The health impact of living with a cognitively impaired elderly spouse: depressive symptoms and social functioning

The purpose of this study was to identify the social and psychological consequences of living with a cognitively impaired spouse among community-dwelling elderly individuals. The study sample consisted of 318 spouse pairs drawn from a representative sample of noninstitutionalized elderly individuals. Our principal findings were that: (a) Cognitive impairment in wives is significantly (p less than .05) associated with depressive symptomatology in husbands, whereas cognitive impairment in husbands is only weakly (p greater than .20) associated with depressive symptomatology in wives; (b) Decreased participation in social/leisure activities is selectively related to spouses' level of cognitive functioning among both men and women; (c) The relationship between wives' cognitive impairment and husbands' depressive symptoms is influenced by perceived availability of financial support from friends and relatives, but not by ADL limitations in wives, lack of emotional or instrumental support from wives, household responsibilities among husbands, or lack of participation in social/leisure activities in husbands.     

Caregiving and institutionalization: perceptions of family conflict and socioemotional support

This study examines the impact of family conflict and socioemotional support among caregivers who institutionize their relatives. Fifty-two wives, forty-three husbands, and sixty-seven daughters were interviewed before and after the placement of a cognitively impaired relative. A repeated measures ANOVA was performed to examine differences in reports of family conflict and socioemotional support among caregivers. Husbands reported greater increases in family conflict than wives or daughters during the institutionization process. Conversely, wives and daughters indicated higher levels of socioemotional support than husbands. Hierarchical regression equations were then calculated to assess the independent contributions of family conflict and socioemotional support to postplacement adaptation. Decreases in socioemotional support during institutionalization significantly predicted postplacement anger among husbands and increases in family conflict significantly predicted postplacement depression among wives. Overall, family conflict and socioemotional support have important implications among caregivers who institutionalize their relatives.     

Leisure participation and subjective well-being: Exploring gender differences among elderly in Shanghai,China

ObjectivesTo explore the association between leisure participation and subjective well-being and the role gender in this issue among elderly Chinese in Shanghai, China.MethodsPrincipal components analysis and logistic regressions are used to analyze the cross-sectional data of the 2013 Shanghai Elderly Life and Opinion Survey that contains 2884 respondents (60+ with a mean age of 72.6) recruited from a multistage cluster sampling design. Subjective well-being is measured by happiness and life satisfaction, and leisure participation is examined by the type and diversity of leisure activities.ResultsPrincipal components analysis identifies four major types of leisure activity that elderly Chinese are actively engaged in—detachment-recovery, aesthetic, social, and performing-arts activities. Among them, social activities and performing-arts activities have the most relevance to subjective well-being. Females are more likely to engage in social and performing-arts activities whereas males are more likely to engage in detachment-recovery and aesthetic activities. Performing-arts activities promote subjective well-being only for females. Social activities are beneficial for both gender groups, but more so for males than for females. While increased levels of leisure diversity are linearly related to increased odds of subjective well-being for females, moderate level of leisure diversity is found to be the most important for males.ConclusionsLeisure participation is positively related to subjective well-being among elderly Chinese, and thus could play a critical role in promoting healthy aging. The major gender differences as observed suggest the need to further explore gender-specific barriers in leisure participation.     

Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption

Aims This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high‐risk alcohol consumption and identifies predictors of changes in concordance and high‐risk consumption. Design, Participants, Measurements Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low‐risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high‐risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high‐risk alcohol consumption and the other partner did not (n = 75). At each follow‐up, husbands and wives completed an inventory that assessed their personal, family and social functioning. Findings Compared to the low‐risk concordant group, husbands and wives in the high‐risk concordant group were more likely to rely on tension‐reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high‐risk drinking included tension‐reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. Conclusions High‐risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long‐term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high‐risk drinking.     

