Household Composition and the Health of Older Residents

This paper observes changes of household composition in response to economic recession and examines the resulting impacts on specific health outcomes of older Americans.  Research has established that aggregate household composition shifts in the face of a business cycle contraction.  Household composition is defined as older Americans who live alone, live with a spouse, with family that includes young children, with adult family members or as older adults who live with other unrelated adults.  Medicare Current Beneficiary Survey data from 1990 to 2011 is exploited to show older Americans combining households with their children and grandchildren at a greater rate during recessionary years.   This paper uses a series of two-part models to examine the impact of these combined household arrangements on the older resident according to the individual’s self-rated health, to particular physical and mental health diagnoses such as hypertension and depression, according to particular health events such as myocardial infarction, according to a count of medical care utilization and preventative care activities and according to a constructed count of unmet needs of activities of daily living and instrumental activities of daily living supports.  Long-term care choices, and particularly institutionalization, are also examined as a factor of household composition.  This paper adds to the body of knowledge of health impacts of economic recessions by specifically targeting older Americans who live on the margin of good health and independence according to their demographic measures.  It also increases the understanding of the relationship between health and household composition.  By controlling for income, resources and state effects, inferences may be drawn as to the health impacts of combined households on the older Americans in their residence.