'Possibilities and challenges for older couples to continue ageing in place'.

Ageing in place is an imminent concern for both older couples and communities. Identifying ways to support ageing in place is required to meet the needs and challenges of older couples and social services systems. Through focus groups with a total of 46 participants and a constant comparative methodology, this study aimed to explore and describe the experiences and reasoning of spousal carers, healthcare professionals, and stakeholders regarding possibilities for older couples to age in place. The findings consisted of one main category, 'Facilitating ageing in place is a win-win situation with challenges' and four interrelated categories, 'Focus on older couples - building relationships and providing adequate services', 'Engaged civil society as a source of care and social inclusion,' 'Motivated professionals with competence and time,' and 'Services working together for a sustainable society,' that present possibilities and challenges for ageing in place. This study suggests that facilitating ageing in place is possible but involves a complex series of challenges that can be linked to different contexts ranging from individuals and couples to civil society, services provided, organisational systems, and existing resources. All these aspects need to be considered and balanced to achieve a situation that contributes to older couples' possibilities to age in place as well as to a sustainable society.

Spousal collaboration mediates the relation between self-rated health and depressive symptoms of Chinese older couples: an actor-partner interdependence approach.

BACKGROUND: Dyadic coping resources have been considered a potential explanatory mechanism of spousal interdependence in health, but the mediation of spousal collaboration for the relationship between self-rated health and depressive symptoms has yet to be examined. This study aimed to investigate the within- (actor effect) and between-partner effects of self-rated health on depressive symptoms in community-dwelling older couples facing physical functioning limitations and to examine the role of spousal collaboration in mediating the actor and cross-partner effects of self-rated health on depressive symptoms. METHOD: Data from 185 community-dwelling older Chinese married couples were analyzed using the actor-partner interdependence mediation model (APIMeM). Couples were interviewed through trained research assistants using the 5-item common dyadic coping subscale of the Dyadic Coping Inventory (DCI), the Visual Analog Scale (VAS) of the QoL questionnaire EQ-5D and the Patient Health Questionnaire-9 (PHQ-9). RESULTS: Husbands' self-rated health had an actor effect on their own depressive symptoms and a partner effect on their wives' depressive symptoms. Wives' self-rated health had an actor effect on their own depressive symptoms. The actor effects between self-rated health and depressive symptoms were partially mediated by their own perception of spousal collaboration. Furthermore, husbands' self-rated health not only affects wives' depressive symptoms directly but also indirectly by influencing wives' perceptions of spousal collaboration. DISCUSSION: The findings from this study underscored the importance of viewing couples' coping processes from a dyadic and gender-specific perspective, since more (perceived) collaborative efforts have beneficial effects on both partners' mental health outcomes.

Memory Trajectories and Disability Among Older Couples: The Mediating Role of Depressive Symptoms.

OBJECTIVES: Using a dyadic approach, this study examined the mediating effect of depressive symptoms on the longitudinal relationships between husbands' and wives' memory trajectories and their prospective disability status. METHODS: Longitudinal data from the Health and Retirement Study 2004-2018 were used. Older (aged 50+) heterosexual couples who had no limitations in the activity of daily living at the baseline (2004) were included (N = 1,310). Latent class growth analysis grouped wives and husbands into distinct memory trajectories in 2004-2014. A structural equation model examined the actor and partner effects of memory trajectories on depressive symptoms in 2016 and disability status in 2018. The mediating effect of depressive symptoms was tested. RESULTS: A total of 4 distinct memory trajectories were found: persistently high, high and slow decline, moderate and slow decline, and low and rapid decline. Only the wife's low and rapid decline memory trajectory predicted her own more depressive symptoms (ß = 0.588, 95% CI: 0.209, 0.967) and her husband's more depressive symptoms (ß = 0.326, 95% CI: 0.004, 0.648). Meanwhile, depressive symptoms had strong and significant actor effects on disability (ß = 0.046, 95% CI: = 0.036, 0.057 for wives; ß = 0.060, 95% CI: = 0.046, 0.074 for husbands). DISCUSSION: The wife's low and rapid decline trajectory was associated with her own and her husband's more depressive symptoms, which in turn increased the disability risk for both partners. Timely identification and treatment of memory decline among wives have the potential to mitigate couples' depressive symptoms and, ultimately, disability risks.

