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

项目总结/摘要 大多数美国老年人患有慢性疾病，疼痛是最常见的身体疾病。 在不同条件下出现的症状。慢性疼痛老年人的配偶是广泛的照顾者， 感觉，并经常提供日常活动的帮助;然而，持续暴露于患者的痛苦， 可能会对这些照顾者的健康和福祉造成损害。此外，我们最近的研究表明， 在亲密的婚姻关系中，年长的配偶比在亲密的婚姻关系中的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，亲密可能对关系有好处， 当病人更痛苦的时候。拟议的项目将测试这些不同的影响及其 长期的影响，在144名老年人的样本慢性腰痛（CLBP），由于高 这种疾病在医疗保险人群中的患病率和治疗相关费用。患者和护理人员 将使用平板电脑每天两次报告他们的日常体验，持续30天。他们还将完成 2年内每6个月进行一次面对面访谈和身体功能评估。目标1：检查 患者日常疼痛体验（严重程度、干扰、灾难化）对配偶的预期影响 看护者的痛苦（即，反应性）和控制反应，以及日常亲密的不同影响。我们 预测患者的疼痛体验将与配偶随后的痛苦有更强的关联， 在亲密度高的日子里，配偶们会比在亲密度低的日子里表现出更多的关心和压力 天此外，我们预测，更大的日常亲密关系将与当天更多的婚姻满意度相关， 对双方都有好处双向和跨日效应也将在这些假设的测试中进行检查。目的2 将使用多层次潜在增长曲线模型来联系日常护理人员的情绪反应和控制 对双方都有长期效果的反应。我们的预测是， 与痛苦较少的患者相比，2年内因疼痛而苦恼的患者会出现更多抑郁症状 很痛苦此外，我们预计，患者的配偶更控制，以回应病人的痛苦， 在2年内，身体功能更差，残疾程度更大，医疗保健利用率增加 与那些配偶控制力较弱的人相比。本研究的意义在于：1）提高 了解晚年疼痛对配偶照顾者幸福的影响; 2）确定长期的 对患者和护理人员的动态、二元体验的后果;以及3）将 用于在未来的研究中为CLBP创建一个以夫妇为导向的干预措施。创新领域包括一部小说 亲密关系的概念化，将揭示其优点和缺点，为夫妇生活 慢性疼痛，重点是老年夫妇，研究设计将使强有力的结论， 日常经历的时间顺序及其长期后果。

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.