Mortgage Borrowing and Chronic Disease Outcomes in Older Age: Evidence from Biomarker Data in the Health and Retirement Study.

OBJECTIVE: The medical diagnosis of a disease is common in older age and can carry significant financial costs. For many older adults, equity in a home is their primary component of wealth; however, housing wealth is illiquid. We analyze the relationship between the liquidation of housing wealth through mortgage borrowing on older homeowners' ability to successfully control a disease. METHODS: We use data on homeowners age 65 and older from the 1998-2016 waves of the Health and Retirement Study (N=3,457). We use biomarkers and physical health indicators to measure disease control following a medical diagnosis of diabetes, heart condition, high blood pressure, lung disease, or cancer. Random effects linear probability and instrumental variable regressions estimate the associations of housing wealth, new mortgage borrowing, and disease control. RESULTS: Descriptively, 28% of older homeowners who borrow against home equity are not controlled on their disease, compared to 33% of non-borrowers. Panel data instrumental variable regressions show that each $10,000 borrowed from home equity after diagnosis is associated with a 17 percentage-point reduction in the probability of the disease not being controlled. DISCUSSION: Many older adults are not able or willing to liquidate housing wealth, and the ability to borrow also depends on changes in home values. Thus, housing wealth is not a uniform social determinant of health but is shaped by older adults' participation in financial markets.

Managing the onset of a new disease in older age: Housing wealth, mortgage borrowing, and medication adherence.

The relationship between wealth and health is an important yet complex topic for health research. While prior studies document the importance of wealth for healthy aging, the understanding of the mechanisms through which wealth supports health consumption is limited. We investigate the wealth-to-health link by explicitly modeling the effect of liquidating home equity through borrowing on health expenditures, measured here as cost-related non-adherence to prescription medications (CRN), following the onset of one of six costly diseases on or after age 65. Using individual-level data from the 2002-2018 waves of the U.S. Health and Retirement Study (3,772 respondents; 13,708 observations), we exploit exogenous spatial and intertemporal variation in ZIP-code level house values to instrument for borrowing. Results indicate each additional $10,000 in new mortgage borrowing is associated with a 1.6 percentage point reduction in CRN. In subsample regressions, this relationship is strongest for older adults for whom home equity is their largest source of wealth. In a falsification test, we find no relationship between house value changes and CRN for older renters, and no effect of mortgage borrowing on prescription drug non-adherence for health or memory reasons. Our results contribute to the literature by documenting how housing wealth can be tapped by older adults through borrowing to smooth health-related consumption following disease diagnosis. However, not all older homeowners are willing or able to borrow from home equity. Our findings suggest that it is not simply the stock of housing wealth that leads to better health outcomes, but instead the liquidation of housing wealth. Housing wealth is thus not a uniform social determinate of health for older homeowners as it is moderated by the ability to borrow.

The role of consumer and mortgage debt for financial stress.

OBJECTIVES: Financial debt held by older adults in the U.S. has grown over the past two decades. This study examines the extent to which credit cards, other consumer debts, and mortgage debt increase financial stress. Outcome measures of financial stress include the material domain ("bill-paying difficulty") and psychological domain ("ongoing financial strain"). METHOD: We analyzed adults age 62 and older in the 2004 to 2016 waves of the Health and Retirement Study using random-effects logit regressions. RESULTS: Unsecured consumer debt is associated with more financial stress per dollar than mortgage debt. A detailed assessment of mortgage debt finds that greater levels of both first and secondary mortgages are associated with greater bill-paying difficulty and greater ongoing financial strain. An increase in new mortgage debt obtained after age 62 is associated with an increase in bill-paying difficulty, but is not significantly associated with ongoing financial strain. In contrast, a reduction in mortgage debt since age 62 is associated with lower bill-paying difficulty and lower levels of ongoing financial strain. CONCLUSION: The relationship between consumer debt, mortgages, and financial stress is nuanced, and depends on both the type and timing of the debt.

Debt Stress and Debt Illusion: The Role of Consumer Credit, Reverse and Standard Mortgages.

OBJECTIVES: This study examines the relationship of debt stress and reverse mortgage borrowing and compares it to stress from standard mortgages and consumer debt. Debt stress is measured as a self-reported response to the amount of debt. METHODS: Using a unique national data set of 1,026 homeowners who chose whether to obtain a reverse mortgage in 2010, we estimate the relationship of 2014 levels of debt stress with various types of debt, assets, and income. Using an ordered probit model, we address the endogeneity of our measures of mortgage and consumer debt using an instrumental variables regression model. RESULTS: We found that consumer debt causes more stress per dollar of debt compared to mortgage debt. Reverse mortgages cause a relatively low level of stress per dollar of debt compared with standard mortgage debt. The average treatment effect of originating a reverse mortgage indicates statistically significantly higher probability of reporting no and not very much debt stress. DISCUSSION: Reverse mortgage debt causes a complex stress response. Stress per dollar of debt is lower for reverse than standard mortgages 4 years after origination. However, reverse mortgages' loan balance grows over time causing total stress to increase, while stress from a standard mortgage decreases as it is repaid. If an older adult uses reverse mortgage funds to repay consumer debt then total stress is reduced.

The Relationship Between Reverse Mortgage Borrowing, Domain and Life Satisfaction.

OBJECTIVES: Reverse mortgages allow adults aged 62 years and older to borrow against the equity in their homes without incurring monthly loan repayments. This study examines the relationship of reverse mortgage borrowing with older adults' satisfaction with their financial situation, housing, health, and daily life/leisure as well as with life as a whole. METHOD: A new national data set of 1,088 older adults, comprised of loan data, credit histories, and responses to a phone survey, was created. Our estimation strategy compares reverse mortgage borrowers to older adults who obtained mandatory counseling but not a reverse mortgage. RESULTS: Reverse mortgage borrowers have significantly higher financial and housing satisfaction compared to nonborrowers; no differences were found for health, daily life/leisure, and general satisfaction. These satisfaction domains contribute differently to general satisfaction for reverse mortgage borrowers relative to nonborrowers: housing satisfaction has a greater influence for borrowers and health a greater influence for nonborrowers. DISCUSSION: Our study provides new knowledge about the longer-term outcomes of reverse mortgage borrowers. The positive association of reverse mortgage borrowing for housing and financial satisfaction and, in turn, general satisfaction, provides insights regarding borrower experiences with this controversial financial tool.