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Objective: Family caregivers generally underestimate the health and well-being of Alzheimer disease (AD) patients when compared to patients' self-assessments. The goals of this study were to identify caregiver, patient, and contextual factors associated with caregiver rating bias.Methods: One hundred five patients with AD, along with their family caregivers, were assessed twice by trained interviewers 1-year apart. In separate interviews, caregivers were asked to rate the quality of life and suffering of their patient relative, and patients provided self-ratings using the same structured instruments. Multivariate cross-sectional and longitudinal analyses were used to identify predictors of caregiver-patient discrepancies.Results: Caregivers consistently reported significantly higher levels of suffering and lower levels of quality of life than patients. Caregiver psychological well-being and health status accounted for a substantial portion of the difference in caregiver and patient ratings in both cross-sectional and longitudinal analyses. Caregiver depression and burden were consistently positively associated with the magnitude of caregiver-patient discrepancy, and caregiver health status was negatively associated with the size of the discrepancy.Conclusions: Caregiver assessments of dementia patients may determine the type and frequency of treatment received by the patient, and caregivers' ability to reliably detect change in patient status can play a critical role in evaluating the efficacy of therapeutic interventions and pharmacologic agents. Clinicians and researchers working with dementia patients who rely on caregiver reports of patient status should be sensitive to the health and well-being of the caregiver and recognize that caregiver assessments may be negatively biased when the caregiver's own well-being is compromised. [ABSTRACT FROM AUTHOR]

A laboratory study of older adults with osteoarthritis and their spouses was conducted to examine the unique influence of exposure to suffering on caregivers' risk for impaired psychological and physical health. Spouses' blood pressure (BP) and heart rate (HR) were monitored during 2 tasks designed to capture their partners' suffering. First, spouses watched their partners (and a stranger) carry heavy logs across an 8-ft space for 3 min, a task that elicited pain expression. Second, spouses spoke about their partners' suffering (and also about a typical meal with their partners). Results showed that spouses' BP and HR increased when watching and talking about their partners' suffering, and exposure to a partner's suffering was more physiologically stressful than to a stranger's suffering. These findings suggest that heightened physiological stress caused by exposure to a loved one's suffering may be one pathway to caregivers' increased risk for cardiovascular disease. [ABSTRACT FROM AUTHOR]

PURPOSE: This report describes the implementation of a novel, patient-driven approach to recruitment for a study of interpersonal communication in a primary care setting involving persons with Alzheimer's disease (AD), their family caregivers, and their primary care providers (PCPs). DATA SOURCES: Patients and caregivers were centrally recruited from a university-based memory clinic, followed by the recruitment of patient's individual PCPs. Recruitment tracking, naturalistic observation, and survey methods were used to evaluate recruitment success. CONCLUSIONS: About half of the patients and caregivers (n = 54; 51%) and most of the PCPs (n = 31; 76%) who we approached agreed to an audiorecording of the patient's next PCP visit. Characteristics of patient, caregiver, and PCP participants were compared to those of nonparticipants. Patient characteristics did not differ by participation status. Caregivers who volunteered for the study were more likely to be female and married than were those who declined to participate. Compared to nonparticipants, PCPs who agreed to the study were appraised slightly more favorably by patients' caregivers on a measure of satisfaction with care on the day of the visit. The vast majority of participating PCPs (95%) reported that the study had little or no impact on the flow of routine clinical operations. IMPLICATIONS FOR RESEARCH: Findings support the feasibility of a patient-driven approach to recruitment for studies involving multiple linked participants. Our discussion highlights possible advantages of such an approach, including the potential to empower patient participants while achieving maximum variability within the pool of clinician participants. [ABSTRACT FROM AUTHOR]

Cross-sectional and longitudinal analyses were carried out to assess the relationship between dementia patient suffering, caregiver depression, and antidepressant medication use in 1222 dementia patients and their caregivers. We assessed the prevalence of 2 types of patient suffering, emotional and existential distress, and examined their independent associations with caregiver depression and antidepressant medication use when controlling for sociodemographic characteristics of caregivers and patients, cognitive and physical disability of the patient, the frequency of patient memory problems and disruptive behaviors, and the amount of time spent caring for the patient. Multiple linear regression models showed that both aspects of perceived patient suffering independently contribute to caregiver depression (emotional distress: beta=1.24; P<0.001; existential distress: beta=0.66; P<0.01) whereas only existential suffering contributes to antidepressant medication use: odds ratio=1.25 95% confidence interval, 1.10-1.42; P<0.01. In longitudinal analyses, increases in both types of suffering were associated with increases in caregiver depression (emotional distress: beta=1.02; P<0.01; existential distress: beta=0.64; P<0.01). This is the first study to show in a large sample that perceived patient suffering independently contributes to family caregiver depression and medication use. Medical treatment of patients that maintain or improve memory but do not address suffering may have little impact on the caregiver. Alzheimer disease patient suffering should be systematically assessed and treated by clinicians. [ABSTRACT FROM AUTHOR]

Inclusion of a close family member (e.g., the spouse) in psychosocial interventions for chronic illness may be more efficacious than focusing solely on the patient. This article reviews and synthesizes randomized, controlled studies designed to address this question (k=12) with various illness populations (heart disease, arthritis, chronic pain, and Type 2 diabetes). For patients, 5 out of 12 studies showed consistent evidence that a family-oriented approach was more beneficial than patient-oriented intervention, whereas 1 study showed that patient intervention provided an advantage over family intervention. In the remaining studies, the more efficacious approach depended on patient gender, the use of cognitive-behavioral intervention strategies, and the time of follow-up assessment. Benefits for family members were rarely assessed, with 1 study showing an advantage for couples intervention. Carefully designed studies are needed to evaluate the benefits of this psychosocial treatment approach, for both the patient and the family member. [ABSTRACT FROM AUTHOR]

This study evaluated a novel intervention for older osteoarthritis (OA) patients and their spousal caregivers that consisted of standard patient education supplemented by information related to effectively managing arthritis as a couple. Twenty-four female OA patients and their husbands were randomly assigned to either an educational intervention that was targeted at both patient and spouse or to a patient education intervention that was targeted at only the patient. Findings revealed that both interventions were evaluated favorably but the couple intervention was better attended than the patient intervention. In addition, patients in the couple intervention experienced greater increased efficacy in managing arthritis pain and other symptoms. The findings of this pilot study point to the utility of a dyadic intervention approach to management of OA in late life. [ABSTRACT FROM AUTHOR]

