without social security benefits and no employment pension may still rely on the economic support from their adult children.

The impact of intergenerational support on self-rated health (SRH) of Chinese older adults in the U.S. has yet to be determined. On the one hand, intergenerational support may exhibit a significant effect on SRH for Chinese older adults who value and maintain traditional Chinese family relationships in the U.S. since mutual support among family members is endorsed by the filial piety culture (Liu et al., 2019). On the other hand, the effect of intergenerational support may be diminished among older adults who were more acculturated into the U.S. culture that values independence among family members. Therefore, we attempt to examine the impact of intergenerational support on SRH among Chinese older adults living in the U.S. cultural contexts.

Mediating Role of Resilience

Very few studies examined the possible mediating role of resilience, an important quality that allows individuals to thrive from adversities (Connor & Davidson, 2003), in linking intergenerational support and health outcomes. Resilience refers to an individual’s ability to recover strength and spirit when confronted with adversity and to adapt positively to stressful conditions (Connor & Davidson, 2003; Luthar et al., 2000). In terms of resilience among older adults, it refers to the process in which an older adult continues to pursue a better quality of life and better health conditions as well as to cope with adversity beyond physical, psychological, or cognitive challenges through protective factors that influence coping, self-esteem, and hardiness (Hicks & Conner, 2014). Protective factors are perceived to lessen the vulnerability of older adults to the negative effect of adversities in later life, such as illness and functional decline. Previous studies suggest that social support is a significant protective factor associated with both coping (Harris, 2008) and hardiness attributes (Dorfman et al., 2009) of resilience among older adults. A supportive network serves as an antecedent that cultivates and enhances older adults coping resources to reverse and prevent age-related threats (Hicks & Conner, 2014). At the same time, the support provided by others might instill a sense of control, which is another important component of hardiness (Pengilly & Dowd, 2000) that helps older adults to better endure or recover from hardships. Due to the filial piety culture and familism beliefs among the Chinese, social support from family members may be one of the primary support resources that older adults rely on to maintain their resilience and cope with adversities. Therefore, intergenerational support may enhance the resilience of Chinese older adults and keep them healthy.

Some empirical findings from China may shed light on our understanding of this potential pathway. A significant pathway from family support to quality of life through enhanced resilience and coping skills among older adults living with HIV/AIDS was found in Nanning, China (Xu et al., 2018). Resilience was found to partially mediate the relationship between family function and quality of life among 474 community-dwelling older adults in Guangzhou (Lu et al., 2017). A study in Taiwan revealed that the positive association between family-related engagement and SRH was significantly mediated by resilience (Wang et al., 2019). These findings indicate that resilience could be one of the potential mechanisms linking intergenerational support and SRH among Chinese older adults.

Moderating Role of Gender

This traditional gender division of household labor may influence the types of support that older adults provide. In a typical household, the father provides economic support, while the mother is more likely to provide emotional support and perform household chores (Ha et al., 2006; Kan & Hertog, 2017). Previous studies conducted in China have already found gender differences in family roles may lead to a gendered pattern of intergenerational support and may further affect the general health status of older adults (Li et al., 2009; Lu et al., 2017). The overseas Chinese communities are strongly influenced by the culture of Chinese immigrants (Ng et al., 2002). Filial piety is still commonly expected and practiced among the Chinese communities in the U.S. (Dong, Zhang, & Simon, 2014). Therefore, gender-based differences in intergenerational support may also exist among Chinese older adults in the U.S.

There are also gender disparities in the socioeconomic status and health outcomes among Chinese older adults. Empirical studies revealed that older Chinese women in the U.S. reported worse physical health and cognitive functioning, as well as, a higher risk of loneliness, stress, depression, and anxiety (Dong, Chen, et al., 2014; Dong, Chen, & Simon, 2014; Simon et al., 2014; Zhang, 2006; Zhang et al., 2014). Additionally, older women reported a significantly higher illiteracy rate than older men since women have been historically denied access to educational resources in Chinese society (Zeng et al., 2003). According to the Reserve Capacity Model, there may be a stronger relationship between individual psychological resources and health status among individuals with low social resources (e.g., low SES) due to limited access to tangible resources to cope with stressors throughout the life course (Gallo et al., 2009). Along this line, socially disadvantaged female older adults in the U.S. may be more likely to rely on personal psychological resources, such as resilience, to cope with stressors and maintain their well-being (Wu et al., 2020). Therefore, we speculate that resilience is more strongly associated with SRH in older women than in older men.

Taken together, in this study, we examined the relationship between intergenerational support and SRH among Chinese older adults residing in the U.S. We also investigated the mediating role of resilience and the moderating role of gender.

Methods

Data

We collected data from individuals in Honolulu, Hawaiʻi. The inclusion criteria for the survey participants consisted of Honolulu residents, who were 55 years or older and self-identified as Chinese (both foreign-born immigrants and native-born Chinese Americans were included). Snowball sampling and convenient sampling were the primary approaches to recruit participants. Key informants were recruited from local Chinese groups, social organizations, local businesses, and faith-based agencies. The identification of key informants was based on their ability to access Chinese communities. Key informants and research team distributed and collected questionnaires from participants. Due to varying levels of English proficiency, English and Chinese versions of the questionnaires were distributed. Oral informed consent was obtained from participants before they filled out the questionnaires. From January 2018 to September 2018, we successfully collected data from 430 older Chinese older adults aged 55 years and above in Honolulu, Hawaiʻi. We excluded older adults who had no children alive (N = 93) since it is challenging to study intergenerational support for this group. The final analytical sample consists of 329 older adults after deleting random missing data.

