Marital Biography, Social Security Receipt, and Poverty

Student loans, physical and mental health, and health care use and delay in college

Objective: Determine relationships between college students' student loan presence and self-rated physical and mental health, major medical problems, mental health conditions, physical, dental, and mental health care visits and delays, and medication use and reductions. Participants: A total of 3,248 undergraduates at two regional public U.S. universities, surveyed Spring 2017. Methods: OLS and Logistic regression. Results: Loan presence was related to significantly worse self-rated physical and mental health and more major medical problems, but not to mental health conditions, or physical or mental health medication use. Respondents with loans were less likely to visit the dentist and more likely to report delaying medical, dental, and mental health care, and reducing medication use to save money. Conclusions: Results provide evidence of health and health care use divides among college students by loan presence.

Marital transitions during earlier adulthood and subsequent health and well-being in mid- to late-life among female nurses: An outcome-wide analysis

Comparing outcomes for individuals remaining married to those for single or divorced individuals might overstate the positive effects of the decision to marry, since marriage carries an inherent risk of divorce and its associated negative outcomes. While a growing literature has examined marital transitions, confounding by past marital history remains a concern and only a limited set of outcomes have been examined. To address these issues, this study examined incident first-time marriage and incident divorce/separation in relation to multiple subsequent physical health, health behavior, psychological distress, and psychosocial well-being outcomes in a large sample of female nurses in the U.S.. Data from the Nurses' Health Study II were studied (1993 to 2015/2017 questionnaire wave, Nmarriage analyses = 11,830, Ndivorce/separation analyses = 73,018, interquartile range of baseline age = 35 to 42 years). A set of regression models were used to regress each outcome on marital transition status, adjusting for a wide range of initial health and wellbeing status in addition to other covariates. Bonferroni correction was performed to account for multiple testing. Among the initially never married, those who became married had lower mortality (RR = 0.65, 95%CI = 0.50, 0.84), lower risks of cardiovascular diseases (e.g., RRstroke = 0.64, 95%CI = 0.50, 0.82), greater psychological wellbeing and less psychological distress (e.g., ßdepressive symptoms = -0.10, 95%CI = -0.15, -0.06). Among the initially married, those who became divorced/separated had lower social integration (β = -0.15, 95%CI = -0.19, -0.11), greater psychosocial distress (e.g., RRdepression = 1.23, 95%CI = 1.10, 1.37), and possibly greater risks of mortality, cardiovascular diseases, and smoking. Future research could study similar questions using data from more recent cohorts, examine potential mechanisms and heterogeneity, and also examine alternative social relationship types.

When Marriage Ends: Differences in Affluence and Poverty Among Older Adults in Israel

Studies show that the economic benefits of marriage carry over into old age and that widowhood and divorce have detrimental economic consequences, especially for women. This study asks how affluence and poverty are affected by the timing of widowhood and divorce and tests whether they operate in symmetry. The study draws on Israel's annual Social Survey from multiple years (2013-2017), conducted by Israel's Central Bureau of Statistics. The sample is limited to older individuals, aged 55+ (n = 4824 men, 5643 women). The findings show that married people are less likely to be poor than unmarried people, but they are not always more likely to be affluent. Widowed men and women, and divorced men are more likely to achieve affluence than continuously married couples. The explanation may be that, in the Israeli context, the widowed tend to inherit benefits accumulated by their late spouse, whereas the divorced tend to divide resources when the marriage dissolves. Women incur higher and longer-term penalties for their change in marital status than do men, so that previously married women tend to have higher rates of poverty and lower rates of affluence than previously married men. The findings show that affluence and poverty do not operate in symmetry and that affluence does not simply mirror poverty, especially among men. For example, early widowed and late divorced men have higher odds of both poverty and affluence than married men. These findings demonstrate that poverty and affluence operate differently and examining both leads to new insights.

Marital Loss and Cognitive Function: Does Timing Matter?

OBJECTIVES

This study examines the association between age at marital loss (i.e., divorce or widowhood) and cognitive function in later life and whether the association differs by gender.

