Bad marriage, broken heart? Age and gender differences in the link between marital quality and cardiovascular risks among older adults

Marital Quality-A Neglected Player in the Prevention of Cardiovascular Diseases: A Systematic Review of Longitudinal Studies

PURPOSE OF REVIEW

Marital quality (MQ) is a psychosocial factor that has been neglected in cardiovascular prevention guidelines, although its association with cardiovascular diseases has been identified in several studies. Therefore, we aim to investigate how MQ either in positive or negative dimensions affect different cardiovascular risk factors and diseases.

RECENT FINDINGS

We systematically searched different databases in September 2023 for longitudinal studies conducted to assess the contribution of MQ to well-established cardiovascular risk factors and diseases. Two independent researchers screened studies and carried out data extraction and quality assessment of included ones. From 12,175 potential studies screened, 40 were included. The presence of significant heterogeneity in methodology, follow-up, and subsequent effect estimates made it unfeasible to do a meta-analysis. Despite the variation, most studies found a significant association of negative MQ measures with physical inactivity (2/2), high levels of smoking (4/5) and alcohol (3/3) use, increased metabolic syndrome risk (3/3), elevated type 2 diabetes mellitus (T2DM) risk and poor T2DM management (3/6), elevated cardiovascular disease risk and progression (9/11), increased body weight and obesity risk (2/3), elevated blood pressure and hypertension risk (7/8). Positive MQ measures were mainly associated with improvement in blood pressure control (2/2), reduced T2DM risk and its good management (1/1), reduced body weight and obesity risk (2/2), and increased survival in cardiovascular diseases (4/4). Based on current evidence, MQ seems to play a crucial role in developing established cardiovascular risk factors and diseases and is worth considering in preventive strategies.

The Role of Psychosocial Stress on Cardiovascular Disease in Women: JACC State-of-the-Art Review

Psychosocial stress can affect cardiovascular health through multiple pathways. Certain stressors, such as socioeconomic disadvantage, childhood adversity, intimate partner violence, and caregiving stress, are especially common among women. The consequences of stress begin at a young age and persist throughout the life course. This is especially true for women, among whom the burden of negative psychosocial experiences tends to be larger in young age and midlife. Menarche, pregnancy, and menopause can further exacerbate stress in vulnerable women. Not only is psychosocial adversity prevalent in women, but it could have more pronounced consequences for cardiovascular risk among women than among men. These differential effects could reside in sex differences in responses to stress, combined with women's propensity toward vasomotor reactivity, microvascular dysfunction, and inflammation. The bulk of evidence suggests that targeting stress could be an important strategy for cardiovascular risk reduction in women.

A tale of two marital stressors: Comparing proinflammatory responses to partner distress and marital conflict

Marital quality shares ties to inflammatory conditions like cardiovascular disease and diabetes. For decades, research has focused on marital conflict as a primary mechanism given its potential to trigger inflammatory responses. However, longitudinal evidence suggests that marital conflict declines over time, and little attention has been paid to the inflammatory aftermath of other types of marital exchanges. A spouse's emotional distress is an important but overlooked marital context, as partners are exposed to each other's upsetting emotions throughout adulthood. To directly compare reactivity in proinflammatory gene expression to these two marital stressors and to examine differences by age and marital satisfaction, 203 community adults ages 25-90 (N = 102 couples) provided blood samples and rated their negative mood before and after they 1) watched their partner relive an upsetting personal memory and, in a separate visit 1-2 weeks later, 2) discussed a conflictual topic in their relationship. Controlling for age, sex, race/ethnicity, BMI, alcohol use, smoking, and comorbidities, increases in proinflammatory gene expression were significantly larger after the partner's upsetting disclosure than after marital conflict (B = 0.073, SE = 0.031, p = .018). This pattern paralleled emotional reactivity to the tasks, wherein negative mood rose more in response to the partner's disclosure than to marital conflict (B = 4.305, SE = 1.468, p = .004). In sum, proinflammatory and mood reactivity to spousal distress exceeded reactivity to marital conflict, a well-established marital stressor. Findings reveal spousal distress as a novel mechanism that may link marriage to inflammation-related diseases, and even pose risks for both happy and unhappy couples across adulthood.

Longitudinal Associations of Family Relationship Quality With Chronic Pain Incidence and Persistence Among Aging African Americans

OBJECTIVES

This study examines how family relationships convey risk or resilience for pain outcomes for aging African Americans, and to replicate and extend analyses across 2 nationally representative studies of aging health.

METHODS

African American participants in Midlife in the United States (MIDUS, N = 755) and the Health and Retirement Study (HRS, N = 2,585) self-reported chronic pain status at 2006 waves and then again 10 years later. Logistic regression was used to estimate the odds of pain incidence and persistence explained by family, intimate partner, and parent-child strain and support, as well as average support and average strain across relationships.

RESULTS

On average, MIDUS participants were younger (M = 52.35, SD = 12.06; 62.1% female) than HRS (M = 66.65, SD = 10.92; 63.7% female). Family support and average support were linked to decreased odds of pain incidence in MIDUS, but only when tested without accounting for strain, whereas parent-child strain was a risk factor for pain incidence in HRS, as was average strain. Family support protected against pain persistence in MIDUS, whereas average support was linked to reduced odds of pain persisting in HRS.

DISCUSSION

Chronic pain outcomes are worse for African Americans for a number of reasons, but parent-child strain may contribute to the risk of new pain developing over time for older adults. Conversely, family support may offer a protective benefit for pain incidence and persistence among aging African Americans. Findings implicate family relationships as a potential target of pain management interventions.

Perceived Discrimination and Incident Dementia Among Older Adults in the United States: The Buffering Role of Social Relationships

OBJECTIVES

Recent studies have found that perceived discrimination as a chronic stressor predicts poorer cognitive health. However, little research has investigated how social relationships as potential intervening mechanisms may mitigate or exacerbate this association. Using a nationally representative sample of U.S. older adults, this study examined how the existence and quality of 4 types of relationships-with a partner, children, other family members, and friends-may modify the impact of perceived discrimination on incident dementia.

METHODS

We analyzed data from the 2006 to 2016 Health and Retirement Study (N = 12,236) using discrete-time event history models with competing risks. We used perceived discrimination, social relationships, and their interactions at the baseline to predict the risk of incident dementia in the follow-ups.

RESULTS

Perceived discrimination predicted a higher risk of incident dementia in the follow-ups. Although having a partner or not did not modify this association, partnership support attenuated the negative effects of discrimination on incident dementia. Neither the existence nor quality of relationships with children, other family members, or friends modified the association.

DISCUSSION

Our findings imply that intimate partnership plays a critical role in coping with discrimination and, consequently, influencing the cognitive health of older adults. Although perceived discrimination is a significant risk factor for the incidence of dementia, better partnership quality may attenuate this association. Policies that eliminate discrimination and interventions that strengthen intimate partnerships may facilitate better cognitive health in late life.

Qualities of Older Adults' Family and Friendship Relationships and Their Association with Life Satisfaction

While family and friendship relationship qualities are associated with life satisfaction, evidence on how these types of relationships interact to contribute to older adults' life satisfaction is sparse. This study examined how family and friendship relationship qualities may be supportive of (compensatory) or conflict with (competing) older adults' life satisfaction. We adopted a cross-sectional design to analyze data from the Health and Retirement Study (n = 1178, females = 54.8%, mean age = 67.9 years, SD = 9.3 years) to examine compensatory (as in social support) and competing (as in social strain) qualities of family and friendship social relationships and their association with life satisfaction in older adults. For greater explanatory power, we also controlled for life satisfaction by sociodemographic variables of age, gender, education, self-reported general health, physical health and activity, depression, and personality traits. Our findings indicate that the spouse/partner support relationship contributes to older adults' life satisfaction overall and is associated with greater social support and less social strain. Friendship support is associated with improved life satisfaction for older adults reporting spouse/partner strain. Relationship support for the life satisfaction of older adults should consider their need for social support from their social network while minimizing the risk of social strain from adversarial relationships in life situations.

Marital Status and Happiness During the COVID-19 Pandemic

Objective

This study examines the long-observed marital advantage in happiness during the COVID-19 pandemic.

Background

The COVID-19 pandemic may have altered the marital advantage in happiness due to changes in social integration processes. However, this has not been explored in previous studies.

