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PubMed2003

A "good death" for whom? Quality of spouse's death and psychological distress among older widowed persons.

Ethicists, policy makers, and care providers are increasingly concerned with helping the dying elderly to experience a "good death." A "good death" is characterized by physical comfort, social support, acceptance, and appropriate medical care, and it should minimize psychological distress for the dying and their families. I identify the predictors of death quality and evaluate how the quality of an older adult's death affects the surviving spouse's psychological adjustment six months after the loss. Analyses use Changing Lives of Older Couples (CLOC) data, a prospective study of married persons ages 65 and older. Positive spousal relationships during the final days increase survivors' yearning yet reduce their anger. Having a spouse die a painful death is associated with elevated anxiety, yearning, and intrusive thoughts. The perception of physician negligence is associated with elevated anger. These findings suggest that improved end-of-life care and pain management will benefit both the dying and their bereaved spouses.

Adaptation, Psychological↗
PubMed2001

Attitudes toward spousal caregiving and their correlates among aging women.

The study examined the attitudes of elderly Israeli women (n = 259) toward three aspects of spousal caregiving: commitment to caregiving, perceived harmful effects, and delegating responsibility to others. In addition, the study examined the contribution of several variables toward explaining these attitudes: background variables, equality in marital relations, spousal resources, and affective variables. The findings indicate that on the whole, commitment to care for the spouse was most prevalent, while perceived harmful effects and delegating responsibility to others were emphasized less. Of the independent variables examined, equality in dyadic relations explained all three aspects of caregiving. Moreover, women with high levels of emotional hardiness were less likely to delegate responsibility for caregiving. In addition, a negative relationship was found between anticipated dependence on the husband and the wife's tendency to delegate responsibility for caregiving. Finally, the affective variables (satisfaction with life and marital complaints) contributed significantly toward explaining attitudes toward spousal caregiving.

Aged↗
PubMed1995

Homicidal behavior and sleep apnea: a case report and medicolegal discussion.

This case report documents the use of sleep apnea as a criminal defense for a man who fatally shot his wife during his usual sleeping hours. The defendant, who had severe sleep apnea as determined by a clinical evaluation and a polysomnographic study, admitted to shooting his wife but claimed that he was asleep at the time. Two physicians testified for the defense that the sleep apnea was of sufficient severity that the defendant may have had a confusional arousal related to the sleep apnea in which he could have shot his wife accidentally. Another physician, testifying for the prosecution, found no evidence to support this defense after a review of the patient's history and polysomnographic records and a review of relevant literature which may have linked sleep apnea with sleep-related violence. In this case, there was substantial apparent motive for the murder, including a past history of spousal and child abuse and a note written by the victim around the time of the shooting describing her intention to take the children and leave the suspect. The jury rejected the sleep apnea defense, handing down a first-degree murder verdict. In the discussion, we briefly review medicolegal issues related to the case as well as prospective guidelines for the medicolegal assessment of future cases.

Adult↗
PubMed2001

Psychological adjustment to sudden and anticipated spousal loss among older widowed persons.

OBJECTIVES: This study examined if older adults' psychological adjustment to widowhood varies based on whether the death was sudden or anticipated and if these effects are mediated by death context characteristics (e.g., predeath caregiving, nursing home use, spouse's age at death, and couple's communication about the death). METHODS: The effects of forewarning on multiple indicators of mental health and grief were examined in a sample of 210 widowed persons who participated in the Changing Lives of Older Couples (CLOC) study. The CLOC is a probability sample of 1,532 married individuals aged 65 and older for whom baseline information was collected in 1987-88, with widowed persons reinterviewed 6, 18, and 48 months after spousal loss. RESULTS: Forewarning did not affect depression, anger, shock, or overall grief 6 or 18 months after the loss. Prolonged forewarning was associated with elevated anxiety both 6 and 18 months after the death. Sudden spousal death elevated survivors' intrusive thoughts at the 6-month follow-up only. Sudden death was associated with slightly higher levels of yearning among women but significantly lower yearning among men both 6 and 18 months after the loss. DISCUSSION: The findings call into question the widespread belief that grief is more severe if death is sudden and suggest a more complex relationship between bereavement and circumstances of spousal death.

