Spousal Dyads Research Articles

Does it Matter Who Delivers Life Reviews? Differences in Spousal and Intergenerational Caregivers

ABSTRACT We developed a depression intervention, Caregiver-Provided Life Review (C-PLR) for care recipients with both dementia and depressive symptoms. We trained family caregivers and caregivers delivered life reviews at home (N = 40 dyads). The purpose of this mixed-methods study was to compare the efficacy of C-PLR quantitatively and examine the outcomes qualitatively among intergenerational (n = 30) and spousal (n = 10) dyads. Intergenerational dyads’ depression and relationship quality significantly improved while spousal dyads’ outcomes were similar but not statistically significant. Qualitative interviews supported gains in both groups. This study demonstrated that C-PLR can be taught to laypersons, however, its effect may differ by the dyad’s relationships. Intergenerational caregivers are more likely to hear new stories and process new memories with their parents while spousal dyads tend to cover previously heard stories, having already shared that information at other points during their relationships. The small number of spousal dyads may explain the lack of significant findings.

Duet playing in dementia care: a new therapeutic music technology

Purpose Supporting the relational worlds of people living with dementia, especially the spousal dyad, is a growing focus in dementia care as is advancing the therapeutic use of music in dementia care. This paper describes a mixed-methods, multi-phase, iterative research study designed to develop the Music Memory Makers (MMM) Duet System, a novel therapeutic music technology, that allows non-musicians to play a personalized repertoire of songs arranged as duets. Methods Following a pilot phase to iteratively assess and refine the MMM Duet System for recreational and therapeutic purposes, multiple sources of data were used to investigate five older spousal dyads’ experiences with the system, two couples living with dementia and three who were not. We assessed perceptions of task difficulty, joint agency, and enjoyment as well as therapeutic benefits associated with enhancing the spousal relationship and sense of couplehood. Results Findings suggest playing meaningful songs together is an enjoyable interactive activity that prompts musical reminiscence, involves joint agency, and supports relationship continuity within a relational, positive approach to dementia care. All couples mastered the task, none evaluated it as “very challenging,” and positive couple interactions were evoked, commonly before and after playing the duets. Conclusions The MMM Duet System is recommended for further research and development as an innovative way to support couples living with dementia with commercial implications, and as a new music technology suitable for use as a research tool.

A post-diagnosis information and support programme for dyads-People living with dementia or mild cognitive impairment and family carers: A feasibility study.

The aim of the study was to establish the feasibility of delivering a structured post-diagnosis information and support program to dyads (persons living with dementia or mild cognitive impairment and family carers) in two primary care settings. A two-phase explanatory mixed-method approach guided by the Bowen Feasibility Framework focused on acceptability, implementation, adaptation, integration and efficacy of a five-part programme. In phase 1, the quantitative impact of the programme on the dyadic programme recipients' self-efficacy, quality of life, dyadic relationship and volume of care was measured. In phase 2, inductive content analysis focused on nurse and dyad participant experiences of the programme. Quantitative and qualitative data were reviewed to conclude each element of feasibility. Four registered nurses working within the participating sites were recruited, trained as programme facilitators and supported to deliver the programme. Eligible dyads attending the respective primary health clinics were invited to participate in the programme and complete surveys at three time points: recruitment, post-programme and 3-month follow-up. Post-programme semi-structured interviews were conducted with dyads and programme facilitators. Twenty-nine dyads completed the program; the majority were spousal dyads. The programme proved acceptable to the dyads with high retention and completion rates. Implementation and integration of the programme into usual practice were attributed to the motivation and capacity of the nurses as programme facilitators. Regarding programme efficacy, most dyads reported they were better prepared for the future and shared the plans they developed during the programme with family members. Implementing a structured information and support programme is feasible, but sustainability requires further adaptation or increased staff resources to maintain programme fidelity. Future research should consider selecting efficacy measures sensitive to the unique needs of people living with dementia and increasing follow-up time to 6 months. This study established the feasibility of registered nurses delivering a post-diagnosis information and support programme for people living with early-stage dementia or mild cognitive impairment and their informal carers in primary care settings. The motivation and capacity of nurses working as programme facilitators ensured the integration of the programme into usual work, but this was not considered sustainable over time. Family carer dyads reported tangible outcomes and gained confidence in sharing their diagnosis with family and friends and asking for assistance. Findings from this study can be used to provide direction for a clinical trial investigating the effectiveness of the structured information and support programme in the primary care setting. The authors have adhered to the EQUATOR STROBE Statement. A public hospital memory clinic and general medical practice participated in project design, study protocol development and supported implementation.