Individual and Interpersonal Characteristics that Influence Male-Dominated Sexual Decision-Making and Inconsistent Condom Use Among Married HIV Serodiscordant Couples in Gujarat,India: Results from the Positive Jeevan Saathi Study

Approximately 40 % of new infections occur among married women. No studies have examined the factors that may contribute to HIV transmission among HIV-negative wives in HIV serodiscordant relationships in Gujarat, India. In 2010, a cross-sectional survey with 185 HIV serodiscordant, married couples (i.e. 185 HIV-positive husbands and their 185 HIV-negative wives) in Gujarat was conducted. Socio-demographic, individual, and interpersonal characteristics of HIV-positive husbands and their HIV negative wives were examined. The association of these characteristics with inconsistent condom use and male-dominated sexual decision-making, were examined using multivariate logistic regression analyses. Approximately 10 % of couples reported inconsistent condom use in the past 3 months and 20 % reported intimate partner violence (IPV). Reports of IPV were associated with a higher odds of inconsistent condom use among HIV-positive husbands (aOR = 6.281). Husbands who reported having received couples counseling had a lower odds of male-dominated decision making about condom use (aOR = 0.372). HIV-negative wives who reported sex communication had a lower odds of male-dominated decision making about condom use (aOR = 0.322) with their HIV-positive husbands. Although condom use is a traditional measure of risk behavior, other factors that facilitate risk, such as male-dominated sexual decision-making need to be considered in analyses of risk.     

Caregiving as a life course transition among older husbands: a prospective study

Guided primarily by transitions theory, this study examined changes over two points in time (approximately 5 years apart) in multiple life domains (i.e., household tasks, social life, marital relationship, and well-being) between two groups of husbands aged 60 and older, who indicated that their wives were not in need of care or assistance due to an illness or disability at the initial interview. The two groups included husbands who identified themselves as a provider of care at Time 2 (T2; i.e., they had transitioned into the caregiver role; n = 26), and those married to healthy wives at T2 (i.e., noncaregivers; n = 262). Data came from a national probability sample of U.S. adults who were primary respondents to the National Survey of Families and Households in 1987-88, and who were followed up longitudinally in 1992-93. Findings suggested that husbands who entered the caregiving role demonstrated significant changes in household responsibilities, social integration, marital relationship, and well-being. Implications for practice and future research on the older husband caregiver are highlighted.     

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.     

Husbands and wives as caregivers: antecedents of depression and burden

Contrasting predictors of depression among 101 men and 214 women providing care to spouses suffering from Alzheimer's Disease indicated that the sole predictor for husbands was ill health, whereas for wives less emotional investment was also predictive. While there were no significant predictors for burden among husbands, for wives, burden was associated with poorer health, less emotional investment, greater spouse impairment, and provision of more assistance with tasks.     

Physical Leisure Participation and the Well-Being of Adults With Rheumatoid Arthritis: The Role of Sense of Belonging

Participation in physical leisure activities was tested as a coping resource among adults with rheumatoid arthritis. Drawing on sociological theory of social integration, sense of belonging was tested as a potential mediator to help explain any significant association found between physical leisure activity and well-being among a population-based sample of adults with rheumatoid arthritis. Greater frequency of physical leisure participation was associated with higher ratings of mental health and physical health, and these associations were partially explained by sense of belonging. Results highlight the potential role of sense of belonging as a component in how activity participation can enhance the well-being of adults coping with disability.     

Spousal characteristics as predictors of well-being in older couples.

This study examined the relations between spousal variables and the psychological well-being of husbands and wives in older couples to determine if spousal characteristics were more important determinants of well-being for wives than for husbands. One hundred-twenty older married men and women completed standardized self-report measures and a short interview. The variables investigated included education, verbal intelligence, personality, physical health, marital adjustment, psychological well-being, as well as response bias to marital defensiveness. Spousal variables significantly predicted wives' well-being (R2 = 29%) with the three most influential predictor variables being the husbands' perception of the marriage, positive dimension of well-being and physical health. In contrast, spousal variables did not significantly predict husbands' well-being. The study supported the hypothesis of differential responsiveness of men and women to spousal variables and highlighted the importance of marital adjustment for the psychological well-being of older wives.     

