Late-life husband and wife relationships are increasingly recognised as an important factor in promoting wellbeing, particularly in terms of the health, social, emotional, financial and practical needs of older people. Knowledge of marital dynamics and how they affect both members of a couple remains scarce. This systematic review aimed to identify and appraise research that has focused explicitly on the dynamics of the relationship, as evinced by data frombothspouses. Implementing rigorous identification strategies, 45 articles were identified and reviewed. These studies were grouped into three broad thematic areas: marital relations and satisfaction; concordance in emotional state or physical health; and the interplay between marital quality and wellbeing. The issues found to affect marital relations and satisfaction in late life included equality of roles, having adequate communication, and transitions to living apart. There is strong evidence for couple concordance in depression, that marital relationships affect ill-health, longevity and recovery from illness, and reciprocally that ill-health impacts on the marriage itself. The research also suggests important gender differences in the impact of marital dynamics on health. It has led to the conclusion that there is a need for more diverse studies of late-life marriages, particularly ones that examine the dynamics of non-traditional elderly couples and that extend beyond a predominant focus on the Caucasian population of the United States.

This study provides insights into the validity and acceptability of Discrete Choice Experiment (DCE) and profile-case Best Worst Scaling (BWS) methods for eliciting preferences for health care in a priority-setting context. An adult sample (N = 24) undertook a traditional DCE and a BWS choice task as part of a wider survey on Health Technology Assessment decision criteria. A ‘think aloud’ protocol was applied, whereby participants verbalized their thinking while making choices. Internal validity and acceptability were assessed through a thematic analysis of the decision-making process emerging from the qualitative data and a repeated choice task. A thematic analysis of the decision-making process demonstrated clear evidence of ‘trading’ between multiple attribute/levels for the DCE, and to a lesser extent for the BWS task. Limited evidence consistent with a sequential decision-making model was observed for the BWS task. For the BWS task, some participants found choosing the worst attribute/level conceptually challenging. A desire to provide a complete ranking from best to worst was observed. The majority (18,75%) of participants indicated a preference for DCE, as they felt this enabled comparison of alternative full profiles. Those preferring BWS were averse to choosing an undesirable characteristic that was part of a ‘package’, or perceived BWS to be less ethically conflicting or burdensome. In a repeated choice task, more participants were consistent for the DCE (22,92%) than BWS (10,42%) (p = 0.002). This study supports the validity and acceptability of the traditional DCE format. Findings relating to the application of BWS profile methods are less definitive. Research avenues to further clarify the comparative merits of these preference elicitation methods are identified.

Links between social relationships and emotional well-being in old age are well documented, but little is known about daily life fluctuations in momentary affective experiences of the oldest-old while interacting with specific social partners. We examined associations between the presence of different types of social partners and moment-to-moment fluctuations in affect in the oldest-old, taking into account individual differences in gender, neuroticism, depressive symptoms, chronic health conditions, and loneliness. Participants (N = 74, M age = 88.7 years, range = 84-102 years, 68% women) provided self-reports concurrently on the presence of social partners and subjective affective states 6 times a day for each of 7 consecutive days (3,071 occasions, in total). Relative to being with other people, time spent alone was associated with lower positive affect in the oldest-old. Being with other family members and friends was associated with more positive affective experiences. Compared with men, women reported more negative affective experiences when they were with their spouses than when their spouses were not present. Individuals with more chronic health problems reported more negative affective experiences when they were with their spouses than not. Participants higher in neuroticism reported more positive affective experiences when they were with their friends, compared with times when their friends were not present. Finally, lonelier individuals reported more positive affective experiences when they were with their spouses than when they were not. These findings suggest that affective experience is a function of individual differences and the type of social partners oldest-old adults interact with in everyday life. We discuss how our findings can be generalized to oldest-olds of different marital statuses, taking into account the proportion of widows in our sample as well as measurement specifics.