The New Old Age Blog: Older People Become What They Think, Study Shows

All of us have beliefs — many of them subconscious, dating back to childhood — about what it means to get older. Psychologists call these “age stereotypes.” And, it turns out, they can have an important effect on seniors’ health.

When stereotypes are negative — when seniors are convinced becoming old means becoming useless, helpless or devalued — they are less likely to seek preventive medical care and die earlier, and more likely to suffer memory loss and poor physical functioning, a growing body of research shows.

When stereotypes are positive — when older adults view age as a time of wisdom, self-realization and satisfaction — results point in the other direction, toward a higher level of functioning. The latest report, in The Journal of the American Medical Association, suggests that seniors with this positive bias are 44 percent more likely to fully recover from a bout of disability.

For people who care about and interact with older people, the message is clear: your attitude counts because it can activate or potentially modify these deeply held age stereotypes.

The researcher who has done more than anyone else to advance our understanding of this is Becca Levy, an associate professor of epidemiology and psychology at Yale University.

In the mid-1990s, she began a series of experiments with older people in laboratory settings. The idea was to expose them subliminally to negative or positive stereotypes by flashing words associated with aging on a computer screen too fast for them to process consciously. Then these seniors were asked to perform a task.

Those exposed to negative words such as “decrepit” had poorer handwriting, slower walking speeds, higher levels of cardiovascular stress and a greater willingness to reject hypothetical medical interventions that could prolong their lives. Those primed with positive words such as “wisdom” did much better.

The experiments involved external stimuli, however, and Dr. Levy was interested in peoples’ subjective experience of older age. For that, she turned to a database of adults age 50 and older in Oxford, Ohio, who were followed for a period of 23 years, from 1975 to 1998.

Many had filled out questionnaires at the start of the study designed to elicit stereotypes about aging. This involved soliciting a “yes” or “no” answer to a series of statements like “things keep getting worse as I get older,” or “as you get older, you get less useful.”

When Dr. Levy looked at 660 participants, she found that those with positive age stereotypes lived 7.5 years longer than those with negative stereotypes. The research was published in The Journal of Personal and Social Psychology in 2002.

What might account for this finding? In her paper, Dr. Levy speculated that people with positive age stereotypes have a stronger will to live, and that this might affect their ability to adapt to the rigors of older age. Also, people with negative age stereotypes may have a heightened cardiovascular response to stress, with attendant ill health effects.

In other research using this data set, Dr. Levy established that people with positive age stereotypes were more likely to eat a balanced diet, exercise, limit their alcohol consumption, stop smoking and get regular physical exams, and that they had a higher level of physical functioning over time. Results were controlled for other factors like illness, gender, race and socioeconomic status.

In these papers, Dr. Levy hypothesized that positive age stereotypes are associated with a greater sense of control and that this enhanced seniors’ sense of self efficacy — their ability to remain captains of their own ship, as it were.

Her new findings about the impact of age stereotypes on older adults’ recovery from disability is an extension of this body of work. In this case, Dr. Levy and her co-authors followed 598 adults age 70 and older in New Haven, Conn., from 1998 to 2008. Disability was defined as needing help with basic activities of daily living like bathing, dressing and walking, and its onset was typically precipitated by an illness or injury.

Again, seniors with positive age stereotypes were much more likely to have good results and recover fully.

Dr. Marie Bernard, a geriatrician who serves as deputy director of the National Institute on Aging, said she found the report “quite intriguing” and that it confirmed her clinical observations in more than 30 years of medical practice. But she cautioned that it is a small study that needs to be replicated.

“What we really need to understand is the mechanism,” she said. “Is it something that is malleable and, if so, could we help people live longer, healthier lives?”

Researchers don’t have an answer to that yet. But many believe that part of the answer has to lie in tackling ageism – which is pervasive in our youth-oriented culture — early on, from earliest childhood.

“Even young kids have negative associations; they tell you that older adults are sick, slow, forgetful, no good,” said Dana Kotter-Gruehn, a visiting assistant professor in the department of psychology and neuroscience at Duke University.

Also generations need to be brought together so that “people can experience what it means to be an older person” and stereotypes can be dispelled, Dr. Kotter-Gruehn said. This has been shown to help change people’s stereotypes about race and homosexuality, she noted.

Closer to home, all of us who interact with older people can “think about how to reinforce the more positive aspects of aging,” Dr. Levy said.

“If all of us became a little more aware of the implications of our communications” — the tone of voice we use with seniors, the attitude we adopt, the use of loaded phrases or expressions, the extent to which we give older adults our full, undivided attention — “that would help quite a lot.”

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U.N. Suspends Immunization Work in Pakistan

 ISLAMABAD, Pakistan — The United Nations suspended all polio-related field activities in Pakistan on Wednesday after more attacks on public health workers attempting to immunize children. Two people were killed and another wounded around the northwestern city of Peshawar.

 The shootings followed a day of violence on Tuesday in the port city of Karachi in which four female health workers were killed. The attacks Wednesday brought the death toll from the three-day polio immunization campaign to eight people, most of them women.