Cognition and Financial Decision-Making in Older Adult Spouses

Introduction: Age-related decline in executive functioning has been found to negatively impact one’s capacity to make prudent financial decisions. The broader literature also speaks to the importance of considering interrelatedness in older spouses’ functioning, as these individuals typically represent one’s longest and closest relationship that involves an extended history of shared experiences. Accordingly, the aim of the present study was to provide the first examination of whether older adults’ financial decision-making capacity is impacted not only by their own but also by their partner’s, level of cognitive functioning. Method: Sixty-three heterosexual spousal dyads comprising older adults aged 60–88 participated. The contribution of executive functioning and perceptions of partner’s cognitive decline on financial decision-making behavior and financial competency was assessed through two actor-partner interdependence models. Results: As predicted, for both genders, one’s own executive functioning was predictive of one’s own financial decision-making capacity. However, of particular interest was the finding that for females (but not males) perceiving greater cognitive decline in their spouse predicted their own (greater) financial competency. Conclusion: Examining whether partner interdependence extends to the realm of financial decision-making is not only a theoretically but also practically important question. These data provide initial insights that such a relationship does exist and highlight further important avenues for future research.

Is it Better to Intermarry? Immigration Background of Married Couples and Suicide Risk Among Native-Born and Migrant Persons in Sweden

Marriage is protective against suicide across most populations, including for persons of different ethnicities and immigrant backgrounds. However, the well-being benefits of marriage are contingent upon marital characteristics—such as conflict and quality—that may vary across spousal dyads with different immigration backgrounds. Leveraging Swedish register data, we compare suicide mortality among married persons on the basis of their and their spouse’s immigration backgrounds. We find that relative to those in a native Swede-Swede union, Swedish men married to female immigrants and immigrant women married to native men are at higher risk of death by suicide, while immigrants of both genders who are married to someone from their birth country have a lower risk of suicide mortality. The findings support hypotheses about the strains that may be encountered by those who intermarry, as well as the potential selection of individuals into inter- and intra-ethnic marriages.

Using the Actor-Partner Interdependence Model to explore the psychological impact of COVID-19 on anxiety in dyads of patients with cancer and caregivers.

Delineating the compound psychological effect of the pandemic on cancer care, and the interdependency across cancer patient-caregiver dyads have yet to be explored. This study examines the levels of psychological impact of COVID-19 on patient-caregiver dyads anxiety, and the interdependent associations between their COVID-19 and cancer concerns, and risk perceptions. There were 352 patients and caregivers (patient-caregiver dyads, N = 176) included in this study (43.2% spousal dyads). Generalized Anxiety Disorder-7 and questionnaires regarding risk perception, perceived confidence in healthcare system, COVID-19, and cancer-related concerns were administered. Actor-Partner Interdependence Model (APIM) analyses were used to determine the interdependent effects. Indirect effects were tested using mediation pathway analyses. Patients reported significantly higher levels of risk perceptions and anxiety than their caregivers (p < 0.01). Anxiety rates (GAD-7 ≥ 10) were also significantly higher (26.7% vs 18.2%, p < 0.01). Dyads' anxiety, "general COVID-19 concerns," "cancer-related concerns," and risk perceptions were correlated (ps < 0.01). APIM showed only actor effects of general COVID-19 concerns, cancer-related COVID-19 concerns, and risk perceptions on anxiety (βs = 0.19-0.53, ps < 0.01). No partner effects were observed. Similar results were found in the composite APIM. Indirect effects of the patient/caregiver's variables on their partner's anxiety were observed in the mediation analyses. Concerns about COVID-19 and cancer care could be indirectly associated in patient-caregiver dyads and need to be proactively addressed. As pandemic evolves into endemicity, engagement with patients and caregivers should strive to be sensitive to their differential needs and messages should be tailored to the informational needs of each.

