Factor structure of the Harmonized Cognitive Assessment Protocol neuropsychological battery in the Health and Retirement Study.

OBJECTIVE: The Harmonized Cognitive Assessment Protocol (HCAP) describes an assessment battery and a family of population-representative studies measuring neuropsychological performance. We describe the factorial structure of the HCAP battery in the US Health and Retirement Study (HRS). METHOD: The HCAP battery was compiled from existing measures by a cross-disciplinary and international panel of researchers. The HCAP battery was used in the 2016 wave of the HRS. We used factor analysis methods to assess and refine a theoretically driven single and multiple domain factor structure for tests included in the HCAP battery among 3,347 participants with evaluable performance data. RESULTS: For the eight domains of cognitive functioning identified (orientation, memory [immediate, delayed, and recognition], set shifting, attention/speed, language/fluency, and visuospatial), all single factor models fit reasonably well, although four of these domains had either 2 or 3 indicators where fit must be perfect and is not informative. Multidimensional models suggested the eight-domain model was overly complex. A five-domain model (orientation, memory delayed and recognition, executive functioning, language/fluency, visuospatial) was identified as a reasonable model for summarizing performance in this sample (standardized root mean square residual = 0.05, root mean square error of approximation = 0.05, confirmatory fit index = 0.94). CONCLUSIONS: The HCAP battery conforms adequately to a multidimensional structure of neuropsychological performance. The derived measurement models can be used to operationalize notions of neurocognitive impairment, and as a starting point for prioritizing pre-statistical harmonization and evaluating configural invariance in cross-national research.

The Health and Retirement Study Harmonized Cognitive Assessment Protocol Project: Study Design and Methods.

INTRODUCTION: The Harmonized Cognitive Assessment Protocol (HCAP) Project is a substudy within the Health and Retirement Study (HRS), an ongoing nationally representative panel study of about 20,000 adults aged 51 or older in the United States. The HCAP is part of an international research collaboration funded by the National Institute on Aging to better measure and identify cognitive impairment and dementia in representative population-based samples of older adults, in the context of ongoing longitudinal studies of aging in high-, middle-, and low-income countries around the world. METHODS: The HCAP cognitive test battery was designed to measure a range of key cognitive domains affected by cognitive aging (including attention, memory, executive function, language, and visuospatial function) and to allow harmonization and comparisons to other studies in the United States and around the world. The HCAP included a pair of in-person interviews, one with the target HRS respondent (a randomly selected HRS sample member, aged 65+) that lasted approximately 1 h and one with an informant nominated by the respondent that lasted approximately 20 min. The final HRS HCAP sample included 3,496 study subjects, representing a 79% response rate among those invited to participate. CONCLUSION: Linking detailed HCAP cognitive assessments to the wealth of available longitudinal HRS data on cognition, health, biomarkers, genetics, health care utilization, informal care, and economic resources and behavior will provide unique and expanded opportunities to study cognitive impairment and dementia in a nationally representative US population-based sample. The fielding of similar HCAP projects in multiple countries around the world will provide additional opportunities to study international differences in the prevalence, incidence, and outcomes of dementia globally with comparable data. Like all HRS data, HCAP data are publicly available at no cost to researchers.

Improving Safe Mobility: An Assessment of Vehicles and Technologies among a Large Cohort of Older Drivers.

Evidence suggests that older driver safety may be improved by good vehicle maintenance, in-vehicle advanced technologies, and proper vehicle adaptations. This study explored the prevalence of several measures of vehicle maintenance and damage among older drivers through inspection of their vehicles. We also investigated the prevalence of in-vehicle technologies and aftermarket adaptations. Vehicle inspections were conducted by trained research staff using an objective, standardized procedure. This procedure, developed by a multidisciplinary team of researchers, was based on a review of inspection checklists used by automobile dealerships and the project team's expertise. The study used baseline data from vehicles of 2988 participants in the multi-site Longitudinal Research on Aging Drivers (LongROAD) study. Among this cohort, vehicles were well maintained, had little damage, and contained a range of advanced technologies but few aftermarket adaptations. Implications of study findings for occupational therapy practice are discussed.

Spousal social support and strain: impacts on health in older couples.

