Spouses Of Adults Research Articles

Shared Risk Factors for Depressive Disorder Among Older Adult Couples in Korea

Although couples may share many risk factors for depressive disorders in their lifetime, whether these factors mediate the shared risk of depressive disorders has rarely been investigated. To identify the shared risk factors for depressive disorder in couples and investigate their mediating roles in the shared risk of depressive disorders among older adult couples. This nationwide, multicenter, community-based cohort study assessed 956 older adults from the Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) and a cohort of their spouses (KLOSCAD-S) between January 1, 2019, to February 28, 2021. Depressive disorders of the KLOSCAD participants. The mediating roles of shared factors in couples on the association between one spouse's depressive disorder and the other's risk of depressive disorders was examined using structural equation modeling. A total of 956 KLOSCAD participants (385 women [40.3%] and 571 men [59.7%]; mean [SD] age, 75.1 [5.0] years) and their spouses (571 women [59.7%] and 385 men [40.3%]; mean [SD] age, 73.9 [6.1] years) were included. The depressive disorders of the KLOSCAD participants were associated with an almost 4-fold higher risk of depressive disorders in their spouses in the KLOSCAD-S cohort (odds ratio, 3.89; 95% CI, 2.06-7.19; P < .001). Social-emotional support mediated the association between depressive disorders in the KLOSCAD participants and their spouses' risk of depressive disorders by itself (β = 0.012; 95% CI, 0.001-0.024; P = .04; mediation proportion [MP] = 6.1%) and through chronic illness burden (β = 0.003; 95% CI, 0.000-0.006; P = .04; MP = 1.5%). Chronic medical illness burden (β = 0.025; 95% CI, 0.001-0.050; P = .04; MP = 12.6%) and presence of a cognitive disorder (β = 0.027; 95% CI, 0.003-0.051; P = .03; MP = 13.6%) mediated the association. The risk factors shared by older adult couples may mediate approximately one-third of the spousal risk of depressive disorders. Identification of and intervention in the shared risk factors of depression among older adult couples may reduce the risk of depressive disorders in the spouses of older adults with depression.

Accompaniment of young adults at the end-of-life: The spouse's lived experience

Studies with the spouses of young adults with cancer at the end-of-life are scarce, and it is little known how they experience care. This study aims to understand the lived experience of the phenomenon of accompaniment for young adults at end-of-life by their spouse. This was a qualitative study, with a hermeneutic-phenomenological design, guided by the conceptual principles of Heidegger and Gadamer. Seven phenomenological interviews were carried out with spouses of young adults, whose narratives were analyzed according to the Gadamerian perspective. The phenomenon of accompaniment unfolded into eight topics: "Accompanying as a human commitment", "Anticipating loss", "Setting limits", "Navigating under the shadow of death through the health services", "Keeping away the shadow of death by infusing life", "Being with", "Initiating the unknown path step by step, seeking to rebuild and co-construct oneself", "The subjectivity and paradoxicality of the lived time". The accompaniment showed to be the most challenging lived experience for these spouses. They were faced with the threat of their partner's untimely death, which determined their expectations from institutions and health professionals. Faced with this threat, they showed to be diligent in the care of their partner, seeking to provide them with more time to live and a meaningful life. This experience was characterized by multiple losses that resulted in suffering, which left marks on the spouses that conditioned the way they saw the present and the future. These results suggest the need for a differentiated intervention to mitigate the suffering of this spouses.

The impact of hypoglycaemia on the quality of life of family members of adults with type 1 or type 2 diabetes: A qualitative systematic review.

To summarize and critically appraise the recent qualitative evidence regarding the impact of hypoglycaemia on the quality of life of family members of adults with type 1 or type 2 diabetes. Four databases were searched systematically (MEDLINE, PsycINFO, CINAHL and Cochrane Library), and results were screened for eligibility. Article quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data were extracted, coded and analysed using thematic analysis. The systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Enhancing transparency in reporting of qualitative research (ENTREQ) guidelines. Eight qualitative studies were included in the final review. The majority of participants were partners or spouses of adults with type 1 diabetes. Thematic synthesis resulted in six analytical themes: 'Hypoglycaemia alters everyday life, reducing freedoms and increasing disruptions', 'Hypoglycaemia has an adverse impact on sleep', 'Hypoglycaemia negatively changes the relationship with the person with diabetes', 'Hypoglycaemia negatively impacts emotional well-being', 'The detection, prevention, and treatment of hypoglycaemia consumes time and energy' and 'Family members have unmet needs for informational and emotional support regarding hypoglycaemia'. Across the six analytical themes, family members described how hypoglycaemia has a severe negative impact on different aspects of their lives, including daily living, personal relationships and emotional well-being. Family members experience the impact of hypoglycaemia as a major recurrent challenge in their lives. The unmet needs of family members need further attention in research and clinical practice.

