Daily Rumination Among Older Men and Women: The Role of Perceived Family and Nonfamily Social Partner Life Stress

OBJECTIVES

Women tend to ruminate more than men, and are generally more hypervigilant to the emotions of others in order to maintain positive social ties. Thus, compared to men, women may ruminate more when their social partners have greater life stresses. However, the literature on stressful events typically focuses on individuals' experiences and perceptions of stressors experienced by specific social ties such as spousal partners and adult children. The purpose of this study was to examine links between perceptions of a broad array of family and nonfamily social partner stresses and daily rumination among older men and women.

METHODS

Adults aged 65 and older (N = 293, 55% women) completed baseline assessments of family and nonfamily life stressors and 5-6 consecutive nightly assessments regarding rumination, interpersonal tensions, worries, and support provision.

RESULTS

Multilevel structural equation models revealed that perceptions of greater family and nonfamily life stressors were associated with greater rumination. The links between family stress and rumination varied by gender: family stress was related to greater rumination among women and not men. Moreover, among women, family and nonfamily stress-rumination links were accounted for by greater daily worries about others, and among men, the nonfamily stress-rumination link was due to greater interpersonal tensions as well as daily worries.

DISCUSSION

These findings may be due in part to gender role socialization and women's greater kin-keeping and investment in family ties.

Alcohol Use and Mortality Among Older Couples in the United States: Evidence of Individual and Partner Effects

BACKGROUND AND OBJECTIVES

Spouses with concordant (i.e., similar) drinking behaviors often report better quality marriages and are married longer compared with those who report discordant drinking behaviors. Less is known regarding whether concordant or discordant patterns have implications for health, as couples grow older. The present study examined whether drinking patterns among older couples are associated with mortality over time.

RESEARCH DESIGN AND METHODS

The Health and Retirement Study (HRS) is a nationally representative sample of individuals and their partners (married/cohabiting) over age 50 in the United States, in which participants completed surveys every 2 years. Participants included 4,656 married/cohabiting different-sex couples (9,312 individuals) who completed at least 3 waves of the HRS from 1996 to 2016. Participants reported whether they drank alcohol at all in the last 3 months, and if so, the average amount they drank per week. Mortality data were from 2016.

RESULTS

Analyses revealed concordant drinking spouses (both indicated they drank in the last 3 months) survived longer than discordant drinking spouses (1 partner drinks and the other does not) and concordant nondrinking spouses. Analysis of average drinks per week showed a quadratic association with mortality such that light drinking predicted better survival rates among individuals and their partners compared with abstaining and heavy drinking. Further, similar levels of drinking in terms of the amount of drinking were associated with greater survival, particularly among wives.

DISCUSSION AND IMPLICATIONS

This study moves the field forward by showing that survival varies as a function of one's own and one's partner's drinking.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

'I feel like this will never end': mental health during the COVID-19 pandemic among older adults with chronic conditions

OBJECTIVES

The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. In this qualitative study, we evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health.

METHODS

A total of 492 adults (M = 64.95 years, SD = 8.91, range = 50-94) who lived in Michigan (82.1%) and 33 other U.S. states completed one anonymous online survey between 14 May 14 and 9 July 2020. Open-ended responses were coded to ascertain relevant concepts and were reduced to develop major themes.

RESULTS

We determined four main themes. The COVID-19 pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health service use.

CONCLUSION

This study indicates that older adults with chronic conditions experienced various challenges to managing their mental health in the early months of the COVID-19 pandemic, but also showed considerable resilience. The findings identify potential targets of personalized interventions to preserve their well-being during this pandemic and in future public health crises.

Daily sleep, well-being, and adult day services use among dementia care dyads

OBJECTIVES

The study aimed to describe daily sleep characteristics for dementia care dyads in the context of adult day services (ADS) use and examine the associations with sleep quality and daytime functioning (fatigue, affect, and behavior problems).

METHODS

Caregivers (CG; N = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons living with dementia (PLWD) across 8 consecutive days (N = 1359), where PLWD attended ADS at least 2 days of the week. On each day, caregivers also reported their own fatigue and affect and PLWD's daytime behavior problems and nighttime sleep problems. Considering the context of ADS use, we compared mean differences in bedtime, wake time, and total time in bed on nights before versus after ADS use. We estimated multilevel models to examine daily sleep-well-being associations.

RESULTS

On nights before an upcoming ADS day, care dyads went to bed and woke up earlier, and spent less time in bed. Further, PLWD had better sleep quality the night before an upcoming ADS day. Using ADS during the day buffered the negative impact of PLWD's sleep problems in the previous night, reducing daytime negative affect for caregivers. For caregivers, using ADS yesterday attenuated the association between shorter than typical time in bed and daytime fatigue; it also attenuated the association between PLWD's nighttime sleep problems and lowered daytime positive affect.

CONCLUSIONS

Regular ADS use may promote earlier sleep timing and protect against the adverse impact of sleep disturbances on daytime functioning for dementia care dyads.

Longitudinal associations between chronic condition discordance and perceived control among older couples

Chronic health conditions among individuals and their partners may diminish perceived control, particularly when these conditions are highly complex. We considered how chronic condition discordance (i.e., the extent that two or more conditions have nonoverlapping self-management requirements) at the individual level and the couple level (i.e., between spouses) was linked to health-related control and personal mastery across an 8-year period, and whether these links varied by age. The U.S. sample included 879 wives (M = 53.81 years) and husbands (M = 57.19 years) from three waves (2006, 2010, and 2014) of the Health and Retirement Study. Dyadic growth curve models controlled for age, minority status, education, own and partner baseline negative marital quality, and own and partner time-varying depressive symptoms, and number of chronic health conditions. Overall, both individual-level and couple-level degrees of chronic condition discordance were associated with initial levels of and rates of change in perceived control. When wives had greater individual-level discordance, they reported lower initial personal mastery. When husbands had greater individual-level discordance, they reported lower initial health-related control and faster declines in health-related control and personal mastery, and their wives reported faster declines in personal mastery. When there was greater couple-level discordance, wives reported lower initial health-related control. Age moderated the associations between wives' individual-level discordance and their own initial level of health-related control and rate of change in personal mastery. Interventions to improve later-life well-being may be enhanced by targeting increases in perceived control among individuals and couples managing complex patterns of chronic conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Caregiver status and illness self-efficacy during the COVID-19 pandemic among older adults with chronic conditions

OBJECTIVES

Older adults providing unpaid care to a relative or friend during the COVID-19 pandemic may have diminished self-efficacy in managing their own chronic illness, especially in the context of more complex self-management. We evaluated whether adults aged 50 and older with caregiving roles are more likely to report reduced illness self-efficacy since the pandemic, and whether this link is exacerbated by a higher number of conditions.

METHODS

Participants (105 caregivers and 590 noncaregivers) residing in Michigan (82.6%) and 33 other U.S. states completed one online survey between May 14 and July 9, 2020.

