Sara M. Moorman

Sexual Behavior in Later Life

Objectives: This research tests the influences of age, biological, and psychosocial factors on sexual expression in later life. Method: The American Association of Retired Persons Modern Maturity Sexuality Survey collected data on diagnosed illnesses, treated illnesses, sexual desire, sexual attitudes, partner circumstances, and sexual behavior from 1,384 persons ages 45 and older. Ordered logistic regression models estimate the associations of age, biological, and psychosocial factors with the frequency of five sexual behaviors. Results: Diagnosed illnesses and treatments are generally unrelated to frequency of sexual activity. Sexual attitudes are related to frequency of partnered behavior and sexual desire is related to frequency of masturbation among both women and men. Satisfaction with the physical relationship with a partner is strongly related to behavior. Age remains significant after all other factors are controlled. Discussion: The authors conclude that the nature of sexual expression in later life reflects the interplay of body, mind, and social context.

Women’s Romantic Relationships After Widowhood

This study examines decisions women make about their romantic lives after widowhood. Participants were women from the Americans’ Changing Lives survey, a nationwide random sample of 3,617 Americans older than age 25 years who, in 1986, were widowed (n = 259) or had been widowed and were remarried (n = 49). Widowed participants provided information about their male companions and their interest in remarriage, as well as information about their social support, mental and physical health, age, and socioeconomic status. Logistic regressions revealed that younger age and greater unhappiness predicted interest in remarriage. Higher trait anxiety predicted having male companionship. Widows who had remarried had higher household incomes and worried less about finances than did widows who did not remarry. Widows appear to make choices about partners based on their individual needs and desires as well as the attributes and availability of partners.

Older Adults’ Preferences for Independent or Delegated End-of-Life Medical Decision Making

Objectives: This study assesses the proportions of participants who prefer independent or delegated medical decision making at the end of life and examines the relationships of personal beliefs, affiliative beliefs, and end-of-life planning behaviors to decision-making preference. Method: Data are drawn from the Wisconsin Longitudinal Study, a sample of nearly 4,500 healthy White Midwestern high school graduates in their mid-60s. Results: Four fifths of participants wanted to make decisions independently. Valuing independence, being less avoidant of thoughts of death, and valuing quality of life over length of life had strong associations with a preference for independent decision making. Those concerned about burdening a caregiver wanted to make independent decisions. Persons who both executed a living will and appointed a durable power of attorney for health care preferred independent decision making. Discussion: Older adults cite personal and affiliative beliefs, not lack of autonomy, as reasons for their choice to decide independently or delegate.OBJECTIVE This study examined the relationship between drinking that exceeds guideline-recommended limits and acute-care utilization for ambulatory-care-sensitive conditions (ACSCs) by older Medicare beneficiaries. METHOD This secondary data analysis used the 2001-2006 Medicare Current Beneficiary Survey (unweighted n = 5,570 community dwelling, past-year drinkers, 65 years and older). Self-reported alcohol consumption (categorized as within guidelines, exceeding monthly but not daily limits, or heavy episodic) and covariates were used to predict ACSC hospitalization, emergency department visit not resulting in admission, and emergency department visit that did result in admission. RESULTS Heavy episodic drinking was significantly associated with higher likelihood of an ACSC emergency department visit not resulting in admission (adjusted odds ratio = 1.91, 95% CI: 1.11-3.30; p < .05). Drinking pattern was not significant for other ACSC measures. DISCUSSION Results partially support the hypothesis that excessive drinking may be related to ACSC acute-care utilization among older adults, suggesting increased risk of lower quality outpatient care.

The importance of feeling understood in marital conversations about end-of-life health care

This study investigates processes within marital discussions about end-of-life medical treatment preferences. The associations among marital quality, the perception of having been understood following discussion, and intentions for whom to appoint as a health care surrogate are addressed. Data from 2,969 white married couples in their mid-60s are analyzed. Four-fifths of primary respondents reported that their partners understood their preferences extremely well. Primary respondents’ perceptions of high marital quality were associated with feeling extremely well understood. In turn, feeling understood partially mediated the relationship between perceptions of marital quality and the intention to appoint the partner as durable power of attorney for health care (DPAHC). Implications for research on marital communication and quality end-of-life health care are discussed.

Solidarity in the Grandparent–Adult Grandchild Relationship and Trajectories of Depressive Symptoms

PURPOSE OF THE STUDY Grandparent-adult grandchild relationships are becoming longer and more common, and therefore potentially more influential in the lives of individuals. This study examined the influence of solidarity (i.e., affinity, contact, and functional exchange) in the grandparent-adult grandchild relationship upon the depressive symptoms of both members of the dyad. DESIGN AND METHODS The study used data from the Longitudinal Study of Generations, a survey of 3- and 4-generation U.S. families that included 7 waves of data collection between 1985 and 2004. The sample was comprised of 374 grandparents and 356 adult grandchildren. We analyzed the data using multilevel growth curve models. RESULTS For both grandparents and adult grandchildren, greater affinity reduced depressive symptoms and more frequent contact increased symptoms. For grandparents only, receiving functional support without also providing it increased depressive symptoms. IMPLICATIONS The average grandparent-adult grandchild relationship is a source of both support and strain to both generations. These relationships exhibit great diversity, however, with large amounts of variation between dyads and within a single dyad over time. We suggest how policy makers and practitioners can identify the relational contexts that best promote the well-being of members of both generations.