Measures

Dependent variables: SRH was evaluated based on the subjective rating of the general health status of the respondents (from 1 = very good to 5 = very poor). We converted this variable into a three-category variable where “1 = Poor/Very Poor,” “2 = Fair,” and “3 = Very good/Good.”

Independent variables: A total of six individual items on intergenerational support were used as independent variables in data analyses. Specifically, intergenerational support was assessed by the frequency (1 = never, 2 = seldom, 3 = sometimes, 4 = often, and 5 = very often) of providing or receiving (1) economic support, (2) housework support, and (3) emotional support to/from adult children in the past 12 months.

Mediating and moderating variables: Resilience was measured by the Connor-Davidson Resilience scale (CD-RISC), which comprised 25 items, such as (1) I am able to adapt to change, (2) I tend to bounce back after illness or hardship, and (3) I have a close and secure relationship. Each item was rated on a five-point scale (0–5), with higher scores representing greater resilience. A composite score was evaluated by averaging the score of the 25 items of resilience and used as a mediating variable in the analysis (Alpha reliability = 0.94). Gender (male = 1) was used as a moderator in this study.

The control variables included age (in years), education (in years), employment status (currently employed = 1), income (three categories: annual income is below 32,500 dollars, annual income is between 32,500 to 99,999 dollars, and annual income is above 99,999 dollars), marital status (currently married/partnered= 1), living arrangement (living with adult children = 1), birthplace (U.S. born = 1), number of children (currently alive), smoking behavior (never smoke = 1), drinking behavior (0 times a week = 1) and the number of chronic diseases.

Analysis

Descriptive statistics are presented in Table 1. The results of the independent-samples t-test and the chi-squared test examining differences in focal variables by gender are also presented in Table 1. To examine the main effect of intergenerational support on SRH and the moderating effect of gender, two ordered logistic regression models were constructed, and the results are summarized in Table 2. Model 1 tested the main effect of each intergenerational support item on SRH while controlling for socioeconomic factors and physical health indicators. Model 2 added six interaction terms between each intergenerational support item and gender (male was the dummy variable) to test the moderating effect of gender. The results of the ordered logistic regression models that examined the mediating effect of resilience are summarized in Table 3. Model 1 summarized the total effect of each intergenerational support item on SRH. Model 2 added resilience to test its mediating effect. We used the Judd and Kenny (1981) Difference of Coefficients approach to calculate the indirect effect. The indirect effect was the difference between the simple regression coefficient obtained from model 1 and the partial regression coefficient obtained from model 2 (Judd & Kenny, 1981). The ordered logistic regression models that examined the mediating role of resilience in different gender groups are also presented in Table 3. Model 1b and Model 2b tested the mediating role of resilience among older men. Model 2c and Model 2c tested the mediating role of resilience among older women. The indirect effects are summarized in Table 4. We then applied the bootstrap method (with 1000 randomly generated bootstrap samples of indirect effect) to test the significance of the indirect effect. The results, including the parameter estimates, bootstrap standard error, and the 95% percentile confidence interval (CI), are also summarized in Table 4. Percentile CI is preferable over normal-based CI since it provides more details about parameter estimates, including precision, and statistical significance, without the need for normality assumptions (Efron, 1987). For each ordered logistic regression we constructed, we used the Wald test to examine whether the model violated the proportional odds assumption. These results were used to determine whether ordered logistic models are appropriate to use.

Table 1.

Sample Characteristics by Gender.

	Whole Sample	Males	Females	GD
	N = 329	N = 131	N = 198	GD
Categorical variables	Percentage
Self-rated health
Very good/Good health	62.09	58.59	61.42	Ns
Fair health	33.65	35.16	34.01
Poor/Very poor health	4.27	6.25	4.57
Household income
Below $32,500	42.25	43.51	41.41	*
$32,500 to $99,999	42.86	36.64	46.97
Above $99,999	14.89	19.85	11.62
Employment status
Currently employed (full time and part time)	15.81	16.03	15.66	Ns
Currently not employed	84.19	83.97	84.34
Marital status
Currently married/Partnered	75.08	91.60	64.14	***
Other marital status	24.92	8.40	35.86
Living arrangement
Living with adult children	31.40	33.00	30.28	Ns
Living without adult children	68.60	67.00	69.72
Birthplace
Foreign born	72.49	74.27	71.32	Ns
U.S. Born	27.51	25.73	28.68
Smoke
Ever smoke	19.81	37.40	6.57	***
Never smoke	80.19	62.60	93.43
Drink
0 times a week	83.92	78.63	89.39	**
1 time a week or above	16.08	21.37	10.61
Continuous variables	Mean (s.d.)
Provided economic support	2.18 (1.20)	2.25 (1.18)	2.15 (1.21)	Ns
Provided housework support	2.31 (1.24)	2.28 (1.26)	2.32 (1.24)	Ns
Provided emotional support	3.11 (1.12)	3.08 (1.16)	3.14 (1.09)	Ns
Received economic support	2.33 (1.19)	2.29 (1.18)	2.35 (1.20)	Ns
Received housework support	2.34 (1.11)	2.33 (1.11)	2.34 (1.12)	Ns
Received emotional support	3.05 (1.07)	3.06 (1.06)	3.04 (1.08)	Ns
Resilience	3.76 (.73)	3.79 (.72)	3.74 (.74)	Ns
Age (in years)	73.32 (9.62)	73.47 (8.65)	73.22 (10.10)	Ns
Education (in years)	11.19 (5.02)	12.06 (5.12)	10.61 (4.84)	**
Number of children (still alive)	2.12 (1.47)	2.08 (1.42)	2.15 (1.51)	Ns
Number of chronic diseases	1.25 (1.12)	1.18 (1.11)	1.30 (1.14)	Ns

