Emotion Regulation and Psychological Dependence on Pain Medication among Hospital Outpatients with Chronic Spinal Pain: The Influence of Rumination about Pain and Alexithymia.

Objective: To examine the extent to which pain acceptance, pain catastrophising and alexithymia moderate associations between pain intensity and psychological pain medication dependence. Methods: Participants (106 hospital outpatients with chronic spinal pain) completed the Leeds Dependence Questionnaire (LDQ) to measure psychological dependence on pain medication, and the Chronic Pain Acceptance Questionnaire-8 (CPAQ-8), the Pain Catastrophising Scale (PCS) and the Toronto Alexithymia Scale-20 (TAS-20), plus the Depression, Anxiety and Stress Scale-21 (DASS-21). Results: Multiple linear regression showed that degree of psychological dependence (measured dimensionally across the range of LDQ scores) was associated with TAS subscale difficulty identifying feelings (DIF) (ß = 0.249, p = <0.002) and PCS subscale rumination (ß = 0.193, p = 0.030), independently of pain intensity and risk behaviors for medication misuse. The effect of pain intensity was moderated by rumination, with pain intensity more strongly associated with dependence when rumination was high (interaction ß = 0.192, p = 0.004). Logistic regression showed that the effect of pain intensity on severe dependence (measured categorically as LDQ score ≥ 20) was moderated by alexithymia, so that severe dependence was independently associated with the combination of intense pain and high alexithymia (interaction odds ratio = 7.26, 95% CIs = 1.63-32.42, p = 0.009). Conclusions: Rumination and alexithymia moderated the associations between pain intensity and psychological pain medication dependence, consistent with emotion regulation theory. This raises the possibility that specifically targeting rumination about pain and symptoms of alexithymia could potentially improve the effectiveness of psychological interventions for chronic pain and help people to avoid or reduce their psychological dependence on pain medication.

Intrapersonal dynamics of closeness versus distance: Qualities of the self-concept distinguish destructive overdependence, dysfunctional detachment, and healthy dependency.

INTRODUCTION: People vary in the degree to which they affiliate with others; exaggerated efforts maintain interpersonal closeness versus distance are codified in longstanding categorical models of personality pathology, and in contemporary dimensional frameworks as well. OBJECTIVE: To examine associations between destructive overdependence (DO), dysfuntional detachment (DD), and healthy dependency (HD) and qualities of the self-concept. METHOD: A mixed-sex sample of 229 adults completed the Relationship Profile Test to assess DO, DD, and HD, and the Object Relations Inventory (ORI) to assess qualities of the self-concept. RESULTS AND CONCLUSION: Analyses indicated that (1) the ORI Strong dimension was uniquely predictive of DO (inversely related); (2) ORI Warm and Nurturing were unique predictors of DD (both inversely related); and (3) ORI Nurturing and Successful were unique predictors of HD. This study illuminates key intrapersonal features of these three personality styles.

Intergenerational Trauma, Dependency, and Detachment.

ABSTRACT: The literature on intergenerational transmission of trauma is predominantly focused on the mental health functioning of children and grandchildren of trauma survivors. Research shows that having a traumatized parent is related to increased psychopathology and dysfunctional attachment patterns in the next generation, but little is known about the effects of parental trauma on other aspects of interpersonal relating. The current study addresses this gap. Participants were young adult students from an urban college; individual and parental trauma histories, and indices of unhealthy dependency, dysfunctional detachment, and healthy dependency, were obtained. Results indicated that a wide range of parental traumas were positively correlated with dysfunctional detachment, but not related to destructive overdependence or healthy dependency. These results suggest that a wide range of parental traumas have a negative impact on the next generation's interpersonal dependency by fostering a tendency to distance themselves from close relationships.

Dependency, Detachment, and Health-Related Behavior in Adult Primary Care Patients.

