The protective role of family ties and the mortality of older people: addressing the bias introduced by the selection of the institutionalized population

Most of the literature linking the living conditions of older people with their health outcomes refers to older populations living in private dwellings, while studies dealing with the topic from a broader perspective, including the institutionalised, are sparse. This can be ascribed to the fact that nation-wide health surveys do not generally include institutionalised populations, and to a strong selection of any institutionalised populations, which calls for specific techniques to deal with the induced bias in estimators. Our study highlights the effect of family support on the survival of older people looking at private and collective households. We examine the relationship between living conditions and mortality in a cohort of 16,263 individuals aged 55 and over, living in both private residences and institutions in France. We perform inverse probabilities of treatment weighting (IPTW) with the Cox model so as to include and adjust for confounders. We found a protective effect for marriage and childbearing in both private and collective settings. We also found a protective institutional effect for those who are disabled.