Notes: t-test was performed for study site and intergenerational support as well as for gender and intergenerational support; chi-square test was performed for study site and self-rated health as well as for gender and self-rated health; *p < .05; **p < .01; ***p < .001; GD stands for gender differences; means and standard deviations (in parentheses) are provided for the continuous variables and percentages (PCT) are provided for categorical and dichotomous variables.

Table 2.

Ordered Logistic Regressions: Regress Self-Rated Health on Intergenerational Support, Resilience, and the Control Variables.

	N = 329
	Main Effects Model 1	Moderating Model 2
Provided economic support	.18 (.14)	.01 (.17)
Provided housework support	−.15 (.14)	−.04 (.19)
Provided emotional support	−.32 (.18)	−.17 (.22)
Received economic support	−.21 (.15)	−.08 (.19)
Received housework support	.15 (.16)	.12 (.20)
Received emotional support	.46 (.19)*	.52 (.24)*
Age	−.05 (.02)	−.05 (.02)
Education (in years)	.02 (.03)	.01 (.04)
$32,500 to $99,999 (below $32,500^a)	.60 (.29)⁺	.66 (.29)*
Above $99,999 (below $32,500^a)	1.10 (.57)*	.98 (.60)⁺
Currently employed (retired and others^a)	.12 (.40)	.15 (.41)
Male (Female^a)	−.09 (.31)	1.74 (.99) ⁺
Currently married/Partnered (others^a)	.07 (.11)	.06 (.10)
Living with adult children (others^a)	−.51 (.31)	−.63 (.32)*
Number of children (currently alive)	.25 (.09)	.25 (.09)
U.S. born (Foreign born)	1.74 (.52)***	1.96 (.54)**
Number of chronic diseases	−.38 (.11)**	−.41 (.12)**
Never smoke (ever smoke^a)	.73 (.70)	.82 (.38)*
No alcohol consumption (more than 1 time a week)	−.80 (.47)⁺	−.93 (.49)*
Interaction terms
Provided economic support * Male		.58 (.30)*
Provided housework support * Male		−.19 (.27)
Provided emotional support * Male		−.48 (.38)
Received economic support * Male		−.52 (.31)
Received housework support * Male		.01 (.35)
Received emotional support * Male		.03 (.41)
/Cut 1	−6.47	−5.78
/Cut 2	−3.52	−2.74
Pseudo R²	17.11	18.99

Notes: ⁺p < .10; *p < .05; **p < .01; ***p < .001’.

^a Stands for the reference group; standard errors are in parentheses.

Table 3.

Ordered Logistic Regressions by Gender: Regress Self-Rated Health on Intergenerational Support, Resilience, and the Control Variables.

