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.     

Home and community-based service and other senior service use: Prevalence and characteristics in a national sample

ABSTRACT

We report on the use of home and community-based services (HCBS) and other senior services and factors affecting utilization of both among Americans over age 60 in the Health and Retirement Study (HRS). Those using HCBS were more likely to be older, single, Black, lower income, receiving Medicaid, and in worse health. Past use of less traditional senior services, such as exercise classes and help with tax preparation, were found to be associated with current use of HCBS. These findings suggest use of less traditional senior services may serve as a “gateway” to HCBS that can help keep older adults living in the community.     

The impact of the Truth and Reconciliation Commission on psychological distress and forgiveness in South Africa

BACKGROUND: Legislation to establish a Truth and Reconciliation Commission (TRC) was passed soon after election of South Africa's first democratic government. Discourse around the TRC focused on the importance of bearing witness to the past, and on the healing powers of forgiveness. However, there was also a concern that individuals with TRC relevant experience would simply be re-traumatized by participation in the process. To date, there has been little empirical data for either hypothesis. METHODS: A nationally representative survey of the South African population (n = 4,351) was undertaken 6-8 years after the TRC process began. Information about subjects' exposure to and participation in the TRC was collected, and views about the testimony of survivors and perpetrators were assessed. To determine the predictors of distress, anger, and forgiveness, linear regressions were undertaken with inclusion of demographic variables, exposure to TRC variables, and attitudes to the TRC. RESULTS: Distress was significantly associated with specific demographic factors (female gender, less education), with having a TRC-related experience to share, and with negative perceptions of the TRC (a negative view of survivors' testimony). Anger had similar associations but was also predicted by lower age. Forgiveness was associated with age and education, with being Coloured, and with having a positive view of perpetrator's testimony, while it was inversely associated with having a TRC experience to share. Distress and anger correlated inversely with forgiveness. Perceptions of the TRC were moderately positive irrespective of many demographic variables (race, education, age). CONCLUSION: In this cross-sectional study, causal relationships are difficult to ascertain. Nevertheless, relationships between increased distress/anger, having a TRC relevant experience to share, and negative perceptions of the TRC, support a view that bearing testimony is not necessarily helpful to survivors. However, in the population as a whole, moderately positive attitudes towards the TRC across sociodemographic variables support a view that the TRC helped provide knowledge and acknowledgment of the past.     

Early Antecedents of Adult Work Stress: Social-Emotional Competence and Anger in Adolescence

We hypothesized that youth with elevated coronary heart disease (CHD) risk who exhibit diminished social-emotional competence and frequent anger in adolescence experience increased occupational stress after becoming adults. Perceived job control and support from coworkers in 57 young Black and White men and women were regressed on measures of social problem-solving skill (SPS) and anger arousal (AR) obtained 5 years earlier when participants were in high school. In models controlling for grade point average (GPA), SPS and GPA independently predicted coworker support in adulthood; anger in high school predicted diminished job control. These findings suggest that occupational stress may have identifiable social-emotional antecedents early in life.     

What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Clinical Orthopaedics and Related Research® - In the assessment of possible periprosthetic knee infection, various imaging modalities are used without consensus regarding the most accurate...     

Erratum to: What is the Accuracy of Nuclear Imaging in the Assessment of Periprosthetic Knee Infection? A Meta-analysis

Clinical Orthopaedics and Related Research® -     

Research on Discrimination and Health: An Exploratory Study of Unresolved Conceptual and Measurement Issues

Objectives. Our goal in this study was to better understand racial and socioeconomic status (SES) variations in experiences of racial and nonracial discrimination.Methods. We used 1999 and 2000 data from the YES Health Study, which involved a community sample of 50 Black and 50 White respondents drawn from 4 neighborhoods categorized according to racial group (majority Black or majority White) and SES (≤ 150% or > 250% of the poverty line). Qualitative and quantitative analyses examined experiences of discrimination across these neighborhoods.Results. More than 90% of Blacks and Whites described the meaning of unfair treatment in terms of injustice and felt certain about the attribution of their experiences of discrimination. These experiences triggered similar emotional reactions (most frequently anger and frustration) and levels of stress across groups, and low-SES Blacks and Whites reported higher levels of discrimination than their moderate-SES counterparts.Conclusions. Experiences of discrimination were commonplace and linked to similar emotional responses and levels of stress among both Blacks and Whites of low and moderate SES. Effects were the same whether experiences were attributed to race or to other reasons.Racial discrimination persists in the United States,1–3 and perceptions of discrimination are associated with negative health outcomes,4–20 whether discrimination is attributed to race or not and whether its targets are members of racial or ethnic minority groups or Whites.5,17–19 Discrimination also helps to account for racial disparities in health.8–16In this study, we focused on 4 core questions about potential race and socioeconomic differences relevant to assessments of discrimination. First, to what extent do White and Black, poor and nonpoor Americans understand race-based discrimination differently? Second, do these groups differ in their uncertainty about how to make sense of incidents of perceived unfairness, given that such attributional ambiguity can lead to health-damaging worry and rumination?5,20 Third, do these groups differ in frequency of discrimination experiences across life domains? Finally, do they differ in the extent to which they attribute unfair treatment to racial versus non–race-based discrimination? Some researchers frame questions about discrimination in terms of unfair treatment and then ascertain the reason for the experience with a follow-up question,8,21 but it is unclear whether questions framed in this manner truly capture racial discrimination.22     

Prognostic importance of marital quality for survival of congestive heart failure

Mounting evidence indicates that social support is associated with better outcomes of cardiovascular disease and reduced all-cause mortality. Much less is known about the specific contribution of marital functioning to these outcomes, and the potential prognostic significance of marital quality for congestive heart failure (CHF) has not been explored. Interview and observational measures of marital quality obtained from 189 patients with CHF (139 men and 50 women) and their spouses were examined as predictors of patient survival up to 48 months after assessment and compared with prediction based on illness severity (New York Heart Association [NYHA] class). Four-year survival rates were 52.5% and 68% for male patients and female patients, respectively. In Cox regression analyses, a composite measure of marital quality predicted 4-year survival as well as the patient's concurrent NYHA class did (both p <0.001). Adjusting for CHF severity did not diminish the prognostic significance of marital functioning, and prediction of survival from marital quality appeared stronger for female than for male patients. Thus, when marital quality and NYHA class are considered jointly, they both make independent, statistically significant contributions to the prediction of patient mortality.