RESULTS

Controlling for sociodemographic and health characteristics, stressors related to COVID-19, and behavioral and psychosocial changes since the pandemic, caregivers were more likely than noncaregivers to report reduced illness self-efficacy when they had a higher number of chronic conditions.

CONCLUSION

These findings highlight the importance of maintaining caregivers' self-care during the COVID-19 pandemic and in future public health crises.

Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality

OBJECTIVES

Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This article examined links between alcohol use and blood pressure within individuals and opposite-sex couples over time, and whether those links vary by negative marital quality among older adults.

METHODS

Participants were from the nationally representative longitudinal Health and Retirement Study that included 4,619 respondents in 2,682 opposite-sex couples who participated in at least 2 of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff.

RESULTS

Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Furthermore, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages.

DISCUSSION

Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.

Associations between relationship quality and treatment-related stress among couples receiving methadone for opioid use disorder

BACKGROUND

Social relationships may buffer or exacerbate stress among patients receiving methadone treatment for opioid use disorder (OUD). Little is known, however, about how relationship quality is linked to treatment-related stress among couples in which both partners receive methadone. We considered the links between relationship quality and treatment-related stress among couples in methadone treatment for OUD.

METHODS

Participants for this cross-sectional observational study included 60 heterosexual married or cohabiting couples aged 18 and older drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both partners completed a self-administered survey which assessed their sociodemographic information, relationship and treatment characteristics, and perceived treatment-related stress. We estimated actor-partner interdependence models to evaluate the links between each partner's perceptions of relationship quality (with their partner and their closest family member or friend) and treatment-related stress.

RESULTS

When their partners reported a more positive partner relationship, women had lower treatment-related stress. When women reported a more positive relationship with their own closest family member or friend, both women and their partners had lower treatment-related stress. When men perceived a more positive relationship with their closest family member or friend, their partners reported greater treatment-related stress. Negative relationship quality was not significantly linked to treatment-related stress.

CONCLUSIONS

This study highlights the importance of considering how social relationship quality might impact the experiences of couples receiving methadone for OUD. In particular, women's close relationships may help to mitigate treatment-related stress.

Social Contact, Emotional Support, and Anxiety during the COVID-19 Pandemic among Older Adults with Chronic Conditions

OBJECTIVES

The COVID-19 pandemic may contribute to heightened anxiety among older adults with chronic conditions, which might be attenuated by social resources. This study examined how social contact and emotional support were linked to anxiety symptoms among adults aged 50 and older with chronic conditions, and whether these links varied by age.

METHODS

Participants included 705 adults (M = 64.61 years, SD = 8.85, range = 50- 94) from Michigan (82.4%) and 33 other U.S. states who reported at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020.

RESULTS

Multiple regression models revealed among younger people, those reporting more frequent social contact had significantly lower anxiety symptoms. Emotional support was not significantly associated with anxiety symptoms.

CONCLUSIONS

More frequent social contact was linked to lower anxiety symptoms for younger but not older individuals. Emotional support was not significantly associated with anxiety symptoms.

CLINICAL IMPLICATIONS

Interventions to manage anxiety during the pandemic among older adults with chronic conditions may benefit from strategies to safely increase social contact, especially for middle-aged adults.

Factors Associated With Sleep Disturbances Related to the COVID-19 Pandemic Among Older Adults With Chronic Conditions

OBJECTIVES

The COVID-19 pandemic may contribute to sleep problems among older adults with chronic conditions. We examined factors linked to pandemic-related sleep disturbances in a US sample of adults aged 50 and older with chronic conditions.

DESIGN

Cross-sectional anonymous online survey between May 14 and July 9, 2020.

SETTING

Michigan (82.3% of participants) and 33 other US states.

PARTICIPANTS

Total of 705 adults (M = 64.57 years, SD = 8.82, range = 50-94) who reported at least one chronic condition.

MEASUREMENTS

Sociodemographic and health characteristics, physical activity, media use, pandemic-related stress, social resources, and pandemic-related sleep disturbances.

RESULTS

In the fully adjusted regression models, people who reported more worry about COVID-19 infection, more financial strain, and greater loneliness reported significantly greater pandemic-related sleep disturbances.

CONCLUSIONS

These findings identify factors that may heighten risk of sleep problems since the COVID-19 pandemic in an especially vulnerable subgroup of older adults.

Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples

OBJECTIVES

Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms.

METHODS

The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006-2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner's baseline report of negative marital quality and number of chronic conditions in each wave.

RESULTS

Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions.

DISCUSSION

Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood.

Daily Social Interactions and HPA Axis Activity Among Midlife and Older Adults

BACKGROUND AND OBJECTIVES

Older people experience fewer negative interactions and report less stress in response to interpersonal tensions. Less is known, however, about the implications of daily social interactions for biological stress responses. We evaluated links between daily positive and negative interactions and 2 key biomeasures of the hypothalamic-pituitary-adrenal axis: salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S). We also considered the moderating effects of age.

RESEARCH DESIGN AND METHODS

Participants included a random sample of 93 individuals aged 40-95 who completed 14 days of daily diary interviews and provided saliva samples during 4 of those days.

RESULTS

Three-level piecewise models showed that individuals had higher sustained DHEA-S levels on days after reporting more positive interactions. Young-old adults (60-79) had lower overall DHEA-S on days when they had more negative interactions than oldest-old adults (80 and older). Oldest-old adults showed a flatter decline in DHEA-S on days after they reported more negative interactions compared to midlife adults (40-59). Daily social interactions were not significantly associated with cortisol.

DISCUSSION AND IMPLICATIONS

Strategies to increase positive interactions may help to build physiological resilience to stress, particularly among midlife and young-old adults.

Individual-Level and Couple-Level Discordant Chronic Conditions: Longitudinal Links to Functional Disability

BACKGROUND

Multiple chronic conditions may erode physical functioning, particularly in the context of complex self-management demands and depressive symptoms. Yet, little is known about how discordant conditions (i.e., those with management requirements that are not directly related and increase care complexity) among couples are linked to functional disability.

PURPOSE

We evaluated own and partner individual-level discordant conditions (i.e., discordant conditions within individuals) and couple-level discordant conditions (i.e., discordant conditions between spouses), and their links to levels of and change in functional disability.

METHODS

The U.S. sample included 3,991 couples drawn from nine waves (1998-2014) of the Health and Retirement Study. Dyadic growth curve models determined how individual-level and couple-level discordant conditions were linked to functional disability over time, and whether depressive symptoms moderated these links. Models controlled for age, minority status, education, each partner's baseline depressive symptoms, and each partner's number of chronic conditions across waves.

RESULTS

Wives and husbands had higher initial disability when they had their own discordant conditions and when there were couple-level discordant conditions. Husbands also reported higher initial disability when wives had discordant conditions. Wives had a slower rate of increase in disability when there were couple-level discordant conditions. Depressive symptoms moderated links between disability and discordant conditions at the individual and couple levels.

