Affection and Sexuality in the Presence of Alzheimer's Disease: A Longitudinal Study

Affection and sexuality were studied longitudinally for two groups of couples, one with an Alzheimer's disease (AD) afflicted spouse and the other spouse the primary caregiver, and a second group with both spouses relatively healthy. Affectional expressions were not different for the two groups prior to illness onset but declined significantly for the AD group five years into the illness trajectory; affection remained stable for the well group. Based on follow-up data obtained two years later, outcomes for afflicted spouses were taken into consideration, and the pattern for affection was be reexamined. Affection increased significantly after nursing home placement of an ill spouse. Fewer AD than well couples were sexually active five years into the illness trajectory. The problem of hypersexuality in a few male afflicted spouses had abated two years later. The number of well couples who were sexually active also declined over time, but several couples continued at the same or higher levels of sexual intimacy. The study contrasts normal aging from pathological deviations within a human developmental perspective.     

Home care for older couples: "it feels like a security blanket . . ."

In this article, the authors explore the home care experience as described by older physically impaired individuals and their caregiving spouses. Separate face-to-face semistructured interviews were carried out with each spouse from nine couples. Analysis of the interview data revealed four themes. For care receivers the themes were Independence and Developing a Trusting Relationship With Home Care Workers. Relief and Continuity were voiced by the caregiving spouses. The authors show how these themes relate to the participants' sense of security, which emerged as a key underlying concept in the home care experience. This study adds to the home care and caregiving literature as it expands our understanding of the relationship between formal and informal caregiving, highlights issues and concerns older couples face as they receive home-based care, and includes both older spouse caregivers and their direct-care recipients.     

Sexual and institutional issues when one spouse resides in the community and the other lives in a nursing home

Later life marriages often include one partner caregiving another. In some situations, institutionalization of a mate may become a viable option. One issue requiring attention when one mate resides in a nursing home and the other lives in the community is that of sexuality between the couple. Four issues are discussed: intimacy/sexual needs of the nursing home resident and the communitydwelling spouse, sexually inappropriate behaviors as related to sexuality between a nursing home resident and his/her spouse, and the role of the nursing home in facilitating relationships between these couples. Clinical implications of these issues are also explored.     

‘She's usually quicker than the calculator’: financial management and decision‐making in couples living with dementia

This article explores how married couples managed their finances and made financial decisions when one spouse had dementia, drawing comparisons with the approaches used prior to the illness. More specifically, the article examines the role of social factors in influencing the involvement of people with dementia in financial management and decision‐making, particularly whether a gender dynamic adopted earlier in a marriage similarly influenced a gendered approach following dementia. The research formed part of a larger study of everyday decision‐making by couples living with dementia which explored the role of non‐cognitive factors in influencing whether people with dementia were involved in decision‐making processes. Twenty‐one married couples living at home took part; the recently‐diagnosed were excluded. Qualitative methods ‐including participant observation and interviews ‐ were used to examine the couples’ fiscal management and decision‐making‐processes, the perceptions of people with dementia and their spouses about their current financial abilities and whether any support provided by spouse‐carers influenced their partners’ financial capacity. The fieldwork was undertaken in the North of England between June 2010 and May 2011. Thematic analysis of the data showed that social factors influenced the perceived capacity of people with dementia and the financial practices adopted by the couples. In particular, gender influenced whether people with dementia were involved in financial decisions. The research demonstrated that non‐cognitive factors need to be taken into account when assessing and facilitating the capacity of people with dementia. In addition, as people with dementia were somewhat marginalised in decisions about designating financial authority (Lasting Power of Attorney), spouse‐carers may need guidance on how to undertake advance care planning and how to support their relatives with dementia in major decision‐making, particularly when there are communication difficulties.     

Dimensions of Ambiguous Loss in Couples Coping With Mild Cognitive Impairment*

Abstract: We applied the theory of ambiguous loss to couples with mild cognitive impairment (MCI), an age‐related decline in memory and other cognitive processes assumed not to interfere with daily activities or the maintenance of personal relationships. Face‐to‐face interviews with 67 older married couples revealed that lack of understanding about the behavioral manifestations of MCI resulted in much ambiguity in their lives. Fluctuations in the elders’ functioning required spouses to alter their daily activities and responsibilities. As a result, couples often experienced distress that affected their emotional involvement with one another. Findings advance theoretical implications of ambiguous loss and provide educators and practitioners with suggestions for working with couples experiencing mild memory loss.     