Adaptation, Psychological↗
PubMed2004

Are there sex differences in emotional and biological responses in spousal caregivers of patients with Alzheimer's disease?

The purpose of this study was to compare emotional and biological responses of men and women who are spousal caregivers of patients with Alzheimer's disease (AD). Quality-of-life measurements, bioinstrumentation data, and immunophenotype assessments were obtained from female and male spousal caregivers of patients with AD. Spousal caregivers (women, n = 45 with average age 69.7; men, n = 16 with average age 71.4 years) completed questionnaires that assessed psychosocial variables. Blood was drawn and lymphocyte subsets (including natural killer [NK] cell number) were determined using flow cytometry. The degree of relaxation was determined measuring muscle tension (EMG) in the frontalis and trapezius muscles, skin conductance, skin temperature, and heart rate. Male spousal caregivers, as compared to female spousal caregivers, had significantly lower levels of stress, depression, caregiver burden (subjective), anxiety, anger-hostility, and somatic symptoms and higher levels of mental health, sense of coherence, NK cell number, and social and physical functioning. There were no statistically significant differences between the 2 groups in social support, coping resources, or T, T suppressor, or activated T cells. Women had more T helper cells and fewer NK cells than men. Men had fewer manifestations of a physiological stress response, as indicated by bioinstrumentation parameters. Unique sex-specific issues need to be considered when strategies are implemented to assist the increasing number of caregivers as our society ages.

Adaptation, Psychological↗
PubMed1999

Wives' convergence with their husbands' alcohol use: social conditions as mediators.

OBJECTIVE: This study examines, in a general population, how the association of wives' alcohol use with their husbands' is mediated by social conditions such as working and child-rearing roles, age, marital happiness and socioeconomic levels. METHOD: Data come from the Québec Health and Social Survey 1992-93. The sample comprised 6,582 couples; 3,872 couples after weighting. Regression analyses assessed the contribution of husbands' drinking to wives' drinking, independently, as well as in interaction with social conditions. Frequency of drinking in general and frequency of five or more drinks per occasion (5+) were analyzed. RESULTS: Wives' drinking is positively related to their husbands' drinking, both in terms of frequency of drinking and, to a lesser degree, of frequency of 5+. The drinking frequency association is not modified by working or child-rearing roles, nor by age, but is more marked for couples of higher socioeconomic levels and for wives happy with marital life. The frequency of 5+ association is not modified by marital happiness or by wives' working roles, but is more marked for couples of higher socioeconomic levels, for couples with a child at home and for younger women. CONCLUSIONS: This study highlights the contribution of social factors to the association of wives' drinking with their husbands' and suggests that these social factors operate through structuring marital drinking interactions. Further research is needed to clarify the complex social processes that mediate the spousal drinking association.

Adolescent↗
PubMed1992

Does spousal participation in Gamblers Anonymous benefit compulsive gamblers?

Extent of gambling-free periods was compared for 90 compulsive gamblers, 44 with spouses who participated in Gamblers Anonymous and 46 with spouses who did not. Although the results were in the direction of a beneficial effect of spousal participation, the relationship was statistically nonsignificant.

Compulsive Behavior↗
PubMed2004

Economic status in later life among women who raised children outside of marriage.

