Partner Plan Choices and Medicare Advantage Enrollment Decisions Among Older Adults.

This study examines the association of partner Medicare Advantage plan status over 1 year with beneficiary and plan characteristics.

Coping target checklist for home-based older adults living with disabilities and their spousal caregivers.

BACKGROUND: The substantial rise in the population of older adults living with disabilities is a prominent concern, presenting a profound challenge for healthcare and social welfare systems. Community-based home care is seen as an effective approach to meet the care needs of older adults living with disabilities. OBJECTIVE: To construct a coping target checklist for home-based older adults living with disabilities and their spousal caregivers. METHODS: The initial draft was developed based on a comprehensive literature review, followed by two rounds of Delphi correspondence final version. RESULTS: A comprehensive literature review resulted in the development of 7 modules, 20 topics. After round 1, 3 items were removed, 3 sections, 1 topic and 1 objective were new additions, 16 items were modified, split or combined. Four sections, 3 sections (Individual coping target for spousal caregivers, Individual coping target for older adults living with disabilities, and Shared coping target), 7 modules, 18 topics and 49 objectives were finally identified in round 2. The content of the list tool is derived from three perspectives: self-management strategies for older adults living with disabilities, caregiving strategies for spousal caregivers, and combined. CONCLUSIONS: The coping target checklist was intended to be evidence-based and reflective of a practical direction for home-based older adults living with disabilities and their spousal caregivers living at home.

Health inequities and societal costs for patients with fibromyalgia and their spouses: a Danish cohort study.

OBJECTIVE: To assess the burden of illness of people with fibromyalgia (FM) and their spouses compared with selected match populations in Denmark. METHODS: Population-based, cohort case-control study using data from Danish registries from 1994 to 2021. Individuals with an FM diagnosis were identified from the National Patient Register (2008-2019) and randomly matched to a 1:4 general population comparator. Spouses or persons co-living with subjects with FM at the time of diagnosis were compared with matched comparator spouses. Healthcare and societal costs, socioeconomic status and occurrence of comorbidities were evaluated for subjects with FM, spouses and controls. RESULTS: 9712 subjects with FM (94.9% females, mean age 50 years) and 5946 spouses were included. At year of diagnosis, subjects with FM had significantly more comorbidities compared with controls, including significantly more comorbid rheumatic disorders. The highest risk at the time of FM diagnosis was a comorbid diagnosis of ankylosing spondylitis (OR 7.0, 95% CI 4.9 to 10.0). Significantly more comorbidities were also observed in spouses. Subjects with FM and spouses had higher healthcare and public transfer costs and lower income from employment at all timepoints. Loss of income from employment in subjects with FM occurred years before establishment of the FM diagnosis. The employment rate after diagnosis was 22%. 10 years after the FM diagnosis, 50% received disability pension as compared with 11% of matched controls. The observed net average increased societal cost for subjects with FM amounted to €27 193 per patient-year after diagnosis. CONCLUSION: FM has major health and socioeconomic consequences for patients, their partners and society and call for improved healthcare strategies matching patients' needs.

Do couples who play together stay together? A longitudinal dyadic examination of shared leisure, financial distress, and relationship outcomes.

We examined whether shared leisure offers protection against negative associations between financial distress and relationship quality (satisfaction and commitment) for lower- and higher-income couples. We expected husbands' and wives' reports of shared leisure would be protective of the effects of financial distress (Time 2) on relationship satisfaction (Time 3) and commitment (Time 4) for higher-income couples (but not lower-income couples). Participants were drawn from a nationally representative, longitudinal study of US newly married couples. The analytic sample included both members of 1382 different-gender couples with data across the three sampled waves of data collection. Shared leisure was largely protective of the effects of financial distress on husbands' commitment for higher-income couples. For lower-income couples, higher shared leisure exacerbated this effect. These effects were only found at extreme levels of household income and shared leisure. When considering if couples who play together stay together, our findings suggest that it can, but it is critical to understand the financial situation of the couple and the resources they may have to support shared leisure activities. Professionals working with couples should consider their financial situation when making recommendation to engage in shared leisure, such as going out for recreation.

Which Came First, the Money or the Sex? Bidirectional, Indirect Associations between Financial Management Behaviors and Sexual Satisfaction among Newlywed Couples.

