Preclinical Dementia and Economic Well-Being Trajectories of Racially Diverse Older Adults.

ObjectivesThis study examined the magnitude, changes, and racial/ethnic disparities in the economic costs of the 16-year preclinical phase of dementia-a period of cognitive decline without significant impact on daily activities. Methods: The study utilized two dementia algorithms to classify individuals with incident dementia in the Health and Retirement Study. These cases were compared to matched controls in terms of poverty status, labor force participation, and unsecured debts. Results: Older adults classified with dementia were more likely to drop out of the labor force and become poor than similar older adults without dementia. Racial/ethnic disparities in poverty persisted during the preclinical period, with non-Hispanic Black older adults more likely to leave the labor force and Hispanic older adults more likely to have unsecured debt. Discussion: Findings highlight the economic costs during prodromal phase of dementia, emphasizing need for early interventions to reduce financial strain across diverse older adults.

How does debt shape health outcomes for older Americans?

The deleterious effects that debt can have on health outcomes are well documented, yet comprehensive studies of the debt-health link for older adults remain limited even as their indebtedness has increased dramatically in recent decades. Additionally, the literature cannot explain the causal pathway linking poor health with debt. Using data from the Health and Retirement Study (1998-2016), we examine a range of physical and mental health measures and assess how they may be shaped by the amount and type of debt held by older adults. To address the likely endogeneity of debt and health, we employ marginal structural models, developed specifically as an identification strategy in the presence of possible endogeneity, alongside population-averaged models that allow us to compare outcomes for populations with and without debt without relying on unverifiable assumptions regarding the underlying population distribution as is the case with random- and fixed-effects models. Findings indicate that carrying any debt has a negative effect on a range of health outcomes for older adults, including objective and subjective physical and mental health. In addition, the more debt older adults carry, the more detrimental it is for their health. Finally, the type of debt matters: while secured debt has a limited, if any, negative impact on health outcomes, unsecured debt has a substantial negative impact on health. Policymakers should design policies that promote the prudent use of debt and discourage carrying large debt burdens, especially unsecured debt, into retirement as this would promote better health outcomes for older Americans.

Local Government Efforts to Mitigate the Novel Coronavirus Pandemic among Older Adults.

As the coronavirus crisis spreads swiftly through the population, it takes a particularly heavy toll on minority individuals and older adults, with older minority adults at especially high risk. Given the shockingly high rates of infections and deaths in nursing homes, staying in the community appears to be a good option for older adults in this crisis, but in order for some older adults to do so much assistance is required. This situation draws attention to the need for benevolent intervention on the part of the state should older adults become ill or lose their sources of income and support during the crisis. This essay provides a brief overview of public support and the financial and health benefits for older individuals who remain in the community during the pandemic. It reports the case example of Austin, Texas, a city with a rapidly aging and diverse population of almost a million residents, to ask how we can assess the success of municipalities in responding to the changing needs of older adults in the community due to COVID-19. It concludes with a discussion of what governmental and non-governmental leadership can accomplish in situations such as that brought about by the current crisis.

Parental Income and Wealth Loss and Transfers to their Young Adult Children.

As young people transition to adulthood, many rely on financial support from their parents to complete schooling and to live independently. Evidence suggests that there has been a gradual lengthening of the time young adults take to transition to adulthood. Young people attempting to move out of their parents' home, complete college, or enter the workforce during the Great Recession faced uncertain economic times, increasing their need for financial support. At the same time, the income and wealth losses experienced by young adults' parents may have disrupted transfers from them. We analyze the impact of large and unexpected declines in parents' income and wealth during and immediately after the Great Recession on monetary transfers to their young adult children using data from the Panel Study of Income Dynamics (PSID) and the PSID Transition to Adulthood study. We find parents' financial support of their young adult children declined during the Great Recession. The likelihood of receiving a transfer declined from 74% in 2005 to 57% in 2009. Parents' loss of income was a factor in the amount of decrease but on average was relatively modest - a $10,000 parental income loss decreased transfers to their adult children by $109. However, parents experiencing large declines in income, those at the 75th and 95th percentile of income loss, reduced transfers to adult children by $1,150 and $1,700, respectively. Declines in parental transfers that reduce college completion rates, increase student loan debt and decrease likelihood of homeownership may have long term consequences for financial well-being.