OBJECTIVE: Many single mothers are likely to face special economic challenges in old age, because they often have limited employment histories and cannot rely on husbands for financial support. This article examines the economic status of these women in later life. METHODS: The analysis uses nationally representative data from the Health and Retirement Study to estimate multivariate models of income, assets, and poverty rates for women aged 65-75 in 1999. RESULT: Controlling for education, current marital status, and race and ethnicity, the models indicate that women who spent > or =10 years raising dependent children outside of marriage are 55% more likely to live in poverty at ages 65-75 than women who were always married when their children were young. DISCUSSION: The financial difficulties confronting single mothers raising children persist into later life. Social Security reforms, especially those that are not tied to the current system of spousal and survivor benefits, could improve retirement security for these vulnerable women, whose numbers will begin to soar when the many women who raised children outside of marriage in the 1970s retire in coming years.

Adolescent↗
PubMed2004

Randomized controlled trial of brief cognitive-behavioural interventions for insomnia in recovering alcoholics.

AIMS: To test the efficacy of a cognitive-behavioural approach to treating disturbed sleep in abstinent alcoholics. DESIGN: Sixty recovering alcoholics with insomnia were assigned randomly to individual therapy, self-help with telephone support or waiting-list control. SETTING: Participants were volunteers recruited from out-patient treatment programs and through the media. MEASUREMENTS: Outcomes were assessed at post-treatment, 3-month and 6-month follow-ups using sleep diaries, the Pittsburgh Sleep Quality Index, wrist actigraphs and time-line follow-back interviews. INTERVENTION: Five sessions of out-patient cognitive-behavioural therapy for insomnia or a self-help manual with five telephone support calls. Treatment duration was 7 weeks. FINDINGS: Treated participants were significantly more improved than control participants on diary measures of sleep quality, sleep efficiency, awakenings and time to fall asleep. No significant differences between the individual therapy and self-help treatment conditions on measures of insomnia severity were evident at post-treatment. Self-reported improvement in sleep was corroborated by clinician and spousal ratings of insomnia severity, but not by actigraph recordings of nocturnal activity. At 3- and 6-month follow-up assessments treatment gains were reasonably maintained in both treatment groups, although individual therapy was associated with a higher rate of clinically significant improvement. At the 6-month follow-up, 60% participants who were regular users of sedative medication at baseline discontinued the use of their medication. Treatment appeared to have little impact in preventing relapses to alcohol. CONCLUSIONS: Recovering alcoholics with insomnia can achieve better sleep by applying cognitive-behavioural strategies.

Adolescent↗
PubMed2003

Effectiveness of communication strategies used by caregivers of persons with Alzheimer's disease during activities of daily living.

Communication difficulties between individuals with Alzheimer's disease (AD) and their caregivers are commonly reported. Caregivers carry the burden of managing breakdowns in communication because people with AD are often unable to modify their communicative behavior. To assist caregivers in this endeavor, clinicians and caregiving professionals have offered a variety of strategies aimed at accommodating the individual's declining abilities. Many of these strategies are intuitively appealing, but they lack empirical support. This study investigated the effectiveness of 10 frequently recommended communication strategies when employed by family caregivers of persons with AD. In particular, we assessed (a) which strategies family caregivers report using and with what degree of success, (b) which of these strategies are used by caregivers in actual interactions with their spouses, and (c) which strategies contribute to improved communication. The study included a self-report questionnaire and wireless audio-recorded interactions between 18 persons with AD and their spousal caregivers during activities of daily living. The findings validate the effectiveness of certain communication strategies (e.g., simple sentences) but not others (e.g., slow speech). The results should be of interest to both family members and professionals who want to enhance communication and the quality of their interactions with persons with Alzheimer's disease.

Activities of Daily Living↗
PubMed1995

Ischemic heart disease and spousal smoking in the National Mortality Followback Survey.

Data on never-smoking decedents from the 1986 National Mortality Followback Survey were used to perform a case-control analysis of ischemic heart disease in relation to spousal cigarette smoking. The case groups consisted of 475 men and 914 women who died from heart disease. Controls consisted of 998 men and 1930 women who died from other causes. In this study there was no association between spousal smoking and ischemic heart disease in either sex (males, odds ratio = 0.97; females, odds ratio = 0.99). The results of this study are in striking disagreement with risk elevations reported in several previous studies of spousal smoking and heart disease.