Method

Data were from the COVID-19 substudy of the National Social Life, Health, and Aging Project (N=2622). A series of regressions were estimated to understand marital status differences in pandemic happiness and changes in relationships with non-resident family and friends. Karlson-Holm-Breen mediation analysis was conducted to examine whether relationships with non-resident family and friends explained the marital association with pandemic happiness.

Results

From pre-pandemic to pandemic, married respondents experienced a greater increase in unhappiness than unmarried counterparts, narrowing happiness gaps. However, unmarried individuals, including cohabiting, divorced, widowed, and never married individuals, continued to report higher levels of unhappiness during the pandemic than married peers. These differences primarily stemmed from pre-pandemic happiness. After controlling for pre-pandemic happiness, cohabiting, widowed, and never married older adults did not significantly differ from their married counterparts in reporting unhappiness during the pandemic. In contrast, divorced individuals remained consistently more unhappy than married individuals during the pandemic, mainly due to deteriorated relationship quality with non-resident family.

Conclusion

During a global crisis, it is crucial for policymakers, healthcare providers, and researchers to develop innovative interventions to promote happiness and healthy aging among all older adults, paying special attention to those who are divorced.

Couple differentiation and health-related quality of life

The purpose of this study was to examine whether couple differentiation influenced mental and physical health-related quality of life in couple members. Data for this study were derived from a larger study at a couple a family therapy clinic. One hundred and thirty-three couples were included in a latent profile analysis, and seventy-two couples were included in analyses of mean differences. The latent profile analysis resulted in three distinct groups by level of couple differentiation: high, moderate, or low in differentiation of self. Analyses of variance indicated evidence that couple differentiation influenced health-related quality-of-life measures. Findings are discussed in the context of Bowen Family Systems Theory and the existing literature.

The influence of parents' and partner's education on own health behaviours

The link between educational attainment and multiple health behaviours has been explained in various ways. This paper provides new insights into the social patterning in health behaviours by investigating the influence of parents' and partners' educational attainments on a composite indicator that integrates the four commonly studied lifestyle behaviours (smoking, alcohol, physical activity and BMI). Two key outcome indicators of interests were created to reflect both ends of the "healthy - unhealthy spectrum". Data was drawn from The Tromsø Study, conducted in 2015/16 (N = 21,083, aged 40-93 years). We controlled for two indicators of early life human capital and one personality trait variable. Partners' education attainments are relatively more important for avoiding unhealthy behaviour than choosing healthy behaviour; on the contrary, parents' education is more important for healthy behaviour. Heterogeneity by sex and age was also evident. The influences of partner's education on widening the socioeconomic contrasts in health behaviours were much stronger in the younger (40-59 years) age group. In conclusion, our results support the hypothesis that own health behaviour is affected by the educational attainments of our 'nearest and dearest' (i.e. spouse, mother, and father), net of own education. This study facilitates a better understanding of education-health behaviours nexus from a life course perspective and supports the importance of family-based interventions to improve healthy behaviours.

A national longitudinal dyadic analysis of spousal education and cognitive decline in the United States

Education plays a significant role in shaping cognitive functioning throughout an individual's life. However, existing research has not adequately explored how the educational attainment of the spouse can impact cognitive functioning over time. This study presents one of the first longitudinal analyses of how spousal education is linked to cognitive trajectories of each member within couples during their later life in the United States. Guided by the linked lives perspective, we analyze data from 8370 couples in the Health and Retirement Study spanning from 2000 to 2018. Results from the Actor-Partner Interdependence Model (APIM) integrated with latent growth curve models reveal that cognitive trajectories exhibit a correlation between spouses over time. Moreover, our analysis uncovers gender-specific effects of spousal education on cognition, shedding light on the underlying mechanisms driving this connection. Notably, the lower educational attainment of husbands is associated with a faster cognitive decline in both themselves and their wives. This association is partially explained by economic resources, but not by health and social behaviors. The lower educational attainment of wives is linked to their own faster cognitive decline as well as lower initial cognitive levels of their husbands, in part via economic resources. However, wives' educational attainment is largely unrelated to their husbands' cognitive decline. Intriguingly, wives' education has a more pronounced impact on the health and social behaviors of their husbands than vice versa, although these health and social behaviors do not appear to influence husbands' cognitive decline. In conclusion, these results underscore the importance of considering spousal education in comprehending the complexities of cognitive decline within dyadic relationships.

Gender differences in social networks and physical and mental health: are social relationships more health protective in women than in men?

Background

Individuals' relationships are characterized by multidimensional aspects and the unique make-up of different features is more or less supportive of physical and mental health. The current study derived social network types based on an extended set of indicators reflecting the structure, function, and quality of relationships, then examined their associations with diverse physical and mental health outcomes separately for men and women.

Methods

Using samples of 620 South Korean adults (Mage = 53.52), Latent Profile Analysis (LPA) was used to uncover distinct social network types, and multiple regression analyses were conducted to examine the link between network types and health outcomes.

Results

LPA analysis derived four network types: diversified, family-(un)supported, friend- based, and restricted. The prevalence and configuration of network types differed between men and women: the family-unsupported type was more prevalent in women than in men whereas the restricted type was more prevalent in men than in women. An individual's network type membership was significantly associated with one's physical and mental health and the positive effects of an optimal network type and the negative effects of a non-optimal network type on mental health were much greater for women than they were for men.

Discussion

The findings suggest that women benefit more from supportive networks but that they are also more vulnerable to a lack of supportive (or the presence of conflict-filled) relationships, and highlight that having diversified and greater quality relationships, and avoiding conflicts are critical for women to have enhanced health.

Partnership status and positive DNA methylation age acceleration across the adult lifespan in the UK

Although a significant body of research has shown that married people are healthier and live longer, empirical research on sex differences in the link between marital status and health suggests results are mixed. Moreover, the sex disparities in marital status and health relationships vary across adulthood. The literature on partnership status and measures of ageing is largely focused on older age groups and is limited in its view of early adulthood. Data from waves 2 and 3 (2010-2012) of Understanding Society: UKHLS were used to examine the association of current partnership status with epigenetic age acceleration (AA) assessed with DNA methylation (DNAm) algorithms 'Phenoage' and ' DunedinPACE ' in 3492 participants (aged 16-97). Regression models were estimated separately for men and women, and further stratified by age groups. Divorced/separated and widowed people showed positive age acceleration compared to the married/cohabiting people (reference group). Some sex differences were apparent, especially, among the single and divorced/separated groups. Age differences were also apparent, for example in men, being single was negatively associated with DNAmAA in the youngest group, but positively in the oldest group compared to partnered counterparts. These findings illustrate the importance of partnerships on the ageing process, in particular marital change through divorce and widowhood for positive age acceleration in adults. For single groups, observations were heterogenous by age and sex.

Psychometric properties of dyadic data from the Marital Quality Scale of Indonesian Javanese couples

BACKGROUND

Researchers have demonstrated that various measurement concepts and dimensions depend on context and timing.

OBJECTIVES

The current study aimed to determine the psychometric properties of the Javanese couples' marital quality scale based on validity and reliability METHODS: In total 840 participants or 420 marital dyad from Java, Indonesia, were involved in this study. The psychometrics properties scale was analyzed using exploratory and confirmatory factor analysis, convergent and discriminant analysis, and composite reliability.

RESULTS

The exploratory factor analysis found relationship quality to consist of support, physical proximity, warmth, communication, acceptance and respect, role sharing, and responsibility factors. Well-being quality consists of happiness, harmony, and problem-solving. The fit of the measurement model was obtained using confirmatory factor analysis. The fit model was also found in the husband's and wife's groups, with no differences between them. The high correlations between wife-husband factors also proved the validity based on convergent and discriminant evidence. The reliability coefficient was high for each dimension and construct.

DISCUSSION

This analysis shows that the marital quality scale developed has information on psychometric properties that can be useful for researchers and the practicians using the marital quality instrument of Javanese couples in particular.

