The role of living arrangements in disability assistance and survival in Mexican older adults

Background and Objectives This study estimates life expectancy with basic activities of daily living (ADL) and instrumental ADL (IADL) limitations by living arrangements at age 60 for Mexican adults, using the Mexican Health and Aging Study (MHAS) data from 2012 to 2021. We extend previous research by examining assistance with ADL and IADL as a measure of disability severity and exploring the association of disability assistance and mortality. Research Design and Methods Generalized estimating equations were used to examine the relationship between receiving help and living arrangements (living alone, with spouse only, or in extended households). Cox proportional hazards regression assessed the effect of receiving help on mortality. Multistate life table models were used to estimate life expectancy with and without help for ADL and IADL limitations, by gender and living arrangements. Results At age 60, those living alone spent a larger share of post-disability life without receiving assistance (ADL: 68.1%; IADL: 19.9%) than those living with others (ADL: 61.6%; IADL: 15.8%). Compared with co-residers, older adults living alone had higher odds of not receiving help with ADL and IADL. Individuals receiving help had higher mortality (ADL hazard ratio [HR]=1.57; IADL HR=1.62), consistent with help being a marker of greater severity, not a causal effect. Discussion and Implications Extended households enable individuals with disabilities to receive assistance for a longer period. Disability assistance was associated with increased mortality risk, highlighting its role as an indirect measure of disability severity.