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Parental Marital Disruption, Family Type, and Transfers to Disabled Elderly Parents

¹ Medicine and Health Policy Institute, Medical College of Wisconsin, Milwaukee.
² Department of Economics, Washington University, St. Louis, Missouri.
³ Agency for Healthcare Research and Quality, Rockville, Maryland; and Georgetown University, Washington, DC.

Address correspondence to Liliana E. Pezzin, PhD, Department of Medicine and Health Policy Institute, Medical College of Wisconsin, Milwaukee, WI 53226. E-mail: lpezzin{at}mcw.edu

	Abstract

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Objectives. The objective of this study was to investigate the effect of parental marital status, marital history, and family type on intergenerational living arrangements and adult children's time and cash transfers to their unpartnered disabled elderly parents.

Methods. We used data from the Asset and Health Dynamics Among the Oldest Old survey to estimate the joint probabilities that an adult child provides time and/or cash transfers to a parent and to analyze a five-level categorical variable capturing parent–child living arrangements.

Results. The estimates suggest significant detrimental effects of parental divorce and step relationship on time transfers and on the probability of coresidence with the index child. Family type, as captured by the composition of the index child's sibling network according to kin relationship to the parent, also affected transfers and living arrangement choices of adult children.

Discussion. The findings that transfers from adult children to their unpartnered disabled elderly parents depend on parental marital status and kin relationship suggest that changing family patterns are altering the traditional role of the family as a support network. These findings raise concerns about the care likely to be available to future cohorts of elderly persons who will have experienced substantially higher rates of divorce, remarriage, and step parenthood than the cohort considered in this study.

Key Words: Divorce • Remarriage • Family type • Intergenerational transfers • Living arrangements

DIVORCE has become an important part of life for many in the United States. It has been estimated that nearly one half of all marriages will end in divorce (Kreider & Fields, 2002; Martin & Bumpass, 1989; Stevenson & Wolfers, 2007). Overall, 45% of children are predicted to experience the breakup of their parents' marriage by the age of 18 (Bumpass & Rindfuss, 1979<--?1-->). One third of all children will eventually live with a step parent before they reach adulthood (Furstenberg & Cherlin, 1991; Glick, 1989), and approximately 52% of children lived with both parents in 1998 compared to 73% in 1972 (Smith, 1999). As a consequence of the increasing incidence of divorce, nonmarital childbirth, and subsequent (re)marriage, the traditional nuclear family—husband, wife, and their joint children—is rapidly being replaced by new, more complex family structures. (We use the U.S. Census Bureau definition of a traditional nuclear family to refer to families in which a child lives with two married biological parents and with only full siblings if siblings are present.) Conventional wisdom teaches that living in nontraditional families has profound negative effects on adults and children, although the scholarly literature is often cautious about the extent to which observed correlations reflect underlying causal mechanisms. A substantial literature within the social sciences has focused on the relationship between nontraditional family structures and outcomes for children (Cherlin, Furstenberg, Chase-Landsdale, & Lindsay, 1991; Duncan & Hoffman, 1985; Furstenberg & Cherlin, 1991; Furstenberg, Nord, Peterson, & Zill, 1983; Ginther & Pollak, 2004; Haveman & Wolfe, 1995; McLanahan & Sandefur, 1994; Morrison & Cherlin, 1995; Painter & Levine, 2000; Seltzer & Bianchi, 1988; Cherlin, 2004). A smaller literature has focused on the relationship between marriage or divorce and the well-being of adult men and adult women (Waite, 1995; Waite & Gallagher, 2000). Relatively little is known, however, about the relationship between nontraditional family structures and adult children's transfers to their disabled elderly parents.

One particularly policy-relevant aspect of intergenerational relations that may be adversely affected by family disruption is care of disabled elderly parents. Intergenerational transfers are a prominent feature of the economic landscape with intra- and inter-household transfers often used to fulfill families' insurance roles: For disabled elderly persons, informal caregiving by adult children (i.e., the provision of services on a nonpaid basis) and intergenerational coresidence represent critical modes of assistance (McGarry & Schoeni, 1997). Recent evidence has suggested that adult children's involvement in parental care has declined over the past several decades (Kotlikoff & Morris, 1990; Spillman & Pezzin, 2000). Dramatic changes in family structure since the 1970s—most notably the relative erosion of the traditional nuclear family—may be a factor in the decline in family caregiving.