	Whole Sample (N = 329)		Males (N = 131)		Females (N = 198)
	Model 1a	Model 2a	Model 1b	Model 2b	Model 1c	Model 2c
Provided economic support	.18 (.14)	.17 (.14)	.68 (.26)**	.72 (.26)**	−.03 (.19)	−.03 (.19)
Provided housework support	−.15 (.14)	−.12 (.15)	−.25 (.24)	−.24 (.24)	−.11 (.21)	−.07 (.22)
Provided emotional support	−.32 (.18)	−.30 (.18)	−.56 (.33)⁺	−.60 (.34)⁺	−.19 (.23)	−.15 (.24)
Received economic support	−.21 (.15)	−.20 (.15)	−.61 (.27)*	−.67 (.28)*	.05 (.20)	.03 (.20)
Received housework support	.15 (.16)	.16 (.17)	.11 (.29)	.13 (.29)	.14 (.22)	.16 (.22)
Received emotional support	.46 (.19)*	.38 (.19)*	.51 (.34)	.50 (.35)	.51 (.25)*	.42 (.26)
Age	−.05 (.02)**	−.05 (.02)**	−.03 (.03)	−.03 (.03)	−.07 (.03)**	−.07 (.03)**
Education (in years)	.02 (.03)	−.01 (.04)	−.02 (.06)	−.05 (.06)	.06 (.05)	.03 (.05)
$32,500 to $99,999 (below $32,500^a)	.62 (.29)*	.58 (.30)*	.23 (.48)	.28 (.50)	1.13 (.40)**	1.07 (.41)**
Above $99,999 (below $32,500^a)	1.10 (.57)⁺	1.05 (.58)⁺	−.11 (.95)	−.28 (.95)	2.49 (.95)**	2.42 (.97)*
Currently employed (retired and others^a)	.16 (.41)	.20 (.41)	.23 (.66)	.32 (.67)	−.42 (.56)	−.45 (.57)
Male (female^a)	−.06 (.29)	−.08 (.29)
Currently married/Partnered (others^a)	.07 (.11)	.06 (.10)	−.07 (.41)	−.05 (.43)	.09 (.10)	.12 (.09)
Living with adult children (others^a)	−.51 (.31)	−.57 (.32)⁺	−.36 (.54)	−.27 (.56)	−.67 (.42)	−.81 (.43)⁺
Number of children (currently alive)	.25 (.09)**	.23 (.09)*	.22 (.15)	.21 (.15)	.40 (.14)**	.37 (.14)**
U.S. born (Foreign born^a)	−.39 (.12)***	−.35 (.12)**	−.41 (.19)*	−.31 (.20)	−.52 (.17)**	−.50 (.17)**
Number of chronic diseases	1.74 (.52)***	1.73 (.53)**	2.45 (1.02)*	2.49 (.10)*	1.69 (.70)*	1.71 (.71)*
Never smoke (ever smoke^a)	.74 (.70)	.46 (.73)	.98 (.87)	.37 (.94)	.66 (1.38)	.67 (1.39)
No alcohol consumption (more than 1 time a week^a)	−.80 (.47)⁺	−.65 (.48)	−.59 (.69)	−.27 (.73)	−1.35 (.77)⁺	−1.19 (.78)
Resilience		.59 (.19)**		.92 (.33)**		.50 (.25)*
/Cut 1	−6.47	−5.02	−6.39	−4.19	−7.63	−6.19
/Cut 2	−3.52	−2.01	−3.42	−1.03	−4.42	−2.95
Pseudo R²	17.11	18.96	19.44	23.30	21.87	23.14

Notes: ⁺p < .10; *p < .05; **p < .01; ***p < .001.

^a Stands for the reference group; standard errors are in parentheses.

Table 4.

Testing the Level of Significance of the Mediating Effect Associated with Resilience.

	Coefficient	Bootstrap Standard Error	95% Percentile Bootstrap Confidence Interval
Received emotional support→	.0784	.0489	(.0079, .2077)
Resilience → SRH (whole sample)	.0784	.0489	(.0079, .2077)
Provided economic support→	−.0423	.1063	(−.2944, .1503)
Resilience → SRH (male subsample)	−.0423	.1063	(−.2944, .1503)
Received economic support→	.0589	.1022	(−.1542, .2856)
Resilience → SRH (male subsample)	.0589	.1022	(−.1542, .2856)
Received emotional support→	.0879	.0661	(.0032, .2479)
Resilience → SRH (Female subsample)	.0879	.0661	(.0032, .2479)

Notes: Percentile confidence interval was used in the bootstrap method.

Results

Descriptive Statistics

The descriptive statistics for the focal variables and the stratified subsamples by gender are presented in Table 1. Approximately 62.1% of Chinese older adults rated their health as very good/good, more than 33.6% of them reported their health as fair, and only 4.3% of the older adults had poor/very poor SRH. The mean scores of provided economic support, housework support, and emotional support for the whole sample were 2.18, 2.31, and 3.11, respectively. For the whole sample, received economic support, housework support, and emotional support had a mean score of 2.33, 2.34, and 3.05, respectively. The results of the independent-samples t-tests and the chi-squared test showed that there were no significant gender differences in SRH and the level of intergenerational support.

The average age of the whole sample was approximately 73.3 years and the mean education was approximately 11 years. Nearly 42.3% of the respondents earned less than $32,500 annually, about 43% had an annual income between $32,500 to $99,999, and only 15% earned more than $99,999 annually. About 16% of the Chinese older adults were currently employed, and around 76% were currently married. Only 31% of the respondents from Honolulu reported living with their adult children and they had 2.1 children on average. Approximately 72.5% of the respondents were foreign-born. Regarding health conditions, on average Chinese older adults had approximately 1.3 chronic diseases. Approximately 19.8% had ever smoked, and more than 16% of them consumed alcohol at least once a week.

Ordered Logistic Regression

Two ordered logistic regression models were constructed to examine the main effect of intergenerational support on SRH and the moderating role of gender while controlling for socio-demographics and other health indicators (Table 2). The test of the parallel lines assumption yielded non-significant test statistics (p = .953 and .998 for Model 1 and Model 2, respectively), which means these two models did not violate the proportional odds assumption. The dependent variable included SRH, with ranks from 1 (poor/very poor) to 3 (very good/good). As shown in Model 1, among all the intergenerational support indicators, only received emotional support was significantly and positively associated with better SRH (b = .46, p < .05) among older Chinese older adults. Model 2 added the interaction terms to test the moderating effect of gender. After adding the interaction terms, the main effect associated with received emotional support was still positively associated with SRH (b = .52, p < .05), however, the interaction term between received emotional support and the dummy variable (male) was not significant. This suggested that the positive effect of receiving emotional support on health was only significant among older women. The results also showed that the interaction term between provided economic support and male was positively associated with SRH (b = .58, p < .05), but the main effect associated with provided economic support was not significant. This indicated that the beneficial effect of provided economic support on health was only significant among older men. Therefore, gender had a moderating effect on the focal relationships.

