Cohort Differences in Parental Financial Help to Adult Children

In this article, we examine birth cohort differences in parents' provision of monetary help to adult children with particular focus on the extent to which cohort differences in family structure and the transition to adulthood influence these changes. Using data from the Health and Retirement Study from 1994 to 2010, we compare financial help to children of three respondent cohorts as the parents in these birth cohorts from ages 53-58 to 57-62. We find that transfers to children have increased among more recent cohorts. Two trends-declining family size and children's delay in marriage-account for part of the increase across cohorts. However, other trends, such as the increase in the number of stepchildren and increasing child's income level, tend to decrease the observed cohort trend.

Envejecimiento, salud y economía. La Encuesta Nacional sobre Salud y Envejecimiento en México

México vive una transición demográfica en la cual el porcentaje de la población mayor de 50 años crece aceleradamente como resultado de un aumento considerable en la esperanza de vida. Dicha población tiene necesidades particulares que deben de ser tomadas en cuenta en la formulación de políticas, sobre todo en materia de acceso a servicios de salud y seguridad social. En este artículo presentamos una descripción general de la Encuesta Nacional de Salud y Envejecimiento (Enasem), un estudio de panel que comenzó en 2001 y que ofrece una oportunidad única para abordar temas demográficos y económicos complejos por medio de la exploración de las características personales, transferencias socioeconómicas e indicadores de salud para una muestra de 15 186 adultos de edad media y avanzada. También presentamos los resultados más relevantes de diferentes estudios que han utilizado la Enasem hasta la fecha. Nuestra revisión indica que México enfrenta desafíos considerables para satisfacer la demanda de servicios médicos para una población que es amenazada por una creciente presencia de enfermedades crónicas, sobre todo para la población de edad avanzada que no cuenta con cobertura de seguro médico.

Ethnic Differences in Time Transfers from Adult Children to Elderly Parents

This article examines differences across racial-ethnic groups in patterns of time transfers from middle-aged adult children to their elderly parents and the degree to which heterogeneity in unobserved family-level factors may explain observed differences. Using data from the 1992 Health and Retirement Study (HRS) on respondents and their siblings, the analysis supports the hypothesis that the determinants of time assistance vary across racial-ethnic groups: Controlling for socioeconomic attributes of potential donors and the recipient, there is evidence of unobserved family-level heterogeneity for Whites and Blacks but not for Hispanics.

Parental Money Help to Children and Stepchildren

Divorce and remarriage have reshaped the American family giving rise to questions about the place of stepchildren in remarried families. In this article, we examine money transfers from a couple to each of their children. We introduce characteristics of the family and estimate the role of shared family membership affecting all children in the family as well as the difference that stepchild status and other individual characteristics make in transfer flows. Data are from the Health and Retirement Study. There are two central results in the analysis. Overall, provision of financial help from parents to children is a family phenomenon. While help to a particular child is episodic, differences between families in provision of help were much greater than the differences in helping one child versus another within families. Second, stepchild status does differentiate one child from another within a family. Stepchildren are disadvantaged, particularly stepchildren of the wife.

Association of blood lipids, creatinine, albumin, and CRP with socioeconomic status in Malawi

BACKGROUND

The objective of these analyses is to document the relationship between biomarker-based indicators of health and socioeconomic status (SES) in a low-income African population where the cumulative effects of exposure to multiple stressors on physiological functions and health in general are expected to be highly detrimental for the well-being of individuals.

METHODS

Biomarkers were collected subsequent to the 2008 round of the Malawi Longitudinal Study of Families and Health (MLSFH), a population-based study in rural Malawi, including blood lipids (total cholesterol, LDL, HDL, ratio of total cholesterol to HDL), biomarkers of renal and liver organ function (albumin and creatinine) and wide-range C-reactive protein (CRP) as a non-specific biomarker for inflammation. These biomarkers represent widely used indicators of health that are individually or cumulatively recognized as risk factors for age-related diseases among prime-aged and elderly individuals. Quantile regressions are used to estimate the age-gradient and the within-day variation of each biomarker distribution. Differences in biomarker levels by socioeconomic status are investigated using descriptive and multivariate statistics.

