Changes in Social Support and Relational Mutuality as Moderators in the Association Between Heart Failure Patient Functioning and Caregiver Burden.

BACKGROUND: Caregivers to patients with heart failure (HF) may experience substantial burden in their roles, yet little is known about factors that exacerbate caregiver burden over time. OBJECTIVES: We test the moderating role of changes in caregivers' social support and patient-caregiver relationship mutuality in the association between HF patient functioning and caregiver burden. METHODS: Data were analyzed using Stata 13.1 for 100 HF primary caregivers, the majority of whom were female (81%), living with the patient (87%), and married or partnered to the patient (70%). Patients reported on dyspnea, disability level, and symptom severity, and caregivers reported on patient-caregiver mutuality, social support, and perceived caregiver burden at both baseline and a 12-month follow-up. RESULTS: Regression analyses using the Structural Equation Modeling framework revealed that declines in caregiver-patient mutuality over the 12 months of the study amplified the association between patient functioning (ie, dyspnea, symptom severity, and disability) and caregiver burden. Change in social support did not significantly moderate the association between any of the patient functioning variables and caregiver burden. CONCLUSIONS: Caregivers' relationships with their care recipient shape how they respond to and interpret the demands of caregiving, and relationships experiencing negative changes over time contribute to caregiver burden. Promoting and sustaining positive social relationships within the caregiver-patient dyad is thus a promising avenue for interventions aimed at reducing the burden experienced by caregivers to patients with HF.

End-of-Life Care Planning: The Importance of Older Adults' Marital Status and Gender.

Background: As the U.S. population ages, dramatic shifts are occurring in the proportion of older adults who are divorced and widowed. Health status and behaviors are known to differ across marital status groups, yet research on end-of-life (EOL) care planning has only compared married and unmarried persons, overlooking differences between divorced and widowed individuals, by gender. Objective: This study aimed to examine marital status differences in EOL care planning by comparing the likelihood of discussions about EOL care, designation of medical durable power of attorney (MDPOA) for health care decisions, and completion of a living will for married, divorced, and widowed older adults, by gender. Methods: Analyses used data from the U.S. Health and Retirement Study for 2243 adults (50 years of age and older), who died during the course of the study. Post-death, proxy respondents reported on the decedents' EOL care discussions, living will completion, and establishment of an MDPOA. Multivariate regressions were estimated to test differences in care planning across marital status groups, for men and women. Results: Divorced men were less likely than married men to have had care discussions and to have engaged in any of the three planning behaviors. Widowers were more likely to have established an MDPOA. Both divorced and widowed women were more likely to have performed any of these EOL planning activities than married women. Conclusions: Divorced men and married women are at risk for lacking EOL care planning. Practitioners are encouraged to discuss the importance of such planning as they encounter these at-risk groups.

Transitioning From Successful Aging: A Life Course Approach.

Objective: The life course perspective and representative U.S. data are used to test Rowe and Kahn's Successful Aging (SA) conceptualization. Four sets of influences (childhood experiences, social structural factors, adult attainments, and later life behaviors) on SA transitions are examined to determine the relative role of structural factors and individual behaviors in SA. Method: Eight waves of Health and Retirement Study data for 12,108 respondents, 51 years and older, are used in logistic regression models predicting transitions out of SA status. Results: Social structural factors and childhood experiences had a persistent influence on transitions from SA, even after accounting for adult attainments and later life behaviors-both of which also impact SA outcomes. Discussion: The findings on sustained social structural influences call into question claims regarding the modifiability of SA outcomes originally made in presentation of the SA model. Implications for policy and the focus and timing of intervention are considered.

A randomized crash injury prevention trial of transitioning high-risk elders from driving.

