Effects of health shocks at older age on older adults and their families: new evidence from large-scale administrative data

The National Institute on Aging awarded The Leland Stanford Junior University $1.24 million on September 30, 2025, under the Aging Research program (CFDA 93.866) to construct and analyze a novel individual-level database linking health trajectories of older adults to the physical, mental, and economic well-being of their family members across multiple generations, covering 1999 to 2024.

The project leverages Census Bureau infrastructure for linking U.S. survey and administrative data to examine interdependencies between the mental, physical, and economic well-being of older adults and their families. The research describes variation in family circumstances of older adults at the time of different health shocks—including Alzheimer's disease and related dementias—across demographic groups, local geographies, and socioeconomic circumstances. The database and analysis address a gap in U.S. policy and research, which has predominantly focused on individual patients rather than the broader family context despite the intricate relationship between family dynamics and health outcomes at older ages.

The award obligates $1,240,040, with a period of performance ending May 31, 2026. Work is performed in California.

Abstract

Family plays a central role in shaping the experiences of aging. Any health shock not only affects the patient but also reverberates throughout the family unit, taking a physical, emotional, and financial toll on family members. The effect on families is likely to be particularly pronounced for health shocks that lead to a pronounced decline in independence, as, for example, happens with the progression of alzheimer's disease and related dementias (adrd). The ways families manage sharp changes in health can have profound effects on both the patient's well-being and that of their caregivers. Despite the intricate relationship between family dynamics and health outcomes at older ages, public policies and much of the existing research in the U.S. Have predominantly focused on individual patients rather than the broader family context. The dearth of evidence relates not to the lack of interest, but to the absence of datasets that could allow studying the effects of health shocks on families. In this project, we propose to start closing this GAP in knowledge by leveraging the new extensive census bureau infrastructure for linking united states survey and administrative data. We will construct and analyze a novel individual-level database that links the health trajectories of older adults to the physical, mental, and economic well-being of their family members across multiple generations, covering twenty-five years from 1999 to 2024. Using this new database, we will comprehensively examine the interdependencies between the mental, physical, and economic well-being of older adults and their families in the united states. First, we will describe the variation in family circumstances of older adults at the time of different health shocks. We will consider variation across demographic groups, local geographies, and socio- economic circumstances. Second, we will use econometric techniques for causal inference to quantify how much major health shocks affect the health and economic well-being of family members, including spouses and adult children.