Concerns about the growing elderly population and the potential erosion of family support have prompted researchers to begin examining the long-term effects of marital disruption. To a large extent, research has focused on the effects of marital disruption by examining the role of divorce and remarriage on the extent and quality of intergenerational relations (Altonji, Hayashi, & Kotlikoff, 1996; Aquilino, 1994; Cooney & Uhlenberg, 1990; Eggebeen, 1992; Furstenberg, Hoffman, & Shrestha, 1995; Lye, Klepinger, Hyle, & Nelson, 1995; Pezzin & Schone, 1999). The general consensus is that divorce reduces family support and the quality of relations between adult children and their parents. Although the impact of divorce on bonds between adult children and their parents is stronger for fathers than for mothers (Furstenberg, 1994; Furstenberg et al., 1995), the quality of relations between divorced mothers and their children is generally lower than that between mothers and children in traditional nuclear families (Johnson, 1989). Research has also suggested that remarriage further weakens the bond between generations (Cooney & Uhlenberg, 1990; Pezzin & Schone, 1999; White, 1994).

Researchers have recently turned their attention to the effects of marital disruption on transfers to elderly parents. Evidence is beginning to accumulate that disabled elderly parents in families that include at least one step child receive lower levels of transfers from their children than parents in traditional nuclear families (Lin, 2008; Pezzin & Schone, 1999, 2001).

This study contributes to the growing literature on the effects of marital disruption, family structure, and step relationships on intergenerational living arrangements and adult children's time and cash transfers to their disabled elderly parents. Our analysis differs from previous research in two important respects. First, we focus on the network of adult children of disabled elderly parents. Because caregiving patterns are the result of decisions made by all children in the network, the entire network is the appropriate unit of analysis. By examining transfers by adult children, we hope to understand the mechanism whereby parents who divorce, remarry, or have step children instead of or in addition to biological children might receive less support. Second, unlike previous research, which has used married elderly parents as the reference group, we investigate the effects of divorce, remarriage, family type, and step children on transfers from adult children to their unpartnered elderly parents, using widowed parents as the reference group. The presence of a spouse or partner generally diminishes the caregiving role of children and weakens children's incentives to provide assistance. Hence, unpartnered elderly persons (i.e., those who are divorced, separated, or widowed) are a group of particular policy interest because they are far more likely to live in a nursing home (Freedman, 1996) and are also more likely to receive assistance from or coreside with their children than their married counterparts (Dwyer & Coward, 1991). By focusing on children of unpartnered elderly parents, we are able to estimate the effects of divorce, remarriage, family type, and step relationship for a group of elderly individuals who, after we control for their disability status, are likely to have similar needs for assistance.

Marital Disruption, Family Structure, and Transfers to Elderly Parents
Researchers from a variety of social science disciplines have offered theories and conceptual perspectives to explain why divorce, remarriage, and step relationships might negatively affect intergenerational relations. Sociologists, developmental psychologists, and demographers have advanced the notions of attachment (Hazan & Shaver, 1992), attribution (Grych & Fincham, 1992), life course (Amato & Booth, 1997; Furstenberg, 1981; Rossi & Rossi, 1990), and social capital (Coleman, 1988) to explain the impact of marital dissolution on adults and children. Amato (2000) reviewed the empirical literature on the consequences of divorce and provided an excellent synthesis of the theoretical perspectives. As Amato noted, a common theme underlying most of this literature is that marital disruption is a stressful life transition to which family members must adjust. The severity and duration of negative outcomes depend on the presence of and interaction between mediator (stressors) and moderator (protective) factors, with successful adjustment among children often varying with contact and attachment to both the custodial and noncustodial parents (Amato, 2000).

Reciprocity is an important component in many of these theories. Interpersonal relationships are often depicted as yielding dividends as the recipient (in this case, the child) accumulates social obligations and expectations of repayment. To the extent that the rules of reciprocal caring are developed, learned, and maintained by repeated contacts, it is thus plausible that discontinuities in family relationships caused by divorce may adversely affect intergenerational exchange.