Social integration and social support among older adults following driving cessation

OBJECTIVES: The objective of this study was to evaluate the impact of driving cessation on social integration and perceived support from relatives and friends among older adults. METHODS: Data came from the population-based Baltimore Epidemiologic Catchment Area Study. We restricted analyses to participants aged 60+ with a history of driving (n=398). Social integration (number and frequency of contact) and perceived social support from relatives/friends, driving status (continuing or ceased), and demographic and health characteristics were assessed at interviews 13 years apart. The potential mediating role of ability to use public transit was also investigated. We used repeated measures random-intercept models to evaluate the effect of driving cessation on social network characteristics over time. RESULTS: Former drivers were older, were more likely to be female and non-White, had lower education, had poorer self-rated health, and had lower Mini-Mental State Examination scores relative to continuing drivers. Over the follow-up period, cessation was associated with reduced network of friends (odds ratio=0.49, p<.05). This association was not mediated by ability to use public transportation. Cessation had no impact on support from friends or relatives. DISCUSSION: Social integration is negatively affected by driving cessation even among elders who feel competent in using alternative forms of transportation, at least concerning networks of friends.     

Evolution Rx: A Practical Guide to Harnessing Our Innate Capacity for Health and Healing,by William Meller

Life changes may precipitate a social breakdown syndrome among the aged in which persons eventually accept a label as incompetent and define themselves as sick or inadequate. But involvement in leisure activities may intervene in the cycle and promote reconstruction. Data are analyzed from interviews with 214 men and 354 women, 72 years of age or older, to examine: (a) the influence of life changes on involvement in leisure activities; (b) the impact of involvement on psychological well-being; (3) sex differences in the impact of leisure activities of the aged. Life changes do not seem to trigger withdrawal from most leisure activities. But leiwre involvement in old age is somewhat sex-linked and participation differentially influences the well-being of men and women. Implications for practitioners are explored.     

Social disengagement and incident cognitive decline in community-dwelling elderly persons.

BACKGROUND: Social engagement, which is defined as the maintenance of many social connections and a high level of participation in social activities, has been thought to prevent cognitive decline in elderly persons. However, few longitudinal studies of this relation have been done. OBJECTIVE: To determine the relation between social disengagement and incident cognitive decline in community-dwelling elderly persons. DESIGN: Cohort study. SETTING: New Haven, Connecticut. PARTICIPANTS: 2812 noninstitutionalized elderly persons (65 years of age or older) who were interviewed in their homes in 1982, 1985, 1988, and 1994. MEASUREMENTS: A global social disengagement scale was constructed from the following indicators: presence of a spouse, monthly visual contact with three or more relatives or friends, yearly nonvisual contact with 10 or more relatives or friends, attendance at religious services, group membership, and regular social activities. Cognitive function was assessed with the Short Portable Mental Status Questionnaire. Response to the questionnaire was scored as high, medium, or low. Cognitive decline was defined as a transition to a lower category. RESULTS: Compared with persons who had five or six social ties, those who had no social ties were at increased risk for incident cognitive decline after adjustment for age, initial cognitive performance, sex, ethnicity, education, income, housing type, physical disability, cardiovascular profile, sensory impairment, symptoms of depression, smoking, alcohol use, and level of physical activity. The 3-year odds ratio was 2.24 (95% CI, 1.40 to 3.58; P < 0.001), the 6-year odds ratio was 1.91 (CI, 1.14 to 3.18; P = 0.01), and the 12-year odds ratio was 2.37 (CI, 1.07 to 4.88; P = 0.03). CONCLUSION: Social disengagement is a risk factor for cognitive impairment among elderly persons.     