RESULTS

Overall, the number of significant associations between the biomarkers and socioeconomic measures is very modest. None of the biomarkers significantly varies with schooling. Except for CRP where being married is weakly associated with lower risk of having an elevated CRP level, marriage is not associated with the biomarkers measured in the MLSFH. Similarly, being Muslim is associated with a lower risk of having elevated CRP but otherwise religion does not predict being in the high-risk quartiles of any of the MLSFH biomarkers. Wealth does not predict being in the high-risk quartile of any of the MLSFH biomarkers, with the exception of a weak effect on creatinine. Being overweight or obese is associated with increased likelihood of being in the high-risk quartile for cholesterol, Chol/HDL ratio, and LDL.

CONCLUSIONS

The results provide only weak evidence for variation of the biomarkers by socioeconomic indicators in a poor Malawian context. Our findings underscore the need for further research to understand the determinants of health outcomes in a poor low-income context such as rural Malawi.

Family structure and the reproduction of inequality: Parents' contribution to children's college costs

This article examines the role of family structure in the financial support parents provide for their children's college education. Data are from the Health and Retirement Study. We focus on aspects of family structure that affect parental support and estimate shared family variance in investments as well as within-family variation using a multilevel model. Family membership accounts for about 60% of the variance in payment of college costs. Small family size, living with both biological parents (compared to one biological parent and a stepparent), higher parental education, and having older parents are associated with greater parental expenditures.

Why Do Families Differ? Children's Care for an Unmarried Mother

An adult child's provision of care to an unmarried elderly mother varies both within and between families. Within-family differences address the variation in different children's behavior within in a family. Between-family differences refer to the propensities that members of a family-the children of one mother-share and that differentiate them from other families. Previous research suggests five hypotheses affecting either within-family or between-family differences. Data from multiple waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) cohort of the Health and Retirement Study (HRS; 16,719 observations on 5,607 mother-child dyads in 1,925 families) are used to estimate a multilevel model with a binary outcome. Results indicate substantial differences between families. Mother's characteristics, family composition, and family history account for about half the between-family differences.

Do early-life conditions predict functional health status in adulthood? The case of Mexico

Relatively few researchers have investigated early antecedents of adult functional limitations in developing countries. In this study, we assessed associations between childhood conditions and adult lower-body functional limitations (LBFL) as well as the potential mediating role of adult socioeconomic status, smoking, body mass index, and chronic diseases or symptoms. Based on data from the Mexican Health and Aging Study (MHAS) of individuals born prior to 1951 and contacted in 2001 and 2003, we found that childhood nutritional deprivation, serious health problems, and family background predict adult LBFL in Mexico. Adjustment for the potential mediators in adulthood attenuates these associations only to a modest degree.

Material resources and population health: disadvantages in health care, housing, and food among adults over 50 years of age

OBJECTIVES

We examined associations between material resources and late-life declines in health.

METHODS

We used logistic regression to estimate the odds of declines in self-rated health and incident walking limitations associated with material disadvantages in a prospective panel representative of US adults aged 51 years and older (N = 15,441).

RESULTS

Disadvantages in health care (odds ratio [OR] = 1.39; 95% confidence interval [CI] = 1.23, 1.58), food (OR = 1.69; 95% CI = 1.29, 2.22), and housing (OR = 1.20; 95% CI = 1.07, 1.35) were independently associated with declines in self-rated health, whereas only health care (OR = 1.43; 95% CI = 1.29, 1.58) and food (OR = 1.64; 95% CI = 1.31, 2.05) disadvantage predicted incident walking limitations. Participants experiencing multiple material disadvantages were particularly susceptible to worsening health and functional decline. These effects were sustained after we controlled for numerous covariates, including baseline health status and comorbidities. The relations between health declines and non-Hispanic Black race/ethnicity, poverty, marital status, and education were attenuated or eliminated after we controlled for material disadvantage.

CONCLUSIONS

Material disadvantages, which are highly policy relevant, appear related to health in ways not captured by education and poverty. Policies to improve health should address a range of basic human needs, rather than health care alone.

