Age at Immigration and Depression: The Mediating Role of Contemporary Relationships With Adult Children Among Older Immigrants

Abstract

Objectives

For the growing population of older immigrants in the United States, both age at immigration and familial relationships are important factors affecting psychological well-being. This study explores how age at immigration and contemporary relationships with adult children combine to explain older immigrants’ depressive symptoms.

Method

This study uses 2014 Health and Retirement Study data from a sample of 759 immigrants aged 65 and older who have at least one adult child aged 21 or older. A series of ordinary least squares regressions and mediational analyses were conducted.

Results

Findings indicate that structural solidarity significantly mediates the association between age at immigration and depressive symptoms. Specifically, immigrating in later life was associated with a lower level of depressive symptoms through its relationship with structural solidarity. In addition, giving monetary support to children and providing care for grandchildren may alleviate depressive symptoms for older immigrants.

Discussion

This study suggests that relationships with adult children may differ with age at immigration. The types of support that older immigrants provide to their adult children may be crucial because such support may instill a sense of obligation and reciprocity that may be beneficial to the psychological well-being of older immigrants.

The foreign-born population is increasing dramatically in the United States, growing from 38 million in 2008 to a projected 78 million in 2065 (Radford, 2019). Although the immigration stream has typically consisted of immigrants arriving at younger ages, recent immigrants to the United States are significantly older, on average, at arrival. From 2000 to 2017, the share of newly arrived immigrants aged 50 or older nearly doubled, increasing from 8% to 15%, while the share who are 65 and older roughly tripled, from 2% to 6% (Camarota & Zeigler, 2019). Immigrants aged 65 and older account for 12% of the immigrant population in the United States (Batalova, 2012). Given this trend, more research is needed to better understand the relationship between age at immigration and well-being among older immigrants. While researchers have found a strong association between age at immigration and mental health (Angel et al., 2001; Lam et al., 2012), most studies have examined differences between those who immigrated as adults and those who arrived as children. Much less is known about immigrants who arrived during late life.

The well-known “healthy migrant hypothesis” states that increased duration of U.S. residence is associated with deteriorating health conditions and a narrowing of health differentials between immigrants and their U.S.-born counterparts because immigrants are positively selected on health (Jasso et al., 2005). However, the stress associated with immigration and acculturation may place immigrants at higher risk for depressive symptoms than their native-born counterparts (Black et al., 1998; Wilmoth & Chen, 2003). Later-life immigration can be particularly stressful. The pressure of coming to a new and unfamiliar environment may increase isolation and the risk of depression (Angel et al., 2001). Because family-based immigration is one of the primary ways that later-life immigrants join their families in the United States (Carr & Tienda, 2013), these experiences are significantly affected by an immigrant’s family members, who play a significant role in fostering psychological well-being by providing a system of social support, developing a sense of cohesion, and transmitting cultural values (Ward et al., 2010). In particular, adult children can serve as a vital source of emotional and material support when older immigrants are unable to care for themselves (Treas & Mazumdar, 2002).

Numerous studies of the relationships between immigrant parents and their adult children have focused on intergenerational solidarity (Bordone & de Valk, 2016). Specifically, prior studies have examined how the length of time spent in the United States affects the relationships between generations: Over time, aging immigrant family members might become less likely to endorse traditional family structures and more likely to embrace forms of family adaptation common in American culture (Singh & Siahpush, 2001). The longer immigrants spend in the host country, the more likely they are to adopt the norms and behaviors of the host country (e.g., becoming less family-oriented), and the less likely they are to adopt cultural norms from the county of origin. In contrast, few studies have explored the association between age at immigration and intergenerational solidarity as well as how these two factors combine to hinder or help the psychological well-being of older immigrants (Gubernskaya et al., 2013). The current study explores the relationships between these three variables and extends the literature by focusing on older parents’ perspectives, which have been largely overlooked. Most prior research examines the children’s perspective, usually emphasizing fiscal concerns about increased care demands as their parents age (Lin et al., 2015). Utilizing data from a large nationally representative sample, this study examines whether intergenerational solidarity mediates the association between age at immigration and depressive symptoms among older adults.