Scholars have established connections between how married couples navigate their finances and their sexual relationship. For example, financial management behaviors are associated with sexual satisfaction among newlywed couples. However, we know very little about the direction of the association between financial management behaviors and sexual satisfaction. Understanding which might predict the other, or if there might be a bidirectional association between the two, could provide information on where to intervene to help newlywed couples with financial or sexual obstacles in their marriage. With three waves of dyadic data (N = 1,205 U.S. newlywed couples), we used structural equation modeling to examine the bidirectional, indirect associations between husbands' and wives' financial management behaviors and their own sexual satisfaction through their own marital satisfaction. Overall, we found that financial management behaviors indirectly predicted changes in sexual satisfaction through marital satisfaction for both husbands and wives. We also found limited evidence that husbands' sexual satisfaction indirectly predicted changes in their own financial management behaviors through their own marital satisfaction. Additionally, these indirect associations differed by gender. Partner effects, however, were largely non-significant. Implications of these findings for those who help newlywed couples with their sexual relationships are discussed.

For richer, for poorer: Financial behaviors, power (im)balance, and relational aggression among different-gender newlyweds in the U.S.

Guided by an intersectional feminism framework, we used three-wave, dyadic survey data from a nationally representative sample of 1625 U.S. different-gender newlywed couples to test three research questions. First, as balanced power is considered a key concept for relational well-being in feminism, we examined developmental trajectories in husbands' and wives' perception of power (im)balance. Second, considering money as a major influence on power and aggression, we examined how financial behaviors relate to power (im)balance and in turn relational aggression-a type of intimate partner violence that is controlling and manipulative in nature. Third, informed by the intersectionality between gender and socioeconomic status (SES), we examined gender differences and SES disparities in the associations among financial behaviors, developmental trajectories of perception of power (im)balance, and relational aggression. Our findings demonstrate that newlywed different-gender couples are experiencing power struggles, where two partners diminish each other's influence over time. We also found that healthy financial behaviors are associated with balanced power and, in turn, less relational aggression (especially for wives and in lower-SES households). Taken collectively, we continue calling for efforts to facilitate money management skills and promote balanced marital power.

The "spillover effect" of long-term care insurance in China on spouses' health and well-being.

This study examined the spillover effect of long-term care insurance (LTCI) on the health outcomes and well-being of spouses for Chinese middle and old-aged adults with expected LTC demand or actual care burdens. Using panel data from the China Health and Retirement Longitudinal Study between 2011 and 2018, we investigated the impact of the introduction of LTCI pilots across several cities on old individuals by using the difference-in-differences (DID) approach. We found a spillover effect of LTCI on the health and well-being outcomes of spouses of middle and old-aged individuals with functional limitations. It might due to the fact that LTCI could relieve economic burden by reducing out-of-pocket medical expenditures, which further affects health and well-being of spouses. The spillover effect on health and well-being was found to be stronger for male spouses and low-educated spouses. Spouses of the individuals aged below 80 years old and those live without adult children were more likely to benefit from the introduction of LTCI. Moreover, providing combination benefits seems to make spouses better off than offering direct services. Therefore, the results implied that the expansion of LTCI not only helped the care recipients themselves but could also improve the health and well-being of the spouses of functionally impaired older adults.

Exploring the Social Determinants of Mental Health by Race and Ethnicity in Army Wives.

OBJECTIVE: To explore the social determinants of mental health (SDoMH) by race/ethnicity in a sample with equal access to healthcare. Using an adaptation of the World Health Organization's SDoMH Framework, this secondary analysis examines the socio-economic factors that make up the SDoMH by race/ethnicity. METHOD: This paper employed configurational comparative methods (CCMs) to analyze various racial/ethnic subsets from quantitative survey data from (N = 327) active-duty Army wives. Data was collected in 2012 by Walter Reed Army Institute of Research. RESULTS: Initial exploratory analysis revealed the highest-scoring factors for each racial/ethnic subgroup: non-Hispanic Black: employment and a history of adverse childhood events (ACEs); Hispanic: living off post and a recent childbirth; junior enlisted non-Hispanic White: high work-family conflict and ACEs; non-Hispanic other race: high work-family conflict and not having a military history. Final analysis showed four models consistently explained clinically significant depression symptoms and four models consistently explained the absence of clinical depression symptoms, providing a solution for each racial/ethnic minority group (non-Hispanic Black, Hispanic, junior enlisted non-Hispanic White, and non-Hispanic other). DISCUSSION: These findings highlight that Army wives are not a monolithic group, despite their collective exposure to military-specific stressors. These findings also highlight the potential for applying configurational approaches to gain new insights into mental health outcomes for social science and clinical researchers.

