Daily Rumination Among Older Men and Women: The Role of Perceived Family and Nonfamily Social Partner Life Stress.

OBJECTIVES: Women tend to ruminate more than men, and are generally more hypervigilant to the emotions of others in order to maintain positive social ties. Thus, compared to men, women may ruminate more when their social partners have greater life stresses. However, the literature on stressful events typically focuses on individuals' experiences and perceptions of stressors experienced by specific social ties such as spousal partners and adult children. The purpose of this study was to examine links between perceptions of a broad array of family and nonfamily social partner stresses and daily rumination among older men and women. METHODS: Adults aged 65 and older (N = 293, 55% women) completed baseline assessments of family and nonfamily life stressors and 5-6 consecutive nightly assessments regarding rumination, interpersonal tensions, worries, and support provision. RESULTS: Multilevel structural equation models revealed that perceptions of greater family and nonfamily life stressors were associated with greater rumination. The links between family stress and rumination varied by gender: family stress was related to greater rumination among women and not men. Moreover, among women, family and nonfamily stress-rumination links were accounted for by greater daily worries about others, and among men, the nonfamily stress-rumination link was due to greater interpersonal tensions as well as daily worries. DISCUSSION: These findings may be due in part to gender role socialization and women's greater kin-keeping and investment in family ties.

The Changing Demography of Late-Life Family Caregiving: A Research Agenda to Understand Future Care Networks for an Aging U.S. Population.

Repeated claims that a dwindling supply of potential caregivers is creating a crisis in care for the U.S. aging population have not been well-grounded in empirical research. Concerns about the supply of family care do not adequately recognize factors that may modify the availability and willingness of family and friends to provide care to older persons in need of assistance or the increasing heterogeneity of the older population. In this paper, we set forth a framework that places family caregiving in the context of older adults' care needs, the alternatives available to them, and the outcomes of that care. We focus on care networks, rather than individuals, and discuss the demographic and social changes that may alter the formation of care networks in the future. Last, we identify research areas to prioritize in order to better support planning efforts to care for the aging U.S. population.

Alcohol Use and Mortality Among Older Couples in the United States: Evidence of Individual and Partner Effects.

BACKGROUND AND OBJECTIVES: Spouses with concordant (i.e., similar) drinking behaviors often report better quality marriages and are married longer compared with those who report discordant drinking behaviors. Less is known regarding whether concordant or discordant patterns have implications for health, as couples grow older. The present study examined whether drinking patterns among older couples are associated with mortality over time. RESEARCH DESIGN AND METHODS: The Health and Retirement Study (HRS) is a nationally representative sample of individuals and their partners (married/cohabiting) over age 50 in the United States, in which participants completed surveys every 2 years. Participants included 4,656 married/cohabiting different-sex couples (9,312 individuals) who completed at least 3 waves of the HRS from 1996 to 2016. Participants reported whether they drank alcohol at all in the last 3 months, and if so, the average amount they drank per week. Mortality data were from 2016. RESULTS: Analyses revealed concordant drinking spouses (both indicated they drank in the last 3 months) survived longer than discordant drinking spouses (1 partner drinks and the other does not) and concordant nondrinking spouses. Analysis of average drinks per week showed a quadratic association with mortality such that light drinking predicted better survival rates among individuals and their partners compared with abstaining and heavy drinking. Further, similar levels of drinking in terms of the amount of drinking were associated with greater survival, particularly among wives. DISCUSSION AND IMPLICATIONS: This study moves the field forward by showing that survival varies as a function of one's own and one's partner's drinking.

'I feel like this will never end': mental health during the COVID-19 pandemic among older adults with chronic conditions.