This investigation examined links between three related personality styles as assessed with the Relationship Profile Test-destructive overdependence, dysfunctional detachment, and healthy dependency-and indices of health and health-related behavior in a mixed-sex (74% female) sample of 100 primary care patients with a mean age of 38.62 (SD = 12.99). Fourteen primary care physicians also participated. As hypothesized, destructive overdependence and dysfunctional detachment scores were positively correlated with number of contacts with the emergency department; healthy dependency scores were inversely related to emergency department contacts and number of overnight hospitalizations. Healthy dependency scores were associated with an array of positive health behaviors; destructive overdependence scores were negatively associated with positive health behaviors. In addition, healthy dependency scores were inversely related to physician ratings of a difficult doctor-patient relationship. These results demonstrate that destructive overdependence, dysfunctional detachment and healthy dependency scores are associated in expected ways with indices of health and health-related behavior, and help illuminate the underlying factors that contribute to comparatively poor health and variations in health service use among overdependent and detached medical patients.

Risk factors for gastrostomy tube dependence in transoral robotic surgery patients.

OBJECTIVES: To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence. METHODS: Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year. RESULTS: A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28-28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37-41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis. CONCLUSIONS: Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.

What is the problem of dependency? Dependency work reconsidered.

Dependency is fundamental to caring relationships. However, given that dependency implies asymmetry, it also brings moral problems for nursing. In nursing theory and theories of care, dependency tends to be framed as a problem of self-determination-a tendency that is mirrored in contemporary policy and practice. This paper argues that this problem frame is too narrow. The aim of the paper is to articulate additional theoretical 'problem frames' for dependency and to increase our understanding of how dependency can be navigated in practices of long-term care. It does so by way of an empirical ethical analysis of how care professionals tackle the problem of dependency in group homes for people with intellectual disabilities. The paper refers to these practices of mitigating the problem of dependency as 'dependency work', a phrase borrowed from Eva Kittay. The analysis of dependency work suggests that for care professionals, dependency is a threefold problem: one of self-determination, one of parity and one of self-worth. These findings suggest that patient autonomy cannot be a full solution to the problem of dependency in long-term care relations. But they also show that dependency as such is not a problem that can be solved, as attempts to mitigate it only serve to tighten the dependency relationship further. This is the paradox of dependency work.

In praise of dependencies: dispersed dependencies and displacement.

Reconceiving or reframing the humanitarian consequences of displacement in terms of 'dispersed dependencies', a term drawn from the field of mental health, sheds light on the disruptive experience of displacement and on affected individuals' relations with other displaced people, hosts, states and humanitarian actors. Dependency for a person is neither a problem nor abnormal; independence is in effect about having a viable set of dispersed dependencies. This description, when applied in the context of disaster or displacement, challenges some humanitarian attitudes and offers some positive directions for humanitarian actors who seek to engage in assistance that is sustainable, contextual, and focused on human choice and dignity.

Conditional Direction Dependence Analysis: Evaluating the Causal Direction of Effects in Linear Models with Interaction Terms.

Direction dependence analysis (DDA) makes use of higher than second moment information of variables (x and y) to detect potential confounding and to probe the causal direction of linear variable relations (i.e., whether x → y or y → x better approximates the underlying causal mechanism). The "true" predictor is assumed to be a continuous nonnormal exogenous variable. Existing methods compatible with DDA, however, are of limited use when the relation of a focal predictor and an outcome is affected by a moderator. This study presents a conditional direction dependence analysis (CDDA) framework which enables researchers to evaluate the causal direction of conditional regression effects. Monte-Carlo simulations were used to evaluate two different moderation scenarios: Study 1 evaluates the performance of CDDA tests when a moderator affects the strength of the causal effect x → y. Study 2 evaluates cases in which the causal direction itself (x → y vs y → x) depends on moderator values. Study 3 evaluates the robustness of DDA tests in the presence of functional model misspecifications. Results suggest that significance tests compatible with CDDA are suitable in both moderation scenarios, i.e., CDDA allows one to discern regions of a moderator in which the causal direction is uniquely identifiable. An empirical example is provided to illustrate the approach.

Dependent person in self-care: analysis of care needs.