End-of-life medical treatment choices: do survival chances and out-of-pocket costs matter?

BACKGROUND

Out-of-pocket medical expenditures incurred prior to the death of a spouse could deplete savings and impoverish the surviving spouse. Little is known about the public's opinion as to whether spouses should forego such end-of-life (EOL) medical care to prevent asset depletion.

OBJECTIVES

To analyze how elderly and near elderly adults assess hypothetical EOL medical treatment choices under different survival probabilities and out-of-pocket treatment costs.

METHODS

Survey data on a total of 1143 adults, with 589 from the Asset and Health Dynamics Among the Oldest Old (AHEAD) and 554 from the Health and Retirement Study (HRS), were used to study EOL cancer treatment recommendations for a hypothetical anonymous married woman in her 80s.

RESULTS

Respondents were more likely to recommend treatment when it was financed by Medicare than by the patient's own savings and when it had 60% rather than 20% survival probability. Black and male respondents were more likely to recommend treatment regardless of survival probability or payment source. Treatment uptake was related to the order of presentation of treatment options, consistent with starting point bias and framing effects.

CONCLUSIONS

Elderly and near elderly adults would recommend that the hypothetical married woman should forego costly EOL treatment when the costs of the treatment would deplete savings. When treatment costs are covered by Medicare, respondents would make the recommendation to opt for care even if the probability of survival is low, which is consistent with moral hazard. The sequence of presentation of treatment options seems to affect patient treatment choice.

Health insurance coverage and the use of preventive services by Mexican adults

The lack of health insurance coverage could be a potentially important deterrent to the use of preventive health care by older adults with high rates of chronic co-morbidities. We use survey data from 12 100 Mexican adults ages 50 and older who participated in the 2001 Mexican Health and Aging Study (MHAS) to analyze the relation between health insurance coverage and the use of preventive health-care services in Mexico. Uninsured adults were less likely to use preventive screenings for hypertension, high cholesterol, diabetes and (breast, cervical and prostate) cancer than insured adults. After adjusting for other factors affecting preventive care utilization in a logistic regression model, we found that these results still hold for high cholesterol and diabetes screening. Similar results hold for the population not working during the survey week and for adults earning below 200% of the poverty line. Our results suggest that insured adults are in a relatively better position to detect some chronic diseases - and have them treated promptly - than uninsured adults because they have better access to cost-effective preventive screenings. Recent public policy initiatives to increase health insurance coverage rates in Mexico could lead to substantially higher preventive health-care utilization rates and improvements in population health.

Childhood predictors of late-life diabetes: the case of Mexico

We investigated the interplay between characteristics of early childhood circumstances and current socioeconomic conditions and health, focusing specifically on diabetes in mid and late life in Mexico. The analysis used data from the 2001 Mexican Health and Aging Study (MHAS), a large nationally representative study of Mexicans born before 1950. We analyzed the extent to which childhood conditions, such as exposure to infectious diseases, a poor socioeconomic environment, and parental education, affect the risk of diabetes in later life. Our results indicate that individuals age 50 and older who experienced serious health problems before age 10 have a higher risk of having late-life diabetes. There is a significant inverse relationship between maternal education and diabetes in late life of adult offspring. Individuals with better educated mothers have a lower risk of being diabetic after age 50. This relationship remains after controlling for other childhood and adult risk factors.

Using anthropometric indicators for Mexicans in the United States and Mexico to understand the selection of migrants and the "Hispanic paradox"

Anthropometric measures including height provide an indication of childhood health that allows exploration of relationships between early life circumstances and adult health. Height can also be used to provide some indication of how early life health is related to selection of migrants and the Hispanic paradox in the United States. This article joins information on persons of Mexican nativity ages 50 and older in the United States collected in the National Health and Nutrition Examination Survey IV (NHANES IV 1999-2002) with a national sample of persons of the same age living in Mexico from the Mexican Health and Aging Survey (MHAS 2001) to examine relationships between height, education, migration, and late-life health. Mexican immigrants to the United States are selected for greater height and a high school, rather than higher or lower, education. Return migrants from the United States to Mexico are shorter than those who stay. Height is related to a number of indicators of adult health. Results support a role for selection in the Hispanic paradox and demonstrate the importance of education and childhood health as determinants of late-life health in both Mexico and the United States.