Impact of Marital Stress on 1-Year Health Outcomes Among Young Adults With Acute Myocardial Infarction

Background Stress experienced in a marriage or committed relationship may be associated with worse patient-reported outcomes after acute myocardial infarction (AMI), but little is known about this association in young adults (≤55 years) with AMI. Methods and Results We used data from VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), an observational cohort study that enrolled individuals aged 18 to 55 years with AMI (2008-2012). Marital stress was self-reported 1 month after AMI using the Stockholm Marital Stress Scale (categorized as absent/mild, moderate, and severe). Outcomes were physical/mental health (Short Form-12), generic health status (EuroQol-5 Dimensions), cardiac-specific quality of life and angina (Seattle Angina Questionnaire), depressive symptoms (Patient Health Questionnaire-9), and all-cause readmission 1 year after AMI. Regression models were sequentially adjusted for baseline health, demographics (sex, age, race or ethnicity), and socioeconomic factors (education, income, employment, and insurance). Sex and marital stress interaction was also tested. Among 1593 married/partnered participants, 576 (36.2%) reported severe marital stress, which was more common in female than male participants (39.4% versus 30.4%, P=0.001). Severe marital stress was significantly associated with worse mental health (beta=-2.13, SE=0.75, P=0.004), generic health status (beta=-3.87, SE=1.46, P=0.008), cardiac-specific quality of life (beta=-6.41, SE=1.65, P<0.001), and greater odds of angina (odds ratio [OR], 1.49 [95% CI, 1.06-2.10], P=0.023) and all-cause readmissions (OR, 1.45 [95% CI, 1.04-2.00], P=0.006), after adjusting for baseline health, demographics, and socioeconomic factors. These associations were similar across sexes (P-interaction all >0.05). Conclusions The association between marital stress and worse 1-year health outcomes was statistically significant in young patients with AMI, suggesting a need for routine screening and the creation of interventions to support patients with stress recovering from an AMI.

Marital Status Differences in Loneliness Among Older Americans During the COVID-19 Pandemic

Guided by the social integration perspective, we conducted one of the first population-based studies on marital status differences in loneliness during the COVID-19 pandemic among older Americans. Analysis of data from the 2020 National Health and Aging Trends Study COVID-19 supplement (n = 2861) suggested that, compared to their married counterparts, divorced and widowed older adults reported higher levels of loneliness during the pandemic, and divorced older adults also felt lonely more often when compared to before the pandemic. These marital status differences in pandemic loneliness cannot be explained by changes in social participation (e.g., working for pay, volunteering, attending religious services, or attending clubs, classes, or other organized activities) or changes in contact frequency with family and friends (via phone calls, emails/texts/social media messages, video calls, or in-person visits). No gender difference was found in the association between marital status and loneliness during the pandemic. These results, coupled with the growth of the unmarried older population, highlight that policymakers, health care providers, and researchers should think creatively about ways to reduce the loneliness gap between married and unmarried groups to promote healthy aging for all older adults, particularly in the face of emerging pandemics that may complicate strategies to improve population health in the future.

Marital Histories and Associations With Later-Life Dementia and Mild Cognitive Impairment Risk in the HUNT4 70+ Study in Norway

Objectives: Earlier studies suggest that being married in later life protects against dementia, and that being single in old age increases the risk of dementia. In this study, we examine midlife marital status trajectories and their association with dementia and mild cognitive impairment (MCI) at ages 70 plus using a large population based sample from Norway. Methods: Based on a general population sample linked to population registries (N = 8706), we used multinomial logistic regression to examine the associations between six types of marital trajectories (unmarried, continuously divorced, intermittently divorced, widowed, continuously married, intermittently married) between age 44 and 68 years from national registries and a clinical dementia or a MCI diagnosis after age 70. We estimated relative risk ratios (RRR) and used mediation analyses adjusting for education, number of children, smoking, hypertension, obesity, physical inactivity, diabetes, mental distress, and having no close friends in midlife. Inverse probability weighting and multiple imputations were applied. The population attributable fraction was estimated to assess the potential reduction in dementia cases due to marital histories. Results: Overall, 11.6% of the participants were diagnosed with dementia and 35.3% with MCI. Dementia prevalence was lowest among the continuously married (11.2%). Adjusting for confounders, the risk of dementia was higher for the unmarried (RRR = 1.73; 95% CI: 1.24, 2.40), continuously divorced (RRR = 1.66; 95% CI: 1.14, 2.43), and intermittently divorced (RRR = 1.50; 95% CI: 1.09, 2.06) compared to the continuously married. In general, marital trajectory was less associated with MCI than with dementia. In the counterfactual scenario, where all participants had the same risk of receiving a dementia diagnosis as the continuously married group, there would be 6.0% fewer dementia cases. Discussion: Our data confirm that staying married in midlife is associated with a lower risk of dementia and that divorced people account for a substantial share of dementia cases.

Neighborhood socioeconomic position, living arrangements, and cardiometabolic disease among older Puerto Ricans: An examination using PREHCO 2002-2007

Cardiometabolic diseases are among the leading causes of mortality worldwide and are increasingly prevalent in rapidly aging populations. Neighborhood socioeconomic position (SEP) and living arrangements are increasingly recognized as important determinants of cardiometabolic health but have not been examined within Puerto Rico. This study examined the association between neighborhood SEP, living arrangements, and incidence of cardiometabolic conditions among island-dwelling older Puerto Ricans, using longitudinal data from the Puerto Rican Elderly Health Conditions Project (Waves I 2002/03 and II 2006/07) linked with 2000 Census data for neighborhood-level conditions. Our sample consists of non-institutionalized adults aged 60 and older who remained in the same residence over both waves of data collection (N = 2,769). We used multilevel multinomial logistic regression models to examine the relationship between neighborhood SEP and the prevalence and incidence of cardiometabolic disease. Findings show that residence in a socioeconomically advantaged neighborhood was positively associated with reporting having one cardiometabolic condition at baseline, but not associated with the incidence of cardiometabolic conditions at follow-up. Living without a partner was negatively associated with reporting having cardiometabolic conditions compared to living with a partner. Similar results were found for the incidence of cardiometabolic conditions. Living arrangements significantly modified the relationship between neighborhood SEP and cardiometabolic conditions. Compared to living with a partner, living alone in a socioeconomically advantaged neighborhood was associated with a reduced risk of reporting having one condition. Living with children in a socioeconomically advantaged neighborhood was associated with a reduced risk of developing one cardiometabolic condition than living with a partner. Living arrangements are more salient to cardiometabolic health than neighborhood SEP. Social programs and services focused on household composition and familial support are needed to identify older Puerto Ricans potentially at risk of underdiagnosed chronic conditions, especially as ongoing economic, demographic, environmental, and healthcare crises potentially exacerbate social inequalities.

Your suffering is my stressor: Proinflammatory gene expression rises with spousal distress in middle-aged and older couples

Marital quality shares ties to inflammation-related conditions like cardiovascular disease and diabetes. Lab-based studies implicate hostility during marital conflict as a mechanism via inflammatory reactivity, but little attention has been paid to the inflammatory aftermath of other marital exchanges. A spouse's emotional distress is an important but overlooked context for middle-aged and older couples, as conflict declines and networks shrink. To examine the links of spousal distress to changes in proinflammatory gene expression, 38 adults ages 40-81 witnessed their spouse relive an upsetting personal memory aloud, rated their mood before and after, and provided blood samples at baseline and twice post-task; they also shared their own upsetting memory and discussed a marital problem in the interim. Those whose spouse disclosed their upsetting memory with greater emotional intensity showed larger elevations in proinflammatory gene expression 30-40 min and 80-90 min after the task. The association replicated for listeners whose negative mood increased more in response to spousal disclosure. Findings were robust to behavior in the other emotional tasks, race, gender, age, alcohol, smoking, comorbidities, and sagittal abdominal diameter. These novel results identify spousal distress as a key marital context that may escalate inflammation-related health risks.

All-cause mortality risk for men and women in the United States: the role of partner's education relative to own education

This study examines the association between educational attainment, relative to that of an intimate partner, and all-cause mortality for men and women in different-sex relationships. Research suggests some health benefits for partnered adults that arise from economic benefits and improved access to health-promoting tools. One way these benefits could be gained is through the pairing of the highly educated. While high individual educational attainment lowers mortality risk, less is known about the risks of mortality associated with one's education, relative to their partner's education. Using National Health Interview Survey Linked Mortality Files (NHIS-LMF) for the years 1999-2014 with prospective mortality follow-up through December 2015 (N = 347,994), we document the association between relative educational attainment and mortality for men and women with different-sex partners in the United States. Fully adjusted Cox proportional hazard models revealed a higher risk of all-cause mortality for men and women who have more education than their partner, relative to those having the same education as their partner. For women only, having less education than their male partner was associated with a lower risk of all-cause mortality. A better understanding of relative status within different-sex partnerships provides insights into partnered adult's mortality risks.