BACKGROUND: The aim of this study was to assess the self-care dependency levels of the dependent person at the time of home discharge and its relationship between (1) the degree of dependency of each self-care domain; (2) the previous dependency levels; and (3) the gender of the dependent person. It also aims to assess the relationship between the degree of dependency of each self-care domain, the length of admission, the length of dependency and the age of the dependent person at the time of discharge. METHODS: A cross-sectional study was conducted. The sample comprised hospitalised adults and elderly in the medical services of a Portuguese hospital during the months of March, April and May of 2018. The data were collected by an interview conducted at the time of home discharge from the hospital medical ward. RESULTS: The average age of dependent people of the sample is 80.7 years (±10.1) with the majority being women (51.7%), with no statistical difference in the mean age according to gender (U = 2205.500; p > 0.05). They were hospitalised on average 11.4 days (±33.2), most of them (44.0%) due to respiratory problems (85% of which were due to pneumonia). There were no statistically significant differences between the length of the hospital stay, the length of dependency and the participants' gender (U = 2200.500, p > 0.05; U = 1688.000, p > 0.05). Medication intake was the highest dependency domain amongst participants (41.3%), followed by instrumental activities of daily living (40.6%) and bathing (39.9%). CONCLUSION: The amount of support required may vary according to the domain that the person is dependent. Thus, it is important to use a robust and reliable assessment tool that will be able to assess the degree of dependency on the various domains of self-care.

[Refinement of the French sociotropy-autonomy scale: Validation of a 20-item measure of social dependency among first-year students at the university]. / Révision de l'échelle française de mesure de la sociotropie et de l'autonomie : validation d'une échelle à 20 items mesurant de dépendance sociale de primo-entrants à l'université.

OBJECTIVE: Sociotropy and autonomy have been described as personality styles promoting the occurrence of stress in individuals. The SAS (for sociotropy-autonomy scale) corresponds to a 60-item instrument devoted to sociotropy and autonomy estimation in various populations. However, the different SAS versions display variations in item scoring, in scale structure and in factor composition. Furthermore, there is a lack of scale invariance analysis. Consistent with a larger work dedicated to understanding contributors of students' achievement during their trainings, the objective of this study was devoted to a refinement of French SAS item properties and to a measure of scale invariance in order to ensure that the French SAS be a trustable tool to measure sociotropy and autonomy among first- year students. Because a preliminary analysis invalidated several SAS items, a second objective has consisted of the definition and validation of a new scale estimating social dependency in students. METHODS: In all, 2365 students registered in first year of technological training (n=778) and health training (n=1587) were enrolled. They were asked to electronically answer the 60-item French SAS. The responses were collected between October and November 2017 for students registered in technological formation, and between March and April 2018 for health students. Item-score correlation coefficients (ritem-score) and anti-image correlation coefficients (AIC) were calculated for each item, and threshold values (ritem-score>0.3 ; AIC>0.6) were considered as acceptance criteria. Factor analyses were run in order to determine scale structure. Internal consistency was deduced from Cronbach's α, McDonald ω and Great Lower Bound (GLB) coefficients. Convergent and discriminant validities were analysed in considering construct reliability coefficient (CR>0.7), average variance extracted (AVE>0.4), mean shared variance and squared correlation coefficient calculated between two factors, as validity criteria. Configurational, metric and scalar levels of invariance were analysed prior to statistical comparisons of the scores obtained by different subgroups. RESULTS: In all, 1223 responses were collected and analysed. GLB and ω coefficients calculated for the full SAS indicated unacceptable internal consistency. Of the 60 items, 40 did not meet the acceptance criteria (i. e. ritem-score<0.3 and AIC<0.6). The remaining items had acceptable psychometric properties, and their composition defined a new scale reflecting the measure of social dependency. The overall scale internal consistency was good (ω=0.83, GLB=0.88). Factor analyses resulted in a replicable 5-factor structure including: need of affection (α=0.74, ω=0.74, GLB=0.77), fear of dropping out (α=0.67, ω=0.68, GLB=0.70), fear of loneliness (α=0.61, ω=0.61, GLB=0.67), attention to others (α=0.69, ω=0.69, GLB=0.71) and worry about the disapproval of others (α=0.71, ω=0.71, GLB=0.74). Discriminant validity was satisfied for all factors. Convergent validity was entirely satisfied for need of affection, fear of dropping out and for attention to others, but it was not optimal for fear of loneliness and worry about the disapproval of others. Invariance measurements identified non-invariant items that were discarded from score calculations. Following statistical comparison, it was observed that female students had higher social dependency and fear of dropping out than males. Furthermore, female students registered in health training had stronger attention to others than did their male equivalents. It was also observed that female health students scored better for social dependency, fear of dropping out, attention to others, and importance of others' gaze than their technology-educated counterparts. CONCLUSION: This work has invalidated the use of the overall 60-item French SAS to measure sociotropy and autonomy in first year students. By contrast, the refinement of the French SAS items led to a trustable 20-item instrument to investigate social dependency. Scale invariance characteristics allow confident statistical comparisons between sub-groups. This work shows that first-year female students registered in health or technological trainings exhibit a higher social dependency than males. Furthermore, first-year female health students show more social dependency than their technological counterparts. Because the conditions of recruitment of first-year students in heath formations in France are planned to change in September 2020, future studies will be warranted to analyse their social dependency.