 The World Health Organization and Unicef ordered their staff members off the streets in response to the latest shootings, although some provincial governments continued to immunize children.

 The shootings represent the most direct assault yet on an urgently needed public health program in one of the world’s last remaining reservoirs of the polio virus. Pakistan is one of three countries were polio remains endemic — the others are Nigeria and Afghanistan — and it has made strong progress against the disease following a disastrous rate of infection last year.

 So far in 2012, officials say, Pakistan has recorded 56 new polio cases, compared with 192 at the same point in 2011. The turnaround is due to a series of nationwide immunization drives targeting children under 5, which can involve up to 225,000 public health workers.

 But the unprecedented series of attacks targeting female health workers in recent days threatens to hinder future immunization efforts.

 The attacks Wednesday were concentrated in the districts around Peshawar. North of the city, a gunman riding a motorcycle killed a female health worker and her driver. Another driver was seriously wounded in a second incident close to the city center. And in Nowshera, east of Peshawar, four female health workers reported being shot at but not hit.

 A spokesman for the Pakistani Taliban denied responsibility for the attacks, although the insurgents have a history of threatening polio eradication programs, claiming they are a cover for American espionage activities.

But the police in Peshawar said that Taliban fighters based in Mohmand tribal agency, north of Peshawar, were involved in at least two of the attacks in the Peshawar area.

One woman who came under fire described the attack, speaking on condition of anonymity for fear of reprisals. “Two people were riding a motorbike,” she said. “The one wearing a mask pulled out a gun and fired four shots. We shouted. The bullets whizzed past us but luckily we were safe.”

 The Taliban’s suspicions about vaccination workers were aggravated by the case of Shakil Afridi, a doctor from the tribal areas who was paid by the Central Intelligence Agency to run a bogus hepatitis vaccination campaign near Osama bin Laden’s house in Abbottabad in the run-up to the May 2011 American commando raid that killed the Qaeda leader.

 But the Taliban have also used the polio campaign — a rare attempt by the government to extend its authority into the tribal belt — for raw political purposes. In North Waziristan, Hafiz Gul Bahadur, a major Taliban-affiliated warlord, has banned polio vaccination until America halts drone strikes in the area.

 In contrast, the Taliban in Afghanistan have taken a more enlightened approach to polio vaccination, in some cases actively sponsoring the campaign, said Shahnaz Wazir Ali, a senior Pakistani polio official.

 “What’s happening here is much, much more sinister,” she said. “And it’s happening right in the heart of our cities.”

 Vaccination rounds in Pakistan take place many times each year, with teams of health workers visiting homes and public spaces to deliver polio immunization drops to children under 5.

 The three-day vaccination round under way this week, which began on Monday, targeted parts of the country worst hit by the virus — the northwest, the tribal belt, and Karachi — and was due to involve an estimated 135,000 health workers, according to the government.

 The lower house of Parliament adopted a unanimous resolution Wednesday condemning the attacks on polio campaign volunteers.

 “We cannot and would not allow polio to wreak havoc on the lives of our children,” Prime Minister Raja Pervez Ashraf said on Tuesday.

 

Ismail Khan contributed reporting from Peshawar, Pakistan.

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President Delivers a New Offer on the Fiscal Crisis to Boehner

Joshua Roberts/Reuters

Speaker John A. Boehner returned to his office on Monday after meeting with President Obama.

WASHINGTON — President Obama delivered to Speaker John A. Boehner a new offer on Monday to resolve the pending fiscal crisis, a deal that would raise revenues by $1.2 trillion over the next decade but keep in place the Bush-era tax rates for any household with earnings below $400,000.

The offer is close to a plan proposed by the speaker on Friday, and both sides expressed confidence that they were closing in on a major deficit-reduction plan that could be passed well before January, when more than a half-trillion dollars in automatic tax increases and spending cuts would kick in.

Senior Republican aides said the speaker was to meet with House Republicans on Tuesday morning to discuss the state of negotiations. But they cautioned that obstacles remained.

“Any movement away from the unrealistic offers the president has made previously is a step in the right direction,” said Brendan Buck, a spokesman for Mr. Boehner. “We hope to continue discussions with the president so we can reach an agreement that is truly balanced and begins to solve our spending problem.”

The two sides are now dickering over price, not philosophical differences, and the numbers are very close.

Mr. Boehner had offered the president a deficit framework that would raise $1 trillion over 10 years, with the details to be settled next year by Congress’s tax-writing committees and the Obama administration. In response, Mr. Obama reduced his proposal to $1.2 trillion from $1.4 trillion on Monday at a 45-minute meeting with the speaker at the White House. That was down from $1.6 trillion initially.

The White House plan would permanently extend Bush-era tax cuts on household incomes below $400,000, meaning that only the top tax bracket, 35 percent, would increase to 39.6 percent. The current cutoff between the top rate and the next highest rate, 33 percent, is $388,350.

On spending, the two sides are also converging.

The White House says the president’s plan would cut spending by $1.22 trillion over 10 years, compared with $1.2 trillion in cuts from the Republicans’ initial offer. Of that, $800 billion is cuts to programs, and $122 billion comes from adopting a new measure of inflation that slows the growth of government benefits, especially Social Security. The White House is also counting on $290 billion in savings from lower interest costs on a reduced national debt.