A National Study of Marital Status Differences in Early Uptake of COVID-19 Vaccine among Older Americans

We provide one of the first nationally representative studies to examine COVID-19 vaccine uptake differences by marital status within the first year after the vaccine was recommended among older Americans. Data were drawn from the National Health and Aging Trends Study (2021). The study sample included 3180 participants aged 65 and older with 1846 women and 1334 men. Results from logistic regression models suggest that divorced/separated older adults were less likely to receive at least one dose of the COVID-19 vaccine in 2021 than their married counterparts, especially among women and individuals with higher education. Widowed and never married respondents were generally not significantly different from married respondents in COVID-19 vaccination status, with only one exception: less-educated never-married respondents were more likely to receive COVID-19 vaccination than their less-educated married counterparts. Our study highlights divorce/separation as a significant social factor associated with COVID-19 vaccine uptake among older adults in the U.S. These findings suggest that divorced/separated older adults are the most vulnerable population segment at risk of low COVID-19 vaccine uptake. Future efforts to improve vaccine equity and uptake should target this group specifically, with tailored interventions to increase their access and uptake of the vaccine.

Marital negativity's festering wounds: The emotional, immunological, and relational toll of couples' negative communication patterns

BACKGROUND

Dyadic stress theories and research suggest that couples' negative communication patterns threaten immune and emotional health, leaving partners vulnerable to illness. Spouses' relationship perceptions can also color how they see and react to marital discussions. To identify pathways linking distressed marriages to poor health, this study examined how self-reported typical communication patterns augmented discussion-based behavioral effects on spouses' blister wound healing, emotions, and discussion evaluations.

METHODS

Married couples completed two 24-hour in-person visits where they had their blood drawn to measure baseline interleukin-6 (IL-6), received suction blister wounds, reported their typical communication patterns (demand/withdraw strategies, mutual discussion avoidance, mutual constructive communication), and engaged in marital discussions. Discussions were recorded and coded for positive and negative behaviors using the Rapid Marital Interaction Coding System (RMICS). Immediately after the discussions, spouses rated their emotions and evaluated the discussion tone and outcome. Wound healing was measured for 12 days.

RESULTS

Couples who reported typically using more demand/withdraw or mutual avoidance patterns had higher baseline IL-6, slower wound healing, greater negative emotion, lower positive emotion, and poorer discussion evaluations. In contrast, couples reporting more mutual constructive patterns reported more favorable discussion evaluations. Additionally, couples' more negative and less positive patterns exacerbated behavioral effects: Spouses had wounds that healed more slowly, reported lower positive emotion, and evaluated the discussions less positively if their typical patterns and discussion-based behaviors were more negative and less positive.

CONCLUSIONS

Couples' typical communication patterns-including how often they use demand/withdraw, mutual avoidance, and mutual constructive patterns-may color spouses' reactions to marital discussions, amplifying the biological, emotional, and relational impact. These findings help explain how distressed marriages take a toll on spouses' health.

The impact of hearing loss on trajectories of depressive symptoms in married couples

Hearing loss is a prevalent chronic stressor among older adults and is associated with numerous adverse health outcomes. The life course principle of linked lives highlights that an individual's stressors can impact the health and well-being of others; however, there are limited large-scale studies examining hearing loss within marital dyads. Using 11 waves (1998-2018) of the Health and Retirement Study (n = 4881 couples), we estimate age-based mixed models to examine how 1) one's own hearing, 2) one's spouse's hearing, or 3) both spouses' hearing influence changes in depressive symptoms. For men, their wives' hearing loss, their own hearing loss, and both spouses having hearing loss are associated with increased depressive symptoms. For women, their own hearing loss and both spouses having hearing loss are associated with increased depressive symptoms, but their husbands' hearing loss is not. The connections between hearing loss and depressive symptoms within couples are a dynamic process that unfolds differently by gender over time.

"We've Got This": Middle-Aged and Older Couples' Satisfying Relationships and We-Talk Promote Better Physiological, Relational, and Emotional Responses to Conflict

OBJECTIVE

Conflict poses multiple relational and health risks. Dyadic stress theories suggest satisfaction and communication alter cardiovascular and autonomic function, key pathways from troubled relationships to poor health. However, "we-talk," a positive communication pattern, can strengthen relationships and promote health. We examined how each spouse's satisfaction and we-talk were related to conflict's physiological, relational, and emotional toll.

METHODS

Married couples ( n = 107 couples, 214 individuals, ages 40-87 years) who were mostly White, highly educated, and higher-income Americans in different-gender relationships engaged in 20-minute conflict discussions while wearing monitors to assess heart rate variability (HRV). Spouses rated their closeness immediately after conflict and their conflict rumination 2 hours later. Conflict transcriptions measured we-talk, or the proportion of first-person plural pronouns (we, us, our).

RESULTS

Satisfied spouses or those in mutually satisfying relationships had higher HRV during conflict ( b = 0.0001, p = .049), felt closer immediately after conflict ( b = 0.07, p < .001), and ruminated less about the conflict 2 hours later ( b = -0.26, p = .026). Spouses' HRV was highest ( b = 0.0002, p = .002) and rumination was lowest ( b = -0.49, p = .019) when they or their partners were satisfied and used we-talk more often. Women's HRV ( b = 0.0001, p = .035) and rumination ( b = -0.01, p = .02) benefited when both spouses were satisfied, as did closeness when women were satisfied ( b = 0.10, p < .001). Men's closeness benefited when they ( b = 0.04, p = .003) or their wives ( b = 0.04, p = .002) were satisfied.

CONCLUSIONS

The combination of mutually satisfying relationships and we-talk was associated with better relational and health outcomes after conflict. These findings are important for middle-aged and older couples whose relationships are central to their health.

A Cohort Comparison of Midlife Marital Quality: A Quarter Century of Change

Marital quality has been declining among recent cohorts, but whether this pattern characterizes middle-aged and older married adults is largely unknown. The doubling of the divorce rate among persons over the age of 50 years foretells poorer quality marriages for today's midlife adults than a generation ago. Combining data on married individuals aged 50-65 years from the 1987-88 National Survey of Families and Households (NSFH) and the 2013 Families and Relationships Study, we conduct a cohort comparison of five dimensions of midlife marital quality. Today's older adults report more marital disagreement and instability as well as less fairness and interaction with their spouses than their counterparts did a generation ago. The two cohorts report comparable levels of marital happiness. Consistent with the upward trend in divorce during the second half of life, the quality of midlife marriages appears to have declined over the past quarter century.

Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The writing panel comprised experts with diverse geographic representation, including multidisciplinary health care providers, a policy-maker, and patient partners. The guideline was developed in accordance with Appraisal of Guidelines for Research and Evaluation (AGREE) II and the Reporting Items for practice Guidelines in HealTh care (RIGHT). Initial recommendations were on the basis of a meta-analysis. These were circulated to a Delphi panel (comprised of corresponding authors from review articles and of programs delivering women-focused CR identified through ICCPR's audit; N = 76), who were asked to rate each on a 7-point Likert scale in terms of impact and implementability (higher scores positive). A Web call was convened to achieve consensus; 15 panelists confirmed strength of revised recommendations (Grading of Recommendations Assessment, Development, and Evaluation [GRADE]). The draft underwent external review from CR societies internationally and was posted for public comment. The 14 drafted recommendations related to referral (systematic, encouragement), setting (model choice, privacy, staffing), and delivery (exercise mode, psychosocial, education, self-management empowerment). Nineteen (25.0%) survey responses were received. For all but 1 recommendation, ≥ 75% voted to include; implementability ratings were < 5/7 for 4 recommendations, but only 1 for effect. Ultimately 1 recommendation was excluded, 1 separated into 2 and all revised (2 substantively); 1 recommendation was added. Overall, certainty of evidence for the final recommendations was low to moderate, and strength mostly strong. These recommendations and associated tools can support all programs to feasibly offer some women-focused programming.