Context: Most deaths in the United States occur among older persons who have 1 or more disabling conditions. As a result, many deaths are preceded by an extended period during which family members provide care to their disabled relative.Objective: To better understand the effect of bereavement on family caregivers by examining predeath vs postdeath changes in self-reported and objective health outcomes among elderly persons providing varying levels of care prior to their spouse's death.Design and Setting: Prospective, population-based cohort study conducted in 4 US communities between 1993 and 1998.Participants: One hundred twenty-nine individuals aged 66 to 96 years whose spouse died during an average 4-year follow-up. Individuals were classified as noncaregivers (n = 40), caregivers who reported no strain (n = 37), or strained caregivers (n = 52).Main Outcome Measures: Changes in depression symptoms (assessed by the 10-item Center for Epidemiological Studies-Depression [CES-D] scale), antidepressant medication use, 6 health risk behaviors, and weight among the 3 groups of participants.Results: Controlling for age, sex, race, education, prevalent cardiovascular disease at baseline, and interval between predeath and postdeath assessments, CES-D scores remained high but did not change among strained caregivers (9.44 vs 9.19; P =.76), while these scores increased for both noncaregivers (4.74 vs 8.25; F(1,116) = 14.33; P<.001) and nonstrained caregivers (4.94 vs 7.13; F(1,116) = 4.35; P =.04). Noncaregivers were significantly more likely to be using nontricyclic antidepressant medications following the death than the nonstrained caregiver group (odds ratio [OR], 12.85; 95% confidence interval [CI], 1.02-162.13; P =.05). The strained caregiver group experienced significant improvement in health risk behaviors following the death of their spouse (1.47 vs 0.66 behaviors; F(1,118) = 20.23; P<.001), while the noncaregiver and nonstrained caregiver groups showed little change (0.27 vs 0.27 [P =.99] and 0.46 vs 0.27 [P =.39] behaviors, respectively). Noncaregivers experienced significant weight loss following the death (149.1 vs 145.3 lb [67.1 vs 65.4 kg]; F(1,101) = 8.12; P =.005), while the strained and nonstrained caregiving groups did not show significant weight change (156.2 vs 155.2 lb [70.3 vs 69.8 kg] [P =.41] and 156.2 vs 154.0 lb [70.3 vs 69.3 kg] [P =.12], respectively).Conclusions: These data indicate that the impact of losing one's spouse among older persons varies as a function of the caregiving experiences that precede the death. Among individuals who are already strained prior to the death of their spouse, the death itself does not increase their level of distress. Instead, they show reductions in health risk behaviors. Among noncaregivers, losing one's spouse results in increased depression and weight loss. [ABSTRACT FROM AUTHOR]

We examined relationships between feelings of mastery and self-esteem in a given role (role adequacy) and caregivers' social and psychological well-being over time. Seventy-five women who occupied the roles of caregiver, mother and wife were assessed twice over a two month interval. Caregiver role adequacy predicted greater family cohesion and marital satisfaction, wife role adequacy predicted greater family cohesion, and mother role adequacy predicted less negative affect. Findings indicate that women can gain a sense of self- worth and mastery through caregiving, and underscore the importance of these role- specific resources to women's psychosocial well-being. [ABSTRACT FROM AUTHOR]

This study examined interrole conflict experienced by 278 women who simultaneously occupied 4 roles: parent care provider, mother to children at home, wife, and employee. Compared with women who experienced no conflict between parent care and their other roles, women reporting parent care conflict tended to have fewer socio-economic resources, to have older children, and to be caring for parents with greater impairment. Women who reported conflicts between parent care and employment were older; had more education; had marriages of longer duration; and had older, more self-sufficient children than women who reported conflict between the parent care role and the mother role. Some evidence was found for the hypothesis that interrole conflict between parent care and other roles mediates the relationship between parent care stress and psychosocial well-being. Results suggest that one way parent care stress exerts its deleterious effects on the well-being of adult daughters is through the incompatible pressures of parent care and other roles. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to examine the degree of individual change in structural indicators of social support (family network contact and close friend network contact) and functional indicators of social support (belonging, appraisal, and tangible support) during late life. METHODS: Using a large population-based sample of older adults, hierarchical linear modeling was applied to examine the extent of change in social contact and support as well as sociodemographic characteristics (age, race, gender, and education) that might explain individual variability in contact and support at baseline and over time. RESULTS: Consistent with predictions, small yet significant increases were observed in belonging support and tangible support. Contrary to predictions, no evidence was found for significant individual change in family network contact, close friend network contact, or appraisal support. Sociodemographic characteristics were more consistent predictors of variability in contact and support at baseline than variability over time. DISCUSSION: The findings of this study add to a growing literature suggesting that late life is not typically characterized by a decline in important social resources. [ABSTRACT FROM AUTHOR]

This study applied theory from the general work and family literature to the dual roles of work and caregiving, in order to examine whether level of satisfaction and time involvement in each of these roles moderate the effects of stress in the other role on well-being. Respondents were 118 employed women who were providing care to an impaired parent or parent-in-law. As predicted, greater time involvement in work was found to buffer women from the negative effects of caregiving stress. Satisfaction with caregiving and satisfaction with work were directly associated with better well-being, beyond the effects of stress in both roles. However, women who experienced high levels of caregiving stress and who were highly satisfied with work were especially vulnerable to depression. These findings illustrate the importance of examining the effects of caregiving stress on well-being in the context of work-related experiences. [ABSTRACT FROM AUTHOR]

