Global Update: African Children Still at Risk of Pneumonia Despite Ceramic Stoves

Small ceramic indoor stoves, such as those sold by women in AIDS self-help groups in Africa, do save fuel and cut down on eye-irritating smoke, a new study has found — but they do not save children from pneumonia.

The study, published in The American Journal of Tropical Medicine and Hygiene, compared 168 households in rural Kenya that used either “upesi jiko” stoves or traditional three-stone indoor fires. The former — the name means “quick stove” in Swahili — has a locally made ceramic firebox that sells for $3. Clay and mud must be built up around it to insulate it and support the pot.

Since it uses less wood, it saves local forests. But it has no chimney, so the smoke stays indoors.

Biweekly visits by researchers found that children in both the stove and open-fire homes got pneumonia equally often. Pneumonia is a leading cause of death for infants in poor countries, and a 2008 study showed that the fine particles and toxic gases in cooking smoke inflame their lungs, doubling the pneumonia risk.

Two years ago, Secretary of State Hillary Rodham Clinton committed $50 million in American aid to help the Global Alliance for Clean Cookstoves get 100 million efficient stoves into households by 2020. But experts are still divided over which stove to pursue; chimneys do not solve all the problems, and stoves with fans burn more cleanly but are expensive and fragile.

Read More..

Backing Off Deal, Boehner Invokes ‘Plan B’ on Taxes

Joshua Roberts/Reuters

 John Boehner winced while talking to a reporter on the way to a closed-door meeting with House Republicans today.

WASHINGTON — Speaker John A. Boehner, pivoting to hardball tactics just days before a deadline in the fiscal impasse, promised to bring a bill to the House floor this week that would raise tax rates only on income over $1 million and leave in place across-the-board spending cuts to military and domestic programs that Republicans have warned could have dire consequences.

The move came less than 24 hours after President Obama offered a more comprehensive deal that would raise tax rates on income over $400,000, raise $1.2 trillion in new revenue and cut $930 billion in spending over 10 years. Mr. Boehner declared that unbalanced and insufficient.

“What we’ve offered meets the definition of a balanced approach, but the president is not there yet,” Mr. Boehner said Tuesday.

The speaker made it clear he would continue negotiating with the president, and some House Republicans emerged from a closed-door meeting with Mr. Boehner confident that a deal was now in reach.

“We’re getting there,” said Representative James B. Renacci, Republican of Ohio.

But to raise the pressure, House leaders will proceed with what they are calling “Plan B,” which could come to a vote as early as Thursday. Under that plan, the House would take up tax legislation and consider two amendments. The first would mirror a bill passed by the Senate that would extend expiring Bush-era tax cuts for income below $250,000. That would be expected to fail, showing the president that his initial offer could not pass. A second amendment would raise that threshold to income below $1 million. The House may also vote on some middle ground, like the president’s $400,000 threshold.

Mr. Boehner told his conference that he would also like the bill to include provisions preventing the existing alternative minimum tax from expanding more to affect the middle class and extending existing tax rates on inherited estates.

But he said the bill would not cancel across-the-board spending cuts, known as sequestration, that would total $110 billion in 2013 and more than $1 trillion over 10 years.

Republicans would then resume the fight over broad spending cuts — especially to entitlement programs like Medicare — in late January or February, when the government must raise its borrowing limit, which many Republicans believe will give them much more leverage than they have now.

Mr. Boehner told Republicans on Tuesday: “Taxes are going up on everyone on Jan. 1. They’re baked into current law. And we have to stop whatever tax rate increases we can. In the absence of an alternative, as of this morning, a ‘modified Plan B’ is the plan.”

Representative Kevin McCarthy of California, the Republican whip, said his operation would be checking whether the party had the votes to pass any tax legislation. If Democrats stay united against the $1 million threshold, it could fail because some Republicans are unlikely to ever vote for a tax increase. Representative Nancy Pelosi of California, the Democratic leader, met with House Democrats on Tuesday and urged unity against the speaker’s plan.