Association between living arrangements and cognitive decline in older adults: A nationally representative longitudinal study in China

BACKGROUND

Living arrangements are critical to the survival and well-being of older people, especially in China where the filial piety culture demands adult children care for and serve their parents. The study aimed to explore the association between living arrangements and cognitive decline among older people in China.

METHODS

Participants included 6,074 older adults over 60 years old (49.65% male, mean age 67.2 years [range 60-98]) from four waves (2011-2018) of the China Health and Retirement Longitudinal Study. Two to four assessments were conducted over a follow-up of an average of 5.3 years (range, 2-7). Cognitive function was assessed using an adapted Chinese version of Mini-Mental State Examination (MMSE). Living arrangements were classified as follows: living alone, living with spouse, living with adult children, living with spouse and adult children and living with others. Multilevel models were used to investigate the relationship between living arrangements and cognitive decline, as well as the gender difference.

RESULTS

As the main type of living arrangements of the study participants (44.91%), living with spouse was taken as the reference group. Compared to the reference group, living alone (β=-0.126, P < 0.001), living with adult children (β=-0.136, P < 0.001), living with spouse and adult children (β=-0.040, P < 0.05) and living with others (β=-0.155, P < 0.05) were all related to a faster rate of cognitive decline. Further, the association between living arrangements and cognitive decline varied by gender. Living alone (β=-0.192, P < 0.001) was associated with a faster cognitive decline only in older men. Living with spouse and adult children (β=-0.053, P < 0.05) and living with others (β=-0.179, P < 0.05) were associated with faster cognitive decline only in older women.

CONCLUSION

This study suggests that living arrangements in older people in China were associated with cognitive decline, and these associations varied by gender. Greater attention to living arrangements might yield practical implications for preserving the cognitive function of the older population.

Association of marital status with cognitive function in Chinese hypertensive patients: a cross-sectional study

PURPOSE

The aim of this study was to evaluate the association of marital status with cognitive function and to examine the potential effect modifiers in Chinese hypertensive populations.

METHODS

A total of 9,525 adult Chinese hypertensive patients were enrolled in this cross-sectional study. Cognitive function, as the dependent variable in our study, was assessed by the Chinese version of the Mini-Mental State Examination (MMSE). We adjusted for potential confounding factors in multiple linear regression models to examine the relationship of marital status with cognitive function. In addition, we divided the population according to sex to explore whether there were sex-specific differences.

RESULTS

Among the 9,525 study participants, the mean (SD) age for men was 63.5 (10.3) years, and the mean MMSE score was 24.9 ± 5.0, whereas for women, the mean (SD) age was 63.8 (9.3) years, and the mean MMSE score was 19.4 ± 6.4. Unmarried persons had lower scores on the MMSE and lower subscores in each of the cognitive domains. A stronger correlation between marital status and a lower MMSE score was statistically significant in men (unmarried men: β = -1.55; 95% CI: -1.89, -1.21) but not women (unmarried women: β = -0.22; 95% CI: -0.56, 0.12; p interaction = 0.006). Compared to men who were widowed or divorced, never married men were more likely to have lower MMSE scores (β = -2.30, 95% CI -3.10,-1.50; p < 0.001).

CONCLUSIONS

Our study demonstrated that being unmarried is an extremely important but neglected social risk factor for cognitive function. Sex was a strong effect modifier: being unmarried was correlated with a higher risk of cognitive decline than being married in Chinese hypertensive men, especially among older men, but this correlation was not observed among women. Moreover, never married men showed poorer cognitive function than those who were divorced or widowed.

Association between zinc deficiency and cognitive decline in community-dwelling older adults

This is a cross-sectional study evaluating the association between zinc deficiency and cognitive decline in 591 community-dwelling older adults living in the cities of Campinas, Limeira, and Piracicaba-SP. Cognitive status was evaluated using the Cognitive Abilities Screening Instrument-CASI-S, considering a decline for scores <23 for those aged 60-69 and <20 for those aged ≥70 years. Among the evaluated cognitive domains, older adults with zinc deficiency had significantly lower mean scores on the memory test (p=0.018). For zinc deficiency, values below 70 µg/dL were considered for women and 74 µg/dL for men. The prevalence of zinc deficiency was 3.9%, and cognitive deficit was 9.4%, being significantly higher in those with zinc deficiency compared with those with normal serum zinc concentrations. In adjusted multiple logistic regression analysis, the factors that remained associated with cognitive decline were zinc deficiency (OR=3.80; 95%CI=1.30-11.12), low schooling level (OR=3.12; 95%CI=1.49-6.50), lack of a partner (OR=1.88; 95%CI=1.04-3.42), risk of malnutrition (OR=3.98; 95%CI=2.36-6.71), and a history of encephalic vascular accident (OR=2.70; 95%CI=1.04-6.98). Zinc deficiency was associated with the presence of cognitive decline in older adults. Actions in primary health care are necessary to prevent the deficiency of this nutrient.

The Impact of Marital Quality as Older Couples Adjust to Dementia Onset

OBJECTIVES

A burgeoning literature links being married to better cognitive health, but less attention has been paid to how couples view their marital relationships. Couples do not always concur in their assessments, and such discrepancies affect both partners' health. We present a dyadic study on whether and how overall and discrepant views of marital quality predicted (a) dementia onset and (b) changes in older adults' depressive symptoms with spousal dementia.

METHODS

A pooled sample of couples aged 50+ (dyad N = 3,936) from the Health and Retirement Study rated positive and negative marital quality at baseline (2006/2008). Each participant reported whether they had been told of having dementia and their depressive symptoms once every other year (2006/2008-2014/2016).

RESULTS

Cox proportional hazards regression revealed that older adults who rated their marriages either more positively or more negatively than their spouses were more likely to develop dementia. We applied multiphase growth curve modeling to older adults whose spouses developed dementia, finding that those in marriages that were more negative overall reported more depressive symptoms but exhibited a smaller increase in these symptoms in response to spousal dementia.

DISCUSSION

This study adds to the literature by showing how discrepant marital assessments shape cognitive aging and offers new insights into identifying older adults with greater dementia risk. Findings also revealed the impact of overall negative marital quality on older adults' psychological adjustment to spousal dementia, which could inform interventions intended to help couples better cope with early-stage dementia from a relational perspective.

Is Marital Quality Related to Physical Activity Across the Life Course for Men and Women?

OBJECTIVES

Although physical activity is linked to multiple health outcomes, a majority of Americans do not meet physical activity guidelines, often with precipitous declines among older adults. Marital quality is a less-explored, but important, factor that may influence physical activity, as spouses often influence each other's health behaviors.

METHODS

We use nationally representative panel data to investigate whether positive and negative dimensions of marital quality influence physical activity, and whether age and gender moderate these relationships.

RESULTS

We find that both marital support and strain are related to higher odds of more frequent active exercise and walking, pointing to the complex influence of marital quality. Marital support became increasingly important to higher levels of walking frequency as men aged.

DISCUSSION

This study provides new information on the ways in which both positive and negative dimensions of marital quality may contribute to trajectories of physical activity across the life course.

Alcohol Use and Blood Pressure Among Older Couples: The Moderating Role of Negative Marital Quality

OBJECTIVES

Spouses often have concordant drinking behaviors and important influences on one another's cardiovascular health. However, little is known about the implications of dyadic drinking patterns for blood pressure, and the marital factors that confer risk or resilience. This article examined links between alcohol use and blood pressure within individuals and opposite-sex couples over time, and whether those links vary by negative marital quality among older adults.

METHODS

Participants were from the nationally representative longitudinal Health and Retirement Study that included 4,619 respondents in 2,682 opposite-sex couples who participated in at least 2 of the waves from 2006 to 2016. Participants reported the number of drinks they typically consume per week, negative marital quality, and had their blood pressure measured via a cuff.

RESULTS

Analyses revealed that greater drinking was associated with increased systolic blood pressure among both husbands and wives. Furthermore, husbands who drank more had higher blood pressure when wives drank more alcohol, whereas there was no association between husbands' drinking and blood pressure when wives drank less alcohol. Interactions with negative marital quality showed that drinking concordance may be associated with increased blood pressure over time in more negative marriages.

DISCUSSION

Findings indicated that spousal drinking concordance, although often associated with positive marital quality, may have negative long-term health effects.

