Mortality after the Hospitalization of a Spouse
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The illness of a spouse can affect the health of a caregiving partner. We examined the association between the hospitalization of a spouse and a partner's risk of death among elderly people.We studied 518,240 couples who were enrolled in Medicare in 1993. We used Cox regression analysis and fixed-effects (case-time-control) methods to assess hospitalizations and deaths during nine years of follow-up.Overall, 383,480 husbands (74 percent) and 347,269 wives (67 percent) were hospitalized at least once, and 252,557 husbands (49 percent) and 156,004 wives (30 percent) died. Mortality after the hospitalization of a spouse varied according to the spouse's diagnosis. Among men, 6.4 percent died within a year after a spouse's hospitalization for colon cancer, 6.9 percent after a spouse's hospitalization for stroke, 7.5 percent after a spouse's hospitalization for psychiatric disease, and 8.6 percent after a spouse's hospitalization for dementia. Among women, 3.0 percent died within a year after a spouse's hospitalization for colon cancer, 3.7 percent after a spouse's hospitalization for stroke, 5.7 percent after a spouse's hospitalization for psychiatric disease, and 5.0 percent after a spouse's hospitalization for dementia. After adjustment for measured covariates, the risk of death for men was not significantly higher after a spouse's hospitalization for colon cancer (hazard ratio, 1.02; 95 percent confidence interval, 0.95 to 1.09) but was higher after hospitalization for stroke (hazard ratio, 1.06; 95 percent confidence interval, 1.03 to 1.09), congestive heart failure (hazard ratio, 1.12; 95 percent confidence interval, 1.07 to 1.16), hip fracture (hazard ratio, 1.15; 95 percent confidence interval, 1.11 to 1.18), psychiatric disease (hazard ratio, 1.19; 95 percent confidence interval, 1.12 to 1.26), or dementia (hazard ratio, 1.22; 95 percent confidence interval, 1.12 to 1.32). For women, the various risks of death after a spouse's hospitalization were similar. Overall, for men, the risk of death associated with a spouse's hospitalization was 22 percent of that associated with a spouse's death (95 percent confidence interval, 17 to 27 percent); for women, the risk was 16 percent of that associated with death (95 percent confidence interval, 8 to 24 percent).Among elderly people hospitalization of a spouse is associated with an increased risk of death, and the effect of the illness of a spouse varies among diagnoses. Such interpersonal health effects have clinical and policy implications for the care of patients and their families.Keywords:
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Stroke
This study examines the degree to which older, noninstitutionalized husbands and wives are involved in providing various types of assistance, the likelihood of providing assistance to one's spouse and to others, and the characteristics associated with giving more forms of help. The findings suggest that older wives are more likely than older husbands to provide most of these forms of assistance. Furthermore, husbands are more likely to help their spouses, while wives are more likely to report helping people outside the conjugal pair. Multiple regression analysis suggests that the ability of the potential recipient spouse to perform daily living tasks is a key factor in determining number of forms of help provided by the potential helping spouse.
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BACKGROUND: Studies have generally shown that kidney donation to a spouse has a positive impact on marriage. But what happens when kidney donation occurs outside of the marriage? This is the first ever study to evaluate the impact on marriage when donation occurs to someone other than the spouse. METHODS: Two groups of donors were studied: those that donated to their spouse and those that donated to someone other than their spouse. An online survey was sent using the Revised Dyadic Adjustment Scale (RDAS) to evaluate the effect of donation on the marriage. This tool consists of 14 questions which measure how satisfying and stable the relationship is. The response of the two groups of donors is the subject of this study. RESULTS: 31 donors who donated to someone outside the marriage and 11 that donated directly to their spouse completed the survey. 10 donor surveys were incorrectly completed and were therefore disregarded from analysis. The results showed equal or better scores when donation occurred to a non-spouse as compared to a spouse. The non-spouse donors actually scored higher on two questions, one regarding the agreement in the relationship when it comes to career choices (P=0.05) and the other regarding the frequency of having stimulating exchanges of ideas (P=0.02). With the highest possible total score of 69, those who donated to a spouse scored 47 and those donating to someone other than spouse scored 53 (P=0.16). The cut-off score for the RDAS is 48. Scores of 47 and below indicate marital distress. In one final additional question 91% of those that donated to a spouse reported “no change or good effect” on the marriage. 97 % of those who donated to someone other than their spouse reported similarly “no change or good effect” on the marriage (P=.46). CONCLUSION: This is the first ever study to evaluate the effect of kidney donation on marriage when the spouse is not the recipient. Marriage is not impacted negatively when kidney donation occurs to someone other than the spouse.