OBJECTIVES: The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. In this qualitative study, we evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health. METHODS: A total of 492 adults (M = 64.95 years, SD = 8.91, range = 50-94) who lived in Michigan (82.1%) and 33 other U.S. states completed one anonymous online survey between 14 May 14 and 9 July 2020. Open-ended responses were coded to ascertain relevant concepts and were reduced to develop major themes. RESULTS: We determined four main themes. The COVID-19 pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health service use. CONCLUSION: This study indicates that older adults with chronic conditions experienced various challenges to managing their mental health in the early months of the COVID-19 pandemic, but also showed considerable resilience. The findings identify potential targets of personalized interventions to preserve their well-being during this pandemic and in future public health crises.

Longitudinal associations between chronic condition discordance and perceived control among older couples.

Chronic health conditions among individuals and their partners may diminish perceived control, particularly when these conditions are highly complex. We considered how chronic condition discordance (i.e., the extent that two or more conditions have nonoverlapping self-management requirements) at the individual level and the couple level (i.e., between spouses) was linked to health-related control and personal mastery across an 8-year period, and whether these links varied by age. The U.S. sample included 879 wives (M = 53.81 years) and husbands (M = 57.19 years) from three waves (2006, 2010, and 2014) of the Health and Retirement Study. Dyadic growth curve models controlled for age, minority status, education, own and partner baseline negative marital quality, and own and partner time-varying depressive symptoms, and number of chronic health conditions. Overall, both individual-level and couple-level degrees of chronic condition discordance were associated with initial levels of and rates of change in perceived control. When wives had greater individual-level discordance, they reported lower initial personal mastery. When husbands had greater individual-level discordance, they reported lower initial health-related control and faster declines in health-related control and personal mastery, and their wives reported faster declines in personal mastery. When there was greater couple-level discordance, wives reported lower initial health-related control. Age moderated the associations between wives' individual-level discordance and their own initial level of health-related control and rate of change in personal mastery. Interventions to improve later-life well-being may be enhanced by targeting increases in perceived control among individuals and couples managing complex patterns of chronic conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality.

OBJECTIVES: Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This article examined links between alcohol use and blood pressure within individuals and opposite-sex couples over time, and whether those links vary by negative marital quality among older adults. METHODS: Participants were from the nationally representative longitudinal Health and Retirement Study that included 4,619 respondents in 2,682 opposite-sex couples who participated in at least 2 of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff. RESULTS: Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Furthermore, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages. DISCUSSION: Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.

Associations between relationship quality and treatment-related stress among couples receiving methadone for opioid use disorder.

BACKGROUND: Social relationships may buffer or exacerbate stress among patients receiving methadone treatment for opioid use disorder (OUD). Little is known, however, about how relationship quality is linked to treatment-related stress among couples in which both partners receive methadone. We considered the links between relationship quality and treatment-related stress among couples in methadone treatment for OUD. METHODS: Participants for this cross-sectional observational study included 60 heterosexual married or cohabiting couples aged 18 and older drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both partners completed a self-administered survey which assessed their sociodemographic information, relationship and treatment characteristics, and perceived treatment-related stress. We estimated actor-partner interdependence models to evaluate the links between each partner's perceptions of relationship quality (with their partner and their closest family member or friend) and treatment-related stress. RESULTS: When their partners reported a more positive partner relationship, women had lower treatment-related stress. When women reported a more positive relationship with their own closest family member or friend, both women and their partners had lower treatment-related stress. When men perceived a more positive relationship with their closest family member or friend, their partners reported greater treatment-related stress. Negative relationship quality was not significantly linked to treatment-related stress. CONCLUSIONS: This study highlights the importance of considering how social relationship quality might impact the experiences of couples receiving methadone for OUD. In particular, women's close relationships may help to mitigate treatment-related stress.

Social Contact, Emotional Support, and Anxiety during the COVID-19 Pandemic among Older Adults with Chronic Conditions.