Objectives: Despite extensive efforts to study individual differences in loneliness and neurocognitive health, little is known about how within-person changes in state loneliness relate to cognitive performance. This study addressed this gap by examining the association between within-person variation in state loneliness and cognitive performance assessed objectively in daily life., Methods: Participants were 313 community-dwelling older adults (70-90 years) who reported momentary feelings of loneliness and completed smartphone-based cognitive tests 5 times daily for 14 consecutive days. Mobile cognitive tests assess visual associative memory, processing speed, and spatial memory., Results: At the day level, average state loneliness levels were negatively related to cognitive performance on the same day and subsequent day. Consistent with the day-level analysis, momentary assessments of increased loneliness were consistently linked to worse cognitive performance on concurrent assessments. However, moments characterized by lower cognitive performance predicted higher levels of loneliness 3-4 hr later (next occasion), but not vice versa., Discussion: The findings suggest a prospective association between loneliness and cognitive performance, with higher daily loneliness negatively associated with cognitive performance on the same day and predicting worse performance the following day. Notably, within a single day, lower cognitive performance at a given moment predicted elevated loneliness later in the day. This highlights a complex, reciprocal relationship-loneliness predicting and being predicted by cognitive performance depending on timescale., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Continuous-time modeling using differential equations is a promising technique to model change processes with longitudinal data. Among ways to fit this model, the Latent Differential Structural Equation Modeling (LDSEM) approach defines latent derivative variables within a structural equation modeling (SEM) framework, thereby allowing researchers to leverage advantages of the SEM framework for model building, estimation, inference, and comparison purposes. Still, a few issues remain unresolved, including performance of multilevel variations of the LDSEM under short time lengths (e.g., 14 time points), particularly when coupled multivariate processes and time-varying covariates are involved. Additionally, the possibility of using Bayesian estimation to facilitate the estimation of multilevel LDSEM (M-LDSEM) models with complex and higher-dimensional random effect structures has not been investigated. We present a series of Monte Carlo simulations to evaluate three possible approaches to fitting M-LDSEM, including: frequentist single-level and two-level robust estimators and Bayesian two-level estimator. Our findings suggested that the Bayesian approach outperformed other frequentist approaches. The effects of time-varying covariates are well recovered, and coupling parameters are the least biased especially using higher-order derivative information with the Bayesian estimator. Finally, an empirical example is provided to show the applicability of the approach.

Objectives: We investigated whether receiving greater pain-related instrumental support is associated with poorer psychological well-being among chronic pain patients who report less positive (e.g., grateful) or more negative (e.g., angry) emotional responses to support., Methods: We conducted regression analyses, utilizing data from two waves of interviews with 152 knee osteoarthritis patients. Three indicators of psychological well-being were examined: depressive symptoms, positive affect, and negative affect., Results: Receiving greater support was associated with poorer psychological well-being at baseline, as well as higher depressive symptoms and negative affect at the 18-month follow-up, only among patients with low positive emotional responses to support. Furthermore, receiving greater support was related to poorer psychological well-being at baseline only among patients with high negative emotional responses to support., Discussion: Care recipients' less positive emotional responses to support may be a risk factor for poorer psychological well-being in both the short- and long-term, when receiving greater support., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

As dyadic health science enters a golden age, important conceptual, theoretical, and technical challenges remain. This forum review brings together perspectives on the burgeoning dyadic literature from several subdisciplines within aging research. We first define key concepts and terms so that interested researchers can navigate the complex and various ways in which dyadic health research is conducted. We discuss exciting scientific advances and close by identifying crucial challenges and considerations that coincide with important future directions for the field., (© The Author(s) 2022. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The current study included an examination of social factors that mitigate or exacerbate insomnia symptoms among older adults who are married or living with a partner. We first examined the unique effects of spousal support and strain on insomnia symptoms and then evaluated the degree to which extramarital social factors (e.g., friend support) moderated spousal influences. Data came from Waves 2 and 3 of the National Social Life, Health, and Aging Project. Our sample consisted of 495 participants who were either married or cohabitating with a partner ( M age in years = 69.84, SD  = 8.08). Spousal strain-but not support-predicted higher insomnia symptoms 5 years later. Spousal influences on sleep, however, were moderated by extramarital factors in nuanced ways. Findings highlight the importance of taking into account older adults' wider social context when examining the ways in which sleep is sensitive to positive and negative aspects of marital quality.

Pain catastrophizing is understood as a negative cognitive and emotional response to pain. Researchers, advocates and patients have reported stigmatizing effects of the term in clinical settings and the media. We conducted an international study to investigate patient perspectives on the term pain catastrophizing. Open-ended electronic patient and caregiver proxy surveys were promoted internationally by collaborator stakeholders and through social media. 3,521 surveys were received from 47 countries (77.3% from the U.S.). The sample was mainly female (82.1%), with a mean age of 41.62 (SD 12.03) years; 95% reported ongoing pain and pain duration > 10 years (68.4%). Forty-five percent (n = 1,295) had heard of the term pain catastrophizing; 12% (n = 349) reported being described as a 'pain catastrophizer' by a clinician with associated high levels of feeling blamed, judged, and dismissed. We present qualitative thematic data analytics for responses to open-ended questions, with 32% of responses highlighting the problematic nature of the term. We present the patients' perspective on the term pain catastrophizing, its material effect on clinical experiences, and associations with negative gender stereotypes. Use of patient-centered terminology may be important for favorably shaping the social context of patients' experience of pain and pain care. PERSPECTIVE: Our international patient survey found that 45% had heard of the term pain catastrophizing, about one-third spontaneously rated the term as problematic, and 12% reported the term was applied to them with most stating this was a negative experience. Clinician education on patient-centered terminology may improve care and reduce stigma., (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Although the marital relationship is often the primary source of emotional support in adulthood, sole reliance on the spouse to discuss health-related issues may be harmful to the well-being of both partners. The first aim of this study was to examine whether declines in health during later life would be associated with poorer psychological well-being in self and partner. We further investigated whether declining health would have a stronger impact on own and partner psychological well-being in the absence of non-spousal health confidants. Longitudinal actor-partner interdependence models (APIMs) were used to test both hypotheses with dyadic data from Wave 2 (2010-2011) and Wave 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP). Contrary to prediction, increased anxiety following spousal declines in gait speed and cognitive function occurred for those whose spouse did (rather than did not) have additional health confidants. A much fuller understanding is needed in regard to whether close relationships provide resources or present unwanted complications to dyadic coping, and the processes by which effects occur.