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This descriptive study explored the demands made by spouse caregivers of terminally ill, adult cancer patients. A one-time, semistructured, at-home interview with 65 spouses, was conducted by the investigator. Content analyses of spouse caregiver interviews revealed nine major categories of caregivi
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Using the Actor-Partner Interdependence Model, this study examined how spouses’ characteristics influence their own and each other’s advance directive (AD) completion. Health and Retirement data on 2,243 heterosexual married couples 65+ were analyzed. Both one’s own age and spouse’s age were positively associated with a higher likelihood of completing an AD. The worse a spouse’s health, the less likely the other spouse would have an AD. Men’s education was positively associated with AD completion for both spouses, but women’s education only increased their own likelihood of having an AD. Men’s prior hospitalization or outpatient surgery also increased the likelihood of having an AD for both themselves and their wives, whereas women’s hospitalization/surgery had no significant effect on either spouse. These findings highlight the need to account for the characteristics and experiences of both husbands and wives in advance care planning research and point to important gender differences in spousal influences.
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Exploring the Most Important Negative Life Events in Older Adults Bereaved of Child, Spouse, or Both
Losing a child or a spouse is described as the worst of experiences. However, it is not known whether older adults bereaved of a child, spouse, or both child and spouse experience these losses as among the most important negative events in their lifetime. The aim of this study was to investigate whether the 1,437 older adults bereaved of a child, spouse, or both included in the southern part of the Swedish National Study of Aging and Care mentioned these losses when asked about their three most important negative life events. Gender differences in their choices of important negative life events were also explored. About 70% of those bereaved of a child or a spouse mentioned these losses as among their three most important negative life experiences. In the child-and-spouse-bereaved group, 48% mentioned both the loss of their child and spouse, while 40% mentioned either the loss of a child or a spouse. Gender differences were only found in the child-and-spouse-bereaved group, with a few more women mentioning the loss of the child but not the spouse, and the men showing the opposite pattern.
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Background Although most people with relapsing onset multiple sclerosis (R-MS) eventually transition to secondary progressive multiple sclerosis (SPMS), little is known about disability progression in SPMS. Methods All R-MS patients in the Cardiff MS registry were included. Cox proportional hazards regression was used to examine a) hazard of converting to SPMS and b) hazard of attaining EDSS 6.0 and 8.0 in SPMS. Results 1611 R-MS patients were included. Older age at MS onset (hazard ratio [HR] 1.02, 95%CI 1.01–1.03), male sex (HR 1.71, 95%CI 1.41–2.08), and residual disability after onset (HR 1.38, 95%CI 1.11–1.71) were asso- ciated with increased hazard of SPMS. Male sex (EDSS 6.0 HR 1.41 [1.04–1.90], EDSS 8.0 HR 1.75 [1.14–2.69]) and higher EDSS at SPMS onset (EDSS 6.0 HR 1.31 [1.17–1.46]; EDSS 8.0 HR 1.38 [1.19–1.61]) were associated with increased hazard of reaching disability milestones, while older age at SPMS was associated with a lower hazard of progression (EDSS 6.0 HR 0.94 [0.92–0.96]; EDSS 8.0: HR 0.92 [0.90–0.95]). Conclusions Different factors are associated with hazard of SPMS compared to hazard of disability progres- sion after SPMS onset. These data may be used to plan services, and provide a baseline for comparison for future interventional studies and has relevance for new treatments for SPMS RobertsonNP@cardiff.ac.uk
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The hazard ratio and median survival time are the routine indicators in survival analysis. We briefly introduced the relationship between hazard ratio and median survival time and the role of proportional hazard assumption. We compared 110 pairs of hazard ratio and median survival time ratio in 58 articles and demonstrated the reasons for the difference by examples. The results showed that the hazard ratio estimated by the Cox regression model is unreasonable and not equivalent to median survival time ratio when the proportional hazard assumption is not met. Therefore, before performing the Cox regression model, the proportional hazard assumption should be tested first. If proportional hazard assumption is met, Cox regression model can be used; if proportional hazard assumption is not met, restricted mean survival times is suggested.风险比（hazard ratio，HR）和中位生存时间是生存分析时的常规分析和报告指标。本文简要介绍了HR和中位生存时间的关系以及比例风险假定在这两者之间的作用，分析了检索出的58篇文献中的110对风险比和中位生存时间比的差异，并通过实例阐明了产生这种差异的原因。结果表明，在不满足比例风险假定时，Cox回归模型计算得到的风险比是不合理的，且与中位生存时间之比不等价。因此，在使用Cox回归模型前，应先进行比例风险假定的检验，只有符合比例风险假定时才能使用该模型；当不符合比例风险假定时，建议使用限制性平均生存时间。.
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For married patients, chronic illness management often includes involvement of their spouses. We examined expectations regarding spouse involvement in the health of a partner with type 2 diabetes ( N = 139 couples) from the perspectives of the patient and spouse. Partners' dyadic expectations and spouses' gender were posited to moderate spouses' diet‐related control and patients' diet adherence. Among male patients, when both partners shared an expectation for spouse involvement greater diet‐related spouse control was associated with better diet adherence of patients. In contrast, when expectations for spouse involvement were not shared, greater spouse control by wives was associated with poorer diet adherence. Dyadic expectations for spouse involvement did not moderate the association between spouse control and diet adherence among female patients. Findings suggest that shared expectations for spouse involvement can facilitate spouses' attempts to improve patients' dietary adherence, especially among male patients and their wives.
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