Patient–Physician End-of-Life Discussions in the Routine Care of Medicare Beneficiaries:

Objective: Medicare reimbursement for physicians who discussed end-of-life care and planning with a patient during an office visit was cut from the 2010 Affordable Care Act. We assessed the characteristics of patients who reported having had such discussions, and whether these discussions are associated with trust in one’s physicians and with rates of family advance care planning (FACP). Method: The sample consisted of 5,199 Medicare beneficiaries who reported having an ongoing relationship with a primary care physician. We estimated ordinal and multinomial logistic regressions that controlled for health care utilization, current health, and recent family deaths. Results: Less than 1% (n = 310) reported an end-of-life conversation with a physician during the course of routine care. However, conversations were associated with greater trust in one’s physician and higher rates of completion of FACP. Discussion: Findings support renewed efforts to reimburse physicians for discussing end of life with their Medicare patients.

Mechanisms Linking Neighborhood Age Composition to Health

Purpose of the Study Age integration theory posits that the age composition of spaces affects the social interactions in which people can engage. This study aimed to examine whether social interactions perceived to involve generativity (i.e., commitment to younger generations), daily discrimination, and/or social cohesion mediate associations between neighborhood age composition, self-reported health, and psychological well-being. Design and Methods We applied multilevel structural equation models to data from 4,017 participants aged 30-84 who participated in the 2004-2006 wave of National Survey of Midlife Development in the United States, merged with data on their 3,714 neighborhoods from the 2010U.S. Census. Results Neighborhoods that represented the age distribution of the United States and neighborhoods that overrepresented older adults were contexts in which residents reported the most generativity and social cohesion. In turn, generativity and social cohesion were associated with better self-reported health and higher psychological well-being. Implications The nature of social interaction links neighborhood age composition to health and well-being. These results clarify the results of prior studies, advance measurement, suggest elaborations to age integration theory, and point to new directions for aging-in-place initiatives.

Caring for My Abuser: Childhood Maltreatment and Caregiver Depression

PURPOSE OF THE STUDY This study examined depressive symptoms among adult survivors of childhood maltreatment who provided care to their former abusive/neglectful parents. We also investigated the extent to which four coping styles--problem-focused coping, emotion-focused coping, positive social support, and negative social support--moderated the association between childhood maltreatment and depressive symptoms of the caregivers. DESIGN AND METHODS Among 1,001 filial caregivers from the 2003-2005 wave of the Wisconsin Longitudinal Study, 18.6% of respondents reported verbal, physical, or sexual abuse in childhood; 9.4% reported neglect in childhood. Ordinary least squares regression models were estimated. RESULTS Persons who had a history of parental abuse showed significantly more frequent depressive symptoms when providing care to their abusive parent(s) compared with caregivers who had not experienced parental abuse. Those who had been neglected had significantly more frequent depressive symptoms than caregivers who did not report neglect. Additionally, the use of emotion-focused coping was more strongly associated with more frequent depressive symptoms among abused caregivers than among caregivers with no history of abuse. IMPLICATIONS This vulnerable group of caregivers should be recognized in the development and implementation of support services for family caregivers at the state and national levels. In direct practice settings, when assessing caregiver stress and burden, the history of childhood maltreatment needs to be taken into account.

The Role of Relationship Biography in Advance Care Planning

Objective: We examine the ways that romantic relationship biographies are related to whether, how, and with whom individuals complete advance care planning (ACP), preparations for end-of-life medical care. Method: Data are from an Internet survey of 2,144 adults aged 18 to 64, all of whom were either married to or cohabiting with an opposite-sex partner. Results: Cohabitors were less likely than married people to complete ACP. Relationship quality was an important influence on ACP, but did not account for the differences between married and cohabiting persons. Differences were largely explained by the age composition of the groups. Discussion: Couples who foresee a long and stable future together are those most likely to engage in end-of-life planning, a preventative health behavior with long-term consequences for well-being.

An Assessment of Social Diffusion in the Respecting Choices Advance Care Planning Program.

This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients’ medical records. Using data from a survey of more than 5,000 White Wisconsin high school graduates in their mid-60s, we found that participants who were living in the La Crosse area were significantly less likely than their peers living elsewhere to have executed a living will or appointed a health care power of attorney. This pattern may reflect psychological reactance, where individuals reject a message or lesson when they perceive compliance as a threat to their autonomy. There was no evidence of social diffusion effects; participants who lived in the La Crosse region themselves or who had social network members residing in the area were no more likely than those with no known ties to the region to have engaged in advance care planning. Future studies should explore the processes through which individuals learn and share with others their knowledge of advance care planning.