Deborah Carr

Deborah Carr
Rutgers, The State University of New Jersey | Rutgers · Institute for Health, Health Care Policy and Aging Research

PhD

About

120
Publications
45,173
Reads
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5,761
Citations
Introduction
Skills and Expertise
Additional affiliations
September 2011 - July 2012
University of Michigan
Position
  • Visiting Scholar
September 2006 - August 2008
University of Wisconsin–Madison
Position
  • Professor (Associate)
September 2002 - present
Rutgers, The State University of New Jersey
Position
  • Professor
Education
August 1992 - August 1997
University of Wisconsin–Madison
Field of study
  • Sociology

Publications

Publications (120)
Article
Advance care planning (ACP) helps ensure that treatment preferences are met at the end of life. Medical professionals typically are responsible for facilitating patients’ ACP, and may be especially effective in doing so if they have first-hand insights from their own planning. However, no large-scale U.S. studies examine whether persons working on...
Article
Advance care planning (ACP) for medical decision-making at the end of life has developed around the expectation of death from long-term, progressive chronic illnesses. We reexamine advance care planning in light of the increased probability of death from COVID-19, an exemplar of death that occurs relatively quickly after disease onset. We draw seve...
Article
Objectives: Advance care planning (ACP) typically comprises formal preparations (i.e., living will and/or durable power of attorney for health care) and informal discussions with family members and health care providers. However, some people complete formal documents without discussing them with others. If they become incapacitated, their appointe...
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COVID-19 fatalities exemplify “bad deaths” and are distinguished by physical discomfort, difficulty breathing, social isolation, psychological distress, and care that may be discordant with the patient’s preferences. Each of these death attributes is a well-documented correlate of bereaved survivors’ symptoms of depression, anxiety, and anger. Yet...
Article
Later‐life families encompass the legal, biological, romantic, and kin‐like relationships of persons ages 65 and older. Research on older families has flourished over the past decade, as population aging has intensified concerns regarding the capacities of families to care for older adults and the adequacy of public pension systems to provide an ac...
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In the course of advance care planning (ACP), people may elect any of the following: a living will, a durable power of attorney for health care, and discussions with family members and health care providers. A small proportion of planners complete legal documents without discussing them with others (formal planning only, FPO). If people who have do...
Article
Objective We evaluate whether non‐spousal family support and strain moderate the effect of disability on older adults' daily frustration and happiness, and whether these patterns differ by gender and marital status. Background Stress buffering perspectives predict that harmful effects of stress on well‐being are buffered by family support, whereas...
Article
Background: Disablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear. Objective: Drawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbei...
Article
Background and objectives: The diminished wellbeing of caregivers is well documented, but studies typically draw upon coarse measures of time use and thus provide limited understanding of the role of specific care activities in the daily lives of care providers. This study uses time diary data to explore whether there are signature care patterns t...
Article
Experienced well-being measures tap a distinct form of subjective well-being (SWB) and have different age-related properties than the more widely studied evaluations of life satisfaction. Unlike evaluations of the quality of life as a whole, experiential measures capture affective reactions soon after they occur. Recent advances in measurement have...
Preprint
Experienced well-being measures tap a distinct form of subjective well-being (SWB) and have different age-related properties than the more widely studied evaluations of life based on satisfaction. Unlike evaluations of the quality of life as a whole, experiential measures capture affective reactions soon after they occur. Recent advances in measure...
Article
We use daily diary data from the Disability and Use of Time supplement to the 2013 Panel Study of Income Dynamics (n = 1,162) to evaluate (1) the extent to which marital/partner support and strain moderate the effects of disability on five activity-related emotions (happiness, calm, sadness, frustration, worry) and overall negative and positive emo...
Article
Background: Wellbeing is often described as U-shaped over the life course, suggesting an apparent paradox that wellbeing remains high at older ages despite increases in impairments. Objective/hypotheses: We explore associations among age, lower body impairments-one of the most common late-life impairments-and three measures of wellbeing: life sa...
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Background and Objectives Physical impairments affect a substantial number of older adults in the United States, with rates increasing with advancing age. Impairment is linked with compromised well-being, although the reasons are not fully understood. We explore the extent to which linkages between impairment severity and well-being are accounted f...
Article
Socioeconomic status (SES) gradients in mortality risk are well documented, although less is known about whether the quality of older adults’ dying experiences is stratified by SES. I focus on six core components of a “good death”: pain and symptom management, acceptance, medical care that is concordant with one’s preferences, dying at home, emotio...
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We evaluate (a) associations between marital quality (emotional support, strain, and overall appraisal) and three negative aspects of experienced well-being (frustration, sadness, and worry) among older husbands and wives and (b) the relative importance of own versus spouse's marital quality assessments for understanding experienced well-being in l...