Incremental Health Care Expenditures of the Spouses of Older Adults With Alzheimer's Diseases and Related Dementias (ADRD)

Previous research has found that having a spouse with Alzheimer's disease and related dementias (ADRD) is associated with higher health care expenditures, however it is unclear if this difference remains after accounting for the demographics and health status of the non-ADRD spouse. This paper aims to estimate the adjusted incremental health care expenditures of having a spouse with ADRD. Cross-sectional study of publicly available survey data (2003-2017 Medical Expenditure Panel Survey). Representative sample of U.S. households. Community-dwelling and married older adults (n = 28,356). Two-part models and recycled prediction techniques to estimate the incremental effects of having a spouse with ADRD on annual health care expenditures, while adjusting for demographics, socioeconomic characteristics, and health conditions. Spouses of older adults with ADRD were older, had worse perceived mental health, and had greater difficulties with activities of daily living, compared to older adults with cognitively normal spouses. Spouses of ADRD patients had significantly higher unadjusted total health care expenditures, however their adjusted incremental expenditure was not significantly greater. After controlling for demographics and health status, ADRD spouses had significantly higher home health care expenditures, but significantly lower outpatient expenditures. Results suggested that the higher health care expenditures in older adults with ADRD spouses can be attributed to the higher rate of comorbidities, rate of functional limitations, and mean age in this group. The increased use of home health and decreased use of outpatient in this population suggests the importance of tailoring preventative health care and social services to meet the needs of this group.

Predictors of Health-related Quality of Life among Spouses of Older Adults with Dementia in the Community-dwelling

Purpose: The purpose of this study was to identify the factors influencing health-related quality of life among spouses of older adults with dementia based on an ecological model. Methods: This study used data from the 2015 Korean Community Health Survey with the subjects of 541 spouses of older adults with dementia. The data were analyzed using descriptive statistics, independent t-test, ANOVA, and hierarchical multiple regression. Results: In this study, 26.5% of quality of life was explained by employment status, physical activity, perception of stress, perception of depressive symptom, self-rated health status, self-rated oral health status, and contact with neighbors. Conclusion: To develop more effective nursing intervention for improvement of quality of life, it needs to consider not only the individual system related factors but also community system related factors including contact with neighbors.

Interpersonal communication and psychological well-being among couples coping with sensory loss: The mediating role of perceived spouse support

Couples who are willing to discuss sensory loss-related issues typically report better well-being, while couples who avoid such discussions tend to report poorer well-being. Inspired by the relationship intimacy model, the present study examined whether the link between couples’ sensory loss-related communication and well-being can be explained by perceived spouse support and whether this mediation mechanism is stable over time. Adults with sensory loss (AWSLs) and their spouses (N ¼ 206 individuals) completed an online survey and were followed up 6 months later. A multi-group actor– partner interdependence mediation model was used to test the mediation mechanism as well as its stability over time. Results showed that the association between couples’ willingness to communicate about the sensory loss and psychological well-being was mediated by perceived spouse support for AWSLs only. Furthermore, this mediation effect remained stable over the 6-month period. These results support prior research that the manner in which couples communicate about the sensory loss is important for their well-being. However, because perceived spouse support was not found to mediate the association for spouses, future studies should investigate other factors as potential mediating mechanisms among spouses of adults with sensory loss.

High Functioning Autism Spectrum Disorders in Adults: Consequences for Primary Caregivers Compared to Schizophrenia and Depression

Primary caregivers experience consequences from being in close contact to a person with autism spectrum disorder (ASD). This study used the Involvement Evaluation Questionnaire to explore the level of consequences of 104 caregivers involved with adults with High Functioning ASD (HF-ASD) and compared these with the consequences reported by caregivers of patients suffering from depression and schizophrenia. Caregivers involved with adults with an HF-ASD experience overall consequences comparable to those involved with patients with depression or schizophrenia. Worrying was the most reported consequence. More tension was experienced by the caregivers of ASD patients, especially by spouses. More care and attention for spouses of adults with an HF-ASD appears to be needed.