The White House came out strongly against the speaker’s move. The White House press secretary, Jay Carney, said “Plan B” could not pass the Senate and “therefore will not protect middle-class families” from large tax increases beginning Jan. 1.

“The president has put a balanced, reasonable proposal on the table that achieves significant deficit reduction and reflects real compromise by meeting the Republicans halfway on revenue and more than halfway on spending from where each side started,” he said. “That is the essence of compromise.”

It is not clear how much this alternative plan is real or a bargaining tactic to extract more concessions from Mr. Obama. Rob Nabors, the president’s chief liaison to Congress, met with House Democrats on Tuesday and said talks were moving forward. But privately, he expressed pessimism that Mr. Boehner could sign on to any deal, according to people familiar with those conversations.

In spite of statements to the contrary just a week ago, House Republicans on Tuesday seemed almost uniformly resigned to some sort of tax rate increases on the nation’s highest earners, though they remained committed to keeping that group as small as possible. “The principle of trying to limit the increases is a good one,” said Representative Jason Chaffetz of Utah. “But now we’ve got to see more spending cuts.”

Jennifer Steinhauer contributed reporting.

Read More..

Samsung drops attempt to ban Apple sales in Europe

STOCKHOLM (Reuters) - Korea's Samsung Electronics on Tuesday said it would drop law suits aimed at banning the sale of Apple Inc. products in Europe just a day after scoring a victory in a battle in the United States with the maker of iPhones.

Samsung and Apple, the world's top two smartphone makers, have been locked in patent disputes in at least 10 countries over the last 18 months since Apple sued Samsung, saying the Korean firm copied its best-selling iPhone and iPad.

On Tuesday, Samsung said it was dropping an attempt to stop the sale of some Apple products in Germany, Britain, France, Italy and the Netherlands, though it did not say it would halt its court battle for compensation.

"Samsung remains committed to licensing our technologies on fair, reasonable and non-discriminatory terms, and we strongly believe it is better when companies compete fairly in the marketplace, rather than in court," the company said in a statement.

A spokesman for Apple declined to comment on Samsung's decision.

The decision comes a day after a judge rejected Apple Inc's request for a ban on the sale of Samsung Electronics' smartphones in the United States.

In August, Apple was awarded $1.05 billion in damages after a U.S. jury found Samsung had copied critical features of the iPhone and iPad. The Samsung products run on the Android operating system, developed by Google.

In January, the European Commission opened an investigation into whether Samsung Electronics has distorted competition in the European mobile device market, breaking EU antitrust rules.

(Reporting by Simon Johnson, additional reporting by Paul Sandle; Editing by Louise Heavens)

Read More..

Who was Gossip Girl? The series finale told all

NEW YORK (AP) — "Gossip Girl" ended its six-season run with a major reveal: The identity of its tattle-tale blogger.

Known only as Gossip Girl and given narrative voice by actress Kristen Bell, she turned out to be a he. The Monday night finale revealed Gossip Girl was secretly the work of character Dan Humphrey.

Dan, played by Penn Badgley, was a budding poet and a student at Manhattan's posh St. Jude's Preparatory School for Boys. But he came from the other side of the tracks, or rather, from Brooklyn, across the East River.

His Gossip Girl blog was a sassy tell-all account of the lives of the privileged young adults who made up the CW drama. Other series stars included Blake Lively, Leighton Meester and Chace Crawford.

At the end, Dan fittingly pronounced Gossip Girl dead.

___

Online:

http://www.cwtv.com

Read More..

Mind: A Misguided Focus on Mental Illness in Gun Control Debate

The gunman, Adam Lanza, 20, has been described as a loner who was intelligent and socially awkward. And while no official diagnosis has been made public, armchair diagnosticians have been quick to assert that keeping guns from getting into the hands of people with mental illness would help solve the problem of gun homicides.