Using a nationally representative sample of couples aged 51+ in the United States (N = 1,923 couples), the current study investigated whether both partners' perceptions of relationship support and strain are associated with an individual's self-rated health and functional limitations. The sample had an average age of 67.17 years (SD = 9.0; range 50-97). Actor-Partner Interdependence Models adjusting for couple interdependencies were applied using multilevel models. After accounting for age, education, gender, race, and couple differences in length of marriage, results indicate that individual perceptions of support were significantly associated with higher self-rated health and fewer functional limitations. These individual-level benefits increased if the spouse also perceived positive support and low strain. Finally, the negative association of an individual's perceived support on functional limitations was greater in those with a spouse reporting low levels of perceived strain. Findings are discussed relative to theory on behavioral and psychological pathways between partners' perceptions of support and health.

The Worst of Times: Depressive Symptoms Among Racialized Groups Living With Dementia and Cognitive Impairment During the COVID-19 Pandemic.

Objective: To explore differences in depressive symptoms for older adults (Black, Latinx, and White) by cognitive status during the 2020 COVID-19 pandemic. Methods: Data from the Health and Retirement Study identified older adults as cognitively normal, cognitively impaired without dementia (CIND), and persons living with dementia (PLWD). Multiple linear regression analyses examined associations between cognitive status and depressive symptoms among these racialized groups. Results: Compared to the cognitively normal older adults racialized as Black, those with CIND reported higher depressive symptoms during the pandemic (overall and somatic) and PLWD had higher somatic symptoms (p < .01). Older adults racialized as White with CIND reported higher somatic (p < .01) symptoms compared to cognitively normal older adults racialized as White. Discussion: The COVID-19 pandemic was a challenging event among older adults racialized as Black with CIND and PLWD. Future studies should examine if these depressive symptoms persist over time.

Are depressive symptoms associated with biological aging in a cross-sectional analysis of adults over age 50 in the United States.

Major depressive disorder accelerates DNA methylation age, a biological aging marker. Subclinical depressive symptoms are common, but their link to DNA methylation aging in older adults remains unexplored. This study analyzed the cross-sectional relationship between depressive symptoms and accelerated DNA methylation aging, considering gender and race/ethnicity in U.S. adults aged over 50. We used data from 3,882 diverse participants in the 2016 Health and Retirement Study wave, measuring blood DNA methylation age against chronologic age for acceleration. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. Multiple linear regression evaluated the association between depressive symptoms and DNA methylation age acceleration, adjusting for sociodemographic factors, blood cell proportions, and health behaviors (physical activity, alcohol use, smoking, and chronic conditions). Gender and race/ethnicity modifications were also tested. Depressive symptoms, measured by continuous CES-D score, high depressive symptoms (CES-D ≥ 4), or any symptoms (CES-D ≥ 1), significantly correlated with increased GrimAge DNA methylation age acceleration (all p ≤ .001) in unadjusted and sociodemographic-adjusted models but were nonsignificant in fully adjusted models. No significant gender or race/ethnicity effect modifications were found in fully adjusted models. Health behaviors significantly influence DNA methylation age acceleration and depressive phenotypes, underscoring the need to understand their roles in assessing psychological factors related to DNA methylation age acceleration. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Food Insecurity and Dementia Risk in U.S. Older Adults: Evidence From the 2013-2021 Panel Study of Income Dynamics.

OBJECTIVES: Growing research suggests that food insecurity is associated with worse cognitive functioning; however, prospective studies are needed to examine food insecurity and dementia risk. Using longitudinal and nationally representative data, we examined the effects of food insecurity on dementia risk among older adults. METHODS: Data were from 3,232 adults (≥65 years) from the Panel Study of Income Dynamics. Food insecurity was assessed biennially using the U.S. Household Food Security Survey Module from 2015 to 2019. Probable dementia risk was assessed biennially using the Eight-Item Interview to Differentiate Aging and Dementia from 2017 to 2021. Inverse probability weighting and marginal structural models were used to account for the time-varying nature of food insecurity and sociodemographic and health confounders. RESULTS: After accounting for baseline and time-varying sociodemographic and health covariates, there was a 2-fold higher association between food insecurity and probable dementia risk (odds ratio 2.11, 95% confidence interval: 1.12-3.98). The results were robust to expanding the exposure to include marginal food security and the outcome to include informant-reported memory loss. Furthermore, there was no evidence of heterogeneity in the association of food insecurity and probable dementia risk by sex, race, and ethnicity, or participation in the Supplemental Nutrition Assistance program. DISCUSSION: Food insecurity is a modifiable social determinant of health. Interventions and policies are needed to reduce food insecurity and promote healthy aging for older adults.

