Caring for Mom and Neglecting
Yourself?
The Health Effects of Caring for an
Elderly Parent
Norma B. Coe
Center for Retirement Research at Boston College
Courtney Harold Van Houtven
VA and Duke University Medical Centers
Funding: Network for Studying Pensions, Aging and Retirement, Tilburg University
John A. Hartford Foundation
Children and Informal Care
•
Adult children most common source in terms of #, and may
be increasing
• Differential life expectancy; Increased divorce rates
• Baby boomer aging
•
IC negatively affects spousal caregiver health
•
Key differences between children and spousal caregivers
• Age and initial health
• Less financial and emotional dependence
• Labor force participation
1
Research Questions
•What are the health effects of initial caregiving on adult
children?
•What are the health effects of continued caregiving?
•Are health effects persistent?
3
Why Should We Care?
If fully rational agents
• Child does not bear full cost of health investments
• Health insurance
•If publicly provided, affects future insurance provision
• Social safety net
•Pay for health declines if stop work due to caregiving
Irrational agents
• Adult child may underestimate health effects
4
Data
• Health and Retirement Study
• 1992-2004 (2-years) panel
• born between 1931-1941
• only a (not co-residing) mother alive
• Two main samples
• Non-caregivers: N=8007; individuals=3316
• Caregivers: N=2557; individuals=1467
• Separated by marital status and gender
5
Health Measures on Adult Children
• Depressive symptoms (CES-D8, 0-8)
• Self-rated health – very good/excellent health vs. other
• High blood pressure ever
• Heart condition since last wave
6
HRS Caregiving Questions
Did you spend a total of 100 or more hours (since Previous
Wave Interview Month-Yeah/in the last two years) helping your
(parents/mother/father) with basic personal activities like
dressing, eating, and bathing?
Did you spend a total of 100 or more hours (since Previous
Wave Interview Month-Year/in the last two years) helping your
(parents/mother/father) with other things such as household
chores, errands, transportation, etc.?
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Health Effects of Caregiving
Hc,t+2 = α + β 1Hc,t + β2Ac,t+2,t + β3Hp + β4Xc + µ
Hc: health (depression, SRH, heart condition, HBP)
Ac: Informal care
Hp: Age, education (both parents), and indicator variables for
needing help with activities of daily living, having diagnosed
memory problem
Xc: Age, age squared, number of children, race, foreign-born,
education categories, ln(net worth), work status
8
Potential Endogeneity
Start caregiving
• Least attachment to the labor force – related to health?
Related to bargaining among siblings?
• Minimum level of health?
• Use FAMILY CHARACTERISTICS as instrumental
variables; strong for marrieds
End of caregiving
• Stop caregiving due to own health declines?
• Use DEATH OF MOTHER as instrumental variable; strong
for all groups
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Methods
•
Appropriate model?
• OLS
• IV
• IV FE
• Accounts for repeated observations over time
• Arellano-Bond estimator
• Accounts for the correlation of prior health with the
error term
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Descriptive Statistics – Adult Child
Explanatory Variables
Caregivers
Non-Caregivers
Female
0.64
0.55
Is an eldest daughter
0.33
0.27
Married
0.73
0.75
Age
57.69
54.76
Education (years)
12.82
12.31
Number of children
3.42
3.38
Number of grandkids
4.28
2.32
Full-time work
0.45
0.51
At least part-time work
0.54
0.57
297,869
249,864
Demographic characteristics
Work/Wealth Measures
Net worth
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Descriptive Statistics
Caregivers
Non-Caregivers
Depressive symptoms
1.16
0.27
Heart condition
0.09
0.11
High blood pressure
0.22
0.36
Self-reported very good or excellent health
0.53
0.53
Mother needs ADL help
0.30
0.23
Mother has doctor diagnosed memory problem
0.04
0.005
Mother’s age
87.40
79.55
Mother’s education (years)
10.04
9.73
Number of girls
1.89
2.23
Number of boys
1.64
1.97
Eldest child in family is female
0.55
0.53
Number of siblings’ kids
6.46
8.04
Health Measures
Mother’s Characteristics
Family Structure Instrument List
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Results - Preview
Different health effects between initial caregivers and
caregivers who continued caregiving
Negative health effects for three out of four subgroups of
adult children; single women appear to be unaffected.
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Health Effects: First 2 Years Caregiving
CES-D8t
Very Good Health or
Bettert
High Blood
Pressuret
Heart Conditiont
OLS
OLS
Probit
Probit
0.0044
0.0084
0.0643
(0.0731)
(0.0167)
(0.0751)
(0.1245)
Observations
3310
3308
3309
3309
Individuals
1403
1403
1403
1403
R-squared
0.24
0.39
0.0269
-0.0202
0.0383
0.1073
(0.0647)
(0.0203)
(0.1142)
(0.1285)
Observations
2993
2990
2993
2987
Individuals
1239
1239
1239
1239
R-squared
0.19
0.34
Married Women
Caregivingt
0.1665**
Married Men
Caregivingt
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Health Effects – Persistence of Effects
Married women: Bad
TWO YEARS OUT
Less likely to be in very good or better health
More likely to have high blood pressure
FOUR YEARS OUT
Increase in depressive symptoms
Less likely to be in very good or better health
More likely to have high blood pressure
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Health Effects – Continued Caregiving
Married women: BAD
• 47% increase in depressive symptoms
• 10% decrease in the probability of reporting very good or
excellent health
Married men: MIXED
• 83% increase in depressive symptoms
• 17% MORE likely to report in very-good or excellent
health.
Single men: BAD
• 40% more likely to have a new heart condition.
16
Health Effects – Persistence of Effects
TWO YEARS OUT: BAD
Depression effect persists for married women
Heart conditions persists for single men
Note: Regression also includes individual level variables, parent-level variables, and year of interview indicator. Standard
errors are clustered on the individual to account for multiple observations of the same person.
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Conclusions
• Negative physical and mental health effects of caregiving,
both for caregivers just starting and continuing caregivers
• Fleeting and some persistent, especially depression
Policy / Cost Implications
• Ignoring the negative health effects overstates the public
and private costs savings from informal care provided by
adult children (JLoS, 2001; VH & Norton, 2004; 2008; CS,
2005; BLL, 2007; Bonsang, 2009)
• Net benefits of informal care to society more
generally
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Extensions
• Health effects of informal care limited to one generation or
multiple?
• Married adult households
• Examine care to in-law vs parent?
• Differentiate between caregiving and new survival/health
information
• Work and Wealth Effects
• Work and Income as an outcome
• Inter-vivos transfers and inheritances
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