The effect of spousal mental and physical health on husbands' and wives' depressive symptoms, among older adults: longitudinal evidence from the Health and Retirement Survey

OBJECTIVE: To estimate the effect of spousal depressive symptoms and physical health on respondents' depressive symptoms in a national sample of older married couples. METHOD: We used data on 5,035 respondent husbands and wives from the 1992 and 1994 waves of the Health and Retirement Survey. Multivariate regression models were estimated to examine the impact of spousal depressive symptoms and physical health on respondents' depressive symptoms. RESULTS: Adjusting for respondent mental and physical health and sociodemographic traits, having a spouse with more depressive symptoms was associated with significantly higher follow-up depressive symptoms in the respondent (p < .001). Controlling for spousal depressive symptoms, a decline in the spouses' physical health was associated with a significant reduction in respondent depressive symptoms (p < .05). DISCUSSION: Our findings suggest that health care providers treating older adults should be sensitive to the possibility that spouses may be affected when clients suffer poor mental or physical health.     

Gender roles, marital intimacy, and nomination of spouse as primary caregiver

Using data from a sample of married men and women undergoing treatment for cancer, we tested two potential hypotheses for the unequal representation of husbands and wives as spousal caregivers, including societal gender role norms and emotional closeness in the marital relationship. Multivariate analyses support both hypotheses; wives are only one third as likely as husbands to select their spouses as caregivers, and spouses who name their mates as confidants are three times more likely than those who do not to also name them as caregivers. We conclude that although gender role norms are key to caregiver selection, the intimacy inherent in the caregiving role renders an emotionally close marriage an important criterion to the selection of spouse as caregiver.     

Blood pressure concordance in older married Mexican-American couples

There is a strong link between marital status and health. What has been lacking in previous literature is the attention to health similarities or concordance in health between married adults, especially in older ethnic couples. To address the issue of health concordance, the investigators examined the extent to which blood pressure is concordant between older Mexican-American spouses. Using Wave 1 of the Hispanic Established Population for the Epidemiological Study of the Elderly (n=553 married couples), ordinary least squares and logistic regression were conducted to assess the degree of similarity between married adults for systolic and diastolic blood pressure (measured as an average and as percent hypertensive). Strong associations were found between spouses for both systolic and diastolic blood pressure (correlation coefficient=0.32 and 0.34, respectively). These associations remain even when spouse age, weight, and health characteristics are included in the models. With life expectancy and the time spent in marriage increasing, examining the concordance in health between older adults becomes increasingly important to target older spouses at risk for declines in health.     

Who foregoes survivor protection in employer-sponsored pension annuities?

PURPOSE: Retirees in traditional pension plans must generally choose between single life annuities, which provide regular payments until death, and joint and survivor annuities, which pay less each month but continue to make payments to the spouse after the death of the retired worker. This article examines the payout decision and measures the share of married retirees with pension annuities who forego survivor protection. DESIGN AND METHODS: The analysis consists of a probit model of the pension payout decision, based on data from the 1992-2000 waves of the Health and Retirement Study. RESULTS: More than one quarter (28%) of married men and two thirds of married women receiving employer-sponsored retirement annuities declined survivor protection. Men with small pensions and limited household wealth, men in better health than their spouses, and men whose spouses have pension coverage from their own employers are more likely than other men to reject survivor protection. IMPLICATIONS: Most workers appear to make payout decisions by rationally balancing the costs and benefits of each type of annuity, suggesting that existing measures to encourage joint and survivor annuities are adequate. However, the growth in 401(k) plans, which are generally not covered by existing laws protecting spousal pension rights, may leave widows vulnerable.     

Relative contributions of spousal support and illness appraisals to depressed mood in arthritis patients

Objective. To examine the ability of cognitive appraisals of illness and spousal support to modify depressed mood in arthritis patients. Methods. Psychosocial data were collected from 64 married patients with rheumatoid arthritis (RA) within 2 years of diagnosis and at an 18–month fol-lowup. Results. The interaction of challenge appraisals with positive support received from the spouse was related to changes in depression over time. There was an increase in depression as challenge appraisals increased when accompanied by greater receipt of positive support, whereas individuals who did not experience a sense of challenge in response to the diagnosis of RA had the lowest levels of residualized depression when they also received higher positive support from their spouses at the beginning of the study. Conclusion. The results are considered in terms of the cognitive-behavioral mediation model suggested by Kerns and associates concerning the relationship of chronic pain to depression and have implications for interventions aimed at arthritis patients and their spouses.     