Estimating the Prevalence of Dementia and Mild Cognitive Impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project.

Importance: Nationally representative data are critical for understanding the causes, costs, and outcomes associated with dementia and mild cognitive impairment (MCI) in the US and can inform policies aimed at reducing the impact of these conditions on patients, families, and public programs. The nationally representative Health and Retirement Study (HRS) is an essential resource for such data, but the HRS substudy providing dementia diagnostic information was fielded more than 20 years ago and more recent data are needed. Objective: The Harmonized Cognitive Assessment Protocol (HCAP) was developed to update national estimates of the prevalence of MCI and dementia in the US and examine differences by age, race, ethnicity, and sex. Design, Setting, and Participants: HRS is an ongoing longitudinal nationally representative study of people 51 years and older with staggered entry dates from 1992 to 2022 and follow-up ranging from 4 to 30 years. HCAP is a cross-sectional random sample of individuals in HRS who were 65 years or older in 2016. Of 9972 age-eligible HRS participants, 4425 were randomly selected for HCAP, and 3496 completed a comprehensive neuropsychological test battery and informant interview, none of whom were excluded. Dementia and MCI were classified using an algorithm based on standard diagnostic criteria and comparing test performance to a robust normative sample. Exposures: Groups were stratified by age, sex, education, race, and ethnicity. Main Outcomes and Measures: National prevalence estimates using population weights. Results: The mean (SD) age of the study population sample (N = 3496) was 76.4 (7.6) years, and 2095 participants (60%) were female. There were 551 participants who self-identified as Black and not Hispanic (16%), 382 who self-identified as Hispanic regardless of race (16%), 2483 who self-identified as White and not Hispanic (71%), and 80 who self-identified as another race (2%), including American Indian or Alaska Native, Asian, Native Hawaiian or Pacific Islander, or another self-described race. A total of 393 individuals (10%; 95% CI, 9-11) were classified as having dementia and 804 (22%; 95% CI, 20-24) as having MCI. Every 5-year increase in age was associated with higher risk of dementia (weighted odds ratio [OR], 1.95 per 5-year age difference; 95%, CI, 1.77-2.14) and MCI (OR, 1.17 per 5-year age difference, 95% CI, 1.09-1.26). Each additional year of education was associated with a decrease in risk of dementia (OR, 0.93 per year of school, 95% CI, 0.89-0.97) and MCI (OR, 0.94, 95% CI, 0.91-0.97). Dementia was more common among non-Hispanic Black individuals (OR, 1.81; 95% CI, 1.20-2.75) and MCI in Hispanic individuals (OR, 1.42; 95% CI, 1.03-1.96) compared with non-Hispanic White individuals. Other group comparisons by race and ethnicity were not possible owing to small numbers. No differences in prevalence were found between female individuals and male individuals. Conclusions and Relevance: Using a comprehensive neuropsychological test battery and large sample, the national prevalence of dementia and MCI in 2016 found in this cross-sectional study was similar to that of other US-based studies, indicating a disproportionate burden of dementia and MCI among older Black and Hispanic adults and those with lower education.

Multigenerational Households During Childhood and Trajectories of Cognitive Functioning Among U.S. Older Adults.

OBJECTIVES: Family structure in childhood influences early brain development and cognitive performance in adulthood. Much less is known about its long-term impact on later-life cognitive functioning. We extend the two-generation family structure approach to investigate the potential contribution of living with grandparents in multigenerational households to differences in cognitive functioning at older ages. METHODS: Data were drawn from 9 waves of the Health and Retirement Study (1998-2014) merged with newly collected childhood family history data. Five types of family structure were assessed: two-parent households, two-parent households with grandparents, single-parent households, single-parent households with grandparents, and grandparent-headed households. Growth curve models were used to estimate trajectories of cognitive functioning over time. RESULTS: Childhood family structure was significantly associated with level of cognitive functioning, but not to rate of cognitive decline. Relative to those from two-parent households, individuals who grew up in multigenerational households showed higher levels of cognitive functioning, including those living with a single parent and grandparents. Those who lived with a single parent alone were the most disadvantaged. The effects of these multigenerational households persisted net of childhood and adulthood socioeconomic status and health outcomes. DISCUSSION: Grandparent coresidence may cultivate a socially enriched home environment, providing resources and protection for early cognitive development that could persist throughout life. Multigenerational living arrangements are likely to increase as the contemporary population ages. More research needs to be done to understand the impact of these living arrangements on future generations' brain health and cognitive aging.