Article
Spousal bereavement can cause a rise in depressive symptoms. This study empirically evaluates 2 competing explanations concerning how this causal effect is brought about: (a) a traditional latent variable explanation, in which loss triggers depression which then leads to symptoms; and (b) a novel network explanation, in which bereavement directly a...
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Despite the large body of literature on bereavement, little is known about the impact of sociohistorical context on individual reactions to spousal loss. This study examines the effect of marital status, time period and gender on physical and mental health, and whether reported difficulties following spousal loss differ at 2 distinctive time period...
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Objectives.We used data from the Changing Lives of Older Couples, a prospective multiwave study of 1,532 married individuals aged 65 and older, to investigate the extent to which spousal loss and death-context characteristics are associated with the stress hormone cortisol at 6 (W1) and 18 (W2) months postbereavement.Method.We used ordinary least s...
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Unlabelled: Bone health may be negatively impacted by childhood socio-environmental circumstances. We examined the independent associations of single-parent childhood and parental death or divorce in childhood with adult bone strength indices. Longer exposure to a single-parent household in childhood was associated with lower bone strength in adul...
Article
The authors examined associations between marital quality and both general life satisfaction and experienced (momentary) well-being among older husbands and wives, the relative importance of own versus spouse's marital appraisals for well-being, and the extent to which the association between own marital appraisals and well-being is moderated by sp...
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Objective: We examine the ways that romantic relationship biographies are related to whether, how, and with whom individuals complete advance care planning (ACP), preparations for end-of-life medical care. Method: Data are from an Internet survey of 2,144 adults aged 18 to 64, all of whom were either married to or cohabiting with an opposite-sex...
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Objectives.We explore gender differences in older adults' appraisals of positive and negative aspects of their marriages, examine how these appraisals relate to global marital satisfaction, and identify distinctive marital profiles associated with global satisfaction in men and women.Method.Data are from the Changing Lives of Older Couples Study (n...
Chapter
Contemporary scholars have moved beyond the question does family structure affect health, and instead explore under what conditions, for which outcomes, for whom, and through which pathways do family structure, context, and process affect health. In this chapter, we: (i) describe core concepts in the study of families and health; (ii) explore the w...
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Objectives.We explore whether spousal caregiving is associated with enhanced well-being for older husbands and wives.Method.We use time diary data from the 2009 Panel Study of Income Dynamics and Disability and Use of Time supplement. We measure experienced well-being as ratings of happiness and frustration during activities recalled for the previo...
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The Wisconsin Longitudinal Study (WLS) is a longitudinal study of men and women who graduated from Wisconsin high schools in 1957 and one of their randomly selected siblings. Wisconsin is located in the upper midwest of the United States and had a population of approximately 14 000 000 in 1957, making it the 14th most populous state at that time. D...
Article
The long-term effects of childhood trauma on health are well-documented, but few population-based studies have explored how childhood trauma affects the risk of developing metabolic syndrome (MetS) in adulthood. Using data from 1234 adults in the second wave of Midlife in the United States (MIDUS), we investigate (1) the extent to which childhood a...
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Purpose of the study: To evaluate the extent to which religious affiliation and self-identified religious importance affect advance care planning (ACP) via beliefs about control over life length and end-of-life values. Design and methods: Three hundred and five adults aged 55 and older from diverse racial and socioeconomic groups seeking outpati...
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We use data from the Changing Lives of Older Couples (CLOC) to examine (1) the effect of late-life widowhood on parent–child relations at 6- and 18-month follow-ups; (2) the extent to which effects are conditional upon three qualities of the late marriage (positive and negative interactions, and emotional dependence); and (3) pathways linking marit...
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We use data from the Midlife Development in the United States study to examine how sexual satisfaction, frequency, and number of partners are associated with men’s body weight. We consider five body weight categories (underweight, normal, overweight, obese I, and obese II/III), and control for potential explanatory factors including demographic cha...
Article
Using the 1957-2011 data from 3682 White non-Hispanic women (297 incident breast cancer cases) in the Wisconsin Longitudinal Study, United States, we explore the effect of occupation in 1975 (at age 36) on breast cancer incidence up to age 72. Our study is motivated by the paradoxical association between higher-status occupations and elevated breas...
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Objectives.Mental health professionals have suggested that widowed persons experience heightened psychological distress on dates that had special meaning for them and their late spouse, such as a wedding anniversary or the late spouse's birthday. This study examined the effects of such occasions on grief, anxiety, and depressive symptoms in a commu...
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Objectives.We explore whether beliefs about the existence and nature of an afterlife affect 5 psychological symptoms (anxiety, anger, depression, intrusive thoughts, and yearning) among recently bereaved older spouses.Method.We conduct multivariate regression analyses using data from the Changing Lives of Older Couples (CLOC), a prospective study o...