Of the $800 billion in straight cuts, the president said half would come from federal health care programs; $200 billion from other so-called mandatory programs, like farm price supports, not subject to Congress’s annual spending bills; $100 billion from military spending; and $100 billion from domestic programs under Congress’s annual discretion.

To make all this happen, Mr. Obama proposed fast-track procedures to help Congressional tax writers overhaul the individual and corporate tax code and make changes to other programs.

Senior Republican aides made it clear that differences remain. For instance, they say the president is still pressing for $1.3 trillion in higher taxes because the change in the way inflation is calculated would not only slow the growth of spending but also raise more revenue by slowing the rate at which tax brackets rise each year with the cost of living. That would mean that incomes would probably grow faster than the rise in tax brackets, pushing people more quickly into higher tax rates.

They also disagree with the president over counting lower interest payments on the national debt as savings.

“A proposal that includes $1.3 trillion in revenue for only $930 billion in spending cuts cannot be considered balanced,” said another spokesman for Mr. Boehner, Michael Steel, using the Republicans’ calculation for the president’s offer.

The president is also insisting on some protections for what he has called the “most vulnerable populations,” which Republican aides said they had not been expecting. The new inflation calculations, for instance, would probably not affect wounded veterans and disabled people on Supplemental Security Income.

And Mr. Obama is sticking by his request for additional upfront spending on infrastructure and an extension of expiring unemployment benefits.

He would also secure some tax and policy changes long sought by both parties but unattainable in the context of smaller budget deals. His proposal would permanently extend popular business tax breaks like the credit for corporate research and development, permanently stop the expansion of the alternative minimum tax so it does not affect more of the middle class, and stop a long-planned and deep cut to Medicare health providers, which Congress has never had the stomach to allow to kick in.

To keep the country from returning to fiscal showdowns, Mr. Obama wants the government’s borrowing limit to rise high enough to take the issue off the table for two years, although he said that Congress could periodically weigh in and try to override a presidential lifting of the debt ceiling, should it want to.

Senior Republican aides made it clear on Monday night that the plan was not what the speaker had wanted. He had proposed higher income tax rates on income over $1 million. That revenue would be supplemented by reinstating a provision in the tax code — phased out by the Bush-era tax cuts — that automatically limits tax deductions and credits for the affluent. The speaker was also ready to accept a White House proposal from Mr. Obama’s first days in office that would limit tax deductions to 28 percent, trimming back deductions for charitable giving and other activities from the top rate paid by the giver, 35 percent currently.

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The New Old Age Blog: In the Middle: Helping Unhappy Couples

A post on Monday discussed the forces that can make an older couple’s good marriage suddenly go bad — an array of subtle, and often-misunderstood, mental, physical and emotional factors that can upset the equilibrium of even the happiest marriages.

Now we have consulted marriage counselors and geriatricians to find out what caregivers — either the grown children of the couple, or one of the spouses involved– can do to help restore peace and balance to these relationships. The experts consulted uniformly agreed that even older people can at least take steps to reduce tensions and improve their relationship, even if they cannot actually change. (Really, who can, at any age?)

“Even though the situation may seem overwhelming, take heart,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc., who specializes in neuropsychology and rehabilitation psychology. “Couples who have been together for 60 years tend to have worked out ways to manage conflict – or they wouldn’t still be together.”

Retreat to a neutral corner

When grown children see their parents fight, many want to run and hide. But those who are assuming an increased caregiving role often feel impelled to jump in and “fix” the problem, as they do with the other caregiving issues.

If you are so inclined, experts speak with one loud voice to advise: Don’t!

Trying to act as emotional broker between your parents can backfire. (Now they tell me! Suffice it to say that after one such effort my sister said to me in not exactly the friendliest tone, “Well, that went well, didn’t it?”)

“It’s better if your parents can find somebody else to talk to than you,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and the author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Don’t give up on marital therapy

“Marital therapy for individuals over 65 years of age is difficult, since habits of a lifetime are deeply ingrained,” stated a study in The Canadian Journal of Medicine, one of the few in the medical literature about marital therapy among older people.

“Yet, in a sense, marital therapy is more crucial for the elderly than for younger patients,” the study continued. “At a time when they are least adaptable and most vulnerable to stress and are entering perhaps the most difficult period of their lives, the elderly must learn new methods of relating and coping” because of the physical and mental changes described in our earlier post.

There’s another reason learning to cope with life changes as a couple is even more critical for older couples: Unlike younger couples, the elderly are rarely in a position to leave the marriage and start over.

Help at least one spouse get counseling

What if only half the couple is ready to seek counseling? Not a problem, therapists said. “You want to help the part of the couple that is suffering,” said Dr. Elaine Rodino, a therapist in private practice in State College, Penn. “The other person may still be the curmudgeon, but I think of it as the law of physics: When you change one aspect of the formula, things change in the total.”