The results of the ordered logistic regressions that examined the mediating role of resilience for the whole sample and the gender stratified subsample are presented in Table 3. The test of the parallel lines assumption also showed non-significant test statistics (p-value ranging from .953 to .987 for all six models). The non-significant results indicate that these six models did not violate the proportional odds assumptions. As indicated in Model 1a and Model 2a, received emotional support, which was significantly and positively associated with SRH in Model 1a, became non-significant after adding resilience in Model 2a. As shown in Model 2a, resilience was positively associated with SRH (b = .59, p < .001). The indirect effect was 0.08 (Table 4), which was obtained by subtracting the partial regression coefficient of received emotional support obtained in Model 2a from the “simple” regression coefficient of received emotional support obtained in Model 1a. The 95% bootstrap CI (Table 4) is between .0079 and .2077. This CI does not include 0, which indicated that this indirect effect was significant at a .05 level of significance. The results suggested that resilience significantly mediated the positive effect of received emotional support on SRH.

As indicated in Model 1b (Table 3), provided economic support was positively associated with better SRH (b = .68, p < .05) among older men. However, received economic support was negatively associated with SRH (b = −.61, p < .05). As indicated in Model 2b (Table 3), among older men, resilience was also positively and significantly associated with SRH (b = .92, p < .001). The indirect effect of provided economic support on SRH through resilience was −.04 (Table 4). The indirect effect of received economic support on SRH through resilience was .06. Neither of the indirect effects was statistically significant based on the results of the 95% percentile CI (Both CIs included 0). Therefore, resilience did not mediate the positive effect of provided economic support and the negative effect of received economic support on SRH among older men.

As indicated in Model 1c and Model 2c (Table 3), receiving emotional support was positively associated with better SRH among older women (b = .51, p < .05). As shown in Model 2a, receiving emotional support was not significant after adding resilience as the mediator, and resilience was positively associated with SRH (b = .50, p < .05). Among older women, the indirect effect of received emotional support on SRH had a value of .09 (Table 4). This indirect effect has a 95% percentile bootstrap CI ranging from .0032 to .2479. This CI does not include 0, indicating that this indirect effect was significant at the .05 level. These results suggest that resilience significantly mediated the positive effect of received emotional support on SRH among older women.

Discussion

In this study, we found that receiving emotional support was significantly and positively associated with better SRH for the whole sample. The moderating role of gender was identified in the focal relationship. Specifically, the positive health effect of receiving emotional support was only significant among older women, while the beneficial health effect of provided economic support was only significant among older men. Resilience significantly mediated the positive effect of received emotional support on SRH, and this effect was identified for the whole sample and among older women. However, resilience did not mediate the positive effect of provided economic support on SRH among older men.

First, we identified the beneficial health effect associated with receiving emotional support. As receiving emotional support indicates the fulfillment of filial piety duty and is an indicator of strong bonds among family members (Silverstein et al., 2006), the emotional support received by older Chinese individuals might reduce the risk of psychological distress and improve their health and well-being (Chen & Silverstein, 2000; Guo et al., 2017; Li et al., 2009; Silverstein et al., 2006). Therefore, older adults who received higher levels of emotional support were more likely to make a positive appraisal of their health status. However, this positive effect was only significant among women. We speculated that emotional support might affect older women more positively. Although experiencing the American lifestyle and culture may greatly alter their familial obligations, Chinese women in the U.S. are still strongly attached to the traditional cultural roles, as women play a major role in taking care of domestic affairs and family members (Dong & Zhang, 2016). Therefore, women cared more for harmony and intimacy among family members (Wu et al., 2008). Frequently receiving emotional support from adult children is an indicator of family cohesion (Chen & Silverstein, 2000; Li et al., 2009). Also, older women bear more and heavier burdens of family obligations than older men in later life (Kan & Hertog, 2017). Thus, they may need greater emotional support to compensate for their sacrifice and help them withstand daily hassles (Guo et al., 2017; Li et al., 2009). Our findings revealed that older women were more sensitive to the sentiment between generations and expected more to establish affectionate connections with their adult children than older men. This gender difference is similar to another study that was conducted in the Chinese community of Chicago, where researchers found that older women perceived more filial piety (such as respect, greetings, happiness, and obedience) receipt from their children than older men (Dong, Zhang, & Simon, 2014).

Our findings revealed a complex pattern for economic support. First, neither providing nor receiving economic support was significantly related to SRH among older women. Regarding older Chinese men, we found that providing and receiving economic support have opposite impacts on SRH. Specifically, receiving economic support was negatively associated with SRH, while providing economic support was positively associated with SRH. A previous study conducted in mainland China found that an increase in the level of economic support might not always benefit older individuals (Guo et al., 2017; Li et al., 2009). This counterintuitive finding was probably because the provided economic support may surplus the needs of recipients and overburden the mental health of older adults (Li et al., 2009). Moreover, frequently receiving support indicated reliance on others, which may erode the recipient’s confidence in their own abilities over time (Chen & Silverstein, 2000). The U.S. culture emphasizes independence, especially economic independence among generations (Zhang et al., 2018). Thus, receiving economic support from adult children may have a detrimental effect on the self-efficacy of older adults and may lead them to report a poorer health status. However, we cannot rule out a possible reverse causality for this association, i.e., those who receive greater financial support might need it to cover their medical and/or living expenses due to their poor health condition (Silverstein et al., 2006).