METHODS

We used mixed-effects models, drawing on longitudinal data from the Health and Retirement Study (1998-2016). The analytical samples included adults aged 51 and older who had ever been widowed (N = 5,639 with 25,537 person-waves) or divorced (N = 10,685 with 50,689 person-waves).

RESULTS

We find that those who were widowed at younger ages had lower cognitive function than their counterparts who were widowed at older ages, for both men and women, after controlling for covariates. Household income and health-related factors partially accounted for the positive association between age at widowhood and cognitive function. Those who divorced at younger ages also had lower cognitive function than their counterparts who divorced at older ages, but this association was only present among men, not women. Health-related factors partially accounted for the association between age at divorce and cognitive function among men.

DISCUSSION

Findings highlight the importance of considering the role of timing of marital loss in cognitive health among older adults.

Gender, union formation, and assortative mating among older women

This paper presents a search-theoretic model of union formation among women, aged 55 and older. Specifically, it provides new estimates of gender differentials in cohabitation and marriage at older ages, and documents recent patterns of assortative mating using data from the 2008-2017 American Community Survey. Our analyses reveal that cohabitation represents a much smaller share of all older unmarried women, all partnered women, and all women in comparison to patterns observed among their male counterparts. The results also reveal highly uneven patterns of union formation by age, race and marital history, which reflect demographically uneven constraints and preferences. Our analyses also document, for the first time, patterns of assortative mating at older ages. Shortages of similarly-aged men, especially among older African American women, seemingly heighten the likelihood of demographically mismatched unions. Older women are less likely to form unions with same-race or economically attractive partners, defined as men having a college-degree. This study shows that older single women, in general, are at a comparative disadvantage in the marriage market, both in forming co-residential unions and in finding partners who match their own social, demographic, and economic profiles. This paper highlights considerable heterogeneity in the experiences of America's older women. It calls for new theoretical approaches that acknowledge the unequal resources and bargaining power among older women in the marriage market.

Affordability of Medical Care Among Medicare Enrollees

Importance

Cost-sharing requirements can discourage patients from seeking care and impose financial hardship. The Medicare program serves many older and disabled individuals with multimorbidity and limited resources, but little has been known about the affordability of care in this population.

Objective

To examine the affordability of medical care among Medicare enrollees, in terms of the prevalence of delaying medical care because of costs and having problems paying medical bills, and risk factors for these outcomes.

Design Setting and Participants

Cross-sectional analyses conducted from November 1, 2019, to October 15, 2021, used logistic regression to compare the probability of outcomes by demographic and health characteristics. Data were obtained from the 2017 nationally representative Medicare Current Beneficiary Survey (response rate, 61.7%), with respondents representing 53 million community-dwelling Medicare enrollees.

Main Outcomes and Measures

New questions about medical care affordability were included in the 2017 Medicare Current Beneficiary Survey: difficulty paying medical bills, ongoing medical debt, and contact by collection agencies. A companion survey question asked whether individuals had delayed seeking medical care because of worries about costs.

Results

Respondents included 10 974 adults aged 65 years or older and 2197 aged 18 to 64 years; 54.2% of all respondents were women. The weighted proportions of Medicare enrollees with annual incomes below $25 000K were 30.7% in the older population and 67.4% in the younger group. Self-reported prevalence of delaying care because of cost was 8.3% (95% CI, 7.4%-9.1%) among enrollees aged 65 years or older, 25.2% (95% CI, 21.8%-28.6%) among enrollees younger than 65 years, and 10.9% (95% CI, 9.9%-11.9%) overall. Similarly, 7.4% (95% CI, 6.6%-8.2%) of older enrollees had problems paying medical bills, compared with 29.8% (95% CI, 25.6%-34.1%) among those younger than 65 years and 10.8% (95% CI, 9.8%-11.9%) overall. Regarding specific payment problems, 7.9% (95% CI, 7.0%-8.9%) of enrollees overall experienced ongoing medical debt, contact by a collection agency, or both. In adjusted analyses, older adults with incomes $15 000 to $25 000 per year had odds of delaying care more than twice as high as those with incomes greater than $50 000 (odds ratio, 2.47; 95% CI, 1.82-3.39), and their odds of problems paying medical bills were more than 3 times as high (odds ratio, 3.37; 95% CI, 2.81-5.21). Older adults with 4 to 10 chronic conditions were more than twice as likely to have problems paying medical bills as those with 0 or 1 condition.

