The elderly in Tanzania suffer a temporary decline in physical well-being (body mass index) immediately after a prime-age adult death. Among factors that could improve the physical well-being of the elderly: raising their incomes and assets, improving road infrastructure, and immunization and other campaigns to control epidemics of communicable diseases.

By the end of 1999, an estimated 24.5 million Africans were living with HIV/AIDS, accounting for more than 70 percent of all global infections. In Tanzania an estimated 1.3 million people (of a total population of 33 million) were believed to be infected with HIV and 140,000 had already died of AIDS. One in every 12 adults is infected.

African couples have large families partly so there will be adult children to support parents in old age. Instead, because of the AIDS epidemic, the elderly are often caring for their infected children or orphaned grandchildren. Ainsworth and Dayton use longitudinal household data from Tanzania's Kagera region to measure the impact of prime-age adult mortality on the level and changes in physical well-being (as measured by body mass index, or BMI) of the elderly. They find that the elderly in nonpoor households have higher BMI. Nonpoor households are more likely to have an adult death and the elderly in these households are more likely to suffer declining BMI in the months before the death of a prime-age adult. The elderly in both poor and nonpoor households experience a significant drop in BMI after an adult death, but BMI recovers over time and there is no long-run association with BMI levels and recent adult deaths.

The elderly hit hardest are those in households not receiving private transfers. Private transfers received by other household members raise the BMI of the elderly, especially after a recent adult death. There is no evidence that nongovernmental organization or public assistance to the household affects short-run changes in BMI. The elderly who have more living children are physically better off, but short-run increases in the number of teenagers in the household are associated with declines in BMI.

Improving the incomes and assets of the poor is key to improving the overall BMI of the elderly. The elderly who have more assets (such as better quality dwellings) tend to have higher BMI. Controlling for individual and household characteristics, the elderly in communities with roads that are navigable year-round have substantially higher BMI. Prevention of communicable disease is key to reducing short-run fluctuations in BMI?through preventing HIV and community immunization programs that benefit the elderly.