Daily Marital Tension and Symptom Severity in Older Adults With Diabetes or Osteoarthritis.

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.

Spouse confidence and physical function among adults with osteoarthritis: The mediating role of spouse responses to pain.

Objective: This study of adults with osteoarthritis and their spouses examined spouse responses to patients' pain as mediators of the associations between spouse confidence in patients' ability to manage arthritis and improvements in patients' physical function and activity levels over time.

Method: Participants were 152 older adults with knee osteoarthritis and their spouses. In-person interviews were conducted with patients and spouses (separately) at 3 time points: baseline (Time[T] 1), 6 months after baseline (T2), and 18 months after baseline (T3).

Too much of a good thing? Overexertion of self-control and dietary adherence in individuals with Type 2 diabetes.

Objectives: The resource model of self-control posits that self-control is a finite resource that can be depleted. Individuals with diabetes must continually restrict their diet, requiring self-control. As a result, dietary adherence is difficult, and lapses are common.

Effects of change in arthritis severity on spouse well-being: The moderating role of relationship closeness.

The severity of a patient's illness may be detrimental for the psychological well-being of the spouse, especially for those in a particularly close relationship. Using 2 waves of data collected from a sample of 152 knee osteoarthritis (OA) patients and their spouses, we examined associations between change in patients' illness severity and change in 3 indicators of spouses' well-being (positive affect, depressive symptoms, and life satisfaction) over a 6-month period. We also tested the hypothesis that spouses' perceived relationship closeness with the patient would moderate these associations.

Emotional reactivity to daily stress, spousal emotional support, and fasting blood glucose among patients with type 2 diabetes.

Stress is associated with higher blood glucose in patients with diabetes, but the strength of this association varies considerably across patients. The current daily diary study of 129 patients with type 2 diabetes examined whether individual differences in emotional stress reactivity were associated with fasting blood glucose and whether emotional support provided by spouses moderated this association. Greater stress reactivity was related to greater variability in patients' fasting glucose readings and, among patients with less support, to higher fasting glucose levels.

Spouse confidence in self-efficacy for arthritis management predicts improved patient health.

Background: In addition to patient self-efficacy, spouse confidence in patient efficacy may also independently predict patient health outcomes. However, the potential influence of spouse confidence has received little research attention.

Purpose: The current study examined the influence of patient and spouse efficacy beliefs for arthritis management on patient health.

Spouses' involvement in their partners' diabetes management: associations with spouse stress and perceived marital quality.

Spouses frequently attempt to influence (control) or support their chronically ill partners' adherence behaviors. Studies have documented effects of spousal control and support on chronically ill individuals, but little is known about how these two forms of involvement in a partner's disease management may be associated with spouses' stress or the quality of their interactions with their ill partners. The current study sought to address this gap by examining spouses' day-to-day involvement in their marital partner's management of type 2 diabetes (n = 129).

The impact of daily arthritis pain on spouse sleep.

Although chronic pain has been linked to poorer psychosocial well-being in the spouse, the extent to which patient pain affects spouse sleep is unknown. The aim of the present study was to test the hypothesis that greater daily knee pain would be associated with poorer sleep for the spouse that evening. We also tested the hypothesis that this pain contagion is exacerbated in couples who have a close relationship.

Daily verbal and nonverbal expression of osteoarthritis pain and spouse responses.

The current study applied a model of pain communication to examine the distinction between verbal and nonverbal pain expression in their prediction of punishing, empathic, and solicitous spouse responses to patient pain. It was hypothesized that on days when patients engaged in more nonverbal expression, spouses would respond more positively (ie, with less punishing and more solicitous and empathic behavior). The same pattern was predicted for verbal expression.

Daily spousal influence on physical activity in knee osteoarthritis.

Background: Physical activity is critical for the management of knee osteoarthritis, and the spouse may play a role in encouraging or discouraging physical activity.