UNLABELLED: Supplemental digital content is available in the text. BACKGROUND: Older adults with medical conditions that impair function are at risk for experiencing a motor vehicle crash. This randomized controlled trial tested an intervention to reduce crash-related risk among older patients. METHODS: A 2-to-1 allocation ratio resulted in comparisons between 26 intervention and 13 attention control (n = 39) group members who were recruited from inpatient and outpatient settings. The intervention consisted of two sessions of facilitated planning in which participants' health, transportation alternatives, attitudes/emotions regarding a change in mobility, and actions to ensure continued safe mobility were discussed. Moreover, all participants received supportive telephone calls during the 6-month intervention period. RESULTS: Results showed that when compared with the control group, the intervention group had significantly better subjective health, had fewer high-risk driving behaviors, and drove less distance on excursions from home at follow-up. Yet, simple repeated-measures analyses were not significant. CONCLUSION: Results suggest that facilitated planning may help ease the transition to driving retirement among some high-risk older patients. Larger samples and longer study duration are needed to confirm these effects and to measure direct crash and injury outcomes. A significant proportion of high-risk patients do not plan for driving retirement and remain a crash risk. LEVEL OF EVIDENCE: Therapeutic/care management study, level III.

Productive and social engagement following driving cessation: a couple-based analysis.

Drawing on interdependence theory, this study examined the cross-spouse impact of driving cessation on productive (work, formal volunteering, and informal volunteering) and social engagement of older couples aged 65+ using longitudinal data from the Health and Retirement Study (1998-2010; N = 1,457 couples). Multilevel modeling results indicate that driving cessation reduced husbands' productive and social engagement, and wives' productive engagement. Spousal driving cessation reduced husbands' likelihood of working or formal volunteering, and wives' likelihood of working or informal volunteering. The more time since spousal driving cessation, the less likely husbands were to work and the less likely wives were to formally volunteer. Results suggest the need for greater recognition of the impact of driving cessation on couples, rather than just individuals, as well as the need for enhanced services or rehabilitation efforts to maintain driving even among couples with one remaining driver.

Examining Rowe and Kahn's Concept of Successful Aging: Importance of Taking a Life Course Perspective.

PURPOSE OF THE STUDY: This article critiques Rowe and Kahn's conceptualization of successful aging using tenets of the life course perspective. DESIGN AND METHODS: A review and synthesis of the literature on successful aging and studies that use a life course perspective. RESULTS: We draw on life course principles that view development as a dynamic lifelong process, embedded in historical time and place, and influenced by the web of relationships individuals are linked to, as well as more distal social structural factors. This discussion questions the relatively static nature of Rowe and Kahn's successful aging model, its emphasis on personal control over one's later-life outcomes, and neglect of historical and cultural context, social relationships, and structural forces in influencing later-life functioning. IMPLICATIONS: Caution in using the model in its current formulation is needed, and we promote thinking about how successful aging can better align with micro- and macrolevel issues through utilization of a life course perspective.

Young women's education and behavioural risk trajectories: clarifying their association with unintended-pregnancy resolution.

In the USA, most pregnancies occurring to teenage women are unplanned, making both the decisions regarding their resolution and the consequences of those decisions important topics of inquiry. Substantial debate surrounds the potential consequences for young women of either carrying an unintended pregnancy to term or voluntarily terminating it. The present study utilises data from The US National Longitudinal Study of Adolescent Health prospectively to examine the predictors of pregnancy resolution decisions in terms of young women's educational goals and their engagement in risk behaviours. Additionally, the long-term consequences of these decisions for education and risk-taking behaviours are identified. Results indicate that young women with strong educational goals have a greater likelihood of terminating an unintended pregnancy than those with low aspirations, and that pregnancy termination predicts higher educational attainment compared to motherhood. Risk behaviours did not predict pregnancy-resolution decisions, but young women who became mothers reported lower rates of subsequent substance use and fewer sexual partners post-pregnancy than those who terminated the pregnancy or who had never been pregnant. Motherhood appears to be a catalyst for lifestyle change among young women, limiting substance use and sexual partnering, in contrast to abortion, which appears to allow adolescents to continue risk-taking trajectories.

Role ambiguity among women providing care for ex-husbands.

Twenty-one women were interviewed regarding their caregiving experiences for ill or dying ex-husbands. Emergent in the analyses was the variety of ways in which they experienced role ambiguity as ex-wife caregivers. This article describes the role ambiguity ex-wife caregivers encountered interpersonally through interactions with network members, institutionally in dealing with professionals and the workplace, and intrapersonally in confusion over their roles and feelings. Consequences of role ambiguity are discussed, and recommendations for policy and practice are made in light of the aging population, changing family forms, and women's care roles.

Giving up the keys: how driving cessation affects engagement in later life.