Arguing against stricter gun-control measures, Representative Mike Rogers, Republican of Michigan and a former F.B.I. agent, said, “What the more realistic discussion is, ‘How do we target people with mental illness who use firearms?’ ”

Robert A. Levy, chairman of the Cato Institute, told The New York Times: “To reduce the risk of multivictim violence, we would be better advised to focus on early detection and treatment of mental illness.”

But there is overwhelming epidemiological evidence that the vast majority of people with psychiatric disorders do not commit violent acts. Only about 4 percent of violence in the United States can be attributed to people with mental illness.

This does not mean that mental illness is not a risk factor for violence. It is, but the risk is actually small. Only certain serious psychiatric illnesses are linked to an increased risk of violence.

One of the largest studies, the National Institute of Mental Health’s Epidemiologic Catchment Area study, which followed nearly 18,000 subjects, found that the lifetime prevalence of violence among people with serious mental illness — like schizophrenia and bipolar disorder — was 16 percent, compared with 7 percent among people without any mental disorder. Anxiety disorders, in contrast, do not seem to increase the risk at all.

Alcohol and drug abuse are far more likely to result in violent behavior than mental illness by itself. In the National Institute of Mental Health’s E.C.A. study, for example, people with no mental disorder who abused alcohol or drugs were nearly seven times as likely as those without substance abuse to commit violent acts.

It’s possible that preventing people with schizophrenia, bipolar disorder and other serious mental illnesses from getting guns might decrease the risk of mass killings. Even the Supreme Court, which in 2008 strongly affirmed a broad right to bear arms, at the same time endorsed prohibitions on gun ownership “by felons and the mentally ill.”

But mass killings are very rare events, and because people with mental illness contribute so little to overall violence, these measures would have little impact on everyday firearm-related killings. Consider that between 2001 and 2010, there were nearly 120,000 gun-related homicides, according to the National Center for Health Statistics. Few were perpetrated by people with mental illness.

Perhaps more significant, we are not very good at predicting who is likely to be dangerous in the future. According to Dr. Michael Stone, professor of clinical psychiatry at Columbia and an expert on mass murderers, “Most of these killers are young men who are not floridly psychotic. They tend to be paranoid loners who hold a grudge and are full of rage.”

Even though we know from large-scale epidemiologic studies like the E.C.A. study that a young psychotic male who is intoxicated with alcohol and has a history of involuntary commitment is at a high risk of violence, most individuals who fit this profile are harmless.

Jeffery Swanson, a professor of psychiatry at Duke University and a leading expert in the epidemiology of violence, said in an e-mail, “Can we reliably predict violence?  ‘No’ is the short answer. Psychiatrists, using clinical judgment, are not much better than chance at predicting which individual patients will do something violent and which will not.”

It would be even harder to predict a mass shooting, Dr. Swanson said, “You can profile the perpetrators after the fact and you’ll get a description of troubled young men, which also matches the description of thousands of other troubled young men who would never do something like this.”

Even if clinicians could predict violence perfectly, keeping guns from people with mental illness is easier said than done. Nearly five years after Congress enacted the National Instant Criminal Background Check System, only about half of the states have submitted more than a tiny proportion of their mental health records.

How effective are laws that prohibit people with mental illness from obtaining guns? According to Dr. Swanson’s recent research, these measures may prevent some violent crime. But, he added, “there are a lot of people who are undeterred by these laws.”

Adam Lanza was prohibited from purchasing a gun, because he was too young. Yet he managed to get his hands on guns — his mother’s — anyway. If we really want to stop young men like him from becoming mass murderers, and prevent the small amount of violence attributable to mental illness, we should invest our resources in better screening for, and treatment of, psychiatric illness in young people.

All the focus on the small number of people with mental illness who are violent serves to make us feel safer by displacing and limiting the threat of violence to a small, well-defined group. But the sad and frightening truth is that the vast majority of homicides are carried out by outwardly normal people in the grip of all too ordinary human aggression to whom we provide nearly unfettered access to deadly force.

