Caring for a dying spouse at the end of life: 'It's one of the things you volunteer for when you get married': a qualitative study of the oldest carers' experiences.

older people aged 80 and over are increasingly providing end-of-life care to spouses at home and often do so for long periods of time, while also trying to manage their own illnesses and disabilities. Little of the research on older spousal carers has focussed on the oldest carers; hence, the needs of this particular population are not fully known.to explore the experiences of the 'oldest carers' in caring for a dying spouse at home.secondary analysis was undertaken on a subset of data from a larger qualitative interview study; this dataset comprised 17 interviews from participants aged 80 or over. Framework analysis methods were used, with items derived from the thematic analysis of the main study.the oldest carers in this subset demonstrated high levels of resilience and the ability to adapt to their caring role. Caring until death was accepted as an integral part of the commitment made to their partner as part of the 'wedding contract'. Carers felt they benefitted from the support provided by family, friends and care services; however, their own care needs were not always recognised by health and social care services.these findings underscore the complexity of the oldest carers' experiences and challenges in times of illness and end of life. Healthcare professionals should be alerted to the myriad ways caregiving is enacted in serious illness and seek opportunities for developing supportive interventions specifically for older carers

Longitudinal Changes in Disabled Husbands’ and Wives’ Receipt of Care

Purpose of the Study: This study contrasts 2-year adjustments in disabled husbands’ and wives’ amount of received care following both worsening and recovery in personal (activities of daily living [ADLs]) and routine care (instrumental activities of daily living [IADLs]) disability. Design and Methods: Using longitudinal data on 789 husbands and 778 wives from the Health and Retirement Study (2000 and 2002), changes in marital partners’ monthly hours of spousal and nonspousal care were jointly modeled using bivariate Tobit models. In addition, asymmetry in the magnitude of responses to worsening and improvement of function was examined. Results: Disabled husbands receive more hours of spousal and nonspousal care following worsening in ADL function than wives. Conversely, disabled wives lose more spousal and nonspousal care hours following improvements in ADL disability than husbands. Moreover, wives recovering in ADL function lose more hours of spousal care than they receive following worsening in personal care disability. There is no evidence of corresponding gender differences in the dynamics of assistance received following changes in IADL function. Implications: Compared with husbands, disabled wives are disadvantaged in the adjustment of their personal care hours. Although disabled married community residents receive more hours of care than their unmarried counterparts, there are important gender differences in the advantages offered by marriage

The major genetic determinants of HIV-1 control affect HLA class I peptide presentation.

Infectious and inflammatory diseases have repeatedly shown strong genetic associations within the major histocompatibility complex (MHC); however, the basis for these associations remains elusive. To define host genetic effects on the outcome of a chronic viral infection, we performed genome-wide association analysis in a multiethnic cohort of HIV-1 controllers and progressors, and we analyzed the effects of individual amino acids within the classical human leukocyte antigen (HLA) proteins. We identified >300 genome-wide significant single-nucleotide polymorphisms (SNPs) within the MHC and none elsewhere. Specific amino acids in the HLA-B peptide binding groove, as well as an independent HLA-C effect, explain the SNP associations and reconcile both protective and risk HLA alleles. These results implicate the nature of the HLA-viral peptide interaction as the major factor modulating durable control of HIV infection