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Spouses in older marriages are increasingly taking on the role of their partner's caregiver in dealing with chronic conditions like heart disease, memory loss, and cancer. In a growing number of instances, both spouses care for each other as they struggle with any one of a variety of health issues such as arthritis, diabetes, and respiratory problems.

In a Yale School of Public Health study published this week in Health Psychology, researchers investigated how both giving and receiving support affects husbands' and wives' blood pressure and emotions when both partners are dealing with health conditions.

The researchers expected that mutual caregiving would lower blood pressure and heart rate for both individuals and that wives would likely reap more benefit from the support than husbands.

The actual findings were surprising. The study's primary author, Yale School of Public Health (YSPH) Associate Professor Joan Monin, explains:

"What we found was that when husband's received support from their wives, the husband's blood pressure and distress decreased," said Monin, who examines caregiver relationships as a researcher with the YSPH Social and Behavioral Sciences Department. "When wives received similar support, husbands and wives felt closer, but both partners' heart rate remained elevated and wives felt even more distressed."

So why did wives benefit less from caregiving support from their spouse?

Monin suspects everyday social interactions and traditional gender roles may be at play. The researchers note in the study that husbands may expect and feel less stressed when they receive support from their wives because they are used to receiving such support in their everyday lives. Wives, on the other hand, may not expect their husbands to engage in such support and are not used to or uncomfortable with receiving it. Indeed, in the study, husbands said they expected more emotional support for the chronic conditions in everyday life than wives did.

The findings are important because they offer new insight into why gender differences exist when it comes to the health benefits of marriage.

Previous research has established that husbands receive more health benefits from marriage than wives do, as evidenced by studies showing husbands tend to die sooner than wives after the death of their spouse. Studies have also shown that wives are more responsible for maintaining an emotionally healthy marriage and that both men and women count on female family members for their needs more than male family members.

While wives may benefit less from spousal caregiving than husbands, support for wives is important for strengthening intimacy and helping wives regulate distress caused by their husband's illness, the researchers said.

Most caregiving studies focus on the health implications of one spouse caring for another. This study is believed to be the first applying controlled rigorous scientific analysis of gender differences in older marriages in which both spouses care for each other as they deal with their own health concerns.

The study encompassed 98 older married couples, who were asked to answer a questionnaire about their current health conditions and their relationship with their spouse. Participants were then randomly assigned one of four conditions: neither spouse received support, only the wife received support, only the husband received support or both spouses received support. The researchers monitored the participants' blood pressure and heart rate before, during and after discussions about caregiving or the lack of it. Participants also self-reported levels of distress, closeness and support during and after the session. In a separate observation, the researchers noted that the quality of support, when provided, was generally the same for both husbands and wives during testing.

Gaining this information is important, Monin says, as it will help design more effective caregiving interventions, especially those that take into account the health conditions of both spouses and the provision of mutual health support within a marriage.

"Men and women appear to respond differently and are attuned differently to the presence or absence of emotional support about health concerns and the quality of that support," the researchers said. "It may be beneficial therefore, for interventions involving older couples with multiple chronic health conditions to be tailored differently to husbands and wives to make them more effective."

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