OBJECTIVES: The COVID-19 pandemic may contribute to heightened anxiety among older adults with chronic conditions, which might be attenuated by social resources. This study examined how social contact and emotional support were linked to anxiety symptoms among adults aged 50 and older with chronic conditions, and whether these links varied by age. METHODS: Participants included 705 adults (M = 64.61 years, SD = 8.85, range = 50- 94) from Michigan (82.4%) and 33 other U.S. states who reported at least one chronic condition and completed an anonymous online survey between May 14 and July 9, 2020. RESULTS: Multiple regression models revealed among younger people, those reporting more frequent social contact had significantly lower anxiety symptoms. Emotional support was not significantly associated with anxiety symptoms. CONCLUSIONS: More frequent social contact was linked to lower anxiety symptoms for younger but not older individuals. Emotional support was not significantly associated with anxiety symptoms. CLINICAL IMPLICATIONS: Interventions to manage anxiety during the pandemic among older adults with chronic conditions may benefit from strategies to safely increase social contact, especially for middle-aged adults.

Caregiver status and illness self-efficacy during the COVID-19 pandemic among older adults with chronic conditions.

OBJECTIVES: Older adults providing unpaid care to a relative or friend during the COVID-19 pandemic may have diminished self-efficacy in managing their own chronic illness, especially in the context of more complex self-management. We evaluated whether adults aged 50 and older with caregiving roles are more likely to report reduced illness self-efficacy since the pandemic, and whether this link is exacerbated by a higher number of conditions. METHODS: Participants (105 caregivers and 590 noncaregivers) residing in Michigan (82.6%) and 33 other U.S. states completed one online survey between May 14 and July 9, 2020. RESULTS: Controlling for sociodemographic and health characteristics, stressors related to COVID-19, and behavioral and psychosocial changes since the pandemic, caregivers were more likely than noncaregivers to report reduced illness self-efficacy when they had a higher number of chronic conditions. CONCLUSION: These findings highlight the importance of maintaining caregivers' self-care during the COVID-19 pandemic and in future public health crises.

Daily sleep, well-being, and adult day services use among dementia care dyads.

OBJECTIVES: The study aimed to describe daily sleep characteristics for dementia care dyads in the context of adult day services (ADS) use and examine the associations with sleep quality and daytime functioning (fatigue, affect, and behavior problems). METHODS: Caregivers (CG; N = 173) reported daily bedtime, wake time, and sleep quality for themselves and the persons living with dementia (PLWD) across 8 consecutive days (N = 1359), where PLWD attended ADS at least 2 days of the week. On each day, caregivers also reported their own fatigue and affect and PLWD's daytime behavior problems and nighttime sleep problems. Considering the context of ADS use, we compared mean differences in bedtime, wake time, and total time in bed on nights before versus after ADS use. We estimated multilevel models to examine daily sleep-well-being associations. RESULTS: On nights before an upcoming ADS day, care dyads went to bed and woke up earlier, and spent less time in bed. Further, PLWD had better sleep quality the night before an upcoming ADS day. Using ADS during the day buffered the negative impact of PLWD's sleep problems in the previous night, reducing daytime negative affect for caregivers. For caregivers, using ADS yesterday attenuated the association between shorter than typical time in bed and daytime fatigue; it also attenuated the association between PLWD's nighttime sleep problems and lowered daytime positive affect. CONCLUSIONS: Regular ADS use may promote earlier sleep timing and protect against the adverse impact of sleep disturbances on daytime functioning for dementia care dyads.

Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions.

Multiple chronic conditions (MCC) are one of today's most pressing healthcare concerns, affecting 25% of all Americans and 75% of older Americans. Clinical care for individuals with MCC is often complex, condition-centric, and poorly coordinated across multiple specialties and healthcare services. There is an urgent need for innovative patient-centered research and intervention development to address the unique needs of the growing population of individuals with MCC. In this commentary, we describe innovative methods and strategies to conduct patient-centered MCC research guided by the goals and objectives in the Department of Health and Human Services MCC Strategic Framework. We describe methods to (1) increase the external validity of trials for individuals with MCC; (2) study MCC epidemiology; (3) engage clinicians, communities, and patients into MCC research; and (4) address health equity to eliminate disparities.