Health Behavior Patterns and Associated Risk of Memory-Related Disorders Among Middle-Aged and Older Chinese Couples.

Objectives: Studies on the interdependence of couples' health behaviors and subsequent cognitive outcomes remain limited. Methods: Longitudinal data from the China Health and Retirement Longitudinal Study (2011-2018) were used (N = 1869 heterosexual couples). Latent class analysis identified the dyadic pattern of health behaviors in 2011 (i.e., alcohol consumption, smoking, and physical inactivity). Stratified Cox models examined the association of latent classes with risk of developing memory-related disorders in 2013-2018. Results: Three classes were identified: class 1 (21.25%, only husband smoke, and both active), class 2 (47.55%, both inactive, neither drink nor smoke), and class 3 (31.20%, both drink and smoke, and both active). Couples' sedentary lifestyle was associated with an increased risk of memory-related disorders among both husbands and wives. Conclusion: Couples were moderately concordant in their physical activity but weakly in smoking and drinking. Couple-based interventions, especially promoting physical activity, may reduce cognitive aging among middle-aged and older Chinese couples.

Concordance of Non-Alcoholic Fatty Liver Disease and Associated Factors among Older Married Couples in China.

Background: Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases which affects mainly middle-aged and older adults, resulting in a considerable disease burden. Evidence of concordance on NAFLD and lifestyle factors within older married couples in China is limited. This study aimed to evaluate spousal concordance regarding lifestyle factors and NAFLD among older Chinese couples. Methods: We conducted a cross-sectional study using data from 58,122 married couples aged 65 years and over recruited from Shenzhen, China during 2018−2020. Logistic regression analyses were used to estimate the reciprocal associations in NAFLD within couples after incremental adjustment for potential confounders. Results: There was a marked concordance regarding NAFLD among older married couples in our study. After adjustment for confounders, the odds of having NAFLD were significantly related to the person's spouse also having NAFLD (1.84 times higher in husbands and 1.79 times higher in wives). The spousal concordance of NAFLD was similar, irrespective of gender. Couples with both a higher educational level and abdominal obesity were more likely to have a concordance of NAFLD compared to couples with both a lower educational level and no abdominal obesity, respectively (p < 0.05). Conclusion: Our results indicated that health care professionals should bear in mind the marked spousal concordance with respect to risk factors and NAFLD for the prevention and early detection of the highly prevalent disease in older Chinese adults.

Depressive Symptom Trajectories and Cognition Among Older American Couples: A Dyadic Perspective.

OBJECTIVES: This study examined whether trajectories of depressive symptoms of one spouse are associated with the other spouse's memory. METHODS: Longitudinal data from the Health and Retirement Study (2004-2016) were used (N = 5690 heterosexual couples). Latent-class growth analysis and structural equation models examined the actor and partner effects of depressive symptom trajectories on memory. RESULTS: Four depressive symptom trajectories were identified (i.e., persistently low, increasing, decreasing, and persistently high). Compared to the low trajectory group, the increasing and persistently high trajectories were associated with worse memory for both men and women. While none of the wives' depressive symptom trajectories was significantly associated with husbands' memory (p > .05), husbands' decreasing trajectory was linked to wives' better memory (ß = 0.498, 95% CI = 0.106, 0.890). DISCUSSION: Older adults with increasing and persistently high depressive symptoms may experience worse memory. Psychosocial interventions targeting depressive symptoms among older men may be beneficial to their spouses' memory.

Having a Good Time Together: The Role of Companionship in Older Couples' Everyday Life.

INTRODUCTION: Companionship (i.e., enjoyable shared activities) is associated with higher emotional and relational well-being. However, the role of companionship for emotional well-being and relationship satisfaction in older couples' everyday life is not well understood. This article studies time-varying associations of companionship with emotional and relational well-being as older couples engage in their everyday life. METHODS: Participants provided three data points a day over 7 days using electronic surveys that were simultaneously completed by both partners. A total of 118 older heterosexual couples reported momentary companionship, positive and negative affect, and closeness. Data were analyzed using an intensive longitudinal dyadic score model. RESULTS: Couples with higher average companionship showed lower overall negative affect, more overall positive affect, and higher overall closeness. During moments of elevated momentary companionship, partners reported more positive affect, less negative affect, and higher closeness. Regarding between-couple partner differences, i.e., when the female partner's momentary companionship was higher on average than the male partner's momentary companionship, the female partner also showed less negative affect, more positive affect, and higher closeness than the male partner. During moments in which the female partner's momentary companionship was higher than the male partner's momentary companionship, the female partner showed less negative affect, more positive affect, and higher closeness than the male partner. DISCUSSION: Older couples show a consistent link between companionship and emotional well-being and closeness in everyday life emphasizing the importance of studying companionship in close relationships.