The Effects of Age at Immigration on Depressive Symptoms

The life course perspective proposes that the motivations and consequences of immigration differ by age (Angel et al., 2001). Immigrants who migrate at younger ages are more likely to be seeking education and employment opportunities, while the majority of later-life immigrants migrate to be reunited with family members (Scommegna, 2013). Further, age at immigration affects the ability of immigrants to learn and use a new language and their opportunities to meet and socialize with a wide range of people (Leu et al., 2008). Given these differences, it is not surprising that age at immigration also influences the extent to which the stress of immigration affects health (Lam et al., 2012).

Experiences of change, loss, perceived discrimination, and social marginalization are associated with depressive symptoms (Saraga et al., 2013). Depression, in turn, is associated with decreased physical, mental, and social function, and greater morbidity (Fiske et al., 2009). Thus, it is perhaps not surprising that depression is a leading cause of morbidity among older immigrants. Mills and Henretta (2001) found that both immigrants who arrived in the United States in later life and those who arrived in childhood have a higher risk of depression than their native-born peers. Prior studies have found that individuals who immigrated at older ages had more depressive symptoms (Guo et al., 2019). Adaptation or acculturation may be particularly challenging for older immigrants who have spent more time in their own (or heritage) cultures, which may have a greater focus on familial relations (Guo et al., 2019). Because later-life immigration often centers on family, disruptions in family relations may increase the need for formal support (Guo et al., 2019). Understanding how older immigrants can effectively adapt to the new family setting is crucial to enhancing the well-being of this rapidly growing population.

Despite the stresses associated with immigration, research has shown that immigrants to the United States have a significantly lower risk of depressive symptoms than their native-born peers, but this initial advantage erodes with time spent in the United States (Scribner, 1996). As immigrants become more assimilated or acculturated to U.S. social and cultural norms, their health status comes to resemble that of their U.S.-born counterparts (Alegría et al., 2017). However, a number of recent studies have questioned the immigrant health advantage, demonstrating the need for a more nuanced understanding of this topic (Guo et al., 2019).

Intergenerational Solidarity

Intergenerational relationships are important for successful coping and social integration in old age (Silverstein & Bengtson, 1997). Lawton et al. (1994) define intergenerational solidarity—or the parent–adult child relationship—as a “higher order concept that encompasses the multiple, complex, and sometimes contradictory ways that parent and children are socially connected to each other” (p. 59). The authors found that intergenerational solidarity consists of six elements: associational solidarity (type and frequency of interaction and activities), structural solidarity (geographic proximity), affectual solidarity (emotional closeness), consensual solidarity (shared opinions), functional solidarity (exchange of assistance and support), and normative solidarity (commitment to filial obligations or responsibility).

In line with the life course perspective, intergenerational solidarity theory focuses on how intergenerational relationships are maintained or change over time, and how they impact an individual’s well-being and functioning. Immigration and the associated social changes affect both individual lives and family relationships, and thus, intergenerational solidarity. Older immigrants may be susceptible to financial hardship and psychological distress. Further, they often live with their children and help care for their grandchildren (Keene & Batson, 2010). Because older immigrants are separated from their social and family networks in their country of origin, they may turn to family members in the United States for support (Merz et al., 2009).

Thus, understanding the relationship between older immigrants and their adult children is crucial to understanding the well-being of older immigrants (Guo et al., 2016). Older immigrants benefit from having close relationships with their children, who can serve as a buffer against the various stressors they encounter (Katz & Lowenstein, 1999). Because family relationships are interdependent, multiple dimensions of intergenerational solidarity might influence the psychological well-being of older immigrants.

Intergenerational Solidarity as a Mediator

There is a high degree of reciprocity between the older generation of immigrants and their adult children. Immigrants who arrive at an older age often live with their children due to high rental costs, insufficient personal income, a mutual need for help, and cultural preferences (Gurak & Kritz, 2010). This greater reliance on adult children for financial support and basic needs may erode older immigrants’ sense of self and well-being. Younger members of immigrant families also often receive support as many older adults immigrate to meet their adult children’s needs for childcare assistance (Xie & Xia, 2011). Some older immigrants even provide financial assistance to their adult children (Rote & Markides, 2014). Although there is little empirical evidence regarding the continuing relationships between later-life immigrants and their adult children, some studies have found that older family members benefit from intergenerational reciprocity more than younger family members (Levitt et al., 1992). Given this imbalance, the parent–child power dynamics in immigrant families often shift, with older adults losing their traditional authority status in the family (Wong et al., 2006).