When dementia affects one of the spouses, therapy can help the caregiving spouse learn coping techniques, “which can reduce the marital discord and stress that can make conditions, especially cognitive difficulties, worse,” said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine.

Consider the general practitioner or internist

If the couple won’t see a marriage counselor or therapist, can a family doctor be of any use? The experts had mixed responses.

Many pointed out that general practitioners have neither the time nor the training to offer much relationship help, unless the origin of the problem is exclusively physical. Others thought they could be of use, if given a little direction from the family.

“I encourage the kids to talk to the doctor in advance and let him know something is going on – signs of depression or other problems the parents won’t talk about,” advised Dr. Dale, adding that a consultation with a geriatrician who is more familiar with problems of the aging might be even more productive. “Then the doctor can say, ‘Gee, you sound really frustrated or down — are there any reasons we can explore?’”

Don’t overlook the importance of intimacy

“Mutually stimulating sexual relationships need care and feeding by both partners at any age, but especially in the geriatric years,” according to a study on marital therapy for the elderly. “The need for physical contact, warmth and touching perhaps reaches a peak in this age of loneliness, decreased self-esteem and poor health.”

Forget the idea that elderly couples are too shy to talk about intimacy, insisted Dr. Rodino. “I saw a couple in their 80s, the husband was getting penile injections at the doctor’s office, and then they hurried home to have sex.”

But Dr. Rodino does concede that for older patients it is especially important to focus not only on sexual function and performance, but on “touching, and non-intercourse sexual relations; I help them rekindle the affection and emotional closeness,” Dr. Rodino said.

Address any neuropsychological issues.

To find out whether the sudden marital conflict may stem from early mental cognitive impairment (M.C.I.) —or to rule M.C.I. out and find the real source of trouble — make sure the spouse obtains a full neuropsychological evaluation. If it is M.C.I., “it convinces everybody that there is more than just abstinence, it’s not a personality problem — and they need to address it,” said Dr. Dale.

Don’t overlook simple solutions

“Sometimes a memory problem is something simple, like low Vitamin B12, that is easily fixed,” said Dr. Dale. “Or hypothyroidism, which is quite common, can affect memory.”

In that case, doctors administer synthroid, a thyroid hormone replacement that Dr. Dale said is “very safe, with almost no side effects.” Other changes in behavior can also be the result of a simple problem or be remedied by a change in medication. Don’t assume the worst.

Put an end to the blame game

Help reframe the problem. “Even if dementia is involved, let them know it’s not that their partner hates them, it’s that he is having cognitive changes,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago.

“When you re-frame it like that, it’s easier for the spouse not to take it personally and not blame themselves and feel it’s something they did,” said Dr. Waite. “It can make a difference.”

A 2009 study in the journal Gerontologist supports this notion: “Care partners likely would benefit from strategies aimed at reducing self-blame, enhancing coping skills … and communicating effectively with the person with M.C.I and significant others.”

Separate the anxiety

Divide and conquer — time away improves time together.

“Older couples, especially those with disabilities, spend way too much time together,” said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program. “It would be a problem for any couple.”

Caregivers can best help by arranging for an activity or outing that each spouse can do separately so they can return to each other refreshed and more cheerful. “That can help a lot,” said Dr. Gwyther.

Dial down the tone

For spouse caregivers, it is important to watch not just what is said, but how it is said. In any relationship, tone influences our interpretation of what our partner says. Those with M.C.I. will especially react to tone, rather than the substance of the exchange, Dr. Dale said.

“Ratchet down the emotions, repeat things calmly,” Dr. Dale said. The person with cognitive problems doesn’t know he asked the same question five times — he only knows that you sound angry at him for no reason he can fathom. One spouse’s anger fuels the other’s, and pretty soon there is a fight or withdrawal.

Zero tolerance for violence

If a spouse becomes violent, “that’s an entirely different issue,” said Dr. Schlossberg. “Call in an expert on family violence” or the police.

Help them help others

Nobody likes feeling dependent and having to ask for help. Finding a way to have your loved one volunteer, help others and continue to feel useful can improve moods and marital interactions – even if M.C.I. is involved.

With one couple Dr. Gwyther saw, the wife was not only “driving her husband nuts because she was asking him the same questions over and over,” but she could no longer drive and deliver food in a mobile meals program as she used to. “So her husband agreed to be the driver — and she took the meals to the doors,” Dr. Gwyther recalled.”It made her feel good to continue to do that — and it made them feel good to do it together.”

Caregiver, heal thyself

You have heard it a million times here and elsewhere but, unlike us, this advice never gets old.

If you are exhausted from caregiving, you are bound to be cranky, and that will make everybody around you edgy and irritable, too — especially the spouse who requires your care. Taking the time to look after your own health and engage in activities that bring you pleasure can go a long way toward reducing stress and reestablishing a peaceful balance in a marriage.

How have you coped with tensions in your marriage — or in your elderly parents’ marriage, as you care for them in their old age? Share in the comments below.

Read More..

The New Old Age Blog: In the Middle: Helping Unhappy Couples

A post on Monday discussed the forces that can make an older couple’s good marriage suddenly go bad — an array of subtle, and often-misunderstood, mental, physical and emotional factors that can upset the equilibrium of even the happiest marriages.