CONCLUSIONS

Discordant chronic conditions within couples have enduring links to disability that partly vary by gender and depressive symptoms. These findings generate valuable information for interventions to maintain the well-being of couples managing complex health challenges.

Accentuate the Positive: The Association Between Informal and Formal Supports and Caregiving Gains

Background: To promote resilience among caregivers for persons living with dementia (PLWDs), we examine how formal and informal supports are linked to caregiving gains, and whether gender moderates the association between supports and gains. Method: Using the National Health and Aging Trends Study and associated National Study of Caregiving, sources of informal (emotional support, practical support, and help with the PLWD) and formal support (respite care, training program, support group) are considered as predictors of caregiving gains, with gender as a moderator of these associations. The sample included 707 caregivers for 502 PLWDs. Results: Greater caregiving gains were significantly associated with emotional support from friends/family (β = 0.14, SE = 0.09, p = .03). Furthermore, attending a caregiver training program was only associated with increased caregiving gains among men (β = 0.11, SE = 0.08, p = .02). Conclusion: Emotional support from family/friends appears particularly consequential for caregiving gains, and male caregivers may benefit most from programs that emphasize skill building.

Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions

Multiple chronic conditions (MCC) are one of today’s most pressing healthcare concerns, affecting 25% of all Americans and 75% of older Americans. Clinical care for individuals with MCC is often complex, condition-centric, and poorly coordinated across multiple specialties and healthcare services. There is an urgent need for innovative patient-centered research and intervention development to address the unique needs of the growing population of individuals with MCC. In this commentary, we describe innovative methods and strategies to conduct patient-centered MCC research guided by the goals and objectives in the Department of Health and Human Services MCC Strategic Framework. We describe methods to (1) increase the external validity of trials for individuals with MCC; (2) study MCC epidemiology; (3) engage clinicians, communities, and patients into MCC research; and (4) address health equity to eliminate disparities.

Loneliness During the COVID-19 Pandemic Among Older Adults With Chronic Conditions

The COVID-19 pandemic may intensify loneliness among older adults with chronic conditions who are at high risk of severe illness, but little is known about factors associated with loneliness during the pandemic. We considered factors linked to loneliness among 701 adults aged 50 years and older with chronic conditions from Michigan (82.5%) and 33 other U.S. states. Participants completed an anonymous online survey between May 14 and July 9, 2020. About two thirds (66.4%) reported moderate to severe loneliness. The fully adjusted regression model revealed that being a person of color, having a spouse or cohabiting partner, and more emotional support were associated with lower levels of loneliness. Higher anxiety symptoms, more worry about COVID-19 infection, and more financial strain because of the pandemic were linked to greater loneliness. These findings inform strategies to support a vulnerable subgroup of older adults during this pandemic and in future public health crises.

Age Differences in Stress, Life Changes, and Social Ties During the COVID-19 Pandemic: Implications for Psychological Well-Being

BACKGROUND AND OBJECTIVES

Experiences of the coronavirus disease 2019 (COVID-19) pandemic and its implications for psychological well-being may vary widely across the adult life span. The present study examined age differences in pandemic-related stress and social ties, and links with psychological well-being.

RESEARCH DESIGN AND METHODS

Participants included 645 adults (43% women) aged 18-97 (M = 50.8; SD = 17.7) from the May 2020 nationally representative Survey of Consumers. Participants reported the extent to which they felt stress related to the pandemic in the last month, the extent to which their lives had changed due to the pandemic, as well as social isolation, negative relationship quality, positive relationship quality, and frequency of depression, anxiety, and rumination in the past week.

RESULTS

Results showed that older people reported less pandemic-related stress, less life change, less social isolation, and lower negative relationship quality than younger people. Greater pandemic-related stress, life change, social isolation, and negative relationship quality were associated with poorer psychological well-being. Poorer social ties (i.e., greater social isolation and negative quality) exacerbated the effects of the COVID-19 pandemic (stress, life change) on psychological well-being.

DISCUSSION AND IMPLICATIONS

Researchers have indicated that older adults may be more vulnerable to COVID-19 pandemic-related stress and social isolation, but this study indicates that young adults may be relatively more vulnerable. Because isolation and negative relationship quality appear to exacerbate the deleterious effects of the COVID-19 pandemic on psychological well-being, reducing social isolation and negative relations are potential targets for intervention.

Gender Differences in Patterns and Correlates of Continued Substance Use among Patients in Methadone Maintenance Treatment

Continued substance use is common during opioid use disorder (OUD) treatment. There are still inconsistencies in how continued substance use and concurrent patterns of substance use among patients with OUD varies by gender. There is still more to learn regarding how factors associated with continued and concurrent use might differ for men and women in methadone maintenance treatment (MMT). Methods: This cross-sectional study examined predictors of concurrent substance use subgroups among patients receiving MMT. The sample included 341 (n = 161 women) MMT patients aged 18 and older from opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a survey assessing sociodemographic and clinical characteristics including past-month substance use. Latent class analyses were conducted by gender to identify groups based on substance use and determine predictors of those classes. Results: Three-class solutions were the optimal fit for both men and women. For both genders, the first subgroup was characterized as Unlikely Users (59.8% women, 52.8% men). Classes 2 and 3 among women were Cannabis/Opioid Users (23.7%) and Stimulant/Opioid Users (13.0%). Among men, Classes 2 and 3 consisted of Alcohol/Cannabis Users (21.9%) and Cannabis/Stimulant/Opioid Users (25.3%). Ever using Suboxone (buprenorphine/naloxone) and depression/anxiety symptoms were significantly linked to substance use group among women, whereas homelessness and employment status were significantly associated with substance use group among men. Conclusions: This study furthers understanding of gender differences in factors associated with continued substance use and distinctive patterns of concurrent substance use that may guide tailored treatments among patients MMT.

Dyadic associations between relationship quality and risk of opioid use among couples receiving methadone for opioid use disorder

BACKGROUND

Social relationships may serve as both protective factors and risk factors for opioid use (nonmedical prescription opioid or illicit opioid use) among patients receiving methadone for opioid use disorder (OUD). Yet little is known about how relationship quality is linked to outcomes among couples receiving methadone. We evaluated the links between relationship quality and risk of opioid use among couples in which both partners received methadone.

METHODS

Participants included 53 heterosexual married or cohabiting couples aged 18 and older who were drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both members of the couple completed a self-administered survey assessing their sociodemographic information, relationship and treatment characteristics, and risk of opioid use.

RESULTS

Roughly half of women (47.2%) and men (52.8%) had a moderate to high risk of nonmedical prescription opioid use and almost two-thirds (64.2%) had a moderate to high risk of street opioid use. Risk of street opioid use was highly correlated within couples. Actor-partner interdependence models revealed that when women reported higher positive relationship quality, they had a lower risk of nonmedical prescription opioid use and their partners had a lower risk of street opioid use. Negative relationship quality was not significantly linked to risk of opioid use.