Medical Care Activities Among Spouses of Older Adults With Functional Disability: Implications for Caregiving Difficulties and Gains

Spouses of older adults with functional disability often provide help with their partner's medical care. Yet little is known about the implications of these activities for spouses' caregiving experiences. We examined how spouses' medical care activities are linked to both positive and negative aspects of caregiving (difficulties and gains), and whether these associations vary by their age, gender, or education. Retrospective analysis of data from the 2011 National Health and Aging Trends Study and National Study of Caregiving cross-sectional studies. Caregivers and care recipients/proxies were interviewed by telephone at home. Nationally representative U.S. sample of 345 spousal caregivers and their community-dwelling care recipients aged 65 years and older. Caregivers' self-reported sociodemographics, care activities, health conditions, well-being, and support resources. Care recipients (or proxies) reported on their health conditions and dementia status. A higher number of health system interaction tasks (e.g., making appointments) were significantly associated with greater emotional caregiving difficulties, whereas a higher number of medical/nursing tasks (e.g., giving shots/injections) were significantly linked to greater caregiving gains. A higher number of medical/nursing tasks were also significantly associated with greater physical difficulties for caregiving wives and spouses with less education. Medical care activities may have both positive and negative consequences for spousal caregivers, which depend partly on sociodemographics. This study underscores the importance of ensuring that spouses have the resources and support needed to provide complex care to their partners.

Life With a Partner with ADHD: The Moderating Role of Intimacy

Adult attention deficit and hyperactivity disorder (ADHD) manifests itself through a variety of symptoms, some of which affect not only occupational and recreational activities but also intimate relationships. Previous findings have focused on the effects of adult ADHD on intimacy and relationships from the ADHD diagnosed person’s point of view. However, spouses of people with ADHD are a neglected population with regard to the effects that ADHD has on their romantic relationships. Our aim was to assess the effects of being married to a spouse with ADHD on marital relationships, and the moderating role of intimacy. We compared healthy spouses of people with ADHD to healthy spouses of healthy adults (M = 38.23, SD = 4.78) in their degree of self-reported intimacy and marital satisfaction. Our findings indicate that spouses of individuals with ADHD report significantly lower intimacy and lower marital satisfaction compared to spouses of individuals without ADHD. Moreover, our findings indicate that spousal reports about their degree of intimacy mediate the relationships between their spouses’ ADHD and their marital satisfaction. Results are discussed in relation to the broad implications that adult ADHD has for romantic intimacy. Our research addresses healthy partners married to a spouse with ADHD, suggesting that living with a partner with ADHD behaviors is challenging. ADHD symptoms negatively affect various qualities in the person experiencing them, but of equal importance is the damage occurring to his or her spouse. Implications for future research and recommendations for clinical work are suggested.

The implementation of a learner-centred conversation training programme for spouses of adults with aphasia in a community setting

Background: Conversational training programmes are increasingly being reported for partners of people with aphasia. The approach, formats used and ways in which these programmes have been evaluated vary. The literature to date provides evidence that conversation partner training can be effective, but it remains unclear as to what specific components contribute to successful outcomes. In this regard, the effectiveness of a learner-centred training programme was demonstrated in the author’s previous work with five couples living with chronic aphasia. Results of this programme, which was delivered in a one-to-one format, included improvements in the quality of conversation for the couples who participated.Aims: The aim of this study was to determine whether similar results could be obtained if the programmes’ original format was modified to include a combination of both individual and group sessions. An additional aim was to describe the content and contribution of both the types of sessions.Methods & Procedures: Four couples living with aphasia participated in this study with a case series descriptive design. The training, delivered by a speech-language pathologist (SLP) and communicative disorders assistant (CDA), consisted of an 8-week communication training programme incorporating content and adult learning strategies similar to the original programme. The modified format included four individual and four group sessions. Couples were seen once a week and were encouraged to practice conversation strategies at home.Outcomes & Results: Results were consistent with those previously reported using the one-on-one format and included an increase in spouses’ use of supportive conversation strategies and an increase in the partner with aphasia’s participation in conversation. Couples reported improved ability to discuss more complex topics, increased positive feelings about conversation and perceived the supportive communication strategies as being useful in their interactions at home. Additional positive effects were reported related to the group experience including the reinforcement of communication strategies learned in training sessions as well as mutual aid and peer support.Conclusions: The use of a format incorporating both individual and group learner-centred training sessions demonstrated positive changes in attitudes and communication behaviours for couples in this study. The group process enhanced the value of the programme by promoting mutual aid and the validation of the personal experiences of each couple. These results have implications for SLPs’ work with couples living with aphasia in the community and demonstrate the benefits of using an adult learning approach that includes both individual and group sessions.