Men's household water fetching in India: Gender inequity is associated with greater responsibility and related risks.

INTRODUCTION: Household water fetching elevates physical and emotional harms, and these are generally assumed to accrue to women due to gendered labor assignments. But even in cases like India where fetching remains a highly feminized task, there are households where the primary responsibility is assumed by men. METHODS: We test the proposition that men's responsibility for water fetching is predicted by greater gender equity, reflected in measures of wives' empowerment. We used an extremely large, nationally representative Demographic and Health Survey dataset from India (2019-2020), narrowed to only households in which spouses co-reside with off-plot water sources (N = 10 616), and applying a multinomial regression approach. RESULTS: In >20% of households, men are the primary fetchers. They are more likely to have primary responsibility when water is more distant, privately purchased, or transported by vehicle. Contrary to predictions, men assume greater responsibility for household water fetching as their wives' empowerment measures decrease and when they want to control their movement. CONCLUSION: Married men in India sometimes assume responsibility for water fetching, but this is not explained by greater household gender equity. The findings also suggest that when men are responsible for fetching they have heightened risk of some forms of physical trauma but less relative psychological harm. Detailing why men fetch water matters for identifying and mitigating the physical and emotion harms of bearing responsibility for water labor, with implications for how gender should be conceptualized in water interventions intending to improve health and well-being.

Job lock among survivors of childhood cancer and their spouses post Affordable Care Act implementation: A Childhood Cancer Survivor Study brief report.

It is unknown how common job lock (i.e., staying at job to maintain health insurance) remains among childhood cancer survivors after Affordable Care Act (ACA) implementation in 2010. We examined prevalence of and factors associated with job lock using a cross-sectional survey from the Childhood Cancer Survivor Study (3503 survivors; 942 siblings). Survivor, spousal, and any survivor/spouse job lock were more frequently reported by survivors than siblings. Survivor job lock/any job lock was associated with older age, low income, severe chronic conditions, and debt/inability to pay debt. Job lock remains more common among survivors than siblings after ACA implementation.

Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study.

BACKGROUND: Little is known about the population of individuals who live with a spouse with cognitive impairment (CI) or dementia. METHODS: Using the US Health and Retirement Study, 2000 to 2018, we estimated the population of adults ≥ 50 years old co-residing with a spouse with probable CI/dementia. We described their socio-demographic and health characteristics and quantified socio-demographic inequities. RESULTS: Among community-dwelling adults ≥ 50 years old, 6% of women and 4% of men co-resided with a spouse with probable CI/dementia. Among those who were married/partnered, the prevalence of spousal dementia was greater for Black and Hispanic adults compared to their White counterparts, and for those with lower versus higher educational attainment. Among spouses, activities of daily living disability, depression, and past 2-year hospitalization was common. DISCUSSION: Millions of older adults, disproportionately Black and Hispanic people and people with lower levels of educational attainment, live with a spouse with CI while also facing their own major health challenges.

Family conflict over illness beliefs and care strategies: implications for burden in family caregivers.

OBJECTIVES: Family conflict is an understudied aspect of the caregiver experience. Drawing from the stress process model, the present study examined the prevalence and correlates of conflict over illness beliefs (e.g. conflict over the care recipient's illness and need for facility placement) and family care strategies (e.g. lack of involvement and support from family members). METHODS: Adult child and spouse caregivers (N = 579) of persons with physical or cognitive impairment from clinic and internet samples completed the Caregiver Reaction Scale (CRS) to assess each topic of conflict and burden. RESULTS: Most caregivers reported conflict with family members over care strategies (63%) or illness beliefs (55%). Clinic caregivers reported greater illness beliefs conflict than online caregivers. Adult children reported greater illness beliefs and family care strategies than spouses. Male caregivers were more likely than female caregivers to report care strategies conflict. Caregiver overload was significantly associated with family care strategies conflict. Both conflicts were positively associated with caregiver burden. CONCLUSIONS: Findings further support that family conflict is a widespread concern associated with burden among online and help-seeking caregivers. Caregiving relationship type and gender may increase likelihood of each conflict. Findings inform recommendations for clinical intervention and assessment of family caregivers.

Money management over the course of marriage: Parenthood, employment and household financial organization in Japan.