Strategy use mediates the relationship between control beliefs and memory performance for middle-aged and older adults

We examined whether the relationship between control beliefs and memory performance varied for young, middle-aged, and older adults and whether strategy use mediated this relationship. Participants were 335 adults, ages 21 to 83, who had been recruited from local probability samples. We used structural equation modeling to test the predicted model and compare it by age group (young, middle-aged, and older adults). As expected, control beliefs were related to memory performance on a word list recall task for middle-aged and older adults, but not for younger adults. An analysis of indirect effects revealed that strategy use partially mediated this relationship. Specifically, middle-aged and older adults who perceived greater control over cognitive functioning were more likely to categorize the words and had better recall performance.     

Recovering from spousal bereavement in later life: does volunteer participation play a role?

OBJECTIVES: Volunteering is an important component of social life but may be interrupted by life events. This research investigated how widowhood influences subsequent volunteer participation as well as the potential moderating effect volunteer participation may have in coping with the death of a spouse. METHODS: Analysis of three waves (1986-1994) of longitudinal data from the Americans' Changing Lives study tested (a) the effect of widowhood on volunteer participation, (b) the influence of the timing since becoming widowed on volunteering and personal well-being, and (c) the interaction effects of volunteering and widowhood on personal well-being. A cross-sectional time-series design is used to test relationships with people aged 50 years and older at baseline. RESULTS: Compared with their continually married counterparts, people who experienced spousal loss reported greater likelihood of pursuing volunteer roles, not immediately but a few years after the death of their spouse. Volunteer roles adopted after spousal loss protected against depressive symptoms, and increases in volunteer hours enhanced self-efficacy. DISCUSSION: These patterns highlight the compensatory function of volunteer participation that helps to offset the negative impact of widowhood on well-being in later life.     

The effect of widowhood on older adults' social participation: an evaluation of activity,disengagement, and continuity theories

PURPOSE: This study evaluated how levels of social participation change as a result of late-life widowhood. Social participation is a multidimensional construct incorporating both formal (e.g., meeting attendance, religious participation, and volunteer obligations) and informal (e.g., telephone contact and social interactions with friends) social roles. DESIGN AND METHODS: Using data from the Changing Lives of Older Couples study, analyses compared widowed persons to continuously married control participants to evaluate whether widowhood affects older adults' levels of social participation. RESULTS: Widowed persons had higher levels of informal social participation than nonwidowed persons, whereas formal social participation levels were comparable between the two groups. Social participation levels decrease before the death of a spouse, primarily because of poor spousal health, and increase following the loss, because of increased support from friends and relatives. IMPLICATIONS: Maintaining continuity in the realm of social participation is a strategy older adults use to cope with spousal loss; however, not all widowed persons have the same resources to alter their levels of social participation.     

Do spouses know how much fatigue,pain, and physical limitation their partners with rheumatoid arthritis experience? Implications for social support

Objective

To determine whether perceptions of clinical manifestations (fatigue, pain, and physical limitation) of rheumatoid arthritis (RA) differ between spouses and their partners with RA, and to determine whether the differences are associated with the perception of beneficial and problematic spousal social support.

Methods

English‐speaking adults with RA of ≥6 months' duration and their spouses (n = 222 couples) completed standardized questionnaires for fatigue, pain, physical limitation, beneficial spousal support, and problematic spousal support. Spouses completed questionnaires based on their perception of their partner with RA. Agreement scores for fatigue, pain, and physical limitation were calculated by subtracting spouse scores from the scores of the partner with RA. Agreement levels were defined a priori: agreement (within ± one‐half of a minimum clinically important difference [MCID] unit), overestimator (< one‐half an MCID), and underestimator (> one‐half an MCID). Separate hierarchical linear regression models were used to measure the association between beneficial support and problematic support after adjusting for RA duration, physical health, sex, educational level, relationship duration, and satisfaction.

