title: Families and Disability Onset: Are Spousal Resources Less Important for Individuals at High Risk of Dementia?
abstract: To determine whether social contacts and spousal characteristics predict incident instrumental or basic activities of daily living (I/ADL) limitations and whether effects differ for individuals with high risk of dementia.
  
  
  
  Cohort study.
  
  
  
  Biennial interviews of Health and Retirement Study participants over up to 12 years.
  
  
  
  4,125 participants aged 65 years and older without baseline I/ADL limitations.
  
  
  
  Participants' family characteristics (living arrangements, proximity to children, contacts with friends, marital status, and spouse's depression, employment, and education) and dementia probability (high versus low risk of dementia based on direct and proxy cognitive assessments) were characterized at baseline. Family characteristics and their interactions with dementia probability were used to predict incident I/ADL limitations in pooled logistic regressions.
  
  
  
  ADL limitation incidence was higher among the unmarried (odds ratio [OR] versus married: 1.14; 95% CI: 1.01-1.30); those married to a depressed spouse (OR versus nondepressed spouse: 1.56, 95% CI: 1.21-2.00); or whose spouse had less than high school education (OR versus spouse with high school or more: 1.29, 95% CI: 1.06-1.57). Living with someone other than a spouse compared with living with a spouse predicted higher risk of both incident ADL (OR: 1.35; 95% CI: 1.11-1.65), and IADL (OR: 1.30; 95% CI: 1.06-1.61) limitations. Effects were similar for respondents with high and low dementia probability.
  
  
  
  Regardless of dementia risk, older adults may receive important marriage benefits, which help delay disability. The salience of spouse's education and depression status implicate modifiable mechanisms, such as information and instrumental support, which may be amenable to interventions.
authors.affiliation: Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Epidemiology, Harvard School of Public Health, Boston, MA. Electronic address: prist@mail.harvard.edu.
authors.forename: Pamela M
authors.initials: PM
authors.lastname: Rist
authors.affiliation: Harvard Center for Population and Development Studies, Cambridge, MA.
authors.forename: Sze Y
authors.initials: SY
authors.lastname: Liu
authors.affiliation: Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA; Department of Epidemiology & Biostatistics, University of California, San Francisco, CA.
authors.forename: M Maria
authors.initials: MM
authors.lastname: Glymour
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D015331:Cohort Studies; D003704:Dementia / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D004185:Disability Evaluation; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D018454:Spouses / Q000523:psychology*; D014481:United States / Q000453:epidemiology
keywords: cognitive function; disability; epidemiology; social ties