Why do spouses provide personal care? A study among care-receiving Dutch community-dwelling older adults.

This study investigates under what conditions older spouses receive personal care from their spouse. Whether spousal care is provided is determined by individual and societal factors related to informal and formal care provision. Individual factors concern the need for care (the care recipient's health status), the spouse's ability to provide care (the spouse's health status) and the quality of the marital bond. Societal factors reflect changing policies on long-term care (indicated by the year in which care started) and gender role socialisation (gender). From the Longitudinal Aging Study Amsterdam, which completed eight observations between 1996 and 2016, we selected 221 independently living married respondents, aged 59-93, who received personal care for the first time and had at least one previous measurement without care use. The results show that if an older adult received personal care, the likelihood of receiving that care from the spouse decreased over the years: from 80% in 1996 to 50% in 2016. A husband or wife was less likely to receive spousal care when the spouse was unable to provide care or the quality of the relationship was low. No gender differences were found in either the prevalence of spousal care use or in the factors associated with that use. Thus, individual factors and the societal context seem to determine whether one receives personal care from their spouse. The decline in the likelihood of personal care provision from a spouse over the years may indicate a crumbling of family solidarity, an unmeasured and growing inability of the older spouse to provide care or an increasing complexity of care needs that requires the use of formal care. As care-giving can be a chronic stressor and most spouses provide care without assistance from others, attention from policy makers is needed to sustain the well-being of older couples.

Partner Pain and Affect in the Daily Lives of Older Couples.

OBJECTIVES: The susceptibility of older adults' affect to fluctuations in their own health (within-person health sensitivity) indicates how they handle everyday health challenges. In old age, affective well-being is often increasingly influenced by close others, yet it is unknown whether older adults' affect is additionally susceptible to fluctuations in their spouse's health (within-partnership health sensitivity) and the extent to which age and relationship satisfaction moderate such associations. METHODS: Parallel sets of multilevel actor-partner interdependence models are applied to self-reported health (feelings of pain/discomfort) and positive and negative affect, obtained 6 times a day over 7 consecutive days from 2 independent samples, the Berlin Couple Dynamics Study (N = 87 couples; Mage = 75 years; M relationship length = 46 years) and the Socio-Economic Panel Couple Dynamics Study (N = 151 couples; Mage = 72 years; M relationship length = 47 years). RESULTS: Husbands and wives had lower positive affect and higher negative affect in moments when they reported more pain (within-person health sensitivity) and when their respective spouse reported more pain (within-partnership health sensitivity). Tests for moderation suggest that within-person, but not within-partnership, health sensitivity is lower at older ages and higher with more satisfying relationships. DISCUSSION: These findings empirically illustrate life-span notions that close relationships shape time-varying health-affect links and thus underscore the theoretical and practical utility of examining social-contextual antecedents of older adults' everyday affective well-being.

Spousal concordance in frailty predicting mental and functional health decline: A four-year follow-up study of older couples in urban and rural China.

