Neighborhood Effects on Residential Living Arrangements among Older Adults

185 Pages·2014·1.46 MB·English

Neighborhood Effects on Residential Living Arrangements among
Older Adults

Amy L. Spring

A dissertation

submitted in partial fulfillment of the

requirements for the degree of

Doctor of Philosophy

University of Washington

2014

Reading Committee:

Stewart Tolnay, Chair

Kyle Crowder

Jerald Herting

Program Authorized to Offer Degree:
Sociology
©Copyright 2014
Amy L. Spring
University of Washington
Abstract
Neighborhood Effects on Residential Living Arrangements among Older Adults
Amy L. Spring
Chair of the Supervisory Committee:
Professor Stewart Tolnay
Department of Sociology

In 2010, the population of older adults – those age 65 or older – numbered 40.4 million in
United States, and was rapidly growing. By 2030, there will be about 72.1 million older adults in
the U.S. The rapid aging of the American population brings up questions of how to provide
housing for an aging society. Older adults can choose from a variety of senior- and non-senior
specific housing options, but a substantial proportion report preferences to live independently in
their own home for as long as they are able. Not every older adult has an equal chance of
remaining in their own home, and some of these inequalities play out at the neighborhood level.
However, most previous research of the determinants of living arrangements among older adults
is limited to individual- and household-level predictors. Few studies have incorporated
ecological variables even though there are theoretical reasons to believe that neighborhood
characteristics are also important. This dissertation attempts to fill the gap in the research
literature, while also contributing to policy discussions surrounding long-term housing options
for older adults. I utilize quantitative methods that rely on approximately twenty years of
longitudinal data from the Panel Study of Income Dynamics, combined with neighborhood-level
data from the US Census Bureau, to explore questions of how neighborhood characteristics
affect the likelihood of independent community-dwelling versus moving to age-segregated senior
housing among older adults. Collectively, the findings indicate that the physical and social
environment of the neighborhood exert important impacts on living arrangements among older
adults, including a neighborhood’s urban, suburban, or rural location; walkability; geographic
access to health care; and proximity to family support. Currently, there are few effective policies
to help older adults retain residential independence that focus on making neighborhood changes,
but the findings suggest there may be several avenues for policy intervention, such as expanding
older adults’ access to services, and rethinking the structure and design of neighborhoods so that
they are more viable living options through the life course and into old age.
TABLE OF CONTENTS

Page

List of Figures ................................................................................................................................. ii

List of Tables ...................................................................................................................................v

Chapter 1: Introduction ....................................................................................................................1

Chapter 2: Data and Methods ........................................................................................................21

Chapter 3: Stranded in the Suburbs? Suburbanization, Sprawl, and Residential Independence
among Older Adults .....................................................................................................40

Chapter 4: A Family Affair? The Effect of Distance to Kin on Independent Community-
Dwelling among Older Adults .....................................................................................72
Chapter 5: Chronic Health Conditions, Disability, and Geographic Access to Health Care:
Implications for Residential Independence among Older Adults ..............................105
Chapter 6: Conclusions: Evidence of Neighborhood Effects on Residential Living
Arrangements among Older Adults ...........................................................................138

References ....................................................................................................................................154

Appendix A: Supplementary Analysis for Chapter 3 ..................................................................175
Appendix B: Supplementary Analysis for Chapter 4 ..................................................................179

Appendix C: Supplementary Analysis for Chapter 5 ..................................................................182
i
LIST OF FIGURES

Figure Number Page

1.1: Number of Persons Age 65+, 1900-2030 (numbers in millions) ............................................18

1.2 Lawton’s Ecological Theory of Aging ....................................................................................19

1.3 Hodge’s Model of Factors Involved in Assuring Older Adults’ Independence ......................20

3.1 Percent of Residents that Moved to Senior Housing, Retirement Communities,
and Assisted-Living Facilities versus Remaining Independent Community-Dwelling,
by Urban Category ...................................................................................................................71

4.1 Mean and Median Distance to Closest Child and Closest Other Relative among
Older Adults ...........................................................................................................................103

4.2 Marginal Predicted Probability of Moving to Senior Housing by Distance to Nearest Child,
with 95% Confidence Intervals ..............................................................................................104

5.1 Heuristic Conceptual Frameworks of the Influence of Health Care Access on
Residential Mobility among Older Adults .............................................................................136

5.2 Marginal Predicted Probability of Moving to Senior Housing by Number of Health Service
Establishments in Zip Code, with 95% Confidence Intervals ...............................................137
ii
LIST OF TABLES

Table Number Page

2.1 Study Variables and Data Sources ...........................................................................................34

2.2 Sample of PSID Older Adults by Residential Outcomes .........................................................35

2.3 Means and Standard Deviations of Block Group Characteristics by Residential Outcome ....36

2.4 Means and Standard Deviations of Individual and Household Characteristics for Older
Adults by Residential Outcome ..............................................................................................38

