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BackgroundOlder adults married to persons living with dementia (PLwD) may be at risk for loneliness and depression. We assessed the prevalence of loneliness and depressive symptoms among spouses of PLwD or cognitive impairment not dementia (CIND), and the role of marital quality in mediating these outcomes.MethodsWe used a US population‐based sample of 4071 couples enrolled in the Health and Retirement Study (2014 and 2016). We included older adults married to PLwD (N = 227), married to persons with CIND (N = 885), or married to persons with no cognitive impairment (NCI) (N = 2959). We determined the prevalence of loneliness (UCLA 3‐item scale), depressive symptoms (CESD‐8 scale), and both, using multivariable logistic regression adjusting for sociodemographic and health‐related characteristics. We then tested for interaction terms between marital quality (4‐item scale) and degree of spousal cognitive impairment for each outcome of loneliness and depressive symptoms.ResultsThe sample was 55% women and on average 67‐years‐old (range: 50–97). After adjustment, spouses of persons with cognitive impairment were more likely to be lonely (NCI: 20%, CIND: 23%, PLwD: 29%; p = 0.04), depressed (NCI: 8%, CIND: 15%, PLwD: 14%; p < 0.01), and both (NCI: 4%, CIND: 9%, PLwD: 7%; p < 0.01). The association between cognition and loneliness, but not depression, differed by marital quality (interaction p‐value = 0.03). Among couples with high marital quality, spousal cognitive impairment was associated with higher likelihood of loneliness (p < 0.05). In contrast, no association existed between spousal cognition and loneliness among couples with lower marital quality (p = 0.37).ConclusionsOne in six spouses of persons with CIND or more advanced disease (PLwD) experienced depressive symptoms, and loneliness among spouses of PLwD was experienced at a twofold rate. By identifying and managing both, and facilitating interventions that promote high‐quality social connection, clinical teams might improve the lives of older couples facing dementia.

Background and Objectives: Many primary care clinics rely on providers and staff to generate quality improvement (QI) ideas without explicitly including patients. However, without understanding patient perspectives, clinics may miss areas for improvement. We identified practice improvement opportunities using a medical student-driven pilot of QI design that incorporates the patient voice and explored provider/staff perceptions of patient perspectives. Methods: One medical student interviewed eight patients for their perspectives on QI opportunities at a university-based primary care practice. Two trainees independently coded interview transcripts using directed content analysis (final codebook: 11 themes) and determined frequency of mentions for each theme. We surveyed 11 providers/staff by asking them to select 5 of the 11 themes and place them in rank order based on their perceptions of patient concerns; their surveys were aggregated into one ranked list. Results: Patients most frequently identified the following themes as QI opportunities: relationship (ie, feeling of personal connection with providers/staff), specialty care, convenience, sustainability, and goal follow-up. While patients frequently identified relationship (rank=1) and goal follow-up (rank=3) as QI opportunities, the provider/staff top five list did not include relationship (rank=10) or goal follow-up (rank=7). Conclusions: Our study demonstrates two things: (1) there are areas of discordance between provider/staff perceptions and patient perspectives regarding practice improvement opportunities; and (2) medical students can participate meaningfully in the QI process. By harnessing patient perspectives with the help of medical trainees, clinics may better understand patient concerns and avoid potential QI blind spots.