Spouses of Older Adults With Late-Life Drinking Problems: Health, Family, and Social Functioning

This study focuses on the health, family, and social functioning of spouses of late-life remitted and continuing problem drinkers, and on predictors of spouses' alcohol-related functioning and depressive symptoms. Three groups of spouses were compared at baseline and a 10-year follow-up: (a) spouses (n = 73) of older adults who had no drinking problems at baseline or follow-up, (b) spouses (n = 25) of older adults who had drinking problems at baseline but not follow-up, and (c) spouses (n = 69) of older adults who had drinking problems at both baseline and follow-up. At each contact point, spouses completed an inventory that assessed their alcohol-related, health, family, and social functioning. At baseline, compared with spouses of problem-free individuals, spouses of older adults whose drinking problems later remitted reported more alcohol consumption, poorer health, more depressive symptoms, and less involvement in domestic tasks and social and religious activities. At the 10-year follow-up, spouses of remitted problem drinkers were comparable to spouses of problem-free individuals, but spouses of continuing problem drinkers consumed more alcohol, incurred more alcohol-related consequences, and had friends who approved more of drinking. Overall, spouses whose friends approved more of drinking and whose partners consumed more alcohol and had drinking problems were likely to consume more alcohol and to have drinking problems themselves. Spouses of older adults whose late-life drinking problems remit can attain normal functioning; however, spouses of older adults with continuing late-life drinking problems experience some ongoing deficits.

Attachment insecurity and perceived partner suffering as predictors of personal distress

This study examined the extent to which perceptions of partner suffering mediate the association between attachment insecurity (anxiety and avoidance) and personal distress among spouses of older adults with osteoarthritis. Fifty-three spouses watched two videos of targets (their partner and an opposite sex stranger) perform a pain-eliciting household task, and spouses were asked to rate their own distress and perceptions of the targets' pain. Spouses also completed self-report measures of trait attachment. Results revealed that attachment anxiety was associated with greater personal distress in reaction to the partner's suffering, and heightened perceptions of partner pain mediated this association. Avoidant attachment was associated with less distress in reaction to the partner's suffering, but not with less perceived pain. The results of this study identify an important mechanism linking attachment insecurity and heightened distress responses when observing the suffering of a significant other.

Comorbid Psychiatric Disorders in Adults with ADHD

Adults with ADHD have been found in prior studies to have a greater risk for various psychiatric disorders. Chief among these are oppositional defiant disorder (ODD) and conduct disorder (CD). Approximately 24–35% of clinic–referred adults diagnosed with ADHD have ODD and 17–25% have CD, either currently or over the course of their earlier development (Barkley, Murphy, & Kwasnik, 1996; Biederman, et al., 1993; Murphy & Barkley, 1996; Murphy, Barkley, & Bush, 2002; Spencer, 2004). These figures for clinic–referred adults are below those reported in studies of ADHD children, particularly studies of hyperactive children followed to adulthood, where levels of ODD and CD may be double or triple these rates reported for adults diagnosed with ADHD (see Barkley, 2006, for a review; Barkley, Fischer, Edelbrock, & Smallish, 1990; Fischer, Barkley, Smallish, & Fletcher, 2002; Weiss & Hechtman, 1993). Among parents of children having ADHD who also meet criteria for ADHD, disruptive behavior disorders are also significantly more common (McGough et al., 2005; Minde, et al., 2003). For instance, one study found that 53% have had ODD and 33% have had CD sometime in their lives (Biederman et al., 1993), figures closer to those seen in follow–up studies of hyperactive or ADHD children. Antisocial Personality Disorder is often an associated adult outcome in a large minority of those children or adolescents who have both ADHD and CD; thus it is not surprising to find that 7–44% of clinic–referred adults diagnosed with ADHD also qualify for a diagnosis of this personality disorder (Biederman et al., 1993; Shekim, Asarnow, Hess, Zaucha, & Wheeler, 1990; Torgersen, Gjervab, & Rasmussen, 2006). Even among those who do not qualify for this diagnosis, many receive higher than normal ratings on those personality traits associated with this personality disorder (Tzelepis, Schubiner, & Warbase, 1995). Substance dependence and abuse are known to occur to a more frequent degree among hyperactive or ADHD children who develop CD by adolescence or Antisocial Personality Disorder by adulthood (Barkley, 2006; Tercyak, Peshkin, Walker, & Stein, 2002). Arecent study of a large general population sample likewise found an association between ADHD and antisocial disorder (Kessler, et al., 2006). Adults clinically diagnosed with ADHD seem to be no exception to this rule linking ADHD, antisocial activities, and drug use disorders. Studies have found lifetime rates of alcohol dependence or abuse disorders ranging between 21% and 53% of adults diagnosed with ADHD, whereas 8–32% may manifest some other form of substance dependence or abuse disorder (Barkley,