Although we might assume that a higher level of intergenerational solidarity would be associated with fewer depressive symptoms, the empirical results are mixed. For example, while some studies have found that affectual solidarity is associated with significantly lower levels of depressive symptoms (Guo et al., 2016), a study of older Mexican Americans found no significant association between affectual solidarity and depressive symptoms (Black et al., 1998).

In addition, although coresidence with adult children benefits older immigrants (Wilmoth & Chen, 2003), it may also introduce tension between generations and place stress on both generations (Guo et al., 2016). These mixed results are not completely unexpected given that while immigrants are likely to be more dependent on their immediate family members for support relative to nonimmigrants, immigrant families may also experience a wider generation gap (Merz et al., 2009). Further, the quality of relationships between parents and children has a large impact on the frequency of contact with adult children (Guo et al., 2016).

Grandparent caregiving is generally associated with positive psychological well-being. Caring for grandchildren may instill a sense of responsibility and reciprocity, which can be beneficial to the mental well-being of older immigrants (Rote & Markides, 2014). However, providing such care may also entail stress, especially when older adults feel pressure to provide childcare or feel burdened by the responsibility (Tang et al., 2017), and when they dedicate a large amount of time or resources to supporting their children and grandchildren. Previous research indicates that receiving assistance is associated with more depressive symptoms, whereas giving assistance is negatively related to depressive symptoms (Liang et al., 2001). In particular, receiving higher levels of instrumental/financial support is associated with greater depressive symptoms among older immigrants because they worry about becoming burden to their adult children (Wong et al., 2006).

Although both theoretical considerations and the extant empirical evidence suggest that age at immigration is related to depressive symptoms, the literature is small and the findings are mixed. Further, more research is needed to understand whether intergenerational solidarity mediates the relationship between these two factors. Thus, building on prior work, this study evaluates two hypotheses: (a) immigration in later life is associated with a higher level of depressive symptoms (relative to immigration earlier in life), and (b) intergenerational solidarity mediates the relationship between age at immigration and depressive symptoms.

Method

Data and Sample

The data were drawn from the Health and Retirement Study (HRS), which surveyed a nationally representative sample of men and women age 51 and older in the United States. The HRS consists of six birth cohorts who entered the study in different calendar years. Once respondents enter the study, they are interviewed every 2 years. A new birth cohort is added every 6 years to maintain a representative sample of the population. Initial cohort response rates ranged from 70% to over 80% across waves; re-interview rates for all cohorts at each wave were between 92% and 95% (HRS, 2011). This study uses data from the 2014 wave, which included an extensive psychosocial questionnaire. The final sample includes 759 older immigrants aged 65 and older who have at least one child aged 21 or older.

Measures

Depressive symptoms

The HRS measures depressive symptoms with a subset of eight items from the standard Center for Epidemiologic Studies Depression scale (CES-D). Respondents were asked about their depressive affect (e.g., I felt depressed), well-being (e.g., I was happy), and somatic symptoms (e.g., I could not get going). Participants responded yes or no to an item asking whether they had experienced each of these symptoms much of the time in the past week. A summary score was then created by summing the number of symptoms (range: 0–8; Cronbach’s alpha = .81).

Age at immigration

Age at immigration was measured using respondent’s reports of the year of their arrival in the United States. The year of arrival was subtracted from their birth year and the resulting ages were grouped into four categories: immigrated before age 18, immigrated at age 18–34, immigrated at age 35–49, and immigrated in later life (age 50 or older) (Wakabayashi, 2010).

Intergenerational solidarity

Seven indicators were used to assess four dimensions of intergenerational solidarity: associational, structural, affectual, and functional (measures of normative and consensual solidarity were not available in the HRS). Associational solidarity was measured via three questions: How often do you meet up/speak on the phone/write or email with your children (asked only for children not living with the respondent)? For each of these questions, the scores ranged from 1 (less than once a year or never) to 6 (three or more times a week). The scores were summed and averaged (range: 1–6).

Structural solidarity was based on a measure combining whether any of the respondent’s adult children lived within 10 miles and whether the respondent lived with any of their children. The item was coded as: 1 = all children live at least 10 miles away, 2 = at least one child lives within 10 miles (but not with the respondent), or 3 = the respondent lives with at least one of their children. Affectual solidarity was measured by two variables; positive and negative emotional relationships. Positive emotional relationships were measured via responses to three questions: “How much do your children really understand the way you feel about things?,” “How much can you open up to your children if you need to talk about your worries,” and “How much can you rely on your children if you have a serious problem?.” The responses were reverse coded from 1 (not at all) to 4 (a lot) and summed (range: 3–12). Negative relationships were assessed by four items concerning the respondent’s feelings about their adult children: “Children make too many demands on you,” “Children criticize you,” “Children let down when you are counting on them,” and “They get on your nerves.” The responses were reverse coded from 1 (not at all) to 4 (a lot) and summed (range: 4–16).