Examining the impact of socioeconomic status, demographic characteristics, lifestyle and other risk factors on adults' cognitive functioning in developing countries: an analysis of five selected WHO SAGE Wave 1 Countries

BACKGROUND

Though extensive studies have been conducted on assessing the predictors of cognitive functioning among older adults in small community-based samples, very few studies have focused on understanding the impact of socioeconomic status (SES), demographic characteristics and other risk factors such as lifestyle and chronic diseases on the cognitive functioning among adults of all ages in a nationally representative population-based sample across low- and middle-income countries. This study, therefore, seeks to evaluate the impact of SES, demographic characteristics and risk factors on the cognitive functioning of adults across all ages in five selected developing countries.

METHODS

Data from 12,430 observations obtained from the WHO Study on Global AGEing and Adult Health (SAGE) Wave 1; consisting of 2,486 observations each for China, Ghana, India, the Russian Federation, and South Africa, were used for the study. A meta-regression and a five-step hierarchical linear regression were used to analyze the data, with cognitive functioning as the dependent variable. Independent variables used in this study include SES; assessed by household income and education, demographic characteristics, other risk factors such as lifestyle, self-reported memory difficulty and chronic diseases.

RESULTS

This study found that SES and lifestyle significantly predicted cognitive functioning in all the five selected countries as obtained by the pooled results of the meta-regression analysis. The hierarchical linear regression results also revealed that demographic characteristics such as age, type of residency, and self-reported memory difficulty significantly impact cognitive functioning in China, Ghana, Russia, and South Africa.

CONCLUSION

The findings in this study provide new insights for policymakers, caregivers, parents, and individuals, especially those in developing countries, to implement policies and actions targeted at improving SES and eliminating risk factors associated with cognitive decline, as these measures could help improve the cognitive functioning among their populations.

Investigating the incidence and risk factors of hypertension: A multicentre retrospective cohort study in Tabuk, Saudi Arabia

Background

Hypertension is a major global health concern affecting approximately 1.13 billion people worldwide, with most of them residing in developing countries. The aim of this study was to determine the incidence of different stages of hypertension and its associated modifiable and non-modifiable risk factors among patients in military-setting hospitals in Tabuk, Saudi Arabia.

Methods

This retrospective cohort study was conducted at two hospitals in Tabuk, Saudi Arabia. The data were collected from hospital electronic records from 1 January 2019 to 31 December 2019. The blood pressure levels of patients from the last three separate medical visits were recorded. Descriptive statistics and multinomial logistic regression were used for the data analysis.

Results

The study included 884 hypertensive patients. The incidences of stage of elevated BP, stage 1, stage 2, and hypertension crisis were 60.0, 29.5, 7.0, and 3.5 cases per 1000 persons. Multivariate analysis indicated that progression from the stage of elevated blood pressure to hypertension crisis was significantly associated with advanced age (odds ratio [OR] = 3.62, 95% confidence interval [CI] = 1.99–8.42), male sex (OR = 2.84, 95% CI: 0.57–5.92), and a positive family history of hypertension (OR = 1.95, 95% CI: 1.23–3.09). Other key determinants of the development of stage of elevated blood pressure to hypertension crisis were current smoking status (OR = 1.74, 95% CI: 1.23–4.76), and physical inactivity (OR = 6.48, 95% CI: 2.46–9.14).

Conclusion

The incidence stage of elevated blood pressure was high among the patients investigated at armed forces hospitals in Tabuk, Saudi Arabia. The logistic regression model proposed in the present study can be used to predict the development of different stages of hypertension. Age, sex, marital status, family history, smoking status, and physical activity play an important role in the development of hypertension. Better strategies to improve awareness, screening, treatment, and management of hypertension are required in Saudi Arabia.

Association between zinc deficiency and cognitive decline in community-dwelling older adults

Abstract This is a cross-sectional study evaluating the association between zinc deficiency and cognitive decline in 591 community-dwelling older adults living in the cities of Campinas, Limeira, and Piracicaba-SP. Cognitive status was evaluated using the Cognitive Abilities Screening Instrument-CASI-S, considering a decline for scores <23 for those aged 60-69 and <20 for those aged ≥70 years. Among the evaluated cognitive domains, older adults with zinc deficiency had significantly lower mean scores on the memory test (p=0.018). For zinc deficiency, values below 70 µg/dL were considered for women and 74 µg/dL for men. The prevalence of zinc deficiency was 3.9%, and cognitive deficit was 9.4%, being significantly higher in those with zinc deficiency compared with those with normal serum zinc concentrations. In adjusted multiple logistic regression analysis, the factors that remained associated with cognitive decline were zinc deficiency (OR=3.80; 95%CI=1.30-11.12), low schooling level (OR=3.12; 95%CI=1.49-6.50), lack of a partner (OR=1.88; 95%CI=1.04-3.42), risk of malnutrition (OR=3.98; 95%CI=2.36-6.71), and a history of encephalic vascular accident (OR=2.70; 95%CI=1.04-6.98). Zinc deficiency was associated with the presence of cognitive decline in older adults. Actions in primary health care are necessary to prevent the deficiency of this nutrient.

Social Health in the National Social Life, Health, and Aging Project

OBJECTIVES

In this article, we present the theoretical framework that guided the development of the National Social Life, Health, and Aging Project (NSHAP) including the measures of social health. We discuss the literature that links social measures to other outcomes, and we discuss in detail how researchers might construct common measures of social health, including those that reflect social relationships, sexuality, social networks, social resources, and social participation.

METHODS

The NSHAP includes multiple detailed measures of social health, collected in the rounds of data collection carried out in 2005, 2010, and 2015, allowing for study of changes over time and as people age among a nationally representative sample of the community-dwelling population of older adults in the United States.

RESULTS

We define indicators of social health, describe measures of each in the 2015 round of NSHAP, and show the distribution of the measures by gender and age. We present scales of dimensions of social health that have been developed elsewhere and describe their properties.

DISCUSSION

We briefly discuss the distribution of these measures by age and gender in the 2015 round of NSHAP. Simple analyses of these categorized measures reveal differences by age and gender that deserve closer attention in future investigations using the NSHAP data.

Couple Analysis in the National Social Life, Health, and Aging Project

OBJECTIVES

Marital and intimate partner relationships are some of the most important social ties that shape older adults' health and well-being. This paper provides analytic guidelines for the couple data in Round 2 (2010-2011) and Round 3 (2015-2016) of the National Social Life, Health, and Aging Project (NSHAP) to encourage more research on marriage and partnership in late life.

METHOD

First, we describe the recruitment of couples and outline how to identify partners in the data sets. Second, we provide descriptive information about the couple sample. Third, we offer guidance for analyzing the dyadic data cross-sectionally and longitudinally.

RESULTS

Round 2 interviewed all primary respondents and a sample of their current cohabiting partners and spouses (n = 955 couples). In Round 3, NSHAP reinterviewed the primary respondents and partners who participated in Round 2 (Cohort 1; n = 621 couples) and recruited a new sample of age-eligible adults along with any cohabiting romantic partners (Cohort 2; n = 766 couples). Couples can be identified using a household ID variable in Round 2 and a partner ID variable in Round 3. Demographic characteristics of the couple sample vary by round and cohort.

DISCUSSION

Researchers can use data from either round to conduct cross-sectional dyadic analyses to examine issues faced by older couples. A common strategy for couple analysis is the actor-partner interdependence model. With 2 rounds of couple-level data, researchers may consider using cross-lagged models in their research.

Marital Strain and Support and Subjective Well-Being in Later Life: Ascribing a Role to Childhood Adversity

Objectives: We integrate the life course perspective with the stress-process model to offer a framework for how childhood conditions moderate the relationship between marital support/strain and subjective well-being in older adulthood for men and women. Methods: Drawing on longitudinal data from the National Social Life, Health, and Aging Project (NSHAP), we use a series of lagged dependent-variable models and stratify the sample by gender. Results: Our results suggest that the benefits associated with greater marital support are stronger for those that did not live with both parents in childhood for men. Women raised in families that experienced financial hardship reported lower subjective well-being in the context of marital strain. Conclusion: Adverse experiences in childhood can be scarring or foster resilience related to well-being in the context of strained or supportive marriages.

Local Ties in the Social Networks of Older Adults

OBJECTIVES

Family members and friends who live nearby may be especially well-positioned to provide social support and companionship for community-residing older adults, but prior research has not examined the distribution and characteristics of local ties in older adults' networks. We hypothesize that local ties are newer, more frequently accessed, and more embedded in the network, and that social disadvantage and neighborhood conditions structure older adults' access to local ties.