Objectives: We investigated whether spousal caregivers' greater perception of being appreciated by their partner for their help was associated with caregivers' better mental health and whether caregivers' higher role overload was related to their poorer mental health. We further evaluated whether spousal caregivers' greater perceived gratitude buffered the association between their role overload and mental health., Methods: We examined 306 spousal caregivers of older adults with chronic illness or disability, drawn from the 2011 National Health and Aging Trends Study and National Study of Caregiving. We defined mental health as better psychological well-being and less psychological distress (i.e., fewer depressive and anxiety symptoms). Hierarchical regression models were estimated to test hypotheses., Results: Greater perceived gratitude was associated with better psychological well-being, and higher role overload was related to poorer psychological well-being and greater psychological distress. In addition, greater perceived gratitude buffered the associations between role overload and anxiety symptoms as well as psychological well-being., Discussion: Findings suggest that spousal caregivers' role overload may be a strong risk factor for their poorer mental health, especially when caregivers feel less appreciated by their partner. Couple-oriented interventions to improve spousal caregivers' mental health could be aimed at reducing their role overload and enhancing perceived gratitude., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Although the adverse link between rumination and sleep quality is well established, much of the literature neglects the role of social factors. This study examined the role of older adults' perceived social support from spouses and from family/friends in modifying the association between trait rumination and sleep quality. Existing hypotheses suggest that social support may play 3 unique roles, each tested within the current study: (H1) support may act as a protective factor that buffers negative effects of rumination on sleep quality, (H2) support may curtail rumination and, in turn, promote sleep quality, and (H3) rumination may erode support and, in turn, undermine sleep quality., Method: Data came from 86 partnered older adults in independent-living or retirement communities (Mage = 75.70 years). We utilized 3 waves of interview data collected annually between 2017 and 2019. The first hypothesis was tested using moderation in multilevel models; the second 2 hypotheses were evaluated with prospective associations using multilevel mediation., Results: Negative effects of high-trait rumination on time-varying sleep quality were attenuated among those who reported high, stable levels of support from their spouses. Perceived family/friend support did not yield the same protective effect. There was no evidence that support preempted, or was eroded by, rumination., Discussion: Perceived spousal support may act as a psychosocial resource that mitigates negative effects of trait rumination on older adults' sleep quality. Interventions aimed at mitigating maladaptive outcomes of rumination on sleep quality for older adults should consider spousal support as a key target., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Extensive evidence suggests that exposure to childhood abuse can lead to harmful health effects across a lifetime. To contribute to the literature, the current study examined whether and how a history of parental childhood abuse affects exposure to and severity appraisal of daily stressors in adulthood, as well as emotional reactivity to these stressors. We analyzed 14,912 daily interviews of 2,022 respondents from the second wave of the National Study of Daily Experiences. Multilevel modeling was utilized to analyze nested data, in that each person provided repeated measures of daily experience for eight consecutive study days. Results showed that more frequent experience of maternal childhood abuse was associated with more severe appraisal of daily stressors. In addition, adults with more frequent maternal childhood abuse exhibited greater emotional reactivity to daily stressors. The current study provides evidence that a history of parental childhood abuse may serve as a vulnerability factor in the process of experiencing and responding to stressful events encountered in daily life. Future research should further explore the long-term health effects of daily stress and emotional experience among adults with a history of parental childhood abuse. Interventions for these adults should focus on promoting emotional resilience in the face of daily stress.

The lack of social contact or good social relationships has been linked with cognitive decline and higher risk for Alzheimer's disease and related dementias. One important but unexamined question is how daily social interactions relate to older adults' cognitive function in daily life. The present study examined how changes in daily social interactions related to fluctuations in older adults' performance on mobile cognitive tests from day to day. Using an ecological momentary assessments approach, 312 older adults (aged 70 to 90 years) completed surveys on social interactions and mobile cognitive tests five times a day for 16 consecutive days using smartphones. Multilevel modeling was used for analyses. Results demonstrated that having more daily social interactions, especially more pleasant social interactions, related to better cognitive performance the same day and over the subsequent two days. Cognitive performance, however, did not predict subsequent changes in social interactions across days. At the between-person level, older adults who had more (vs. less) frequent interactions with close partners on average, especially with their friends, had better cognitive performance. Finally, the average levels of social interactions also moderated the within-person associations between daily social interactions and the same-day cognitive performance. In sum, results from this study highlight the importance of having pleasant social interactions and frequent interactions with friends for older adults' cognitive function in daily life, and have important implications for future behavioral interventions targeting certain features of daily social interactions to reduce risk of cognitive decline and Alzheimer's disease and related dementias., Competing Interests: The authors have declared that no competing interests exist.

