The authors examined spouses' provision of health-related support and control as predictors of health behavior and mental health among patients participating in cardiac rehabilitation (N = 94 couples). Cross-sectional analyses revealed that spouses' support was positively associated with patient health behavior. Prospective analyses of change over 6 months (N = 65 couples) revealed that spouses' support predicted increased patient mental health, whereas spouses' control predicted decreased patient health behavior and mental health. Findings suggest that spouses' efforts to facilitate patients' healthy lifestyle behaviors are associated with patients' health behavior and mental health, but not always as spouses might intend.

Our findings offer insight into partners' day-to-day disease-related interactions and identify those that are likely to be beneficial versus detrimental for patients' physical and psychological health.

Discussion integrates solidarity theory, developmental stake, and contingency theory. Most middle-aged adults provide more to grown offspring than to parents, consistent with their greater stake in their progeny. Middle-aged adults also respond to crises (i.e., parental disability) and everyday needs (i.e., offspring student status) in providing intergenerational support, in accordance with contingency theory.

The positive effect of activities on well-being is proposed to be mediated by self-conceptualizations and facilitated by socioeconomic status. The hypothesized processes were estimated with LISREL VIII using data from a large cross-sectional survey with a sample of 679 adults aged 65 and older who were representative of older adults living in the Detroit area. Findings indicate that the frequency of performing both leisure and productive activities yields an effect on physical health and depression and that these effects are mediated in part by a sense of self as agentic, but less clearly by a sense of self as social. Furthermore, socioeconomic status, operationalized as formal educational attainment, facilitates the effect of leisure to a greater extent than that of productive activities.

Findings suggest that spousal exercise support on its own or in conjunction with spousal exercise control may facilitate daily diabetes management through physical activity.

Although there are often immediate behavioral benefits in response to partners' use of both pressure and persuasion, the long-term health effects of these strategies seem to be accounted for by their opposing links to positive emotions. Findings further refine theory on health-related social control in marriage.

We investigated two types of negative and positive social control strategies, warning and encouragement, used by spouses to urge patients with type II diabetes to improve adherence to the diabetic diet. Warning refers to things a spouse may say or do to caution the patient about the consequences of eating a poor diet, and encouragement refers to things a spouse may say or do to promote healthier food choices by the patient. Our dyadic design (n=109 couples) assessed spouses' use of warning and encouragement (reported by spouses and by patients), as well as patients' reports of dietary adherence. Spouses being actively involved in patients' dietary choices was the largest category of open-ended descriptors of both warning and encouragement. Both spousal warning and encouragement were associated with patients' adherence to the recommended diabetic diet, with warning associated with poorer adherence and encouragement associated with better adherence. Moreover, it was the spouses' perceptions of their own influence attempts, and not patients' reports, that were consequential for patients' adherence. Patients' dietary behavior, and ultimately disease management, appears to be best served when the spouse uses more positively toned and less coercive influence attempts.

OBJECTIVES To compare the characteristics and outcomes of dementia caregivers to caregivers of adults with cognitive impairment, not dementia (CIND). DESIGN Cross-sectional study SETTING In-home assessment for cognitive impairment and self-administered caregiving questionnaire. PARTICIPANTS 169 primary family caregivers of participants in the ADAMS (Aging, Demographics, and Memory Study). ADAMS participants were age 71 or older drawn from the nationally representative Health and Retirement Study. MEASUREMENTS Neuropsychological testing, neurologic examination, clinical assessment and medical history were used to assign a diagnosis of normal cognition, CIND, or dementia. Caregiving measures included caregiving time, functional limitations, depressive symptoms, physical and emotional strain, caregiving rewards, caregiver health, and demographic characteristics. RESULTS Dementia caregivers spent approximately 9 hours/day providing care, compared to 4 hours/day among CIND caregivers (p=0.001). 44% of dementia caregivers exhibited depressive symptoms, compared to 26.5% of CIND caregivers (p=0.033). Physical and emotional strains were similar in both groups of caregivers. Regardless of the strains, nearly all caregivers reported some benefits from providing care. Emotional strain experienced by CIND caregivers was partially explained by behavioral problems (p=0.01) and difficulty with IADLs (p=0.01) in persons with CIND. For those with dementia, behavioral problems predicted caregiver emotional strain (p<0.001) and depressive symptoms (p = 0.01). CONCLUSIONS While support services are available to dementia caregivers, CIND caregivers also expend considerable time and experience strains. The real caregiver burden of cognitive impairment in the US population may therefore be greatly underestimated if we focus exclusively on people who have reached the diagnostic threshold for dementia.