Read More..

Advertising: Finding a Documentary Audience, for a Cause

DOCUMENTARY films are notoriously difficult to finance, with filmmakers often spending more time scrounging up money to make a film than actually producing it. Unlike big Hollywood films, where having the presence of a marquee name can attract dollars, documentary filmmakers often must try to explain how a niche idea can succeed at the box office.

The director and backers of “Girl Rising,” a documentary that is a cornerstone of a media campaign about educating girls around the world, hope to change that. To promote the new film, and demonstrate the impact that documentaries can have on audiences, they will rely on technologies often used by more traditional advertisers, including personalized ads for employees of companies viewing them online.

“If what you are after is engagement and connection to a cause,” said Richard E. Robbins, the director, “how you use the tools that are available to you is very different than if you are trying to market ‘Batman.’ ”

Money donated by consumers seeing the film will be funneled to a nonprofit group, 10x10, which will then distribute the funds to various nonprofits helping to educate girls.

Many documentary filmmakers have trouble quantifying the social and financial impact their films can have, Mr. Robbins said. And many are confronted with “a dearth of evidence to support the idea that documentary films affect change.”

But using highly targeted advertising can help filmmakers learn who is donating, how much they are donating, how much interest there is in a film and whether there is enough interest to warrant a screening in a city, he said. Having that information might also help persuade future investors to support documentaries connected to causes.

“Girl Rising,” which will be released in March, is being financed in part by 10x10, which supports educating girls around the world through film and social media advocacy.

Ads promoting “Girl Rising” will be shown to employees of 57 companies that the filmmakers selected in hopes they will support efforts to educate girls in developing countries. Those companies include Apple, Bank of America, Oracle, Goldman Sachs, Wal-Mart, Disney and Procter & Gamble.

“Those companies are deeply invested in vibrant economies overseas, healthy supply chains, diversity, attracting and retaining and identifying new employees, skilled employees,” said Holly Gordon, executive director at 10x10. “We thought that they would be advocates for these issues of gender diversity and global education.”

Employees at the companies will see ads on their computers at work, customized to use the company name. For example, an Oracle employee will see an ad that says “Oracle employees can change the world,” with a link to see a trailer for the film and donate to the cause.

A group of former ABC News journalists, known as the Documentary Group, and Vulcan Productions announced the creation of 10x10 and its media campaign at the United Nation’s first International Day of the Girl in October. Additional funds for organization came from Intel, the Ford Foundation, Google, the Nike Foundation, the Skoll Foundation and the Fledgling Fund.

“Girl Rising,” the first film backed by the group, features stories inspired by nine girls in countries like Haiti, Nepal, Sierra Leone, Uganda and Afghanistan. Some of the segments are narrated by celebrities like Meryl Streep, Selena Gomez and Kerry Washington.

Well-known writers from each of the countries, including Mona Eltahawy, an Egyptian-American author, and Edwidge Danticat of Haiti helped to write the stories of each of the girls to whom they were paired. Each story will be presented differently; some will be animated while others will be live action.

Chris Golec, the chief executive of Demandbase, the company behind the ads, said technology that aimed at the Internet addresses at the companies would be used to find the right users for each ad.

“Targeting people at work is four times more likely to drive engagement than somebody coming from a residential I.P. address,” said Mr. Golec, referring to the Internet addresses of home viewers. “If you personalize the ad with the company name that they work for you get a three times higher click through rate on the ad.”

Using such digital advertising also helps the filmmakers and producers in another way, said Mr. Robbins. “It’s infinitely more trackable, there’s so much more data,” he said. “We can measure conversion rates, who our audience is — its not just anonymous people buying tickets.”

Distribution of “Girl Rising” will be in phases, beginning in January at the Sundance Film Festival, where one chapter will be shown. It will make its official debut in March for International Women’s Day at an event in New York City, and with a smaller event in Los Angeles. CNN will show the film in June as part of the network’s new film division.

