@article {751, title = {Perceptions and implications of received spousal care: evidence from the Caregiver Health Effects Study.}, journal = {Psychol Aging}, volume = {18}, year = {2003}, month = {2003 Sep}, pages = {593-601}, abstract = {

The experiences of older care recipients have received far less theoretical and empirical attention than those of their family caregivers. In this study of 91 care recipients, the authors assessed perceptions of the amount, timing, and manner of spousal assistance; the amount of strain experienced from receiving care; and psychological well-being. Although female care recipients were more likely to report dissatisfaction with the manner in which assistance was provided, there were few gender differences in perceptions of care overall. In a stringent test of the hypothesis that perceived quality of spousal care affects recipient well-being, the authors found that poorer quality of care was related to increased depressive symptoms and a decreased sense of mastery 1 year later. These longitudinal effects were independent of the recipient{\textquoteright}s physical disability, marital quality, and care-receiving strain as well as the caregiver{\textquoteright}s well-being. These findings argue for a comprehensive assessment of the care-receiving experience that includes both care-recipient and caregiver perspectives.

}, keywords = {Aged, Caregivers, Chronic Disease, Disabled Persons, Family Health, Female, Health Status, Humans, Longitudinal Studies, Male, Mental Health, Quality of Health Care, Research Design, Spouses}, issn = {0882-7974}, doi = {10.1037/0882-7974.18.3.593}, author = {Martire, Lynn M and Schulz, Richard and Wrosch, Carsten and Newsom, Jason T} } @article {732, title = {Transitions in spousal caregiving.}, journal = {Gerontologist}, volume = {43}, year = {2003}, month = {2003 Apr}, pages = {230-41}, abstract = {

PURPOSE: This study describes transitions over 5 years among community-dwelling elderly spouses into and within caregiving roles and associated health outcomes.

DESIGN AND METHODS: Participants in the Caregiver Health Effects Study (n = 818) were interviewed four times over 5 years with changes in their caregiving status described. Analyses of the effect on health outcomes of transitions were performed on those for whom four observations were available (n = 428).

RESULTS: Only half (49.5\%) of noncaregivers at baseline remained noncaregivers at 5-year follow-up. The remainder experienced one or more transitions, including moving into the caregiving role, their own or their spouse{\textquoteright}s death, or placement of their spouse in a long-term care facility. The trajectory of health outcomes associated with caregiving was generally downward. Those who transitioned to heavy caregiving had more symptoms of depression, and poorer self-reported health and health behaviors.

IMPLICATIONS: Transitions into and within the caregiving role should be monitored for adverse health effects on the caregiver, with interventions tailored to the individual{\textquoteright}s location in the caregiving trajectory.

}, keywords = {Adaptation, Psychological, Aged, Aged, 80 and over, Caregivers, Female, Health Behavior, Health Status, Humans, Long-Term Care, Male, Residence Characteristics, Spouses, Stress, Psychological, Time Factors}, issn = {0016-9013}, doi = {10.1093/geront/43.2.230}, author = {Burton, Lynda C and Zdaniuk, Bozena and Schulz, Richard and Jackson, Sharon and Hirsch, Calvin} } @article {767, title = {Concurrent and long-term predictors of older adults{\textquoteright} use of community-based long-term care services: the Caregiver Health Effects Study.}, journal = {J Aging Health}, volume = {16}, year = {2004}, month = {2004 Feb}, pages = {88-115}, abstract = {

OBJECTIVE: This study examined concurrent and long-term associations between caregiver-related characteristics and the use of community long-term care services in a sample of 186 older adults caring for a disabled spouse.

METHOD: We used two waves of data from the Caregiver Health Effects Study, an ancillary study of the Cardiovascular Health Study. Caregiver-related need variables as predictors of service use were of primary interest and included caregiving demands, caregiver mental and physical health, and mastery. Their contribution to service use was examined after controlling for known predictors of service use.