METHODS

We use egocentric network data from 15,137 alters named by 3,735 older adults in Wave 3 of the National Social Life, Health, and Aging Project (NSHAP). We conduct dyadic analysis to compare characteristics of local and nonlocal ties. Logistic regression models estimate how personal and neighborhood characteristics are associated with naming local kin and local non-kin ties.

RESULTS

Nearly half of the older adults named at least one local network tie, and about 60% of these local ties are non-kin. Local ties are newer, frequently accessed, and highly embedded in older adults' networks. Local kin ties are most common among socially disadvantaged older adults. Local non-kin ties are most common among white older adults and those who live in areas with high levels of collective efficacy, although local non-kin ties are also associated with residence in high-poverty neighborhoods.

DISCUSSION

Local ties may bring unique benefits for community-residing older adults, but their availability is likely structured by residential mobility, neighborhood context, disparities in resources, and support needs. Future research should consider their implications for health and well-being.

Couple Religiosity and Well-Being Among Older Adults in the United States

Objectives: This article evaluates whether couples' religious similarity is consequential for the health of older married men and women. Alternatively, we examine whether women's religiosity alone is health-protective to their husbands. Methods: Using dyadic data from the US National Social Life, Health, and Aging Project, a representative sample of 913 individuals ages 62-91 plus their marital partners, we perform latent-class analysis to separate older couples into classes based on religious characteristics. Ordered logistic regression models are then used to assess whether different combinations of religious (dis)similarity are associated with married men and women's well-being. Results: We find that older women in highly religious, homogamous marriages report better mental and physical health relative to women in heterogamous and secular (non-religious) marriages. No significant associations were observed for men. Discussion: Our results emphasize that religiosity is not only an individual trait-dis/similarities within a couple have important implications for older women's well-being.

Marital status differences in suicidality among transgender people

The suicide rate for transgender people is among the highest of any group in the United States. Yet, we know little about disadvantages or resources available to transgender people to prevent suicide. The overall purpose of this study is to assess how marital status modifies the risk of suicide among transgender people. We analyzed data from the 2015 U.S. Transgender Survey to predict marital status differences in both suicide ideation and suicide attempt in the past year. The analytic sample for suicide ideation included 17,117 transgender respondents (9,182 transwomen and 7,935 transmen), and the analytic sample for suicide attempt was limited to 8,058 transgender respondents (4,342 transwomen and 3,716 transmen) who reported suicide ideation in the last 12 months. Results from binary logistic regression models suggested that never married and previously married transmen and transwomen, regardless of their partnership status, generally had higher risk of both suicide ideation and attempt than their married transgender counterparts with only one exception: never married transwomen had lower risk of suicide ideation (but not attempt) than their married transwomen counterpart after sociodemographic characteristics were accounted for. These findings draw attention to the heterogeneity of the transgender population, highlighting marital status as a key social factor in stratifying the life experiences of transgender people.

Own health, spousal health and transitions in loneliness among middle-aged and older adults in China

This study examines the effects of own and spousal health on transitions in loneliness over time among married middle-aged and older adults in China, and explores the possible gender differences in these effects using data from the three waves of the China Health and Retirement Longitudinal Study (2011–2015). The sample includes 6,422 men and 6,391 women who were married and aged 45 and older at the baseline survey. Middle-aged and older adults with poorer physical and emotional health statuses are more likely to transition into and less likely to transition out of loneliness in a two-year period. Spouse's emotional health also affects both types of transition in loneliness and spouse's functional limitation affects transition into loneliness through spouse's emotional health. In addition, for married men, their own functional limitation is significantly associated with their transitions into and out of loneliness. For married women, their spouse's functional limitation is significantly associated with their transition into loneliness and this is mainly through its association with spouse's emotional health. Also, for married women, their spouse's emotional health is significantly associated with their transition out of loneliness. Social interventions to reduce feelings of loneliness need to take a couple approach and consider both spouses’ health problems and how they may affect their daily activities and their interactions with each other and with others.

Social Cost and Health: The Downside of Social Relationships and Social Networks

The research tradition on social relationships, social networks, and health dates back to the beginning of sociology. As exemplified in the classic work of Durkheim, Simmel, and Tönnies, social relationships and social networks play a double-edged-protective and detrimental-role for health. However, this double-edged role has been given unbalanced attention. In comparison to the salubrious role, the deleterious role has received less scrutiny and needs a focused review and conceptual integration. This article selectively reviews the post-2000 studies that demonstrate the harmful physical and mental health consequences of social relationships (intimate relationships and parenthood) and social networks. It uses a parsimonious three-category typology-structural forms, structural composition, and contents-to categorize relationship and network properties and proposes the social cost model, in contrast to the social resource model, to synthesize and integrate the adverse aspects of these properties. It concludes with future research directions.

Study protocol for the Exercising Together© trial: a randomized, controlled trial of partnered exercise for couples coping with cancer

BACKGROUND

Most cancer survivors are married, and cancer strains the physical and mental health of each partner and their intimate relationship. We created a partnered strength training program, Exercising Together©, where the survivor and his/her partner exercise as a team in order to improve physical and mental health of both members of the couple as well as the quality of their relationship. We have not yet determined if Exercising Together© is similarly effective in couples coping with different types of cancer nor if training as a team has unique and added benefits over those derived from supervised group training and/or shared behavior change. The purpose of this study is to determine the unique benefits of Exercising Together© on physical, mental, and relational health in couples coping with breast, prostate, or colorectal cancer.

METHODS

Survivors of prostate, breast and colorectal cancer (N = 294, 98 per cancer site) and their intimate, co-residing partners are recruited to participate in a single-blind, parallel group, randomized trial comparing three exercise groups that train twice per week for 6 months. Couples are randomized to one of three groups: (1) Exercising Together© where partners train as a team in a supervised group setting; (2) separate supervised group exercise classes for survivors or partners, respectively; (3) unsupervised home exercise program provided to each partner. The primary outcome is relationship quality (dyadic coping by the Dyadic Coping scale, emotional intimacy by the Dyadic Adjustment Scale, physical intimacy by the Physical Intimacy Behavior Scale, and symptom incongruence). Secondary outcomes are physical health (% body fat by DXA, serum fasting lipids (triglycerides, HDL, and LDL cholesterol), insulin resistance (HOMA-IR), resting blood pressure, C-reactive protein, TNF alpha, and physical functioning by the short Physical Performance Battery and SF-36) and mental health (depressive symptoms, anxiety, fear of recurrence) of each partner. Outcomes are collected at baseline, mid (3 months), post-intervention (6 months), and follow-up (12 months).

DISCUSSION

Exercising Together© could shift the paradigm of survivorship care toward novel couple-based approaches that could optimize outcomes for each partner because their health is interdependent on each other and their relationship.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03630354 . Registered August 14, 2018.

"We Faced Every Change Together". Couple's Intimacy and Sexuality Experiences from the Perspectives of Transgender and Non-Binary Individuals' Partners

In recent years, there has been a growing interest in the study of transgender and non-binary (TGNB) individuals' romantic and sexual relationships. The present study explored, from TGNB people's partners' perspective, how the couple experiences sexuality and intimacy, the effects from gender dysphoria in these relational domains, and how dysphoria is managed. For this purpose, 99 partners of TGNB individuals were recruited for an online study. Participants were asked to answer the following open-ended questions: "In the intimacy and sexuality with your partner, are there any parts of your or your partner's body that are/were off-limits?" "How did you manage this before, during, and after transition?" The data were analyzed through thematic analysis, and four overarching themes emerged: 1) Positive Aspects of the Relationship; (2) Challenges; (3) Strategies to Manage Dysphoria; and (4) Expected Improvement through Access to Medical Affirmation. The results suggest that gender dysphoria is one of the main challenges in experiencing intimacy and sexuality, but TGNB individuals and their partners can rely on several relational and practical resources to navigate it and enjoy positive experiences with intimacy and sexuality. The findings provide valuable information about how TGNB individuals and their partners build healthy and fulfilling relationships, and they can help clinicians better understand both members' perspectives in these romantic couples in the context of couples' therapy and sexual counseling.

