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ENQUIRE PROJECT DETAILS BY GENERAL PUBLIC |
| Project Details |
| Funding Scheme : | General Research Fund | ||||||||||||||||||||||||||||
| Project Number : | 17605119 | ||||||||||||||||||||||||||||
| Project Title(English) : | When Both Spouses Have Functional Decline: Spousal Collaboration Dynamics in Mastering Daily Stressors Using Ecological Momentary Assessment | ||||||||||||||||||||||||||||
| Project Title(Chinese) : | 運用生態瞬間評估探索夫婦協同應對老化過程中的日常挑戰 | ||||||||||||||||||||||||||||
| Principal Investigator(English) : | Prof Lou, Vivian Weiqun | ||||||||||||||||||||||||||||
| Principal Investigator(Chinese) : | 樓瑋群 | ||||||||||||||||||||||||||||
| Department : | Department of Social Work and Social Administration | ||||||||||||||||||||||||||||
| Institution : | The University of Hong Kong | ||||||||||||||||||||||||||||
| E-mail Address : | wlou@hku.hk | ||||||||||||||||||||||||||||
| Tel : | |||||||||||||||||||||||||||||
| Co - Investigator(s) : |
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| Panel : | Humanities, Social Sciences | ||||||||||||||||||||||||||||
| Subject Area : | Social and Behavioural Sciences | ||||||||||||||||||||||||||||
| Exercise Year : | 2019 / 20 | ||||||||||||||||||||||||||||
| Fund Approved : | 1,163,688 | ||||||||||||||||||||||||||||
| Project Status : | Completed | ||||||||||||||||||||||||||||
| Completion Date : | 31-12-2022 | ||||||||||||||||||||||||||||
| Project Objectives : |
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| Abstract as per original application (English/Chinese): |
Background: In a super-aging society like Hong Kong, a huge number of older couples are getting frail together. Current research on informal carer dominantly takes a spousal caregiving perspective by clearly distinguish between roles of caregivers and care-receivers, overlooking a prevalent phenomenon that both spouses are at risk of functional decline and help with each other in daily life. Despite there is a few literature on the concordant health outcomes between spouses, no systematic research has been conducted to examine couple’s experiences of handling daily stressors and its well-being impacts. To address these research gasps, the proposed study advocates a paradigm shift from an individual-based examination of caregiver and care-receiver to investigating collaborative care arrangements within older couples and takes a first step to investigate the vivid experiences of how functionally impaired couples dealing with daily stressors.
Objectives: The study aimed to test specific functions of couple’s collaborative dynamics in mastering daily stressors that could facilitate more positive individual and relational well-being outcomes, and whether the effectiveness of collaboration varies as a function of perceived control of self and spouse during collaboration. By integrating interdependence theory and frameworks of dyadic coping, this study will test two sets of hypothesizes: (1) spousal collaboration buffers the temporal relationship between daily stressors and psychophysiological responses, and such buffering effects are enhanced when spouses exhibit a reciprocal pattern of control in collaboration; and (2) more frequent use of collaboration to deal with daily stressors is prospectively associated with greater well-being and marital satisfaction.
Methodology: We propose to use a combined research design comprising a longitudinal survey and ecological momentary assessment (EMA). The EMA research protocol has been validated in our previous work as a feasible and reliable method for studying real-life experiences of community-dwelling older adults. A sample of 75 older couples wherein both spouses reported functional decline will be recruited to participate in a baseline survey, a 14-day EMA, and a 12-month follow up survey. During the 14-day EMA period, each participant will be instructed to use mobile devices to provide self-report data (e.g., daily stressors, affect) and cardiovascular recordings four times daily.