Partner’s Emotional Dependency Scale: Psychometrics.

INTRODUCTION: Emotional dependency in a partner implies an excessive permanent affectional bonding to the other individual that is dysfunctional, associated with low self-esteem and conceals a lack of affection. Emotional dependency generates a series of negative emotional consequences: symptoms of anxiety and depression, obsessive thoughts, sleep disorders and abandonment of social relations and leisure. In recent decades several tools have been developed to measure emotional dependency, but they are more focused on measuring dependent personality disorder, centered on an exclusively young population or are not validated in the Spanish population. The aim of this research is to design and validate a new scale to overcome these limitations. METHOD: The sample population included 166 adults (53 men and 113 women) from the general population, to whom a new scale was applied (partner’s emotional dependency scale, SED), as well as the CDE (Emotional Dependency Questionnaire). RESULTS: The scale has a unidimensional structure, showing good internal consistency (Cronbach’s alpha = .90) and a high convergent validity with the CDE (r = .86). There is no difference between men and women with regarding emotional dependency. Some cut-off points have been established based on the degree of emotional dependency (low, moderate, high and extreme). CONCLUSIONS: The SED is a brief assessment tool, simple to conduct and allows the degree of emotional dependency to be assessed unidimensionally with regard to a stable intimate relationship (current or past) in a normative population.

Assessment of family functioning in families with a child diagnosed with type 1 diabetes: Validation and clinical relevance of the general functioning subscale of the McMaster family assessment device.

BACKGROUND: Type 1 diabetes (T1D) can have a negative effect on family functioning, which is associated with deterioration in metabolic control. Therefore, a valid tool for assessing family functioning is clinically relevant. We assessed the quality and validity of the Danish general functioning (GF) subscale of the family assessment device (FAD). Additionally, we investigated GF scores among adolescents with T1D and their parents and the relationship between family functioning and background variables, including metabolic control. METHODS: All Danish families with a child diagnosed with T1D (N = 1997) were invited to participate in a web-based survey. In total, 616 adolescents (aged 12-17 years) and 1035 parents (of children aged 2-17 years) responded. The quality and validity of measurements made using the GF subscale were assessed using the Rasch model and graphical log-linear Rasch models (GLLRMs). Differences among GF responses were also assessed using GLLRMs. The relationships between GF scores and background variables were examined by multivariate analyses. RESULTS: A dichotomized version of the GF subscale provided essentially valid measures of family functioning. Furthermore, the GF subscale measured family functioning most accurately in families with worse family functioning than in our population. To accurately characterize family functioning, it is important to take both parent's and adolescent's perceptions into account. Family functioning was associated with glycated hemoglobin (HbA1c) levels, and discrepancies in family functioning were associated with higher HbA1c levels. CONCLUSIONS: A dichotomized GF subscale is useful for assessment of family functioning. Parent's and adolescent's scores should be kept separate. Family functioning is associated with HbA1c levels.

Psychopathology, health-related quality-of-life and parental attitudes in pediatric asthma.