Association of Physical Function With Driving Space and Crashes Among Older Adults.

BACKGROUND AND OBJECTIVES: Balancing both driver mobility and safety is important for the well-being of older adults. However, research on the association of physical function with these 2 driving outcomes has yielded inconsistent findings. This study examined whether physical functioning of older drivers, as measured by the Short Physical Performance Battery (SPPB), is associated with either driving space or crash involvement. METHODS: Using cross-sectional data of active drivers aged 65-79 years from the AAA Longitudinal Research on Aging Drivers (LongROAD) study (n = 2,990), we used multivariate log-binomial and logistic regressions to estimate the associations of the SPPB with either self-reported restricted driving space in the prior 3 months or any crashes in the past year. Interaction with gender was assessed using likelihood ratio tests. RESULTS: After adjustment, older drivers with higher SPPB scores (higher physical functioning) had lower prevalence of restricted driving space (8-10 vs. 0-7, prevalence ratio [PR] = 0.88, 95% confidence interval [CI]: 0.78-0.99; 11-12 vs. 0-7, PR = 0.78, 95% CI: 0.61-0.99). Fair (8-10), but not good (11-12), scores were significantly associated with reduced crash involvement (8-10 vs. 0-7, odds ratio [OR] = 0.71, 95% CI: 0.60-0.84). Gender was not a significant effect modifier. DISCUSSION AND IMPLICATIONS: This study provides evidence that higher physical functioning is associated with better driving mobility and safety and that the SPPB may be useful for identifying at-risk drivers. Further research is needed to understand physical functioning's longitudinal effects and the SPPB's role in older driver intervention programs.

Factors associated with cognition in adults: the Seattle Longitudinal Study.

A better understanding of factors that affect cognition could lead to improved health and greater independence for older adults. We examined the association of four modifiable factors (leisure-time physical activity, leisure-time cognitive activity, self-directed work, and hypertension) with changes in two aspects of fluid intelligence (verbal memory and inductive reasoning). Data for 626 adults collected over 14 years (three time points) were analyzed by multi-level modeling. A component of self-directed work, higher work control, was associated with better verbal memory (p < .05) and inductive reasoning (p < .01). There were no significant interactions among these factors. The findings suggest that a strong sense of control at work may be protective for fluid intelligence in adults.

The impact of the Great Recession on educational pursuits in adulthood in the US.

Economic downturns are known to spark periods of increased enrolment in traditional educational pursuits. The current study leverages 30-year longitudinal data from the Longitudinal Study of American Life (LSAL; N=1,556) to examine individual characteristics and experiences in adolescence, just prior to the Great Recession, and during it, to understand why some individuals chose to pursue new education or training in response to the recession whereas others did not. Indicators from adolescence include measures of self-esteem, locus of control, persistence, achievement in mathematics and achievement in science and were collected from 1987 to 1993. inclusive. Pre-recession indicators include level of education, occupational and marital status and were collected in 2007. Indicators of the impact of the recession were collected retrospectively in 2014 and include whether a job was lost, whether work hours were reduced, and whether there was difficulty making rent/mortgage payments. Binary logistic regression identified persistence in adolescence, pre-recession education level, reporting reduced hours and difficulty paying rent/mortgage during the recession as associated with the likelihood of pursuing new education during the recession. A follow-up analysis investigated whether the pursuit of additional education/training in response to the recession predicted the likelihood of being employed in 2017. Results indicate that obtaining new education during the recession was associated with later employment status, but the significance and direction of the effect depends on pre-recession education level. Implications of this longitudinal, life course analysis are discussed in addition to recommendation for future directions.

Gratitude across the life span: Age differences and links to subjective well-being.

Gratitude has been described as an adaptive evolutionary mechanism that is relevant to healthy psychological and interpersonal outcomes. Questions remain as to whether the presence and benefits of gratitude are consistent from young adulthood to old age; prior research has yielded mixed evidence. We examined the magnitude and direction of age differences in gratitude in three samples (combined N = 31,206). We also examined whether gratitude was associated with greater/lesser well-being at different periods in the life course. We found that the experience of gratitude was greatest in older adults and least in middle aged and younger adults. Further, we found that the associations between gratitude and subjective well-being remained relatively constant across the lifespan. Findings are discussed from a developmental perspective.

