Geographic Relocation in Response to Parents' Health Shocks: Who Moves and How Close?

Objective: This article examines how parent-child geographic proximity changes around the onset of parental health shocks in the United States. Differences in the likelihood of moving closer across social groups are also investigated. Background: Adult children often care for older parents with health problems, but this requires relatively close proximity. As families are becoming smaller and many adult children live away from their parents, it is unclear how responsive families will be to older adults' health problems. Method: We estimate a series of fixed effects and event study models on data from the Health and Retirement Study (2004-2018) to assess changes in parent-child proximity after parents' first onset of cognitive impairment and functional limitations. Results: We find robust evidence that parents and children tend to stay close or move closer to each other in response to parent's health declines. Moves occur immediately and in subsequent waves after the onset of health shocks. Reductions in parent-child distance are consistently larger among mother-daughter dyads, dyads without spouses or multiple children, and non-Hispanic white families. Conclusion: The geographic availability of adult children to provide care is responsive to parents' needs. After the onset of a serious health condition, most older adults have a spouse or child living close enough to provide care. Parents' and children's lives are dynamically linked, and either or both may relocate to facilitate care.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population.

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

Intergenerational support and retirement timing among older men and women by race/ethnicity.

Retirement timing is associated with health and economic outcomes for older adults. However, it is unclear how the pressures of supporting older parents and young adult children are associated with retirement. This study uses a life course perspective to consider how the linked lives of working older adults and their support of adult children and parents are associated with retirement. Cox proportional hazard models are estimated using the Health and Retirement Study (1992-2014) to assess the relationship between intergenerational support exchanges and retirement timing by gender and race/ethnicity. Providing most types of intergenerational support and especially providing time support are associated with an increased risk of retirement. Unlike all other respondents, Hispanic women providing intergenerational time support have similar retirement risks as those not providing any intergenerational support. These differing patterns by race/ethnicity suggest that earlier life course trajectories may shape older adults' ability to respond to family needs.

Gender, Age of Migration, and Cognitive Life Expectancies Among Older Latinos: Evidence From the Health and Retirement Study.

OBJECTIVES: Migration and gender are important factors that differentiate the Latino immigrant experience in the United States. We investigate the association between nativity status, age of migration, and cognitive life expectancies among a nationally representative sample of Latino adults aged 50 and older to explore whether age of migration and gender influence cognitive aging across the life course. METHODS: This study used data from the Health and Retirement Study (1998-2016) to estimate Sullivan-based life tables of cognitive life expectancies by nativity, age of migration, and gender for older Latino adults. Cognitive status was based on the Langa-Weir algorithm. We test for both within-group (i.e., nativity and age of migration) and gender differences to explore the overall burden of disease among this rapidly growing population. RESULTS: Foreign-born Latinos, regardless of age of migration or gender, spend a greater number of years after age 50 with cognitive impairment/no dementia than U.S.-born Latinos. However, the number of years spent with dementia varied by subgroup with midlife immigrant men and late-life immigrant men and women exhibiting a significant disadvantage relative to the U.S.-born. Furthermore, we document a gender disadvantage for all Latino women, regardless of immigrant status. DISCUSSION: The robust relationship between nativity, age of migration, and cognitive aging suggests that older foreign-born Latinos experiencing cognitive decline may place serious burdens on families. Future research should target the needs of different subgroups of older Latinos who are entering their last decades of life to develop culturally appropriate long-term care programs.

Co-residence beliefs 1973-2018: Older adults feel differently than younger adults.

Objective: This brief study examines support for co-residence (i.e. aging parents living with their adult children), and how age predicts support for this belief considering the rapidly aging U.S. population. Background: Co-residence, a form of intergenerational transfer between family members, can help facilitate care for aging parents as well as help older adults age in the community. Support for this type of co-residence was on the rise in the 1970s and 1980s. Method: Support for co-residence of older adults living with their adult children is estimated using 36,843 responses from the U.S. General Social Survey from 1973 to 2018. Descriptive analyses, logistic regression, and decomposition analyzes are used to test explanatory factors in trends, focusing on differences for older (age 65 and older) vs. younger (under 65) respondents. Results: Older adults are less supportive than younger adults of co-residence even as support has generally increased across time. Decomposition results show that a little over half of the difference between younger and older adults is explained by cohort replacement, with two-fifths of the difference unexplained by social or demographic factors. Conclusion: Findings suggest that although cohort replacement has contributed to an attitude shift over time, important age differences in attitudes remain. Older adults are less supportive of co-residence than younger adults.

National estimates of kinship size and composition among adults with activity limitations in the United States.