Conclusion: The findings of this study will serve as the first evidence of the phenomenon of collaborative dynamics of functionally impaired couples’ mastering on daily problems. Findings will also inform the development of couple-centered care models that address the joint health needs of both spouses in super-aging societies globally. 面對超高齡社會的來臨，越來越多的老年夫婦會一起攜手經驗老化的過程。以往關於照顧者的研究一般會假設夫妻中有需要照顧的一方，另一方為主要照顧者。但是在日常生活中經常觀察到的是夫婦一起經驗老化的日常，有時候你照顧我，有時候我照顧你，有時候互相照顧，區分照顧者和被照顧者在理論上和實際上都未能解釋夫妻共老的實際經驗，夫妻在健康層面互相影響的研究也非常有限。本研究提出照顧者研究需要一個新的研究範式 – 系統研究夫妻兩人如何協同應對老化中的日常挑戰，特別是在當夫婦體驗到功能健康逐漸衰落的情境下。 故此，本研究目的是1）探索夫妻在面對共同老化的日常過程中如何運用協同應對策略；2）在協同應對過程中對自己及對方行為的控制感是有效協同的關鍵。為了實現這兩個研究目的，擬檢驗以下的兩個假設：首先，夫妻間的協同能緩衝老化過程日常的挑戰與健康指標之間的關係，這種緩衝會在夫妻有協同應對策略的情境下得到強化；其次，在日常生活中越多運用協同應對策略，越有機會有良好的健康與婚姻滿意度。 在本研究團隊發展的一套有效生態瞬間評估方法實踐步驟的基礎上，本研究綜合運用生態瞬間評估及長期問卷調查的方法。擬在社區招募75對老年夫婦，邀請參與夫婦在12個月間隔前後參與標準化的問卷調查，並在兩次調查之間參與14天的生態瞬間評估。 本項目是首個系統探索夫妻協同應對老化日常中挑戰的研究專案，預計研究結果將對瞭解及預測夫妻共同應對老化的理論和實際有建設性的影響，深化照顧者研究理論及為支援照顧者政策和服務的實際提供實證基礎。 |
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| Realisation of objectives: | All three project objectives were fully achieved. Research design: This study adopted a multiple method approach by integrating longitudinal design and Ecological Momentary Assessment (EMA) with three main components: (1) a baseline interviewer-administered geriatric assessment, (2) a 14-day EMA, and (3) a 12-month follow-up assessment. This multiple method approach was initiated and tested by our research team, and a pilot study was successfully implemented in a sample of community-dwelling Chinese elderly to study the procedure protocol and collect biopsychosocial data in 2020. Recruitment: Recruitment took place from Nov 2020 to Aug 2021. Of 174 (87 couples) eligible participants with functional decline (PwFD) from four elderly community centers, 166 participants (83 couples) consented to participate [mean age (SD) = 77.33 (6.83); mean marital year (SD) = 50.14 (8.10); independence in ADLs = 65.1%]. Male PwFD were slightly older [mean age (SD) = 79.2 (6.69)] as compared to their female partners [mean age (SD) = 75.5 (6.50)]. Male PwFD also experienced lower independence when performing ADL [mean (SD) = 95.6 (10.0)] then their wives [mean age (SD) = 96.2 (7.49)]. Data collection and analysis: Due to the COVID-19 pandemic, baseline data was collected by either face-to-face interview or online survey, we over-recruited 16 PwFD to cover the underestimated attrition (10.7%). A 14-day EMA was conducted, with a total of 156 PwFD (78 couples) finished the EMA, equivalent to 6% attrition rate. Additionally, we successfully collected a 1-day EMA one week after, with 154 PwFD (77 couples) to understand the changes in psychosocial well-being. The 12-month follow-up assessment was conducted with 129 PwFD (64 couples plus one male; attrition rate = 22.3%). No missing data was reported. Due to social distancing and closure of community centers, we collaborated with Central South University to collect physiological data using an electrocardiogram (ECG). For objective 1, we proposed one hypothesis. H1: Spousal collaboration buffers the temporal relationship between daily stressors and affective responses, and such buffering effects are enhanced when spouses exhibit a reciprocal pattern of control during collaboration. In this model, spousal collaboration refers to common dyadic coping (CDC) measured using a subscale of the Dyadic Coping Inventory (range: 1-15). CDC are coping strategies in which the couples participate complementarily which can be either problem-focused or emotion-focused, when dealing with daily stressors. A total of 21 daily stressors were identified from the Daily Inventory of Stressful Events (DISE) and the stress experienced by PwFD was averaged to obtain a continuous score (range: 1-5). Affective responses were measured using 10 selected items from the Positive and Negative Affect Scale (PANAS), mean score of positive affect (range: 1-5) and negative affect (range: 1-5). As daily stressors can be transmitted between couples, spousal collaboration was hypothesized to enhance positive affect and reduce negative affect. Figure 1 illustrated the differences in positive and negative affect among couple, showing support to the use of EMA as data collection method. Positive affect. Our analysis showed that number of daily stressors (b = -.04, 95% CI [-.06, -.03], z = -.51, p < .001) and spousal collaboration (b = .16, 95% CI [.14, .18], z = 13.82, p < .001) has a direct effect on positive affect, respectively. Spousal collaboration was found to moderate the relationships between the number of daily stressors and positive affect (b = .01, 95% CI [.00, .01], z = 4.19, p < .001). PwFD with a higher spousal collaboration experienced higher positive affect when dealing with daily stressors, while PwFD with lower spousal collaboration experienced lower positive affect when dealing with daily stressors. Negative affect. Our analysis showed that number of daily stressors (b = .09, 95% CI [.08, .10], z = 17.03, p < .001) and spousal collaboration (b = -.06, 95% CI [-.08, -.04], z = -6.84, p < .001) has a direct effect on negative affect, respectively. Spousal collaboration was found to moderate the relationships between the number of daily stressors and negative affect (b = -.01, 95% CI [-.02, -.01], z = -10.23, p < .001). PwFD with a higher spousal collaboration experienced lower negative affect when dealing with daily stressors, while PwFD with lower spousal collaboration experienced higher negative affect when dealing with daily stressors. For objective 2, we proposed one hypothesis. H2: Spousal collaboration buffers the temporal relationship between daily stressors and cardiovascular activation, and such buffering effects are enhanced when spouses exhibit a reciprocal pattern of control during collaboration. Perceived control is an understudied temporal aspect of collaboration that may be of importance in postulating collaborative outcomes. Feeling controlled or over-dominated by one’s spouse has been found to associate with psychophysiological arousal. A prolonged corrected QT (QTc) interval refers to an irregular heart rhythm that can be detected using an ECG. QT interval prolongation is associated with increased mortality, especially among adults over age 40. Due to the pandemic, we experienced social distancing and closure of community centers (which prevented on-site support for data collection using ECG), as well as delay of delivery of ECG machines (Checkme Pro F5 Health Monitor; ordered in Sep 2020, and delivered in Feb 2021). We contacted one of the Co-Is to collect data in China (n = 6; 20-day EMA and ECG; twice per day), under the Central South University, resulting in a total of 240 valid data points. Following Hodges’ formula, we transformed QT interval (in milliseconds) using standard heart rate: QTc = QT + 0.00175 * (heart rate – 60). Cardiovascular activation. Our analysis showed that number of daily stressors has no significant direct effect on QTc interval among PwFD (b = -9.32, 95% CI [-20.00, 1.40], z = -1.7.0, p = .088). Spousal collaboration has a direct effect on QTc interval (b = 28.94, 95% CI [25.0, 32.89], z = 14.37, p < .001). Spousal collaboration was found to moderate the relationships between the number of daily stressors and QTc interval (b = -29.44, 95% CI [-33.1, -25.74], z = -15.57, p < .001). PwFD with a higher spousal collaboration experienced shorter QTc interval when dealing with daily stressors, while PwFD with lower spousal collaboration experienced longer QTc interval when dealing with daily stressors. For objective 3, we proposed two hypotheses. H3: More frequent use of spousal collaboration to deal with daily stressors is prospectively associated with greater individual well-being. In this model, individual well-being refers to depressive symptomatology. This outcome was measured using the Chinese version Patient Health Questionnaire-9 (PHQ-9; range: 0-27), with baseline mean score (SD) = 4.46 (4.28). Among the 166 PwFD, 28.9% reported mild depression, 8.4% reported moderate depression, 2.4% reported moderately severe depression, and only 0.6% reported severe depression. Among these PwFD, female participants [mean (SD) = 5.18 (4.59)] reported significantly higher depressive symptoms than their husbands [mean (SD) = 3.73 (3.83)], t(164) = 2.20, p = .029. Another hypothesis concerns the prediction on marital satisfaction. In this study, marital satisfaction was measured using the 7-item Relationship Assessment Scale (RAS; range: 5-35), with baseline mean score (SD) = 28.9 (5.48). Among the 166 PwFD, female participants [mean (SD) = 27.3 (6.28)] reported significantly lower marital satisfaction than their husbands [mean (SD) = 30.5 (3.97)], t(164) = -3.90, p < .001. We used regression analyses to predict 1-year depressive symptomatology and marital satisfaction among the PwFD, an average score of RAS was computed for subsequent analysis. | ||||||||||||||||||||||||||||
| Summary of objectives addressed: |
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| Research Outcome | |||||||||||||||||||||||||||||
| Major findings and research outcome: | PwFD who reported higher than average levels of CDC experienced a lower negative affect when dealing with daily stressors (b = .03, 95% CI [.02, .05], z = 3.84, p < .001). On the other hand, PwFD who reported lower than average levels of CDC experienced a higher negative affect when dealing with daily stressors (b = .15, 95% CI [.14, .16], z = 22.08, p < .001). From these results, it can be concluded that the effect of daily stressors on negative affect is moderated by CDC. Overall, H1 is supported. Our results showed that PwFD in China who reported higher than average levels of CDC experienced a lower effect of daily stressors on QTc (b = -87.4, 95% CI [-112.7, -62.02], z = -6.75, p < .001). Also, PwFD who reported lower than average levels of CDC experienced a higher effect of daily stressors on QTc (b = 56.3, 95% CI [31.1, 81.53], z = 4.37, p < .001). From these results, it can be concluded that H2 is supported. Spousal collaboration buffers the temporal relationship between daily stressors and cardiovascular activation (in terms of QTc interval in milliseconds). The mean score of PHQ-9 for all participants’ baseline and follow-up was 4.46 (SD = 4.28) and 4.35 (SD = 5.05), respectively. For female participants, the CDC is a predictor for their follow-up PHQ-9. When they use CDC more frequently, their PHQ-9 score will decrease to some degree (B = -6.123, 95% CI [-11.71, -.54], p =.032). CDC affects females in dealing with daily stressors but not males. Males are more affected by demographic factors including age (B = -2.437, 95% CI [-4.61, -.26], p =.029) and ADL conditions (B = -4.216, 95% CI [-7.75, -.69], p = .020). Their PHQ-9 will decrease to some extent if they are more independent, and with age increases. The mean score of marital satisfaction (measured by RAS) for all participants’ baseline and follow-up was 4.13 (SD = 0.79) and 4.18 (SD = 0.82), respectively. For all participants, the baseline RAS score (B = 0.992, 95% CI [.78, 1.21], p < .001) is a strong predictor for their follow-up RAS score. For female participants, the CDC is a predictor for their follow-up RAS. When they use CDC more frequently, their RAS score will increase (B = 1.472, 95% CI [.44, 2.51], p = .006). | ||||||||||||||||||||||||||||
| Potential for further development of the research and the proposed course of action: |
In a super-ageing society like Hong Kong, our study addressed important research gaps regarding older couples’ experiences of getting frail together. This project has generated a theory-driven and evidence-based predictive model to explain the manifestation of CDC in managing daily stressors among older couples with functional decline. It enriches the conceptualisation of daily stressors, collaborative dynamics, and well-being outcomes, by integrating interdependency theory and the current collaborative coping framework. The findings call for a paradigm shift from ‘focusing on spousal caregiving in ageing’ to ‘enhancing spousal collaboration among older couples experiencing frail together’. The PI applied research findings from this project to inform interventions of another project entitled “YWCA Jockey Club Joyful Marriage Project” in 2021, to enhance marital satisfaction and well-being among older adults. The PI will also transfer knowledge to a territory-wide caregiver support project (funded by The Hong Kong Jockey Club Charities Trust; amount > HKD25 million). An intervention program will be developed to optimise CDC, stressed on mutual support, mutual goal-setting, mutual caregiver training, and marital enhancement therapies, for older couples. Additionally, the purchased ECGs will be fully utilised in other projects led/co-led by the PI, including health talk, intelligent robotics development, balance sensor development, etc. | ||||||||||||||||||||||||||||
| Layman's Summary of Completion Report: | Spousal collaboration is a valuable strategy to buffer the negative affect, cardiovascular-related mortality risk, depressive symptomatology, and marital dissatisfaction. Research on spousal interdependence focuses on ameliorating the negative effects of a caregiver, least attention is paid to understanding how older couples depend on each other when they aged, due largely to functional decline and loss of independence in daily living. This multimethod study explores the buffering effect of common dyadic coping (CDC) in dealing with daily stressors among older couples. From Nov 2020 to Aug 2021, 166 older couples completed a survey at baseline. Among them, 156 joined a 14-day EMA data collection. Additionally, 129 completed a 12-month follow-up survey. Data analysis indicated that CDC moderates the relationships between daily stressors and positive and negative affect, respectively. More importantly, more frequent use of the CDC predicted lower depressive symptoms and higher marital satisfaction. Coaching older couples to employ CDC as a strategy to manage daily stressors is crucial to render older couples find the right balance and age gracefully together. The findings inform the development of an intervention program in a territory-wide caregiver support project. Consequentially, facilitates older couples to have and hold each other ‘in sickness and in health’. | ||||||||||||||||||||||||||||
| Research Output | |||||||||||||||||||||||||||||
| Peer-reviewed journal publication(s) arising directly from this research project : (* denotes the corresponding author) |
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| Recognized international conference(s) in which paper(s) related to this research project was/were delivered : |
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| Other impact (e.g. award of patents or prizes, collaboration with other research institutions, technology transfer, etc.): |
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| SCREEN ID: SCRRM00542 |