Health rating and life satisfaction in the later middle years

The empirical linkage between self-rating of health and feelings of well-being in regard to overall life satisfaction, community satisfaction, job satisfaction, and marital satisfaction were assessed using data from a mail survey of 1,650 men and women who were 50 to 55 years of age. Health rating was a significant correlate of all four of the satisfaction measures. Moreover, there was little evidence to suggest that the relationship of health to expressed well-being varied by gender, education, marital status, income, number of relatives in the area, number of friends nearby, or frequency of leisure involvement.     

Predictors of social leisure activities in older Europeans with and without multimorbidity

Older people spend much time participating in leisure activities, such as taking part in organized activities and going out, but the extent of participation may differ according to both individual and environmental resources available. Chronic health problems become more prevalent at higher ages and likely necessitate tapping different resources to maintain social participation. This paper compares predictors of participation in social leisure activities between older people with and those without multimorbidity. The European Project on Osteoarthritis (EPOSA) was conducted in Germany, UK, Italy, The Netherlands, Spain and Sweden (N = 2942, mean age 74.2 (5.2)). Multivariate regression was used to predict social leisure participation and degree of participation in people with and without multimorbidity. Fewer older people with multimorbidity participated in social leisure activities (90.6 %), compared to those without multimorbidity (93.9 %). The frequency of participation was also lower compared to people without multimorbidity. Higher socioeconomic status, widowhood, a larger network of friends, volunteering, transportation possibilities and having fewer depressive symptoms were important for (the degree of) social leisure participation. Statistically significant differences between the multimorbidity groups were observed for volunteering and driving a car, which were more important predictors of participation in those with multimorbidity. In contrast, self-reported income appeared more important for those without multimorbidity, compared to those who had multimorbidity. Policies focusing on social (network of friends), physical (physical performance) and psychological factors (depressive symptoms) and on transportation possibilities are recommended to enable all older people to participate in social leisure activities.     

Intrafamilial transmission and risk assessment of HTLV-I among blood donors in southern Taiwan

The human T-lymphotropic virus type I (HTLV-I) is one of the important etiological agents of adult T-cell leukemia/lymphoma and of HTLV-I associated myelopathy or tropical spastic paraparesis. There is still a lack of data concerning HTLV-I transmission by seropositive carriers in Taiwan. We investigated the patterns of HTLV-I intrafamilial transmission in HTLV-I seropositive blood donors and assessed the risk factors of HTLV-I transmission in relatives of HTLV-I carriers in Taiwan. A total of twenty HTLV-I seropositive donors and their 103 relatives were enrolled. Among those 103 relatives, 40 (38.8%) were seropositive for HTLV-I. Their ages ranged from one to 70 years old with a mean age of 31.0 +/- 1.65 year-old. Three of the ten wives of male carriers were HTLV-I seropositive. However, none of the six husbands of female carriers were HTLV-I seropositive. Mother-to-child vertical transmission was found in nine of 48 (18.8%) tested. Significant risk factors of HTLV-I transmission among relatives of HTLV-I carriers were hospital admission, previous transfusion, breast feeding, anti-HCV seropositivity and female relatives of age >/= 30 with odds ratio (OR) of 9.73, 8.64, 4.36, 8.86 and 4.91, respectively (all p < 0.05). Nonsignificant risk factors of HTLV-I transmission were sharing needles, operation history, HBsAg seropositivity and male relatives of age >/= 30. Our findings suggest that mother-to-child and husband-to-wife transmissions are the important forms of intrafamilial transmission of HTLV-I in Taiwan. Screening for HTLV-I in family members of HTLV-I seropositive blood donors may be warranted.     