Overview of the Health and Retirement Study and Introduction to the Special Issue.

Twenty five years ago, the largest academic behavioral and social science project ever undertaken in the U.S. began: the Health and Retirement Study (HRS). The HRS is an invaluable publicly available dataset for investigating work, aging, and retirement and informing public policy on these issues. This biennial longitudinal study began in 1992 and has studied more than 43,000 individuals and produced almost 4000 journal articles, dissertations, books, book chapters, and reports to date. The purpose of this special issue of Work, Aging and Retirement is to describe the HRS and highlight relevant research that utilizes this rich and complex dataset. First, we briefly describe the background that led to the development of the HRS. Then we summarize key aspects of the study, including its development, sampling, and methodology. Our review of the content of the survey focuses on the aspects of the study most relevant to research on worker aging and retirement. Next, we identify key strengths and important limitations of the study and provide advice to current and future HRS data users. Finally, we summarize the articles in this Special Issue (all of which use data from the HRS) and how they advance our knowledge and understanding of worker aging and retirement.

Prevalence, attitudes, and knowledge of in-vehicle technologies and vehicle adaptations among older drivers.

The purpose of the present study was to gain a better understanding of the types of in-vehicle technologies being used by older drivers as well as older drivers' use, learning, and perceptions of safety related to these technologies among a large cohort of older drivers at multiple sites in the United States. A secondary purpose was to explore the prevalence of aftermarket vehicle adaptations and how older adults go about making adaptations and how they learn to use them. The study utilized baseline questionnaire data from 2990 participants from the Longitudinal Research on Aging Drivers (LongROAD) study. Fifteen in-vehicle technologies and 12 aftermarket vehicle adaptations were investigated. Overall, 57.2% of participants had at least one advanced technology in their primary vehicle. The number of technologies in a vehicle was significantly related to being male, having a higher income, and having a higher education level. The majority of respondents learned to use these technologies on their own, with "figured-it-out-myself" being reported by 25%-75% of respondents across the technologies. Overall, technologies were always used about 43% of the time, with wide variability among the technologies. Across all technologies, nearly 70% of respondents who had these technologies believed that they made them a safer driver. With regard to vehicle adaptations, less than 9% of respondents had at least one vehicle adaptation present, with the number of adaptations per vehicle ranging from 0 to 4. A large majority did not work with a professional to make or learn about the aftermarket vehicle adaptation.

Successful Aging as the Intersection of Individual Resources, Age, Environment, and Experiences of Well-being in Daily Activities.

OBJECTIVE: We conceptualize successful aging as a cumulative index of individual resources (the absence of disease and disability, high cognitive and physical functioning, social embeddedness) in the service of successful aging outcomes (global well-being, experienced well-being, and vital status), and conditioned by age, social structure, and environment. METHOD: The study used baseline and follow-up data from the 2008-2014 waves of the Health and Retirement Study (N = 17,230; age = 51-101). Linear, multilevel, and logistic models compared individual resources at baseline as independent, cumulative, and binary predictors of outcomes 4 years later. RESULTS: Individual resources were unequally distributed across age group and social structures (education, wealth, race, gender) and had a cumulative effect on all successful aging outcomes. For experienced well-being, individual resources were most important at midlife and for groups with lower education. Person-environment congruence (social cohesion, city satisfaction) was associated with all successful aging outcomes and conditioned the effect of individual resources on experienced well-being. DISCUSSION: A cumulative index allows for gradations in resources that can be compensated for by external factors such as person-environment congruence. This index could guide policy and interventions to enhance resources in vulnerable subgroups and diminish inequalities in successful aging outcomes.

Effects of Pre-Retirement Personality, Health and Job Lock on Post-Retirement Subjective Well-being.

Retirement can be difficult, and experiences vary greatly. Although health, financial status, and family responsibilities have been associated with retirement adjustment, individual psychosocial characteristics may also play a role. Moreover, relatively little is known about the impact of perceived 'job lock'-the belief that retirement is impossible due to financial or health constraints-and its relationship with later retirement adjustment. The current study addresses these limitations in the literature by examining the retirement transition over four years in a large sample of U.S. adults, with a particular focus on the ways in which personality may affect this transition. Data collected at baseline (2008/2010) and again four years later (2012/2014) included the Big Five personality traits, pre-retirement job lock, self-rated health, and multiple indicators of post-retirement well-being, such as global and experienced well-being (anchored within activities in a single day). Participants were drawn from the Health and Retirement Study (N = 716; Mage = 61.9 at baseline). Results indicated that experienced positive affect was the only post-retirement well-being outcome with a significant association with job lock, although only for those with low conscientiousness. Findings also suggest that pre-retirement personality and subjective health play an important role for post-retirement well-being. Thus, the current study highlights the importance for researchers and practitioners to consider both pre-retirement personality and health when evaluating individuals' management of the retirement transition. Word Count: 224.

