other partner: "He just looks at me and I can tell if he is sad or lonely" "I understand her and she understands me." Conflicts arose when the nursing plan of care differed from the independent spouse's understanding of the partner's needs. Unspoken Affection. Couples positioned wheelchairs within patting distance of each o t h e r , held hands, touched each other's thighs, and made frequent eye contact. They verbalized their emotional satisfaction with the relationship: "We don't have to have words to have companionship." "He sends me messages that he loves me." Emotional Give and Take. Emotional support from each spouse cont r i b u t e d to s a t i s f a c t i o n with the marriage and with living in the nursHelp couples living in a nursing home keep the spark alive. ing home. The poor health of one partner often threatened emotional give and take. When the more depenBY LINDA HOOGENDIJK/VIRGINIA BROOKE dent spouse was memory-impaired, s the population ages, and couple was functionally more depen- the other spouse talked about missing more married couples join the dent than the other (M=4.8, S.D. 2.4, the shared history the couple had acranks of seniors, we can ex- ADL 0-6) in bathing, dressing, trans- cumulated: "I think he has forgotten pect to see the number of couples in ferring, toileting, and continence(l). many of the things we used to do." The following strategies can support nursing homes rise. What are they Dependent spouses had lower cognilike? What do they think of their mar- tive function on the Mental Status couples rivingin the nursing home. Q u e s t i o n n a i r e (M=6.2, S.D. 3.6, * Be sensitive to the couple's routine. riages and living arrangements? When a spouse is unable to complete To find out, we interviewed 30 cou- MSQ=0-10)(2). a normal routine, such as visiting or The declining health of one partner ples living in 14 facilities: 18 couples taking the partner for a daily stroll, resided in nursing homes; 12 lived usually was the deciding factor for complete the routine for the spouse. apart with one spouse in the nursing nursing home placement. Typically, home and the other in an attached re- the spouse in better health helped • Provide social activities that include both partners. tirement apartment. The mean age care for the other. Some performed was 85 years. The mean length of the such tasks as making the other's bed. ° Accept that conflict can and does exist in a stable marriage. Do not inmarriages was over 52 years, with a Two men changed the pads of their intervene in the dynamics of the marmode of 67 years. Roughly half (47%) continent wives. riage. The qualitative interviews revealed of the total sample shared the same that the couples generally were satisfied ° Develop ways to allow married couroom in the nursing home. ples to remain together. Couples in Most of the men in the study had with their surroundings, their marriage, which one spouse was in the retirebeen farmers or craftsmen; the wom- and the number of visits from family ment apartment and one was in the Several themes characterized the en had been homemakers, clerks, and nursing home slbent considerable ensecretaries. The mean number of chil- relationships: ergy trying to stay connected. Stability. These were long-term dren for these couples was 2.2; nearly a quarter (23%) had no children. The marriages. Said one spouse, "We are • Acknowledge the contributions of one spouse caring for the other. Ofcouples had been in the nursing home old friends who never go away." fer extra emotional and physical Cohesion. The couples spent a from one month to six years, with a great deal of each day together, probsupport to the independent spouse median stay of nine months. as the dependent spouse becomes According to the Activities of Dai- lem solved together, and interacted more ill. ly Living Scale, one spouse in each with the staff as a family unit. "We" statements dominated the interviews. REFERENCES Separation due to illness threatened LINDA H O O G E N D I J K , RN-C, MN, is chair 1. Katz, K, and others. Studies of illness in the aged. this cohesion. of the department of nursing, Spokane ComThe index of ADL: A standardized measure of bioZ s s l t m e d CollseHslt£ The more inlogical and psychological function. JAMA munity College, Spokane, WA. V I R G I N I A 185:914-919, Sept. 21,1963. B R O O K E , RN, PhD, is assistant professor at dependent spouse spoke for the de2. Kahn, R. L., and others. Brief objective measure for the Intercollegiate Center for Nursing Educapendent spouse and often stated that the determination of mental status in the aged. tion, Spokane. "Fnc authors give special thanks Am.J. Psychiatry117:326-328; 19S0. he or she understood the needs of the to Carol Alien, GNE Spokane VNA.
After All These Years
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