3.1 Means and Standard Deviations of Block Group Characteristics by Urban Category ............68

3.2 Logistic Regression Models Predicting Moves to Senior Housing among Older Adults ........69

3.3 Logistic Regression Model of Destination Choice among Movers to Senior Housing ...........70

4.1 Logistic Regression Models of Residential Transitions among Older Adults .........................99

4.2 Origin and Destination Neighborhoods for Moves between Independent Community-
Dwellings by Eventual Residential Outcome for PSID Heads and Wives Age 55+ .............101

4.3 Logistic Regression Models of Destination Choice among Movers to Senior Housing .......102

5.1 Percentages, Means, and Standard Deviations for Health Variables by Residential
Transitions..............................................................................................................................133

5.2 Logistic Regression Models Predicting Moves to Senior Housing with Sequential
Effects of Geographic Access to Health Care and Individual Health Status .........................134

5.3 Logistic Regression Models Predicting Moves to Senior Housing with Interactions
between Geographic Access to Health Care and Individual Health Status ...........................135

A.1 Logistic Regression Models Predicting Moves to Senior Housing among Older Adults, by
Alternative Definitions of Block Group Urban Category ......................................................175

A.2 Multinomial Logistic Regression Model Predicting Block Group Urban Category
for Older Adults Living in an Independent Community-Dwelling .......................................176

A.3 Means and Standard Deviations for Block Group Urban Category in Origin and
Destination Neighborhoods by Type of Residential Transition ............................................177

A.4 Logistic Regression Models Predicting All Moves among Older Adults with Block
Group Urban Category and Block Group Characteristics .....................................................178
iii
B.1 Logistic Regression Models Predicting All Moves among Older Adults with Distance
to Kin .....................................................................................................................................179

B.2 Correlations among Family Support Variables .....................................................................180

B.3 Multinomial Logistic Regression Model Predicting Block Group Urban Category
for Older Adults Living in an Independent Community-Dwelling .......................................181

C.1 Logistic Regression Models Predicting All Moves with Interactions between
Geographic Access to Health Care and Individual Health Status ..........................................182

iv
ACKNOWLEDGEMENTS
There are many people that I wish to acknowledge who have helped me along the way,
many of whom will go unnamed, but a few that I wish to mention here. I would like to thank
Stew Tolnay for being a supportive advisor from the moment I walked into his office my first
year of graduate school. I would like to thank Kyle Crowder for encouraging me to go to
graduate school and seeing me all the way through it. I would like to thank Rachel Garshick
Kleit for her years of support and encouragement. I would like to thank Jerry Herting for
providing helpful and challenging feedback that made me a better researcher. And thank you to
Mark Ellis for his helpful ideas that have inspired my plans for future research.
I would also like to thank my graduate student colleagues, especially members of the
2007 cohort. Thank you for all that you have taught me, for being a sounding board for my
research, and for the fun times attending conferences and enjoying a beer together every now and
then.
Thank you to my parents, John and Sharon, for stressing the importance of education, and
providing me with the opportunity and encouragement to pursue whatever I wanted to in life.
Thank you to my sister Laura and my soon-to-be brother-in-law Anthony for being great friends
and keeping me sane through this whole process. Finally, thank you to my husband Shawn, who
has helped me in so many ways it is impossible to name them all, but whose humor, patience,
and unconditional support have been instrumental over the last ten years.

v
CHAPTER 1

Introduction

Housing an Aging Society

One of our most basic needs as humans, young or old, is adequate housing. This need
perhaps reaches a critical point at older ages, when individual health and functional mobility
begin to decline, and aspects of one’s environment that never used to be problematic present new
challenges. Not long ago, most older adults eventually moved in with one of their children
(Smith 1982). Today, co-residing with children is relatively rare, and living independently,
whether with a spouse, domestic partner or (increasingly) on one’s own, is the dominant living
arrangement among older adults (US Administration on Aging 2011). Yet some older adults are
more likely to maintain an independent living arrangement than others. Some of this difference
represents personal preference, but some of it represents underlying inequalities, including
inequalities in race, socioeconomic status, social support, and access to high-quality housing and
neighborhoods.
Concerns about adequate housing among older adults are becoming even more critical as
the population of older adults in the United States continues to grow. The population of older
adults – those age 65 or older – numbered 40.4 million in 2010, an increase of 5.4 million, or
15.3% since 2000 (US Administration on Aging 2011). Older adults represented 13.1% of the
US population in 2010, or over one in every eight Americans. The older population will continue
to grow substantially in the future (see Figure 1.1). The older population will grow rapidly
between the years 2010 and 2030 when the “baby boom” generation reaches age 65. By 2020,
1