Results

Response rate for couples was 82%. Relative to participants with RA, spouses overestimated fatigue (26%), pain (29%), and physical limitation (39%), and underestimated fatigue (11%), pain (17%), and physical limitation (34%). After statistically controlling for demographic, disease, and psychosocial variables, participants with RA whose spouses underestimated fatigue received more problematic support (R² = 3.7%, P = 0.002), as did those whose spouses underestimated or overestimated physical limitation (R² = 3.4%, P = 0.017).

Conclusion

Persons with RA perceived more problematic spousal support when their spouse underestimated fatigue, or underestimated or overestimated physical limitation levels.     

The effectiveness of a telephone support program for caregivers of frail older adults

PURPOSE: The purpose of this study was to evaluate the effectiveness of a telephone support group program on spouses and adult child caregivers of frail older adults. DESIGN AND METHODS: The Telephone Support Group (TSG) model is a multicomponent group program offered in 12 weekly, 90-minute group sessions. It includes emotion-focused and problem-focused coping strategies, education, and support. We recruited for this study 36 spouses and 61 adult children and randomly assigned them to TSG or to usual services. We assessed the participants before and after the completion of TSG or usual services. RESULTS: The results indicated that, for adult child caregivers, TSG was more effective than usual services in reducing burden, depression, social support, and pressing problems, and increasing knowledge and use of community services. We found no significant differences for spouse caregivers. IMPLICATIONS: This is the first study to compare the effectiveness of TSG for adult child and spouse caregivers of frail older adults. TSG showed itself to be an effective means of delivering support to adult child caregivers of frail older adults but not to spouses. More research is needed about how to make TSG effective for spouse caregivers.     

Marital quality and psychological adjustment to widowhood among older adults: a longitudinal analysis

OBJECTIVES: This study examined whether psychological adjustment to widowhood is affected by three aspects of marital quality--warmth, conflict, and instrumental dependence-assessed prior to the loss. METHODS: The Changing Lives of Older Couples (CLOC) is a prospective study of a two-stage area probability sample of 1,532 married individuals aged 65 and older. The CLOC includes baseline data on marital quality and mental health and data on grief, anxiety, and depression collected 6, 18, and 48 months after spousal loss. RESULTS: Widowhood was associated with elevated anxiety among those who were highly dependent on their spouses and lower levels of anxiety among those who were not dependent on their spouses. Levels of yearning were lower for widowed persons whose relationships were conflicted at baseline and higher for those reporting high levels of marital closeness and dependence on their spouses. Women who relied on their husbands for instrumental support had significantly higher levels of yearning than men who depended on their wives. DISCUSSION: The findings contradict the widespread belief that grief is more severe if the marriage was conflicted and suggest a more complex relationship between bereavement and characteristics of the marriage.     

Health and living arrangements among older Americans: does marriage matter?

OBJECTIVE: This research examines how physical and mental health influence living arrangements among older Americans and whether these effects differ for married and unmarried persons. METHODS: Data came from the Asset and Health Dynamics Among the Oldest Old study. These two intervals were pooled, and hierarchical multinomial logistic regressions were used to analyze pooled time lags. RESULTS: Functional status and cognitive functioning are significantly associated with living arrangements among those not married. Health conditions exert no significant effects among those married. Given the same functional status, unmarried elders are significantly more likely than their married counterparts to reside with their children or with others. DISCUSSION: These results underscore the critical role of the spouse in influencing living arrangements, providing new evidence supporting the assertion that a spouse is the greatest guarantee of support in old age and the importance of the marriage institution.     

Assistance received by employed caregivers and their care recipients: who helps care recipients when caregivers work full time?

PURPOSE: This study examined the association among caregiver labor force participation, employees' caregiving activities, and the amount and quality of care received by care recipients. DESIGN AND METHODS: Telephone interviews were conducted with 478 adults who were employed full time and 705 nonemployed adults who provided care to a family member or friend aged 50 or older, identified through random sampling of California households. We assessed care recipient impairment and service problems; the amounts and types of assistance received from caregivers, family and friends, and paid providers; and caregiver utilization of support services. RESULTS: Care recipients of caregivers employed full time were less likely to receive large amounts of care from their caregivers, more likely to receive personal care from paid care providers, more likely to use community services, and more likely to experience service problems than were care recipients of nonemployed caregivers. Employed caregivers were more likely to use caregiver support services than were nonemployed caregivers. IMPLICATIONS: Accommodation to caregiver full-time employment involves selective supplementation by caregivers and their care recipients, reflecting increased reliance on formal support services as well as increased vulnerability to service problems and unmet care recipient needs. These findings suggest the need for greater attention to the well-being of disabled elders whose caregivers are employed full time.     

