Age Difference of Spouses and Long-Term Care

目前，美国每年用于长期护理的支出总额为1000亿美元。这些支出的规模使我们必须了解长期护理需求的过去和未来趋势。这项拟议研究的目的是研究配偶之间年龄差距的缩小将如何影响长期护理需求的未来趋势。已经确定的是，是否有健康的配偶是进入养老院的主要决定因素：与没有健康配偶的残疾人相比，与健康配偶结婚的残疾人进入养老院的可能性大约是前者的一半。反过来，在20世纪，配偶之间年龄差距的缩小可能大大影响了健康配偶的可得性。1900年出生的女性的平均年龄比自己大4.2岁。然而，出生于1950年的同一名女性，最终会嫁给比她大2.5岁的丈夫。我们打算证明这种下降有两个影响：(1)所有的老年夫妇将倾向于维持更长时间的婚姻，因为他们在年龄上更接近。(2)如今的老年女性往往有更年轻、更健康的丈夫，而如今的老年男性往往有更年长的妻子。第一种效应会减少养老院的需求，而第二种效应则模棱两可。我们建议量化这两种影响，并估计它们对养老院需求的总体影响。首先，我们将使用来自社会保障局的生命表数据来计算年龄差距变化对老年人结婚率的影响。接下来，我们建议使用AHEAD研究的数据来估计残疾、婚姻状况和已婚人士配偶的年龄对养老院进入概率的影响。作为分析的一部分，我们将使用人口普查数据来推算有关不在AHEAD中的已故配偶年龄的数据。该分析量化了年龄差距变化对已婚人士进入养老院的概率的影响。利用我们对已婚人群进入养老院的概率变化和已婚人群进入养老院的概率变化的估计，我们计算了年龄差距变化对整体养老院需求的总影响。

National expenditures on long-term care currently total $100 billion annually in the US. The magnitude of these expenditures makes it imperative for us to understand past and future trends in long-term care demand. The aim of the proposed research is to examine how the declining age gap between spouses will affect future trends in the demand for long-term care. It has been well-established that the presence or absence of a healthy spouse is a major determinant of nursing home entrance: a disabled person married to a healthy spouse is about half as likely to enter a nursing home as a disabled person without a healthy spouse. In turn, the availability of healthy spouses may have been substantially affected by the shrinking age gap between spouses over the twentieth century. A woman born 1900 on average ended up with a husband who was 4.2 years older than she. The same woman born in 1950, however, would have ended up with a husband just 2.5 years older. We propose to show that this decline has two effects: (1) All elderly couples will tend to stay married longer, because they are more closely matched in age. (2) Today's elderly women will tend to have younger, healthier husbands, but today's elderly men will tend to have older wives. The first effect will reduce nursing home demand, while the second has an ambiguous effect. We propose to quantify both effects and estimate their overall effect on nursing home demand. First, we will use life table data from the Social Security Administration to compute the effect of the changing age gap on the prevalence of marriage among the elderly. Next, we propose to use data from the AHEAD study to estimate the probability of nursing home entrance by disability, marital status, and the age of a married person's spouse. As part of this analysis, we will use Census data to impute data on the ages of deceased spouses absent from the AHEAD. This analysis quantifies the effect of the changing age gap on the probability of nursing home entrance for married people. Using our estimates of the changing probability of being married, and the changing probability of nursing home entrance for married people, we then compute the total effect of the changing age gap on overall nursing home demand.