BACKGROUND: The number of adults living with limitations in daily activities in the United States is large, and projected to increase. Families, which are becoming more complex, are critical to the wellbeing of this population. OBJECTIVE: We present national estimates of the size and composition of kin networks for adults with activity limitations. METHODS: We use the 2013 Panel Study of Income Dynamics to assess kin relationships of adults aged 40 and older with an activity limitation. We assess kin relations up and down one generation and horizontally, including spouses, adult children, parents, siblings, step-kin, parent-in-laws, children-in-law, and sibling-in-laws. We estimate kinship size and differences across race/ethnicity, education, and marital status. We also estimate the number of helpers. RESULTS: Adults with activity limitations have a substantial number of adult kin: 9.1 on average, while only 12% have fewer than four kin. Spouses and adult biological children, the most common caregivers, account for less than one-third of these kin. Kin networks are much larger among those who report their background as Hispanic rather than non-Hispanic white or Black, married rather than unmarried, and less-than-college rather than college-educated. CONCLUSIONS: Despite concerns about increasing family complexity, we find that 88% of individuals with a limitation have four or more family members, and as kin size increases the average number of kin helping increases from one to two. CONTRIBUTION: We provide estimates of kinship size and composition for adults with disabilities, assessing the number of kin, types of kin, and sociodemographic differences.

Mitigating Poverty through the Formation of Extended Family Households: Race and Ethnic Differences.

In times of hardship, moving in with family is one strategy for alleviating economic deprivation and uncertainty. The ability of the family to buffer against poverty may vary by the resources available to and the economic needs of individuals. I assess how the formation of extended-family households is associated with a move into or out of poverty and how this association varies by race and ethnicity, since economic resources and norms around extended-family households differ. Using longitudinal data that span four years, I estimate linear fixed effects regression models to assess how changes in living arrangements are related to changes in poverty. I find that moving into an extended-family household reduces poverty, especially for the joining family unit. Most of this poverty reduction occurs through a family safety net, with a non-poor family taking in poor family units.

Nativity and Country of Origin Variations in Life Expectancy With Functional Limitations Among Older Hispanics in the United States.

This study examined racial/ethnic, nativity, and country of origin differences in life expectancy with and without functional limitations among older adults in the United States. We used data from the National Health Interview Survey (1999-2015) to estimate Sullivan-based life tables of life expectancies with functional limitations and without functional limitations by sex for U.S.-born Mexicans, foreign-born Mexicans, U.S.-born Puerto Ricans, island-born Puerto Ricans, foreign-born Cubans, and U.S.-born Whites. We find that Latinos exhibit heterogeneous life expectancies with functional limitations. Among females, U.S.-born Mexicans, foreign-born Mexicans, and foreign-born Cubans spend significantly fewer years without functional limitations, whereas island-born Puerto Ricans spend more years with functional limitations. For men, U.S.-born Puerto Ricans were the only Latino subgroup disadvantaged in the number of years lived with functional limitations. Conversely, foreign-born Cubans spend significantly fewer years without functional limitations. To address disparities in functional limitations, we must consider variation in health among Latino subgroups.

Gender and Age of Migration Differences in Mortality Among Older Mexican Americans.

OBJECTIVES: Using a gendered life course perspective, we examine whether the relationship between age of migration and mortality is moderated by gender among a cohort of older Mexican Americans. METHODS: Data from the Hispanic Established Populations for the Epidemiological Study of the Elderly and recently matched mortality data are used to estimate Cox proportional hazard models. RESULTS: Our findings indicate that the relationship between age of migration and mortality is moderated by gender, suggesting a more nuanced perspective of the immigrant mortality paradox. Among men, midlife migrants exhibit an 18% lower risk of mortality compared to their U.S.-born co-ethnics, possibly due to immigrant selectivity at the time of migration. Conversely, late-life migrant women exhibit a 17% lower risk of mortality relative to U.S.-born women, attributed in part to socio-cultural characteristics that influence lifestyle risk factors across the life course. DISCUSSION: Selection mechanisms and acculturation processes associated with the immigrant experience are contingent on both age and gender, suggesting the utility of an integrated life course approach to contextualize the mortality profiles of older immigrants. These findings demonstrate the heterogeneity among immigrants and highlight the need to understand gender differences in the migration process when assessing the immigrant mortality paradox.

The Economic Organization of Extended Family Households by Race/Ethnicity and Socioeconomic Status.