Longitudinal Research on Aging Drivers (LongROAD): study design and methods.

BACKGROUND: As an important indicator of mobility, driving confers a host of social and health benefits to older adults. Despite the importance of safe mobility as the population ages, longitudinal data are lacking about the natural history and determinants of driving safety in older adults. METHODS: The Longitudinal Research on Aging Drivers (LongROAD) project is a multisite prospective cohort study designed to generate empirical data for understanding the role of medical, behavioral, environmental and technological factors in driving safety during the process of aging. RESULTS: A total of 2990 active drivers aged 65-79 years at baseline have been recruited through primary care clinics or health care systems in five study sites located in California, Colorado, Maryland, Michigan, and New York. Consented participants were assessed at baseline with standardized research protocols and instruments, including vehicle inspection, functional performance tests, and "brown-bag review" of medications. The primary vehicle of each participant was instrumented with a small data collection device that records detailed driving data whenever the vehicle is operating and detects when a participant is driving. Annual follow-up is being conducted for up to three years with a telephone questionnaire at 12 and 36 months and in-person assessment at 24 months. Medical records are reviewed annually to collect information on clinical diagnoses and healthcare utilization. Driving records, including crashes and violations, are collected annually from state motor vehicle departments. Pilot testing was conducted on 56 volunteers during March-May 2015. Recruitment and enrollment were completed between July 2015 and March 2017. CONCLUSIONS: Results of the LongROAD project will generate much-needed evidence for formulating public policy and developing intervention programs to maintain safe mobility while ensuring well-being for older adults.

Job Lock, Work, and Psychological Well-being in the United States.

The purpose of the present study was to examine job lock in relation to well-being among workers in the U.S. Job lock refers to a circumstance in which a worker would like to retire or stop working altogether, but perceives that they cannot due to needing the income, and/or health insurance. Prior to examining job lock as a potential predictor of life satisfaction we first investigated the construct validity of job lock. Results from a sample of N=308 workers obtained via MTurk indicated that job lock due to financial need was more strongly associated with continuance and affective organizational commitment and job satisfaction compared to health insurance job lock. Job lock due to health insurance needs was related to a dimension of career entrenchment. We then tested hypotheses regarding the relation between job lock at T1 and life satisfaction at T2, two years later. Specifically, we hypothesized that perceptions of job lock would be negatively related to life satisfaction. Using two independent samples from the Health and Retirement Study (HRS), we found that both types of job lock were highly prevalent among workers age 62-65. Job lock due to money was significantly associated with lower life satisfaction 2 years later. The findings for job lock due to health insurance were mixed across the two samples. This study was an important first step toward examining the relation between job lock, an economic concept, in relation to workers' job attitudes and well-being.

Stress and Negative Relationship Quality among Older Couples: Implications for Blood Pressure.

OBJECTIVES: The cardiovascular system may represent a significant pathway by which marriage and stress influence health, but research has focused on married individuals cross-sectionally. This study examined associations among chronic stress, negative spousal relationship quality, and systolic blood pressure over time among middle-aged and older husbands and wives. METHOD: Participants were from the nationally representative longitudinal Health and Retirement Study. A total of 1,356 (N = 2,712) married and cohabitating couples completed psychosocial and biomeasure assessments in waves 2006 and 2010. Analyses examined whether Wave 1 (2006) relationship quality and stress were associated with changes in blood pressure over time. RESULTS: The effects of stress and negative relationship quality were dyadic and varied by gender. Husbands had increased blood pressure when wives reported greater stress, and this link was exacerbated by negative spousal relationship quality. Negative relationship quality predicted increased blood pressure when both members of the couple reported negative quality relations. DISCUSSION: Findings support the dyadic biopsychosocial model of marriage and health indicating: (a) stress and relationship quality directly effect the cardiovascular system, (b) relationship quality moderates the effect of stress, and (c) the dyad rather than only the individual should be considered when examining marriage and health.