Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 104

The structure of relationships in older adulthood is changing. Figure 4.3 shows relationship trends in adults over 50 in the US from 1990 to 2015. While the majority of older adults are married, the number of divorcees, those who have never married, and those who cohabit are all increasing, particularly among women.¹⁷ In general, marriage offers financial, psychosocial, and health benefits to both members of the couple, but the health benefits are more pronounced for men. The benefits of marriage are modulated by the quality of the relationship; benefits are significantly diminished if one or both members of the couple are dissatisfied with the relationship.

Figure 4.3 Trends in the relationship status of adults over age 50 in the US from 1990 to 2015.

Source: Data from trends in relationship status of adults over age 50 in the US, from 1990 to 2015, US Census Bureau (www.census.gov).

The term grey divorce revolution refers to an increase in the divorce rates in adults over 50. From 1990 to 2015, the divorce rate of older adults in the US doubled from 5 to 10 in 1000, and this rate is expected to remain stably high, even as divorce rates decrease in younger generations. Marriage dissolution (through either divorce or widowhood) is one of the most stressful events that can occur in a person's life; providers should be sensitive to potential psychological distress as well as threats to the person's financial and social support systems. Globally, divorced or widowed older women are a vulnerable population, particularly in the developing world, and may be at risk for abuse, forced arranged marriages, abandonment, or extreme poverty.

The decision to remarry versus cohabit is based on both personal and financial reasons. The economics of cohabitation versus marriage in older adulthood can be complex. Marriage allows couples to share government benefits, tax incentives, and insurance policies. In many settings, the spouse becomes the de facto medical decision‐maker in the event of patient incapacity. However, cohabitation instead of marriage may make sense for many older adults. Cohabitation allows a person to retain their financial autonomy. People who cohabit may continue to qualify for retirement pensions and/or government benefits from a former spouse. In the event of cohabitation, children generally remain the de facto medical decision‐makers and will inherit a person's assets unless otherwise stated in a will. The health effects of cohabitation (versus marriage) remain an area of active research. As in marriage, it seems that men receive greater health benefits from cohabitation than women, but both members seem to benefit financially and psychologically. Unlike younger couples, older adults who cohabit are likely to do so stably without remarriage or ending the relationship.