This study examines differences in the amount of economic support or mutual benefit derived from extended family living arrangements by studying differences in monetary contributions to essential household expenditures across family units in extended family households. Using the 2008 Survey of Income and Program Participation, multivariate regression and selection models are estimated to assess racial differences in family contributions toward household expenses in extended family households. Extended family households have very unequal monetary contributions towards household rent and utilities, although Hispanics have less unequal monetary contributions compared to other racial groups. Hispanic and Asians extended family households experience decreasing inequality in financial contributions as the income of each family increases whereas no relationship between financial contributions and income is found for whites or blacks. This suggests a different cultural orientation to extended family living arrangements for Asians and Hispanics compared to non-Hispanic whites.

Race Differences in Linking Family Formation Transitions to Women's Mortality.

We examine how the timing and sequencing of first marriage and childbirth are related to mortality for a cohort of 4,988 white and black women born between 1922 and 1937 from the National Longitudinal Survey of Mature Women. We use Cox proportional hazard models to estimate race differences in the association between family formation transitions and mortality. Although we find no relationships between marital histories and longevity, we do find that having children, the timing of first birth, and the sequencing of childbirth and marriage are associated with mortality. White women who had children lived longer than those who had none, but the opposite was found for black women. The effects of birth timing also differed by race; delaying first birth to older ages was protective for white women but not black women. These results underscore the importance of social context in the study of life course transitions.

Prevalence and Trends in Morbidity and Disability Among Older Mexican Americans in the Southwestern United States, 1993-2013.

This study examines the prevalence of morbidity and disability among older Mexican Americans using 5-year age groups. Twenty-year panel data from the Hispanic Established Populations for the Epidemiological Study of the Elderly are used to make detailed comparisons by nativity and gender. Results show that prevalence rates for most chronic conditions for both males and females do not vary by nativity. For disabilities, nativity is a significant predictor of increased instrumental activity of daily living disability for foreign-born females and reduced activity of daily living disability for U.S.-born males. Additionally, results show significant interactions between nativity and age cohorts, with the gap increasing with age for males and decreasing with age for females. These results have important implications for health services and health policy. Given the rapid aging of the Mexican American population, the prevention and treatment of medical conditions, particularly among the foreign-born, should be a major public health priority to reduce dependence from disabilities.

Physical Functioning and Disability Trajectories by Age of Migration Among Mexican Elders in the United States.

Objectives: To address a gap in our understanding of the long-term consequences of nativity and age of migration for the health of the Mexican elderly population. Method: We employ age graded latent growth curve models stratified by gender to examine the extent of physical functioning and disability, measured in terms of performance-oriented mobility assessments (POMAs) and activities of daily living (ADLs) after age 65 in a large longitudinal sample of Mexican-origin individuals. Results: Self-care measured ADLs show no age of migration differences. However, physical capacity measured POMAs differ significantly for men and women by age of migration. Migrants who arrived in midlife have fewer functional limitations at age 65 but have steeper increase in POMAs with age. Discussion: With a rapidly changing demographic profile that includes a large number of aging Mexican-origin immigrants, our society must implement social and health policies to ameliorate the negative health outcomes among immigrant and U.S.-born minority groups.

Cumulative Advantage, Cumulative Disadvantage, and Evolving Patterns of Late-Life Inequality.

Purpose of the Study: Earlier studies have identified a pattern of cumulative advantage leading to increased within-cohort economic inequality over the life course, but there is a need to better understand how levels of inequality by age have changed in the evolving economic environment of recent decades. We utilized Survey of Income and Program Participation (SIPP) data to compare economic inequality across age groups for 2010 versus 1983-1984. Design and Methods: We examined changing age profiles of inequality using a summary measure of economic resources taking into account income, annuitized value of wealth, and household size. We adjusted for survey underreporting of some income and asset types, based on National Income Accounts and other independent estimates of national aggregates. We examined inequality by age with Gini coefficients. Results: Late-life (65+) inequality increased between the 2 periods, with Gini coefficients remaining higher than during the working years, but with a less steep age difference in inequality in 2010 than in 1983-1984. Inequality increased sharply within each cohort, particularly steeply in Depression-era, war-baby, and leading-edge baby boom cohorts. The top quintile of elderly received increasing shares of most income sources. Implications: Increasing inequality among older people, and especially in cohorts approaching late life, presages upcoming financial challenges for elderly persons in the lower part of the income distribution. Implications of this increasingly high-inequality late-life environment need to be carefully evaluated as changes are considered in Social Security and other safety-net institutions, which moderate impacts of economic forces that drive increasingly disparate late-life economic outcomes.

Age of Migration and the Incidence of Cognitive Impairment: A Cohort Study of Elder Mexican-Americans.