CONCLUSIONS

Couples in which both partners receive methadone for OUD may be at risk of return to use, and positive partner relationships may play a role in lowering this risk. Women's perceptions of relationship quality might be a particularly important target for clinical care and interventions.

Chronic condition discordance and physical activity among midlife and older couples

OBJECTIVE

Chronic conditions in middle and later life are associated with lower physical activity. Yet little is known about chronic condition discordance (i.e., the extent to which conditions have nonoverlapping self-management requirements) within older individuals and couples and its implications for physical activity. We determined how the degrees of chronic condition discordance at the individual level and the couple level (i.e., between spouses) were linked to moderate physical activity across an 8-year period.

METHOD

The U.S. sample included 1,621 couples from five waves of the Health and Retirement Study (2006-2014). Dyadic growth curve models estimated how individual-level and couple-level chronic condition discordance were linked to initial levels of and rates of change in moderate activity. Models controlled for age, minority status, education, and own and partner reports of baseline negative marital quality, time-varying depressive symptoms, and time-varying number of chronic conditions.

RESULTS

A considerable proportion of wives (25.4%) and husbands (18.9%) reported moderate activity less than once a week. When individuals (wives: β = -0.10; husbands: β = -0.09) or their spouses (wives: β = -0.04; husbands: β = -0.05) had greater individual-level chronic condition discordance, lower initial moderate activity was reported. When husbands had greater individual-level discordance, both wives (β = -0.16) and husbands (β = -0.19) had a faster rate of decline in moderate activity over time. Couple-level chronic condition discordance was not significantly linked to moderate activity.

CONCLUSIONS

These findings suggest the importance of promoting physical activity among individuals and couples managing complex chronic conditions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Midlife Children's and Older Mothers' Depressive Symptoms: Empathic Mother-Child Relationships as a Key Moderator

OBJECTIVE

This study aimed to evaluate the link between midlife children's and older mothers' depressive symptoms, whether this link is exacerbated in highly empathic mother-child relationships (i.e., shared strong feelings of being loved, cared for, and understood in the mother-child tie), and whether these associations vary by children's gender.

BACKGROUND

Empathic mother-child relationships in later life may intensify the link between midlife children's and older mothers' depressive symptoms. Yet little is known about the emotional implications of the mother-child tie for midlife daughters and sons.

METHOD

The sample included 234 midlife children (M = 49.75 years) and their mothers (M = 75.27 years) from Wave 1 of the Family Exchanges Study. Linear regressions were estimated to determine the link between midlife children's and older mothers' depressive symptoms and the potential moderating role of highly empathic mother-child relationships.

RESULTS

Midlife children had greater depressive symptoms when their mothers had greater depressive symptoms in the context of highly empathic mother-child relationships. This association was not moderated by children's gender.

CONCLUSION

These findings underscore the enduring emotional salience of the mother-child tie and emphasize the importance of relationship characteristics that may heighten the link between midlife children's and their mothers' depressive symptoms.

IMPLICATIONS

Interventions to prevent or treat depressive symptoms among midlife adults may benefit from accounting for the role that their mothers' depressive symptoms might play in maintaining these symptoms, particularly when mother-child ties are highly empathic.

Stressors and Resources Related to Medication Management: Associations With Spousal Caregivers' Role Overload

BACKGROUND AND OBJECTIVES

Managing medications can be stressful for spousal caregivers, but little is known about particular aspects of medication management that are most consequential for caregiving outcomes. We examined care stressors and resources related to medication management, their associations with role overload among spousal caregivers, and whether these links vary by care recipients' number of chronic health conditions and dementia status.

RESEARCH DESIGN AND METHODS

This cross-sectional study included 377 spousal caregivers of adults aged 65 and older from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate how medication-related stressors (ordering medication, keeping track of medications, giving injections) and resources (medication reminder systems, shared medication management within the spousal dyad) are associated with caregivers' role overload. Care recipients' number of chronic health conditions and dementia status were considered as moderators. Models controlled for caregivers' sociodemographic characteristics, chronic health conditions, and other care tasks.

RESULTS

Caregivers who administered injections reported more role overload, whereas those who worked with care recipients to jointly manage medications reported less role overload. Keeping track of medications was linked to caregivers' greater role overload when care recipients had 5 or more chronic health conditions. Finally, care recipients' use of medication reminder systems was linked to less role overload for caregivers of a partner with dementia.

DISCUSSION AND IMPLICATIONS

Devising strategies to assist spousal caregivers in the more onerous components of medication management and promote resources that mitigate medication-related stress may improve caregiver well-being.

So Close and Yet So Irritating: Negative Relations and Implications for Well-being by Age and Closeness

OBJECTIVES

Negative social relationships are associated with poor health, chronic illness, and mortality. Yet, we know little about the dynamics of negative aspects of relationships within individual's closest relationships over time, how those experiences vary by age, and the implications of those relationships for well-being.

METHOD

A total of 592 participants (ages 25-97; M = 57.5; 63.3% women) from the Social Relations Study completed monthly web surveys for up to 12 months. Each month they reported negative relationship quality with their three closest network members and multiple dimensions of well-being (positive affect, negative affect, self-rated health, and sleep quality).

RESULTS

Multilevel models revealed older individuals reported less negativity in their relationships than younger people, but fewer age differences in the closest tie. Greater negative relationship quality predicted poor well-being (i.e., greater negative affect, sleep problems). Links between negative relations and well-being were less strong among older individuals; especially in the closest ties.

DISCUSSION

Results were partially consistent with the strength and vulnerability integration (SAVI) model, which proposes fewer age-related improvements in emotion regulation when individuals are unable to avoid tensions. Despite feeling just as negative as younger individuals, older individuals may be more resilient to tensions in their closest relationships.

Predictors of Secondary Role Strains Among Spousal Caregivers of Older Adults With Functional Disability

BACKGROUND AND OBJECTIVES

Aging spouses commonly care for a partner with functional disability, but little is known about how spousal caregiving may impact different life domains. This study evaluated how caregiving characteristics are associated with secondary role strains among spousal caregivers.

RESEARCH DESIGN AND METHODS

This cross-sectional study examined 367 spousal caregivers and their partners from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Hierarchical regressions were estimated to determine how caregiver background factors (sociodemographics, health conditions) along with primary objective (care activities, care recipient health conditions, and dementia status) and subjective (emotional caregiving difficulties, role overload) stressors are linked to care-related valued activity restriction, negative caregiving relationship quality, and care-related family disagreements. Gender differences were considered.

RESULTS

After accounting for all predictors, older caregivers and caregivers providing more help with activities of daily living and health system interactions (e.g., scheduling appointments) were more likely to report activity restriction, whereas caregivers with more emotional difficulties reported higher negative caregiving relationship quality. Role overload was positively associated with all three secondary strains. For husbands only, caring for a partner with more chronic conditions was linked to higher negative caregiving relationship quality and caring for a partner with dementia was associated with a greater likelihood of family disagreements.