Factors Associated With Sleep Disturbances Related to the COVID-19 Pandemic Among Older Adults With Chronic Conditions.

OBJECTIVES: The COVID-19 pandemic may contribute to sleep problems among older adults with chronic conditions. We examined factors linked to pandemic-related sleep disturbances in a US sample of adults aged 50 and older with chronic conditions. DESIGN: Cross-sectional anonymous online survey between May 14 and July 9, 2020. SETTING: Michigan (82.3% of participants) and 33 other US states. PARTICIPANTS: Total of 705 adults (M = 64.57 years, SD = 8.82, range = 50-94) who reported at least one chronic condition. MEASUREMENTS: Sociodemographic and health characteristics, physical activity, media use, pandemic-related stress, social resources, and pandemic-related sleep disturbances. RESULTS: In the fully adjusted regression models, people who reported more worry about COVID-19 infection, more financial strain, and greater loneliness reported significantly greater pandemic-related sleep disturbances. CONCLUSIONS: These findings identify factors that may heighten risk of sleep problems since the COVID-19 pandemic in an especially vulnerable subgroup of older adults.

Gender Differences in Patterns and Correlates of Continued Substance Use among Patients in Methadone Maintenance Treatment.

BACKGROUND: Continued substance use is common during opioid use disorder (OUD) treatment. There are still inconsistencies in how continued substance use and concurrent patterns of substance use among patients with OUD varies by gender. There is still more to learn regarding how factors associated with continued and concurrent use might differ for men and women in methadone maintenance treatment (MMT). Methods: This cross-sectional study examined predictors of concurrent substance use subgroups among patients receiving MMT. The sample included 341 (n = 161 women) MMT patients aged 18 and older from opioid treatment programs in Southern New England and the Pacific Northwest. Patients completed a survey assessing sociodemographic and clinical characteristics including past-month substance use. Latent class analyses were conducted by gender to identify groups based on substance use and determine predictors of those classes. Results: Three-class solutions were the optimal fit for both men and women. For both genders, the first subgroup was characterized as Unlikely Users (59.8% women, 52.8% men). Classes 2 and 3 among women were Cannabis/Opioid Users (23.7%) and Stimulant/Opioid Users (13.0%). Among men, Classes 2 and 3 consisted of Alcohol/Cannabis Users (21.9%) and Cannabis/Stimulant/Opioid Users (25.3%). Ever using Suboxone (buprenorphine/naloxone) and depression/anxiety symptoms were significantly linked to substance use group among women, whereas homelessness and employment status were significantly associated with substance use group among men. Conclusions: This study furthers understanding of gender differences in factors associated with continued substance use and distinctive patterns of concurrent substance use that may guide tailored treatments among patients MMT.

Loneliness During the COVID-19 Pandemic Among Older Adults With Chronic Conditions.

The COVID-19 pandemic may intensify loneliness among older adults with chronic conditions who are at high risk of severe illness, but little is known about factors associated with loneliness during the pandemic. We considered factors linked to loneliness among 701 adults aged 50 years and older with chronic conditions from Michigan (82.5%) and 33 other U.S. states. Participants completed an anonymous online survey between May 14 and July 9, 2020. About two thirds (66.4%) reported moderate to severe loneliness. The fully adjusted regression model revealed that being a person of color, having a spouse or cohabiting partner, and more emotional support were associated with lower levels of loneliness. Higher anxiety symptoms, more worry about COVID-19 infection, and more financial strain because of the pandemic were linked to greater loneliness. These findings inform strategies to support a vulnerable subgroup of older adults during this pandemic and in future public health crises.

Discordant Chronic Conditions and Depressive Symptoms: Longitudinal Associations Among Middle-Aged and Older Couples.