Does Sexual Orientation Complicate the Relationship Between Marital Status and Gender With Self-rated Health and Cardiovascular Disease?

A substantial body of work has demonstrated the importance of marital status for health, yet the vast majority of this work has studied heterosexual marriages and relationships. To understand the role of marital status in shaping health among heterosexual, lesbian, gay, and bisexual men and women, we examine data from a probability-based sample of adults living in 40 U.S. states for selected years between 2011-2015. We test two physical health outcomes-poor-to-fair self-rated health and cardiovascular disease-and present predicted probabilities and pairwise comparisons from logistic regression models before and after adjustment for demographic characteristics, socioeconomic status, health behaviors, and depression. Overall, findings reveal some important similarities and differences in the relationships between marital status and health by sexual orientation and gender. First, the health benefits of marriage extend to sexual minority adults, relative to adults who are either formerly or never married. Among heterosexual adults, adjusted models also highlight the healthy status of never-married adults. Second, the health benefits associated with intimate relationships appear less dependent on legal marriage among sexual minorities than among heterosexual adults. Third, we document a persistent health disadvantage for bisexual adults compared with heterosexual adults, particularly among women who are formerly married, indicating some elevated health vulnerability among selected sexual minority women. Fourth, associations between sexual orientation and health are more similar across marital status groups for men than women. Altogether, these findings add much needed nuance to our understanding of the association between marital status and health in an era of increasing diversity in adult relationships.

A national longitudinal study of marital quality and cognitive decline among older men and women

We provide one of the first national longitudinal studies of the association between trajectories of marital quality and cognitive functioning among older adults, with close attention paid to gender differences. Data were drawn from the Health and Retirement Study (HRS) 2006-2016. Marital quality trajectories were assessed at three waves: 2006/2008, 2010/2012, and 2014/2016. Cognitive trajectories were assessed at five waves: 2008, 2010, 2012, 2014, and 2016. The final analytic sample included 7901 respondents age 50 and older (4334 men and 3567 women) who were either married or cohabiting during the study period. Results from parallel linear growth curve models suggest that among older adults, initial positive marital quality was associated with better initial cognition, and initial negative marital quality was associated with worse initial cognition. Results from multiple group analysis further suggest that marital quality was significantly associated with men's cognitive trajectories but not women's. Among men, an increase in positive marital quality was associated with a slower rate of cognitive decline, whereas an increase in negative marital quality was associated with a faster rate of cognitive decline. These findings suggest that older men who experience a decline in marital quality may be vulnerable to cognitive decline and that reducing marital strain and improving marital quality may protect men's cognitive health in later life.

Gender Differences in the Link Between Marital Status and the Risk of Cognitive Impairment: Results From the Korean Longitudinal Study of Aging

In the context of South Korea, characterized by increasing population aging and a changing family structure, this study examined differences in the risk of cognitive impairment by marital status and investigated whether this association differs by gender. The data were derived from the 2006-2018 Korean Longitudinal Study of Aging. The sample comprised 7,568 respondents aged 45 years or older, who contributed 30,414 person-year observations. Event history analysis was used to predict the odds of cognitive impairment by marital status and gender. Relative to their married counterparts, never-married and divorced people were the most disadvantaged in terms of cognitive health. In addition, the association between marital status and cognitive impairment was much stronger for men than for women. Further, gender-stratified analyses showed that, compared with married men, never-married men had a higher risk of cognitive impairment, but there were no significant effects of marital status for women.

Assessment of Modifiable Factors for the Association of Marital Status With Cancer-Specific Survival

IMPORTANCE

Married patients with cancer have better cancer-specific survival than unmarried patients. Increasing the early diagnosis and definitive treatment of cancer among unmarried patients may reduce the survival gap.

OBJECTIVES

To evaluate the extent to which marriage is associated with cancer-specific survival, stage at diagnosis, and treatment among patients with 9 common solid cancers and to recommend methods for reducing the survival gap.

DESIGN, SETTING, AND PARTICIPANTS

This retrospective, population-based cohort study included patients older than 18 years who were diagnosed with 1 of 9 common cancers between January 1, 2007, and December 31, 2016. Patient data were retrieved from the Surveillance, Epidemiology, and End Results Program. Statistical analyses were performed from August 1 to October 1, 2020.

EXPOSURES

Marital status, classified as married and unmarried (including single, separated, divorced, widowed, and unmarried patients or domestic partners).

MAIN OUTCOMES AND MEASURES

The primary outcome was the time ratio (TR) of cancer-specific survival (married vs unmarried). Mediation analyses were conducted to determine the extent to which the association of marriage with cancer-specific survival was mediated by stage at diagnosis and treatment.

RESULTS

This study included 1 733 906 patients (894 379 [51.6%] women; 1 067 726 [61.6%] married; mean [SD] age, 63.76 [12.60] years). Multivariate analyses found that those who were married were associated with better cancer-specific survival than unmarried patients (TR, 1.36; 95% CI, 1.35-1.37). Early diagnosis in breast cancer, colorectal cancer, endometrial cancer, and melanoma mediated the association between marital status and cancer-specific survival (breast cancer: proportion mediated [PM], 11.4%; 95% CI, 11.2%-11.6%; colorectal cancer: PM, 10.9%; 95% CI, 10.7%-11.2%; endometrial cancer: PM, 12.9%; 95% CI, 12.5%-13.3%; melanoma: PM, 12.0%; 95% CI, 11.7-12.4%). Surgery mediated the association between marital status and cancer-specific survival in lung (PM, 52.2%; 95% CI, 51.9%-52.4%), pancreatic (PM, 28.9%; 95% CI, 28.6%-29.3%), and prostate (PM, 39.3%; 95% CI, 39.0%-39.6%) cancers. Chemotherapy mediated the association of marital status with cancer-specific survival in lung (PM, 37.7%; 95% CI, 37.6%-37.9%) and pancreatic (PM, 28.6%; 95% CI, 28.4%-28.9%) cancers. Improved cancer-specific survival associated with marriage was greater among men than women (men: TR, 1.27; 95% CI, 1.25-1.28; women: TR, 1.20; 95% CI, 1.19-1.21). The contribution of receiving an early diagnosis and treatment with surgery or chemotherapy to the association between marital status and cancer-specific survival was greater among men than women (early diagnosis: PM, 21.7% [95% CI, 21.5%-21.9%] vs PM, 20.3% [95% CI, 20.2%-20.4%]; surgery: PM, 26.6% [95% CI, 26.4%-26.7%] vs PM, 11.1% [95% CI, 11.0%-11.2%]; chemotherapy: PM, 6.8% [95% CI, 6.7%-6.8%] vs PM, 5.1% [95% CI, 5.0%-5.2%]).

CONCLUSIONS AND RELEVANCE

In this study, survival disparities associated with marital status were attributable to early diagnosis in breast, colorectal, and endometrial cancers as well as melanoma and to treatment-related variables in lung, pancreatic, and prostate cancers. The findings also suggest that marriage may play a greater protective role in the cancer-specific survival of men than of women.

Sexual Obligation and Perceived Stress: A National Longitudinal Study of Older Adults

Objectives: This study examines the relationship between sexual obligation and perceived stress among older adults in the United States.Methods: Using longitudinal data from three waves of the National Social Life, Health, and Aging Project (NSHAP), our sample included 1,477 partnered, sexually-active respondents aged 57 to 85 at the baseline survey. We estimated mixed-effects models to test how feelings of sexual obligation are related to changes in perceived stress score.Results: Sexual obligation was positively associated with perceived stress score. The positive relationship between sexual obligation and perceived stress score became stronger over the study period among older men, although it remained relatively stable among older women. Relationship quality only partially explains this relationship.Conclusions: Feeling more obligated to have sex had a significantly greater effect on older men's perceived level of stress over time than older women's. This association became marginally significant after relationship quality was controlled for, suggesting that relationship quality was a key explanatory factor for the gendered patterns in sexual obligation's linkage to stress. These results highlight the importance of understanding gendered sexuality among aging older adults within the context of their relationship.Clinical Implications: Older adults' feelings of sexual obligation can manifest in their daily stress experience. Clinicians seeking to lower older adults', in particular older men's, stress levels should address the context of their sexual life and if they feel obligated to have sex, along with the positive and negative aspects of their relationship, as these could elevate their stress levels over time.