Spousal Concordance for Alcohol Dependence: Evidence for Assortative Mating or Spousal Interaction Effects?

BACKGROUND: Alcohol dependence (AD) is among the most common psychiatric disorders, and impacts the health and well-being of problem drinkers, their family members, and society as a whole. Although previous research has consistently indicated that genetic factors contribute to variance in risk for AD, little attention has been paid to nonrandom mating for AD. When assortative mating occurs for a heritable trait, spouses are genetically correlated and offspring are at increased risk of receiving high-risk genes from both parents. The primary goal of the present analyses is to test hypotheses about the source(s) and magnitude of spousal associations for AD using a twin-spouse design. METHODS: DSM-IV AD (without the clustering criterion) was assessed via telephone interview for 5,974 twin members of an older cohort of the Australian Twin Register (born 1902-1964) and 3,814 spouses of the twins. Quantitative genetic modeling was used to determine the extent to which variability in risk for AD was influenced by genetic factors, the extent of spousal association for AD, and whether the association was attributable to assortative mating, reciprocal spousal interaction, or both processes. RESULTS: Genetic factors explained 49% of the variance in risk for AD. There was no evidence of gender differences in the spousal interaction effect, the degree of rater bias, or the association between the twin's report of spouse AD and the spouse's AD phenotype. Either the assortative mating parameter or the spousal interaction parameter could be removed from the model without a significant decrement in fit, but both could not be dropped simultaneously, suggesting a lack of power to differentiate between these 2 causes of spousal correlation. When both effects were included in the model, the spousal correlation was 0.29, the assortative mating coefficient was 0.45 (i.e., "like marries like"), and the reciprocal spousal interaction coefficient was -0.10 (i.e., after controlling for assortative mating, the additional impact of spousal interactions is slightly protective). CONCLUSIONS: These analyses provide evidence of significant spousal associations for AD, with assortative mating increasing spouse similarity and spousal interaction effects decreasing it after controlling for assortative mating. Although the genetic impact is modest, assortative mating results in an increased proportion of offspring exposed to 2 alcoholic parents and the associated detrimental environmental sequelae, and increases the likelihood of offspring inheriting high-risk genes from both parents.     

Effects of own and spousal disability on loneliness among older adults

OBJECTIVES: This study examines the effects of own and spousal disability on social and emotional loneliness among married adults aged 65 and older. METHOD: Data from 710 men and 379 women of a Dutch community sample were analyzed with linear regression analyses. RESULTS: For men, only their wives' disability was related to higher levels of social loneliness, whereas for women mainly their own disability was related to higher levels of social loneliness. Own disability and spousal disability were related to higher levels of emotional loneliness among both men and women. Effects of disability remained unaffected after controlling for characteristics of the social network and the marital relationship. DISCUSSION: Findings underscore the importance of considering effects of both spouses' health on measures of individual well-being. Also, the traditional division of social roles makes older married men relatively vulnerable to social loneliness when their wives suffer from disability.     

Widow(er) poverty and out-of-pocket medical expenditures near the end of life

OBJECTIVES: Elderly widows are three times as likely to live in poverty as older married people. This study investigates the gap in poverty, income, and wealth between these groups. Focus is placed on the role played by out-of-pocket medical expenditures spent on dying spouses. METHODS: A national panel survey of people age 70 and older in 1993 was used. Income, poverty, wealth, and out-of-pocket expenditures were examined before and after widowhood, with comparisons made with couples not experiencing a death. RESULTS: Forty-four percent of the difference in economic status between widow(er)s and married elderly persons was due to disparities in economic status that existed prior to widowhood. The remaining 56% was due to factors more directly related to the death of a spouse, including the loss of income and expenses associated with dying. On average, out-of-pocket medical expenditures in the final 2 years of life were equal to 30% of the couple's annual income. For couples in the bottom quarter of the income distribution, these expenditures were 70% of their income. DISCUSSION: As policy makers continue to debate expansions and reforms of Medicare, the potential effects of these reforms on economic well-being, particularly among widows, should be considered.     