Functional solidarity was assessed by monetary support transfers to and from children and providing childcare for grandchildren. Two items measured the amount of monetary support (answers were log-transformed to reduce skewness). Childcare for grandchildren was measured by hours of care provided per year. To deal with extreme values, the variable was top-coded at the 95th percentile of the distribution, which was 300 hr of providing childcare. Unfortunately, HRS did not collect information on a wide range of other types of help that parents often provide to adult children, including transportation, errands, housework, and repairs (Kahn et al., 2011).

Covariates

Sociodemographic characteristics, including age (years), gender (male vs female), race, total household income ($, log-transformed), functional limitations (number of ADL), and education (years), were included as covariates. Chronic conditions (range: 0–5) were measured as diagnosis of diabetes, cancer, coronary heart disease, stroke, and psychiatric distress except depression. Each disease was measured as a dichotomous variable (0 = no, 1 = yes). In addition, controls were included for number of children (range: 1–6 [≥6]) (Seltzer et al., 2013).

Analytic Strategy

After the direct effects of age at immigration on depressive symptoms were estimated, the single mediation effects of intergenerational solidarity on the relationship between age at immigration and depressive symptoms were examined. Mediation effects were computed using the product of the coefficients methods (Preacher & Hayes, 2008; see the Figure 1). First, the mediators were regressed on age at immigration. Next, depressive symptoms were regressed on each mediator. Lastly, age at immigration and each mediator were included in a model predicting depressive symptoms. In addition, the bias-corrected bootstrapping method was applied in the test of mediating effects, as suggested by Preacher and Hayes (2008). Bootstrapping methods are widely used because they effectively increase both statistical power and control over Type I errors, especially when multivariate normality cannot be assumed in small samples (Preacher & Hayes, 2008). We do this because the sample of late-life immigrants is relatively small and by bootstrapping we reduce the likelihood of reporting a significant association when it is in fact not significant (i.e., false positives). The current study used 5,000 bootstrapping samples. After generating 5,000 estimates of the total and specific indirect effects, the average estimates were calculated. These estimates provide an empirical, nonparametric approximation of the sampling distribution of mediation effects (Preacher & Hayes, 2008). The analyses were performed in Stata version 16. A hot decking procedure was used to impute missing data so all observations could be used in the regression analyses.

Results

Table 1 presents unweighted descriptive statistics. Comparing immigrant groups by age shows that in this sample, immigrants who came to America between ages 35 and 49 were older (M = 78.1, SD = 7.91) than their counterparts who arrived at other ages. Immigrants who arrived at age 50 or older were significantly more likely to be Hispanic or “other” race/ethnicity (47.62% and 22.22%, respectively) compared to those who arrived at other ages. Table 1 also provides information on dimensions of intergenerational solidarity. In the full sample, respondents contacted their children, on average, more than once or twice a month (associational solidarity; M = 3.88, SD = 1.06) and lived more than 10 miles away from their children’s residence (M = 1.73, SD = 1.03). On average, respondents were somewhat positive close to their children (positive affectual solidarity; M = 10.08, SD = 1.85) and they were a little negatively close to their children (negative affectual solidarity; M = 6.51, SD = 2.63). In terms of instrumental support, respondents gave on average $7,758 to and received $3,810 from their adult children. Finally, respondents provided an average of 24 hr of childcare per year for their grandchildren (M = 23.89, SD = 71.29).

Table 2 includes the unstandardized beta coefficients with associated standard errors and Z values, as well as the bootstrapping results with bias-corrected 95% confidence intervals (95% CIs) showing the results of the direct effects of age at immigration on depressive symptoms. Bootstrap regression results indicate a significant relationship between immigrating at age 50 or older and depressive symptoms (b = .58, SE = .28, p < .05), controlling for sociodemographic characteristics and number of children (95% bias-corrected bootstrap CI did not overlap zero indicating a significant direct effect).

