Abstract Background and Objective older adults have increased risk of social isolation, loneliness and cognitive functioning impairment, but the relationships among these factors are not conclusive. We investigated the potential mediation mechanism of loneliness on the association between social isolation and cognitive functioning among Chinese older adults within their cultural context. Design secondary analysis of the baseline wave (2011–12) of the harmonised China Health and Retirement Longitudinal Study. Setting and Subjects community-dwelling older adults in China (N = 7,410 participants aged 60–101 years). Methods we applied a multiple indicator multiple cause approach to determine whether the construct of social isolation is well defined by four indicators (social activity engagement, weekly adult children contact, caregiving for grandchildren and living alone) and used structural equation modelling to examine the direct and indirect effects among variables of interest. Results the results demonstrated that social activity engagement, weekly adult children contact and caregiving for grandchildren were significantly related to social isolation (β = −0.26 to −0.28) (Living alone was fixed to 1 for model identification.) The indirect effect of social isolation on cognitive functioning through loneliness was significant (β = −0.15), indicating loneliness was an important mediator. However, the direct effect of social isolation on cognitive functioning also remained significant (β = −0.83), suggesting a partial mediation effect. Conclusions our study highlights the mediation role of loneliness in the relationship between social isolation and cognitive functioning among Chinese older adults. The findings support the beneficial effects of maintaining social relations and coping with feelings of loneliness on older adults’ cognitive functioning.

he incidence of type 1 diabetes is rising (1), as is the number of older adults (>65 years of age) who are living with type 1 diabetes (2). The life expectancy of individuals diagnosed with type 1 diabetes increased by 15 years between 1950-1964 and 1965-1980 (3). Type 1 diabetes is associated with a number of health complications, including myocardial infarction, cerebrovascular accidents, retinopathy, neuropathy, nephropathy (4), hypoglycemia and hypoglycemia unawareness (5), and dementia-all of which are more common among older adults (3,6,7). Although individuals are now living longer with type 1 diabetes, they may experience significant functional and cognitive decline as a result of their illnesses. Older adults with type 1 diabetes are generally an understudied population. Type 1 diabetes management in adulthood is most often examined at the individual level (8,9). Although couple relationships are the most important resource for supporting

Objective: Dyadic coping theories posit that spousal involvement may benefit illness management through collaborative and supportive (C&S) strategies and shared illness appraisals. Illness appraisals have only been examined as individual differences rather than fluctuating daily as individuals manage the difficult Type 1 diabetes regimen. The study examined how daily illness appraisals of individuals with Type 1 diabetes and their spouses were linked to spouses' daily C&S strategies and whether C&S strategies were most beneficial for daily diabetes outcomes when they occurred in the context of shared illness appraisals. Method: Couples (N ϭ 199) in which one person had Type 1 diabetes (M age patients ϭ 46.81; 52.3% female; spouses ϭ 46.40, 47.5% female) completed a 14-day diary assessing illness appraisals (ranging from nonshared through shared) and spouses' C&S strategies. Patients reported daily self-regulation failures, self-care behaviors, and perceived coping effectiveness. Daily blood glucose was gathered from glucometers. Results: Multilevel models indicated both within-person and between-person effects of patients' and spouses' illness appraisals on C&S strategies with higher shared illness appraisals associated with greater C&S strategies. Greater shared illness appraisals were associated with fewer self-regulation failures and better self-care. C&S strategies were associated with lower self-care and higher blood glucose levels. Appraisal interacted with C&S strategies such that C&S strategies were associated with more self-regulation failures, lower self-care, and lower perceived coping effectiveness when patients reported lower shared appraisals. Conclusions: Results suggest that C&S strategies may be more detrimental for diabetes management when individuals view diabetes as less shared.

We-talk (first-person plural pronoun usage) is frequently used to represent the degree to which a person views an illness as shared within a couple. There is evidence that we-talk is related to good relationship and health. However, research has failed to examine the implications of we-talk for spouses and the interpersonal mechanisms that underlie relational and health benefits. To address these limitations, we investigated the association of we-talk to relationship and health among 199 couples in which one person had type 1 diabetes. We-talk was assessed in the context of a brief coping interview with patients and spouses separately. Patients reported their perceptions of their spouse’s behavior over the past month. Actor–partner interdependence, regression, and bootstrap models showed that patient we-talk was unrelated to patient and spouse well-being, but greater spouse we-talk was associated with higher patient relationship satisfaction, higher patient self-efficacy, and better patient self-care behavior. For spouses, greater spouse we-talk also was associated with higher relationship satisfaction, lower stress, and fewer depressive symptoms. Mediational analyses showed that patients’ perceptions of spouses’ greater emotional support and fewer critical behaviors partially accounted for these associations. Spouse we-talk may be more important than patient we-talk because it signifies that spouses are involved in helping with diabetes management, namely by providing emotional support and refraining from criticizing the patient.

