Health trends, disparities, and determinants; Family and intergenerational supports; Effects of place on health and aging; Effects of social, economic, and healthcare policy on health and aging; Health and aging of specific populations; Disability and long-term care.
2020. Adriana Reyes. Health Shocks and Changes in Spatial Proximity between Parents and Children.
Background: Over half of caregivers who provide substantial help to older adults are adult children . However, family caregiving is facilitated by relatively close geographic proximity, especially because children provide an average of 77 hours of assistance a month . Living near children enables a wide range of support, and therefore older adults may migrate to be closer to children in response to or in anticipation of health declines . Previous research has found that when adult children move, they are more likely to choose locations close to their parents compared to other locations, especially when parents are very old . Similarly, elderly adults’ migration patterns are motivated by a desire for close geographic proximity to their children . Recent estimates suggest that a majority of parents and children live near each other, especially those with fewer socioeconomic resources . Yet, the number of older adults without an adult child nearby is projected to increase dramatically over the next two decades . As many rural areas experience an out-migration of young people and declining economic opportunities, the ability of older adults to rely on children for caregiving may be compromised in these areas. We know that children play a significant role in caring for their aging parents; however, we know less about how health shocks associated with Alzheimer’s disease and other conditions may alter the geographic location of children and parents. Building on this context, this project will pursue two specific aims:
Aim 1: Construct a panel dataset of spatial proximity between parents and their adult children. The data will document, at each wave, the distance between parents and their adult children and changes across waves.
Aim 2: Identify the correlates of changes in proximity and co-residence. The project will examine how changes in proximity evolve relative to changes in health, such as an Alzheimer’s diagnosis.
Priority Research Areas: Determinants of Health, Well-Being and Longevity, Family and Intergenerational Dynamics
2020. Emily Wiemers. The Consequences of Disabilities in Late Middle Age for Consumption Well-Being.
Background: This project will use the rich data in the Panel Study of Income Dynamics (PSID) to examine the consequences of disability in late middle age for economic well-being using consumption-based measures (e.g., food, housing, services) rather than income-based measures. It will exploit the long health histories in the PSID to examine whether declines in consumption at the time an adult becomes disabled are predicted by or mediated by reports of poor health earlier in life, particularly in childhood. The project will address two specific aims:
Aim 1: Examine the impact of the onset of work-limiting disabilities in late middle age on health, non-durable, and non-health service consumption, focusing on spousal labor supply and wealth as sources of smoothing consumption. This aim will recognize that, for married people, there is a tension between providing care to a disabled spouse and increasing labor supply to smooth consumption after the onset of a spouse’s disability.
Aim 2: Examine whether adverse childhood health conditions explain declines in consumption for those experiencing a work-limiting disability in late middle age. Individuals with poor health in childhood may save to insure their consumption against expected future adverse health shocks. Alternatively, they may be unable to self-insure because poor health in childhood limits earnings. Adverse childhood health conditions may also predict the severity of disabilities later in life, even in the absence of insurance effects.
Priority Research Areas: Family and Intergenerational Dynamics, Disability, Health Care and Long-Term Care
2020. Pinka Chatterji. 3. Medicare Part D and Disparities in Chronic Disease among the U.S. Elderly Population .
Background: Health insurance may be a key factor underlying disparities in chronic disease among the U.S. elderly population. Notably, a study that used data from 1999 to 2006 found that racial/ethnic disparities in control of blood pressure and diabetes become smaller after age 65, suggesting that Medicare reduces disparities in chronic disease . Medicare introduced optional prescription drug coverage in 2006 (Part D). The introduction of Part D may have made Medicare an even more important factor in remediating disparities given the important role of prescription drugs in controlling chronic disease. Prior work suggests that there are racial/ethnic differences in medication adherence for chronic diseases [14, 15], and Part D has increased medication usage overall among the elderly population [16, 17]. To our knowledge, however, no studies have investigated the potentially strong effects of Part D on older adults’ awareness and control of chronic disease, or the effects of Part D on racial/ethnic and education-related disparities in chronic disease. The project will address two specific aims:
Aim 1: Test whether the introduction of Medicare Part D affected disparities in awareness and control of hypertension, diabetes, and hyperlipidemia using national data sets that include biomarkers.
Aim 2: Test whether Part D affected disparities in prescription drug use and out-of-pocket spending on drugs among elderly individuals with chronic diseases.
Priority Research Areas: Determinants of Health, Well-Being and Longevity, Effects of Policy and Place on Health
2020. Shannon Monnat. Demographic, Geographic, and Temporal Trends in Co-Occurring Use Disorders and Mortality from Opioids, Other Drugs, and Alcohol among Middle-Age and Older Adults in the United States.
Background: Opioid use disorders (OUD) and overdose death rates have grown to unprecedented levels [18, 19]. The U.S. has also experienced large increases in cocaine, methamphetamine, and non-opioid prescription (especially benzodiazepines) overdoses over the past decade. Deaths from alcohol use and use disorders (AUD) are also rising, especially among older adults, women, and low-SES individuals [20, 21]. These crises are costly, getting worse, and interdependent. Excessive alcohol use is common among individuals who misuse opioids , with more than half of individuals with OUD also meeting criteria for AUD ; more than half of opioid-related deaths involve alcohol or another drug . Use disorders and overdose rates are also geographically patterned [25, 26]. Moreover, while drug and alcohol mortality rates have increased across many demographic groups over the past 20 years, increases in the middle-age cohort (35-64 years) have been startling. Thus, we focus on the relationship between drug- and alcohol- use disorders and between drug- and alcohol- related mortality among middle-aged and older adults. The specific aims of this two-year study are to:
Aim 2: Identify typologies of counties based on use disorders and mortality from opioids, other drugs, and alcohol.
Aim 3: Compare the county groups found in Aim 2 by sociodemographic, economic, and other characteristics.
Priority Research Areas: Health Trends and Disparities, Effects of Policy and Place on Health
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