Living Alone in the United States and Europe: The Impact of Public Support on the Independence of Older Adults.

While we know that living alone is often associated with greater risk of financial hardship, we have limited knowledge on the possible link between the availability of public support and independent living. We use data from the 2014 Health and Retirement Study and the 2011-2015 Survey of Health, Ageing and Retirement in Europe to compare income and wealth profiles of the population aged 60 and above who are living alone in the United States and 19 European countries. We find that the likelihood of living alone is higher in generous welfare states, with social support and spending both positively associated with living alone. The relationship between personal resources and living alone has a smaller positive gradient in countries with robust welfare systems. The lack of adequate public support in less generous welfare states may constrain the ability of many low-income older adults without a partner to continue living independently.

Work-Related Opportunity Costs Of Providing Unpaid Family Care In 2013 And 2050.

Older Americans living in the community who need help with functional limitations overwhelmingly rely on unpaid care, which is often provided by working-age family members. This study assessed the impact of unpaid family caregiving on the likelihood of working and hours worked for caregivers and calculated the related cost of forgone earnings in 2013 and 2050. The current economic cost is about $67 billion, which by midcentury will likely double to $132-$147 billion, fueled primarily by the growth of the disabled older population and the increased share of better-educated caregivers. Average opportunity cost per caregiver will likely increase by 8-20 percent and per US resident by 54-72 percent. Future policy action could benefit from accounting fully for the economic costs in addition to the benefits of unpaid caregiving, which would help better define the scope and size of programs needed to support caregivers.

Hispanics' Retirement Transitions and Differences by Nativity.

OBJECTIVE: This study examines differences in retirement decisions between older Hispanics and non-Hispanics, with a special focus on the role of nativity. METHODS: We use 1998-2012 waves of the Health and Retirement Study. We estimate survival models of retirement and compare retirement transitions for U.S.-born Hispanics, foreign-born Hispanics, non-Hispanic Whites, and non-Hispanic Blacks. RESULTS: Foreign-born Hispanics retire significantly later than other racial and ethnic groups. Controlling for personal characteristics, their risk of retirement is 39% lower compared with non-Hispanic Whites. Retirement transitions do not differ significantly between U.S.-born Hispanics and non-Hispanic Whites. DISCUSSION: Difference in retirement timing between U.S.- and foreign-born Hispanics may partly be due to lower incomes and wealth accumulation of foreign-born Hispanics. Workforce development initiatives, policy initiatives promoting retirement savings, and Social Security reforms could improve future retirement security for older Hispanics, and make retirement a viable option for more foreign-born Hispanics.

Household Composition and Longitudinal Health Outcomes for Older Mexican Return Migrants.

Mexican return migrant population is increasing, yet our knowledge about their lives after resettlement in Mexico remains fragmentary. Using 2001-2012 longitudinal data from the Mexican Health and Aging Study, we investigate difference in household composition for older migrants who returned from the United States compared to nonmigrants. Furthermore, we fit a Cox proportional hazards model to assess the relationship between household composition and health and functional trajectories of return migrants and nonmigrants. The results indicate that return migrants with long duration of U.S. stay have different household composition than nonmigrants or short-term migrants: On average, they have smaller household size, including fewer females who may be available to offer assistance to older adults. Presence of middle-age females in the household has positive effects on health and functional trajectories. We highlight implications of this research for policy makers in Mexico and the United States.

Relationship Status and Long-Term Care Facility Use in Later Life.