The purpose of this study was to describe older adults' social network and support during a physical activity intervention and its association with physical activity. Mixed methods were used for this secondary analysis of existing data from a physical activity intervention. Seventy-three participants who completed a session by telephone on using support comprised the sample. Participants reported on average approximately eight individuals in their social network. Half reported support for physical activity from a spouse/partner, adult child, or friend. Those who perceived support for self-reported physical activity tended to have greater improvements on average from baseline for mean daily minutes of physical activity than those with no perceived support. Four-fifths developed a plan for a spouse/partner, friend, adult child, or sibling to provide physical activity support. Participants reported that the session was helpful and increased their confidence in using support; over one-quarter intended to use support after the intervention ended., Competing Interests: Declarations of Competing Interest None., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objectives: Seminal research with spouses of chronic pain patients indicates that providing patients with instrumental support can be either costly or beneficial for spouses' well-being. Drawing from the invisible support literature, this study evaluated the extent to which patients' recognition of spouses' support moderated daily and long-term associations between spouses' support provision and negative affect., Method: Data came from a sample of spouses (N = 145) of knee osteoarthritis (OA) patients, and the patients themselves. Participants completed a baseline interview, 22 days of daily diaries, and two follow-up interviews 6 and 18 months after baseline. Multilevel models were estimated to test study hypotheses., Results: As expected, support visibility moderated daily and long-term associations between spouses' instrumental support provision and negative affect. Spouses reported elevated levels of negative affect in response to providing patients with extra care and attention, but only when their support was not recognized (i.e., reported) by patients., Discussion: Findings from the current study pinpoint support visibility as a protective factor that may mitigate negative short- and long-term effects of spousal instrumental support provision on spouses' negative affect. Promoting patients' awareness of their spouses' support may offset negative emotional consequences of caregiving in the context of chronic health stressors., (© The Author(s) 2019. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Detecting subtle behavioral changes in everyday life as early signs of cognitive decline and impairment is important for effective early intervention against Alzheimer's disease. This study examined whether features of daily social interactions captured by ecological momentary assessments could serve as more sensitive behavioral markers to distinguish older adults with mild cognitive impairment (MCI) from those without MCI, as compared to conventional global measures of social relationships., Method: Participants were 311 community dwelling older adults (aged 70 to 90 years) who reported their social interactions and socializing activities five times daily for 14 consecutive days using smartphones., Results: Compared to those with normal cognitive function, older adults classified as MCI reported less frequent total and positive social interactions and less frequent in-person socializing activities on a daily basis. Older adults with and without MCI, however, did not show differences in most features of social relationships assessed by conventional global measures., Discussion: These results suggest that certain features of daily social interactions (quality and quantity) could serve as sensitive and ecologically valid behavioral markers to facilitate the detection of MCI., (© The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objectives: Relationships with confidants play an important role in older adults' health and well-being. Particularly, family and friend confidants could significantly support or interfere with older adults' marital relationships. This study used a dyadic approach to examine the influence of the structural features of both spouses' family and friend confidant networks on older couples' marital quality over 5 years., Methods: Analyses used dyadic data from Wave 2 (2010-2011) and Wave 3 (2015-2016) interviews of the National Social Life, Health, and Aging Project (NSHAP), a nationally representative sample of community-dwelling older adults. Longitudinal actor-partner interdependence models were used to examine the influence of spouses' family and friend confidant networks on couples' marital quality., Results: Having a larger friend confidant network or closer connections with friend confidants predicted greater marital quality for wives and husbands 5 years later. Larger family confidant networks of both spouses predicted greater marital quality for wives over time. However, husbands reported worse marital quality over time if wives reported having closer connections with their own family confidants at baseline., Discussion: This study demonstrates the importance of family and friend confidant networks for older couples' marital quality and highlights the benefits of having a larger or closer friend confidant network. Future research should examine mechanisms that account for the effects of spouses' family and friend confidant networks on older couples' marital quality., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Musculoskeletal disorders such as knee osteoarthritis (OA) are the primary cause of chronic pain in older adults. Recommended self-management strategies for knee OA include staying physically active in the face of pain, but many patients avoid activities they are capable of doing. The overall purpose of this study was to examine the extent to which daily pain catastrophizing, a maladaptive coping strategy, could influence OA patients' physical activity and sedentary behavior. The current study used data from 143 older knee OA patients who completed electronic daily diaries for 22 days and wore an accelerometer to capture physical activity and sedentary behavior. At the beginning of each day, patients reported their pain catastrophizing regarding the day ahead. Results from multilevel models demonstrated that on mornings when patients catastrophized more than usual about their pain in the day ahead, they spent more time in sedentary behavior and engaged in fewer minutes of moderate to vigorous physical activity that day. Cross-day lagged analyses further showed that the effect of morning pain catastrophizing on subsequent sedentary behavior extended to the next day. More time spent in sedentary behavior, in turn, contributed to greater pain catastrophizing the next morning. These findings support the mechanistic role of daily pain catastrophizing in the avoidance of physical activity for older OA patients, and suggest that effective interventions for pain catastrophizing may also reduce sedentary behavior and enhance physical activity, with longer-term benefits for pain management, physical function, and overall health.

Objectives: This study examined whether older patients' greater daily pain perceived by their spouses was associated with spouses' higher daily negative affect. We further investigated whether spouses' lower confidence in patients' ability to manage pain exacerbated the daily association between perceived patient pain and spouses' negative affect. Method: We used baseline interviews and a 22-day diary of knee osteoarthritis patients and their spouses ( N = 144 couples). Multilevel models were estimated to test hypotheses. Results: Daily perceived patient pain was not associated with spouses' daily negative affect. However, spouse confidence significantly moderated the association. Only spouses with lower confidence in patients' pain management experienced higher negative affect on days when they perceived that patients' level of pain was higher than usual. Discussion: Findings suggest that spousal caregivers' lack of confidence in patients' pain management may be a risk factor for spouses' affective distress in daily life.

Objective and Background: The current study examines the types of childhood experiences with mothers (i.e., maternal abuse, affection, discipline) among caregivers of aging mothers, and investigates whether membership in specific latent classes, particularly maternal maltreatment, is associated with psychological functioning among caregivers., Method: Using data from the Midlife in the United States (MIDUS), we used the Bolck, Croon, and Hagenaars (BCH) approach of latent class analysis (LCA) to predict distal outcomes., Results: We identified four latent classes (prevalence rate noted): "Affectionate and authoritative" (65%), "affectionate and permissive" (11%), "emotionally abusive and neglectful" (8%), and "emotionally/physically abusive and authoritative" (16%). Caregivers in the "emotionally/physically abusive and authoritative" class endorsed high probabilities of both maternal affection and abuse and were most negatively affected across the three psychological functioning outcomes (i.e., self-rated mental health, psychological distress, and psychological well-being)., Conclusion and Implications: In support of the life course perspective, our findings emphasized the importance of examining adult children caregivers' early life experiences with aging mothers and how those experiences can impact the psychological effects of caregiving. This study suggests specific practice implications; for example, assessment tools for evaluating caregiver burden should consider life course factors such as caregivers' childhood experiences with aging parents.

Objectives: This study identified daily associations between sleep, emotion, and marital functioning in the context of chronic pain. Because spouses' sleep is compromised on nights when patients experience more pain, we set out to identify implications of spouses' sleep for their own emotion (anger) upon waking and marital interaction (marital tension) throughout the rest of the day. We further considered whether spouses' critical attitudes about patients' pain-related coping exacerbated associations between their sleep, morning anger, and marital tension., Method: Data came from a study of knee osteoarthritis patients (50+ years old) and spouses (N = 138 couples) who completed daily diaries across 22 days. Multilevel models were estimated to test hypotheses., Results: Spouses woke up angrier on mornings when they reported that their sleep was more unrefreshing than usual. This association was stronger among more critical spouses. Morning anger resulting from unrefreshing sleep, however, did not predict marital tension throughout the rest of the day., Discussion: Findings highlight the potential value of intervention efforts aimed at promoting spouses' sleep quality in an effort to offset negative emotional consequences that may undermine spouses' and patients' adjustment in the context of chronic pain., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.

