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The health effects of caregiving by grandparents in Taiwan: an instrumental variable estimation

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Abstract

Previous research on the health effects of caring for grandchildren has had variable findings, including both positive and negative effects on the health of grandparents. The estimated effects of caregiving may be affected by selection, with the health of grandparent affecting the likelihood of undertaking caregiving. The health effects of caregiving also likely differ according to the cultural motivations for caregiving by grandparents. This paper assesses whether selection into caring for grandchildren affects the estimated effects of caregiving on the health of Taiwanese grandparents. We used four waves (1993–2003) of the Survey of Health and Living Status of the Elderly in Taiwan to estimate the effect of grandparent caregiving on self-rated health, mobility, and depression. To control for unobserved selection into caregiving, we employed time-varying instrumental variables (the number of grandchildren and marital status of adult children) in addition to person fixed effects. After adjusting for baseline differences, caregivers had better self-rated health, fewer mobility limitations, and fewer depressive symptoms compared to the non-caregivers, which suggest evidence of health improvement for grandparents. Instrumental variable analysis showed that caring for grandchildren was endogenously determined with grandparents’ mobility limitations, and grandparent caregivers benefited from a significant reduction in the number of mobility limitations. Our finding suggests that caring for grandchildren can be beneficial for the health of Taiwanese grandparents and supports our hypothesis that a culturally expected role of caregiving results in role enhancement.

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References

  • Andersen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10(2), 77–84.

    Google Scholar 

  • Atchley, R. C. (1997). Social forces and aging: An introduction to social gerontology (7th ed.). Belmont, CA: Wadsworth.

    Google Scholar 

  • Baker, L. A., & Silverstein, M. (2008). Preventive health behaviors among grandmothers raising grandchildren. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 63(5), S304–S311.

    Article  Google Scholar 

  • Berndt, T. J., Cheung, P. C., Lau, S., Hau, K. T., & Lew, W. J. F. (1993). Perceptions of parenting in mainland China, Taiwan, and Hong Kong: Sex differences and societal differences. Developmental Psychology, 29(1), 156.

    Article  Google Scholar 

  • Blustein, J., Chan, S., & Guanais, F. C. (2004). Elevated depressive symptoms among caregiving grandparents. Health Services Research, 39(6 Pt 1), 1671–1689.

    Article  Google Scholar 

  • Bolin, K., Lindgren, B., & Lundborg, P. (2008). Informal and formal care among single living elderly in Europe. Health Economics, 17(3), 393–409.

    Article  Google Scholar 

  • Bureau of Health Promotion. (2003). Survey of health and living status of the Elderly (2003) overview. Taiwan: Department of Health.

    Google Scholar 

  • Burton, L. M. (1992). Black grandparents rearing children of drug-addicted parents: Stressors, outcomes, and social service needs. The Gerontologist, 32, 744–751.

    Article  Google Scholar 

  • Cameron, A. C., & Trivedi, P. K. (2009). Microeconometrics using stata. College Station, Tex: Stata Press.

    Google Scholar 

  • Chang, M. C. (2007). Grandparents health in the grandparent-grandchild households. The Journal of Nursing, 54(5), 77–81. [Article in Chinese].

    Google Scholar 

  • Chen, F., & Liu, G. (2012). The health implications of grandparents caring for grandchildren in China. [Research Support, N.I.H., Extramural]. Journals of Gerontology Series B, Psychological Sciences and Social Sciences, 67(1), 99–112. doi:10.1093/geronb/gbr132.

    Article  Google Scholar 

  • Chi, S.-M. (2004). The research on health status and satisfaction with life of grandparents raising grandchildren. Taipei, Taiwan: Chinese Culture University.

    Google Scholar 

  • Coe, N. B., & Van Houtven, C. H. (2009). Caring for mom and neglecting yourself? The health effects of caring for an elderly parent. Health Economics, 18(9), 991–1010. doi:10.1002/hec.1512.

    Article  Google Scholar 

  • Cornman, J. C., Lynch, S. M., Goldman, N., Weinstein, M., & Lin, H. S. (2004). Stability and change in the perceived social support of older Taiwanese adults. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 59(6), S350–S357.

