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PubMed1990

Predictors of institutionalization among Alzheimer disease victims with caregiving spouses.

A theoretical model predicting "desire to institutionalize" and actual institutionalization was developed and tested on a sample of 220 persons caring for a demented spouse. Significant predictors of "desire to institutionalize" include age and education of caregiver, spouse's forgetful behaviors, ADL tasks done by the caregiver, medications taken by the caregiver, services used, and quality of relationship with spouse. Predictors of actual institutionalization are desire to institutionalize, length of time spent as a caregiver, religion, uplifts, and forgetful behaviors of the impaired spouse.

Aged↗
PubMed1993

Dementia and cancer: a comparison of spouse caregivers.

Can prominent themes that have emerged in dementia caregiving research be extrapolated to caregivers of persons with other chronic illnesses such as cancer? To answer this question, the present study compared 272 spouse caregivers of dementia sufferers with 30 spouse caregivers of cancer victims on multiple indicators of well-being. Group contrasts using MANOVA revealed that dementia caregivers were more adversely affected by their role than cancer caregivers. Illness duration and caregivers' employment status did not help to explain this difference, yet caregiver age was a robust covariate. Specifically, younger spouse caregivers were significantly more compromised than older spouse providers.

Age Factors↗
PubMed1980

Spouse-subject interviews and the reliability of diet studies.

Recently published data suggest relationships between ingestion of a number of food items and risk of cancer of the stomach, bowel and mouth. This engenders concern over the accuracy of such data. To study this, dietary interviews of 158 males in the Western New York Study of Cancer Epidemiology are compared to their spouses' estimates of the husband's dietary histories as taken in separate interviews. Respondents were asked to estimate the frequency with which the males consumed each of several foods. For analysis, the frequency estimates were assembled into categories similar to those used in recent epidemiologic analysis: 5-7 times per week, 1-4 times per week, 1-3 times per month and less than once per month. Generally, 60-80% of respondents pairs agree exactly on the frequency of consumption for individual food items. Over 90% of spouse and respondent food frequency estimates are within one frequency category of each other. Radical disagreements between spouses are rare; generally, in less than 2% of spouse pairs does one member estimate the maximum frequency category, and the other minimum frequency category. The authors suggest therefore that, although diet histories are not precisely replicable, they must be adequate to reveal gross differences between cases and controls.

Adult↗
PubMed1983

Spouse behavior and coronary heart disease in men: prospective results from the Framingham heart study. II. Modification of risk in type A husbands according to the social and psychological status of their wives.

Analyses of spouse data from the Framingham Heart Study indicated that the risk of developing coronary heart disease among Type A men, compared with Type B men, was modified by the behavior or social status of their wives. Between 1965 and 1967, 269 spouse pairs, in which the husbands were 45-64 years of age, were administered an extensive psychosocial questionnaire. These pairs were followed over a 10-year period for the development of heart disease. When Type A and Type B men were stratified by the social and personality characteristics of their wives, it was found that the differential rate of heart disease between Type A and Type B men was present only in situations where the wives' characteristics might be deemed stressful. Type A husbands were 2.5 times as likely to develop coronary heart disease as Type B husbands if married to women with 13 or more years of education, and had 3.5 times the coronary risk of Type B husbands if married to a woman employed outside the home. When spouses were stratified by behavior type, employed outside the home. When spouses were stratified by behavior type, the highest rates of coronary heart disease were among Type A men married to Type B wives (25%). This rate was over three times the rate among Type B men married to Type B wives (7.8%). When tests for interaction between the behavior type of husbands and characteristics of wives were calculated, significant effects were found among blue-collar men on all variables except wives' educational level. This indicates that Type A men in white-collar occupations are at higher risk of heart disease regardless of wives' characteristics; whereas, the effect of behavior type among men in blue-collar occupations was interrelated with and modified by wives' characteristics. These results were apparent regardless of the husbands' standard coronary risk factors.

Behavior↗
PubMed1994

Domestic workers in Colombia as spouses: security and servitude.

The article presents the qualitative findings about the spousal role of women who are in per diem domestic work in Colombia. Sixty participants obtained through a random sample of employer homes were interviewed about the nature and the quality of their roles. The results provided are based on the participants' descriptions of their subjective experiences as spouses within the larger context of women's roles and daily life experiences. The results suggest that the women find many aspects of their spousal roles satisfying. On top of these experiences are their feelings that the spouses' role provides them with cariño (being loved and cared for). Additionally, sharing parenting was an important aspect of the satisfaction in the relationship. On the other hand, the women identified many stresses including a constant sense of demoralization and being fearful of abandonment. Being, or fearing, the other women and living with their spouse's aggressions were also described as stressful aspects of their role. Strategies to cope with the stress included taking time out alone, having emotional reactions, blaming the spouse for the stress, and talking with others. The meaning of the need for security and the price of servitude are discussed.