In Japan, differentiated gender expectations are strongly emphasized and Japanese wives shoulder the majority of the domestic work. Although previous research has examined the gendered division of paid and unpaid work in Japan, much less attention has been paid to household money management patterns among Japanese couples. Traditionally, Japanese women do the household financial organization, regardless of their employment status. Husbands transfer all of their income and other earnings to their wives and receive a monthly allowance as pocket money. We use data from the Japanese Panel Survey of Consumers (JPSC), 1994-2019 waves, to construct fixed-effect models to investigate how parenthood, wife's employment and husband's relative income are associated with different money management systems in Japan. Our findings show that parenthood is positively associated with female money management systems, whereas in dual-earner couples, women are less likely to manage household money. The results suggest that female money management in Japan is positioned as part of the package of wife / mother / homemaker roles and is a "female" task rather than "male". The results also show that the applicability of Western money management typologies and theoretical frameworks is limited for the Japanese context.

Long-term effects on healthcare utilisation among spouses of persons with stroke.

BACKGROUND: Stroke is a common and costly disease affecting the person with stroke and their relatives. If the negative effect on the health of informal caregivers to a person with stroke translates into an increased healthcare consumption has not yet been studied. Further, the importance of including costs and health consequences of informal caregiving in health economic evaluation supporting decision-making is an ongoing discussion. Therefore, this study aims to estimate the long-term effect on healthcare utilisation among spouses of persons with a first-ever stroke. METHOD: The study population consists of spouses of persons with first-ever stroke events in 2010-2011 and a reference population matched on age, sex and municipality of residence. We have access to information on healthcare utilisation five years before and five years after the stroke event for the whole study population. Using a difference-in-difference approach, the main analysis estimates the effects on primary and specialist outpatient care visits and days with inpatient care per year. Further, we analyse the healthcare utilisation among spouses depending on the modified Rankin Scale (mRS) of the person with stroke. RESULTS: Our main analysis indicates that spouses have slightly more days with inpatient care five years after the stroke event than the reference population (p = 0.03). In contrast, spouses have fewer primary and specialist outpatient care visits than the reference population following the stroke event. In the analysis where spouses' healthcare utilisation is analysed according to the mRS status of the person with stroke, we identify the most notable change in the number of visits to specialist outpatient and days with inpatient care among spouses of persons with mRS 3 (dependency in daily activities). CONCLUSION: Our study suggests that being the spouse of a person with stroke has minor effects on healthcare utilisation. Further, healthcare utilisation is most affected among the spouses of persons with stroke and dependency in daily activities (mRS 3). According to our results, it does not seem vital to include spouses of persons with stroke healthcare utilisation in health economic evaluations.

Variance Decomposition of the Continuous Assessment of Interpersonal Dynamics (CAID) system: Assessing sources of influence and reliability of observations of parent-teen interactions.

The Continuous Assessment of Interpersonal Dynamics (CAID) is an observational tool that measures warmth and dominance dynamics in real time and is sensitive to individual, dyadic, and contextual influences. Parent-adolescent interpersonal dynamics, which conceptually map onto parenting styles, are an integral part of positive adolescent adjustment and protect against risky outcomes. The current study's goal was to test the degree to which sources of influence on CAID data observed in a previous study of married couples generalize to a sample of parent-adolescent dyads. We examined data from ten raters who rated moment-to-moment warmth and dominance using CAID in a sample of 61 parent-adolescent dyads (N = 122) who were largely non-Hispanic White (62%) or African American (30%) based on parent report (adolescent M age = 14; 57% female). Dyads interacted in four different discussion segments (situations). We applied Generalizability Theory to delineate several sources of variance in CAID parameters and estimated within and between-person reliability. Results revealed a number of different influences, including the person, kinsperson (adolescent versus parent), dyad, rater, situation, and interactions among these factors, on ratings of parent-adolescent interpersonal behavior. These results largely replicate results from married couples, suggesting that the factors that influence ratings of interpersonal interactions largely generalize across sample types.

Unilateral divorce laws affect women's welfare.