Keeping Secrets or Educating Others: A Dyadic Analysis of Group Entitativity’s Influence on Spouses’ Label Management Connected to AATD

In 1963, Goffman argued that forming a group based on shared stigma may provide benefits. However, there is no empirical research on whether perception that a separate, unique, coherent group exists (i.e., group entitativity) influences coping, such as educating others or secrecy, for the stigmatized individual or his or her spouse. Further, little is known about how spouses influence each other in terms of promoting the education of others about a stigmatizing condition, especially when it comes to the role of believing that stigma-based groups, to which they may both belong, exist. This study provides a step toward bridging this gap in the research by applying the label management model in efforts to understand coping for couples in which one spouse is diagnosed with genetic mutations leading to alpha-1 antitrypsin deficiency (AATD). This study included 50 married couples in which one spouse is diagnosed with genetic mutations leading to alpha-1 antitrypsin deficiency (AATD). We found that group entitativity related to those with AATD counterbalanced the influence of genetic stigma on spouses’ intentions to keep the diagnosis secret or to educate others about it. Intrapersonal and interpersonal influences appeared among spouses. Attention is needed on the power of creating groups for stigmatized persons and their relatives. Indeed, people live within a dynamic world of group entities, and multiple social identities including spousal and familial. While attention has been paid to the diffusion of stigmas to loved ones, less has been paid to the uplift of group entities for them.     

婚检HIV阳性人群干预效果分析

目的了解婚检者人类免疫缺陷病毒（HIV）阳性人群实施干预后，预防HIV婚内配偶性传播和母婴传播的效果。方法对广西防城港市防城区2011-2012年21例婚前医学检查人群确认HIV抗体阳性者及其配偶实施综合干预措施。结果21例患者干预前无1例告知对方病情，也未使用安全套。干预后，17例主动告知对方病情，告知率80．95％；坚持使用安全套的有17对夫妻，使用率80．95％。13例确诊患者自愿接受抗病毒药物治疗，占61．94％。5例孕妇为未知情下怀孕，均在指定母婴阻断单位分娩。新生儿出生后均选择人工喂养，全都使用了抗病毒药物，满周岁时HIV检测均为阴性。21例患者确诊后1年，11例未离婚者中8例配偶未检测出HIV抗体，3例配偶拒绝检测。结论对婚检HIV抗体阳性人群实施综合性干预措施，可降低HIV配偶间及母婴传播的发生率，实行的预防配偶及母婴传播综合措施是有效的。     

Heavy alcohol use and marital dissolution in the USA

Using the first five waves of the US Health and Retirement Study, a nationally representative survey of middle-aged persons in the USA conducted between 1992 and 2000, we assessed the association between alcohol consumption and separation and divorce (combined as divorced in the analysis) for 4589 married couples during up to four repeated 2-yr follow-up periods. We found that drinking status was positively correlated between spouses. The correlations did not increase over the follow-up period. Discrepancies in alcohol consumption between spouses were more closely related to the probability of subsequent divorce than consumption levels per se. Couples with two abstainers and couples with two heavy drinkers had the lowest rates of divorce. Couples with one heavy drinker were most likely to divorce. Controlling for current consumption levels, a history of problem drinking by either spouse was not significantly associated with an increased probability of divorce. Our findings on alcohol use and marital dissolution were highly robust in alternative specifications.     

Knowledge, attitudes and beliefs about HIV infection and AIDS among healthy factory workers and their wives, Kinshasa, Zaire

As a first step in designing an AIDS prevention program at a large factory in Kinshasa, Zaire, we collected information on attitudes towards human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS) from factory foremen and their wives. Trained moderators conducted twelve focus group discussions (from November through December 1987) that addressed knowledge, attitudes and beliefs about HIV infection and AIDS. In general, participants were familiar with HIV infection and AIDS and considered these conditions leading health problems in Kinshasa. Although participants had a fairly accurate understanding of the causes of HIV infection, modes of transmission and preventive measures, many myths and misconceptions existed. Many participants did not believe that condom use would consistently prevent infection through sexual intercourse. Participants strongly favored the counseling of seropositive persons but showed less consensus about whether the spouse of a seropositive person should be notified of the partner's test result. Participants predicted that couples in which one member is seropositive and the other is not would experience marital discord and friction with family, neighbors and co-workers. These findings were applied to the development of a counseling and educational program for seropositive factory employees and their spouses.     