Adult↗
PubMed1992

Support from spouse as mediator and moderator of the disruptive influence of economic strain on parenting.

A model is presented regarding associations between economic strain, support from spouse, and quality of parenting. The model was tested using a sample of 451 2-parent families, each of which included a seventh grader (age 12-13). Parent and adolescent reports, as well as observational ratings, were used as indicators of constructs. Analysis using structural equation modeling procedures indicated that level of spouse support was positively related to supportive parenting, whereas economic strain operated to undermine parental involvement. As posited, economic strain produced its effect through a direct relation with parenting and indirectly through its association with spouse support. These findings held for mothers and fathers, regardless of the gender of the child. Spouse support moderated the impact of economic strain on supportive parenting for mothers but not fathers. Possible explanations for this gender difference are presented.

Adult↗
PubMed1984

The significant of an ill spouse for assessing health differences in an elderly population.

In a survey of 678 elderly residents of Alameda County, California, it was found that respondents who reported their spouses as being ill in the last six months were more likely to report their own health as poor than those respondents whose spouses were not previously ill. The spouse's health was found to be the best predictor of the respondent's health. Research in this area may lead to a better understanding of the elderly spouse as a source of social support and may provide geriatricians with new insights into the health risks facing the married elderly.

Aged↗
PubMed1989

The effectiveness of diabetes education programs for older patients and their spouses.

Improvements in diabetes knowledge, psychosocial functioning, and metabolic control were assessed following a six-week diabetes education program for older male patients (aged 65 to 82 years) and their spouses. Before and after the program, scored questionnaires were administered to patients and their wives regarding knowledge, quality of life, stress, family involvement in diabetes care, and patient involvement in social activities. The patients were again assessed six months later. Results were compared to those of younger adult male patients (aged 28 to 64 years). The older patients significantly increased their knowledge of diabetes (P less than .05), and to an extent equal to that of younger individuals. Reduction in stress correlated with their increase in knowledge (r = 0.9; P less than .05) and their improved diet-related quality of life (r = 0.7; P less than .02). A decrease in stress was still evident six months after the program P less than .01). Perceived quality of life for areas requiring greater life-style modification (diet and exercise) increased (P less than .01), and was maintained at six months. In contrast, younger patients reported decreases in perceived quality of life (P less than .05). Older patients with participating spouses, compared to those without, showed greater improvement in knowledge (P less than .02), increase in family involvement (P less than .05), less stress (P less than .02), and improvement in metabolic control of diabetes (P less than .001). The program increased spouses' knowledge and perceived involvement in the care of their diabetic partners (P less than .01). This study suggests that diabetes education is an effective intervention for elderly patients and their spouses.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

Spouse caregivers' attitudes toward obtaining a diagnosis of a dementing illness.

OBJECTIVES: To examine attitudes of spouse caregivers about the process of obtaining a diagnosis of a dementing illness, including perceived benefits and obstacles to obtaining a diagnosis and suggestions for improving the process. DESIGN: A mail survey of spouse caregivers of dementia patients followed by the Michigan Alzheimer's Disease Research Center. PARTICIPANTS: The 233 spouse caregivers of dementia patients who returned a completed questionnaire. RESULTS: More than three-fourths of the sample rated the following benefits of obtaining a diagnosis as very or extremely important: ruling out other causes of memory or behavior problems, allowing family members to get information about dementia, may qualify my spouse for drug treatment, and will allow me to plan for the future. Primary obstacles included the time required to obtain a diagnosis, the cost of procedures, lack of access to physicians trained to diagnose dementing illnesses, and not receiving a referral from a primary care physician (41.6%, 41.0%, 40.8%, and 24.1% of the sample, respectively, agreed or strongly agreed that the factor posed a barrier to obtaining a diagnosis). Content analysis of responses to two open-ended questions identified problematic or stressful aspects of obtaining a diagnosis and suggestions for making the process easier for the patient and family. CONCLUSION: Results suggest the need to provide an orientation to the diagnosis and assessment process for patients and family members, develop a training session for physicians to better prepare them to address the emotional needs of patients and families and to disclose the diagnosis in an informative and compassionate manner, and provide outreach education to primary care physicians to increase knowledge and awareness of dementing illnesses and to increase referrals to community-based services and health professionals able to address the concerns of family members.

Adult↗
PubMed1994

Alzheimer's disease: the impact of the family on spouses, offspring, and inlaws.