RACIAL AND ETHNIC DIFFERENCES IN HEALTH OF SPOUSES OF COGNITIVELY IMPAIRED OLDER ADULTS

Abstract Introduction A large body of research in the U.S. shows that non-Hispanic black (black) and Hispanic older adults have higher rates of cognitive impairment and dementia compared to Whites. Little research has examined how cognitive life courses differentially affect spouses of cognitively impaired older adults. Objectives This paper will describe the different life courses of spouses of cognitively impaired older adults by race and ethnicity in the U.S. Methods Using data from the 2010 Health and Retirement Survey, we examine differences in the health of spousal dyads where one partner becomes cognitively impaired over follow up, by 2016. Spousal dyads are limited to Hispanic (n=464 dyads), i black (n=345 dyads), or white (n=2,409 dyads) couples who were both cognitively normal at baseline and had cognition information at follow up. Results Hispanic and Black dyads were more likely to have at least one partner become cognitively impaired over the follow up period despite being younger than White dyads. A total of 23% of Hispanic dyads, 26% of Black dyads and 16% of White dyads were N/CI at follow up. Despite fewer chronic conditions at baseline, a higher proportion of Hispanic dyads with no chronic conditions had at least one member become cognitively impaired (20%) compared to Whites (6.28%). Conclusion Our results show that health of couples changes differently by race and ethnicity. A higher proportion of Hispanic and Black dyads have partners with cognitive impairment and the cognitive impairment happens earlier in life.

THE MORE THINGS CHANGE, THE MORE THEY STAY THE SAME: CHANGE AND CONTINUITY IN ENDURING SOCIAL TIES

Abstract Enduring social ties with family and friends hold important implications for health and well-being across adulthood. Social relationships are simultaneously sources of support and strain, and both positive and negative aspects of relationships change daily and over time. This symposium explores continuity and change in relationship strains (i.e., conflicts, support needs) experienced in the context of enduring social relationships, particularly in response to anticipated and emerging needs for support in later life. First, Meinertz, Gilligan, and Suitor use qualitative data from spousal dyads to compare mothers’ and fathers’ explanations of which adult child they prefer as their future caregiver. Next, using longitudinal data across two waves, Bui, Kim, and Fingerman investigate how different types of past support exchanges between parents and adult children are associated with older parents’ care receipt and expectations. Third, Koumoutzis, Cichy, and Kinney explore the association between change in parental disability and adult children’s intergenerational ambivalence (i.e., both positive and negative sentiments), including the extent to which adult children’s stress and reward appraisals mediate the link between parental disability and ambivalence. Kyungmin and colleagues explore how older adults (age 62-76) felt burden in their relationship with their very old parents (age 81-101) and what factors are associated with feelings of burden across two cultural contexts, the U.S. and Korea. Lastly, using ecological momentary assessment, Birditt and colleagues examine longitudinal trajectories of negative ties (i.e., irritating, demanding) and the links between daily positive and negative social interactions and emotional well-being.

THE ROLE OF GENDER IN FATHERS' AND MOTHERS' PREFERENCES FOR FUTURE ADULT CHILDREN CAREGIVERS

Abstract Previous caregiving research has focused on a single care recipient; however, no research has explored the potential simultaneous care needs of fathers and mothers in the same family. Drawing from gender role theory, we use qualitative data from 76 spousal dyads from the Within-Family Differences Study to compare fathers’ and mothers’ explanations of which adult child they prefer as their future caregiver. In 72% of families, fathers and mothers did not share the same care preferences suggesting that care preferences are dispersed among multiple adult children within the same family. In families in which fathers and mothers shared care preferences, 75% chose the same daughter. Additional findings showed that fathers’ explanations for a preferred caregiver aligned with mothers’ explanations; however, differences were identified based on children’s gender. These findings shed light on the similarities and differences in parental care preferences and underscore the influence of gender in family care networks.