DISCUSSION AND IMPLICATIONS

Secondary role strains may develop through similar and unique pathways for caregiving wives and husbands. Further research is needed to identify those who could benefit from support in managing their care responsibilities alongside other life areas.

Multiple Chronic Conditions in Spousal Caregivers of Older Adults With Functional Disability: Associations With Caregiving Difficulties and Gains

OBJECTIVES

Multiple chronic conditions (MCCs) are common and have harmful consequences in later life. Along with managing their own health, many aging adults care for an impaired partner. Spousal caregiving may be more stressful when caregivers have MCCs, particularly those involving complex management. Yet, little is known about combinations of conditions that are most consequential for caregiving outcomes.

METHOD

Using a U.S. sample of 359 spousal caregivers and care recipients from the 2011 National Aging Trends Study and National Study of Caregiving, we examined three categories of MCCs based on similarity of management strategies (concordant only, discordant only, and both concordant and discordant) and their associations with caregiving difficulties and gains. We also considered gender differences.

RESULTS

Relative to caregivers without MCCs, caregivers with discordant MCCs reported fewer gains, whereas caregivers with both concordant and discordant MCCs reported greater emotional and physical difficulties. Wives with discordant MCCs only reported a trend for greater physical difficulties. Caregivers with concordant MCCs did not report more difficulties or gains.

DISCUSSION

Spousal caregivers with MCCs involving discordant management strategies appear to be at risk for adverse care-related outcomes and may benefit from support in maintaining their own health as well as their caregiving responsibilities.

Medical Comorbidities of Dementia: Links to Caregivers' Emotional Difficulties and Gains

OBJECTIVES

To evaluate how eight major medical comorbidities of dementia (arthritis, cancer, diabetes, heart disease, hypertension, lung disease, osteoporosis, and stroke) are associated with caregivers' perceptions of emotional caregiving difficulties and caregiving gains (ie, benefits or rewards from the care role).

DESIGN

Nationally representative cross-sectional surveys of community-dwelling persons living with dementia (PLWDs) and their co-resident family caregivers in the United States.

SETTING

The 2011 National Health and Aging Trends Study and National Study of Caregiving.

PARTICIPANTS

Total of 356 co-resident family caregivers of community-dwelling PLWDs.

MEASUREMENTS

Caregivers' sociodemographic and health characteristics, caregiving stressors, emotional caregiving difficulties, caregiving gains, and chronic health conditions of PLWDs.

RESULTS

Caregivers most commonly cared for a PLWD with arthritis (65.5%), followed by hypertension (64.9%), diabetes (30.1%), stroke (28.8%), osteoporosis (27.1%), heart disease (23.3%), cancer (21.5%), and lung disease (17.2%). Logistic regressions revealed that caregivers were 2.63 and 2.32 times more likely to report higher than median emotional caregiving difficulties when PLWDs had diagnoses of diabetes and osteoporosis, respectively, controlling for caregiver sex, relationship to the PLWD (spouse vs non-spouse), educational attainment, self-rated health, and assistance with activities of daily living and medical care activities. Caregivers were also 2.10 times more likely to report lower than median caregiving gains when PLWDs had a diagnosis of osteoporosis.

CONCLUSION

Comorbid health conditions among PLWDs have distinct implications for caregiving outcomes. Clinical care and interventions to improve the well-being of both care dyad members should support caregivers in managing medical comorbidities of dementia. J Am Geriatr Soc 68:609-613, 2020.

DISCORDANT CHRONIC CONDITIONS AND DEPRESSIVE SYMPTOMS AMONG MIDDLE-AGED AND OLDER COUPLES

Discordant chronic conditions (i.e., those with competing management requirements) have adverse consequences for well-being, yet little is known about their implications among couples. We evaluated how depressive symptoms are linked to discordant conditions within individuals and between spouses across an 8-year period. The U.S. sample included 1,116 middle-aged and older couples from five waves (2006 – 2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models controlled for age, minority status, education, depressive symptoms in the previous wave, and each partner’s report of baseline marital quality and number of chronic conditions in each wave. Wives and husbands with their own discordant conditions reported higher depressive symptoms, and this association intensified over time. Over and above this link, husbands had higher depressive symptoms when there were discordant conditions between spouses. Both individual-level and couple-level discordant chronic conditions appear to have enduring implications for depressive symptoms in middle and later life.

DAILY SOCIAL INTERACTIONS AND BIOLOGICAL STRESS REACTIVITY: ARE THERE AGE DIFFERENCES?

Older people experience fewer negative social interactions and report less anger and stress when faced with interpersonal tensions. Little is known, however, about age differences in biological responses to social interactions. We evaluated how salivary DHEA-S, a key indicator of stress reactivity, is associated with daily positive and negative social interactions among midlife and older adults. Participants were drawn from the Daily Health, Stress, and Relationship Study, which includes 93 adults age 40 to 95 who completed 14 days of daily diary interviews and provided saliva samples on four of those days. Multilevel models showed that people had higher DHEA-S on days in which they reported more positive interactions. Older respondents were less reactive to negative interactions relative to younger respondents. These findings indicate that positive social interactions may benefit biological stress reactivity regardless of age, whereas older adults are more resilient to the adverse effects of negative social interactions.

Daily interpersonal tensions and well-being among older adults: The role of emotion regulation strategies

Interpersonal tensions are more strongly associated with well-being than other types of stressors in late life. Yet, there is little understanding of how older adults' preferences for different emotion regulation strategies may buffer or exacerbate effects of daily interpersonal tensions on emotional well-being. The present study examined links between interpersonal tensions and daily emotional well-being and whether those links were exacerbated or buffered by general emotion regulation strategy preferences. Participants were from the Daily Experiences and Well-Being Study, which included 293 older adults (aged 65 + years old) who completed baseline interviews, followed by 5-6 days of ecological momentary assessments, and a leave-behind questionnaire regarding emotion regulation strategies. Interpersonal tensions predicted poorer emotional well-being throughout the day and even more so for oldest-old individuals (aged 80 +) compared to young-old individuals. The effects of tensions on emotional well-being were attenuated among adults who generally preferred reappraisal and exacerbated among people who generally preferred avoidance. Reappraisal was particularly important for buffering the effects of tensions among individuals with poorer self-reported health. The findings regarding active coping were more nuanced and varied by age. The current study advances previous research on emotion regulation and social relations by examining older adults and revealing that links between interpersonal tensions, emotion regulation strategies, and emotional well-being vary on the basis of age and self-rated health. This study highlights the importance of considering how personal characteristics may shape later-life well-being in the context of coping with interpersonal tensions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Perceptions of Purpose in Life Within Spousal Care Dyads: Associations With Emotional and Physical Caregiving Difficulties

Background

Greater feelings of purpose in life are associated with better health and may reduce the negative impact of chronic stress. Yet little is known about how purpose in life may buffer the negative effects of caregiving, a common chronic stressor in middle and later life.