A substantial body of economics literature has established that economic relationships within families are crucial determinants of the effectiveness of policy initiatives (Barro, 1974; Becker, 1981; Bernheim, 1989; Lundberg & Pollak, 1993, 1994). As a means of exploring the nature of implicit agreements between elderly parents and their adult children, economists have focused primarily on the motives for intergenerational transfers. The most prominent strand of this literature has posited intergenerational "altruism" as the motive for child-to-parent transfers. A second, and more controversial, strand of research has departed from the assumption of altruism and proposed "exchange" as the main motive for child-to-parent transfers (Altonji, Hayashi, & Kotlikoff, 1992, 1997; Bernheim, Shleifer, & Summers, 1985; Cigno, 1991; Cox, 1987; Cox, Hansen, & Jimenez, 1996; Cox & Rank, 1992). Although the precise nature of the postulated exchange mechanism differs across studies, it generally reflects one of two notions: reciprocity, whereby transfers are made as a repayment for past parental transfers; or strategic behavior, whereby transfers are made in the hope of securing future parental transfers.

With respect to marital dissolution, economists have argued that divorce reduces the resources devoted to children (Duncan & Hoffman, 1985). As a consequence, children's consumption, health, and human capital will be underprovided following divorce (Weiss & Willis, 1985). Hence, when parents divorce, the altruistic and/or reciprocal ties between generations will be weakened. This weakening of ties is especially likely between children and noncustodial parents.

Contact and resource flows are likely to be further weakened when parents remarry. Remarriage creates a multitude of economic and social ties across households. Membership in blended families tends to be more fluid than in traditional nuclear families, and family roles are less clearly specified (Cherlin, 1978; Furstenberg, 1987). The increased complexity in family structure and household organization also increases the "transaction costs"—the costs involved in monitoring and enforcing implicit relational agreements within and across households—likely leading to further reductions in transfers.

Although most researchers are concerned about the effects of rising rates of divorce and remarriage on the future of the family, a few researchers have rejected doom-and-gloom forecasts of declining support between generations based on these trends. For example, Wachter (1997) pointed out that if one includes step kin, the size of kin networks has not contracted; Amato has observed that "divorce, although temporarily stressful, represents a second chance at happiness for adults and an escape from a dysfunctional home environment for children" (Amato, 2000, p.13) and that adults find fulfillment and children develop successfully in a variety of family structures (Amato, 2000; Amato & Keith, 1991; Logan & Spitze, 1996). Despite looser norms about roles of members in step and blended families, remarriage may promote interactions between parents and their acquired step children, positively influencing the degree of reciprocity shared by step generations and increasing the kin supply available to elderly parents as they age and require assistance (Curran, McLanahan, & Knab, 2003). Evidence is lacking, for example, on whether changes within the family and the consequent restructuring of kinship ties following marital disruption have led to shifts in patterns of time and cash transfers to elderly parents. In what follows, we provide new evidence of the effects of parental divorce and remarriage on adult children's decisions to provide care to frail elderly parents and examine how sibling network composition affects the long-term-care behavior of individual members.

	METHODS

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We drew data for this analysis from matched observations from Waves 1 and 2 of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey. The AHEAD survey is an ongoing stratified panel survey that began in 1993 with a nationally representative sample of community-based persons aged 70 and older from the United States. Respondents are followed longitudinally roughly every 2 years. A total of 8,219 respondents, corresponding to 6,052 households, were interviewed in Wave 1 of AHEAD (AHEAD1), the data source of all independent variables. Data from Wave 2 of AHEAD (AHEAD2), collected in 1995 and the source of our outcome variables, included re-interviews of 6,948 elderly persons (attrition due to death and interview nonresponse accounted for 9.6% and 5.8%, respectively, of sample size loss between Waves 1 and 2).

For the purpose of our analysis, we limited our sample to AHEAD respondents who reported in Wave 2 their marital status as widowed or as divorced/separated (AHEAD does not distinguish between divorce and separated), who reported having at least one living child, and who reported having difficulty with at least one basic or instrumental activity of daily living (ADL). The basic ADLs were transferring, dressing, bathing, toileting, eating, and walking across a room; instrumental ADLs (IADLs) were grocery shopping, preparing meals, taking medications, using a telephone, and managing household finances. Because the unit of analysis in our study is the network of adult children, we exploited the sibling structure of the AHEAD data and formed individual records for each of the 4,863 children associated with the 1,593 elderly parents meeting our inclusion criteria.