OBJECTIVES: Individuals often manage chronic conditions in middle and later life that may diminish well-being. Little is known, however, about discordant conditions (i.e., two or more conditions with competing self-management requirements) among older couples and their links to depressive symptoms. We considered discordant conditions at both the individual level and the couple level (i.e., between spouses), along with their long-term implications for depressive symptoms. METHODS: The U.S. sample included 1,116 middle-aged and older couples drawn from five waves (2006-2014) of the Health and Retirement Study. Longitudinal actor-partner interdependence models evaluated whether individual-level and couple-level discordant chronic health conditions were concurrently linked to depressive symptoms, and whether these associations became stronger over time. Models controlled for age, minority status, education, prior wave depressive symptoms, and each partner's baseline report of negative marital quality and number of chronic conditions in each wave. RESULTS: Wives and husbands reported significantly greater depressive symptoms when they had individual-level discordant conditions about 2 years after baseline, and these links intensified over time. Beyond this association, husbands had significantly greater depressive symptoms when there were couple-level discordant conditions. DISCUSSION: Individual-level and couple-level discordant conditions may have lasting implications for depressive symptoms during midlife and older adulthood.

Accentuate the Positive: The Association Between Informal and Formal Supports and Caregiving Gains.

Background: To promote resilience among caregivers for persons living with dementia (PLWDs), we examine how formal and informal supports are linked to caregiving gains, and whether gender moderates the association between supports and gains. Method: Using the National Health and Aging Trends Study and associated National Study of Caregiving, sources of informal (emotional support, practical support, and help with the PLWD) and formal support (respite care, training program, support group) are considered as predictors of caregiving gains, with gender as a moderator of these associations. The sample included 707 caregivers for 502 PLWDs. Results: Greater caregiving gains were significantly associated with emotional support from friends/family (ß = 0.14, SE = 0.09, p = .03). Furthermore, attending a caregiver training program was only associated with increased caregiving gains among men (ß = 0.11, SE = 0.08, p = .02). Conclusion: Emotional support from family/friends appears particularly consequential for caregiving gains, and male caregivers may benefit most from programs that emphasize skill building.

Age Differences in Stress, Life Changes, and Social Ties During the COVID-19 Pandemic: Implications for Psychological Well-Being.

BACKGROUND AND OBJECTIVES: Experiences of the coronavirus disease 2019 (COVID-19) pandemic and its implications for psychological well-being may vary widely across the adult life span. The present study examined age differences in pandemic-related stress and social ties, and links with psychological well-being. RESEARCH DESIGN AND METHODS: Participants included 645 adults (43% women) aged 18-97 (M = 50.8; SD = 17.7) from the May 2020 nationally representative Survey of Consumers. Participants reported the extent to which they felt stress related to the pandemic in the last month, the extent to which their lives had changed due to the pandemic, as well as social isolation, negative relationship quality, positive relationship quality, and frequency of depression, anxiety, and rumination in the past week. RESULTS: Results showed that older people reported less pandemic-related stress, less life change, less social isolation, and lower negative relationship quality than younger people. Greater pandemic-related stress, life change, social isolation, and negative relationship quality were associated with poorer psychological well-being. Poorer social ties (i.e., greater social isolation and negative quality) exacerbated the effects of the COVID-19 pandemic (stress, life change) on psychological well-being. DISCUSSION AND IMPLICATIONS: Researchers have indicated that older adults may be more vulnerable to COVID-19 pandemic-related stress and social isolation, but this study indicates that young adults may be relatively more vulnerable. Because isolation and negative relationship quality appear to exacerbate the deleterious effects of the COVID-19 pandemic on psychological well-being, reducing social isolation and negative relations are potential targets for intervention.

Daily Social Interactions and HPA Axis Activity Among Midlife and Older Adults.