The structure of lay consultation networks: managing illness in community settings

Objective: We examined the structure of lay consultation networks among elderly people. Methods: Data were gathered through interviews with 548 elderly adults living in Florida retirement communities and in Cleveland. Respondents identified people they consulted about symptom or disease information, health worries, what the doctor said, and consulting health providers. Network size, composition, geographic dispersion, gender homogeneity, and division of labor were assessed. Results: Eighty percent identified at least one network member (range = 1 to 7 consultants). Networks largely consisted of family members, particularly spouses and women. Older adults talked most frequently with network members about physician visits. Widowed individuals were more likely to rely on children and friends and have networks outside their neighborhoods than married elders. Women's networks included a broader range of relationships than men's networks. Discussion: Results reaffirmed the importance of gender in structuring networks in late life. The low prevalence of friends supports Cartensen's Selectivity Theory.     

The unique contribution of key existential factors to the prediction of psychological well-being of older adults following spousal loss

PURPOSE: This study examined the unique contribution of key existential factors to the prediction of psychological well-being of older adults following spousal loss. DESIGN AND METHOD: A number of measures to assess psychological well-being, sociodemographic standing, social resources, and religious and spiritual resources were administered to a volunteer sample of widows and widowers to test the hypothesis that existential factors such as personal meaning, religiosity, and spirituality are more potent predictors of psychological well-being than are previously hypothesized variables of sociodemographic, social support, and physical factors. RESULTS: A hierarchical regression analysis of the data supported the hypothesis that existential factors are major contributors to psychological well-being of older adults following spousal loss. Findings showed that widowers, compared to widows, scored lower on the measure of psychological well-being. IMPLICATIONS: Implications of the findings are discussed for practitioners working with bereaved spouses; suggestions for further research concerning bereavement and psychological well-being are made.     

Comparison of informal caregiving by black and white older adults in a community population

OBJECTIVES: To examine the prevalence of informal caregiving and demographic factors associated with caregiving time in older community residents and compare caregiving prevalence and time spent providing care by black and white residents. DESIGN: A cross-sectional, population-based study. SETTING: The study was conducted as part of the Chicago Health and Aging Project (CHAP) in a geographically defined community of black and white residents aged 65 and older. PARTICIPANTS: Participants were 5,924 community residents (61.4% black; 38.6% white) who answered questions about informal caregiving responsibilities during a structured interview about a broad range of health and social factors. METHODS: Data were collected during an in-home interview. Multiple logistic and linear regression models were used to examine the association between caregiving and race, gender, age, marital status, and education. RESULTS: More than 16% of residents had provided care to others during the previous 12 months, and 10.3% were currently providing care. Compared with whites, blacks were 30% more likely to be caregivers, spent almost 13 more hours each week in caregiving activities, and were more likely to assist friends. The probability of caregiving increased significantly with age for married persons, decreased with age for unmarried persons, and was lower for men compared with women. The time spent providing care each week increased significantly with age for married persons and did not differ between men and women. CONCLUSIONS: Although physicians and other healthcare providers typically view older people as the recipients of informal care, individuals older than age 65 provide a substantial amount of care to others with health problems and disability. Most research has focused on the needs of young and middle-aged caregivers, and little is known about the needs of these older caregivers. Future research should use sampling strategies that provide adequate numbers of white and non-white participants for meaningful comparisons. This will permit identification of racial and cultural differences in caregiving so that interventions can be tailored to specific groups.     

The Battered Woman Grows Old

Satisfying marital relations contribute to the psychological health and quality of life of older adults. Marital problems do develop in late life and previous conflicts may continue. One problem is the battered wife who grows older and remains in the marital relationship. These authors review two cases of older women admitted to the geropsychiatric unit of a private psychiatric hospital for the treatment of depression and who had also been physically abused by their spouses. The presentation of the cases illustrate the similarities between the reasons older battered women and younger battered women remain in an abusive relationship. The cases also provide some preliminary indications that these reasons become reinforced as one ages and that when a shift occurs in the pattern of abuse the older women appears more likely to become depressed.