Wealth in Middle and Old Age in Mexico: The Role of International Migration

This article examines the impact that past migration to the U.S. has on the current economic well-being of individuals in middle or old age who have returned to Mexico. A priori, the net effect of U.S. migration on wealth among return migrants is difficult to predict; there are counteracting factors that can affect wealth positively or negatively. Using data from the Mexican Health and Aging Study 2001 and correcting for selection factors, the long-term effect of U.S. migration for return migrants was found consistently positive in terms of their accumulated personal wealth at middle and old age. This article speculates about the possible mechanisms that can explain this apparent advantage.

[Ageing, health and economics. National inquest into health and ageing in Mexico]

Mexico is experiencing a demographic transition in which the percentage of the population older than 50 years of age is growing rapidly as a result of increases in life expectancy. This population has special needs that must be taken into account when formulating policy, especially in terms of access to health care services and social security. In this article we present a general description of the Mexican Health and Aging Survey (MHAS), a panel study that began in 2001 and that provides a unique opportunity to study complex demographic and economic issues through the exploration of personal characteristics, socioeconomic transfers and health indicators for a sample of 15 186 middle and older age adults. We also present the most important results from different studies that have used MHAS up to date. Our review shows that Mexico faces substantial challenges in order to be able to satisfy the demand for health services for a population that is being increasingly threatened by chronic disease, particularly the elderly population that lacks health insurance coverage.

Financial assistance from middle-aged couples to parents and children: racial-ethnic differences

OBJECTIVES

To examine racial-ethnic differences in the allocation of financial transfers to parents, children, and others by middle-aged couples.

METHODS

Multinomial specification of alternative recipients of financial transfers, using data from the 1992 Health and Retirement Survey.

RESULTS

Transfer patterns are sensitive to parental health and wealth, to children being young or in school, as well as to the donors' health and wealth. Controlling for these and other factors, including family size and structure, Blacks and Whites are the most likely, and Hispanics the least likely, to financially help their parents compared to assisting offspring. Black couples are the most likely to sacrifice their own consumption to assist parents financially.

DISCUSSION

Future research on transfers should attempt to capture unmeasured noneconomic sources of variation proxied by the race-ethnicity indicator.

Asset and Health Dynamics Among the Oldest Old: an overview of the AHEAD Study

This chapter provides background information for the study of Asset and Health Dynamics Among the Oldest Old (AHEAD), a prospective panel survey of persons born in 1923 or earlier who were residing in the community at the time of the 1993 baseline. Interviews were sought with both spouses in married households, and an overall total of 8,222 were completed. We review the interdisciplinary scientific issues that motivated the study, describe the fundamental design decisions that structured AHEAD, and summarize the content in the core and experimental modules. The study provides unusually detailed data on cognition, family structure and transfers, and assets. Data are presented on sample selections, response rates, and oversamples of minority groups. Basic descriptive data on the demographic, health, and socioeconomic attributes of respondents also are presented. Plans for future waves of AHEAD are described, including a next-of-kin interview for decreased respondents.

The division of family labor: care for elderly parents

We consider the division of caregiving efforts among the children of older, functionally limited parents. Our model of parental care assumes that care decisions are made in the context of an extended family, with each child taking into account not only the parent's needs and the child's own circumstances, but also the characteristics and actual care behavior of siblings. We propose a simultaneous-Tobit statistical framework that embodies these assumptions. The model is estimated using data from the 1993 Asset and Health Dynamics Among the Oldest Old (AHEAD) study. The findings indicate that a child's hours of parent care are reduced, but on much less than a one-for-one basis, as the parent-care hours of siblings increase. We also find that a child's supply of parent-care hours is reduced by having sisters, holding constant the care efforts of siblings.