    Article  Google Scholar 

  • Cox, D., & Rank, M. R. (1992). Inter-vivos transfers and intergenerational exchange. The Review of Economics and Statistics, 74(2), 305–314.

    Article  Google Scholar 

  • Directorate General of Budget. (2010). Types of childcare taken by fertile married women aged 15–64 years. In Women’s marriage, fertility and employment survey. http://eng.stat.gov.tw/ct.asp?xItem=17761&CtNode=1662&mp=5.

  • Emick, M. A., & Hayslip, B., Jr. (1999). Custodial grandparenting: Stresses, coping skills, and relationships with grandchildren. International Journal of Aging and Human Development, 48(1), 35–61.

    Article  Google Scholar 

  • Fuller-Thomson, E., & Minkler, M. (2001). American grandparents providing extensive child care to their grandchildren: Prevalence and profile. Gerontologist, 41(2), 201–209.

    Article  Google Scholar 

  • Giarrusso, R., Silverstein, M., & Feng, D. (2000). Psychological costs and benefits of raising grandchildren: Evidence from a national survey of grandparents. In C. B. Cox (Ed.), To grandmother's house we go and stay: Perspectives on custodial grandparents (pp. 71–90). New York: Springer.

    Google Scholar 

  • Goode, W. J. (1960). A theory of role strain. American Sociological Review, 25(4), 483–496.

    Article  Google Scholar 

  • Grinstead, L. N., Leder, S., Jensen, S., & Bond, L. (2003). Review of research on the health of caregiving grandparents. Journal of Advanced Nursing, 44(3), 318–326.

    Article  Google Scholar 

  • Hank, K., & Buber, I. (2009). Grandparents caring for their grandchildren. Journal of Family Issues, 30(1), 53–73. doi:10.1177/0192513x08322627.

    Article  Google Scholar 

  • Hayslip, B., Jr, & Kaminski, P. L. (2005). Grandparents raising their grandchildren: A review of the literature and suggestions for practice. Gerontologist, 45(2), 262–269.

    Article  Google Scholar 

  • Healy, G. N., Dunstan, D. W., Salmon, J., Cerin, E., Shaw, J. E., Zimmet, P. Z., et al. (2008). Breaks in sedentary time: Beneficial associations with metabolic risk. Diabetes Care, 31(4), 661–666. doi:10.2337/dc07-2046.

    Article  Google Scholar 

  • Hermalin, A. I., Roan, C., & Perez, A. (1998). The emerging role of grandparents in Asia. Elderly in Asia research report series no. 98–52: Population Studies Center, University of Michigan.

  • Hughes, M. E., Waite, L. J., LaPierre, T. A., & Luo, Y. (2007). All in the family: The impact of caring for grandchildren on grandparents’ health. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 62(2), S108–S119.

    Article  Google Scholar 

  • Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: A review of twenty-seven community studies. [Research Support, US Gov’t, P.H.S.Review]. Journal of Health and Social Behavior, 38(1), 21–37.

    Article  Google Scholar 

  • Jendrek, M. P. (1993). Grandparents who parent their grandchildren: Effects on lifestyle. Journal of Marriage and Family, 55(3), 609–621.

    Article  Google Scholar 

  • Johnson, R. J., & Wolinsky, F. D. (1993). The structure of health status among older adults: Disease, disability, functional limitation, and perceived health. [Research Support, US Gov’t, P.H.S.]. Journal of Health and Social Behavior, 34(2), 105–121.

    Article  Google Scholar 

  • Kolomer, S. (2008). Grandparent caregivers. Journal of Gerontological Social Work, 50(Suppl 1), 321–344.

    Article  Google Scholar 

  • Krause, N., & Liang, J. (1992). Cross-cultural variations in depressive symptoms in later life. International Psychogeriatrics, 4(Suppl 2), 185–202.

    Google Scholar 

  • Leder, S., Grinstead, L. N., & Torres, E. (2007). Grandparents raising grandchildren: Stressors, social support, and health outcomes. Journal of Family Nursing, 13(3), 333–352.

    Article  Google Scholar 

  • Lin, J.-P. (2009). National survey of grandparents-grandchildren interactions. Taipei: National Taiwan Normal University.