Variable Definitions
The dependent variables we examined in this study were intergenerational living arrangements and cash and time transfers provided by adult children to their elderly parents. We represented living arrangements with a five-level categorical variable indicating whether the parent lives (1) with the index child, (2) with another child, (3) with other relatives or nonrelatives, (4) in a nursing home, or (5) alone (reference category). We coded a child as providing time transfers to the parent if the elderly respondent identified that child as having provided assistance with one or more ADLs or IADLs in the past 4 weeks; zero otherwise. Finally, we based our measure of cash transfers on the elderly parent's report that a child had provided financial assistance greater than $500 to the parent in the past 2 years.

Of primary interest for our analysis were variables that represented family type and how the index child was related to the parent (biological child or step child). We introduce the term family type to denote the composition of the index child's sibling network (i.e., the kin relationship between the index child's siblings and the parent) and to distinguish it from the familiar notion of family structure, which is prominent in discussions of outcomes for children (Ginther & Pollak, 2004). Our definition of family type characterizes the index child's sibling network according to the presence or absence of other biological or step children of the parent. Specifically, we created two variables that identified (a) index children whose sibling network included at least one step child of the parent and (b) index children whose sibling network included at least one biological child of the parent. We also included a variable reflecting whether the index child was a biological or a step child. Finally, we included an interaction term between the index child's relationship to the parent and the presence of step children in the sibling network; we did this to identify potentially differential effects for biological children in blended families relative to biological children in traditional nuclear families.

All of our models included a rich set of control variables to capture differences across adult children and their elderly parents along a number of dimensions: demographic and economic characteristics of the parent, parental health and functioning, and demographic and economic characteristics of the index child and the child's sibling network. In addition to measuring basic demographic characteristics (age, race, gender, and education), we included two variables to measure parental marital history: the parent's current marital status (currently divorced; reference category was currently widowed) and an indicator of whether the parent had experienced at least one remarriage. We incorporated parental economic status into the analysis by two constructs: (a) current, nonbequeathable income (the sum of Social Security and pension income); and (b) bequeathable wealth (the parent's total net worth). We captured parental health by the inclusion of two indicators based on severity of disability: parents with (a) 1 or 2 ADLs or (b) 3 or more ADLs, both relative to parents who were limited on IADLs only. Finally, we represented the economic status of children by two indicator variables that reflected the economic well-being of children relative to the parent: (a) whether the index child was financially worse off than the parent respondent and (b) whether all siblings of the index child were worse off than the parent respondent (AHEAD asks the parent respondent about each child's financial status relative to his or her own but does not collect any additional information about the income and wealth of the children). Table 1 contains a complete list of variable definitions and summary information for our sample.

We used a bivariate probit specification to model jointly the probabilities that an adult child provides time (T_ij) and/or cash (C_ij) transfers to a parent. Specifically, for every child i in family j, we estimated transfer equations of the form

where X_ij is a child–parent specific variable capturing the nature of their relationship (biological vs step); Z_ij is a vector of child-specific variables, including family size and type, assumed to affect the adult child's willingness to provide transfers; and Y_j is a vector of parent-specific variables (invariant within a family) capturing demographic, economic, and health status factors assumed to affect the parent's need for transfers (parental race, marital status, marital history, and disability level). We estimated the coefficients of the model—, β, , ', β' and '—along with the correlation coefficient .

Elderly respondents in our sample were observed in one of five distinct living arrangements (with the index child, with another child, with other relatives or nonrelatives, in a nursing home, or alone). To estimate living arrangements, we used a multinomial logit specification. Formally, we assumed that the value of living arrangement k for the ith child in family j is given by

where X, Y, and Z are defined as above and '', β'', and '' are the coefficients to be estimated. The predicted living arrangement is that which exhibits the highest latent value, L_ijk = 1 if L*_ijk > L*_ijm; mk; L_ijk = 0otherwise.

We obtained estimates of the bivariate probit transfer equations and the multinomial logit living arrangements via maximum likelihood. Because our data included observations on more than one child in multiple sibling families, we adjusted the standard errors of our estimates to reflect the inherent correlation across observations.

	RESULTS

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Table 2 presents summary information on cash and time transfers, as well as living arrangements, for the children in our sample. The first panel provides information on children's transfers by parental marital status and marital history. The next panel focuses on children's transfers by their relationship to the parent, and the last panel shows children's transfers by family type.