It is projected that by 2020 there will be 8.7 million veterans over the age of 65 years, more than half (64%) of whom served during the Vietnam War. The effects of military service on mental health and well-being may be more pronounced later in life among those who served in Vietnam than prior cohorts of veterans. Many veterans confront and rework their wartime memories later in life in an attempt to find meaning and coherence, engaging in a process referred to as Later-Adulthood Trauma Reengagement (LATR). LATR often occurs in the context of other stressors that are a normative part of aging, such as role transitions (e.g., retirement), declines in physical health, and the death of close others (e.g., spouses), perhaps because these events trigger reminiscence. Importantly, LATR may result in either positive (e.g., acceptance) or negative (e.g., distress) psychological outcomes. It has been suggested that the presence of social/environmental resources, including socioemotional support, may aid veterans in successfully navigating LATR. We, therefore, review relevant areas of research to delineate the role that various layers of social context may play in -helping - or hindering - aging Vietnam veterans as they navigate LATR in the context of normative late-life stressors. We conclude by offering fruitful directions for future research and applied implications for intervention efforts., (© 2019 S. Karger AG, Basel.)

Pain catastrophizing has been shown to predict greater pain and less physical function in daily life for chronic pain sufferers, but its effects on close social partners have received much less attention. The overall purpose of this study was to examine the extent to which pain catastrophizing is an interpersonal coping strategy that is maladaptive for patients and their spouses. A total of 144 older knee osteoarthritis patients and their spouses completed baseline interviews and a 22-day diary assessment. Multilevel lagged models indicated that, on days when patients reported greater catastrophizing in the morning, their spouses experienced more negative affect throughout the day. In addition, a higher level of punishing responses from the spouse predicted greater pain catastrophizing the next morning, independent of patient pain and negative affect. Multilevel mediation models showed that patients' morning pain catastrophizing indirectly impacted spouses' negative affect and punishing responses through patients' own greater negative affect throughout the day. There was no evidence that spouses' empathic or solicitous responses either followed or preceded patients' catastrophizing. These findings suggest that cognitive-behavioral interventions that reduce pain catastrophizing should be modified for partnered patients to address dyadic interactions and the spouse's role in pain catastrophizing.

The aims of the current study were to examine the long-term effects of childhood maltreatment on current relationships with parents and whether the quality of current relationships with parents mediates the associations between childhood maltreatment and psychological health in late adulthood. Using 2 decades of longitudinal data from the Wisconsin Longitudinal Study, multilevel structural equation modeling was employed to examine the associations between reports of childhood maltreatment, aspects of current relationships with parents (i.e., perceived closeness, contact frequency, and exchange of social support), and psychological well-being/distress of adult children. Key results indicated that reports of maternal childhood abuse and neglect predicted lower levels of perceived closeness with aging mothers, which were subsequently associated with reduced psychological well-being of adult children. We did not find evidence of mediation between reports of paternal childhood abuse/neglect, current relationships with fathers, and psychological outcomes. Our findings suggest a significant linkage between childhood and later-life intergenerational relationships. Adults who were maltreated by their mother as children may continue to experience challenges in this relationship. Further research is needed to examine how these past and current relational dynamics affect caregiving experiences and outcomes. In addition, when intervening with adults with a history of childhood maltreatment, practitioners should evaluate contemporary relationship quality with the abusive mother and help address any unresolved emotional issues with the parent. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background : Partner involvement can influence positive airway pressure (PAP) therapy use among patients with obstructive sleep apnea (OSA). This study assessed the feasibility, acceptability, and preliminary efficacy of a couples-oriented education and support (CES) intervention for PAP adherence. Participants : Thirty newly diagnosed OSA patients and their partners were randomly assigned to one of three groups: an education and support intervention directed at both patient and partner (CES), an education and support intervention directed only at the patient (PES), or usual care (UC). Methods : Feasibility and acceptability were assessed through enrollment and posttreatment program evaluations, respectively. Assessments of sleep quality, daytime sleepiness, and daytime function were obtained from both patients and partners at baseline and 3 months after PAP initiation. Objective PAP adherence was assessed at 1 week, 1 month, and 3 months. Results : Recruitment and attrition data suggest adequate feasibility. All patients and partners in the CES group reported that the intervention was helpful. Patients in the CES and PES groups increased their PAP adherence over the first month of treatment, whereas PAP adherence decreased over this period in the UC group. For patients, large to medium effects for sleep quality ( d  = -1.01), daytime sleepiness ( d  = -0.51), and daytime function ( d  = 0.51) were found for the CES group. The PES and UC groups effect sizes were large to small for sleep quality ( d  = -0.94; d  = -0.40), daytime sleepiness ( d  = -0.42; d  = -0.82), and daytime function ( d  = 0.41; d  = 0.57), respectively. For partners, large effects for daytime sleepiness ( d  = -1.31) and daytime function ( d  = 1.54) and small to medium effect for sleep quality ( d  = -0.31) were found for the CES group. Worsening of sleep quality ( d  = 0.65) and no change in daytime sleepiness or daytime function were found for the PES group. For the UC group, medium to large effects were found for sleep quality ( d  = -0.77), daytime sleepiness ( d  = -0.77), and daytime function ( d  = 0.65). Conclusions : The findings of this pilot study provide support for taking a couples intervention approach to improve PAP adherence.

Objective : The present study examined how the different attributes of daily social interactions (quality and quantity) were associated with physical health, and how these associations vary with age. Method : Using an ecological momentary assessment approach, participants from an adulthood lifespan sample ( n = 172; aged 20-79 years) reported their social interactions five times daily, and physical symptoms and symptom severity at the end of each day, for one week. Main outcome measures: Number of physical symptoms and physical symptom severity. Results: There was a within-person main effect of the quality (positivity), but not the quantity (frequency), of social interactions on the number of reported physical symptoms and their severity. Moderation analyses further revealed that the quality of daily social interactions predicted fewer physical symptoms for older adults, but not for younger adults; in contrast, the frequency of social interactions predicted less severe physical symptoms for younger adults, but not for older adults. Finally, the reported severity of physical symptoms predicted less frequent but more positive social interactions the next day. Conclusions: Our findings point to the bidirectional associations between social interactions and health and highlight the importance of considering individuals' developmental context in future research and interventions.