AIMS AND OBJECTIVES: To examine the joint effects of self and spousal frailty status on functional and mental health in Chinese older adults and determine whether such effects vary by urban versus rural residency. BACKGROUND: Frailty is a clinical syndrome among old adults and would lead to adverse outcomes. However, studies on the interactive patterns of frailty status between spouses and the joint effects of such patterns on health outcomes are scarce. DESIGN: Data were from the China Health and Retirement Longitudinal Study (CHARLS). A total of 2,581 married seniors who participated both 2011 and 2015 waves of the CHARLS were categorised into four groups: robust self-robust spouse (RR), robust self-frail spouse (RF), frail self-robust spouse (FR) and frail self-frail spouse (FF). METHODS: Frailty was measured using the physical frailty phenotype scale. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CESD). Functional health was measured by difficulties in activities of daily living (ADL) and instrumental activities of daily living (IADL). The generalised estimating equation was used to estimate the effects of concordant frailty on mental and functional outcomes, stratified by rural/urban residency. This study followed the STROBE checklist. RESULTS: The FF group reported higher levels of ADL/IADL difficulties and depressive symptoms at follow-up than the RR group; urban individuals in the RF group reported higher follow-up depression than the RR group; and rural individuals from the FR or RF groups reported more follow-up ADL/IADL difficulties than the RR group. CONCLUSION: Frailty and subsequent health decline are interdependent in older couples, and the rural/urban context is important for understanding this interdependence in the older Chinese population. RELEVANCE TO CLINICAL PRACTICE: Couples-based intervention strategies are needed to tackle situations in which one or both spouses are concurrently facing frailty.

Positive life stories of Stroke-Survivor's spousal caregiving in Hong Kong: Lessons for policy and practice.

BACKGROUND: Advances in medical-care for immediately post-stroke mean that many stroke-survivors now live a normal lifespan, although they may suffer residual disability. They are often cared for at home by their spouse, who may be ill-prepared for this task, and may also have health concerns. As demands on formal services increase with population aging in Hong Kong, equipping spousal-caregivers with positive effective caring strategies is increasingly important. OBJECTIVE: To understand what constitutes positive spousal-caregiving for stroke-survivors in Hong Kong within the cultural lens of 'Zhong (Loyalty)' METHOD: Naturalistic qualitative research was employed to hear stories about positive caregiving from Hong Kong couples living with stroke sequelae. Three in-depth face-to-face semi-structured interviews were undertaken with eleven dyads (stroke-survivor alone, spousal-caregiver alone, then the couple together). Data validation was by member-checking, further questions, and feedback at a second interview, and corroboration by field-notes. FINDINGS: A strength-based interactive model of positive spousal-caregiving was described, whose core tenet was Zhong (Loyalty). This fostered, and in turn was nurtured by, three paired key behaviours (1. Learning new skills linked with satisfaction when efforts paid off; 2. Utilizing formal and informal resources linked with supporting others; 3. Cherishing and bringing out the best linked with managing life- and self-care). Couples' capacity to develop these behaviours reflected their inner strengths. CONCLUSIONS: Couples who practiced positive caring and were resilient in the face of adversity were likely to optimise dyadic health and deal constructively with unexpected challenges. To address a looming shortfall between client need, and formal health and social services in Hong Kong, evidence-based policies are required to support effective, positive community-based spousal-caregiving.

Alignment of Physical Activity in Older Couples Affected by Osteoarthritis: Investigation by Accelerometry and Questionnaire.

This study examined whether an alignment of physical activity (PA) between osteoarthritis patients and their spouses, which was previously proven by accelerometry, might also be revealed by self-report. The PA of 28 cohabitating couples (58-83 years) was assessed by means of synchronous accelerometry (ActiGraph wGTX3-BT) and compared to their according self-reports in the German Physical Activity, Exercise, and Sport Questionnaire (BSA-F). Both methods were used to quantify the average weekly light PA, moderate to vigorous PA (MVPA), and total PA. Accelerometry revealed no differences in weekly light PA and total PA (p ≥ 0.187) between patients and spouses, whereas the patients' spouses accumulated significantly more MVPA (p = 0.015). In contrast, the self-report did not reveal any differences between the two groups in terms of PA (p ≥ 0.572). Subsequent correlation analyses indicated that accelerometry data for mild PA and total PA were significantly correlated in couples (r ≥ 0.385, p ≤ 0.024), but MVPA was not (r = 0.257, p = 0.097). The self-reported PA data, on the other hand, did not indicate any significant correlation (r ≤ 0.046, p ≥ 0.409). The presented results give a first indication that an alignment of PA between osteoarthritis patients and their spouses is most likely to be detected by accelerometry, but not by self-report.

Team mentored reflective practice in gerontological social work education.