Qualitative analysis of a BSW field placement with a hospital-owned physician practice in a skilled nursing facility

Health services and medical social work are being reshaped in the wake of managed care and the movement toward community-based delivery systems. In this article, a bachelor's of social work student is assigned to a field placement to work with a hospital-owned physician practice in a skilled nursing facility. Structured interviews are conducted with the field placement student, the physician, a resident (client), the field placement instructor, two social work designees, and the facility administrator to ascertain the student's practice activities. Findings indicate a wide range of duties at both micro- and macro practice levels. Value issues and potential considerations for practitioners entertaining professional associations with physicians are examined.     

A Caregiving Model of Coping with a Partner's Depression*

Abstract: To test a caregiving model of depression in spouses, 31 married couples completed interview and questionnaire assessments of depressive symptoms and caregiving activities. Spouses living with a partner with depressive symptoms had more symptoms of depression themselves. However, this association was found to be fully mediated by spouses’ perceived level of caregiving stress and burden. Results suggest that feelings of stress associated with caring for a depressed spouse may lead to depressive symptoms in the caregiving spouse and should be addressed in treatment.     

Extramarital sex: impact on depression and commitment in couples seeking marital therapy

The effects of extramarital sex on depression and commitment were examined in couples seeking marital therapy. One hundred and twenty couples completed a standard assessment battery which assessed level of depression, level of commitment and demographic variables. Couples presenting extramarital sex as an issue reported higher rates of depression and lower levels of commitment to their marriages. In fact, all couples presenting extramarital sex indicated either lowered commitment, elevated depression, or both. Interestingly, it was the spouse engaging in extramarital sex who was most likely to show higher levels of depression and/or lower levels of commitment than other same sex spouses presenting for marital therapy. The need for individual sessions with the spouse engaging in extramarital sex as a preliminary step in marital therapy is discussed.     

Spousal similarities in fruit and vegetable consumption

PURPOSE: To explore similar patterns of fruit and vegetable consumption between health center employees and their spouses. DESIGN: Cross-sectional mailed survey assessing frequency of fruit and vegetable consumption, as well as demographics and knowledge, attitudes, access, and social support related to fruit and vegetable consumption. SETTING: Six Massachusetts health centers. SUBJECTS: Two hundred eleven health center employee/spouse pairs (422 individuals). MEASURES: The kappa statistic measured agreement in fruit and vegetable consumption between employees and spouses. The Spearman rho coefficient measured correlations for individual responses. Multiple Linear Regression Models examined variables that explained fruit and vegetable consumption level differences. RESULTS: Response rate was 59%. Mean fruit and vegetable daily intake was 4.68 and 4.30 servings for employees and spouses, respectively. Over 75% of employee and spouse estimates measuring fruit and vegetable consumption-related information, on average, were within one survey response category of each other. Knowledge, attitudes, and access indices were significantly correlated with fruit and vegetable consumption for both employees and spouses. The social support index was significantly correlated with fruit and vegetable consumption only for the spouses. Differences in knowledge, attitudes, and access indices between employees and spouses helped to explain different fruit and vegetable consumption levels. Nonresponse, selection, recall, and seasonal reporting biases may limit the findings' generalizability. CONCLUSIONS: The effectiveness of worksite nutrition interventions may be improved by involving family/household members.     

Husbands caring for wives with dementia: a longitudinal study of continuity and change

The longitudinal study reported in this article examines how the patterns of change over time for husbands who continue to care for their spouses in the community compare with husbands who place their spouses in nursing homes. There were 74 older men enrolled in the study initially; follow-up interviews were conducted with the available husbands who continued to provide care in their own homes or who had placed their spouses in nursing homes after one year. Potential theoretical relevance of the current findings and their implications for health and mental health social workers in terms of assessment, treatment, and program development for older male caregivers is highlighted.     

