The significant of an ill spouse for assessing health differences in an elderly population

The Health Impact of Living with a Cognitively Impaired Elderly Spouse

The purpose of this study was to identify the health consequences of living with a cognitively impaired spouse in a sample of 318 spouse pairs, drawn from a representative sample of noninstitutionalized elderly individuals. Our principal findings were that (a) cognitive impairment in wives was significantly (p < .05) associated with elevated systolic blood pressure in husbands, whereas cognitive impairment in husbands was not associated with systolic blood pressure in wives; (b) cognitive impairment in wives was significantly (p < .05) associated with perceived declines in health status in husbands, but cognitive impairment in husbands was not related to perceived declines in health status in wives; (c) the relationships between wives' cognitive impairment and husbands' blood pressure and perceived health status were not mediated through limitations in activities of daily living in wives, chronic conditions in wives, or perceived inadequacy of emotional or instrumental support; and (d) cognitive functioning in one spouse was not related to health behaviors in the partner. Taken together, our results suggest that spouses of community-dwelling impaired individuals are not so severely affected that they cannot function normally. However, they suffer from health problems that can have serious consequences.

Coping and psychological well being in families of elderly cancer patients

This article reviews research directions on elderly cancer patients and the consequences of their disease for their partners and families. In a systematic review of the research literature, five research directions were identified: first, the relationship between the family and the etiology of the disease; second, the importance of the family as a source of social support; third, family caregivers as second order patients and the moderating role of psychological factors; fourth, cancer as a challenge for the family and fifth, ways of providing social and psychological support for the families of patients including examples for intervention programs. It is shown that the assumption of a "psychogenic" etiology may inhibit adaptive processes. Depending on its quality, social support can trigger adaptive coping in the patients. Elderly patients seem to be ambivalent in their attitudes towards social support because they may feel hindered with respect to their autonomy. Distress among family members is sometimes very similar to the distress experienced by patients. Several studies have shown that distress is differentially influenced by disease-related, personal and interpersonal factors as well as social resources. Interpersonal factors seem to have a specific impact on the adaptive capacities of patients and their family members. Open communication, a "healthy" family cohesion and adaptive competence seem to positively influence patients' coping. Support programs which actively include family members seem to be effective in reducing the distress of patients and their relatives. Some conclusions will be drawn including a discussion of future research directions.

The oldest-old: how do they differ from the old-old?

This article reviews findings from the Berkeley Older Generation Study, a long-term longitudinal study of aging. The findings show many important differences between the oldest-old age group and other, younger-old individuals. Marked variation is demonstrated in the verbal scale of intelligence. More than half of oldest-old individuals did not decline, and some actually increased in verbal IQ. Four personality traits (i.e., agreeableness, satisfaction, intellect, extroversion) are stable. The fifth trait, energetic, may reflect responses to external circumstances, including physical health. As for social relationships, most individuals--including the oldest-old--still retain ties with important family members and friends. Individual differences are great, stressing the danger of accepting stereotypes about old individuals.

Marital satisfaction in couples with rheumatoid arthritis

OBJECTIVE

To understand correlates of marital satisfaction in persons with rheumatoid arthritis (RA) and their spouses.

METHODS

In a cross-sectional survey, 79 persons with RA and 78 spouses completed the Kansas Marital Satisfaction Scale, the revised Ways of Coping Questionnaire scales, and the Health Assessment Questionnaire. A series of linear regression analyses were then performed to investigate correlates of marital satisfaction for patients and spouses.

RESULTS

Seventy-six percent of patients were women. Mean patient age was 56.5 years (+/- 12.5 years), number of years married was 30.7 (+/- 13.5), and duration of RA was 14.2 years (+/- 9.0 years). Demographic features of spouses resembled those of patients. Patients and spouses were generally satisfied with their marriages. Linear regression analyses showed that lower marital satisfaction in patients was associated with higher education level (P < 0.01), patient's greater use of escape into fantasy (P < 0.01), patient's greater use of finding blame (P < 0.05), and spouse's higher use of escape into fantasy (P < 0.001). Spouses less satisfied with their marriages were more likely to use passive acceptance (P < 0.05) and less likely to find blame (P < 0.05). Female spouses were less likely to be satisfied in their marriages (P < 0.01) than male spouses.

CONCLUSIONS

This study indicates that certain passive coping styles are associated with lower marital satisfaction in persons with RA and their spouses. More highly educated patients and female spouses are also less satisfied in their marriages. These cross-sectional correlations should not be regarded as causal and should be examined further in longitudinal studies.

Factors that contribute to positive perceived health in an older population

This study explored the extent to which factors commonly associated with negative outcomes of aging also predicted positive perceived health in a group of community-dwelling older people. Questionnaires originally administered during a randomized trial of HMO's outpatient group visit program supplied data from approximately 700 participants. Stepwise modeling identified significant factors within categories of predictors of perceived health. Hierarchical multiple linear regression then modeled the incremental importance of theoretically-derived categories of factors. Many but not all of the factors previously associated with negative outcomes of aging also predicted positive perceived health, accounting for 38% of the variation. The most important predictors were fewer chronic conditions and no worsening of those conditions, mobility and better physical performance status, and the absence of depression. Gender, limitations in daily living activities, dementia, and utilization of services had little effect. The categories of f factors associated with positive perceived health had cumulative, interdependent effects.