RESULTS: At Time 1, more caregiver depressive symptoms predicted greater service use; at Time 2, more caregiver activity restriction and depressive symptoms predicted greater formal service use; increases in caregiver activity restriction and depressive symptomatology over time predicted increases in service use.

DISCUSSION: Caregiver-related need variables play a significant role in defining utilization patterns of community-based long-term care services among older adults.

}, keywords = {Aged, Caregivers, Community Health Services, Disabled Persons, Forecasting, Health Services for the Aged, Humans, Long-Term Care, Regression Analysis, Spouses, United States}, issn = {0898-2643}, doi = {10.1177/0898264303260448}, author = {Bookwala, Jamila and Zdaniuk, Bozena and Burton, Lynda and Lind, Bonnie and Jackson, Sharon and Schulz, Richard} } @article {828, title = {The course of functional decline in older people with persistently elevated depressive symptoms: longitudinal findings from the Cardiovascular Health Study.}, journal = {J Am Geriatr Soc}, volume = {53}, year = {2005}, month = {2005 Apr}, pages = {569-75}, abstract = {

OBJECTIVES: To examine the relationship between persistently high depressive symptoms and long-term changes in functional disability in elderly persons.

DESIGN: A community-based, prospective, observational study.

SETTING: Participant data from the Cardiovascular Health Study.

PARTICIPANTS: From the overall sample of 5,888 subjects, three types of participants were identified for this study: (1) persistently depressed individuals, who experienced an onset of depressive symptoms that persisted over 4 years (n=119); (2) temporarily depressed individuals, who experienced an onset of depressive symptoms that resolved over time (n=259); and (3) nondepressed individuals, with persistently low depressive symptoms throughout the follow-up period who were matched on baseline activity of daily living (ADL) scores, sex, and age to the previous two groups combined (n=378).

MEASUREMENTS: Four consecutive years of data were assessed: validated measures of depression (10-item CES-D), functional disability (10-item ADL/instrumental ADL measure), physical performance, medical illness, and cognition.

RESULTS: The persistently depressed group showed a greater linear increase in functional disability ratings than the temporarily depressed and nondepressed groups. This association between persistent depression and functional disability was robust even when controlling for baseline demographic and clinical/performance measures, including cognition. The persistently depressed group had an adjusted odds ratio (OR) of 5.27 (95\% confidence interval (CI) 3.03-9.16) for increased functional disability compared with the nondepressed group over 3 years of follow-up, whereas the temporarily depressed group had an adjusted OR of 2.39 (95\% CI=1.55-3.69) compared with the nondepressed group.

CONCLUSION: Persistently elevated depressive symptoms in elderly persons are associated with a steep trajectory of worsening functional disability, generating the hypothesis that treatments for late-life depression need to be assessed on their efficacy in maintaining long-term functional status as well as remission of depressive symptoms. These results also demonstrate the need for studies to differentiate between persistent and temporary depressive symptoms when examining their relationship to disability.

}, keywords = {Activities of Daily Living, Aged, Case-Control Studies, Depressive Disorder, Disabled Persons, Female, Humans, Longitudinal Studies, Male, Multivariate Analysis, Risk, United States}, issn = {0002-8614}, doi = {10.1111/j.1532-5415.2005.53202.x}, author = {Lenze, Eric J and Schulz, Richard and Martire, Lynn M and Zdaniuk, Bozena and Glass, Thomas and Kop, Willem J and Jackson, Sharon A and Reynolds, Charles F} } @article {963, title = {Socioeconomic position and incident mobility impairment in the Cardiovascular Health Study.}, journal = {BMC Geriatr}, volume = {7}, year = {2007}, month = {2007 May 10}, pages = {11}, abstract = {

BACKGROUND: We investigated if personal socioeconomic position (SEP) factors and neighborhood characteristics were associated with incident mobility impairment in the elderly.

METHODS: We used data from the Cardiovascular Health Study, a longitudinal, population-based examination of coronary heart disease and stroke among persons aged 65 and older in the United States.