Objective: Considering that unknown psychopathology might play a role in the management of pediatric asthma, this study examines how self-esteem and psychosocial family environment (child-raising attitudes and parental coping strategies) influence the physical and psychosocial well-being of these children. Hence, this paper aims to predict psychosocial factors influencing health-related quality-of-life (HRQL) in children with asthma without a documented history of mental illness. Methods: 32 patients with asthma and 32 controls aged 8-18 years were included in the study. All participants were largely middle-income, Caucasian school-aged children. The child-raising attitudes examined were: dependency, egalitarianism/democratic attitude, rejection of the homemaking role, marital conflict, and strictness/authoritarianism. The parental coping strategies were; social support seeking, problem-solving attitude and avoidance. Results: Psychiatric comorbidity was present in 72% of asthma patients and 22% of the controls. The most common mental illness identified was generalized anxiety disorder; 32% vs 13%, respectively. Dependency was the only parental child-raising attitude that differed significantly between groups (47 ± 8 vs 41 ± 11, respectively. p = 0.035). There was a negative correlation between the PARI dependency subscale and the total HRQL score according to the parents (rp= -0.39, p = 0.027). The most influential factors connected with the total HRQL score in asthma were Rosenberg self-esteem scale score, presence of psychopathology and dependency according to the child. Conclusions: Simple ways to overcome emotional dependency and fortify self-esteem (exercises promoting self-awareness, opportunities cultivating decision-making, and a considerable freedom-of-choice to experience consequences) worth recommending to parents of children with asthma. Patients with suspected mental illness must be referred for psychiatric evaluations.

Who knows best? A Q methodology study to explore perspectives of professional stakeholders and community participants on health in low-income communities.

BACKGROUND: Health inequalities in the UK have proved to be stubborn, and health gaps between best and worst-off are widening. While there is growing understanding of how the main causes of poor health are perceived among different stakeholders, similar insight is lacking regarding what solutions should be prioritised. Furthermore, we do not know the relationship between perceived causes and solutions to health inequalities, whether there is agreement between professional stakeholders and people living in low-income communities or agreement within these groups. METHODS: Q methodology was used to identify and describe the shared perspectives ('subjectivities') that exist on i) why health is worse in low-income communities ('Causes') and ii) the ways that health could be improved in these same communities ('Solutions'). Purposively selected individuals (n = 53) from low-income communities (n = 25) and professional stakeholder groups (n = 28) ranked ordered sets of statements - 34 'Causes' and 39 'Solutions' - onto quasi-normal shaped grids according to their point of view. Factor analysis was used to identify shared points of view. 'Causes' and 'Solutions' were analysed independently, before examining correlations between perspectives on causes and perspectives on solutions. RESULTS: Analysis produced three factor solutions for both the 'Causes' and 'Solutions'. Broadly summarised these accounts for 'Causes' are: i) 'Unfair Society', ii) 'Dependent, workless and lazy', iii) 'Intergenerational hardships' and for 'Solutions': i) 'Empower communities', ii) 'Paternalism', iii) 'Redistribution'. No professionals defined (i.e. had a significant association with one factor only) the 'Causes' factor 'Dependent, workless and lazy' and the 'Solutions' factor 'Paternalism'. No community participants defined the 'Solutions' factor 'Redistribution'. The direction of correlations between the two sets of factor solutions - 'Causes' and 'Solutions' - appear to be intuitive, given the accounts identified. CONCLUSIONS: Despite the plurality of views there was broad agreement across accounts about issues relating to money. This is important as it points a way forward for tackling health inequalities, highlighting areas for policy and future research to focus on.

Home care as reablement or enabling arrangements? An exploration of the precarious dependencies in living with functional decline.