Purpose: The purpose of this study was to examine four types of spousal influence-spouses' daily activity, autonomy support, pressure, and persuasion-on the daily physical activity of adults living with knee osteoarthritis.

Methods: A total of 141 couples reported their daily experiences for 22 days using a handheld computer and wore an accelerometer to measure moderate activity and steps.

Spouse Control and Type 2 Diabetes Management: Moderating Effects of Dyadic Expectations for Spouse Involvement.

For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes (N = 139 couples) from the perspectives of the patient and spouse. Partners' dyadic expectations and spouses' gender were posited to moderate spouses' diet-related control and patients' diet adherence.

Spouses' attempts to regulate day-to-day dietary adherence among patients with type 2 diabetes.

Objective: To investigate daily dietary adherence and diabetes-specific distress among older adults with type 2 diabetes mellitus (T2DM) as a function of spouses' diet-related support and diet-related control (persuasion and pressure) and whether these daily processes differ among couples who do and do not appraise responsibility for managing T2DM as shared.

Methods: End-of-day diaries were completed by 126 couples in which one partner had T2DM (patient) and the other did not (spouse). Using electronic diary methods, each partner independently recorded data for 24 consecutive days (patients recorded their day's dietary adherence and diabetes-specific distress; spouses recorded their day's involvement in patients' dietary management).

Influences of spousal support and control on diabetes management through physical activity.

Objectives: Spouses may be involved in their partner's diabetes management by providing social support to affirm healthy behaviors and social control to modify health behaviors. Yet, investigations of the influence of spousal involvement on daily patient health behaviors are limited. In daily diaries, we investigated how spousal support and control independently and jointly influence patient physical activity and efficacy to engage in physical exercise on a daily basis.

Older adults' beliefs about the timeline of type 2 diabetes and adherence to dietary regimens.

The common-sense model posits that behavioural coping with illness is shaped by a complex combination of individuals' abstract and concrete beliefs about their illness. We investigated this theoretical assumption in a study of 116 older adults diagnosed with type 2 diabetes who completed in-person interviews at baseline and six and 12 months later. Specifically, we examined (1) the interaction of patients' abstract and concrete beliefs about the timeline of their diabetes as a predictor of change in adherence to a healthy diet and (2) whether these interactive effects differ among male and female patients.

Setbacks in diet adherence and emotional distress: a study of older patients with type 2 diabetes and their spouses.

Objectives: We investigated patients' difficulties in managing their diet (i.e. diet setbacks) and associations with change in disease-specific and general emotional distress (diabetes distress and depressive symptoms) among patients with type 2 diabetes and their spouses.

When does Spousal Social Control Provoke Negative Reactions in the Context of Chronic Illness?: The Pivotal Role of Patients' Expectations.

Spouses often monitor and seek to alter each other's health behavior, but such social control attempts can provoke behavioral resistance and emotional distress. Expectations regarding spouses' roles in their partners' health may influence reactions to spousal social control, with resistance and hostility less likely to occur among people who believe spouses should be involved in their partners' health. Evidence consistent with this idea emerged in a study of 191 patients with type 2 diabetes.

Independence centrality as a moderator of the effects of spousal support on patient well-being and physical functioning.

Objective: In this study, we examined whether the benefits of spousal assistance for patient well-being and physical functioning depend on the fit between amount of assistance provided and the personal importance of completing activities independently.

Methods: Individuals with osteoarthritis of the hip or knee were assessed for independence centrality, depressive symptoms, self-efficacy for managing pain, and physical functioning (N = 159 to 230). Spouses reported the amount of support provided with daily tasks.

Are spouses of chronically ill partners burdened by exerting health-related social control?

Spouses often seek to influence the health behaviors of chronically ill partners, but little research has examined whether spouses find such involvement to be burdensome. The current study examined this question in a sample of 191 nondiabetic spouses whose partners had type 2 diabetes. Results revealed that spouses who attempted to exert more control over their partners' dietary behavior experienced greater burden, particularly when their partners exhibited poor dietary adherence and reacted negatively to spouses' involvement.