This article reports the findings from a study designed to identify qualities of the multigeneration family system that affected the relationship between the demands of Alzheimer's disease on the family and the health and well-being of (a) spouses, (b) offspring, and (c) offspring's spouses or "inlaws." Members of 97 families of patients with Alzheimer's disease, recruited from four University-affiliated Alzheimer's Centers, completed detailed questionnaires and participated in a 45-minute telephone interview to assess care-strain, personal stress, appraisals of three major domains of family life (World View, Structure/Organization, and Emotion Management), and three health and well-being indices (Anxiety/Depression, Somatic Symptoms, and Well-Being). Multivariate multiple regression equations, run separately for each of the three groups of family respondents and each of the three family domains, indicated: (1) no significant associations between the severity of the elder's disease and family member health and well-being; (2) female family members reported poorer health and well-being than male family members; and (3) caregiver strain was negatively associated with family member health and well-being. Further, appraised family qualities were associated with the health and well-being of the three groups of respondents differently: directly for offspring, interactively with severity of patient disorder for inlaws, and not at all for spouses. The data suggested that some family qualities served a protective function, whereas others exacerbated the negative effects of caregiving by affecting personal health and well-being. The findings are interpreted in terms of the different roles and expectations for care-giving placed on spouses, offspring, and inlaws. It is suggested that programs of intervention for patients with Alzheimer's and other chronic diseases should focus on the multigeneration family as the context for care, rather than only on the primary caregiver.

Activities of Daily Living↗
PubMed1996

Mortality after death of spouse in relation to duration of bereavement in Finland.

STUDY OBJECTIVES: (1) To assess the extent to which death of a spouse causes excess mortality by controlling for the effects of confounding and other sources of bias. Three possible sources of bias are considered: accidents common to spouses, common socioeconomic environment, and common lifestyles. (2) To assess the duration specific effects of death of a spouse on mortality. DESIGN AND SETTING: Prospective study of mortality in Finland among all 35-84 year old married Finnish men and women (1,580,000 people). Baseline sociodemographic measurement from the 1985 census records. Follow up by computerised record linkage to death certificate registers for the period 1986-91 (about 116,000 deaths, of which almost 10,000 among the bereaved) using personal identification codes. RESULTS: (1) After controlling for confounding effects, excess mortality was 17% in men and 6% in women. (2) Excess mortality was higher for short durations than long durations of bereavement. (3) Excess mortality after bereavement was higher in men than women. CONCLUSIONS: Controlling for confounding does not seem to have a crucial modifying effect on the relationship between spousal bereavement and mortality. It seems that death of a spouse has a causal effect on mortality. However, although spousal bereavement is a major stressful life event, this causal effect seems to be relatively small and short lived.

Accidents↗
PubMed1984

'Hospice' versus 'hospital' care--re-evaluation after 10 years as seen by surviving spouses.

This study compares terminal cancer care in 1967-69 with care in 1977-79 as evaluated by surviving spouses of patients who died in St Christopher's Hospice and other local hospitals. Patients and their surviving spouses reported less personal distress in both settings in 1977-79 than in 1967-69 and the patients were also thought to have suffered less pain. These differences were found before, during and, in surviving spouses, after the period of terminal care. They were confirmed in subsamples of 30-34 patients matched for age, sex, socio-economic status and duration of terminal period. Improvements may be attributable to the training in terminal care provided by staff of the Hospice since 1967 and augmented in its Study Centre which was opened in 1973. Although pain and distress in the patient is no longer a major problem in either setting, spouses in 1977-79 remain less anxious at St Christopher's Hospice than at other hospitals; they play a larger part in the care of the patient and are in closer contact with staff before and after bereavement.

Aged↗
PubMed1975

Concordance for coronary risk factors among spouses.

Values for several coronary risk factors, including systolic and diastolic blood pressure, serum cholesterol, triglycerides, blood glucose, uric acid, hemoglobin, weight, vitral capacity and cigarette smoking have been found to be similar among spouses in the Framingham Study. However, longitudinal analyses show that this spouse concordance does not increase over a twelve-year observation period, suggesting that it has arisen through the marriage of similar people rather than through the sharing of a common marital environment. Apparent conflicts between cross-sectional and longitudinal findings have been resolved by showing that spouses who were concordant at the begining of the study are more likely to survive to later exams, while discordant spouse pairs tend to be dissolved through the death of one of their members.

Adult↗
PubMed1991

Depression through the first year after the death of a spouse.