Retention of Participant and Study Partner Dyads in Alzheimer’s Disease Clinical Trials

AbstractBackgroundStudy retention is crucial to clinical trial success. Greater than expected dropout rates can lead to reduced power and biased results. Alzheimer’s disease (AD) trial success depends not only on participants but also on their study partners. We investigated whether study partner type was associated with the risk of dropout in large Phase 3 registration trials.MethodWe used data from two trials of bapineuzumab for patients with mild‐to‐moderate AD. Data were provided by the sponsor of the trials, Janssen Research &amp; Development, LLC for use in these analyses. The co‐primary endpoints were the change from baseline to week 78 in the Disability Assessment for Dementia (DAD) and the 11‐item AD Assessment Scale (ADAS Cog‐11). We defined completers as participants with baseline and week 78 scores on ADAS Cog‐11 or DAD. Participants were excluded from our analyses if they did not declare a study partner type in the Resource Utilization in Dementia‐Lite (RUD‐Lite) or if they were missing ADAS Cog‐11 and DAD at baseline. Time‐to‐dropout was defined as the time from study enrollment to the time of the last visit during which ADAS Cog‐11 or DAD were conducted.ResultData were available for 1,234 participants in the non‐carrier study and 1,221 participants in the carrier study. Table 1 presents baseline characteristics for participants included in our analysis (n = 1,229 non‐carriers and n = 1,097 carriers). In both trials, we observed a higher proportion of participants enrolled with a spouse (non‐carriers: 817, 66.3%; carriers: 837, 76.3%). Approximately 75% of spousal dyads completed the non‐carrier trial, while 60% of adult‐child dyads and 54% of dyads with other study partners completed the trial. Differences in the proportion of completers were lower in the carrier study, with approximately 75%, 73%, and 70% of completers among spousal, adult child, and “other” dyads. The same trend for time‐to‐dropout can be seen in Figure 1.ConclusionWe found that a higher proportion of spousal dyads completed the trials compared to other dyad types. Understanding the factors driving these associations may help understand reasons for dropout and could lead to the development of retention strategies.

Advance Planning for Technology Use in Dementia Care: Development, Design, and Feasibility of a Novel Self-administered Decision-Making Tool.

BackgroundMonitoring technologies are used to collect a range of information, such as one’s location out of the home or movement within the home, and transmit that information to caregivers to support aging in place. Their surveilling nature, however, poses ethical dilemmas and can be experienced as intrusive to people living with Alzheimer disease (AD) and AD-related dementias. These challenges are compounded when older adults are not engaged in decision-making about how they are monitored. Dissemination of these technologies is outpacing our understanding of how to communicate their functions, risks, and benefits to families and older adults. To date, there are no tools to help families understand the functions of monitoring technologies or guide them in balancing their perceived need for ongoing surveillance and the older adult’s dignity and wishes.ObjectiveWe designed, developed, and piloted a communication and education tool in the form of a web application called Let’s Talk Tech to support family decision-making about diverse technologies used in dementia home care. The knowledge base about how to design online interventions for people living with mild dementia is still in development, and dyadic interventions used in dementia care remain rare. We describe the intervention’s motivation and development process, and the feasibility of using this self-administered web application intervention in a pilot sample of people living with mild AD and their family care partners.MethodsWe surveyed 29 mild AD dementia care dyads living together before and after they completed the web application intervention and interviewed each dyad about their experiences with it. We report postintervention measures of feasibility (recruitment, enrollment, and retention) and acceptability (satisfaction, quality, and usability). Descriptive statistics were calculated for survey items, and thematic analysis was used with interview transcripts to illuminate participants’ experiences and recommendations to improve the intervention.ResultsThe study enrolled 33 people living with AD and their care partners, and 29 (88%) dyads completed the study (all but one were spousal dyads). Participants were asked to complete 4 technology modules, and all completed them. The majority of participants rated the tool as having the right length (>90%), having the right amount of information (>84%), being very clearly worded (>74%), and presenting information in a balanced way (>90%). Most felt the tool was easy to use and helpful, and would likely recommend it to others.ConclusionsThis study demonstrated that our intervention to educate and facilitate conversation and documentation of preferences is preliminarily feasible and acceptable to mild AD care dyads. Effectively involving older adults in these decisions and informing care partners of their preferences could enable families to avoid conflicts or risks associated with uninformed or disempowered use and to personalize use so both members of the dyad can experience benefits.

Psychobiological Evaluation of Day Clinic Treatment for People Living With Dementia - Feasibility and Pilot Analyses.