RESULTS: Among 3,684 persons without baseline mobility impairment, lower baseline SEP was associated with increased risk of incident mobility disability during the 10-year follow-up period, although the strengths of these associations varied by socioeconomic indicator and race/sex group.

CONCLUSION: Among independent-living elderly, SEP affected development of mobility impairment into later life. Particular effort should be made to prevent or delay its onset among the elderly with low income, education, and/or who live in economically disadvantaged neighborhoods.

}, keywords = {Aged, Aged, 80 and over, Coronary Disease, Disabled Persons, Education, Female, Follow-Up Studies, Humans, Incidence, Longitudinal Studies, Male, Mobility Limitation, Residence Characteristics, Social Class, Stroke, United States}, issn = {1471-2318}, doi = {10.1186/1471-2318-7-11}, author = {Nordstrom, Cheryl K and Diez Roux, Ana V and Schulz, Richard and Haan, Mary N and Jackson, Sharon A and Balfour, Jennifer L} } @article {1102, title = {Spousal suffering and partner{\textquoteright}s depression and cardiovascular disease: the Cardiovascular Health Study.}, journal = {Am J Geriatr Psychiatry}, volume = {17}, year = {2009}, month = {2009 Mar}, pages = {246-54}, abstract = {

OBJECTIVES: To assess the effects of suffering in a spouse on prevalent and incident psychiatric (depression) and physical morbidity (cardiovascular disease [CVD]) in their partner, controlling for known risk factors for depression and CVD.

DESIGN: Descriptive longitudinal study.

PARTICIPANTS: A total of 1,330 older married couples enrolled in the Cardiovascular Health Study, a large epidemiologic study of the elderly.

MEASUREMENTS: Predictor variables were physical, psychological, and existential/spiritual indicators of suffering. Primary outcomes were prevalent and incident depression and CVD.

RESULTS: Controlling for known risk factors for depression, the authors found a dose-response relationship between suffering in a spouse and concurrent depression in their partner as well as a relationship between suffering and the partner{\textquoteright}s future risk for depression. With respect to CVD, and controlling for subclinical CVD at baseline, husbands whose wives reported high levels of suffering also had higher rates of prevalent CVD, but there were no significant associations between wives suffering and husbands incident CVD. There were no associations between husbands{\textquoteright} suffering and wives{\textquoteright} prevalent or incident CVD.

CONCLUSION: Exposure to spousal suffering is an independent and unique source of distress in married couples that contributes to psychiatric and physical morbidity. More attention should be paid to the interpersonal effects of suffering in married couples and to its role in contributing to morbidity.

}, keywords = {Activities of Daily Living, Aged, Cardiovascular Diseases, Caregivers, Depression, Female, Follow-Up Studies, Humans, Incidence, Logistic Models, Longitudinal Studies, Male, Prevalence, Risk Factors, Socioeconomic Factors, Spouses, Stress, Psychological, Surveys and Questionnaires}, issn = {1545-7214}, doi = {10.1097/JGP.0b013e318198775b}, author = {Schulz, Richard and Beach, Scott R and Hebert, Randy S and Martire, Lynn M and Monin, Joan K and Tompkins, Connie A and Albert, Steven M} } @article {1216, title = {Autonomic nervous system dysfunction and inflammation contribute to the increased cardiovascular mortality risk associated with depression.}, journal = {Psychosom Med}, volume = {72}, year = {2010}, month = {2010 Sep}, pages = {626-35}, abstract = {

OBJECTIVE: To investigate prospectively whether autonomic nervous system (ANS) dysfunction and inflammation play a role in the increased cardiovascular disease (CVD)-related mortality risk associated with depression.

METHODS: Participants in the Cardiovascular Health Study (n = 907; mean age, 71.3 {\textpm} 4.6 years; 59.1\% women) were evaluated for ANS indices derived from heart rate variability (HRV) analysis (frequency and time domain HRV, and nonlinear indices, including detrended fluctuation analysis (DFA(1)) and heart rate turbulence). Inflammation markers included C-reactive protein, interleukin-6, fibrinogen, and white blood cell count). Depressive symptoms were assessed, using the 10-item Centers for Epidemiological Studies Depression scale. Cox proportional hazards models were used to investigate the mortality risk associated with depression, ANS, and inflammation markers, adjusting for demographic and clinical covariates.