Now we have consulted marriage counselors and geriatricians to find out what caregivers — either the grown children of the couple, or one of the spouses involved– can do to help restore peace and balance to these relationships. The experts consulted uniformly agreed that even older people can at least take steps to reduce tensions and improve their relationship, even if they cannot actually change. (Really, who can, at any age?)

“Even though the situation may seem overwhelming, take heart,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc., who specializes in neuropsychology and rehabilitation psychology. “Couples who have been together for 60 years tend to have worked out ways to manage conflict – or they wouldn’t still be together.”

Retreat to a neutral corner

When grown children see their parents fight, many want to run and hide. But those who are assuming an increased caregiving role often feel impelled to jump in and “fix” the problem, as they do with the other caregiving issues.

If you are so inclined, experts speak with one loud voice to advise: Don’t!

Trying to act as emotional broker between your parents can backfire. (Now they tell me! Suffice it to say that after one such effort my sister said to me in not exactly the friendliest tone, “Well, that went well, didn’t it?”)

“It’s better if your parents can find somebody else to talk to than you,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and the author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Don’t give up on marital therapy

“Marital therapy for individuals over 65 years of age is difficult, since habits of a lifetime are deeply ingrained,” stated a study in The Canadian Journal of Medicine, one of the few in the medical literature about marital therapy among older people.

“Yet, in a sense, marital therapy is more crucial for the elderly than for younger patients,” the study continued. “At a time when they are least adaptable and most vulnerable to stress and are entering perhaps the most difficult period of their lives, the elderly must learn new methods of relating and coping” because of the physical and mental changes described in our earlier post.

There’s another reason learning to cope with life changes as a couple is even more critical for older couples: Unlike younger couples, the elderly are rarely in a position to leave the marriage and start over.

Help at least one spouse get counseling

What if only half the couple is ready to seek counseling? Not a problem, therapists said. “You want to help the part of the couple that is suffering,” said Dr. Elaine Rodino, a therapist in private practice in State College, Penn. “The other person may still be the curmudgeon, but I think of it as the law of physics: When you change one aspect of the formula, things change in the total.”

When dementia affects one of the spouses, therapy can help the caregiving spouse learn coping techniques, “which can reduce the marital discord and stress that can make conditions, especially cognitive difficulties, worse,” said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine.

Consider the general practitioner or internist

If the couple won’t see a marriage counselor or therapist, can a family doctor be of any use? The experts had mixed responses.

Many pointed out that general practitioners have neither the time nor the training to offer much relationship help, unless the origin of the problem is exclusively physical. Others thought they could be of use, if given a little direction from the family.

“I encourage the kids to talk to the doctor in advance and let him know something is going on – signs of depression or other problems the parents won’t talk about,” advised Dr. Dale, adding that a consultation with a geriatrician who is more familiar with problems of the aging might be even more productive. “Then the doctor can say, ‘Gee, you sound really frustrated or down — are there any reasons we can explore?’”

Don’t overlook the importance of intimacy

“Mutually stimulating sexual relationships need care and feeding by both partners at any age, but especially in the geriatric years,” according to a study on marital therapy for the elderly. “The need for physical contact, warmth and touching perhaps reaches a peak in this age of loneliness, decreased self-esteem and poor health.”

Forget the idea that elderly couples are too shy to talk about intimacy, insisted Dr. Rodino. “I saw a couple in their 80s, the husband was getting penile injections at the doctor’s office, and then they hurried home to have sex.”

But Dr. Rodino does concede that for older patients it is especially important to focus not only on sexual function and performance, but on “touching, and non-intercourse sexual relations; I help them rekindle the affection and emotional closeness,” Dr. Rodino said.

Address any neuropsychological issues.

To find out whether the sudden marital conflict may stem from early mental cognitive impairment (M.C.I.) —or to rule M.C.I. out and find the real source of trouble — make sure the spouse obtains a full neuropsychological evaluation. If it is M.C.I., “it convinces everybody that there is more than just abstinence, it’s not a personality problem — and they need to address it,” said Dr. Dale.

Don’t overlook simple solutions

“Sometimes a memory problem is something simple, like low Vitamin B12, that is easily fixed,” said Dr. Dale. “Or hypothyroidism, which is quite common, can affect memory.”

In that case, doctors administer synthroid, a thyroid hormone replacement that Dr. Dale said is “very safe, with almost no side effects.” Other changes in behavior can also be the result of a simple problem or be remedied by a change in medication. Don’t assume the worst.

Put an end to the blame game

Help reframe the problem. “Even if dementia is involved, let them know it’s not that their partner hates them, it’s that he is having cognitive changes,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago.

“When you re-frame it like that, it’s easier for the spouse not to take it personally and not blame themselves and feel it’s something they did,” said Dr. Waite. “It can make a difference.”

A 2009 study in the journal Gerontologist supports this notion: “Care partners likely would benefit from strategies aimed at reducing self-blame, enhancing coping skills … and communicating effectively with the person with M.C.I and significant others.”