Providing economic support to adult children, on the other hand, was positively associated with SRH among older men. This result was inconsistent with those of previous studies conducted in mainland China (Liu et al., 2019; Silverstein et al., 2006), where it was found that providing economic support was not beneficial for the well-being of older adults. Different cultural and socioeconomic circumstances might play an important role in explaining the inconsistency. In Chinese family-oriented values, providing economic support to adult children in later life is considered deviating from traditional filial piety norms and reflects the incompetence of adult children to be financially independent (Liu et al., 2019). However, when older Chinese individuals migrated to the U.S., they attempted to integrate with the host communities. They also had high expectations regarding their children’s achievements in the U.S. (Zhang & Hong, 2013). Obtaining educational resources, especially collegiate education for their children, was vital to meet their expectations (Liu & Zhang, 2017). Therefore, although economic independence is greatly valued in the U.S., older Chinese adults often provide economic support to their children in their early adulthood to ensure they can earn the desired social status. Additionally, this positive association between provided economic support and SRH was probably because the monetary assistance to adult children strengthened feelings of self-efficacy and power of the older adults in the family (Chen & Silverstein, 2000). Also, the economic support to adult children might be exchanged for future support when required (Liu et al., 2019). Therefore, providing economic support to adult children was rewarding and beneficial for health outcomes.

Most importantly, we found that resilience significantly mediated the positive effect of received emotional support on SRH. This significant mediating effect was identified for the whole sample and among older women. However, resilience did not mediate the positive effect of provided economic support on SRH among older men. Our results indicated that the beneficial effects of emotional support on health outcomes were partially due to enhanced resilience at an individual level. Previous research found that social support is important for individuals to cultivate and strengthen resilience (Earnshaw et al., 2015; Hicks & Conner, 2014). Old age is associated with a decline in power resources, such as money, approval, esteem, and compliance (Ramos & Wilmoth, 2003) According to social exchange perspectives, older adults have limited resources to maintain a balanced exchange relationship with other groups (Dowd, 1975). Therefore, their social interactions and social group participation might decline. Family support can play a significant role in helping older adults cope with any age-related adversities without other support resources (Smith & Hung, 2012). This phenomenon is especially important in the Chinese familism cultural context, where the family is the center of resource allocation. With strong emotional support from adult children, older adults are more likely to develop strong feelings of control (Chen & Silverstein, 2000; Pengilly & Dowd, 2000), which may help them become hardy and gain confidence to recover from adverse physical or psychosocial experiences in later life (Dorfman et al., 2009; Hicks & Conner, 2014). This can significantly strengthen the resilience of older individuals.

While resilience was beneficial to the health status of men and women, its mediating effect was more significant among older women than older men. This finding is in line with the Reserve Capacity Model, suggesting that psychological resources are more strongly associated with health outcomes among those with more social disadvantages (Elliot & Chapman, 2016; Gallo et al., 2009). As suggested by our data and previous research findings, older Chinese women in the U.S. generally have lower education and a limited opportunity for well-paid jobs (Chen et al., 2014). Additionally, women generally have a longer life expectancy and are younger than their husbands; they are more likely to be widowed as they age compared to men (Dong, Zhang, & Simon, 2014). The lower social status of women implies that they generally have fewer tangible socioeconomic resources to cope with adversities in later life. Therefore, older Chinese women may rely more on individual psychological resources, such as resilience, to enhance their health (Gallo et al., 2009).

Several limitations need to be addressed. First, the current study relied on cross-sectional and regional data, preventing us from making causal inferences and generalizing the findings to older Chinese adults living in other parts of the U.S. Second, the generalizability may be further reduced since the recruitment of older adults at the study sites was primarily based on snowball and convenient sampling. A relatively small sample size increases the likelihood of a Type II error which may skew the research findings. Moreover, considering the importance of gender in shaping focal relationships, a potentially biased gender ratio in our sample may affect the generalizability of findings related to gender differences. For future research, there is a need to apply survey weights to make the gender ratio in our sample more representative of the study population. Finally, as we collected data using self-administered questionnaires, we might have excluded older adults with limited literacy.

Despite these limitations, our study highlighted the importance of considering the impact of resilience and gender differences when examining intergenerational support and SRH among Chinese older adults residing in the U.S. For instance, health professionals and practitioners may provide educational materials to help adult children fulfill their aging parents’ emotional needs. Additionally, framing a culturally tailored program that facilitates certain types of intergenerational support would help strengthen resilience and promote the health of Chinese older adults in the U.S. (Jarrott et al., 2022).

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a research grant from the Rory Meyers College of Nursing at New York University

IRB Protocol/Human Subjects Approval

The research protocol received full ethical approval from the University of Hawaiʻi at Mānoa, Institutional Review Board (CHS#22774).