Objectives: Childhood abuse has long-term negative effects on adult psychological well-being. This study examined whether and how adults with a history of childhood abuse may experience poor psychological functioning partly due to aspects of current family relationships., Method: We estimated multilevel mediation models using 3 waves of longitudinal data from 3,487 participants in the study of Midlife Development in the United States. Outcomes measured included negative affect, life satisfaction, and psychological well-being. We included aspects of family relationships as mediators: perceived support, perceived strain, frequency of contact, and hours of providing instrumental and emotional support., Results: Multilevel mediation models showed that childhood verbal and physical abuse negatively affected diverse aspects of family relationships in later adulthood (i.e., less perceived support, more perceived strain, less frequent contact, and fewer hours of providing instrumental support). We also found that less perceived support and more family strain significantly mediated the associations between childhood abuse and all 3 psychological functioning outcomes., Discussion: Childhood abuse appears to hinder perceived availability of family support in adulthood, which may undermine the psychological functioning of adults with a history of childhood abuse. To improve their psychological health, interventions should focus on facilitating supportive and functional family relationships., (© The Author(s) 2018. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Sedentary behavior (SB), which has been linked with numerous adverse health outcomes, is prevalent among adults with osteoarthritis (OA). The associations between SB and daily physical and psychological health outcomes for OA patients, however, have received little attention., Purpose: Using accelerometer and self-report data, the current study examined how the amount of time OA patients spent in SB was associated with their pain and affect in daily life, independent of physical activity., Methods: Over 22 days, 143 older adults (mean age = 65 years) with knee OA wore an accelerometer to measure SB and physical activity, and also reported their pain and affect three times a day using a handheld computer. Multilevel analyses were conducted to examine the prospective within-person associations between SB and subsequent pain or affect within the same day and across days, independent of physical activity., Results: The time spent in SB daily predicted less pain but worse affect at the end of that day, above and beyond the effects of physical activity, as well as demographics and individual differences in general health and depression. Moreover, cross-day lagged analyses indicated that time spent in SB on 1 day predicted higher negative affect the next morning. Finally, the average level of SB was also associated with worse average affect at the between-person level., Conclusions: SB may be related to less pain in the short term but detract from patients' emotional well-being. Future intervention should aim to reduce daily SB to improve OA patients' emotional well-being., (© Society of Behavioral Medicine 2018. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The current study tested the hypotheses that knee osteoarthritis (OA) patients and spouses who report more spousal understanding of patient's pain would report greater marital satisfaction. A total of 124 couples completed interviews at three time points across 18 months. Results from dyadic analyses showed that patients who felt more understood by their spouse report, and have spouses who report, higher marital satisfaction concurrently. In addition, patients who felt more understood by their spouse reported higher marital satisfaction over time. Spouses' reports of understanding also had a significant influence on the patients' and their own marital satisfaction concurrently. Results highlight the importance of spouses understanding knee OA patients' pain for both dyad members' marital satisfaction.

Introduction: Spousal caregivers face increased cardiovascular risks; lab studies suggest that autonomic reactivity to patients' physical suffering may play a role. To evaluate this mechanism in daily life, our pilot study characterized the feasibility of recruiting couples for a multimethod, in-home assessment. We examined the usability of the resulting data in an effort to link spousal cardiovascular changes to patient pain expression during couples' everyday interactions., Method: For two 48-hr periods, individuals with rheumatoid arthritis (RA) and their partners wore heart monitors while audio-recordings captured couples' in-home interactions. Interbeat intervals were subsetted in 1-, 2-, and 5-min windows before and after each pain expression. Pre-post difference scores in high-frequency heart rate variability (HF-HRV) and heart rate were examined., Results: Of the 17 screened RA patients, 11 were ineligible, and 3 partners declined. The 3 participating couples completed all study activities. The resulting 288 hr of recordings were coded for patients' RA symptom expression, which varied from none to an average of 11 times daily. One couple had sufficient data for physiological analysis: Contrary to prediction, spouse HF-HRV significantly increased after patient symptom expression., Conclusions: Recruitment rates mirrored other couples studies, and enrolled couples complied with study procedures. In-home conversations were reliably coded and successfully linked to spousal ongoing cardiovascular activity. Preliminary findings highlight the importance of optimal sampling windows and suggest symptom expression as a relevant process for some spouses but not others. We offer recommendations for efficiently scaling up the method in future studies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Background: Greater marital quality is associated with better psychological and physical health. The quality of daily marital interactions is likely to be especially important for individuals with chronic illness, but this question has received little attention., Purpose: Using data from two diary studies, the current study examined whether individuals with chronic illness would experience more severe symptoms on days with more marital tension due in part to greater negative affect on those days., Methods: The samples included individuals with knee osteoarthritis (OA, N = 145) or type 2 diabetes mellitus (T2DM, N = 129) and their spouses. Participants reported on daily marital interaction quality, affect, and symptom severity (patients only) for 22 days (knee OA) or 24 days (T2DM). Separate multilevel models were run for patients and spouses, controlling for the partner's marital tension and negative affect as well as both partners' daily marital enjoyment and positive affect. We examined same-day and across-day associations., Results: For individuals with T2DM or knee OA, more severe symptoms on days with more marital tension were due in part to their greater negative affect on those days. Individuals with knee OA who experienced more pain had more negative affect and marital tension the next day., Conclusions: Negative marital interactions may exacerbate physical symptoms. Effects of daily marital tension likely accumulate over time and have long-term implications for health.

