Academic journal article Journal of Marriage and Family

Complex Families and Late-Life Outcomes among Elderly Persons: Disability, Institutionalization, and Longevity

Academic journal article Journal of Marriage and Family

Complex Families and Late-Life Outcomes among Elderly Persons: Disability, Institutionalization, and Longevity

Article excerpt

The authors examined the effects of marital status and family structure on disability, institutionalization, and longevity for a nationally representative sample of elderly persons using Gompertz duration models applied to longitudinal data from 3 cohorts of the Health and Retirement Study (N = 11,481). They found that parents with only stepchildren have worse outcomes than parents with only biological children. Elderly mothers with only stepchildren become disabled and institutionalized sooner, and elderly men with only stepchildren have shorter longevity relative to their counterparts with only biological children. The effect of membership in a blended family differs by gender. Relative to those with only biological children, women in blended families have greater longevity and become disabled later, whereas men in blended families have reduced longevity. The findings indicate that changing marital patterns and increased complexity in family life have adverse effects on late-life health outcomes.

Key Words: aging, disability, divorce, families in middle and later life, intergenerational relations, stepfamilies.

Social factors, in addition to biological and economic factors, are well documented influences on health and health behaviors (Thomas, 2011; Umberson, Crosnoe, & Reczek, 2010; Umberson & Montez, 2010). For all persons, but especially for the very young and the very old, the family is an important component of the social support network. Any changes in the structure of the family that affect social support and intergenerational exchange, therefore, may ultimately affect health.

As a result of gradual deterioration with age or sudden health shocks, elderly persons face a considerable probability of becoming disabled and unable to care for themselves. About 20% of persons age 65 or older in the United States have chronic disabilities (Martin, Freedman, Schoeni, & Andreski, 2009), roughly one third have mobility limitations, and 7% to 8% have severe cognitive impairments (Freedman, Martin, & Schoeni, 2000). For older persons facing functional decline, families have long Department of Medicine and Health Policy Institute, Medical College of Wisconsin, 8701 Watertown Plank Rd., Milwaukee, WI 53226 (

'Department of Economics and Olin Business School, Washington University, Campus Box 1133, St. Louis, MO 63130-4899.

''Agency for Healthcare Research and Quality and Georgetown University, Old North 404, 37th and O Streets NW, Washington, DC 20057.

This article was edited by Deborah S. Carr.

been a mainstay of assistance, by providing care directly or by providing the economic resources to allow such family members to remain independent. Dramatic changes in American families over the last half century, however, have trans- formed intergenerational relations and social support that is potentially available to older adults. Beginning with the Baby Boom cohorts and continuing thereafter, there has been a trend toward increased incidence of divorce and subse- quent (re)marriage as well as nonmarital cohab- itation. As a consequence, more complex family structures have displaced the traditional nuclear family for large segments of the U.S. popu- lation (Wächter, 1997). Given the far-reaching repercussions for the distribution of economic and social well-being through its impact on late- life health outcomes (e.g., disability, longevity) and health care use (e.g., institutionalization) of elderly persons, the potential erosion of the family as a support network is a matter of policy as well as research concern.

The spouse is typically the primary source of social support for older adults. In the absence of a spouse, children often become the mainstay of support. The degree to which children serve as effective sources of support, however, is likely to vary as family structures become more complex. Cherlin (2004), for example, argued that as marriage has become increasingly deinstitutionalized, the social norms that accompany it have become less well defined, resulting in greater ambiguity regarding expectations of intergenerational support. …

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