ORCID iDs

Sizhe Liu

Wei Zhang

Bei Wu

References

Chen

Simon

M. A.

Dong

(2014). Gender differences in depressive symptoms in US Chinese older adults. AIMS Medical Science, 1(1), 13–27.https://doi.org/10.3934/medsci.2014.1.13

Chen

Silverstein

(2000). Intergenerational social support and the psychological well-being of older parents in China. Research on Aging, 22(1), 43–65. https://doi.org/10.1177/0164027500221003

Connor

K. M.

Davidson

(2003). Development of A New resilience scale: The connor-davidson resilience scale (CD-RISC). Depression and Anxiety 18(2), 76–82. https://doi.org/10.1002/da.10113

Dong

Chen

Simon

M. A.

(2014). Understanding depressive symptoms among community-dwelling Chinese older adults in the greater Chicago area. Journal of Aging and Health, 26(7), 1155–1171. https://doi.org/10.1177/0898264314527611

Dong

Chen

Simon

M. A.

(2014). Anxiety among community-dwelling US Chinese older adults. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 69(Suppl_2), S61–S67. https://doi.org/10.1093/gerona/glu178

Dong

Zhang

(2016). Gender difference in the expectation and receipt of filial piety among U.S Chinese older adults. Journal of Social Science Studies, 2(2), 240. https://doi.org/10.5296/jsss.v2i2.7827

Dong

Zhang

Simon

M. A.

(2014). The expectation and perceived receipt of filial piety among Chinese older adults in the Greater Chicago area. Journal of Aging and Health, 26(7), 1225–1247. https://doi.org/10.1177/0898264314541697

Dorfman

L. T.

Mendez

E. C.

Osterhaus

J. K.

(2009). Stress and resilience in the oral histories of rural older women. Journal of Women & Aging, 21(4), 303–316. https://doi.org/10.1080/08952840903285237

Dowd

J. J.

(1975). Aging as exchange: A preface to theory. Journal of Gerontology, 30(5), 584–594. https://doi.org/10.1093/geronj/30.5.584

10.

Earnshaw

V. A.

Lang

S. M.

Lippitt

Jin

Chaudoir

S. R.

(2015). HIV stigma and physical health symptoms: Do social support, adaptive coping, and/or identity centrality act as resilience resources? AIDS and Behavior, 19(1), 41–49. https://doi.org/10.1007/s10461-014-0758-3

11.

Efron

(1987). Better bootstrap confidence intervals. Journal of the American statistical Association, 82(397), 171–185. https://doi.org/10.1080/01621459.1987.10478410

12.

Elliot

A. J.

Chapman

B. P.

(2016). Socioeconomic status, psychological resources, and inflammatory markers: Results from the MIDUS study. Health Psychology, 35(11), 1205–1213. https://doi.org/10.1037/hea0000392

13.

Gallo

L. C.

Penedo

F. J.

Espinosa de los Monteros

Arguelles

(2009). Resiliency in the face of disadvantage: Do hispanic cultural characteristics protect health outcomes? Journal of Personality, 77(6), 1707–1746. https://doi.org/10.1111/j.1467-6494.2009.00598.x

14.

Guo

Chi

Silverstein

(2017). Intergenerational support and depression among Chinese older adults: Do gender and widowhood make a difference? Ageing & Society, 37(4), 695–724. https://doi.org/10.1017/s0144686x15001403

15.

J.-H.

Carr

Utz

R. L.

Nesse

(2006). Older adults’ perceptions of intergenerational support after widowhood: How do men and women differ? Journal of Family Issues, 27(1), 3–30. https://doi.org/10.1177/0192513x05277810

16.

Harris

P. B.

(2008). Another wrinkle in the debate about successful aging: The undervalued concept of resilience and the lived experience of dementia. The International Journal of Aging Human Development, 67(1), 43–61. https://doi.org/10.2190/AG.67.1.c

17.

Hicks

M. M.

Conner

N. E.

(2014). Resilient ageing: A concept analysis. Journal of Advanced Nursing, 70(4), 744–755. https://doi.org/10.1111/jan.12226

18.

Jarrott

S. E.

Turner

S. G.

Naar

J. J.

Juckett

L. M.

Scrivano

R. M.

(2022). Increasing the power of intergenerational programs: Advancing an evaluation tool. Journal of Applied Gerontology, 41(3), 763–768. https://doi.org/10.1177/07334648211015459

19.

Judd

C. M.

Kenny

D. A.

(1981). Process analysis: Estimating mediation in treatment evaluations. Evaluation Review, 5(5), 602–619. https://doi.org/10.1177/0193841x8100500502

20.

Kan

M. Y.

Hertog

(2017). Domestic division of labour and fertility preference in China, Japan, South Korea, and Taiwan. Demographic Research, 36, 557–588. https://doi.org/10.4054/demres.2017.36.18

21.

Song

Feldman

M. W.

(2009). Intergenerational support and subjective health of older people in rural China: A gender-based longitudinal study. Australasian Journal on Ageing, 28(2), 81–86. https://doi.org/10.1111/j.1741-6612.2009.00364.x

22.