Prevailing research has suggested that social relationships get better with age, but this evidence has been largely based on studies with lengthy reporting intervals. Using an ecological momentary assessment approach, the present study examined age differences in several characteristics of social interactions as reported in near-real time: the frequency, quality, and partner type. Participants (N = 173) ages 20-79 years reported their social interactions at 5 random times throughout the day for 1 week. Results revealed that age was associated with higher frequency of interacting with family and lower frequency of interacting with peripheral partners. These age effects, however, became nonsignificant after accounting for contextual factors such as race, gender, education, employment status, family structure, and living arrangement. In contrast, a curvilinear relationship best characterized age differences in both positive and negative ratings of daily social interaction quality, with middle-aged adults reporting the lowest positive ratings and older adults reporting the lowest negative ratings among all ages. Contextual factors did not account for these patterns of age differences in interaction quality. Furthermore, the intraindividual variability of interaction frequency with peripheral partners, partner diversity, and interaction quality (positivity and negativity) was lower among older adults than among younger adults. Findings from the present study portray a nuanced picture of social interactions in daily life and advance the understanding of social interactions across the life span. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

This study examined two types of illness-related communication (disclosure and holding back) and their associations with psychological adjustment and marital satisfaction in patients with knee osteoarthritis (OA) and their spouses. A sample of 142 couples reported on disclosure and holding back of OA-related concerns, marital satisfaction, and depressive symptoms at two time points across 1 year. Results from dyadic analyses indicated that holding back was associated with decreases in one's own marital satisfaction for patients and spouses and increases in one's own depressive symptoms for spouses over 1 year. In addition, increases in disclosure were associated with increases in marital satisfaction for patients and spouses over time. Holding back and disclosure did not have significant interpersonal effects on the partner's psychological adjustment or marital satisfaction. These results provide support for the hypothesized intrapersonal effects of disclosure and holding back on marital satisfaction and psychological adjustment over time for both OA patients and their spouses, and highlight the importance of open communication for dyadic coping among couples dealing with chronic illness. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Objectives: For most partnered adults, sleep is not an individual-level behavior-it is a shared health behavior with a partner. This study examined whether perceived nightly sleep duration and sleep quality covaried within couples and whether the unique influence of partner sleep on individual sleep differed by gender., Design: Eight consecutive days of diary data., Participants: US hotel employees and their spouses/partners (N=76 from 38 couples, 600 daily observations)., Measurements: Each day, couples separately reported their previous night's sleep duration (in hours) and sleep quality (1=very unsatisfactory to 5=very satisfactory). Analyses adjusted for sociodemographic, family, work, and day-level characteristics., Results: Dyadic multilevel modeling revealed positive covariation in nightly sleep duration within couples. After controlling for the effects of contextual covariates, partner influence on individual sleep duration was more apparent in men's sleep. When a female's sleep duration was longer or shorter than usual, their male partner's sleep duration was also longer or shorter than usual, respectively. However, a female's sleep was not significantly predicted by her male partner's sleep duration after taking into account the effects of her sleep on the male partner's sleep and contextual covariates. Sleep quality covaried on average across days between partners, and this association did not differ by gender., Conclusions: Our results demonstrate positive covariation in sleep duration and sleep quality within couples. Couples' sleep duration covaried night-to-night, and their sleep quality covaried on average across days. A male's sleep duration is predicted by the female partner's sleep duration but not vice versa. Future research should examine health consequences of couple sleep covariation., (Copyright © 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.)

Depression is associated with disturbances to sleep and the 24-h sleep-wake pattern (known as the rest-activity rhythm: RAR). However, there remains a need to identify the specific sleep/RAR correlates of depression symptom severity in population subgroups, such as strained dementia caregivers, who are at elevated risk for major depressive disorder. We assessed the cross-sectional associations of sleep/RARs with non-sleep depression symptom severity among 57 (mean age: 74 years, standard deviation: 7.4) strained dementia caregivers who were currently without clinical depression. We derived sleep measures from polysomnography and actigraphy, modelled RARs using a sigmoidally transformed cosine curve and measured non-sleep depression symptom severity using the Hamilton Depression Rating Scale (HRDS) with sleep items removed. The following sleep-wake measures were associated with greater depression symptom severity (absolute Spearman's correlations ranged from 0.23 to 0.32): more time awake after sleep onset (WASO), higher RAR middle level (mesor), relatively shorter active periods (alpha), earlier evening settling time (down-mesor) and less steep RARs (beta). In multivariable analysis, high WASO and low RAR beta were associated independently with depression symptom severity. Predicted non-sleep HDRS means (95% confidence intervals) in caregivers with and without these characteristics were: normal WASO/beta = 3.7 (2.3-5.0), high WASO/normal beta = 5.5 (3.5-7.6), normal WASO/low beta = 6.3 (3.6-8.9) and high WASO/low beta = 8.1 (5.3-10.9). Thus, in our sample of strained caregivers, greater sleep fragmentation (WASO) and less sustained/sharply segregated resting and active periods (low RAR beta) correlate uniquely with depression symptom severity. Longitudinal studies are needed to establish whether these independent sleep-wake correlates of depression symptoms explain heightened depression risk in dementia caregivers., (© 2017 European Sleep Research Society.)

Objective: The present study aimed to clarify the circumstances under which activity restriction (AR) is associated with depressive symptoms among patients with osteoarthritis (OA) and their spouses., Method: A total of 220 older adults with OA and their caregiving spouses participated in the study. The actor-partner interdependence model (APIM) was used to examine the associations between AR stemming from patients' OA and the depressive symptoms of patients and spouses. The potential moderating role of marital satisfaction also was examined., Results: After accounting for pain severity, health, and life stress of both patients with OA and spouses, higher AR was associated with more depressive symptoms for both patients and spouses. In regard to partner effects, patients whose spouse had higher AR reported more depressive symptoms. In addition, the association of spouses' and patients' AR and their own depressive symptoms was moderated by their marital satisfaction. For both patients and spouses, the associations between their own AR and depressive symptoms were weaker for those with higher levels of marital satisfaction compared with those with lower levels of marital satisfaction., Discussion: This pattern of findings highlights the dyadic implications of AR and the vital role of marital satisfaction in the context of chronic illness.

Self-management of a chronic illness involves not only monitoring symptoms, adhering to medication regimens, and keeping medical appointments but also making and maintaining difficult lifestyle changes. This article highlights correlational and intervention research suggesting family members are influential in children's and adults' illness management. The argument is made that a dyadic approach to chronic illness management that targets the influence of close relationships may yield more sustainable effects on patient behavior than has been achieved in the past. In particular, dyadic approaches aimed at helping patients and family members to find ways to collaborate in goal setting for these behaviors is recommended. Such dyadic interventions may also benefit family members who are ill or are at risk because of poor health behaviors. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)