BACKGROUND AND OBJECTIVES: To explore nativity and age of migration differentials in the incidence of cognitive impairment among older Mexican-Americans. RESEARCH DESIGN AND METHODS: We employ maximum-likelihood discrete time hazard models to estimate risk ratios of cognitive impairment in a sample of 2,708 Mexican-Americans 65 and older who were cognitively healthy at baseline over a follow-up period of up to 20 years. RESULTS: Late-life immigrant women have a 46% higher risk of cognitive impairment compared to U.S.-born Mexican-American women. Conversely, midlife immigrant men have a 29% lower risk of cognitive impairment compared to U.S.-born Mexican-American men. The incidence of cognitive impairment did not differ for early-life and midlife immigrant women relative to U.S.-born women or for early- and late-life immigrant men compared to U.S.-born men. DISCUSSION AND IMPLICATIONS: Differences in cognitive impairment risk between U.S.-born and foreign-born Mexican-American subgroups may be partly due to health selectivity. Cognitive impairment is more prevalent among immigrant groups which may result in a higher burden on family members and/or high dependency on public resources. Programs are needed that can detect decline at earlier stages and reduce the risk for cognitive impairment among older immigrants entering their last decades of life.

The Longevity Legacy of World War II: The Intersection of GI Status and Mortality.

PURPOSE OF THE STUDY: We examine hypotheses involving the potential health advantages of selection into military service and the potential health disadvantages associated with the experience of military service by comparing later-life mortality rates for veterans and nonveterans as well as among veterans based on their cohort of reentry into civilian life. DESIGN AND METHODS: We use data on 3,453 men, including 1,496 veterans from the older men cohort of the National Longitudinal Surveys to estimate Cox proportional hazard mortality models. We distinguish between veterans and nonveterans and further classify veterans by age at exit while incorporating measures associated with military selection, health behaviors, and socioeconomic status. RESULTS: Veterans who were discharged from the military at older ages have a mortality advantage relative to veterans discharged at younger ages. For the 1914-1921 birth cohorts, the mortality advantage for veterans who exited around age 30 is apparent for deaths before age 65, but rates equalize across all groups when deaths at older ages are included. These findings are robust to the inclusion of background characteristics, education, occupation, body mass index, smoking, marital status, and proxies for service deferments. IMPLICATIONS: Rather than focusing on a general health effect of military service, per se, future research should distinguish among individual traits; the nature, timing, and duration of exposures relative to life course stage; and the sociohistorical context of military service to expand our understanding of the differential health consequences of military service.

Health insurance instability among older immigrants: region of origin disparities in coverage.

OBJECTIVES: We provide a detailed analysis of how the dynamics of health insurance coverage (HIC) at older ages differs among Latino, Asian, and European immigrants in the United States. METHOD: Using Survey of Income and Program Participation data from the 2004 and 2008 panels, we estimate discrete-time event history models to examine first and second transitions into and out of HIC, highlighting substantial differences in hazard rates among immigrants aged 50-64 from Asia, Latin America, and Europe. RESULTS: We find that the likelihood of having HIC at first observation and the rates of gaining and losing coverage within a relatively short time frame are least favorable for older Latino immigrants, although immigrants from all three regions are at a disadvantage relative to native-born non-Hispanic Whites. This disparity among immigrant groups persists even when lower rates of citizenship, greater difficulty with English, and low-skill job placements are taken into account. DISCUSSION: Factors that have contributed to the lower rates and shorter durations of HIC among older immigrants, particularly those from Latin America, may not be easily resolved by the Affordable Care Act. The importance of region of origin and assimilation characteristics for the risk of being uninsured in later life argues that immigration and health care policy should be jointly addressed.

Trends in cancer screening by citizenship and health insurance, 2000-2010.

While early detection through screenings for breast, cervical, and colorectal cancer is essential in improving cancer survival, it is not evenly utilized across class, race, ethnicity, or nativity. Given that utilization of early detection through screenings is not evenly distributed, immigrants who have much lower rates of health insurance coverage are at a disadvantage. We use National Health Interview Survey data linked with the Medical Expenditures Panel Survey to examine the trend in screening rates for breast, cervical, and colorectal cancer from 2000 to 2010, comparing U.S.-born natives, foreign-born citizens, and foreign-born non-citizens. We find that citizenship is clearly advantageous for the foreign-born, and that screening rates are higher among citizens compared to non-citizens overall, but uninsured non-citizens sometimes have higher screening rates that uninsured natives. Health insurance is pivotal for higher screening rates with clear differences among the insured and uninsured. Policies aimed at reducing disparities in cancer screening need to take into account nativity, citizenship, and access to health insurance.