The evaluation of a learner‐centred training programme for spouses of adults with chronic aphasia using qualitative case study methodology

Background: Family education, training, and counselling programmes have been cited as one way to complement traditional interventions for the individual with aphasia. However, the literature still represents the speech‐language pathologist as the expert in a directive role.Aims: This article describes the second phase of a research study aimed at addressing the psychosocial sequelae of aphasia by developing and studying the effects of a learner‐centred training programme for spouses of adults with chronic aphasia designed to improve conversational interaction between couples. The first phase of this research included the development of a communication‐training programme that integrated principles and strategies from speech‐language pathology and adult education (Sorin‐Peters, 2002). The second phase described in this paper included the delivery and evaluation of the programme using a qualitative case study methodology. The use of the qualitative case study methodology to study the psychosocial consequences of aphasia is described in a companion paper (Sorin‐Peters, 2004). This paper presents the results of one qualitative case study in detail to demonstrate how the qualitative case study methodology was implemented, and a summary of the cross‐case analysis for the five couples, examining the effectiveness of the programme.Methods & Procedures: Using videotaped data, the Couple Questionnaire, and a semi‐structured interview, this study examined changes in attitudes and communication behaviours in five couples immediately after conversation partner training and at 2 months follow‐up. All data were transcribed and analysed for patterns of change.Outcomes & Results: Communication outcomes included changes in conversational interaction as well as in the transaction of information in conversation for all five couples. These included positive changes in the management of conversational repair. There was more balanced control after training and the cognitive competence of the partners with aphasia was revealed following the training. In addition, different conversational genres emerged throughout the programme that could be organised hierarchically. Results indicated ways in which the adult learning principles were actualised across the five cases. Themes emerged related to the expression of emotion about aphasia, including feelings of anger, sadness, and grief, and increased acceptance of the aphasia after the training. Themes related to marital issues emerged and were intertwined with emotions and communication.Conclusions: The adult learning model approach promoted positive and comprehensive changes, and perhaps more than those achieved via existing medical‐model or psychosocial approaches. The adult learning approach to individuals with chronic aphasia extends the existing psychosocial model by acknowledging both the spouse's and person with aphasia's competence as adult learners, by viewing the person with aphasia not only as part of a social unit, including the family, but also as part of a broader system, including multiple environmental and cultural factors that interact interdependently to effect change, and by focusing on the importance of communication for the expression of emotions and the maintenance and development of marital relations. The results suggest the benefits of the expansion of the speech‐language pathologist's role with couples with aphasia to include an adult learning approach to improving conversational interaction between people with aphasia and their spouses.

The marital and family functioning of adults with ADHD and their spouses

Little is known about the family relationships of adults with Attention-Deficit/Hyperactivity Disorder (ADHD). Thus, the marital adjustment and family functioning of 33 married adults with ADHD and their spouses was compared to 26 non-ADHD control participants and their spouses. Results revealed that married adults with ADHD reported poorer overall marital adjustment on the Dyadic Adjustment Scale (DAS; Spanier, 1989) and more family dysfunction on the Family Assessment Device (FAD; Eptein, Baldwin, & Bishop, 1983) than control adults. The spouses of adults with ADHD did not differ from control spouses in reports of overall marital adjustment and family dysfunction. A greater proportion of their marital adjustment scores, however, fell within the maladjusted range. The ADHD adults' perceptions of the health of their marriages and families were more negative than their spouses' perceptions. The way in which spouses of ADHD adults compensated for their partners' difficulties were explored through clinical interviews. The findings in this study underscore the need for assessments and treatments to address marital and family functioning of adults with ADHD.