Table 3 presents the results of the mediation analyses (all analyses controlled for sociodemographic characteristics and number of children). The bootstrap results indicate that some dimensions of intergenerational solidarity are statistically significant mediators of the relationship between age at immigration and depressive symptoms. First, immigration in later life was significantly associated with a higher level of structural solidarity than immigration in childhood (b = .23, p < .05). In turn, structural solidarity was negatively associated with depressive symptoms (b = −.09, p < .01). The mediational analysis showed that structural solidarity significantly mediated the association between immigration during later life and reduced depressive symptoms. In addition, compared to immigration in childhood, immigration at age 18–34 (b = −.67, p < .05) and immigration in later life (b = −1.18, p < .05) were negatively associated with associational solidarity, which was, in turn negatively associated with depressive symptoms (b = −.10, p < .01). Associational solidarity marginally mediated with the association between immigration at age 18–34/immigration in later life and depressive symptoms. Also, the results indicate that positive affectual solidarity (b = −.07, p < .05), giving monetary support (b = −.05, p < .05), and providing grandchild care (b = −.04, p < .05) were negatively associated with depressive symptoms while receiving monetary support (b = .06, p < .05) was positively associated with depressive symptoms, but they were not significantly associated with age at immigration. Furthermore, immigration at age 18–34 (b = −.15, p < .05) and age 35–49 (b = −.23, p < .01) were both significantly associated with lower negative affectual solidarity than immigration in childhood, although negative affectual solidarity was not significantly associated with depressive symptoms.

Discussion

The current study examined how contemporary relationships between parents and their adult children influence the association between age at immigration and depressive symptoms among older adults. Prior studies have shown that the lives and well-being of older immigrants are intrinsically linked with their families, in particular their adult children (Guo et al., 2016). Although immigrants have a wide variety of cultural characteristics, they share commonalities that may influence their well-being in later life, and the current findings indicate that relationships with adult children may differentially influence the relationship between age at immigration and depression.

Age at Immigration and Depressive Symptoms in Later Life

With regard to the first hypothesis, immigration in later life was associated with a higher level of depressive symptoms. Although there is prior empirical evidence that foreign-born individuals have an initial health advantage over native-born individuals, this study found that later-life immigrants did not have a health advantage relative to those who had immigrated earlier. These results are perhaps not surprising given that those who immigrate in later life likely experience significant challenges associated with immigration, such as acculturation, language barriers, and reduced social networks (Das-Munshi et al., 2012), which can lead to decreased social mobility and a higher risk of mental health problems. More research is needed to better understand the factors associated with depressive symptoms for recently arrived older immigrants.

Mediating Effects of Intergenerational Solidarity

With regard to the second hypothesis, the results of nonparametric bootstrap analyses indicated that structural solidarity significantly mediated the association between age at immigration and depressive symptoms. Specifically, immigration in later life was associated with diminished depressive symptoms through structural solidarity. This pattern aligns with earlier research (e.g., Hank, 2007) showing that living in close geographic proximity to adult children alleviates the negative impact of depressive symptoms among older immigrants. Previous research has shown that geographical proximity is strongly associated with frequent contact with children as well as the exchange of emotional and financial support with children. Living far from adult children may have a negative impact on older adults, particularly those who immigrated in later life, because coresidence with adult children is an important source of instrumental and financial support (Gurak & Kritz, 2010). However, prior research has also shown that older adults are better off living independently if they have pensions and are healthy (Wong et al., 2006). Further, coresidence with adult children can result in more negative interactions between a parent and child because both are less likely to be able to avoid such interactions (Akiyama et al., 2003).

The results of the current study indicate that later-life immigrants have less frequent contact with their children, on average, than those who immigrated earlier in life. Because the associational solidarity measure in HRS did not include coresiding children, the results suggest that late-life immigrants who do not reside with their children may have infrequent contact with their children. The infrequency of contact may be due to lower levels of emotional closeness and/or personal commitment to and effort in relationships (Guo et al., 2016). Maintaining regular contact with adult children is beneficial to parent–child relations, reducing the sense of loneliness and isolation that is commonly experienced by older immigrants. Frequent contact between older parents and children tends to increase closeness and relationship quality (Lawton et al., 1994), which may be particularly important for later-life immigrants who may have limited extended social networks, although the companionship of family members may not be sufficient to stave off loneliness for these individuals (Treas & Mazumdar, 2002). Frequent parent–child interactions, however, provide not only opportunities to share interests and opinions, but also a chance to fight and disagree (Van Gaalen et al., 2010). Moreover, relationships between later-life immigrants and their children might still be strong even if they live far away or have limited contact (Kalmijn & Dykstra, 2006).