The transition from late adolescence to emerging adulthood is particularly challenging for those with T1D. The findings that individuals with greater depressive symptoms have poorer adherence and glycemic control relative to those with lower depressive symptoms, and that increases in depressive symptoms are associated with declines in adherence, highlight the importance of screening and monitoring depressive symptoms during this life transition. (PsycINFO Database Record

Objective To examine (a) changes in parental involvement across early emerging adulthood, (b) whether yearly fluctuations in parental involvement were associated with adherence and glycated hemoglobin (HbA1c) over time, and (c) whether higher involvement was more beneficial for those with poorer executive function (EF). Methods A total of 228 high school seniors (M age = 17.76) with type 1 diabetes reported on mothers’ and fathers’ acceptance, knowledge of diabetes activities, disclosure to mothers and fathers regarding diabetes, and adherence at four yearly time points. At baseline, participants completed performance-based measures of EF. HbA1c was collected from assay kits. Results Growth curve models revealed significant declines in disclosure to fathers and mothers’ and fathers’ knowledge of diabetes activities; no changes were found in mothers’ or fathers’ acceptance nor disclosure to mothers. Multilevel models indicated significant between-person effects for nearly all aspects of parental involvement with more acceptance, knowledge, and disclosure associated with better HbA1c and adherence. Within-person effects for disclosure to fathers, and mothers’ and fathers’ knowledge indicated that in years when emerging adults perceived higher amounts of these types of involvement (compared with their own average), HbA1c was lower. Within-person effects were found for acceptance to mothers, disclosure to mothers and fathers, and mothers’ diabetes knowledge for adherence. Disclosure to fathers and mothers’ knowledge of diabetes activities were especially beneficial for HbA1c for those with poorer EF performance. Conclusions Parental involvement in diabetes management remains important during the high-risk time of emerging adulthood, especially for those with poorer EF.

Objective: To examine the influence of daily sleep quality in patients with type 1 diabetes (T1D) on that of their spouses and to investigate the influence of couples’ sleep quality on patients’ diabetes-specific stressors and couples’ general stressors the following day. Methods: 199 patients with type 1 diabetes (Mage = 46.82) and their spouses (Mage = 46.41) completed a 14-day diary where they reported on their own sleep quality, and the presence of general stressors. Patients reported the presence of diabetes-specific stressors. Multi-level modeling examined the effects of daily variability in (within-person effects) and average levels of (between-person effects) sleep quality on the number of next-day diabetes-specific stressors (controlling for prior day stressors). Furthermore, the actor-partner interdependence model was used to examine the effect of sleep quality on general stressors. Results: Greater patients’ daily sleep quality was related to their spouses’ greater sleep quality. Increases in the patients’ own daily- and average sleep quality were uniquely associated with fewer next day diabetes-specific stressors. Better own daily- and average sleep quality were associated with fewer general stressors for both partners. Spouses’ increased daily sleep quality was associated with fewer general stressors of patients. Conclusions: The results support that sleep quality is a dyadic phenomenon among couples and suggest that better sleep quality may buffer diabetes specific and general stress in couples coping with T1D.

Objective: Communal coping with a chronic illness has been associated with better health outcomes and includes two components: an individual's appraisal of the illness as shared and collaborative strategies to manage the illness. Although multiple methods have been used to assess these constructs, there is limited understanding of whether these methods tap similar components of communal coping. The study goals were to assess how individuals diagnosed with type 1 diabetes communally cope with their romantic partner using multiple methods to (a) distinguish between the two components of communal coping and (b) examine links of both components to health outcomes and test whether interactions between the two are linked to health outcomes. Method: Individuals with type 1 diabetes (n = 199, 52% female, 90% non-Hispanic white) completed self-report, diary, observational, and open-ended interviews to measure communal coping. Psychological well-being, diabetes distress, and diabetes health outcomes were assessed. Results: A confirmatory factor analysis supported our hypothesis that communal coping is reflected by 2 distinct components: shared appraisal and collaborative coping. There were no direct effects of either shared appraisal or collaboration to outcomes, however, the interaction between shared appraisal and collaboration was linked to diabetes distress, self-care, and self-efficacy. Specifically, collaboration was linked to worse outcomes at low shared appraisal but not high shared appraisal. Conclusions: These findings support the two components of communal coping and suggest that collaboration can be detrimental for health among those who do not view an illness as shared.