Spouses use of social control to improve diabetic patients' dietary adherence.

We investigated two types of negative and positive social control strategies, warning and encouragement, used by spouses to urge patients with type II diabetes to improve adherence to the diabetic diet. Warning refers to things a spouse may say or do to caution the patient about the consequences of eating a poor diet, and encouragement refers to things a spouse may say or do to promote healthier food choices by the patient. Our dyadic design (n=109 couples) assessed spouses' use of warning and encouragement (reported by spouses and by patients), as well as patients' reports of dietary adherence.

When the going gets tough, does support get going? Determinants of spousal support provision to type 2 diabetic patients.

Although spousal support has been linked to positive outcomes in various health-related contexts, some research has found that the amount of social support provided to those who are chronically ill deteriorates over time. The current study refines the literature by considering multiple factors associated with spouses' provision of emotional support to partners with Type 2 diabetes. This diary study (N = 126 couples) examined the roles that stressor (disease severity and diabetes-specific anxiety), recipient (negative and positive affect), provider (negative and positive affect), and relationship (tension and enjoyment) factors play in spouses' provision of emotional support.

Spousal support following knee surgery: roles of self-efficacy and perceived emotional responsiveness.

Objective: The objective was to investigate self-efficacy to manage recovery from surgery and perceptions of the spouse's emotional responsiveness of adults recovering from knee surgery as mediators of the association between the quality of support from the spouse following surgery and recovery outcomes.

Research Method: In-person interviews of married older adults (N = 134) with osteoarthritis of the knee who underwent total knee replacement surgery were conducted at 1 month before surgery, 1 month after surgery, and at 3 months after surgery.

Main Outcome Measures: Outcomes were knee limitations and depressive symptoms.

Spouses' use of pressure and persuasion to promote osteoarthritis patients' medical adherence after orthopedic surgery.

Objective: The authors investigated health-related effects of social control (influence) that spouses exert in relation to osteoarthritis patients' medical adherence after total knee replacement surgery. Patients' behavioral and emotional responses to control were examined as mediators of associations between spouses' use of two control strategies (pressure, persuasion) and patients' physical and psychological recovery.

Design: The authors used a three-wave panel design with assessments at one month before surgery, 1 month and 3 months after surgery.

Impact of adult day services on behavioral and psychological symptoms of dementia.

Purpose: This study explored whether adult day service (ADS) use was associated with reductions in behavioral and psychological symptoms of dementia (BPSD) in individuals with dementia.

Design And Methods: We used a quasi-experimental design to compare a group of 133 persons with dementia (PWDs) who initially enrolled in an ADS program to a control group not using these services (n = 68). Caregivers used a 24-hour log on multiple, consecutive days to report on five domains of BPSD.

The caregiver stress process and health outcomes.

Objective: The authors examine the impact of two caregiving stressors, care receivers' behavior problems (an objective stressor) and caregivers' feelings of overload (a subjective stressor), on three dimensions of caregiver health.

Method: The participants were 234 primary caregivers of elderly relatives with dementia living in the community who completed a comprehensive interview about their current care situation, including stressors and health.

Results: Higher levels of both objective and subjective stressors were associated with all three dimensions of caregiver health: poorer self-reported health, more negative health behaviors, and greater use of health care services.

Spouses' provision of health-related support and control to patients participating in cardiac rehabilitation.

The authors examined spouses' provision of health-related support and control as predictors of health behavior and mental health among patients participating in cardiac rehabilitation (N = 94 couples). Cross-sectional analyses revealed that spouses' support was positively associated with patient health behavior. Prospective analyses of change over 6 months (N = 65 couples) revealed that spouses' support predicted increased patient mental health, whereas spouses' control predicted decreased patient health behavior and mental health.