The marital relationship and psychosocial adaptation and glycemic control of individuals with diabetes.

OBJECTIVE: To explore the relationship between marital relationship domains (i.e., intimacy and adjustment) and glycemic control and psychosocial adaptation to diabetes. RESEARCH DESIGN AND METHODS: A total of 78 insulin-treated adults with both type 1 and type 2 diabetes were assessed on a single occasion. They completed two marital quality measures (Spanier Dyadic Adjustment Scale and Personal Assessment of Intimacy in Relationships Scale) and four quality-of-life measures (Diabetes Quality of Life Scale, Medical Outcomes Study Health Survey, Problem Areas in Diabetes Scale, and Positive and Negative Affect Scale). Glycemic control was assessed by HbA(1c). Demographic data (age, sex, type and duration of diabetes, years married, other medical conditions, family history, disability, and years of education) were gathered from the chart and questionnaires. RESULTS: Concerning psychosocial adaptation, both of the marital quality measures were predictors of aspects of adaptation. Better marital satisfaction was related to higher levels of diabetes-related satisfaction and less impact, as well as less diabetes-related distress and better general quality of life. Higher levels of marital intimacy were related to better diabetes-specific and general quality of life. Concerning glycemic control, there was a nonsignificant trend for marital adjustment scores to relate to HbA(1c) (P = 0.0568). CONCLUSIONS: For insulin-treated adults with diabetes, quality of marriage is associated with adaptation to diabetes and other aspects of health-related quality of life. The suggestive finding that marital adjustment may relate to glycemic control warrants further study. Future work should also explore the impact of couples-focused interventions on adaptation, adherence, and glycemic control.

Obesity, disease, and functional limitation in later life.

Little is known about the effects of obesity late in life. Using data from the Longitudinal Study of Aging and the Assets and Health Dynamics of the Oldest Old Survey, this study finds an increased prevalence of obesity, over time, among those 70 and older. Obesity is related most strongly to limitations in activities of daily living (ADLs) for women and to activities related to mobility. One ADL, eating, has a negative association to obesity. Obesity is associated with an increased prevalence of arthritis, diabetes, and hypertension. These results are cross-sectional and are based on self-reports of height and weight; they must be interpreted cautiously.

Nursing home entry in Germany and the United States.

This paper investigates the transition into a nursing home in old age, using recent panel survey data from Germany and the United States. Among the questions addressed are: what is the incidence of nursing home entry, and how does it vary by age and sex; and to what extent are differentials in nursing home entry attributable to variations in family composition? Although the percentage of older persons living in nursing homes is similar in these two countries, the age-specific rates of movement into them appear to be much lower in Germany than in the USA, possibly due to the effects of public policies. The correlates of nursing home entry appear to be similar across countries as well, although data limitations limit our ability to make definitive comparisons.

The influence of caregiving and employment on the voluntary activities of midlife and older women.

One factor thought to contribute to higher levels of stress among caregivers is the restriction on personal time and leisure activities that they feel. We use data from the National Survey of Families and Households (NSFH) to examine the influences that caregiving, the relationship of the care-recipient with the caregiver, and the intensity of the caregiving have on women's participation in personal, family-centered, and community activities. We find that care-giving regardless of age, does not reduce the frequency of participation in voluntary activities. In fact, among younger women, some types of caregiving are associated with significantly higher levels of participation. Based on our results, we conclude that caregiving does not necessarily result in a "loss of self." Caregivers may be using outside activities as a way to relieve the stress of the caregiving tasks; caregivers may be particularly adept at balancing roles, or most caregiving may not be at a level of intensity sufficient to interfere with other activities.

Living arrangements of minority elders.

We used 1990 census data to examine differences in the current living arrangements of minority elderly. We found that differences among the minority populations in age, sex, and marital status account for only a small part of the observed differences in living arrangements. However, while minority groups as a whole differ substantially from the White population, national ethnic patterns within groups appear to be relatively small. Hispanic ethnic groups vary little once differences in marriage patterns are taken into account, although differences are greater within the Asian population.

Age patterns of mortality and cause-of-death structures in Sweden, Japan, and the United States.

This paper uses a new standard model of adult mortality to compare the mortality patterns of Swedes, Japanese, and U.S. whites between 1950 and 1985. It examines changes in the age patterns of mortality and the cause-of-death structures within the populations, and the relationships between those two factors. As Japan has reached a level of mortality similar to that in Sweden, the age patterns of mortality in the two populations have become more similar despite distinct differences in causes of death. The United States has a cause-of-death structure similar to that of Sweden, but the age pattern of mortality is very different. High mortality in the middle age range in the United States results in approximately a one-year loss of life expectancy at age 45 in comparison with Sweden.

Differences in the use of health services by metropolitan and nonmetropolitan elderly.

This study examined the importance of place of residence on the elderly's use of health services through Andersen's framework of health service utilization. The study found that nonmetropolitan elderly, both farm and nonfarm, make fewer physician visits than their metropolitan counterparts. This difference is not explained by differences in their predisposing or need characteristics. No residential differences were found in the number of short-term hospital stays or in the number of days of bed disability. No evidence was found that nonmetropolitan elderly substitute days of bed disability for physician care or for hospital stays. Also, little residential variation was found in the effect of predisposing, enabling, and need factors on physician use. The most likely explanation for the observed differences in physician use is the shortage of physicians in nonmetropolitan areas. However, without the ability to attach contextual information to national data on health status and service use, the relative importance of access to services cannot be adequately addressed.

Future caregivers: projected family structures of older persons.

Elderly persons depend upon spouses and children for emotional, physical, and financial support. In particular, the use of institutional long-term care has been shown to vary by family status. Changes in past and future levels of mortality, fertility, marriage, and divorce will influence the probability that elderly persons of the future have surviving spouses and children. This research uses multiple decrement life tables and component projection methods to project the future family status of elderly persons until the year 2020. The high level of fertility among women during the 1950s will result in greater proportions of future elderly persons having surviving children. Declines in mortality, coupled with increases in rates of marriage, increase the probability that both men and women will have spouses surviving in their old age.

An overview of demographic analysis as a method for evaluating census coverage in the United States.

"Since the 1950 U.S. census, demographic methods based on the fundamental balancing equation of demography have played an important role in the evaluation of the census net undercount. Application of this set of methods, called demographic analysis, results in national estimates of the net undercount for age-race-sex groups. Although results of demographic analysis are readily available in Bureau of the Census publications, the procedures used to estimate each of the components of population change are less well-known. In this paper we review the historical foundation of demographic analysis, beginning with Coale's 1950 census evaluation project and concluding with the recent evaluation of the 1990 census. We examine each of the components of the method, how their estimation has changed over time, and how they were estimated for the 1990 census."