RESULTS: Depression was associated with ANS dysfunction (DFA(1), p = .018), and increased inflammation markers (white blood cell count, p = .012, fibrinogen p = .043) adjusting for covariates. CVD-related mortality occurred in 121 participants during a median follow-up of 13.3 years. Depression was associated with an increased CVD mortality risk (hazard ratio, 1.88; 95\% confidence interval, 1.23-2.86). Multivariable analyses showed that depression was an independent predictor of CVD mortality (hazard ratio, 1.72; 95\% confidence interval, 1.05-2.83) when adjusting for independent HRV and inflammation predictors (DFA(1), heart rate turbulence, interleukin-6), attenuating the depression-CVD mortality association by 12.7\% (p < .001).

CONCLUSION: Autonomic dysfunction and inflammation contribute to the increased cardiovascular mortality risk associated with depression, but a large portion of the predictive value of depression remains unexplained by these neuroimmunological measures.

}, keywords = {Aged, Autonomic Nervous System Diseases, Biomarkers, C-Reactive Protein, Cardiovascular Diseases, Cause of Death, Cohort Studies, Comorbidity, Depressive Disorder, Electrocardiography, Female, Follow-Up Studies, Heart Rate, Humans, Inflammation, Interleukin-6, Leukocyte Count, Male, Risk Factors}, issn = {1534-7796}, doi = {10.1097/PSY.0b013e3181eadd2b}, author = {Kop, Willem J and Stein, Phyllis K and Tracy, Russell P and Barzilay, Joshua I and Schulz, Richard and Gottdiener, John S} } @article {6082, title = {The effect of widowhood on husbands{\textquoteright} and wives{\textquoteright} physical activity: the Cardiovascular Health Study.}, journal = {J Behav Med}, volume = {37}, year = {2014}, month = {2014 Aug}, pages = {806-17}, abstract = {

This prospective study examined the effect of widowhood on physical activity by comparing widowed elders to health status-, age-, and sex-matched married controls. Participants included 396 married controls and 396 widows/widowers age 64-91 (M age~=~72.7~years) who experienced the death of their spouse while participating in the Cardiovascular Health Study. Compared to married controls, widowed men, but not women, were more likely to increase their physical activity following the death of their spouse. However, this increased level of activity was not sustained and declines as time since spousal death passes. Moreover, during the year before spousal death, soon-to-be widowed men, but not women, increase their physical activity. Our results suggest that widowed men experience significant changes in physical activity and that the transition to widowhood contribute to these changes.

}, keywords = {Aged, Aged, 80 and over, Cardiovascular System, Female, Health Surveys, Humans, Male, Middle Aged, Motor Activity, Prospective Studies, Sex Characteristics, Spouses, Time Factors, Widowhood}, issn = {1573-3521}, doi = {10.1007/s10865-013-9532-7}, author = {Stahl, Sarah T and Schulz, Richard} } @article {6696, title = {Husbands{\textquoteright} and Wives{\textquoteright} Physical Activity and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study.}, journal = {Ann Behav Med}, volume = {49}, year = {2015}, month = {2015 Oct}, pages = {704-14}, abstract = {

BACKGROUND: When examining older adults{\textquoteright} health behaviors and psychological health, it is important to consider the social context.

PURPOSE: The purpose of this study was to examine in older adult marriages whether each spouse{\textquoteright}s physical activity predicted changes in their own (actor effects) and their partner{\textquoteright}s (partner effects) depressive symptoms. Gender differences were also examined.

METHOD: Each spouse within 1260 married couples (at baseline) in the Cardiovascular Health Study completed self-report measures at wave 1 (1989-1990), wave 3 (1992-1993), and wave 7 (1996-1997). Dyadic path analyses were performed.