The psychosocial functioning of children and spouses of adults with ADHD.

It is unclear what the impact of parental ADHD is on the day-to-day life of the rest of the family and how it contributes to the intergenerational transmission of this disorder. The psychosocial functioning of 23 spouses and 63 children of 33 families with an ADHD parent and 20 spouses and 40 children of 26 comparison families was examined. Both adults and their spouses were assessed for lifetime and current Axis I and Axis II diagnoses, present general psychiatric symptoms and their marital relationships. Children were screened for ADHD and other problems, using the C-DISC, CBLC, TRF and the Social Adjustment Inventory. Children with an ADHD parent had higher rates of psychopathology than those from comparison families. Children with ADHD had more co-morbidities than non-ADHD children. Family and marital functions were impaired in ADHD families regardless of the gender of the affected parent. Children without ADHD from families with one psychiatrically healthy parent did well while the behaviour of children with ADHD was always poor and not associated with parental mental health. The results underscore the strong genetic contribution to ADHD and the need to carefully assess the non-ADHD parent as they seem to influence the well-being of non-ADHD children in families with an ADHD parent.

The Emotional, Social, and Behavioral Implications of Insulin-Induced Hypoglycemia.

Hypoglycemic episodes occur commonly in patients with insulin-dependent (Type I) diabetes and are associated with several negative sequelae. These include unpleasant symptoms, deterioration in cognitive-motor functions, embarrassment, accidents, unconsciousness, seizures, and even death. Although hypoglycemic disruptions in cognitive and motor function caused by neuroglycopenia are well-documented, the effects of hypoglycemia on other areas of psychosocial function have received less scientific attention. This paper examines the impact of hypoglycemia on emotional status, social behavior, and relationships. The physical symptoms and cognitive impairment that occur with hypoglycemia are caused primarily by hormonal changes and neuroglycopenia. These physiologic responses also seem to cause negative changes in affect and social behavior. These include changes in acute mood state, such as feelings of tension and anger, as well as negative interpersonal behavior, such as argumentiveness. Patients may also develop significant fear of hypoglycemia (FOH) and engage in behaviors aimed at avoiding low blood glucose levels, which may jeopardize metabolic control. Nondiabetic family members, who witness episodes and often must provide emergency treatment, can experience significant distress. Parents of diabetic children who have experienced unconsciousness exhibit high FOH, as do spouses of diabetic adults who have frequent episodes. Taken together, the research clearly shows that hypoglycemia can have a significant negative impact on psychosocial function and quality of life, which has important clinical and empirical implications.

Recognizing cancer as a family disease: worries and support reported by patients and spouses.

Data were obtained via mailed questionnaire from 91 adults with cancer and 78 spouses of adults with cancer. Findings suggest that spouses and patients worry equally about their own personal health, and that spouses worry more about patients' futures than the patients do themselves. In addition, spouses and patients report participating equally in the treatment process, yet patients report receiving significantly more social support than do spouses. The results point to the need for expanded attention to the concept of cancer as a "family disease," with special emphasis on the unique and often neglected experience of spouses of adult cancer patients.

Time Spent Caregiving and Help Received by Spouses and Adult Children of Brain-Impaired Adults

Caregivers for brain-impaired adults differ in living arrangements, amount of time spent giving care, and assistance received from family and friends and from paid help depending on their kin relationship and employment status. Spousal caregivers devote large amounts of time to caregiving, and husbands spend no less time than wives. Most caregivers receive little assistance from other family members and friends, but husbands receive more than others. Employed spouses receive more paid help than those without jobs, but employment does not affect the amount of paid help received by adult daughters.

Stress, coping, and adaptation in spouses of older adults with chronic dementia

This article examines the relative effects of psychological and social characteristics on the well-being of caregiving spouses of older adults with chronic dementia. Fifty-one spouses completed questionnaires assessing dementia severity, distress in appraisal of dementia symptoms, perceived support from family and peers, reliance on specific coping strategies, and psychological well-being. The results of the path analysis show that gender, appraisal of dementia symptoms, perceived peer support, and three types of coping strategies—problem solving, positive focus, and wishful thinking—are significant predictors of well-being. Overall, the predictor variables accounted for 60.3 percent of the variance in psychological well-being. Findings document the salience of these characteristics in further study of caregiver functioning. More generally, results provide support for multidimensional models of stress, coping, and adaptation. Implications for clinical intervention are summarized.