Methods

This cross-sectional study utilized a U.S. sample of 315 spousal caregivers and their partners with functional disability drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving to examine how both parties' perceptions of purpose in life are associated with caregivers' emotional and physical caregiving difficulties. We also evaluated whether care recipients' purpose in life moderates the association between caregivers' purpose in life and care-related difficulties. Finally, we considered whether these links differed by caregiver gender. Models controlled for caregivers' sociodemographics, care tasks, support resources, valued activity participation, and each care partner's health conditions.

Results

Caregivers' greater purpose in life was significantly linked to fewer physical caregiving difficulties. Caregivers' greater purpose in life was significantly associated with fewer emotional care-related difficulties among caregiving wives and when care recipients' purpose in life was low.

Conclusions

Although the associations between purpose in life and care-related difficulties are likely bidirectional, purpose in life may represent an important resource for combating the adverse consequences of caregiving. This study highlights the value of considering personal resources and their implications for caregivers' well-being within a dyadic context.

Purpose in Life Among Family Care Partners Managing Dementia: Links to Caregiving Gains

BACKGROUND AND OBJECTIVES

Purpose in life is associated with better health and has been found to minimize caregiving stress. Greater purpose may also promote caregiving gains (i.e., rewards or uplifts from providing care), yet the implications of purpose for positive aspects of the care role are largely unknown. The present study determined how perceptions of purpose in life among persons with dementia (PWDs) and their family caregivers are linked to caregiving gains.

RESEARCH DESIGN AND METHODS

This cross-sectional study examined 153 co-resident family caregivers drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. Linear regressions were estimated to evaluate associations between caregivers' and PWDs' reports of their own purpose in life and caregivers' perceived caregiving gains, along with whether these associations vary by caregiver gender. Models controlled for caregivers' sociodemographic characteristics, relationship to the PWD, care tasks, role overload, negative caregiving relationship quality, and both care partners' chronic health conditions.

RESULTS

Caregivers' higher purpose in life was significantly linked to greater caregiving gains. Beyond this association, PWDs' higher purpose in life was significantly associated with greater caregiving gains for women but not for men.

DISCUSSION AND IMPLICATIONS

Purpose in life is a psychological resource that contributes to positive caregiving outcomes. Interventions to improve caregiver well-being could benefit from strategies that strengthen and maintain feelings of purpose among caregivers and PWDs.

Relationship Quality Between Older Fathers and Middle-Aged Children: Associations With Both Parties' Subjective Well-Being

Objectives

Relationships between fathers and their children are salient to both parties throughout the life course. Yet little is known about how these ties may affect well-being in later life. This study examined the implications of aging fathers' and middle-aged children's perceptions of father-child relationship quality for their own and the other party's well-being.

Method

Using a sample of 103 fathers (M = 77.88 years) and their children (M = 49.92 years) drawn from Wave 1 of the Family Exchanges Study, we estimated actor-partner interdependence models to evaluate associations between each party's perceptions of father-child relationship quality and their well-being.

Results

Fathers had elevated depressive symptoms when they reported more negative relationships with children. This association was exacerbated for fathers of daughters when daughters reported a highly negative relationship. Fathers had better self-rated health, however, when they reported more positive relationships with daughters. Children had elevated depressive symptoms and lower life satisfaction when they reported more negative ties with fathers. Finally, sons had lower depressive symptoms when they reported more positive ties with fathers.

Discussion

Findings suggest that father-child relationship quality has significant implications for the well-being of both aging fathers and middle-aged daughters or sons.

Pain intensity, depressive symptoms, and functional limitations among older adults with serious mental illness

OBJECTIVE

To examine pain-related activity interference as a mediator for the relationship between pain intensity and depressive symptoms among older adults with serious mental illness (SMI).

METHOD

Ordinary least-squares regressions were used to investigate the mediation analysis among older adults with SMI (n = 183) from community mental health centers. Analyses used secondary data from the HOPES intervention study.

RESULTS

Higher pain intensity was associated with greater pain-related activity interference. Higher pain intensity and pain-related activity interference were also associated with elevated depressive symptoms. Finally, greater pain-related activity interference significantly mediated the association between higher pain intensity and elevated depressive symptoms.

CONCLUSIONS

These findings demonstrate that pain and depressive symptoms may be linked to functional limitations. Clinicians and researchers in the mental health field should better address pain-related activity interference among older adults with SMI, especially among those with higher pain intensity and elevated depressive symptoms.

Drinking Together: Implications of Drinking Partners for Negative Marital Quality

OBJECTIVE

Concordant and discordant alcohol use has significant implications for negative marital quality among married couples. Yet, we know little about the frequency with which individuals drink with their spouse versus with other social partners, or the implications of drinking with one's spouse and with others for negative marital quality.

METHOD

Participants were from the third wave of the Social Relations and Health Study, in which 312 (59% women; ages 22-87) married/cohabitating respondents completed a baseline telephone survey followed by monthly web surveys regarding their alcohol use, drinking partners, and negative marital quality.

RESULTS

Multilevel models revealed that men and women drink more often with their spouse than with others. Drinking any amount of alcohol with one's spouse for a greater proportion of months was associated with lower negative marital quality (e.g., less criticism and fewer demands) among men and women. The effects of drinking with others varied by gender such that more frequent drinking with others (family and nonfamily) was associated with lower negative marital quality among women and higher negative marital quality among men in the next month.

CONCLUSIONS

These findings reveal that drinking with one's spouse may partly explain why concordant drinking spouses report lower negative marital quality. Furthermore, drinking with others may be beneficial for women's marriages but harmful for men's. The findings are consistent with the concept of the drinking partnership, which suggests that drinking with one's spouse is often linked to positive outcomes, including lower negative marital quality.

Conflict Strategies in the Parent-Adult Child Tie: Generation Differences and Implications for Well-Being

Objectives

Irritations often arise in intergenerational ties. Middle-aged individuals report that their relationships with adult children are more important and more negative than ties with aging parents. However, it is unclear whether midlife individuals use different interpersonal conflict strategies with adult children compared to aging parents, and whether the strategies used have implications for psychological well-being.

Method

This study examined middle-aged individuals' reports of conflict strategies with their adult children and their aging parents and their own depressive symptoms. Participants were from the Family Exchanges Study; middle-aged adults (N = 365, ages 45 to 66 years) reported on the conflict strategies used with each of their adult children and their aging parents.

Results

Models revealed that middle-aged individuals use more active strategies (e.g., discussing problems) with their adult children than their aging parents. In contrast, individuals used more passive strategies (e.g., avoidance) with aging parents than adult children. Further, passive strategies used with adult children are associated with greater depressive symptoms.