    Google Scholar 

  • Liu, Y.-W. (2001). The quality of life for grandmother who providing care for grandchildren. Hualien, Taiwan: Tzu Chi University.

    Google Scholar 

  • Lo, M., & Liu, Y. H. (2009). Quality of life among older grandparent caregivers: A pilot study. Journal of Advanced Nursing, 65(7), 1475–1484.

    Article  Google Scholar 

  • Loh, C.-P. (2009). Physical inactivity and working hour inflexibility: Evidence from a U.S. sample of older men. Review of Economics of the Household, 7(3), 257–281. doi:10.1007/s11150-009-9055-8.

    Article  Google Scholar 

  • Marx, J., & Solomon, J. C. (2000). Physical health of custodial grandparents. In C. B. Cox (Ed.), To grandmother’s house we go and stay: Perspectives on custodial grandparents (pp. 37–55). New York: Springer.

    Google Scholar 

  • McClellan, M., McNeil, B. J., & Newhouse, J. P. (1994). Does more intensive treatment of acute myocardial infarction in the elderly reduce mortality? Analysis using instrumental variables. The Journal of the American Medical Association, 272(11), 859.

    Article  Google Scholar 

  • Mehta, K. K., & Thang, L. L. (2011). Experiencing grandparenthood: An Asian perspective (Vol. 47). Berlin: Springer.

    Google Scholar 

  • Ministry of Interior Department of Statistics, R. O. C. (2009). Report on the Old Status Survey.

  • Minkler, M., & Fuller-Thomson, D. E. (2001). Physical and mental health status of American grandparents providing extensive child care to their grandchildren. Journal of the American Medical Women’s Association, 56(4), 199–205.

    Google Scholar 

  • Minkler, M., Fuller-Thomson, E., Miller, D., & Driver, D. (1997). Depression in grandparents raising grandchildren: Results of a national longitudinal study. Archives of Family Medicine, 6(5), 445–452.

    Article  Google Scholar 

  • Moen, P., Robison, J., & Dempster-McClain, D. (1995). Caregiving and women’s well-being: A life course approach. Journal of Health and Social Behavior, 36(3), 259–273.

    Article  Google Scholar 

  • Musil, C. M., & Ahmad, M. (2002). Health of grandmothers: A comparison by caregiver status. Journal of Aging and Health, 14(1), 96–121.

    Article  Google Scholar 

  • Ofstedal, M. B., Zimmer, Z. S., & Lin, H. S. (1999). A comparison of correlates of cognitive functioning in older persons in Taiwan and the United States. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54(5), S291–S301.

    Article  Google Scholar 

  • O’Reilly, P., & Caro, F. G. (1994). Productive aging: An overview of the literature. Journal of Aging and Social Policy, 6(3), 39.

    Article  Google Scholar 

  • Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. Gerontologist, 30(5), 583–594.

    Article  Google Scholar 

  • Pebley, A. R., & Rudkin, L. L. (1999). Grandparents caring for grandchildren. Journal of Family Issues, 20(2), 218–242. doi:10.1177/019251399020002003.

    Article  Google Scholar 

  • Pruchno, R. (1999). Raising grandchildren: The experiences of black and white grandmothers. Gerontologist, 39(2), 209–221.

    Article  Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 149–166.

    Article  Google Scholar 

  • Rozario, P. A., Morrow-Howell, N., & Hinterlong, J. E. (2004). Role enhancement or role strain. Research on Aging, 26(4), 413–428.

    Article  Google Scholar 

  • Sieber, S. D. (1974). Toward a theory of role accumulation. American Sociological Review, 39(4), 567–578.

    Article  Google Scholar 

  • Silverstein, M., Cong, Z., & Li, S. (2006). Intergenerational transfers and living arrangements of older people in rural China: Consequences for psychological well-being. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 61B(5), S256.

    Article  Google Scholar 

  • Staiger, D., & Stock, J. H. (1997). Instrumental variables regression with weak instruments. Econometrica, 65(3), 557–586.

    Article  Google Scholar 

  • Strawbridge, W. J., Wallhagen, M. I., Shema, S. J., & Kaplan, G. A. (1997). New burdens or more of the same? Comparing grandparent, spouse, and adult-child caregivers. Gerontologist, 37(4), 505–510.