Selection of children to provide care: the effect of earlier parental transfers

We use the first wave of data from the Asset and Health Dynamics Among the Oldest Old (AHEAD) study to examine the effects of past parent-to-child financial transfers on selection of a child to provide assistance with basic personal care for unmarried parents. We estimate a fixed-effects conditional logit model and find a positive and significant association between past financial transfers and a child's current helping behavior. The coefficient of past financial transfers is in the direction hypothesized, and its magnitude is 80% as large as that of gender, a well-documented powerful predictor of parental caregiving. There appears to be substantial evidence that earlier parent-to-child financial gifts play a role in determining which child in the family will provide assistance.

Intergenerational transfers: a question of perspective

Informal intergenerational transfers have traditionally been examined from the perspective of the older generation; more recent studies have proceeded from the perspective of adult children. Drawing upon principles of formal demography, we establish the mathematical relationship between the two generations' perspectives. We then consider the importance of generational perspective with regard to prevalence estimates of intrafamily transfers. Transfers examined include coresidence, household and financial assistance, and personal caregiving. Results have implications for projection of future trends in intrafamily transfers and for data collection.

Family, households, and care arrangements of frail older women: a structural analysis

Previous research has examined determinants of the living arrangements and the informal-care arrangements of older women; research on care arrangements has often taken living arrangements as given. Here we consider each separately, then go on to analyze the simultaneous determinants of living and care arrangements. Factors influencing these outcomes can be categorized as indicators of opportunities, resources, needs, or preferences. Of particular interest is the extent to which kin availability--specifically, the existence of living children--constrains opportunities, the role of financial resources, and the consequences of needs as revealed by levels of physical and mental disability. Our analysis consists of multinomial-logit models estimated with data from the 1982 National Long-Term Care Survey. The results indicate the importance of kin availability, with striking differences in the living and care arrangements between childless and other older women. Among those with children, there are less striking but consistent differences according to the number and sex composition of living children. Finally, variables representing needs for care are generally the strongest predictors of all the outcomes analyzed.

America's elderly

The older population in the US has grown twice as fast as the rest of the population in the last 20 years. This growth is expected to accelerate early in the next century as the large baby boom cohorts move through middle age and become elderly. Today, about 1 in 8 Americans is 65 years of age or older. By 2030, 1 out of every 4 persons will be in older person. Substantial improvements in life expectancy at all ages, particularly at extreme old age, mean that not only will there be a greater proportion of elderly in the population, but the more will be the "oldest-old," over 85. By 2050, they will be more than 1/4 of the population. As people live longer, many are active and healthy well past retirement. However, many individuals living into their 80s have to cope with chronic disabilities affecting their capacity to perform day-to-day activities. Modern medicine has made great inroads against mortality from such illnesses as heart disease and stroke, but has not eliminated all the effects of these diseases. As the population ages, the issues of health care funding and availability, particularly long-term care, increase in importance. Contrary to widespread belief, the elderly are not abandoned by their families to nursing home care. The vast majority--95%--live in the community. Those needing assistance generally receive help from family and friends. This has created a tremendous demand for federal subsidies to support community-based long-term care services. 1/4 of the federal budget is now spent on the elderly--$270 billion in 1986. Medicaid and Medicare are among the government's success stories, but these programs are threatened by their very success. Economists estimate that government expenditures are 3 times greater for the elderly than for children, raising the issue of "intergenerational equity"--how to balance the amount of care society provides to those who have already contributed with what is provided to those who will contribute in the future. The view that the young and old simply compete for fixed resources is misleading. It ignores the interdependence among generations, and the burdens and benefits of intergenerational transfers at all stages of the life course.

Household composition choices of older unmarried women

This article extends previous research on the household composition of older unmarried women, using a statistical model that treats each of a woman's surviving children as a distinct potential provider of a shared household. Additional possibilities--living alone, living with other nuclear-family relatives, and living with others--are also recognized, providing a varied range of household-structure opportunities for older women. The approach allows us to identify individual child attributes associated with the propensity to coreside with the older unmarried mother. The results confirm earlier findings regarding the importance of income, age, and disability status as determinants of the household composition of older women. We find, however, that unmarried children, especially sons, are more likely to share a household with an elderly mother than are married children. Working reduces the likelihood that a married daughter will live with her older mother. Overall, the findings suggest that the attributes, more so than the sheer numbers, of living children influence the household structure of their mothers.