Separate the anxiety

Divide and conquer — time away improves time together.

“Older couples, especially those with disabilities, spend way too much time together,” said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program. “It would be a problem for any couple.”

Caregivers can best help by arranging for an activity or outing that each spouse can do separately so they can return to each other refreshed and more cheerful. “That can help a lot,” said Dr. Gwyther.

Dial down the tone

For spouse caregivers, it is important to watch not just what is said, but how it is said. In any relationship, tone influences our interpretation of what our partner says. Those with M.C.I. will especially react to tone, rather than the substance of the exchange, Dr. Dale said.

“Ratchet down the emotions, repeat things calmly,” Dr. Dale said. The person with cognitive problems doesn’t know he asked the same question five times — he only knows that you sound angry at him for no reason he can fathom. One spouse’s anger fuels the other’s, and pretty soon there is a fight or withdrawal.

Zero tolerance for violence

If a spouse becomes violent, “that’s an entirely different issue,” said Dr. Schlossberg. “Call in an expert on family violence” or the police.

Help them help others

Nobody likes feeling dependent and having to ask for help. Finding a way to have your loved one volunteer, help others and continue to feel useful can improve moods and marital interactions – even if M.C.I. is involved.

With one couple Dr. Gwyther saw, the wife was not only “driving her husband nuts because she was asking him the same questions over and over,” but she could no longer drive and deliver food in a mobile meals program as she used to. “So her husband agreed to be the driver — and she took the meals to the doors,” Dr. Gwyther recalled.”It made her feel good to continue to do that — and it made them feel good to do it together.”

Caregiver, heal thyself

You have heard it a million times here and elsewhere but, unlike us, this advice never gets old.

If you are exhausted from caregiving, you are bound to be cranky, and that will make everybody around you edgy and irritable, too — especially the spouse who requires your care. Taking the time to look after your own health and engage in activities that bring you pleasure can go a long way toward reducing stress and reestablishing a peaceful balance in a marriage.

How have you coped with tensions in your marriage — or in your elderly parents’ marriage, as you care for them in their old age? Share in the comments below.

Read More..

European Mobile Stocks Fall After Costly Spectrum Auction

BERLIN — Shares of four big European cellphone operators fell Monday after they paid more than twice what investors had been expecting in a spectrum auction in the Netherlands, raising concern that a damaging bidding war could sap the industry.

The Dutch auction began Oct. 31 and ended Friday, raising 3.8 billion euros, or $5 billion, for spectrum that the companies plan to use for high-speed service using Long Term Evolution, or LTE, technology. But analysts warned that the sale, to be followed next year by a much larger spectrum auction in Britain, could herald a new round of expensive infrastructure levies that might restrict operators at a time when their sales have been stagnating.

The winners were KPN, the former Dutch monopoly; Vodafone, the British mobile group; the German company T-Mobile; and the Swedish operator Tele2.

LTE supports all of the typical high-speed applications, including audio and video streaming and Internet browsing, but is much faster, cutting download times and significantly expanding the capacity of existing networks to handle increases in data traffic.

After the bidding, KPN, which is owned in part by the Mexican communications mogul Carlos Slim Helú, canceled its dividend for 2012 and lowered its projected investor payout for 2013 to cover the 1.35 billion euros the company spent in the auction.

On Monday, the first day of stock trading after the completion of the auction, shares of KPN fell nearly 15 percent in Amsterdam, the steepest drop in more than a decade. Shares of Vodafone were down 1.7 percent by the close of the day in London. Shares of Deutsche Telekom, the parent company of T-Mobile, fell 0.3 percent in Frankfurt, and shares of Tele2 declined 1 percent in Stockholm.

“The money raised in the Dutch auction was a lot more than investors were expecting,” said Phil Kendall, an analyst at Strategy Analytics in Milton Keynes, England. “The concern now is that the sums will now be so great the technology will be unprofitable.”

Mr. Kendall said mobile operators were eager to obtain additional spectrum because extensive bandwidth had become increasingly critical to handle the explosion of mobile Internet data, which is testing the capacity of some carriers’ grids and causing overloading.

“Really, for many operators, the only way they will be able to differentiate themselves from other operators is by having enough spectrum to manage the demand on their services,” Mr. Kendall said. “That is why there is such intense interest in buying more frequency.”

More radio spectrum, or wireless network capacity, is crucial to delivering the high speeds advertised for LTE, which theoretically can produce download rates of up to 300 megabits per second on a wireless connection. Such speeds and the expanded capacity of the networks are considered essential to support the rapid expansion of the wireless Internet, as well as the increasing use of mobile grids for robotic communication between devices.

Speeds on the first generation of LTE networks activated in Germany, South Korea, Sweden and the United States have averaged much less, generally 10 to 25 megabits per second, in part because operators do not have enough spectrum to exploit the technology’s full potential.

The Dutch auction also raised the specter of another costly round of infrastructure fees on the cellphone industry similar to those in 1999 and 2000, when operators paid billions for the first European 3G mobile licenses.

