Dyadic Loneliness and Changes to HbA1c Among Older US Couples: The Role of Marital Support as Stress Buffer

Abstract

Objectives: Both experiencing loneliness and having a lonely partner can be psychosocial stressors, with implications for health. Yet, marital support may buffer against the cardiometabolic effects of loneliness. This study examines (1) whether own and/or partner’s loneliness predict changes in HbA1c over 4 years and (2) whether marital support moderates these effects. Methods: Actor–partner interdependence models analyzed data from 1,854 older couples who provided psychosocial and biomarker data at two timepoints (2008/2012 or 2010/2014) of the Health and Retirement Study. Results: Neither partner’s loneliness predicted changes in HbA1c overall. However, significant interactions indicated that both own baseline loneliness and partner’s baseline loneliness predicted significant increases to HbA1c over 4 years among those who reported below-average marital support. Discussion: Both the experience of loneliness and loneliness of a dyadic partner may have longitudinal consequences for cardiometabolic health. However, these effects are contingent upon perceived quality of the marriage, specifically marital support.

Loneliness and HbA1c among older Irish couples: Retirement as life stage context

“…For these same reasons, loneliness in either partner in a relationship may be a “stress generating” experience (e.g., Hammen, 2006). That is, having a lonely partner can itself be quite stressful, and this stress can lead to both inferior health behaviors, and to physiological responses to stress, which then impair physical health over time (Hammen, 2006; Stokes & Barooah, 2021). In accordance with the stress generation hypothesis, we anticipate that the experience of loneliness – in either partner within a couple – may lead to worse health outcomes for both partners.…”

“…Taken alongside the severe economic recession in 2008, when Ireland's housing bubble crashed and the national banking system broke down (Whelan, 2014), these changes speak to the changing nature of retirement in Ireland: A life course transition that is further delayed for many, due to lost savings and pension system changes, but which can occur earlier – whether voluntarily or involuntarily – based on factors such as financial capacity, as well as health or health problems (e.g., Barrett & Mosca, 2013; Mosca & Barrett, 2014). Indeed, those who retire involuntarily, due to poor health, report worse mental health than those who retire by choice (Mosca & Barrett, 2014), which may have further implications for the health and well‐being of their dyadic partners (Hammen, 2006; Stokes, 2017a; Stokes & Barooah, 2021).…”

“…These cases may be unique, insofar as the selection into retirement and the changes to future time horizons and intimate relationships may be thrust upon older participants in poor health, rather than freely chosen, with potential implications for both well‐being and health. Moreover, the examination of retirement status and loneliness within older couples allows for an examination of the ways in which factors such as age, ill health, employment status, and well‐being are intricately intertwined, not only for individual older adults themselves (e.g., Mosca & Barrett, 2014), but for their dyadic partners as well (e.g., Stokes & Barooah, 2021).…”

“…Studies focusing on the potential pathways or mechanisms of loneliness' general effects on health have largely focused on cardiometabolic health (e.g., Hawkley et al, 2010; Hawkley & Capitanio, 2015; O'Luanaigh et al, 2012; Valtorta et al, 2016; Xia & Li, 2018). This has included analysis of loneliness and HDL, LDL, and total cholesterol; metabolic syndrome; systolic blood pressure; and HbA1c, among others (e.g., Das, 2019; Hawkley & Cacioppo, 2010; O'Luanaigh et al, 2012; Stokes & Barooah, 2021; Whisman, 2010). This is due to loneliness' role as a psychosocial stressor, which may lead to heightened stress reactivity or abnormal stress responses that can be reflected by impaired cardiometabolic health (see, e.g., Das, 2019; O'Luanaigh et al, 2012).…”

“…HbA1c itself is a measure of glycemic control and an indicator of diabetes; it is also a risk factor for diabetes‐related disorders, including cardiovascular disease, and higher levels of HbA1c have been associated with increased risk of cardiovascular disease among persons both with and without diabetes (Santos‐Oliveira et al, 2011). Moreover, although studies concerning loneliness and cardiometabolic health in general have produced somewhat mixed results across different biological markers and across different populations (see, e.g., Stokes & Barooah, 2021 for discussion of this), studies examining HbA1c in particular have identified significant associations of loneliness with elevated HbA1c among older adults in Ireland (O'Luanaigh et al, 2012) as well as with older adults and their spouses' HbA1c levels in the U.S., although these latter associations appear contingent upon relational context (Stokes & Barooah, 2021). Taken together, this emerging literature suggests that (a) loneliness can have cardiometabolic implications for older persons, including older married adults; (b) HbA1c is a marker of cardiometabolic health that appears sensitive to the experience of loneliness as a stressor; and (c) the cardiometabolic implications of loneliness may materialize only under certain relational circumstances.…”