OBJECTIVES: Most older adults prefer to "age in place" and avoid formal long-term care. Yet demographic shifts, including population aging and an increasing prevalence of remarried and unmarried older adults, could undermine these goals, making it important to consider carefully how and why relationship status relates to long-term care risk. METHOD: We fit hazard models to a sample of adults aged 65 and older from eight waves (1998-2012) of the Health and Retirement Study (N = 21,564). We consider risk of any long-term care facility admission, as well as risk of long-duration stays. RESULTS: Widowed, divorced, and never married adults have the highest risks of long-term care admission. Remarried and partnered adults have similar risks of long-term care admission as continuously married adults. Relationship status is more important for men than for women, especially when considering long-duration stays. Relationship status is also more significant for non-Hispanic White and Hispanic adults compared with non-Hispanic Black adults. Economic resources and, to some extent, social ties partially explain the association between relationship status and long-term care use. DISCUSSION: By addressing the prohibitive costs of long-term care services which enable aging in place (e.g., home health care), relationship status disparities in long-term care may be reduced. Future studies should consider the link between long-term care facility use and relationship status in future cohorts as well as examine how relationship status structures access to a range of long-term care options.

Gender Differences in Institutional Long-Term Care Transitions.

INTRODUCTION: This study investigates the relationship between gender, the likelihood of discharge from institutional long-term care (LTC) facilities, and post-discharge living arrangements, highlighting sociodemographic, health, socioeconomic, and family characteristics. METHODS: We use the Health and Retirement Study to examine individuals age 65 and older admitted to LTC facilities between 2000 and 2010 (n = 3,351). We examine discharge patterns using survival analyses that account for the competing risk of death and estimate the probabilities of post-discharge living arrangements using multinomial logistic regression models. RESULTS: Women are more likely than men to be discharged from LTC facilities during the first year of stay. Women are more likely to live alone or with kin after discharge, whereas men are more likely to live with a spouse or transfer to another institution. Gender differences in the availability and use of family support may partly account for the gender disparity of LTC discharge and post-discharge living arrangements. CONCLUSION: Our findings suggest that women and men follow distinct pathways after LTC discharge. As local and federal efforts begin to place more emphasis on the transition from LTC facilities to prior communities (e.g., transitional care initiatives under the Patient Protection and Affordable Care Act), policymakers should take these gender differences into account in the design of community transition programs.

How do race and Hispanic ethnicity affect nursing home admission? Evidence from the Health and Retirement Study.

OBJECTIVES: This study investigates how health- and disability-based need factors and enabling factors (e.g., socioeconomic and family-based resources) relate to nursing home admission among 3 different racial and ethnic groups. METHOD: We use Cox proportional hazard models to estimate differences in nursing home admission for non-Hispanic whites, non-Hispanic blacks, and Hispanics from 1998 to 2010 in the Health and Retirement Study (N = 18,952). RESULTS: Racial-ethnic differences in nursing home admission are magnified after controlling for health- and disability-based need factors and enabling factors. Additionally, the degree to which specific factors contribute to risk of nursing home admission varies significantly across racial-ethnic groups. DISCUSSION: Our findings indicate that substantial racial and ethnic variations in nursing home admission continue to exist and that Hispanic use is particularly low. We argue that these differences may demonstrate a significant underuse of nursing homes for racial and ethnic minorities. Alternatively, they could signify different preferences for nursing home care, perhaps due to unmeasured cultural factors or structural obstacles.

The balance of intergenerational family transfers: a life-cycle perspective.

The aim of this study is to determine the likelihood and net amount of parent-child transfers over the adult life cycle across European welfare regimes. The study introduces an economic life-cycle model of family transfers to describe the evolution of family exchanges across generations over time, which reveals a nonlinear relationship of age and net family transfers. Furthermore, it refines the method of estimating parent-child net transfers. Data come from the Survey of Health, Ageing, and Retirement in Europe, and include 36,095 parent-child dyads from 11 European countries representing social democratic, conservative, and traditional welfare-state regimes. The findings reveal net value of family intergenerational support follows a nonlinear pattern across the adult life cycle, with positive transfers from parents to adult children decreasing modestly until advanced old age when the decrease intensifies. Net family support benefits individuals and generations with larger relative need. The transition in the net family support pattern starts later and is less pronounced across social democratic welfare-regime countries while the opposite is true in traditional welfare-regime countries. These findings might be interpreted as being linked to differences in the public policies guaranteeing different levels of provision for dependent populations across different welfare regimes. They are consistent with a comparatively smaller role of family support in the intergenerational redistribution of resources in societies with larger public intergenerational support to dependent populations.