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Objectives: Medical professionals typically approach advance care planning (ACP) as an individual-level activity, yet family members also may play an integral role in making decisions about older adults' end-of-life care. We evaluate the effects of marital satisfaction and parent-child relationship quality on older adults' use of advance directive...
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Objectives: The effectiveness of advance care planning (ACP) may depend on family members' understanding of patient preferences. However, we know of no studies that explore the association between family relationship dynamics and ACP. ACP includes a living will, durable power of attorney for health care (DPAHC) appointment, and discussions. We eva...
Article
In Widowhood in an American City (1973), Helena Lopata observed that widows struggle with new romantic relationships because their children often are resentful toward these new partners. Since the publication of Lopata's classic work, however, few studies have explored empirically the ways that widow(er)'s dating affects their relationships with ch...
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Anger has been linked to cardiovascular disease, but few studies have examined the relationship between anger and type 2 diabetes. The aim was to investigate associations among different indicators of anger expression, adiposity, and nondiabetic glucose metabolism in a national survey of adults. Participants were 939 adults without diabetes in the...
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I use data from the Wisconsin Longitudinal Study (n = 4,971) to evaluate the extent to which socioeconomic status affects three health-related (living will, durable power of attorney for health care, and discussions) and one financial (will) component of end-of-life planning. Net worth is positively associated with all four types of planning, after...
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We use Wisconsin Longitudinal Study data (n = 2,678) to assess the effects of religious denomination and ideology on end-of-life treatment preferences in two hypothetical terminal illness scenarios: physical pain and severe cognitive impairment. We found no statistically significant differences when comparing traditionally defined religious denomin...
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The author investigated (a) whether Whites, Blacks, Latinos, and Asians differ in their rates of advance care planning (ACP; that is, living will, health care proxies, discussions), (b) sources of within-racial group heterogeneity, and (c) racial differences in the explanations offered for not doing ACP. The author estimated logistic regression mod...
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Purpose of the study: I examine whether 5 aspects of a significant other's death quality (pain, decision-making capacity, location, problems with end-of life care, and preparation) affect whether one does advance care planning (ACP). I also identify specific aspects of others' deaths that respondents say triggered their own planning. Design and m...
Article
We use quantitative and qualitative data to explore the psychological impact of weight change among American adults. Using data from the Midlife Development in the United States (MIDUS) study, a survey of more than 3000 adults ages 25-74 in 1995, we contrast underweight, normal weight, overweight, obese I, and obese II/III persons along five psycho...
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This study examines the potential social diffusion effects of the Respecting Choices advance care planning program administered in La Crosse, Wisconsin, since 1991. The program produces educational materials for patients, trains facilitators to help patients prepare for end of life, and ensures that advance directives are connected to patients’ med...
Article
Over the last 200 years, where, when and how Americans die has changed dramatically. Throughout the 19th and early 20th centuries, most deaths occurred with little warning, typically due to short-term infectious diseases. In the contemporary United States, death typically happens to older adults following a long-term chronic illness. Most older adu...
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What happens when older men become widowers? Popular books, movies, and television present widowers as lost and unable to cope or care for themselves. These stereotypes do not encapsulate the experiences of real widowers, how their daily lives change, and what being a widower means to individuals in both sociological and practical ways. By Himself...
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I evaluate the extent to which ethnic disparities in advance care planning reflect cultural and religious attitudes and experience with the painful deaths of loved ones. Data are from a sample of 293 chronically ill older adults who are seeking care at one of two large medical centers in urban New Jersey. Blacks and Hispanics are significantly less...
Article
Sebastiaõ Salgado, the internationally renowned Brazilian photojournalist, is the 2010 recipient of the American Sociological Association's (ASA) Award for Excellence in the Reporting of Social Issues. This award honors individuals for their promotion of sociological knowledge and a broader vision of sociol-ogy. Each year since 2007, the ASA has re...
Chapter
Studies dating back to Emile Durkheim’s (1897) Suicide demonstrate that social relationships ­provide emotional, social, and economic supports that enhance physical and emotional well-being throughout the life course (House et al. 1988). Over the past three decades, however, researchers have discovered that social relationships are not universally...
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In 1999, Stroebe and Schut published their seminal article on the Dual Process Model (DPM), a conceptual model which changed the direction of bereavement research. While earlier models of grief focused primarily on psychological adjustment in the wake of a severed emotional attachment, the DPM model places equal emphasis on practical—even mundane—d...
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While the preclinical development of type 2 diabetes is partly explained by obesity and central adiposity, psychosocial research has shown that chronic stressors such as discrimination have health consequences as well. We investigated the extent to which the well-established effects of obesity and central adiposity on nondiabetic glycemic control (...