Discussion

Findings are consistent with the intraindividual stake hypothesis and imply that conflict strategies used with adult children may be more consequential for psychological well-being than those used with aging parents.

Loneliness and Illicit Opioid Use Among Methadone Maintenance Treatment Patients

Background: Loneliness has been linked to greater substance use, especially among women. Yet little is known about how loneliness is associated with treatment outcomes for patients with opioid use disorder (OUD). Objectives: We evaluated how patient reports of using illicit opioids (i.e. heroin or non-prescription pain medications) are linked to perceptions of loneliness in a sample of adults receiving methadone maintenance treatment (MMT), and whether this link varies by gender. Methods: Participants for this cross-sectional observational study included 371 MMT patients aged 18 and older drawn from four opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a self-administered survey assessing sociodemographic and health information, loneliness, illicit opioid use, and MMT characteristics. Logistic regressions were estimated to examine the link between patient odds of illicit opioid use in the past month and perceived loneliness. Results: Patient gender moderated the association between illicit opioid use and loneliness such that severe loneliness was associated with higher odds of using illicit opioids among women (OR = 3.00, 95% CI [1.19, 7.57], p=.020) but lower odds of using illicit opioids among men (OR = 0.35, 95% CI [0.14, 0.87], p=.024), accounting for age, marital status, work status, depressive symptoms, and MMT characteristics (treatment episode, treatment duration, and methadone dose). Conclusions/importance: This study underscores the importance of considering loneliness in the management of OUD. Routine clinical care and treatment may benefit from strategies to build and sustain social connections that support long-term recovery among MMT patients.

Prevalence rates of arthritis among US older adults with varying degrees of depression: Findings from the 2011 to 2014 National Health and Nutrition Examination Survey

OBJECTIVE

Arthritis and depressive symptoms often interact and negatively influence one another to worsen mental and physical health outcomes. Better characterization of arthritis rates among older adults with different levels of depressive symptoms is an important step toward informing mental health professionals of the need to detect and respond to arthritis and related mental health complications. The primary objective is to determine arthritis rates among US older adults with varying degrees of depression.

METHODS

Using National Health and Nutrition Examination Survey 2011 to 2014 data (N = 4792), we first identified participants aged ≥50 years. Measures screened for depressive symptoms and self-reported doctor-diagnosed arthritis. Weighted logistic regression models were conducted.

RESULTS

Prevalence of arthritis was 55.0%, 62.9%, and 67.8% in participants with minor, moderate, and severe depression, respectively. In both unadjusted and adjusted regression models, a significant association between moderate depression and arthritis persisted. There were also significant associations between minor and severe depression with arthritis.

CONCLUSIONS

Arthritis is commonly reported in participants with varying degrees of depression. This study highlights the importance of screening for and treating arthritis-related pain in older adults with depressive symptoms and the need for future geriatric psychiatry research on developing integrated biopsychosocial interventions for these common conditions.

Are You Sleeping? Dyadic Associations of Support, Stress, and Worries Regarding Adult Children on Sleep

Purpose of the study

Sleep is a key factor in maintaining positive health and well-being throughout life. Although the negative outcomes of sleep problems are becoming better understood, less is known about how intergenerational relationships might affect sleep. Thus, this investigation examines the dyadic associations of support for, stress over, and worrying about adult children on sleep quality for husbands and wives.

Design and Methods

The sample included 186 heterosexual married couples drawn from the Family Exchanges Study. To account for nonindependence in the dyadic data and explore questions of mutual influence, we used actor-partner interdependence models.

Results

Husbands' and wives' reports of supporting their adult child and husbands' worry were associated with husbands' sleep quality. Conversely, wives' stress about supporting their adult child was associated with wives' sleep quality. Findings suggest that relationships with adult children have different associations for sleep quality among middle-aged husbands and wives.

Implications

Our findings have implications for health-related research with couples and families and for providers who work with individuals struggling with sleep problems. Assisting aging parents to be aware of and manage ways that stress, support, and concern for adult children relate to their sleep may benefit them in multifaceted ways.

A Bright Side to the Work-Family Interface: Husbands' Support as a Resource in Double-and-Triple-Duty Caregiving Wives' Work Lives

Purpose of the Study

This study examined how women who combine long-term care employment with unpaid, informal caregiving roles for children (double-duty-child caregivers), older adults (double-duty-elder caregivers), and both children and older adults (triple-duty caregivers) differed from their workplace-only caregiving counterparts on workplace factors related to job retention (i.e., job satisfaction and turnover intentions) and performance (i.e., perceived obligation to work while sick and emotional exhaustion). The moderating effects of perceived spouse support were also examined.

Design and Methods

Regression analyses were conducted on survey data from 546 married, heterosexual women employed in U.S.-based nursing homes.

Results

Compared to workplace-only caregivers, double-duty-elder and triple-duty caregivers reported more emotional exhaustion. Double-duty-child caregivers reported lower turnover intentions and both double-and-triple-duty caregivers felt less obligated to work while sick when perceiving greater support from husbands.

Implications

Results indicate that double-and-triple-duty caregiving women's job retention and obligation to work while sick may depend on perceived spouse support, highlighting the important role husbands play in their wives' professional lives. Findings also lend support to the emerging literature on marriage-to-work positive spillover, and suggest that long-term care organizations should target marital relationships in family-friendly initiatives to retain and engage double-and-triple-duty caregiving employees.

Parental Support of Adult Children and Middle-Aged Couples' Marital Satisfaction

Background and Objectives

Middle-aged adults commonly provide support to grown offspring. Yet little is known about how parental support may be related to parents' marital quality at midlife. This study explored couple patterns of support given to adult children and their implications for marital satisfaction.

Research Design and Methods

In a sample of 197 middle-aged couples from Wave 2 of the Family Exchanges Study, we estimated actor-partner interdependence models to evaluate the links between each spouse's reports of tangible and nontangible support given to adult children and their marital satisfaction.

Results

Wives and husbands were more satisfied with their marriage when they and their partner gave more frequent nontangible support to adult children. By contrast, wives and husbands were less satisfied with their marriage when they gave more frequent nontangible support to adult children and their partner gave low levels of this support.

Discussion and Implications

Findings shed light on the conditions under which support given to adult offspring may enhance or undermine marital quality. This study highlights the value of considering both individual and couple-level characteristics of parent-child relationships and their potential consequences for midlife couples.

"I've learned to just go with the flow": Family caregivers' strategies for managing behavioral and psychological symptoms of dementia

Background and objectives

Behavioral and psychological symptoms of dementia are highly prevalent, stressful, and challenging to manage. Caregivers’ approaches for handling these behaviors have implications for both care partners’ well-being. Yet the specific strategies that caregivers use in their daily management of behavioral and psychological symptoms of dementia are relatively unknown. This study used in-depth focus group data to examine family caregivers’ strategies for managing behavioral and psychological symptoms of dementia.