The threat to welfare societies posed by population ageing has urged high-income countries to rethink the provision of social and healthcare services for the ageing population. One widely implemented policy solution is 'reablement': short-term home-based training programmes focusing on re-enabling older people to carry out activities of daily living independently. Drawing on empirical material from multisited ethnographic fieldwork of reablement practices in a Danish municipality we explore how the assumptions about independence embedded in the concept's linguistic parts - 're', 'able' and 'ment' - map onto lives characterised by functional decline. We find that home care applicants: (i) are often too deeply dependent on the capacities of others in order to have their independence restored; (ii) negotiate individual meanings of independence to maintain their identity as able human beings; and (iii) might possibly gain new capacities through reablement, yet these are not individual and stable achievements, but rather temporary effects of the care relations with eldercare professionals. Rather than reablement we, therefore, suggest the term 'enabling arrangements' as more appropriate for capturing independence as a distributed, negotiated and continuous accomplishment. Finally, we discuss the practical and ethical implications of this term.

Self-Compassion, Coping Strategies, and Caregiver Burden in Caregivers of People with Dementia.

OBJECTIVE: Caring for someone with dementia can have negative consequences for caregivers, a phenomenon known as caregiver burden. Coping strategies influence the impact of caregiving-related stress. Specifically, using emotion-focused strategies has been associated with lower levels of burden, whereas dysfunctional strategies have been related to increased burden. The concept of self-compassion has been linked to both positive outcomes and the coping strategies that are most advantageous to caregivers. However, as yet, no research has studied self-compassion in caregivers. Therefore, the aim of this study was to explore the relationship between self-compassion, coping strategies and caregiver burden in dementia caregivers. METHOD: Cross-sectional survey data was collected from 73 informal caregivers of people with dementia recruited from post-diagnostic support services and caregiver support groups. RESULTS: Self-compassion was found to be negatively related to caregiver burden and dysfunctional coping strategies and positively related to emotion-focused coping strategies. Dysfunctional strategies mediated the relationship between self-compassion and caregiver burden, whereas emotion-focused strategies did not. CONCLUSION: Caregivers with higher levels of self-compassion report lower levels of burden and this is at least partly due to the use of less dysfunctional coping strategies. CLINICAL IMPLICATIONS: Interventions that develop self-compassion could represent a useful intervention for struggling caregivers.

A Comparison of the Influence of Anticipated Death Trajectory and Personal Values on End-of-Life Care Preferences: A Qualitative Analysis.

OBJECTIVES: We examined anticipated preferences for end-of-life (EOL) care in healthy older adults in the context of various terminal disease scenarios to explore the relationship between personal values and diseases and conditions that would influence EOL care choices. METHODS: Qualitative Descriptive Analysis was used to derive themes and the relationship between EOL preference themes and personal value themes in 365 respondents in a national sample of healthy older adults who completed a survey on their anticipated preferences for end-of-life (EOL) care. RESULTS: Reluctance to burden close others was the most frequently voiced personal value across all conditions affecting EOL preferences, followed by the personal value of quality of life. Concern about whether one's wishes would be honored was more commonly voiced in the context of hypothetical, prospective terminal cancer than in neurological conditions. Respondents who voiced desire for autonomy in how they would die clearly attributed extreme pain as the primary influence on EOL preferences. CONCLUSIONS: Comprehensive assessment of patient personal values should include consideration of particular chronic disease scenarios and death trajectories to fully inform EoL preferences. CLINICAL IMPLICATIONS: Because personal values do influence EOL preferences, care should be taken to ascertain patient values when presenting diagnoses, prognoses, and treatment options. In particular, patients and families of patients with progressive neurological diseases will likely face a time when the patient cannot self-represent EOL wishes. Early discussion of values and preferences, particularly in the context of cognitive disease is vital to assure patient-directed care.

Intergenerational Ambivalence and Dyadic Strain: Understanding Stress in Family Care Partners of Older Adults.