BackgroundHospitalization is often stressful and burdensome for people living with dementia (PwD) and their informal caregivers (ICs). Day clinic treatment may provide a suitable alternative, but is often precluded by a diagnosis of dementia. Furthermore, it is often caregiver-based ratings that measure treatment success as the validity of self-reports in PwD is critically discussed. We therefore set out to examine the feasibility of psychobiological stress measures in PwD and ICs and to evaluate treatment trajectories considering both the day clinic context and the daily life of the dyads.MethodA total of 40 dyads of PwD (mean age: 78.15 ± 6.80) and their ICs (mean age: 63.85 ± 13.09) completed paper-and-pencil questionnaires (covering stress, depressive symptoms, and caregiver burden among others) in addition to the measurement of hair cortisol concentrations (HCC) at admission, discharge, and follow-up 6 months after day clinic treatment. As part of an ambulatory assessment, for 2 days at the beginning and 2 days at the end of the day clinic treatment, PwD and ICs collected six saliva samples per day for the analysis of salivary cortisol (sCort) and alpha-amylase (sAA).ResultsPaper-and-pencil questionnaires and HCC assessments were more feasible than the ambulatory assessment. We found discrepancies between subjective and physiological markers of stress in PwD. Whereas HCC decreased over time, self-reported stress increased. Child–parent dyads reported decreases in neuropsychiatric symptoms, associated burden, and self-reported stress from admission to follow-up. In daily life, both PwD and ICs showed characteristic diurnal profiles of sAA and sCort, however, we found no differences in summary indicators of salivary stress markers over time.DiscussionThe psychobiological evaluation was feasible and added informative value, underlining the potential of physiological stress markers to complement self-reports on stress in PwD and to objectively evaluate treatment trajectories. In this sample, HCC was more feasible and acceptable as biological marker of stress compared to saliva samples. Concerning treatment trajectories, differential effects on the dyads were found, with child–parent dyads benefiting more from day clinic treatment compared to spousal dyads.

Dyadic effects on depressive symptoms of spouse caregivers and their care recipients: evidence from China

Objectives The likelihood of providing care to a spouse in middle and older ages has increased as life expectancy increases, but knowledge about how the caregiver and care recipient influence each other’s mental health is limited. This study examined whether a partner’s physical, cognitive, and mental health in a spousal caregiving dyad are associated with the other partner’s depressive symptoms in China and whether the dyadic effects vary by gender. Methods This study used data from Wave 3 (2015) and Wave 4 (2018) follow-up surveys of the China Health and Retirement Longitudinal Study (CHARLS). The analytic sample featured 1,245 dyads of care recipients aged 45 or older and their spouse caregivers. The Actor-Partner Interdependence Model was used to test the dyadic effects among all couples in the analytic sample, couples with wife caregivers and couples with husband caregivers, respectively. Results We found that caregiver’s depressive symptoms at Wave 3 were significantly associated with care recipient’s depressive symptoms at Wave 4 in the full sample. Regardless of caregiver or care recipient roles, wives’ mental health was impacted by their husbands’ depressive symptoms, but not vice versa. Wife recipient’s cognitive impairment was associated with husband caregiver’s lower depressive symptoms. Conclusion This study sheds light on the mental health of couples in the context of caregiving in China. The findings indicate that interventions to support couples in a caregiving dyad need to consider the influence they have on each other, and the gender and health conditions of each in the dyad.

Dyadic Relationships Between Self-Rated Health and Cognition Among Older Adults and Their Spousal Caregivers