Conclusions and Relevance

The findings of this study suggest that unaffordability of medical care is common among Medicare enrollees, especially those with lower incomes, or worse health, or who qualify for Medicare based on disability. Policy reforms, such as caps on patient spending, are needed to reduce Medical cost burdens on the most vulnerable enrollees.

The Economic Consequences of Gray Divorce for Women and Men

OBJECTIVES

Gray divorce, which describes divorce among persons aged 50 and older, is increasingly common reflecting the doubling of the gray divorce rate since 1990. Yet, surprisingly little is known about the consequences of gray divorce and in particular how women and men fare economically during the aftermath.

METHOD

Using longitudinal data from the 2004-2014 Health and Retirement Study, we estimated hybrid fixed/random-effects models comparing women's and men's economic well-being prior to, during, and following gray divorce and subsequent repartnering.

RESULTS

Women experienced a 45% decline in their standard of living (measured by an income-to-needs ratio), whereas men's dropped by just 21%. These declines persisted over time for men, and only reversed for women following repartnering, which essentially offset women's losses associated with gray divorce. No gender gap emerged for changes in wealth following divorce with both women and men experiencing roughly a 50% drop. Similarly, repartnering was ameliorative only for women's wealth.

DISCUSSION

Gray divorce is often financially devastating, especially for women. Although repartnering seems to reverse most of the economic costs of gray divorce for women, few form new co-residential unions after divorce. This study offers a cautionary tale about the financial aftermath of gray divorce, which is likely to contribute to growing economic disadvantage among older adults.

Divorce, health, and socioeconomic status: An agenda for psychological science

This brief review article discusses marital dissolution and health with a focus on two specific themes. First, we introduce and discuss the search for plausible causal pathways that link the end of marriage to distal health outcomes. Second, we suggest that the socioeconomic status disruptions that follow divorce represent a plausible causal pathway and emphasize the need for more psychological science in this area of study. Although there is substantial literature that demonstrates that divorced adults, especially divorced women, experience significant financial disruptions, the research in this area remains broad and largely the province of family sociology and demography. Research is needed to better understand adults' psychological and behavioral responses to changes in their financial situation after the end of marriage.

The double burden of poverty and marital loss on the mental health of older Australian women; a longitudinal regression analysis using 17 annual waves of the HILDA cohort

PURPOSE

Compared to men, older women have poorer mental health and are more vulnerable to poverty, especially when living alone. However, few studies have examined how gender, marital status and poverty are inter-related and are associated with mental health. This study examines the gendered associations between relative poverty, marital status and mental health in older Australians.

METHODS

Drawing on 17 waves of the HILDA Survey, fixed-effects longitudinal regression analysis was utilised to examine the association between: (1) relative poverty (< 50% median household income) and mental health (MHI-5); (2) marital status and poverty, in a cohort of Australians aged 65 + years. We then examined effect modification of the association between relative poverty and mental health by marital status.

RESULTS

Within-person associations, stratified by gender, showed that women in relative poverty reported poorer mental health than when not in relative poverty, however no association was observed for men. Being divorced/separated was associated with increased odds of relative poverty for women, but not men. Widowhood was strongly associated with relative poverty in women, and also among men, albeit a smaller estimate was observed for men. There was no evidence of effect modification of the relationship between relative poverty and mental health by marital status for either men or women.

CONCLUSION

This study provides evidence that relative poverty is a major determinant of mental health in older Australian women. Addressing gender inequities in lifetime savings, as well as in division of acquired wealth post marital loss, may help reduce these disparities.

Marital loss and risk of dementia: Do race and gender matter?

