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

项目总结 多发病是中老年人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了沉重的负担，导致 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，人们对多发性疾病的个体如何 以有利于或损害其长期健康的方式影响其配偶和/或受其影响。此外，几乎没有人 研究已经考虑了配偶双方都患有多发病。多发性慢性疾病可能会特别 当他们涉及不协调的管理策略(例如，降低心血管风险)时会有压力 因素与减轻痛苦)在配偶内部或之间，由于更高的支持需求。不和谐的条件 也可能会给有限的个人资源带来压力，扰乱每个伴侣的自我照顾日常生活，导致减少 促进健康的行为(例如，体育活动)和增加的健康危险行为(例如，饮酒) 最终会降低他们的健康和福祉。这个项目将通过研究模式来推进文献 中老年夫妇的多发病及其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。 拟议的项目将利用健康和退休研究的十次浪潮(1996年至2014年)的数据 (小时)，包括配偶二人组的两个成员。我们将探索三个具体的调查领域：第一，我们 将确定配偶内部和配偶之间的多发病模式，重点放在他们的 管理活动以及模式是否因社会人口结构而异。第二，我们将长期评估 夫妻多发病模式与夫妻双方心理健康(抑郁)的关系 健康行为(睡眠、体育活动、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)和社会心理资源(控制 信念、与配偶、家庭成员和朋友的关系质量)，这些因素会缓和这些联系。 该项目将生成有关多种慢性病组合的关键信息，这些慢性病可能 对老年夫妇的健康和幸福有持久的影响。研究已经证实，有 配偶一方的疾病与其配偶的身体和心理之间的一致联系 健康；但先前的工作几乎完全强调了配偶中的一方患有单一的慢性疾病， 忽视对每个合作伙伴的多种情况及其对油井的潜在后果的理解 婚姻中的存在和健康。研究结果将为有针对性的干预措施提供指导，以促进长期良好的 年长的个人和家庭管理多种慢性病以及更全面的 多发病的治疗探讨。

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.