Taking Care of Us© (TCU) study protocol: feasibility and acceptability of a dyadic intervention for couples living with heart failure.

BACKGROUND: There are more than 1 million hospital admissions and 3 million emergency visits for heart failure in the USA annually. Although spouse/partners make substantial contributions to the management of heart failure and experience poor health and high levels of care strain, they are rarely the focus of heart failure interventions. This protocol describes a pilot randomized controlled trial that tests the feasibility, acceptability, and preliminary change in outcomes of a seven-session couple-based intervention called Taking Care of Us© (TCU). The TCU© intervention is grounded in the theory of dyadic illness management and was developed to promote collaborative illness management and better physical and mental health of adults with heart failure and their partners. METHODS: A two-arm randomized controlled trial will be conducted. Eligible adults with heart failure and their co-residing spouse/partner will be recruited from a clinical site in the USA and community/social media outreach and randomized to either the TCU© intervention or to a control condition (SUPPORT©) that offers education around heart failure management. The target sample is 60 couples (30 per arm). TCU© couples will receive seven sessions over 2 months via Zoom; SUPPORT© couples will receive three sessions over 2 months via Zoom. All participants will complete self-report measures at baseline (T1), post-treatment (T2), and 3 months post-treatment (T3). Acceptability and feasibility of the intervention will be examined using both closed-ended and open-ended questions as well as enrollment, retention, completion, and satisfaction metrics. Preliminary exploration of change in outcomes of TCU© on dyadic health, dyadic appraisal, and collaborative management will also be conducted. DISCUSSION: Theoretically driven, evidence-based dyadic interventions are needed to optimize the health of both members of the couple living with heart failure. Results from this study will provide important information about recruitment and retention and benefits and drawbacks of the TCU© program to directly inform any needed refinements of the program and decision to move to a main trial. TRIAL REGISTRATION: ClinicalTrials.gov (NCT04737759) registered on 27 January 2021.

Rewriting age to overcome misaligned age and gender norms in later life.

In this paper we suggest that older adults undergo a misalignment between societal age norms and personal lived experience, and attempt reconciliation through discursive strategies: They rewrite how they frame chronological age as well as their subjective relations to it. Using a sample of 4041 midlife and older adults from the 2004-2006 wave of the National Survey of Midlife Development in the United States (MIDUS II), we explore associations of age and gender with subjective age and at what age respondents felt people enter later life. Our results confirm that as men and women age, they push up the age at which they think people enter later life, and slow down subjective aging (there is a growing gap between subjective and chronological age). Relations between a person's age and at what age they think people enter later life were stronger for men than for women. For every year they get older get older, men push up when they think people enter later life by 0.24years, women by 0.16years. Age norms surrounding the transition to later life may be more prominent for men than for women, and the difference in their tendencies to push up when they mark entry into later life may be a reflection of this greater prominence.

Mechanisms Linking Neighborhood Age Composition to Health.

Purpose of the Study: Age integration theory posits that the age composition of spaces affects the social interactions in which people can engage. This study aimed to examine whether social interactions perceived to involve generativity (i.e., commitment to younger generations), daily discrimination, and/or social cohesion mediate associations between neighborhood age composition, self-reported health, and psychological well-being. Design and Methods: We applied multilevel structural equation models to data from 4,017 participants aged 30-84 who participated in the 2004-2006 wave of National Survey of Midlife Development in the United States, merged with data on their 3,714 neighborhoods from the 2010U.S. Census. Results: Neighborhoods that represented the age distribution of the United States and neighborhoods that overrepresented older adults were contexts in which residents reported the most generativity and social cohesion. In turn, generativity and social cohesion were associated with better self-reported health and higher psychological well-being. Implications: The nature of social interaction links neighborhood age composition to health and well-being. These results clarify the results of prior studies, advance measurement, suggest elaborations to age integration theory, and point to new directions for aging-in-place initiatives.

Workability and Requests for Flexible Work Arrangements Among Older Adults: The Role of a Time and Place Management Intervention.

This article investigates the effect of an intervention on the workability of older adults (i.e., the competence, health, and other mental and physical characteristics that workers need to meet the demands of their jobs). We used data from health care workers ( N = 437) who participated in a "time and place management" (TPM) intervention. Although related to flexible work options that aim to give workers more choice and control over the time and place of their work, TPM is conceptually distinct in that it focuses on the processes and guidelines necessary to the successful management of choice and control rather than the options alone. We focused on how the TPM intervention moderated the relationship between age and workability over time, with a particular focus on variation by baseline workability. Our results indicated that the intervention can benefit older workers with low workability.