Recent studies have found that marital loss through divorce or widowhood is associated with a higher risk of dementia for older adults. However, whether these associations vary by race and gender is less clear. To address this gap, we drew upon longitudinal data from the Health and Retirement Study (2000-2016) to investigate the association between marital loss and dementia risk, separately for non-Hispanic Whites and non-Hispanic Blacks. We further examined gender variations in the link between marital loss and dementia risk within each racial group. Results from discrete-time event history models suggested that widowhood is significantly associated with a higher risk of dementia for both Whites and Blacks, controlling for basic demographic characteristics. However, while divorce is significantly associated with a higher risk of dementia for Blacks, the association is marginally significant (p < 0.1) for Whites. There are few significant gender variations in these associations except for the effect of divorce among Whites. Even after controlling for economic and health-related factors, we found that divorce is associated with a higher risk of dementia among White men but not among White women. Economic resources explain a significant portion of the association between widowhood and dementia risk, more so for Whites than for Blacks. Our findings call for more research into the pathways through which marital loss shapes the risk of dementia across racial and ethnic groups.

Grandparental partnership status and its effects on caring for grandchildren in Europe

Grandparents are important childcare providers, but grandparental relationship status matters. According to several studies, caregiving is reduced after grandparental divorce, but differential responses by grandmothers versus grandfathers have often been glossed over. To explore the effects of relationship status on grandparental care, we analysed data from the Survey of Health, Ageing and Retirement in Europe (SHARE) comparing four grandparental relationship statuses (original couple, widowed, divorced, and repartnered) with respect to grandmothers' and grandfathers' provision of care to their birth children's children. When proximity, kinship laterality, and grandparents' age, health, employment, and financial status were controlled, divorced grandmothers without current partners provided significantly more childcare than grandmothers who were still residing with the grandfather, those who had new partners unrelated to the grandchildren, and widows without current partners. Grandfathers exhibited a very different pattern, providing substantially less grandchild care after divorce. Grandfathers in their original partnerships provided the most grandchild care, followed by widowers, those with new partners and finally those who were divorced. Seemingly contradictory findings in prior research, including studies using SHARE data, can be explained partly by failures to distinguish divorce's effects on grandmothers versus grandfathers, and partly by insufficient controls for the grandmother's financial and employment statuses.

The Roles of Marital Dissolution and Subsequent Repartnering on Loneliness in Later Life

OBJECTIVES

Loneliness in later life is associated with poorer health and higher risk of mortality. Our study assesses whether gray divorced adults report higher levels of loneliness than the widowed and whether social support or repartnership offset loneliness.

METHOD

Using data from the 2010 and 2012 Health and Retirement Study, we estimated ordinary least squares regression models for women (n = 2,362) and men (n = 1,127) to examine differences in loneliness by dissolution pathway (i.e., divorce versus widowhood), accounting for social support and repartnership.

RESULTS

Divorced men were lonelier than their widowed counterparts. Although social support reduced loneliness among men, the difference between the divorced and widowed persisted. Repartnership assuaged men's loneliness and reduced the variation between divorced and widowed men. Among women, the results did not reveal differences in loneliness for the divorced and widowed although social support and repartnership linked to less loneliness.

DISCUSSION

Later-life marital dissolutions increasingly occur through divorce rather than spousal death. Some older adults go on to form new partnerships. Our findings demonstrate the importance of gerontological research widening the lens beyond widowhood to consider the ramifications of later-life divorce and repartnership for well-being.

Midlife Marital Dissolution and the Onset of Cognitive Impairment

BACKGROUND AND OBJECTIVES

Marital dissolution has become more common in midlife with the doubling of the divorce rate among middle-aged adults. Guided by the stress model that stipulates losing economic, social, and psychological resources lowers well-being, we posited that midlife adults who experienced divorce or widowhood were at greater risk of cognitive impairment than the continuously married. Subsequent repartnering was expected to negate the increased risk.

RESEARCH DESIGN AND METHODS

We used data from the 1998-2016 Health and Retirement Study to estimate discrete-time event history models using logistic regression to predict cognitive impairment onset for men and women.

RESULTS

Roughly 27% of men who experienced spousal death in midlife went on to experience mild cognitive impairment by age 65. For women, experiencing divorce or widowhood was associated with higher odds of cognitive impairment onset although these differentials were accounted for by economic, social, and psychological resources. Men and women who repartnered after marital dissolution did not appreciably differ from their continuously married counterparts in terms of their likelihoods of cognitive impairment onset.