BACKGROUND AND OBJECTIVES: Older people experience fewer negative interactions and report less stress in response to interpersonal tensions. Less is known, however, about the implications of daily social interactions for biological stress responses. We evaluated links between daily positive and negative interactions and 2 key biomeasures of the hypothalamic-pituitary-adrenal axis: salivary cortisol and dehydroepiandrosterone sulfate (DHEA-S). We also considered the moderating effects of age. RESEARCH DESIGN AND METHODS: Participants included a random sample of 93 individuals aged 40-95 who completed 14 days of daily diary interviews and provided saliva samples during 4 of those days. RESULTS: Three-level piecewise models showed that individuals had higher sustained DHEA-S levels on days after reporting more positive interactions. Young-old adults (60-79) had lower overall DHEA-S on days when they had more negative interactions than oldest-old adults (80 and older). Oldest-old adults showed a flatter decline in DHEA-S on days after they reported more negative interactions compared to midlife adults (40-59). Daily social interactions were not significantly associated with cortisol. DISCUSSION AND IMPLICATIONS: Strategies to increase positive interactions may help to build physiological resilience to stress, particularly among midlife and young-old adults.

Chronic condition discordance and physical activity among midlife and older couples.

OBJECTIVE: Chronic conditions in middle and later life are associated with lower physical activity. Yet little is known about chronic condition discordance (i.e., the extent to which conditions have nonoverlapping self-management requirements) within older individuals and couples and its implications for physical activity. We determined how the degrees of chronic condition discordance at the individual level and the couple level (i.e., between spouses) were linked to moderate physical activity across an 8-year period. METHOD: The U.S. sample included 1,621 couples from five waves of the Health and Retirement Study (2006-2014). Dyadic growth curve models estimated how individual-level and couple-level chronic condition discordance were linked to initial levels of and rates of change in moderate activity. Models controlled for age, minority status, education, and own and partner reports of baseline negative marital quality, time-varying depressive symptoms, and time-varying number of chronic conditions. RESULTS: A considerable proportion of wives (25.4%) and husbands (18.9%) reported moderate activity less than once a week. When individuals (wives: ß = -0.10; husbands: ß = -0.09) or their spouses (wives: ß = -0.04; husbands: ß = -0.05) had greater individual-level chronic condition discordance, lower initial moderate activity was reported. When husbands had greater individual-level discordance, both wives (ß = -0.16) and husbands (ß = -0.19) had a faster rate of decline in moderate activity over time. Couple-level chronic condition discordance was not significantly linked to moderate activity. CONCLUSIONS: These findings suggest the importance of promoting physical activity among individuals and couples managing complex chronic conditions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Dyadic associations between relationship quality and risk of opioid use among couples receiving methadone for opioid use disorder.

BACKGROUND: Social relationships may serve as both protective factors and risk factors for opioid use (nonmedical prescription opioid or illicit opioid use) among patients receiving methadone for opioid use disorder (OUD). Yet little is known about how relationship quality is linked to outcomes among couples receiving methadone. We evaluated the links between relationship quality and risk of opioid use among couples in which both partners received methadone. METHODS: Participants included 53 heterosexual married or cohabiting couples aged 18 and older who were drawn from two opioid treatment programs in Rhode Island and Massachusetts. Both members of the couple completed a self-administered survey assessing their sociodemographic information, relationship and treatment characteristics, and risk of opioid use. RESULTS: Roughly half of women (47.2%) and men (52.8%) had a moderate to high risk of nonmedical prescription opioid use and almost two-thirds (64.2%) had a moderate to high risk of street opioid use. Risk of street opioid use was highly correlated within couples. Actor-partner interdependence models revealed that when women reported higher positive relationship quality, they had a lower risk of nonmedical prescription opioid use and their partners had a lower risk of street opioid use. Negative relationship quality was not significantly linked to risk of opioid use. CONCLUSIONS: Couples in which both partners receive methadone for OUD may be at risk of return to use, and positive partner relationships may play a role in lowering this risk. Women's perceptions of relationship quality might be a particularly important target for clinical care and interventions.