Household composition choices of older unmarried women

This article extends previous research on the household composition of older unmarried women, using a statistical model that treats each of a woman’s surviving children as a distinct potential provider of a shared household. Additional possibilities— living alone, living with other nuclear-family relatives, and living with others— are also recognized, providing a varied range of household-structure opportunities for older women. The approach allows us to identify individual child attributes associated with the propensity to coreside with the older unmarried mother. The results confirm earlier findings regarding the importance of income, age, and disability status as determinants of the household composition of older women. We find, however, that unmarried children, especially sons, are more likely to share a household with an elderly mother than are married children. Working reduces the likelihood that a married daughter will live with her older mother. Overall, the findings suggest that the attributes, more so than the sheer numbers, of living children influence the household structure of their mothers.

Central catecholamines, cognitive impairment, and affective state in elderly schizophrenics and controls

Central catecholamine concentrations were determined in autopsy samples from older schizophrenic and control subjects for both the hypothalamus and the nucleus accumbens. The results of these analyses and demographic variables were regressed on antemortem measures of cognitive function and mood state. In the hypothalamus, there are significant direct relationships of homovanillic acid (HVA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) with depressed mood, as measured by an adaptation of the Hamilton Rating Scale for depression. In the nucleus accumbens, dopamine (DA) and MHPG had significant inverse relationships with antemortem cognitive function, as measured by an adaptation of the Mini Mental State Exam. Results in this sample indicate that after controlling for age, the catecholamine concentrations accounted for approximately 50% of the variance in the antemortem measures of mood or cognition, depending on the loci measured.

In-home services for the dependent elderly. Determinants of current use and implications for future demand

Nationally representative data are used to examine the factors affecting the service utilization patterns of disabled elderly in the community. The probability of formal service use was found to respond directly to the severity of care needs and indirectly to the availability of informal care providers. The analysis suggests that, at extreme levels of need, frail elderly and their families overcome the price and supply barriers that characterize today's home care market to secure at least some outside assistance.

Platelet monoamine oxidase activity: demographic characteristics contribute to enzyme activity variability

In a large (n = 459) sample of adults free of psychiatric, neurologic, and endocrinologic disease, platelet monoamine oxidase activity was analyzed by multiple regression of the demographic variables age, race, and gender on enzyme activity. Reported here are variations for all three demographic variables such that significantly greater enzyme activity is seen in female, older, and white subjects relative to male, younger, and black subjects. For each demographic group the data demonstrated a curvilinear relationship of age and enzyme activity with a nadir of activity at age 30. For this sample enzyme activity nearly doubled between subjects at age 30 and at age 80. We believe this study to be the first to report racial differences in this enzyme activity and to analyze normative data for this enzyme by multiple regression techniques.

Determinants of the community living arrangements of older unmarried women

Data from the nationally representative 1976 Survey of Income and Education provide the opportunity to examine the joint effects of age, marital status, personal income, and the need for functional assistance on living arrangements of older unmarried white women. A particular interest in this research is testing the hypothesis that the effects of income and functional health are interactive. This hypothesis implies that the effect of functional disability on living arrangements is contingent on level of personal income. Log-linear model analyses indicate that, although the main effects of all independent variables except marital status are significant, none of the interaction effects are significant. Odds calculated under the best-fitting model show that an unimpaired older woman has seven times the chance of living alone as one who requires frequent assistance, whereas those in the lowest income group have only a quarter of the likelihood of living alone as someone in the highest income group.

Suicide prevention centers. Ecological study of effectiveness

While suicide prevention services are continually expanding, efforts to measure their efficacy are seldom found in the literature. This study examines the effect of suicide prevention centers in North Carolina on the suicide rate in 1970. The data are examined in a ecological context, i.e., pertinent demographic variables are included in the analysis of the suicide rate in North Carolina counties with an emphasis on structural and contextual effects. A review of the literature on suicide prevention center efficacy, a description of those counties in North Carolina that support such centers, and a rigorous testing of their effect on the countywide suicide rate are undertaken in the present analysis. All of the analyses of the data indicate that the centers have minimal effect on the suicide rate.