RESULTS: Husbands{\textquoteright} physical activity significantly predicted own decreased depressive symptoms (actor effect). For both spouses, own physical activity did not significantly predict the spouse{\textquoteright}s depressive symptoms (partner effects). However, husbands{\textquoteright} physical activity and depressive symptoms predicted wives{\textquoteright} physical activity and depressive symptoms (partner effects), respectively. Depressive symptoms did not predict physical activity.

CONCLUSION: Findings suggest that husbands{\textquoteright} physical activity is particularly influential for older married couples{\textquoteright} psychological health.

}, keywords = {Aged, Cardiovascular System, Depression, Female, Health Surveys, Humans, Longitudinal Studies, Male, Motor Activity, Sex Characteristics, Spouses}, issn = {1532-4796}, doi = {10.1007/s12160-015-9705-4}, author = {Monin, Joan K and Levy, Becca and Chen, Baibing and Fried, Terri and Stahl, Sarah T and Schulz, Richard and Doyle, Margaret and Kershaw, Trace} } @article {6928, title = {Social Network Size and Cranial Magnetic Resonance Imaging Findings in Older Adults: The Cardiovascular Health Study.}, journal = {J Am Geriatr Soc}, volume = {63}, year = {2015}, month = {2015 Nov}, pages = {2430-2}, keywords = {Aged, Brain, Cardiovascular Diseases, Cross-Sectional Studies, Female, Geriatric Assessment, Humans, Magnetic Resonance Imaging, Male, Neuroimaging, Social Participation, Social Support}, issn = {1532-5415}, doi = {10.1111/jgs.13805}, author = {Flatt, Jason D and Rosso, Andrea L and Aizenstein, Howard J and Schulz, Richard and Longstreth, W T and Newman, Anne B and Fowler, Nicole R and Rosano, Caterina} } @article {7001, title = {Mortality After Bereavement: The Role of Cardiovascular Disease and Depression.}, journal = {Psychosom Med}, volume = {78}, year = {2016}, month = {2016 Jul-Aug}, pages = {697-703}, abstract = {

OBJECTIVES: Late-life bereavement is associated with an increased risk of mortality. This study assesses the associations among bereavement, cardiovascular disease (CVD), and depressive symptoms on mortality in older men and women.

METHODS: We examined data from the Cardiovascular Health Study, a prospective population-based cohort study of older adults. We compared mortality in those who became bereaved from 1989 to 1999 (n = 593) to an age- and sex-matched sample of individuals who remained married (n = 593). Cox regression was used to examine the association between bereavement and 3-year all-cause mortality and whether or not the association differed by sex, presence of CVD, or postbereavement depressive symptoms.

RESULTS: One hundred ninety-nine (16.8\%) individuals died. There was no association of bereavement with mortality (hazard ratio [HR] = 0.98 [0.74-1.30]). However, there were significant interaction effects of bereavement with participant sex (p < .001) and CVD (p = .010). Bereavement decreased the risk of mortality in women (HR = 0.67 [0.46-0.97]) and increased the risk of mortality in men (HR = 1.77 [1.14-2.75]). Within sex, the association of bereavement with mortality differed according to CVD status. The reduced risk of mortality associated with bereavement in women was only observed in women with CVD, and the increased risk in men was only observed in men without CVD. High levels of depressive symptoms attenuated the relation between bereavement and mortality in men without CVD.

CONCLUSIONS: The relation between bereavement and mortality was different in men and women and varied by CVD status. Bereavement decreased mortality in women with CVD and increased mortality in men without CVD.

}, issn = {1534-7796}, doi = {10.1097/PSY.0000000000000317}, author = {Stahl, Sarah T and Arnold, Alice M and Chen, Jia-Yuh and Anderson, Stewart and Schulz, Richard} } @article {7127, title = {Spousal Associations Between Frailty and Depressive Symptoms: Longitudinal Findings from the Cardiovascular Health Study.}, journal = {J Am Geriatr Soc}, volume = {64}, year = {2016}, month = {2016 Apr}, pages = {824-30}, abstract = {

OBJECTIVES: To determine whether older adult spouses{\textquoteright} frailty states and depressive symptoms are interrelated over time.