PURPOSE: Many older adults consider driving vital to maintaining their preferred lifestyle and engagement with society, yet it is normative for individuals to eventually stop driving. This study examined the impact of driving cessation on older adults' productive and social engagement and whether their mental and physical health mediated this relationship. DESIGN AND METHODS: Multilevel modeling was used to analyze longitudinal data (N = 4,788 adults age 65 and over) from the Health and Retirement Study (1998-2010). RESULTS: Productive engagement (paid work, formal volunteering, and informal volunteering) was negatively affected when older adults stopped driving, but social engagement was not immediately compromised by their transition to nondriver status. The role of physical health and mental health as mediators in explaining this relationship was negligible. IMPLICATIONS: The results suggest that interventions aimed at maintaining nondrivers' participation in productive roles should focus on factors other than enhancement of health and well-being to spur greater engagement (e.g., availability of and barriers to use of public transportation). Also important in the intervention process is planning for mobility transitions. Future research should test for geographic (e.g., urban vs. rural) differences in the impact of driving cessation on productive and social engagement.

Spousal perceptions of marital stress and support among grandparent caregivers: variations by life stage.

Few studies have examined how raising grandchildren influences the marital relationship of grandparent caregivers although half of such caregivers are married. This study used national survey data from Midlife Development in the United States (MIDUS) to contrast perceptions of spousal support and strain for grandparents who had recently provided care for grandchildren along with their own young children (n=16), and grandparents who had recently cared for grandchildren only (n=96). Results revealed an interaction between caregivers' sex and family situation with grandmother caregivers who were raising both their own minor children and grandchildren reporting less spousal support than grandfathers in the same situation. Differences on the spousal strain dimension were not significant. Grandmother caregivers occupying 2 caregiving roles appear to have a unique experience with caring for grandchildren. These results parallel other studies that show that grandparent caregivers have poorer outcomes when they hold multiple caregiving roles simultaneously.

Remembered parenting styles and adjustment in middle and late adulthood.

BACKGROUND: Authoritative parenting is the parenting style often associated with positive outcomes for children and adolescents. This study considers whether remembered parenting styles in childhood predict multiple dimensions of functioning in adulthood. METHODS: We used the 1995 National Survey of Midlife Development in the United States data set (N = 2,232) to assess the association between parenting behaviors remembered from childhood-classified as authoritative, authoritarian, indulgent, and uninvolved-and psychological well-being, depressive symptoms, and substance abuse, in a subsample of mid- and later-life adults. Differences in outcomes by sex, race, and childhood socioeconomic status were also examined across parenting styles. RESULTS: Adults who remembered authoritative compared with authoritarian and uninvolved parents reported greater psychological well-being and fewer depressive symptoms, and those with uninvolved parents noted greater substance abuse. No outcome differences were found between remembered authoritative and indulgent parenting styles. A few sex and race interactions were identified: Authoritative parenting (compared with uninvolved) was more strongly associated with men's psychological well-being than women's, and authoritative parenting (compared with authoritarian) predicted reduced depressive symptoms for Whites more than non-Whites. CONCLUSIONS: There is some support that remembered parenting styles continue to be related to functioning across the lifespan. There is also evidence of resiliency, flexibility, and malleability in human development.

Women in the middle: generational position and grandmothers' adjustment to raising grandchildren.

This study compared the adjustment of two groups of grandmothers who were providing primary care for grandchildren in split-generation households: 25 grandmothers in the oldest generation of their families (G1), and 22 grandmothers who had living parents or in-laws (G2). It was hypothesized that because of potential demands on them as middle-generation women, G2 grandmothers would report greater burden and depression in their caregiving roles than G1 grandmothers. After controlling for numerous factors that are associated with generational position, the hypothesis was confirmed. In addition to being in the middle generation, having grandchildren with problems predicted elevated depression and burden. Grandmothers who were educated beyond high school also reported greater role burden.

Parental divorce in young adulthood: some preliminary findings.

Developmental differences in reactions to parental divorce have not been examined beyond adolescence, and the impact of divorce on older offspring has thus been minimized. Central themes that emerged from an exploratory study of 18-to-23-year-olds suggest that the break-up of their parents' marriage represents a critical event deserving of further attention from researchers and clinicians.