Attracting students to gerontological social work has long been difficult. A possible strategy is to provide students with experiential learning opportunities with older adults that provide them with support while reflecting on this work. Our Team Mentored Reflective Practice model represents an effort to enhance students' reflective practice skills in the context of a clinical research project in which both instructors and students form a supportive team. Students reported a number of benefits that included the development of meaningful relationships with older clients, clinical skills that related to memory loss, and the integration of research and practice. Students who were engaged in the team mentored process of reflection evidenced changes in how they were thinking about clients. These new understandings have the potential to impact the ways in which students work with older adults.

Study of mutual influence between trait anxiety and risk of depression among older couples facing cancer.

INTRODUCTION: The present study aims to examine the process of mutual influence in older couples with cancer diagnosis by studying their risk of depression. MATERIALS AND METHODS: 282 couples with one spouse diagnosed with cancer were selected from the Three-City cohort study. Dyadic analyses were used to determine whether trait anxiety affects the risk of depression and whether a mutual influence process occurs prior and post cancer diagnosis. Cross-sectional analyses were performed at two time-points: before and after receiving the diagnosis. RESULTS: A higher level of anxiety among cancer patients resulted in a decreased risk of depression among spousal caregivers. Moreover, a higher anxiety among spousal caregivers increased their own risk of depression, but it didn't influence depression risk among cancer patients. While there is an intra-individual relationship between a higher level of trait anxiety and a greater risk of depression prior to cancer diagnosis, there is no cross-influence between spouses. DISCUSSION: The study findings indicate that a dyadic psychological adjustment process might help older adults to cope with cancer by limiting the risk of depression among spousal caregivers.

Behavioral Conformity of Physical Activity and Sedentary Behavior in Older Couples with One Partner Suffering from End-Stage Osteoarthritis.

PURPOSE: The present study investigates behavioral conformity regarding physical activity (PA) and sedentary behavior (SB) in older couples where one partner suffers from osteoarthritis (OA). Hereby the question is addressed whether and to what extent the typical physical limitations of OA patients have negative effects on their partners. PATIENTS AND METHODS: The habitual PA and SB of end-stage osteoarthritis patients (n = 32, 52-81 years | n = 14 gonarthrosis, n = 18 coxarthrosis), their spouses (n = 32, 50-83 years) and control couples (n = 26 subjects, 52-78 years) were assessed by accelerometry. Besides individual results of accelerometry hourly couple-specific performance ratios were calculated for four parameters of PA (number of steps, vector magnitude (VM), metabolic rate (MET), and total time in moderate-to-vigorous PA (MVPA)) and two parameters of SB (number of sedentary bouts and total time of sedentary bouts per hour). Analyses of covariance were used to explore differences in hourly couple-specific performance ratios between couples affected by osteoarthritis and control couples. RESULTS: Significant differences in PA were observed between the three groups, whereby the patients showed the lowest PA and the subjects of the control group the highest PA. In contrast to this, SB did not differ between the three groups. The hourly analyses of couple-specific performance ratios revealed significant differences between the target couples (patients and spouses) and the control couples for all parameters of PA. Thereby, the deviance in PA between the patients and their spouses was always smaller than in control couples and also decreased with age. The investigation of SB, on the other hand, revealed larger deviations between the patients and their spouses as compared to control couples and no changes with age. CONCLUSION: This study confirmed the known negative impact of osteoarthritis on the PA and SB of elderly patients. More important, however, was the finding that the patients' spouses adapt to this poor health behavior and show reduced PA as well. Consequentially, spouses of OA patients should be considered as a risk group for inactivity-related diseases in old age. This should be considered in interventions that aim to use the individual support of spouses to increase the PA of OA patients.

"Crossover" in Depressive Symptoms Among Older Couples: Are Previous Findings Artifactual?

Objective: This study examined effects of a partner's depressive symptoms on those of a focal respondent. Method: Data were from the 2008-through-2014 waves of the Health and Retirement Study. Linear growth modeling was used to distinguish within- from between-person variation, and genetic instrumental variables to take endogeneity into account. Results: A partner's 2008 depressive symptoms had no associations with within-person change in those of a respondent between 2010 and 2014. Corresponding linkages with their between-person variation in 2010 were positive and significant for both genders. Among women, these last estimates remained intact in genetic instrumental variable models restricted to white couples. Discussion: Results indicate that contrary to previous literature, late life relationships are not marked by "crossover" of depressive symptoms. Women's affect may, however, be influenced by such transmission in the relationship's history. Beyond depression, findings suggest current theories of dyadic health effects may partly rest on flawed evidence.