DESIGN: Longitudinal, dyadic path analysis using the Actor-Partner Interdependence Model.

SETTING: Data were from baseline (1989-90), Wave 3 (1992-93), and Wave 7 (1996-97), all waves in which frailty and depressive symptoms were measured, of the Cardiovascular Health Study (CHS), a multisite, longitudinal, observational study of risk factors for cardiovascular disease in adults aged 65 and older.

PARTICIPANTS: Spouses in 1,260 community-dwelling married couples.

MEASUREMENTS: Frailty was measured using the CHS criteria, categorized as nonfrail, prefrail, or frail. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale.

RESULTS: Within individuals (actor effects), greater frailty predicted greater subsequent depressive symptoms, and greater depressive symptoms predicted greater subsequent frailty. Between spouses (partner effects), an individual{\textquoteright}s greater frailty predicted the spouse{\textquoteright}s greater frailty, and an individual{\textquoteright}s greater depressive symptoms predicted the spouse{\textquoteright}s greater depressive symptoms.

CONCLUSION: Frailty and depressive symptoms are interrelated in older adult spouses. For older couples, interventions to prevent or treat frailty and depression that focus on couples may be more effective than those that focus on individuals.

}, keywords = {Aged, Aged, 80 and over, Cardiovascular Diseases, Depression, Female, Frail Elderly, Humans, Longitudinal Studies, Male, Risk Factors, Spouses, United States}, issn = {1532-5415}, doi = {10.1111/jgs.14023}, author = {Monin, Joan and Doyle, Margaret and Levy, Becca and Schulz, Richard and Fried, Terri and Kershaw, Trace} } @article {7361, title = {Brain Structural Markers and Caregiving Characteristics as Interacting Correlates of Caregiving Strain.}, journal = {Am J Geriatr Psychiatry}, year = {2017}, month = {2017 Feb 21}, abstract = {

OBJECTIVE: To evaluate the association between brain structural markers and caregiving strain among older informal caregivers.

DESIGN: A secondary data analysis combining data from the Caregiver Health Effects Study (1993-1994) and the Cardiovascular Health Study MRI examination (1992-1994).

SETTING: Four United States communities.

PARTICIPANTS: Co-residing spousal caregivers (N = 237; mean age: 76.2 years, SD: 2.2 years).

MEASUREMENTS: Visually rated ventricular and white matter (WM) grades from magnetic resonance imaging, caregiving strain defined as "emotional or physical strain associated with providing care" for any of 12 activities of daily living (ADLs) and instrumental activities of daily living (IADLs), plus measures of caregiving characteristics and caregiver{\textquoteright}s health.

RESULTS: Overall, 56\% of caregivers reported strain. We detected an interaction where strain was very common (>82\%) among caregivers who helped with four or more IADLs, regardless of WM grades, and among caregivers with the worst WM grades (WM grades >=4), regardless of the number of IADLs they helped with. Among caregivers helping with fewer than four IADLs, having WM grade 4 or greater was associated with a 55\% higher prevalence ratio for reporting strain. This association remained statistically significant but was most markedly attenuated by adjustments for: care recipient{\textquoteright}s memory and behavioral problems, caregiver{\textquoteright}s depression symptoms, and caregiver{\textquoteright}s ADL impairment.

CONCLUSIONS: Caregiving strain is very common among older informal caregivers who provide help with many IADLs, and among caregivers who help with fewer IADLs, but have manifest signs of white matter pathology. Modern quantitative-neuroimaging studies are needed to evaluate whether more subtle variability in brain structure confers caregiving strain and the related health consequences.

