Diverging Effects of Closeness in Older Adults with Chronic Low Back Pain and Spousal Caregivers

项目摘要/摘要 大多数美国老年人患有慢性健康状况，而疼痛是最常见的身体状况 在各种情况下都会出现症状。患有慢性疼痛的老年人的配偶是广泛的照顾者 感觉，并经常在日常活动中提供帮助；然而，持续暴露于患者的痛苦是 可能会对这些照顾者的健康和福祉造成影响。此外，我们最近的研究表明 处于亲密婚姻关系中的年长配偶比处于婚姻关系中的年长配偶更容易受到伴侣痛苦的影响 不那么亲密的关系。这一有趣的发现表明，亲密关系可能对两人的关系有好处，但却有坏处。 当患者更痛苦的时候，为配偶提供帮助。拟议的项目将测试这些不同的影响及其 144例患有慢性下腰痛(CLBP)的老年人样本的长期意义 这种疾病在医疗保险人群中的患病率和与治疗相关的费用。病人和照顾者 将在30天内每天报告两次使用平板电脑的日常体验。他们还将完成 在两年内每6个月进行一次面谈和身体机能评估。目标1是检查 患者日常疼痛体验(严重程度、干预、灾难)对配偶的预期影响 照顾者的痛苦(即反应性)和控制反应，以及日常亲密的不同影响。我们 预测患者的痛苦经历将与配偶随后的痛苦有更强的关联，以及 在亲密程度高的日子里，配偶们会比在亲密程度低的日子里做出更多的关心和压力。 几天。此外，我们预测，日常亲密程度越高，当天的婚姻满意度就越高， 对双方来说都是如此。双向和跨日效应也将在对这些假设的测试中进行检验。目标2 将使用多水平潜在增长曲线模型将日常照顾者的情绪反应性和控制力联系起来 应对措施，为双方带来更长期的结果。我们的预测是，配偶 与那些不那么痛苦的人相比，患者痛苦的人在两年内会有更多的抑郁症状 很苦恼。此外，我们预计，配偶对患者疼痛的反应更具控制力的患者 将在两年内具有更差的身体功能、更大的残疾和更高的医疗保健利用率 与配偶控制力较弱的人相比。本研究的意义在于：1)改进 了解晚年疼痛对配偶照顾者幸福感的影响；2)确定较长期的 动态、二元体验对患者和照顾者的影响；以及3)结果将是 用于在未来的研究中为CLBP创建以夫妇为导向的干预。创新领域包括一部小说 关系亲密的概念化，将揭示其对夫妻生活的利弊 对于慢性疼痛，关注老年夫妇，以及一项研究设计，将使关于以下方面的有力结论成为可能 日常经验的时间序列及其更长期的后果。

PROJECT SUMMARY/ABSTRACT The majority of older Americans live with chronic health conditions, and pain is the most common physical symptom experienced across conditions. Spouses of older adults with chronic pain are caregivers in a broad sense, and often provide assistance with daily activities; however, ongoing exposure to patients’ suffering is likely to take a toll on the health and well-being of these caregivers. Moreover, our recent research suggests that older spouses in a close marital relationship are more affected by their partner’s pain than spouses in a less close relationship. This intriguing finding suggests that closeness may be good for the relationship but bad for spouses when patients are in more pain. The proposed project will test for these divergent effects and their longer-term implications in a sample of 144 older adults with chronic low back pain (CLBP), due to the high prevalence and treatment-related costs of this condition in the Medicare population. Patients and caregivers will report on their daily experiences twice per day for 30 days using tablet computers. They will also complete in-person interviews and physical function assessments every 6 months over 2 years. Aim 1 is to examine prospective effects of patients’ daily pain experience (severity, interference, catastrophizing) on spousal caregivers’ distress (i.e., reactivity) and controlling responses, and divergent effects of daily closeness. We predict that patients’ pain experience will have stronger associations with spouses’ subsequent distress, and spouses will respond with more solicitousness and pressure, on days of high closeness than on low closeness days. In addition, we predict greater daily closeness will be associated with more marital satisfaction that day, for both partners. Bi-directional and cross-day effects also will be examined in tests of these hypotheses. Aim 2 will use multilevel latent growth curve modeling to link daily caregiver emotional reactivity and controlling responses with longer-term outcomes for both partners. Our prediction is that spouses who are more distressed by patients’ pain will have more depressive symptoms over 2 years compared to those who are less distressed. In addition, we expect that patients whose spouse is more controlling in response to patients’ pain will have worse physical function, greater disability, and increased health care utilization over 2 years compared to those whose spouse is less controlling. Significance of this study lies in: 1) improved understanding of the impact of late-life pain on spousal caregivers’ well-being; 2) identification of longer-term consequences of dynamic, dyadic experiences for both patients and caregivers; and 3) findings that will be used to create a couple-oriented intervention for CLBP in future research. Areas of innovation include a novel conceptualization of relationship closeness that will reveal its advantages and disadvantages for couples living with chronic pain, a focus on older couples, and a study design that will enable strong conclusions regarding temporal sequence of daily experiences and their longer-term consequences.