Data from the middle panel suggested considerable variation in transfers by the type of relationship (biological vs step) of the parent and child. The likelihood of cash as well as time transfers from biological children, for example, was about 4 times that from step children. Consistently, results for living arrangements indicated that step children were significantly less likely than biological children to coreside with the parent (1.8% vs 7.9%) and more likely to have a parent living alone or in a nursing home (63.6% vs 60.6% and 10.6% vs 7.5%, respectively).

The bottom panel of Table 2 provides information about family type. Distinguishing children by family type, we found that children in traditional nuclear families were significantly more likely to provide cash and time transfers than children in blended families (i.e., families with step children). Similarly, index children of parents in blended families were less likely to coreside with the parent and slightly more likely to have their parent live with other relatives or nonrelatives than were index children in traditional nuclear families. These findings raised the possibility that a child's transfer behavior might depend not only on the relationship to the parent (i.e., biological or step), as proposed in the literature, but also on the composition of the sibling network. To investigate and isolate these effects, we turned to multivariate analyses, which we discuss below.

Findings from these multivariate analyses were consistent with the univariate results discussed above and indicated that the general pattern of lower transfers from step children and children of divorced parents persisted despite the inclusion of a wide array of potential confounders. Table 3 presents estimated coefficients from the bivariate probit model of cash and time transfers and relative risk ratios from the multinomial logit model of living arrangements for children who had an unpartnered disabled elderly parent. The multivariate results indicated that step children were significantly less likely to provide cash or time transfers to their elderly parents; they were also significantly less likely to coreside with a parent (relative to the parent living alone). The estimates also suggested a detrimental effect of parental divorce on time transfers and on the probability of coresidence with the index child: Children of divorced parents were about half as likely as children of widowed parents to coreside with a parent.

Given the inherent difficulty in interpreting the underlying coefficients from the bivariate probit and multinomial logit models, particularly for interacted constructs, we calculated predicted probabilities of all outcomes for alternative child–parent relationship/family type combinations. We computed these predicted probabilities, shown in Table 4, by setting the relevant relationship and family type variables to new values while holding all other variables constant at their original levels. We calculated predicted probabilities for each child and then averaged them across the sample. One can interpret differences in the predicted probabilities across alternative relationship/family type groups as the marginal effects of the variables of interest on the outcomes.

The predictions also indicated that the addition of other biological children to a family with step children had a strong effect on living arrangements of biological children (Rows C and D of Table 4). The likelihood that the index biological child had a parent who lived with another child was 12 times greater—12.5% in blended families with multiple biological children compared to 1% in blended families in which only the index child shared a biological link with the parent. This increase was accompanied by a sizable decrease in the probability that the parent lived with the index child (11.6% to 7.8%) or with another relative or nonrelative (13.7% to 7.3%) and a somewhat smaller decrease in the likelihood that the parent lived alone (67.3% to 64.3%). Overall, the lowest probability that the parent coresided with the index child occurred in blended families in which the index child was a step child (Rows F and H). Parents were most likely to live alone when their only child was a step child (78.6%, Row E) and were most likely to be institutionalized when their family network was blended (12.2%, Row H) or consisted solely of step children (11.7%, Row G).

In addition to highlighting the effects of child–parent relationship, family type, and parental marital history, our remaining results in Table 3 suggest that children's decisions to provide financial or time transfers to their elderly parents are driven by a number of other factors. We observed that children were more likely to provide time transfers to older parents as well as to parents with higher levels of disability, a result likely capturing children's responses to the parents' needs for care. Cash transfers, however, did not appear sensitive to these or most other parent-specific demographic and health variables (except for a higher propensity among Black/African American children). Instead, we found that a child's cash transfers depended primarily on the parent's wealth, as measured by his or her net worth, and the child's relative financial status. Finally, our finding of a positive, albeit modest, correlation between the cash and time transfer equations may suggest that children in our sample do not view financial transfers as substitutes for time transfers. Alternatively, the positive correlation between cash and time assistance may reflect unobservable characteristics, such as the child's "giving disposition" or the parent's unobservable need (Soldo & Henretta, 2007).

Lastly, results regarding parent and child living arrangements were generally consistent with expectations. Parental characteristics, such as disability level and race/ethnicity, affected living arrangements, as did competing demands on the child's time (marital status and the presence of children), the child's economic status, and the number of siblings in the index child's sibling network.