}, issn = {1545-7214}, doi = {10.1016/j.jagp.2017.02.015}, author = {Smagula, Stephen F and Beach, Scott and Rosso, Andrea L and Newman, Anne B and Schulz, Richard} } @article {7806, title = {Longitudinal Associations Between Cognitive Functioning and Depressive Symptoms Among Older Adult Spouses in the Cardiovascular Health Study.}, journal = {Am J Geriatr Psychiatry}, year = {2018}, month = {2018 Jul 03}, abstract = {

OBJECTIVE: To examine the bidirectional associations between older adult spouses{\textquoteright} cognitive functioning and depressive symptoms over time.

DESIGN: Longitudinal, dyadic path analysis with the actor-partner interdependence model.

SETTING: Data were from visit 5 (1992/1993), visit 8 (1995/1996), and visit 11 (1998/1999) of the Cardiovascular Health Study, a multisite, longitudinal, observational study of risk factors for cardiovascular disease in adults 65 years or older. Demographic information was from the 1989/1990 original and 1992/1993 African American cohort baseline visits.

PARTICIPANTS: Husbands and wives from 1,028 community-dwelling married couples (N = 2,065).

MEASUREMENTS: Cognitive functioning was measured with the Modified Mini-Mental State Exam. Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale. Age, education, and disability (activities of daily living and instrumental activities of daily living) were included as covariates.

RESULTS: Cross-partner associations (partner effects) revealed that one spouse{\textquoteright}s greater depressive symptoms predicted the other spouse{\textquoteright}s lower cognitive functioning, but a spouse{\textquoteright}s lower cognitive functioning did not predict the other spouse{\textquoteright}s greater depressive symptoms over time. Within-individual associations (actor effects) revealed that an individual{\textquoteright}s lower cognitive functioning predicted the individual{\textquoteright}s greater depressive symptoms over time, but greater depressive symptoms did not predict lower cognitive functioning over time. Effects did not differ for husbands and wives.

CONCLUSION: Having a spouse who is depressed may increase one{\textquoteright}s risk of cognitive decline as well as one{\textquoteright}s risk of depression. Interventions for preventing cognitive decline and depression among older adults may be enhanced by considering the marital context.

}, issn = {1545-7214}, doi = {10.1016/j.jagp.2018.06.010}, author = {Monin, Joan K and Doyle, Margaret and Van Ness, Peter H and Schulz, Richard and Marottoli, Richard A and Birditt, Kira and Feeney, Brooke C and Kershaw, Trace} } @article {7772, title = {Time-varying social support and time to death in the cardiovascular health study.}, journal = {Health Psychol}, year = {2018}, month = {2018 Sep 10}, abstract = {

OBJECTIVES: There is a consensus that social connectedness is integral for a long, healthy life. However, studies of social support and survival have primarily relied on baseline social support measures, potentially missing the effects of fluctuations of perceived support over time. This is especially important for older adults who experience increased changes in disability. This study examined whether among older adults time-varying perceived social support was associated with time to death (main effect model of support) and whether time-varying disability was a modifier (stress-buffering model of support). Gender and marital status were also examined as modifiers.

METHODS: Older adults in the Cardiovascular Health Study ( = 5,201) completed self- report measures of demographics and psychological health and clinical risk factors for mortality at baseline (1989-1990). Perceived social support and disability were measured from baseline through Wave 11 (1998-1999). Cox regression of time to death with time-varying covariates was performed.

RESULTS: Time-varying as well as baseline-only perceived social support was associated with greater survival in the unadjusted models but not after adjustment. Gender, marital status, and time-varying disability were not significant modifiers.

CONCLUSIONS: In contrast with the previously reported association between baseline individual differences in perceived social support and time to death, older adults{\textquoteright} baseline-only and fluctuating perceptions of perceived support over time were not associated with time to death after adjustment for other clinical physical and psychological risk factors. Research is needed to identify other relationship factors that may be more informative as time-varying predictors of health and longevity in large longitudinal data sets. (PsycINFO Database Record

}, issn = {1930-7810}, doi = {10.1037/hea0000660}, author = {MacNeil-Vroomen, Janet and Schulz, Richard and Doyle, Margaret and Murphy, Terrence E and Ives, Diane G and Monin, Joan K} }