This paper studies whether unilateral divorce affects women's welfare. Unilateral divorce refers to a divorce regime where each of the spouses can dissolve the marriage unilaterally (i.e. without mutual consent). First, it builds a simple theoretical model that finds that women are better off under unilateral divorce than under mutual consent. Second, it makes use of data from the U.S. between 2003 and 2014 to explore empirically whether unilateral divorce affects the amount of time women devote to three different activities that might be seen as proxies of their level of welfare, such as, housework, leisure and relaxing activities, and personal care. We find causal evidence suggesting that unilateral divorce improves women's welfare. Namely, it reduces housework carried out by women, while it increases their amount of time devoted to leisure and relaxing activities, and personal care. Further results suggest these changes are not due to improvements in gender equality per se. Moreover, we find that the decrease in housework and the surges in leisure and relaxing activities are permanent, whereas the increase in personal care is temporary. These findings are important from a policy perspective to motivate the introduction of unilateral divorce laws.

Health effects of long-term care insurance on spouses of disabled people: a quasi-experimental study.

BACKGROUND: It is still uncertain whether and how formal long-term care (LTC) systems affect the health status of family members. This paper examines the health effects of long-term care insurance (LTCI) on spouses of disabled people in China. METHODS: The data is from China Health and Retirement Longitudinal Survey (CHARLS), a longitudinal survey of a nationally representative sample of Chinese residents aged 45 or older and their spouses, and China City Statistical Yearbook. Exploiting the regional variation in the implementation of LTCI in the first round of pilot cities in China, a difference-in-difference (DID) strategy is applied to identify the causal effects of LTCI on the health status of spouses of disabled people. We carefully identify the causal effects by controlling for city-level covariates, testing common trends between the treatment and control groups, combining propensity score matching (PSM) with DID, selecting the second round of pilot cities as the control group, controlling for city fixed effects (FE) instead of individual FE, and evaluating selection bias from omitted observable and unobservable factors. RESULTS: The introduction of LTCI in China reduces the number of painful body parts and the self-reported health score significantly, indicating that spouses of disabled people get physical health benefits from LTCI coverage. However, the impact of LTCI on the depression index remains ambiguous and needs to be analyzed further. LTCI improves the physical health status of spouses of disabled individuals mainly through the time reallocation channel, while the impact of the consumption promotion channel has not been verified. Furthermore, the beneficial effects of LTCI on physical health are stronger for spouse caregivers and spouses with lower-level education and lower household income. CONCLUSION: These findings demonstrate that LTCI not only improves the health status of family caregivers by reducing their caregiving burden but also has beneficial health effects on non-caregiver family members. Policy designs of LTCI should emphasize the orientation of home and community-based care services (HCBS), which can not only satisfy the care preferences of disabled individuals, reduce the care burden on family caregivers, promote the health of all family members, but also prevent a large number of disabled individuals from choosing high-cost institutional care and reduce the financial burden of the LTCI Fund.

Increasing pressure on US men for income in order to find a spouse.

In contemporary societies, social status - especially income - is one of the most important determinants of ever marrying among men. Using U.S. census data, we estimated the importance of income for ever marrying among men and women, analyzing birth cohorts from 1890 to 1973. We examined individuals between the ages of 45 and 55, a total of 3.5 million men and 3.6 million women. We find that for men, the importance of income in predicting ever being married increased steadily over time. Income predicted only 2.5% of the variance in ever marrying for those born in 1890-1910, but about 20% for the 1973 cohort. For women, the opposite is true: the higher a woman's income among those born between 1890 and 1910, the lower her odds of ever being married, explaining 6% of the variance, whereas today a woman's income no longer plays a role in ever being married. Thus, our results provide evidence that income may represent a very recent selection pressure on men in the US, a pressure that has become increasingly stronger over time in the 20th and early 21st centuries.

Influence of financial strain on intimate partner violence and the moderating role of employment status among wives in Nigerian military homes.

This study examines the influence of financial strain on intimate partner violence (physical and psychological) experienced by wives of military personnel in Nigeria. The moderating role of employment status was also sought. Data was collected using a structured questionnaire made up of standardized scales with appropriate psychometric properties. Participants of the cross-sectional survey were purposively sampled and comprised 284 female spouses of military personnel in South-Western Nigerian. Results indicated a significant difference in the level of physical [t(282) = 6.775; p < .05] and psychological violence [t(282) = 8.388; p < .05] reported by participants with high and low financial strain. Employment status did not moderate the influence of financial strain on both dimensions of intimate partner violence (ß1 = 0.027; p > .05; ß2 = 0.052; p > .05) and accounted for an insignificant R2 increase of 0.01% and 0.08%, respectively. The practical implications of findings for intervention and future studies were discussed.