Differences between and within genders in caregiving strain: a comparison between caregivers of demented and non-caregivers of non-demented elderly people

Fifty-two caregivers for demented and 66 non-caregivers for non-demented elderly were investigated both within a gender and between genders. All participants were relatives and a burden questionnaire was used. The results showed that there was not always a difference between the caregivers for demented and the non-caregivers for non-demented elderly which may indicate that being a relative, even to a non-demented elderly, has obviously its own problems and importance. However, results showed more significant differences between female caregivers and female non-caregivers than between male caregivers and male non-caregivers, with females caring for a demented elderly suffering most strain. Their strain was exhibited by health problems, conflicts in the family, strained relations with family and others, a less positive outlook and limits in social support because of the caregiving situation. When investigating the group of male caregivers and male non-caregivers, it was found that males caring for a demented elderly person experienced a lack of positive outlook and a need for social support. The elderly person's residence in the group of caregivers for demented elderly people and in the group of non-caregivers for non-demented elderly people did not, however, appear to indicate any significant differences.

Longitudinal analysis of multiple indicators of health decline among spousal caregivers

The hazards for experiencing major health events were studied longitudinally among 150 spousal caregivers of Alzheimer's disease (AD) patients and 46 married control participants. Based on longitudinal assessments from one to six years, the hazards of reaching any of three health events (extended physical illness or disability > 1 month, unhealthy medical rating from a nurse interview, or hospitalization) were not significantly different in a group comparison of caregivers to controls (Cox proportional hazards assumption, p > .05). However, there was a trend [X2(1, N = 107) = 3.13, p = .08] for caregivers to have a greater hazard for serious illness. Among caregivers only, a greater hazard for reaching at least one of these health events was associated with providing more activities of daily living (ADL) assistance [X2(1, N = 125) = 3.83, p = .05] but not with problem behaviors of the AD patient (p > .05). These results suggest that providing extensive ADL assistance may have health implications for spousal AD caregivers, while caregiving, per se, does not. Furthermore, these physical health impacts of caregiving may be best characterized using multidimensional assessments. Contrary to our guiding hypothesis, caregivers encountering more problem behaviors of their AD spouse were less likely to be hospitalized, X2(1, N = 145) = 5.88, p = .02. This finding may reflect a reluctance by caregivers to schedule necessary medical care when their spouses are most problematic, and this may have further long-term health implications for caregivers.

Health conditions and service utilization of adults with elder care responsibilities

This study examines health conditions and health care services utilization rates of 628 caregivers and 6,599 noncaregivers age 50 or older who were members of Kaiser Foundation Health Plan in Northern California. Controlling for age, gender, and race, caregivers were more likely than noncaregivers to report backaches, insomnia, arthritis, rectal problems, and hearing problems; they were also more likely to report having two or more current health conditions of any kind. However, caregivers and noncaregivers did not differ significantly with regard to the number of outpatient medical visits or with regard to the number of outpatient psychiatry visits.

Marriage, spousal caregiving, and a husband's move to a nursing home. A changing role for the wife?

1. Gerontological nurses, when working with elderly couples experiencing role transitions upon nursing home placement, must attend to the needs of the healthier spouse, as well as the institutionalized patient. 2. Letting the community-dwelling wife set the tone for what her continued role will be allows her to define her marriage in a way that serves her needs at this transitory time. 3. If a woman defines herself as a wife, the nurse or nurse clinician's task may be to aid her in redefining the role's tasks, responsibilities, and limitations imposed by the nursing home setting. 4. If a woman does not perceive herself as a wife, nurses must help her accept these feelings as natural, and support her need to establish an identity as an individual and not as part of a couple.

The long haul: the effects of home care on caregivers

The effects and implications of caring for a spouse with a long-term physical or cognitive disability is a developing topic in the field of women's health. In the present study, women with longer caregiving experience had more physical health problems than did those with less time caregiving, while younger women found caregiving more psychologically burdensome than did older women. Nursing interventions must be directed toward preventing a decline in the caregiver's health and development of a second patient who herself needs a caregiver.

Caregiving spouses. Physical and mental health in perspective

The self-reported physical and mental health of 315 persons caring for a spouse who had been diagnosed with Alzheimer's disease or a related disorder was compared with general population norms for existing data bases controlling for age and gender. Results suggest that across all indicators of mental health, spouse caregivers are more depressed, express higher levels of negative affect, are more likely to use psychotropic drugs, and have more symptoms of psychological distress than the general population. In terms of physical health, caregivers report higher than expected rates of diabetes, arthritis, ulcers, and anemia, yet they use medical services at rates which are similar or lower than those reported by the general population. Since no simultaneous control group was studied, these results suggest, but do not prove, the presence of differences between caregivers and non-caregivers.

Assessing health differences in an elderly population: a five-year follow-up

A sample of several hundred elderly residents of Alameda County was recontacted after 5 years to determine the effects over time of different social support and demographic variables on health status. The follow-up investigation demonstrated a strong relationship between respondents' social support resources in 1980 and their subsequent self-rated health. Indeed, social contacts in 1980, together with age and financial need, enabled us to correctly "predict" respondents' subsequent health status in close to two-thirds of the cases. As anticipated, however, the variable most strongly associated with self-rated health in the earlier cross-sectional study--illness of a mate during the preceding 6 months--disappeared as a predictor variable in the longitudinal study. This finding is in keeping with the literature on bereavement and other stressful life events which demonstrates that the health impact of such stressors is in most cases time-limited. The study findings support earlier research demonstrating the important role of social support for health maintenance and disease prevention in the elderly. They further underscore the need for intervention strategies designed to strengthen the network resources of those elders at high risk for social isolation.