Liu

Zhang

(2017). Immigration-related stressors and mental health problems among Asian-American Immigrants. International Journal of Population Studies, 3(1), 22–41. https://doi.org/10.18063/ijps.2017.01.002

23.

Liu

Zhang

L.-H.

(2019). Contributory behaviors and life satisfaction among Chinese older adults: Exploring variations by gender and living arrangements. Social Science & Medicine, 229, 70–78. https://doi.org/10.1016/j.socscimed.2018.06.015

24.

Yuan

Lin

Zhou

Pan

(2017). Depression and resilience mediates the effect of family function on quality of life of the elderly. Archives of Gerontology and Geriatrics, 71, 34–42. https://doi.org/10.1016/j.archger.2017.02.011

25.

Luthar

S. S.

Cicchetti

Becker

(2000, May-Jun). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71(3), 543–562. https://doi.org/10.1111/1467-8624.00164

26.

A. C. Y.

Phillips

D. R.

Lee

W. K.-m.

(2002). Persistence and challenges to filial piety and informal support of older persons in a modern Chinese society: A case study in tuen mun, Hong Kong. Journal of Aging Studies, 16(2), 135–153. https://doi.org/10.1016/s0890-4065(02)00040-3

27.

Pengilly

J. W.

Dowd

E. T.

(2000). Hardiness and social support as moderators of stress. Journal of Clinical Psychology, 56(6), 813–820. https://doi.org/10.1002/(sici)1097-4679(200006)56:6<813::aid-jclp10>3.0.co;2-q

28.

Ramos

Wilmoth

(2003). Social relationships and depressive symptoms among older adults in southern Brazil. The Journals of Gerontology Series B: Psychological Sciences Social Sciences, 58(4), S253–S261. https://doi.org/10.1093/geronb/58.4.s253

29.

Silverstein

Cong

(2006). Intergenerational transfers and living arrangements of older people in rural China: Consequences for psychological well-being. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(5), S256–S266. https://doi.org/10.1093/geronb/61.5.s256

30.

Simon

M. A.

Chang

E.-S.

Zhang

Ruan

Dong

(2014). The prevalence of loneliness among US Chinese older adults. Journal of Aging and Health, 26(7), 1172–1188. https://doi.org/10.1177/0898264314533722

31.

Smith

C. S.

Hung

L.-C.

(2012). The influence of eastern philosophy on elder care by Chinese Americans: Attitudes toward long-term care. Journal of Transcultural Nursing, 23(1), 100–105. https://doi.org/10.1177/1043659611423827

32.

U.S. Census Bureau . (2021). Chinese in the U.S. Fact Sheet. Retrieved September 9 from https://www.pewresearch.org/social-trends/fact-sheet/asian-americans-chinese-in-the-u-s/#find-out-more

33.

Wang

W.-P.

L.-H.

Zhang

Tsay

R.-M.

(2019). Culturally-specific productive engagement and self-rated health among Taiwanese older adults. Social Science & Medicine, 229, 79–86. https://doi.org/10.1016/j.socscimed.2018.07.037

34.

Chi

Mjelde-Mossey

L. A.

Silverstein

N. M.

(2008). Gender differences in contributory behaviors among the oldest-old Chinese in Shanghai. Ageing International, 32(1), 65–77. https://doi.org/10.1007/s12126-008-9001-8

35.

Pei

Zhang

Northridge

(2020 Jun-Jul). Immigrant status, resilience, and perceived oral health among Chinese Americans in Hawaii. Research on Aging, 42(5–6), 186–195. https://doi.org/10.1177/0164027520912493

36.

Yue

Silverstein

N. M.

Axelrod

D. T.

Shou

L. L.

Song

P. P.

(2005). Are contributory behaviors related to culture? Comparison of the oldest old in the United States and in China. Ageing International, 30(3), 296–323. https://doi.org/10.1007/s12126-005-1017-8

37.

Lin

Chen

Liu

(2018). Ageism, resilience, coping, family support, and quality of life among older people living with HIV/AIDS in Nanning, China. Global Public Health, 13(5), 612–625. https://doi.org/10.1080/17441692.2016.1240822

38.

Zeng

Liu

George

L. K.

(2003). Gender differentials of the oldest old in China. Research on Aging, 25(1), 65–80. https://doi.org/10.1177/0164027502238343

39.

Zhang

Simon

M. A.

Dong

(2014). The prevalence of perceived stress among US Chinese older adults. AIMS Medical Science, 1(1), 40–56. https://doi.org/10.3934/medsci.2014.1.40

40.

Zhang

Hong

(2013). Perceived discrimination and psychological distress among asian Americans: Does education matter? Journal of Immigrant Minority Health, 15(5), 932–943. https://doi.org/10.1007/s10903-012-9676-5

41.

Zhang

Lacanienta

Liu

(2018). Successful ageing or resilient ageing: Perceptions from elderly Chinese in hawai’i. China Journal of Social Work, 11(3), 236–245. https://doi.org/10.1177/2333721418778182

42.

Zhang

(2006). Gender differentials in cognitive impairment and decline of the oldest old in China. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61(2), S107–S115. https://doi.org/10.1093/geronb/61.2.s107