Multimorbidity Patterns in Middle-Aged and Older Couples: Implications for Psychological Well-Being and Health Behaviors

项目摘要 多发性硬化症是中年和老年人中日益普遍的公共卫生问题。 多种慢性病给个人及其家庭带来沉重负担，导致高发病率。 住院、残疾和死亡率。配偶关系是健康相关影响的重要来源， 为患有慢性病的老年人提供支持。然而，人们对患有多发性硬化症的人如何 影响和/或受其配偶影响，从而有益或有害其长期健康。此外，少数 研究考虑了夫妻双方的多次死亡。多种慢性疾病可能特别 当涉及不协调的管理策略时（例如，降低心血管危险 因素与减少疼痛）内或配偶之间，由于提高支持的需要。不一致条件 也可能会使有限的个人资源紧张，扰乱每个伴侣的自我护理程序，导致减少 健康促进行为（例如，体力活动）和增加的健康风险行为（例如，酒精使用）， 最终损害他们的健康和幸福。本项目将通过研究以下模式来推进文献： 中年和晚年夫妇中的多次死亡，他们对心理健康的长期影响， 健康行为，以及可能缓冲或加剧这些联系的社会人口和心理社会因素。 拟议的项目将利用十波（1996年至2014年）健康与退休研究的数据 (HRS)，包括配偶二分体的两个成员。我们将探讨三个具体的调查领域：首先，我们 将确定配偶内和配偶之间的多重婚姻模式，重点是他们的和谐， 管理活动以及模式是否因社会人口统计学而异。第二，我们将长期评估 夫妻的多重情感模式与夫妻双方的心理健康（抑郁）之间的关联 症状）和健康行为（睡眠、身体活动、饮酒和吸烟）。第三，我们将确定 社会人口学特征（年龄、性别、种族和教育）和心理社会资源（对照 信仰，与配偶、家庭成员和朋友的关系质量），这些因素会调节这些关联。 该项目将产生关于多种慢性疾病组合的关键信息， 对老年夫妇的健康和幸福有持久的影响。研究表明， 配偶一方的疾病与他或她的伴侣的身体和心理之间的一致关联 健康;但以前的工作几乎只强调配偶一方的单一慢性病， 忽视了对每个合作伙伴的多种条件及其潜在后果的理解， 婚姻中的健康与幸福调查结果将为有针对性的干预措施提供信息，以促进长期的良好- 作为老年人和家庭管理多种慢性疾病，以及更全面的 治疗多发性硬化症的方法。

PROJECT SUMMARY Multimorbidity is an increasingly prevalent public health concern among middle-aged and older adults. Multiple chronic conditions place a high burden on individuals and their families, leading to elevated rates of hospitalization, disability, and mortality. The spousal tie is a crucial source of health-related influence and support for aging adults with chronic illness. Yet little is known about how individuals with multimorbidity may affect and/or be affected by their spouse in ways that benefit or harm their long-term health. Moreover, few studies have considered multimorbidity in both spouses. Multiple chronic conditions may be particularly stressful when they involve management strategies that are discordant (e.g., reducing cardiovascular risk factors vs. reducing pain) within or between spouses due to heightened support needs. Discordant conditions may also strain limited personal resources and disrupt each partner's self-care routines, resulting in decreased health-promoting behaviors (e.g., physical activity) and increased health-risk behaviors (e.g., alcohol use) that ultimately diminish their health and well-being. This project will advance the literature by examining patterns of multimorbidity within mid- and late-life couples, their long-term implications for psychological well-being and health behaviors, and sociodemographic and psychosocial factors that may buffer or exacerbate these links. The proposed project will draw on data from ten waves (1996 to 2014) of the Health and Retirement Study (HRS), including both members of the spousal dyad. We will explore three specific areas of inquiry: First, we will determine patterns of multimorbidity within and between spouses, focusing on concordance in their management activities and whether patterns vary by sociodemographics. Second, we will evaluate long-term associations between couples' multimorbidity patterns and both spouses' psychological well-being (depressive symptoms) and health behaviors (sleep, physical activity, alcohol use, and smoking). Third, we will identify sociodemographic characteristics (age, gender, race, and education) and psychosocial resources (control beliefs, relationship quality with one's spouse, family members, and friends) that moderate these associations. This project will generate critical information about combinations of multiple chronic conditions that may have lasting effects on health and well-being in aging couples. Research has established that there are consistent associations between one spouse's illness and his or her partner's physical and psychological health; but prior work has placed a near exclusive emphasis on a single chronic condition in one spouse, neglecting an understanding of each partner's multiple conditions and their potential consequences for well- being and health within the marriage. Findings will inform targeted interventions to promote the long-term well- being of older individuals and families managing multiple chronic conditions as well as a more comprehensive approach to the treatment of multimorbidity.