Investors were concerned that the Dutch prices could set a precedent for auctions planned in Britain and perhaps Poland next year, as well as others that will be held across Europe over the next five years, as bandwidth is freed up and sold by national governments to wireless carriers. Germany, which held its latest spectrum auction in 2010, has indicated that it may hold another in 2016.

Those license sales in 1999 and 2000, engineered in most cases by governments to extract the maximum from mobile operators, led to large profit write-downs by operators including Vodafone and Telefónica, which owns the carrier O2.

With completion of the Dutch auction, the focus will now shift to Britain, where the sector’s regulator is planning to begin its spectrum auction in January.

All four British mobile network operators are expected to bid: Everything Everywhere, the venture of Deutsche Telekom and France Telecom; Vodafone; O2 U.K.; and 3, a unit of Hutchison Whampoa. The former landline monopoly BT has not ruled out a potential bid, which could further raise the stakes.

Matthew Howett, an analyst at Ovum, a research firm in London, said the British auction could raise £2 billion to £4 billion, or $3.2 billion to $6.5 billion.

“The £2 billion to £4 billion range that is widely touted is based on similar auctions elsewhere in Europe,” he said. “There is nothing to suggest that the U.K. should be any different. It’s possibly the most competitive market in Europe and all existing operators will want to make sure they walk away with spectrum to feed the almost insatiable appetite we in the U.K. now have for data.”

This article has been revised to reflect the following correction:

Correction: December 17, 2012

An earlier version of this article erroneously stated the amount paid by KPN for spectrum in the auction. It was 1.35 billion euros, not $1.35 billion.

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Report Cites Bias by Police In Killings In Canada

OTTAWA — Robert W. Pickton, a pig farmer, managed to murder 49 women before his arrest in 2002 largely because of “systemic bias by the police” against the victims, the commissioner who investigated the actions of the police said Monday.

Up until Mr. Pickton’s arrest, at least 67 women had disappeared in British Columbia, mainly from Vancouver’s downtown East Side. The victims were mainly members of Canadian aboriginal groups, and most were prostitutes and drug addicts. All were killed or are presumed dead. After a 10-month trial in 2007, Mr. Pickton was convicted of six counts of second-degree murder and sentenced to life in prison. During his interrogation, he confessed to killing 49 women.

The inquiry’s 1,448-page report shows that although some people were alarmed at the rising number of missing women in the area during the 1990s, the police were indifferent largely because of the women’s social status and race. It was an indifference, said the man who led the inquiry, Wally T. Oppal, that extended to much of the city’s population.

“There was an institutional, systemic bias against the women,” Mr. Oppal said at a news conference Monday. “They were poor, they were aboriginal, they were drug addicted and they were not taken seriously.”

He added, “What if you were made to feel invisible, unworthy?”

Despite Mr. Oppal’s condemnation of the police as well as his passionate plea for eliminating the poverty in the aboriginal communities where many of the victims were born, it was not clear whether his findings would satisfy the families of the victims or native groups. Several aboriginal leaders were critical of the two-year inquiry’s focus on the actions of the police rather than on broad issues of poverty.

Mr. Oppal’s news conference was repeatedly interrupted by hecklers identified by Canadian news outlets as relatives of the victims. At one point, Mr. Oppal was silenced as a native drummer played and family members sang, some raising clenched fists.

In addition to indifference, the Vancouver Police Department and the Royal Canadian Mounted Police, which patrols the suburb of Port Coquitlam, where Mr. Pickton killed his victims on his farm, were faulted for poor communication, lack of cooperation and a failure to accept that a sharp rise in disappearances in 1997 could have been the work of a serial killer.

Mr. Oppal particularly faulted the police and prosecutors for their actions after Mr. Pickton was arrested and charged with stabbing a prostitute in 1997 during the height of the disappearances.

The prostitute, whose name is protected under a court order, reluctantly agreed to let Mr. Pickton drive her out to his ramshackle farm for a sex act. Once there, she saw evidence that other women had been at the farm. Mr. Pickton handcuffed the woman and then repeatedly stabbed her before she escaped.

The police and prosecutors eventually suspended charges against Mr. Pickton, apparently because of doubts over the prostitute’s reliability as a witness. Moreover, the inquiry also found that they ignored her suggestions that Mr. Pickton had taken other prostitutes to the farm. Mr. Oppal said that if the police had followed up, it was “conceivable” that Mr. Pickton could have been stopped at that point.

Instead, the two police forces, the report found, felt little urgency to act on the disappearances of prostitutes or to even warn people in the downtown East Side of the rapid rise in disappearances.

“The Vancouver Police Department deeply regrets anything we did that may have delayed the eventual solving of these murders,” the force said in a statement. “It may also come as small consolation to those who still grieve that we are committed to learning from our mistakes.”

In the end, Mr. Pickton was caught by a police officer who had been on the job for just 18 months and was serving a search warrant for weapons. The officer initiated a wider search of the farm after finding items of women’s clothing and accessories.

“Pickton was not even attempting to hide the fruits of his violent acts,” Mr. Oppal said. “It was there for everyone to see.”