The role of family caregivers in HIV medication adherence

This study examines the role that mid-life and older wives and mothers play in promoting medication adherence among their HIV-infected husbands or adult sons who require daily living assistance. Interviews were conducted with 112 caregiving dyads, with caregivers reporting on their own behaviours and attitudes towards medications, and care-recipients (persons living with HIV [PLH]) providing information about their own adherence practices. By examining how caregiver characteristics, behaviours, and attitudes may influence PLH adherence it is explicitly recognized that caregivers and PLH are linked within a caregiving dyad. Findings indicate that caregivers often remind PLH to take medications, but these reminders are not significantly associated with adherence. Caregivers also report strong attitudes about medication hassles, concerns over treatment failure and general concerns about adherence. Controlling for background characteristics, high perceived adherence hassles on the part of the caregiver were associated with low PLH adherence, providing evidence of shared influence within the caregiving dyad. Adherence interventions may maximize their effectiveness if they consider the role of the family caregiver because these data suggest that caregiver attitudes are linked with PLH adherence behaviours.     

Increased frequency of coronary heart disease in relatives of wives of myocardial infarct survivors: Assortative mating for lifestyle and risk factors?

The frequency of myocardial infarction (MI) and coronary artery disease (CAD) was studied among the first-degree relatives of 126 spouses of male survivors of MI, and compared with the frequency of MI and CAD among relatives of 126 age-matched control subjects. MI and CAD were as frequent among the relatives of the wives as among the relatives of their husbands with MI. MI and CAD were less frequent among the relatives of control subjects. Familial aggregation of CAD, therefore, is not limited to patients' relatives, but also affects the wives' families. This finding can be explained by assortative mating, i.e., marriage partners choose mates with similar lifestyles and risk factors that lead to CAD.     

“Isn’t he wonderful?” Exploring the contribution and conceptualization of older husbands as carers

This paper explores the relationship between the dimensions of a debate cited at the intersection of ageing, gender, and family care. It draws together evidence from the General Household Survey for Britain 2000 and social research to explore the contribution and conceptualization of caring by older husbands. UK research on caring reveals that among older spouses, equal numbers of husbands and wives provide intensive care. It has been argued that within late-life marriage an over-riding desire to retain independence erodes gender-determined task allocation, suggesting not only similarity but equality between wives and husbands as carers. More recent qualitative research challenges this assumption and suggests two key findings: that older husbands are motivated to care by a combination of marital duty and reciprocal love, and that they manage the tasks of caring within an instrumental framework. Further, it is clear that pre-existing gender relations continue to be powerful determinants of the experience of caring, and that marital power is retained by men in late-life marriage. Overall, the caring contribution of older husbands is imbued with positive meaning, is highly valued, and offers a distinctive role and identity; this contrasts sharply with the caring experiences of older wives. Her key research interests are older people with mental health problems, older carers, preventive services, and social inequalities and later life. Her current research interests are service provision for older people and quality of life, the service user movement in welfare, citizenship rights, and user empowerment. Material from the National Statistics is Crown Copyright; it has been made available by the Office of National Statistics through the Data Archive and has been used with their permission. Neither the ONS nor the Data Archive bears any responsibility for the analysis or interpretation of the data reported in this paper.     

Who expects to continue working after age 62? The retirement plans of couples

OBJECTIVES: This study examines the individual, spousal, and household characteristics associated with the retirement expectations of husbands and wives. METHODS: Using data from the 1992 Health and Retirement Study, subjective probabilities of working full-time after reaching age 62 and age 65 are used to measure retirement expectations. The retirement expectations of husbands and wives are modeled simultaneously using a joint-generalized least-squares approach. RESULTS: Within a marriage, retirement expectations are shaped by individual, spousal, and household characteristics. We observe some gender differences in cross-spousal influence with wives' retirement expectations being more influenced by husbands' resources and constraints than vice versa. Nonetheless, individual and household factors associated with retirement expectations are widely shared by husbands and wives. DISCUSSION: Husbands and wives both respond to individual and joint constraints and opportunities when planning for retirement. Findings support that there is considerable overlap in retirement planning of husbands and wives during early parts of the retirement decision-making process. However, inequity in cross-spousal influences is a defining characteristic of retirement decision making. Implications for both policy makers and practitioners are briefly discussed.