OBJECTIVES: The present study used Pearlin, Mullan, Semple & Skaff's (1990) caregiving stress process model as a framework to examine the comparative influence of two stressors: (a) intergenerational ambivalence as a unified construct and (b) dyadic strain, which is one isolated component of intergenerational ambivalence. METHODS: Participants were 120 women providing healthcare and medication assistance to an earlier generation family member with physical and/or cognitive impairments. RESULTS: Hierarchical regression confirmed that intergenerational ambivalence explained perceived stress in family care partners, beyond the variance accounted for by other commonly reported stressors such as length of caregiving experience, memory/cognitive and functional impairments of the care recipient, caregiver overload, family conflict and financial strain. Further analyses revealed that examining dyadic strain apart from intergenerational ambivalence may more accurately explain the influence of ambivalence scores on care partners' perceived stress. CONCLUSIONS AND CLINICAL IMPLICATIONS: The comparative influence of dyadic strain versus ambivalence suggests that stress-reducing interventions may benefit from a focus on reducing care partners' experiences of negative strain in the dyadic relationship rather than managing ambivalence.

Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS).

BACKGROUND: Little is known about how the proportions of dependency states have changed between generational cohorts of older people. We aimed to estimate years lived in different dependency states at age 65 years in 1991 and 2011, and new projections of future demand for care. METHODS: In this population-based study, we compared two Cognitive Function and Ageing Studies (CFAS I and CFAS II) of older people (aged ≥65 years) who were permanently registered with a general practice in three defined geographical areas (Cambridgeshire, Newcastle, and Nottingham; UK). These studies were done two decades apart (1991 and 2011). General practices provided lists of individuals to be contacted and were asked to exclude those who had died or might die over the next month. Baseline interviews were done in the community and care homes. Participants were stratified by age, and interviews occurred only after written informed consent was obtained. Information collected included basic sociodemographics, cognitive status, urinary incontinence, and self-reported ability to do activities of daily living. CFAS I was assigned as the 1991 cohort and CFAS II as the 2011 cohort, and both studies provided prevalence estimates of dependency in four states: high dependency (24-h care), medium dependency (daily care), low dependency (less than daily), and independent. Years in each dependency state were calculated by Sullivan's method. To project future demands for social care, the proportions in each dependency state (by age group and sex) were applied to the 2014 UK [corrected] population projections. FINDINGS: Between 1991 and 2011, there were significant increases in years lived from age 65 years with low dependency (1·7 years [95% CI 1·0-2·4] for men and 2·4 years [1·8-3·1] for women) and increases with high dependency (0·9 years [0·2-1·7] for men and 1·3 years [0·5-2·1] for women). The majority of men's extra years of life were spent independent (36·3%) or with low dependency (36·3%) whereas for women the majority were spent with low dependency (58·0%), and only 4·8% were independent. There were substantial reductions in the proportions with medium and high dependency who lived in care homes, although, if these dependency and care home proportions remain constant in the future, further population ageing will require an extra 71 215 care home places by 2025. INTERPRETATION: On average older men now spend 2·4 years and women 3·0 years with substantial care needs, and most will live in the community. These findings have considerable implications for families of older people who provide the majority of unpaid care, but the findings also provide valuable new information for governments and care providers planning the resources and funding required for the care of their future ageing populations. FUNDING: Medical Research Council (G9901400) and (G06010220), with support from the National Institute for Health Research Comprehensive Local research networks in West Anglia and Trent, UK, and Neurodegenerative Disease Research Network in Newcastle, UK.

The Pursuit of Romantic Alternatives Online: Social Media Friends as Potential Alternatives.

What causes some marriages to stand the test of time while others fail? Marital commitment is the key force underlying the stability, quality, and longevity of the romantic relationship. Commitment is strengthened in the presence of marital satisfaction, the absence of alternative attractions, and steady investments made in the relationship. Commitment is also a consequence of increasing dependence. When partners are emotionally engaged with their virtual connections, their dependence on the significant other decreases. On the contrary, dependence on the partner increases when people feel satisfied with their relationship, think unfavorably about the quality of available alternatives, and feel that they have made great investments in their relationship. Technological advancements of the present era have spawned a wide array of social networking sites (SNSs) that display boastfully curated profiles of virtual connections. These overly glossed profiles may lead social media users to feel deficient in their lives. Previous research has shown that Facebook use can reduce relationship satisfaction by providing potential romantic alternatives and deflecting time and emotional investments away from the committed relationship. This article examines the commitment literature and discusses how commitment is undermined in the contemporary era. Finally, marital therapy is addressed with suggestions for future areas of exploration.