Couples' patterns of adjustment to colon cancer

The objectives for this longitudinal study were to: (a) compare colon cancer patients' and their spouses' appraisal of illness, resources, concurrent stress, and adjustment during the first year following surgery; (b) examine the influence of gender (male vs female) and role (patient vs spouse caregiver) on study variables; (c) assess the degree of correlation between patients' and spouses' adjustments; and (d) identify factors that affect adjustment to the illness. Fifty-six couples were interviewed at one week post diagnosis, and at 60 days and one year post surgery. Based on a cognitive-appraisal model of stress, the Smilkstein Stress Scale was used to measure concurrent stress; the Family APGAR, Social Support Questionnaire, and Dyadic Adjustment Scale were used to measure social resources; the Beck Hopelessness Scale and Mishel Uncertainty in Illness Scales were used to measure appraisal of illness; and the Brief Symptom Inventory and Psychosocial Adjustment to Illness Scale were used to measure psychosocial adjustment. Repeated Measures Analysis of Variance indicated that spouses reported significantly more emotional distress and less social support than patients. Gender differences were found, with women reporting more distress, more role problems, and less marital satisfaction, regardless of whether they were patient or spouse. Both patients and spouses reported decreases in their family functioning and social support, but also decreases in emotional distress over time. Moderately high autocorrelations and modest intercorrelations were found among and between patients' and spouses' adjustment scores over time. The strongest predictors of patients' role adjustment problems were hopelessness and spouses' role problems. The strongest predictors of spouses' role problems were spouses' own baseline role problems and level of marital satisfaction. Interventions need to start early in the course of illness, be family-focused, and identify the couples at risk of poorer adjustment to colon cancer.     

Older Adults With Diabetes and Osteoarthritis and Their Spouses: Effects of Activity Limitations,Marital Happiness,and Social Contacts on Partners' Daily Mood

Using daily diary data from 28 later life couples where one spouse had diabetes and osteoarthritis, we examined crossover effects of target spouses' daily activity limitations and their partners' daily mood. On days when target spouses' daily activity limitations were higher than average, partners' positive mood decreased and negative mood increased; when target wives' limitations were higher than average, husbands' positive mood was higher. Marital happiness and frequency of telephone conversations of target spouses buffered some relations. Results advance our understanding of daily health processes within later life marriages by identifying crossover effects of activity limitations of an ill spouse with the mood of their partner and underscore the role of marital happiness and social contacts in buffering these associations.     

Fatal violence among spouses in the United States, 1976-85.

In this paper we examine patterns and trends in homicides between marriage partners in the United States for 1976 through 1985 using data from the Federal Bureau of Investigation's Supplemental Homicide Reports (FBI-SHR). We identified 16,595 spouse homicides accounting for 8.8 per cent of all homicides reported to the FBI-SHR during this 10-year period. The rate of spouse homicide for this 10-year period was 1.6 per 100,000 married persons. The risk of being killed by one's spouse was 1.3 times greater for wives than for husbands. Black husbands were at greater risk of spouse homicide victimization than Black wives or White spouses of either sex. The risk of victimization was greater for spouses in interracial than in intraracial marriages and increased as age differences between spouses increased. From 1976 through 1985, the risk of spouse homicide declined by more than 45.0 per cent for both Black husbands and wives but remained relatively stable for White husbands and wives. Demographic patterns in the risk of spouse homicide were similar to those reported for nonfatal spouse abuse suggesting that the causes of spouse homicide and nonfatal spouse abuse may be similar.     

Marriage as a risk factor for HIV: Learning from the experiences of HIV-infected women in Malawi

Abstract

The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of women's lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriage's effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what women's experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe women's lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review women's narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.     

Factors Affecting Utilization of Family Planning Services in a Post-Conflict Setting,South Sudan: A Qualitative Study

This study aims to explore and examine the conjectures surrounding the utilization of family planning services among currently married couples of childbearing age in Renk County.This study has adopted a qualitative method to collect data on factors affecting the utilization of family planning services through focus group discussions and in-depth interviews, in rural and urban areas of Renk County. It targeted married women, men as well as unmarried men and women. The researchers conducted nine focus group discussions and nine interviews at both Jelhak (rural setting) and Renk (urban setting). The results suggested that the people of Renk County prefer to have large families and therefore choose not to use family planning methods. The data collected was analyzed by means of thematic analysis. This included the construction of a thematic framework, coding, editing and categorization of available data as well as the creation of sub-themes.The result also suggested that perception is a main factor that affects utilization of family planning services with a majority of the people in Renk and Jelhak preferring to have many children in order to increase the family size for some reasons. These are linked to religion, social stigma and taboo that are attached to childless people or users of family planning methods for birth control purposes.The responses revealed some variation in perception between rural (Jelhak) and urban (Renk) areas. Respondents from Renk area reported that some people use family planning services for economic reasons that involve alleviation of financial difficulties and provision of better education when the family size is small. On the other hand, rural people from Jelhak perceive family planning to be socially un-acceptable. Furthermore, men and women of Jelhak reported that after each birth of a child, married couples avoid sexual relationship for a period of two years as means of family planning. Women of both Urban and Rural settings reported intentions to use conventional methods of family planning without the knowledge of their spouses.