The More We Are in Control, the Merrier? Partner Perceived Control and Negative Affect in the Daily Lives of Older Couples.

OBJECTIVES: It is well established that daily perceived control is closely associated with lower negative affect (NA) among older adults. However, it is an open question whether control perceptions of one's partner are also uniquely associated with one's own NA. METHOD: To examine such associations in dyads of older long-term partners, we make use of data obtained 6 times a day over 7 consecutive days as participants went about their everyday lives (N = 87 couples; mean age = 75 years; mean relationship length = 46 years). Our multilevel actor-partner models for dyadic data analyses covary for relevant individual and couple differences in sociodemographic characteristics, self-reported physical health, and cognitive functioning. RESULTS: Corroborating and extending earlier reports, results reveal that higher momentary perceived control was associated with lower NA. Most importantly, we found that higher momentary perceived control of the partner is additionally and uniquely associated with lower NA of the actor. DISCUSSION: We discuss possible mechanisms and underlying pathways of how perceived control may help both partners downregulate their negative emotions in daily life. We close by considering conceptual and practical implications.

Tenacious Goal Pursuit, Flexible Goal Adjustment, and Life Satisfaction Among Chinese Older Adult Couples.

We aimed to examine the roles of tenacious goal pursuit (TGP) and flexible goal adjustment (FGA), mediated by positive self-perceptions of aging (PSA), in Chinese older couples' life satisfaction. Using a cross-sectional design, 245 Chinese older couples (age range: 55-93 years) completed measures of TGP, FGA, PSA, and life satisfaction. The results showed that (a) spousal interrelations existed for TGP and FGA; (b) TGP and FGA had significant actor effects on life satisfaction, with FGA having a stronger effect; (c) although the partner effect of FGA did not differ between husbands and wives, husbands' TGP was positively associated with wives' life satisfaction, but not vice versa; and (d) PSA mediated the effects of TGP and FGA on life satisfaction at the actor and partner levels. These results have implications for developing couple-based interventions to enhance successful aging, with a focus on promoting both partners' accommodative coping and positive age beliefs.

Successful aging, change in sexual interest and sexual satisfaction in couples from four European Countries.

Although the importance of sexuality and physical intimacy for well-being of older adults has been recognized, the role of sexuality in successful aging (SA) has been largely neglected. Building on our previous work, here we further validated a three-dimensional model of SA and examined its associations with sexual satisfaction and change in sexual interest among older heterosexual couples (aged 60-75 years). Participants were recruited in a probability-based survey, which was carried out in 2016-2017 in four European countries. Using structural equation modeling of the Actor-Partner Interdependence, we observed significant relationships between SA and sexual satisfaction for both male and female partners across countries. Among women, their retrospectively assessed change in sexual interest over the past 10 years was consistently associated with sexual satisfaction. Partner effects were gender-specific: male partners' SA was significantly related to their female partners' change in sexual interest, which in turn was linked to male partners' sexual satisfaction. The findings point to substantial ties between successful aging and sexuality in older European couples. Taking into account the prevalent stereotypes about old age and sexuality, this study's findings can assist professionals working with aging couples.

Social and productive activities and health among partnered older adults: A couple-level analysis.

OBJECTIVES: We theorize and test the health of older adults as a result of their activity engagement, as well as a product of their spouse's engagement. METHOD: We draw on 15 waves of couple-level data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Using responses of time engaged in nine different activities, we estimate Latent Class Models to describe activity profiles of partnered older adults. Given potential health selections into activity engagement, we lag older adults' activity engagement by one wave to examine its association with subsequent health. We then investigate associations between the lag of the spouse's activities with respondents' health, controlling for their own activity engagement at the previous wave. RESULT: We find four activity profiles for men, and three for women. Respondents who were predominantly engaged in community activities generally report better subsequent health. Beyond their own activity engagement, for both older men and women, having a partner who was also community engaged associate with better subsequent health, though for older women, there were little differences between having a husband who was community engaged or inactive. DISCUSSION: Our findings highlight the value of considering activities of partnered older adults at the couple level.