DISCUSSION AND IMPLICATIONS

A stressful life event, midlife marital dissolution can be detrimental to cognitive well-being, placing individuals at increased risk of developing dementia in later life. The growing diversity of partnership experiences during the second half of life points to the continued importance of examining how union dissolution and formation shape health and well-being.

Early-Life Parent-Child Relationships and Adult Children's Support of Unpartnered Parents in Later Life

OBJECTIVES

The proportion of older adults who are unpartnered has increased significantly over the past 25 years. Unpartnered older adults often rely on their adult children for support. Most previous studies have focused on proximal factors associated with adult children's support of their parents, while few have examined distal factors, such as parent-child relationships formed during childhood. This study fills the gap by investigating the direct and indirect associations between early-life parent-child relationships and adult children's upward transfers to unpartnered parents.

METHOD

Data came from two supplements to the Panel Study of Income Dynamics, in which respondents were asked about their relationships with mothers and fathers before age 17 and their transfers of time and money to parents in 2013. Path models were estimated for unpartnered mother-adult child dyads and father-adult child dyads separately.

RESULTS

For adult children of unpartnered mothers, psychological closeness has a direct, positive association with time transfer, while physical violence has an indirect association with time transfer through adult children's marital status. For adult children of unpartnered fathers, psychological closeness has neither a direct nor an indirect association with time or money transfer, but physical violence has a direct, negative association with time transfer.

DISCUSSION

Early-life parent-child relationships play a pivotal role in influencing adult children's caregiving behavior, both directly and indirectly. Our findings suggest that by improving their relationships with children early in life, parents may be able to increase the amount of time transfer that they receive in late life.

Families in Later Life: A Decade in Review

Later-life families encompass the legal, biological, romantic, and kin-like relationships of persons ages 65 and older. Research on older families has flourished over the past decade, as population aging has intensified concerns regarding the capacities of families to care for older adults and the adequacy of public pension systems to provide an acceptable standard of living. Shifting patterns of family formation over the past half-century have created a context in which contemporary older adults' family lives differ markedly from earlier generations. Decreasing numbers of adults are growing old with their first and only spouse, with rising numbers divorcing, remarrying, forming non-marital romantic partnerships, or living single by choice. Remarriage and the formation of stepfamilies pose challenges and opportunities as older adults negotiate complex decisions such as inheritance and caregiving. Family relationships are consequential for older adults' well-being, operating through both biological and psychosocial mechanisms. We synthesize research from the past decade, revealing how innovations in data and methods have refined our understanding of late-life families against a backdrop of demographic change. We show how contemporary research refines classic theoretical frameworks and tests emerging conceptual models. We organize the article around two main types of family relationships: (1) marriage and romantic partnerships and (2) intergenerational relationships. We discuss how family caregiving occurs within these relationships, and offer three promising avenues for future research: ethnic minority and immigrant families; older adults without close kin ("elder orphans"); and the potentials of rapidly evolving technologies for intergenerational relationships and caregiving.

Divorce, Repartnering, and Stepfamilies: A Decade in Review

This article reviews key developments in the past decade of research on divorce, repartnering, and stepfamilies. Divorce rates are declining overall, but they remain high and have risen among people older than age 50. Remarriage rates have declined, but the overall proportion of marriages that are remarriages is rising. Transitions in parents' relationships continue to be associated with reduced child well-being, but shifting patterns of divorce and repartnering during the past decade have also reshaped the family lives of older adults. We review research on the predictors and consequences of these trends and consider what they reveal about the changing significance of marriage as an institution. Overall, recent research on divorce, repartnering, and stepfamilies points to the persistence of marriage as a stratified and stratifying institution and indicates that the demographic complexity of family life is here to stay.

Wealth in Middle and Later Life: Examining the Life Course Timing of Women's Health Limitations

BACKGROUND AND OBJECTIVES

Guided by cumulative inequality theory, this study poses two main questions: (a) Does women's poor health compromise household financial assets? (b) If yes, is wealth sensitive to the timing of women's health limitations? In addressing these questions, we consider the effect of health limitations on wealth at older ages, as well as examine how health limitations influence wealth over particular segments of the life course, giving attention to both the onset and duration of health limitations.