Although other dimensions of solidarity did not mediate the relationship between age at immigration and depressive symptoms, giving monetary support to children was significantly associated with decreased depressive symptoms among older immigrants. This result is consistent with previous research showing that older parents who gave monetary support (especially large amounts) found it highly rewarding and had lower levels of depressive symptoms (Bangerter et al., 2015). As Perrig-Chiello and Höpflinger (2005) found, giving financial support can reduce burden and distress when the givers receive positive feedback for their support. This study also found that providing care for grandchildren was associated with decreased depressive symptoms. Immigrants often feel a sense of obligation to help their adult children with childcare as they seek to cope with a variety of post-immigration challenges, including finances, employment, and career development (Chen et al., 2011). Engaging in multiple roles, including as a provider of grandchild care, promotes greater social connectedness and integration as well as increased emotional satisfaction, and thus providing grandchild care may have positive health outcomes for older immigrants.

Limitations and Implications

The analysis has several limitations. First, the study has limited generalizability. Although the HRS 2014 wave includes respondents from the original HRS cohort, AHEAD, and children of the depression cohorts, and therefore encompasses a large range of older individuals, respondents enter each HRS cohort when they are between the ages of 51–56. This study uses age 50 as the lower threshold for late-life immigration even though 50 is relatively young in the context of current life expectancies. A previous study suggested that age 50 can serve as a lower threshold for late-life immigrants because this age represents approximately two-thirds of the average life expectancy and people who migrate at age 50 or older are likely to experience work history disruption (Carr & Tienda, 2013). Additionally, setting the cutoff to an older age limited the sample too much. Future research is needed to explore intergenerational relationships using nationally representative data for individuals who immigrated after age 56.

Second, the limited number of immigrants in the sample (and the small sample size more generally) meant it was not feasible to examine differences by country of origin or racial/ethnic or cultural differences. In addition, the study used cross-sectional data, and thus could not verify the temporal order of the independent variable, mediator, and dependent variables. As a result, the study cannot exclude, for example, the possibility that immigration is associated with a higher level of depressive symptoms, which may lead to weakened relationships with children. Longitudinal analyses would strengthen the robustness of the mediation model. Regarding functional solidarity, the study measured downward support as care for grandchildren, but did not capture upward support. The reciprocal exchange of support between generations should be considered in future research. Further, this study used single-mediation analysis, however, multiple mediator analysis using path analysis would enhance the models by controlling for the indirect effects via all other mediators.

This study was not able to examine reasons for immigration and how those factors might interact with mental health and age at immigration. Factors that push individuals to immigrate (e.g., political instability or heavy taxation in the sending country) versus factors that pull individuals to a new country (e.g., less pollution or a higher-quality health care system) may impact mental health differently after immigration, and those effects may differ by age at immigration. Finally, prior research has shown that women and unmarried individuals tend to maintain closer contact with family and thus have better psychological well-being than men or married individuals. Although it was beyond the scope of the current paper, future research would benefit from examining whether the effect of intergenerational solidarity on psychological well-being differs by gender and marital status among older immigrants.

Despite these limitations, this study provides a valuable profile of older immigrants and suggests several practical implications of the complex relationship between age at immigration, intergenerational solidarity, and depressive symptoms. Although late-life immigrants live closer to adult children than those who immigrated earlier in life, this does not translate into having more frequent contact with their children. It is important for practitioners working with older immigrants with depressive symptoms to consider the role of close family members and to be aware of how intergenerational supports are exchanged with adult children. In particular, later-life immigrants tend to have limited social networks and resources, which increases their loneliness/social isolation. Because old age amplifies this issue, increasing family solidarity and integration is likely particularly important for the well-being of later-life immigrants in old age.

Funding

This work was supported a grant from the National Institute on Aging at the National Institutes of Health to the Population Studies Center at the University of Michigan (5T32-AG000221-29). Data used for this research were provided by the Health and Retirement Study (HRS), managed by the Institute for Social Research at the University of Michigan and supported by a grant from the National Institute on Aging at the National Institutes of Health (U01AG009741).

Conflict of Interest

None declared.

References