Design

As part of a larger study (NINR R01NR014200), four focus groups were conducted with a total of 26 family caregivers of older adults with dementia. Caregivers were asked to describe the strategies they use to manage behavioral and psychological symptoms of dementia. Data from audio-recorded sessions were transcribed, coded to identify relevant concepts, and reduced to determine major categories.

Results

Caregivers managed behavioral and psychological symptoms of dementia through (1) modifying interactions within the care dyad (e.g., simplifying communication); (2) modifying the care environment (e.g., using written prompts); (3) activity engagement; (4) humor; (5) self-care; and (6) social support.

Conclusion

Family caregivers manage behavioral and psychological symptoms of dementia using strategies to minimize stress and address the needs of both care partners. Caregivers’ own accounts of these approaches reveal a window into their everyday management of difficult behaviors. The present findings generate key information for routine clinical care and targeted interventions to promote caregiver well-being.

Medical Care Tasks among Spousal Dementia Caregivers: Links to Care-Related Sleep Disturbances

OBJECTIVE

Medical care tasks are commonly provided by spouses caring for persons living with dementia (PLWDs). These tasks reflect complex care demands that may interfere with sleep, yet their implications for caregivers' sleep outcomes are unknown. The authors evaluated the association between caregivers' medical/nursing tasks (keeping track of medications; managing tasks such as ostomy care, intravenous lines, or blood testing; giving shots/injections; and caring for skin wounds/sores) and care-related sleep disturbances.

METHODS

A retrospective analysis of cross-sectional data from the 2011 National Health and Aging Trends Study and National Study of Caregiving was conducted. Spousal caregivers and PLWDs/proxies were interviewed by telephone at home. The U.S. sample included 104 community-dwelling spousal caregivers and PLWDs. Caregivers reported on their sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and sleep disturbances. PLWDs (or proxies) reported on their health conditions and sleep problems.

RESULTS

Caregivers who performed a higher number of medical/nursing tasks reported significantly more frequent care-related sleep disturbances, controlling for sociodemographic and health characteristics, caregiving stressors, negative caregiving relationship quality, and PLWDs' sleep problems and health conditions. Post hoc tests showed that wound care was independently associated with more frequent care-related sleep disturbances after accounting for the other medical/nursing tasks and covariates.

CONCLUSION

Spousal caregivers of PLWDs who perform medical/nursing tasks may be at heightened risk for sleep disturbances and associated adverse health consequences. Interventions to promote the well-being of both care partners may benefit from directly addressing caregivers' needs and concerns about their provision of medical/nursing care.

"The Filter is Kind of Broken": Family Caregivers' Attributions About Behavioral and Psychological Symptoms of Dementia

OBJECTIVES

Behavioral and psychological symptoms of dementia (BPSD) are common, often challenging to manage, and may erode caregivers' well-being. Few studies have explored caregivers' perspectives of what causes these behaviors, but such attributions may be important-particularly if they negatively impact the care dyad. This study examined causal attributions about BPSD among individuals caring for a family member with dementia.

DESIGN

In-depth qualitative data were obtained from family caregivers of older adults with dementia.

SETTING

As part of a larger study (NINR R01NR014200), four focus groups were conducted with caregivers by an experienced facilitator.

PARTICIPANTS

A total of 26 family caregivers participated in the four focus groups.

MEASUREMENTS

Caregivers reported their own attributions about the causes of their care recipient's BPSD. Sessions were audio-recorded. Data were transcribed, coded to determine relevant concepts, and reduced to identify major categories.

RESULTS

Five categories were determined. Caregivers attributed BPSD to: 1) neurobiological disease factors; 2) physical symptoms or comorbid health conditions; 3) psychological reactions to dementia; 4) shifting social roles and relationships following dementia onset; and 5) environmental changes such as lack of routine and medical transitions (e.g., hospitalization). Despite this seemingly multifactorial attribution to BPSD etiology, a number of respondents also indicated that BPSD were at least partly within the care recipient's control.

CONCLUSIONS

Family caregivers attribute BPSD to a range of care recipient and environmental factors. Caregivers' own causal beliefs about BPSD may reflect unmet educational needs that should be considered in the development of targeted interventions to minimize caregiving stress.

Falls and Hospitalizations Among Persons With Dementia and Associated Caregiver Emotional Difficulties

Background and Objectives

Falls and hospitalizations are adverse health events commonly experienced by persons with dementia (PWDs). These events often require urgent care from a family caregiver and may increase caregiver stress. We examine falls and hospitalizations among PWDs as predictors of caregivers' reported care-related emotional difficulty, in addition to care-related stressors.

Research Design and Methods

Cross-sectional telephone survey of 652 informal caregivers for PWDs. A multinomial logistic regression examined falls (last month) and hospitalizations (prior year) experienced by PWDs as predictors of caregivers' care-related emotional difficulty, accounting for demographic characteristics and primary and secondary caregiving stressors.

Results

Over 20% of caregivers reported high levels of care-related emotional difficulty. Controlling for demographic characteristics and primary and secondary caregiving stressors, the PWD's prior month fall was significantly associated with greater care-related emotional difficulty; the PWD's hospitalizations were not associated with care-related emotional difficulty.

Discussion and Implications

Approximately 30% of PWDs had experienced a past year hospitalization and prior month fall, and one in five caregivers reported high emotional difficulty related to care. Although secondary strains and resources of caregiving were strong predictors of care-related emotional difficulty, PWDs' falls represent a significant stressor that increases odds of caregiver emotional difficulty over and above other strains. Consequently, a fall experienced by a PWD may represent a key time for clinicians to assess caregiver well-being.

"What Hath Night to Do with Sleep?": The Caregiving Context and Dementia Caregivers' Nighttime Awakenings

OBJECTIVES

Care provision for persons with dementia can be rewarding yet may disrupt caregiver's sleep health. Using the National Health & Aging Trends Study and the National Study of Caregiving, we examine care receiver and caregiver contextual factors, caregiver health and psychological wellbeing as predictors of caregivers' nighttime awakenings.

METHODS

The sample for this cross-sectional study included 451 caregivers for individuals with dementia surveyed by telephone.

RESULTS

Nighttime awakenings (1 item measure of waking and not being able to return to sleep) almost every night were reported by 16% of caregivers and 10% reported that helping the care receiver caused their sleep to be interrupted most nights. In a multinomial logistic regression, caregivers' greater nighttime awakenings were associated with caring for care recipients with higher fall risk, as well as caregiver characteristics of more chronic medical conditions and emotional difficulty of the care role.

CONCLUSIONS

Emotional caregiving difficulties were associated with nighttime awakenings even accounting for caregivers' health and care receivers' disability. Thus, interventions improving caregiver distress may improve sleep health.

CLINICAL IMPLICATIONS

Clinicians should screen caregivers for nighttime awakenings so that evidence-based interventions and treatments can be implemented to prevent persistent sleep disturbances.