Adult↗
PubMed1998

Psychosocial changes following retirement.

This study was designed to: (a) identify the perceptions of retirees about changes in their life patterns during retirement; (b) investigate the kinds of adjustment problems occurring in retirement as a basis for developing prevention oriented pre-retirement programs; and (c) identify extant factors which could demonstrate underlying themes relating to retirement adjustment. A 72-item, multiple response questionnaire was used to gather demographic data, information on use of time, pre-retirement planning, health problems, changing life patterns, and adjustment to retirement. It is the latter which is reported in these findings. The population included 1565 retirees from a designated company living in the south-eastern United States of America, with a response of 764 subjects (48.82%). Findings suggest the respondents were generally healthy and well adjusted; however, numerous adjustment problem areas were identified within the six life patterns. Additional factor analysis (principal components) demonstrated four factors of particular importance: satisfaction with retirement, retirement concerns, spousal relationships, and pre-retirement preparation outcomes.

Adaptation, Psychological↗
PubMed2006

The Babel effect: community linguistic diversity and extramarital sex in Uganda.

We examine the association of community linguistic diversity with non-spousal sexual activity in Uganda. We conducted a survey on rates of sexual contact in last 12 months among 1709 respondents age 18-60 living in Uganda in early 2001. Households were selected at random from Demographic and Health Survey (DHS) 2000 household sampling frame listings in 12 districts and 120 clusters. Household listings described the principal language spoken by every household in the cluster. Sexual contact was reported by 26 vs. 13% of unmarried women in multilingual vs. monolingual clusters respectively. Extramarital sexual contact occurred for 29 vs. 16% for married men in multilingual vs. monolingual clusters respectively. These results were robust to multivariate models which included confounders such as urbanity, and cluster distance to market places, cinemas, and transportation. Our results suggest a robust association between residence in a multilinguistic community and higher rates of non-spousal sex.

Adolescent↗
PubMed2005

A statewide case-control study of spousal homicide-suicide in older persons.

OBJECTIVE: Homicide-suicides are rare relative to suicides and homicides, but these lethal events are an emerging public health concern. They have a mortality count similar to meningitis, pulmonary tuberculosis, influenza, and viral hepatitis, and the rate may be increasing in the United States, especially among older persons. The goal of this case-control study was to identify factors that differentiate older married men who commit homicide-suicide from those who commit suicide only. METHODS: A total of 20 spousal homicide-suicides involving persons age 55 years and older were ascertained in Florida between January 1, 1998 and December 31, 1999 from medical examiner records. Two suicide controls were matched to each homicide-suicide perpetrator by age, race, marital status, method of death, and medical examiner district. Perpetrator groups were compared on sociodemographic characteristics, medical variables, and autopsy findings. RESULTS: Homicide-suicide perpetrators displayed significantly more domestic violence or were caregivers for their wives, in contrast to suicide perpetrators, who had health problems and were receiving care from their spouses. Both groups of perpetrators had reported depressed mood, and there were no differences in sociodemographic factors. CONCLUSIONS: Depression plays a significant role in both homicide-suicide and suicide, but the associated factors are different: we see caregiving strain in perpetrators of homicide-suicide, and living with physical health disorders as a care-recipient in men who commit suicide. Marital conflict is a significant factor in some spousal homicide-suicides.

Aged↗
PubMed1996

Voices of impoverished Brazilian women: health implications of roles and resources.