    Article  Google Scholar 

  • Strom, R., Strom, S., Shen, Y. L., Li, S. J., & Sun, H. L. (1996). Grandparents in Taiwan: A three-generational study. International Journal of Aging and Human Development, 42(1), 1–19.

    Article  Google Scholar 

  • Szinovácz, M. (1998). Handbook on grandparenthood. Westport, CT: Greenwood Press.

    Google Scholar 

  • Szinovacz, M. E., DeViney, S., & Atkinson, M. P. (1999). Effects of surrogate parenting on grandparents’ well-being. Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 54(6), S376–S388.

    Article  Google Scholar 

  • Van Houtven, C. H., & Norton, E. C. (2004). Informal care and health care use of older adults. Journal of Health Economics, 23(6), 1159–1180.

    Article  Google Scholar 

  • van Willigen, J., Lewis, D. C., Yoon, H., & Hendricks, J. (2006). The cultural context of aging. In Handbook on asian aging. New York: Baywood.

  • Verbeek, M., & Nijman, T. (1992). Testing for selectivity bias in panel data models. International Economic Review, 33(3), 681–703.

    Article  Google Scholar 

  • Waldrop, D. P., & Weber, J. A. (2001). From grandparent to caregiver: The stress and satisfaction of raising grandchildren. Families in Society, 82, 461–472.

    Google Scholar 

  • Wang, C. C., Lu, T. H., Liao, W. C., Yuan, S. C., Kuo, P. C., Chuang, H. L., et al. (2010). Cigarette smoking and cognitive impairment: A 10-year cohort study in Taiwan. Archives of Gerontology and Geriatrics, 51(2), 143–148. doi:10.1016/j.archger.2009.09.041.

    Article  Google Scholar 

  • Wang, Y., & Marcotte, D. E. (2007). Golden years? The labor market effects of caring for grandchildren. Journal of Marriage and Family, 69(5), 1283–1296. doi:10.1111/j.1741-3737.2007.00447.x.

    Article  Google Scholar 

  • Warren, T. Y., Barry, V., Hooker, S. P., Sui, X., Church, T. S., & Blair, S. N. (2010). Sedentary behaviors increase risk of cardiovascular disease mortality in men. Medicine and Science in Sports and Exercise, 42(5), 879–885.

    Article  Google Scholar 

  • Wheelock, J., & Jones, K. (2002). ‘Grandparents are the next best thing’: Informal childcare for working parents in Urban Britain. Journal of Social Policy, 31(03), 441–463. doi:10.1017/S0047279402006657.

    Article  Google Scholar 

  • Winefield, H., & Air, T. (2010). Grandparenting: Diversity in grandparent experiences and needs for healthcare and support. International Journal of Evidence-Based Healthcare, 8(4), 277–283. doi:10.1111/j.1744-1609.2010.00187.x.

    Article  Google Scholar 

  • Wooldridge, J. M. (2002). Econometric analyses of cross section and panel data. Cambridge, MA: MIT Press.

    Google Scholar 

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Acknowledgments

This manuscript was written as part of the first author’s dissertation and the data source was provided by the Bureau of Health Promotion (BHP), Department of Health in Taiwan. An earlier version of this paper was presented at the 2011 Annual Meeting of the Gerontological Society of America at Boston with travel support from the National Science Council, Taiwan. We would like to thank Young Kyung Do and the two anonymous reviewers for their helpful comments on the manuscript.

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Authors and Affiliations

  1. Department of Health Policy and Management, The University of North Carolina, Chapel Hill, NC, USA

    Li-Jung E. Ku, Sally C. Stearns & George M. Holmes

  2. Institute of Gerontology, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan City 701, Taiwan

    Li-Jung E. Ku

  3. Department of Medicine, Center for Health Services Research and Development in Primary Care, Duke University Medical Center, VA Medical Center, Durham, NC, USA

    Courtney H. Van Houtven

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  1. Li-Jung E. Ku
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Ku, LJ.E., Stearns, S.C., Van Houtven, C.H. et al. The health effects of caregiving by grandparents in Taiwan: an instrumental variable estimation. Rev Econ Household 10, 521–540 (2012). https://doi.org/10.1007/s11150-012-9154-9

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