This study examines spouses who are in a caregiving situation to discern how they influence each other’s health. Previous studies reported health concordance and cross-domain effects among caregiver and care-recipient dyads. However, it is less understood of the health dyadic relationships among spouses who are in a caregiving situation. No studies have specifically looked into the relationship between self-rated health (SRH) and cognitive functioning among spousal caregiving dyads over time. In this study we analyzed the longitudinal reciprocal relationships between SRH and cognitive functioning measured by the Telephone Interview for Cognitive Status among older adults and their spousal caregivers, and whether the relationship differed by whether husband or wife was the caregiver. Longitudinal data from the Health and Retirement Study (2010-2016) on 540 dyads were pooled and analyzed using structural equation modeling under an actor-partner interdependence model. Results revealed cognitive concordance among older spouses in which caregivers’ cognition is associated with care-recipients’ cognition subsequently (β=0.05, p<.05). SRH concordance was not significant. Cross-domain results showed only one significant direction, that is, care-recipients’ cognition in the subsequent time was significantly correlated with caregivers’ SRH, regardless of whether husband (β=0.09, p<.05) or wife (β=0.08, p<.05) was the caregiver. Our study found that married couples in a spousal caregiving situation displayed cognitive but not overall health concordance, and cross-domain effects of caregiver’s SRH on spousal care recipient’s cognition subsequently. The reciprocal associations suggest that addressing and improving either partner’s physical health and cognition may benefit both dyad members.

The Other Caregivers: Informal Non-Spousal Male Caregivers for Persons With Dementia

Informal caregivers for persons with Alzheimer's disease and related dementias (ADRD) have become an integral part of the long-term health care system. They are relied on to provided day-to-day care that is challenging, complex, and often spans several years. Most of the research on informal caregivers for persons with ADRD have focused on spousal caregiving, mother-daughter dyads, and daughters. There is sparse literature on informal non-spousal male caregivers for persons with ADRD. The objective of this research was to obtain an understanding of the experiences of informal non-spousal male caregivers for persons with ADRD. This descriptive qualitative pilot study consisted of in-depth one-on-one interviews with three informal non-spousal male caregivers for persons with ADRD. Four themes emerged through data analysis: 1) the male perspective and experience of caregiving, 2) relationship dynamics, 3) caregiving challenges, and 4) finding meaning within caregiving. Conclusion: Similar to other caregivers, informal non-spousal male caregivers assisted with transportation, managing medical appointments, as well as bathing and personal care. Differences with other caregivers, specifically female caregivers, emerged in terms of descriptions of traditional versus non-traditional gender roles. The implications of this study are that public policies, support services and medical professionals need to understand and be able to address the different experiences and needs of informal non-spousal male caregivers.

Patterns Among Same-Sex Spousal Couples: Diverse Sociocultural Representation in Alzheimer’s Research

Emerging evidence shows that understanding characteristic patterns between study partners (SP) and subjects can inform initiatives to diversify representation of sociocultural groups in ADRD research. This study examined same-sex spousal dyads with the goal of identifying bellwethers of opportunities to build diversity in ADRD research. Descriptive analysis of The Aging, Demographics and Memory Study (ADAMS), which enrolled a subset of subjects from the Health and Retirement Study and a SP for each subject. Eight same-sex spousal couples were among 718 SP-subject dyads (1.1%). Gay men were 3 times as likely to be spousal SPs (n=6) than lesbians (n=2), even though women far outnumber men overall. Patterns in caregiving and other characteristics also differed. Same-sex couples are underrepresented in ADRD research. Patterns among those enrolled suggest masculine and feminine norms may drive research engagement. This is discussed in the context of increasing sociocultural diversity in ADRD research across key social groups.

Predictors of Sleep Among Spousal Care Dyads Living With Chronic Conditions

Systematic screening improves delirium detection among hospitalized older adults. This poster describes the development and pilot testing of an iOS-based app that incorporates the Ultra-Brief Confusion Assessment Method (UB-CAM), a two-step, delirium detection protocol that combines the UB-2 (2-item screener) and 3D-CAM. Previous work tested a RedCAP-based UB-CAM app in 527 patients with 399 physicians, nurses, and certified nursing assistants (CNAs) showing it can be successfully completed by all three disciplines in 97% of eligible patients in 80 seconds on average with over 85% accuracy relative to a gold standard. To improve accessibility to the clinical setting, our research team now collaborated with a computer scientist to develop and refine an iOS-based UB-CAM app for the iPhone and iPad through iterative “laboratory” testing. The app was piloted by non-clinician, research testers in hospitalized older adults (age x̄ =83, SD= 8.0) with dementia (Clinical Dementia Rating Scale x̄ =1.1, SD= .30); 64% were assessed to be delirium positive. The app demonstrated preliminary efficiency (90 seconds on average), high acceptability (100% satisfaction of users), and reliability (100% inter-rater). This project underscores the need for close collaboration between researchers, clinicians, and computer scientists with iterative testing of bedside-facing apps prior to testing with patients. Next steps include testing effectiveness in a pragmatic trial with clinician users (physicians, nurses, CNAs), integrating the UB-CAM app into the routine hospital care of all older patients. Having rapid, accurate bedside delirium detection has the potential to transform care.