RESEARCH DESIGN AND METHODS

Using 36 years of data from the National Longitudinal Survey of Mature Women, piecewise growth curve and linear regression models were used to estimate the effects of life course timing and duration of health limitations on household wealth.

RESULTS

The findings reveal that women who experienced health limitations accumulated substantially less wealth over time, especially if the health limitations were manifest during childhood or early adulthood.

DISCUSSION AND IMPLICATIONS

This study identifies how early-life health problems lead to less wealth in later life.

Later Life Marital Dissolution and Repartnership Status: A National Portrait

Objectives

Our study compares two types of later life marital dissolution that occur after age 50-divorce and widowhood-and their associations with repartnership status (i.e., remarried, cohabiting, or unpartnered).

Method

We used data from the Health and Retirement Study to provide a portrait of later life divorce and widowhood for women and men. Next, we tested whether marital dissolution type is related to women's and men's repartnered status, distinguishing among remarrieds, cohabitors, and unpartnereds, net of key sociodemographic indicators.

Results

Divorcees are more often repartnered through either remarriage or cohabitation than are widoweds. This gap persists among women net of an array of sociodemographic factors. For men, the differential is reduced to nonsignificance with the inclusion of these factors.

Discussion

Later life marital dissolution increasingly occurs through divorce rather than widowhood, and divorce is more often followed by repartnership. The results from this study suggest that gerontological research should not solely focus on widowhood but also should pay attention to divorce and repartnering during later life.

Depressive Symptoms Following Later-life Marital Dissolution and Subsequent Repartnering

The doubling of the divorce rate among individuals over age 50 during the past 20 years underscores the urgency of studying the consequences of gray divorce and subsequent repartnering for adult well-being. We filled this gap by using the 1998-to-2014 Health and Retirement Study to evaluate how the levels of depressive symptoms changed following gray divorce versus widowhood. Individuals who divorced or became widowed already had experienced higher levels of depressive symptoms before dissolution relative to those who remained married. Compared with those who became widowed, those who transitioned to divorce experienced a lower elevation and a shorter time to recovery in depressive symptoms. When repartnering, both groups experienced similar magnitudes of initial reduction and subsequent rates of increase. Both the negative consequences of marital dissolution and the beneficial effects of repartnership for mental health persisted for several years, although ultimately they reverted to their predissolution levels of depressive symptoms.

Sibling Influences, Sibling Similarities, and Parent Care in Late Life

Researchers have extensively examined why some particular adult children provide care to their aged parents, but rarely considered sibling similarities and influences in their examinations. Guided by social learning theory and diffusion of responsibility theory, we investigate whether sibling similarities are associated with adult children's care hours, net of the parent's and child's characteristics. Based on social comparison theory, we further examine whether such associations differ across adult children, depending on whether adult children share the same characteristics as their siblings. Using Round 5 data from the National Health and Aging Trends Study, we find that adult children provide more care hours when siblings are close in age, supporting social learning theory. In contrast, adult children provide fewer care hours in the presence of a greater share of siblings who are unpartnered or close to the parents, supporting diffusion of responsibility theory. Consistent with social comparison theory, social learning is stronger for younger adult children, and diffusion of responsibility is weaker when adult children are unpartnered or close to the parents. Findings from this study highlight the importance for future research of going beyond parent-child dyads and incorporate sibling influences when studying the caregiving behavior of adult children.

Marriage, Cohabitation, and Divorce in Later Life

Older adults are at the forefront of family change as a declining share experiences lifelong marriage and rates of cohabitation and divorce in later life continue to rise. The goal of this article is to review recent scholarship on marriage, cohabitation, and divorce among older adults and identify directions for future research. The varied family experiences characterizing the later life course demonstrate the importance of moving beyond marital status to capture additional dimensions of the marital biography, including transitions, timing, duration, and sequencing. Cohabitation operates as an alternative to marriage for older adults and is increasingly replacing remarriage following divorce or widowhood. The gray divorce rate has doubled in recent decades as older adults abandon marriage in favor of unmarried partnerships or singlehood. The retreat from marriage among older adults raises important questions about the ramifications of family change for health and well-being as well as access to caregivers given that spouses historically have been the primary source of care.