	DISCUSSION

TOP Abstract Methods Results Discussion References

 
Aside from the growth in the elderly population, one of the most marked demographic trends of the 20th century was the tremendous increase in divorce and remarriage. These trends have precipitated dramatic changes in family structure, a development that has captured the attention of researchers and policy makers concerned with the well-being of children. Relatively little research, however, has explored the effects of these demographic trends on transfers by adult children to their disabled elderly parents.

In this article, we have examined the effects of divorce and remarriage on adult children's transfers of time and cash to disabled elderly parents as well as on the living arrangements of disabled elderly parents. In general, our results support the notion that family disruption, broadly conceived, has a negative impact on child-to-parent transfers. Our finding of a detrimental effect of parental divorce on children's transfers is consistent with the literature and suggests a growing number of elderly persons who will be particularly vulnerable in later life due to weaker ties to their children.

We also examined the independent effects of family type. We found strong evidence that step children are less likely than biological children to provide assistance across all outcomes. Contrary to expectations, however, the biological children of a parent who also has step children are no less likely than the biological children of a parent who has no step children to transfer resources to their elderly parent. In fact, biological children whose sibling networks include only additional step children were significantly more likely than biological children in traditional nuclear families to provide care and to coreside with the parent—a result that might reflect biological children's attempts to compensate for the limited involvement of step children. As indicated by our parent-level analyses (Pezzin & Schone, 1999), however, the offsetting behavior by biological children in these families does not compensate fully for the lower level of transfers by step children.

Historically, children's time transfers have been an important component of support to disabled elderly persons (Morgan, 1984). Our findings that transfers from adult children to their elderly parents depend on parental marital status, kin relationship, and, to a lesser extent, family type suggest that changing family patterns are altering the traditional role of the family as a support network. These findings raise concerns about future cohorts of elderly persons who will have experienced substantially higher rates of divorce, remarriage, and step parenthood than the AHEAD cohort considered in this study. Nonmarital fertility is also a concern. Because the AHEAD cohort has very low rates of nonmarital fertility, any attempt to use AHEAD to infer the effect of nonmarital fertility on family transfers would require very strong assumptions.

Evidence also suggests increased reliance on government subsidized formal care by elderly persons facing reduced informal care provided by their adult children (Spillman & Pezzin, 2000). That evidence and our findings imply increased demands on public programs, such as Medicare and Medicaid, to fill in the gap resulting from lower levels of private transfers within these complex families. Of equal concern is the possibility that disabled elderly persons who are not eligible for public long-term-care benefits and who cannot otherwise afford formal care will have their needs unmet.

In addition to highlighting the complexities associated with defining and measuring family type, our study also indicates that much remains to be learned about family behavior and suggests several avenues for future exploration. Data limitations precluded investigating the dynamic processes underlying intergenerational relations. A notable limitation of the AHEAD surveys is the lack of information about the timing and nature of early family transitions. For example, the data did not allow us to distinguish step relationships that resulted from remarriage following widowhood from those that resulted from remarriage following divorce. We were also unable to ascertain directly the relationship among adult children (full siblings, half siblings, or step siblings) or the alternative demands placed on step children who may be at risk for providing care to their own biological parents. Finally, we know little about the parents or sibling networks of the spouses of the adult children in our sample. Information about the timing of family transitions and the history of all members in the extended family would allow us to distinguish the potentially differential effects of the step relationships acquired through alternative processes and the effects of competing demands on transfers from biological children and step children. Such analyses require rich and complex data on the extended family, data that are currently unavailable.

Finally, research on the relationship between family type and transfers to elderly persons may shed some light on the motives for intergenerational transfers. Research examining the motives for late-life child-to-parent transfers has generally ignored family type, implicitly assuming that elderly parents and adult children shared the economic and social stability of traditional nuclear families throughout their lives. Our results suggest the need to consider family type, in addition to divorce and remarriage, when constructing and estimating models of intergenerational transfers.

	Acknowledgments

 
The views expressed in the paper are our own. No official endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services is intended or should be inferred. We gratefully acknowledge the financial support of the National Institute on Aging under Grants 1 R01 AG24049 and R01 AG025475.

All authors contributed to the conceptualization of the paper. Data construction and data analysis were performed by L. E. Pezzin and B. S. Schone. All authors contributed to the drafting of the manuscript.

	Footnotes

 
Decision Editor: Kenneth F. Ferraro, PhD

Received for publication April 29, 2008. Accepted for publication August 7, 2008.

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