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DealBook: S.E.C. Says Asset Firm Manipulated Trades to Enrich Some Clients

Just a few years ago, sitting in his 19th-floor office with panoramic views of the Pacific Ocean, 3,000 miles from Wall Street, Peter J. Eichler Jr., had reached the top of the money management world.

His firm, Aletheia Research and Management, based in Santa Monica, Calif., controlled more than $10 billion. Mr. Eichler’s stellar investment performance attracted the likes of Goldman Sachs and Morgan Stanley, which entrusted him with millions of dollars of their clients’ money.

Late Friday, federal regulators accused Mr. Eichler of cheating some of his clients, the latest in a spate of legal troubles facing the 55-year old investor.

In a civil action filed in Federal District Court in Los Angeles, the Securities and Exchange Commission said that Mr. Eichler had perpetrated a “cherry-picking” scheme, steering profitable trades into his personal accounts while allocating money-losing investments into hedge funds that he managed.

Mr. Eichler’s scheme, the government said, allowed his accounts and those of favored clients to earn $4.1 million in illegal profits, while he saddled the hedge funds with trading losses of about $4.4 million.

“Aletheia and Eichler had an obligation to treat all clients with equal fairness, but instead they cherry-picked winners and losers and unfairly disadvantaged investors in two hedge funds to profit themselves,” said Michele Wein Layne, the head of the S.E.C.’s Los Angeles office.

In a statement issued through his lawyers, Mr. Eichler said he was cooperating with the S.E.C. and that his firm “did not intentionally or otherwise harm any of its investment products or its clients.”

Named after the Greek word for “truth and disclosure,” Aletheia was started in 1997 by Mr. Eichler, a former Bear Stearns executive.

An inspired salesman, Mr. Eichler promoted a buy-and-hold investment style. In meetings, he liked to compare himself to the celebrated stock pickers Warren E. Buffett and Peter Lynch. For years, Aletheia trumpeted its track record in a splashy full-page ad in Barron’s, the financial weekly.

Mr. Eichler lived like a Hollywood mogul. Until recently, a driver chauffeured him around Los Angeles in a Maybach sedan, shuttling him between Aletheia’s headquarters and his multimillion-dollar homes in Pacific Palisades and Malibu.

Aletheia’s outsize returns attracted marquee clients like the pension fund of Royal Dutch Shell and state pensions in Louisiana and Oklahoma. A number of brokerage houses, including Goldman and Morgan Stanley, anointed him a “preferred manager” and placed clients’ money with him.

But the government says that since 2009, Mr. Eichler favored certain clients while shortchanging others. Mr. Eichler executed options trades — speculative, leveraged bets on stocks that magnify profits and losses — but waited about an hour to allocate them. He then placed winning trades in his own accounts and those of certain special clients, the commission said; losing trades were diverted to a pair of hedge funds that he managed.

Trades assigned to Mr. Eichler’s personal accounts were profitable about 98 percent of the time, while only 32 percent of the trades allocated to the Aletheia hedge funds made money, according to the S.E.C.

The government’s complaint added to Mr. Eichler’s growing legal problems. Last month, his firm sought bankruptcy protection. The state of California has said it is owned more than $2 million in unpaid taxes and fines and has suspended Aletheia’s corporate status.

Mr. Eichler is also the defendant in two lawsuits that accuse him and his firm of improper conduct. A wrongful-termination complaint filed in 2010 by Roger Peikin, a co-founder of Aletheia, said that Mr. Eichler had “successfully rid himself of all internal controls, allowing him free rein to operate Aletheia as his personal fiefdom.”

And Proctor Investment Managers, a New York firm, sued Mr. Eichler over the terms of a deal in which Proctor had taken a 10 percent stake in Aletheia. Had it known about Mr. Eichler’s “penchant for dishonesty,” Proctor said, it would not have partnered with him.

Both lawsuits accuse Mr. Eichler of treating the company as his personal piggy bank, including flying private jets for personal use.

As part of the S.E.C. complaint, regulators said that Mr. Eichler had also violated the law by failing to inform its investors this year that his firm was in precarious financial condition.

The firm still has $1.4 billion in assets under management, according to a recent securities filing, though bankruptcy court documents suggest the number has dropped to as low as $250 million. Goldman and Morgan Stanley have cut their ties to Aletheia.

The criminal authorities have also taken an interest in Mr. Eichler and his firm. Last month, prosecutors in the tax division of the United States attorney’s office in Los Angeles asked the court to notify it of all pleadings made in the Aletheia bankruptcy case.

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The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping with Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and Associate Professor in the Department of Psychiatry and Behavioral Sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said, “she did it because she thought that they would run out of money, even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment (M.C.I.) comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently (usually badly) due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in the Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that, Dr. Waite said, “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink, or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in the Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it’s hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and tomorrow we’ll try to provide some advice from experts.

Read More..

The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping with Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and Associate Professor in the Department of Psychiatry and Behavioral Sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said, “she did it because she thought that they would run out of money, even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment (M.C.I.) comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently (usually badly) due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in the Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that, Dr. Waite said, “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink, or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in the Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it’s hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and tomorrow we’ll try to provide some advice from experts.

Read More..