Predictors of Sleep Among Spousal Care Dyads Living With Chronic Conditions

Sleep health relates closely to physical health and well-being among older adults with chronic health conditions. However, little is known about the dyadic sleep patterns of these individuals and their spousal caregivers. Secondary analyses of the 2015 National Health and Aging Trends Study and National Study of Caregiving (N= 62 care dyads, mean age 78.59 years for care recipients and 75.77 years for caregivers) were completed to examine the sleep patterns, and related factors, of spousal dyads at both the individual and dyadic levels. Sleep measures included frequency in trouble falling back asleep and insomnia symptoms. Predictors included demographics, depressive symptoms, and positive affect for dyads and contextual factors such as dementia caregiving, care burden and support, neighborhood cohesion, and relationship quality. Multilevel dyadic and actor-partner interdependence models were used to complete analyses. Though intraclass correlation was poor (dementia care dyads ICC=0.123, non-dementia care dyads ICC=0.043), persons with dementia/spousal caregiver dyads (n=102) had more similar sleep and insomnia patterns than dyads with other chronic conditions. Poor sleep among dyads was correlated with higher care burden (β = -0.31, p <.0001), however, better relationship quality marginally enhanced the association (β = -0.23, p = .08). Individual depressive symptoms negatively affected dyadic sleep patterns. However, positive affect only had an actor effect and was related to better individual sleep. Other contextual factors did not affect sleep patterns. These findings suggest the importance of both caregiver and care recipient characteristics on sleep at dyadic levels, particularly those with dementia.

Work–family enrichment: an integrative review

PurposeThe purpose of this study is to provide an integrative review of work–family enrichment literature.Design/methodology/approachThe study is based upon 206 peer-reviewed papers derived from systematic search in the Scopus database. The review ascertains its relevance by analyzing the publication trends, research designs, data analysis techniques, sample characteristics, measures and findings of selected articles.FindingsThe study notes a rising trend of publication activity in the Asian region on this topic. Empirical research using regression is the most popular research design in this field. Most of the research studies have targeted samples based on family type and/or gender. The majority of the studies include directionality to measure work–family enrichment. Notably, work-related antecedents and consequences have received the most attention from the research community. Crossover models have concentrated on spousal dyad samples.Originality/valueAs per the authors' knowledge, the study is a primary attempt to integrate the extant literature on this subject. Additionally, the study presents the gender role ideology as a potential moderator and provides future research directions along with managerial implications.

Older Spousal Dyads and the Experience of Recovery in the Year After Traumatic Brain Injury.

BACKGROUND: Significant others of older persons with traumatic brain injury (TBI) may be more likely to face increased caregiving responsibilities, leading to increased relationship challenges. Relatively little is known about this cohort. The study aimed to describe the impact of experiencing a mild/moderate TBI on the older adult as well as the significant other in the year post injury. DESIGN AND METHODS: This is a multiple-case study using data from a larger parent study. Qualitative content analysis of interviews conducted at 1, 3, 6, and 12 months post injury with 3 dyads was performed (24 interviews) and included cross-case and cross-time comparisons. RESULTS: Dyads that included persons 65 years and older with a mild-moderate TBI and their significant others were enrolled (N = 3/6 individuals). The identified themes were struggling to accept limitations and acceptance, gratitude, fear and concern, frustration/anger/guilt/resentment, broader social support, emotional coping, and the presence or absence of broader social support. CONCLUSIONS: Feelings of hope, gratitude, and acceptance serve as vital ways for couples to continue toward a path of recovery and healing. Lack of social support was a stressor, creating a barrier to recovery. Significant others tended to focus on others versus self-care needs. Nurses should integrate social support and self-care into the assessment of the spousal dyad after TBI. These findings can also inform the development of support groups and case management models for both patients after TBI and their significant others.