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We use data from the American Time Use Survey (ATUS) to investigate racial differences in the amount of time individuals spend traveling to, waiting for, and receiving outpatient healthcare services on a randomly selected survey interview day. Of the 60,674 participants in the 2003–2006 waves of the ATUS, 2.67% (n=1,621) reported a clinical encount...
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We review research on families and health published between 2000 and 2009 and highlight key themes and findings from innovative, methodologically rigorous studies. Whereas research in prior decades focused primarily on whether family structure affects child and adult health, contemporary research examines the contextual and processual factors that...
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We use data from the Changing Lives of Older Couples (CLOC) study to investigate the extent to which: (1) five personality traits (agreeableness, conscientiousness, emotional stability/neuroticism, extraversion, and openness) moderate the effect of late-life spousal loss on depressive symptoms; (2) these patterns vary based on the expectedness of t...
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Prior research suggests that midlife husbands have worse health when they earn less than their wives; however, the mechanism(s) for this relationship have not been evaluated. In this study, the author analyzes 1,319 heterosexual married couples from the Health and Retirement Study to explore three theoretically grounded mechanisms. The author begin...
Article
We explore the content and correlates of older adults' end-of-life treatment preferences in two hypothetical terminal illness scenarios: severe physical pain with no cognitive impairment, and severe cognitive impairment with no physical pain. For each scenario, we assess whether participants would reject life-prolonging treatment, accept treatment,...
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I examine the ways that bereaved older adults attribute responsibility for their late spouses' deaths, and the consequences of such attributions for psychological adjustment to loss. Data are from the Changing Lives of Older Couples, a prospective study of married persons ages 65 and older Bereaved persons whose late spouse smoked and had a sedenta...
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The authors examined whether the effect of parental death on adults siblings' relationship quality varies on the basis of the presence and perceived effectiveness of a deceased parent's formal preparations for end-of-life care. The authors used data from the Wisconsin Longitudinal Study and focused on the relationship quality of a bereaved adult ch...
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We use prospective couple-level data from the Changing Lives of Older Couples to assess the extent to which spouses concur in their assessments of marital quality (N = 844) and whether discrepancies in spouses' marital assessments affect the bereaved spouse's psychological adjustment 6 months after loss (n = 105). Spouses' assessments of marital qu...
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Using a sample of 540 siblings and twins from the National Survey of Midlife Development in the United States, this study examines the relationship between the age at which men become biological fathers and their subsequent health. The analysis includes both between-family models that treat brothers as independent observations and within-family mod...
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When terminally ill patients become mentally incapacitated, the patient's surrogate often makes treatment decisions in collaboration with health care providers. We examine how surrogates' errors in reporting their spouse's preferences are affected by their gender, status as durable power of attorney for health care (DPAHC), whether the surrogate an...
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Change and Stability is the culmination of more than five decades of research conducted by Melvin Kohn, one of the most influential scholars working in the social structure and personality tradition. The overarching theme of the SSP paradigm is that social-structural location – whether one’s social class, national origin or political context – shap...
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Widowhood is widely regarded as a women’s issue. In all developed and nearly all developing nations, women are more likely than men to survive the death of their spouse, reflecting men’s higher rates of mortality and the tendency of women to marry men slightly older than themselves. Women also are more likely than men to remain unmarried after thei...
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We document the extent to which older adults accurately report their spouses' end-of-life treatment preferences, in the hypothetical scenarios of terminal illness with severe physical pain and terminal illness with severe cognitive impairment. We investigate the extent to which accurate reports, inaccurate reports (i.e., errors of undertreatment or...
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Little is known about the specific ways that young-old men and women cope with marital disruption. Using data from the Wisconsin Longitudinal Study, we examine: (1) the extent to which widowhood and divorce in one's 50s or early 60s affect depressive symptoms and alcohol use; and (2) the extent to which coping strategies and personality traits prot...
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We examine the extent to which body weight affects three types of perceived interpersonal mistreatment, and evaluate whether these patterns vary by race, social class, and gender in a large sample of American men and women. We use data from the first wave (1995) of the Midlife Development in the United States (N = 3,511), a survey of persons aged 2...
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Background: In Crossing the Quality Chasm, the Institute of Medicine recommended that patient-centered care should not waste patients' time and should recognize the involvement of family and friends. Studies have documented the time spent by physicians on outpatient visits, but not that spent by patients and their companions. The patient's perspec...
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This study examines: (1) the extent to which acute and chronic stressors related to spousal loss affect the physical functioning of bereaved spouses; and (2) how these patterns differ for men and women. We use data from the Changing Lives of Older Couples (CLOC) study, which tracks older adults prior to spousal loss, and 6, 18, and 48 months after...