This qualitative study was based on individual interviews with 75 Brazilian women in an impoverished peri-urban squatter community (favela) in southeastern Brazil. The purposes of the study were to describe women's role involvement in domestic and employment contexts; identify stresses and satisfactions of maternal, spousal, and employment roles; and assess personal and environmental role constraints and resources from the perspective of women's health. The analytic approach to the interview data was qualitative content analysis, through which thematic categories of maternal, spousal, and employment role satisfactions and stresses were identified by the researchers. Women's unrelenting work in the face of harsh social and economic environments was a broad theme woven throughout the women's descriptions of their lives. The confluence of role constraints affecting the participants' lives included poverty, marginalization, abuse, and lack of support and recognition by partners and society. In order to overcome great adversity and meet heavy role demands, these women relied on self, faith in God, family, and health resources. Implications for women's health promotion are discussed.

Adult↗
PubMed1995

Publication bias in the environmental tobacco smoke/coronary heart disease epidemiologic literature.

Two approaches are used to assess publication bias in the environmental tobacco smoke/coronary heart disease (ETS/CHD) literature: (1) Statistical tests applied to all sex-specific relative risk (rr) estimates from 14 previously published studies indicate that publication bias is likely. A funnel graph of the studies' log relative risks plotted against their standard errors is asymmetrical, and weighted regression of the studies' log relative risks on their standard errors is significant (P < 0.01). (2) Previously unpublished ETS/CHD relative risks from the American Cancer Society's Cancer Prevention Studies (CPS-I and CPS-II) and the National Mortality Followback Survey (NMFS) do not show an increased CHD risk associated with ETS exposure. CPS-I: men, rr = 0.97 (0.90-1.05); CPS-I: women, rr = 1.03 (0.98-1.08); CPS-II: men, rr = 0.97 (0.87-1.08); CPS-II: women, rr = 1.00, (0.88-1.14); NMFS: men, rr = 0.97 (0.73-1.28); women, rr = 0.99 (0.84-1.16). Comparison of pooled relative risk estimates from 14 previously published studies (rr = 1.29; 1.18-1.41) and unpublished results from three studies (rr = 1.00; 0.97-1.04) also indicates that published data overestimate the association of spousal smoking and CHD (chi 2 = 25.1; P < 0.0001).

Adult↗
PubMed1990

Couples with an elderly parent with Alzheimer's disease: perceptions of familial relationships.

This study examined family relationships in families with and without an elderly parent with Alzheimer's disease. Spouses (29 pairs with an Alzheimer's diseased parent; 29 pairs with a healthy elderly parent) completed questionnaires regarding their perceived relationships with each other, their parent, and one of their own children (aged 8-18). In addition, they completed surveys that inquired about feelings of burden regarding the target parent. Couples perceived a poorer relationship with parents with Alzheimer's disease when contrasted to couples who had a healthy elderly parent. In addition, wives with an Alzheimer's parent also tended to have a more negative relationship with their husbands than wives who had a healthy parent. Perceptions of burden were associated with poorer spousal relationships for wives but not husbands.

Adaptation, Psychological↗
PubMed1997

Marital interactions of male versus female alcoholics.

This study assessed the interactions of 131 alcoholic and nonalcoholic couples as they engaged in discussions of personally relevant problems. For 50 couples, the husband was alcoholic; for 15 couples, the wife was alcoholic; for 16 couples, both spouses were alcoholics; and for 50 couples, neither spouse was alcoholic. Observations were conducted during sessions when alcohol was consumed and in nondrinking sessions. Female alcoholic couples (with nonalcoholic spouses) demonstrated high negativity in the "no-drink" session, which was normalized in the drink session, suggesting an adaptive function to alcohol use. Concordant couples (both members were alcoholic) also demonstrated high negativity in the no-drink session, but exhibited increased negativity in the drink session, suggesting that concordance has a maladaptive impact on marital interaction. All alcoholic groups demonstrated greater negativity and lower positivity and congeniality in their marital interactions compared to nonalcoholic couples. Couples with male alcoholics were the least divergent from normal control couples. Unique female patterns in alcoholism are discussed in terms of adaptive and reinforcing patterns and spousal influences.

Adaptation, Psychological↗