OBJECTIVE: This study assesses the frequency of depressive syndromes during the first 13 months after the death of a spouse. METHOD: Men and women whose spouses had recently died were identified through death certificate records. These subjects completed a multidimensional questionnaire and were interviewed 7-8 weeks (2 months) after the death. Follow-up questionnaires were completed 7 and 13 months after the death. The questionnaires contained specific items corresponding to DSM-III-R criteria for depressive episodes as well as other widely used measures of depressive symptoms such as the Zung Depression Scale and the Hopkins Symptom Checklist. RESULTS: Eighty-four (24%) of 350 widows and widowers met criteria for depressive episodes at 2 months, 72 (23%) of 308 did so at 7 months, and 46 (16%) of 286 did so at 13 months. At each time period, the prevalence was substantially higher than the 4% rate of depressive episodes observed in a comparison group of 126 subjects whose spouses were still living. Widows and widowers most likely to meet criteria for depressive episodes 13 months after the bereavement were younger, had past histories of major depression, were still grieving 2 months after the loss, and met DSM-III-R criteria for depressive episodes 2 and/or 7 months after the death. CONCLUSIONS: Depressive episodes are common after the death of a spouse. Clinicians should maintain a high index of suspicion for the possibility of depression, particularly in young widows and widowers who have a past history of depression or who experience a full depressive syndrome soon after the loss.

Depressive Disorder↗
PubMed1997

Spouse-aided therapy with depressed patients.

Twenty-three non-maritally distressed depressed patients who were married or cohabitating were randomly assigned to either individual behavioral-cognitive therapy or spouse-aided treatment. Both treatment conditions focused on depressed mood, behavioral activity, and dysfunctional cognitions, the difference being that in the spouse-aided treatment the partner was involved in all aspects of treatment, whereas in the individual condition the partner was not involved. MANOVAs revealed that treatment led to statistically significant improvement on depressed mood, behavioral activity, and dysfunctional cognitions. Treatment did not affect relationship variables (marital satisfaction, communication, and expressed emotion) for both spouses. Spouse-aided therapy was as effective as individual cognitive-behavior therapy.

Adolescent↗
PubMed1997

Pain behavior, spouse responsiveness, and marital satisfaction in patients with rheumatoid arthritis.

Although the pain behavior of some diagnostic groups has been shown to be reactive to social influences, the reactivity of pain behavior in a rheumatoid arthritis (RA) population remains an open question. The authors in this article combined laboratory and self-report assessment techniques to examine the extent to which the pain report and behavior of 52 RA patients was susceptible to influence of social factors within the marital unit. The authors' findings suggest that (a) different types of spouse responsiveness (e.g., solicitous, punishing) may be viewed differently by the RA population than more general chronic pain populations; (b) the patient's perception of spouse responsiveness is a significant predictor of the pain behavior, whereas the spouse's perception of these same behaviors is not; and (c) the patient's perception of the spouse's responsive behavior adds significantly to the prediction of pain behavior over a model based on "disease impact" variables alone.

Adult↗
PubMed2003

Caregiver strain in spouses of stroke patients.

OBJECTIVE: To test the ability of a previously generated logistic regression model to predict caregiver strain from carer mood, negative affectivity and perceived patient functional ability. DESIGN: Postal prospective survey. SETTING: Spouses of community-residing patients identified from hospital stroke registers. METHOD: Spouses were assessed at three and six months after stroke. A previously derived equation was used to make predictions at three months of their level of strain at six months, which were compared with observed outcomes. MEASURES: Spouses were asked to complete the Caregiver Strain Index (CSI), the General Health Questionnaire (GHQ-12), the Positive and Negative Affectivity Schedule (PANAS) and to assess patients' independence in activities of daily living on the Extended Activities of Daily Living Scale (EADL). RESULTS: Of 409 stroke patients, 276 had an identifiable co-resident spouse and 116 (42%) completed the measures. At three months after stroke, 39 carers (34%) were under significant strain with 40 (35%) under strain at six months. The predictive model using the GHQ-12, PANAS and EADL at three months was 78% accurate in predicting levels of caregiver strain at six months. CONCLUSION: Carers at risk of later strain could be identified for further follow-up. Services to provide emotional support to carers might be effective in the reduction of carer strain.

Activities of Daily Living↗
PubMed1986

Comparative effectiveness of three types of spouse involvement in outpatient behavioral alcoholism treatment.

Treatment was provided to 53 alcoholics and their spouses in one of three outpatient behavioral treatment conditions: minimal spouse involvement (MSI) (N = 21), alcohol-focused spouse involvement (AFSI) (N = 13) or alcohol-focused spouse involvement plus behavioral marital therapy (ABMT) (N = 19). Subjects were followed for 6 months after treatment. All subjects markedly decreased their drinking and reported increased life satisfaction. ABMT subjects were more compliant than AFSI subjects with conjoint homework assignments, decreased their drinking more quickly during treatment, relapsed more slowly after treatment and maintained marital satisfaction better. ABMT subjects were more likely than MSI subjects to stay in treatment and maintained their marital satisfaction better after treatment. Clinical and theoretical significance of the findings are discussed.

Adaptation, Psychological↗