Organizers are also using technology to get viewers to book a screening of the film in the city of their choice. Supporters of 10x10 will receive an e-mail asking them to go to a Web site, Gathr.us, which will keep track of the number of screening requests from various cities.

Read More..

The Lede Blog: Latest Updates on Shooting Aftermath

Two of the children killed in Friday’s shooting at Sandy Hook Elementary School in Newtown, Conn., were to be buried Monday, as investigators continued to try to piece together the motive behind Adam Lanza’s rampage, which claimed the lives of 20 children and six adults at the school and Mr. Lanza’s mother before Mr. Lanza killed himself.

Read More..

U.S. could wrap up Google probe this week: sources

WASHINGTON (Reuters) - U.S. regulators this week could drop their investigation of how Google ranks certain searches, without requiring any major changes in how the online giant does business, according to two people knowledgeable about the investigation.

Google had been accused of giving competitors in lucrative areas like travel a lower ranking in search results, thus making it harder for their customers to find them.

But the Federal Trade Commission is expected to conclude that Google's actions were legal and end its more than two-year probe of the company.

FTC Chairman Jon Leibowitz has said he wanted the case wrapped up by the end of the year. He is widely expected to step down within a month but has not announced his resignation.

Google is expected to agree to some changes in its business practices, however. For example, it is expected to end the practice of "scraping," or using reviews from other websites, for its own products, the sources said.

And it is also expected to allow customers who use its advertising network to be able to export data on the effectiveness of those ad campaigns, the sources said.

Google and the FTC are also expected to reach an agreement on when the company can request sales bans when filing patent infringement lawsuits.

The company is expected to agree to strict conditions when filing these lawsuits if the patent in question has been determined to be essential to a standard, the sources said.

The European Commission, which is also probing Google on the issue of search fairness, is expected to announce a decision next month.

Google's U.S. critics, anticipating disappointment from the FTC, have already said they would take their evidence to the Justice Department to press the antitrust division to take up the case.

(Reporting By Diane Bartz)

Read More..

Beck looks for new connection with 'Song Reader'

NASHVILLE, Tenn. (AP) — Beck Hansen wants you to think about the way music has changed over the last century and what that means about how human beings engage each other these days.

Laboring over the intricate and ornate details of his new "Song Reader" sheet music project, he was struck by how social music used to be — something we've lost in the age of ear buds.

"You watch an old film and see how people would dance together in the '20s, '30s and '40s. You'd go out and people would switch partners and it was a way of social interaction," Hansen said. "It's something that was part of what brought people together. Playing music in the home is another aspect of that that's been lost. Again, I'm not on a campaign to get people to take up songs and play music in their home or anything. But it is interesting to me, the loss of that, what it means."

Beck hopes the "Song Reader" inspires some of us to pick up instruments and limber our vocal cords. It includes 20 songs annotated on sheet music that's been decorated in the style popular in the early 20th century when the songwriting industry was a thriving enterprise with billions of songs sold.

The 42-year-old singer notes in the book's preface that Bing Crosby's "Sweet Leilani" sold an estimated 54 million copies in 1937, meaning about 40 percent or more of the U.S. population was engaged in learning how to play that song. They were touching it directly, speeding it up, slowing it down, changing the lyrics and creating something new.

"There's popular bands now that people know the words to their songs and can sing along, but there's something about playing a song for yourself or for your friends and family that allows you to inhabit the song and by some sort of osmosis it becomes part of who you are in a way," he said. "So when I think of my great-grandparents' generations, music defined their lives in a different way than it does now."

Beck proposed the idea to McSweeney's Dave Eggers in 2004 and it soon blossomed into something more ambitious as the artist wrapped his mind around the challenge of not just writing a song, but presenting it in a classic way that also engages fans who might not be able to read music or play their own instruments.

They quickly agreed it would make no money, but it seemed like an idea worth exploring.

"And it seemed like only Beck would have thought of it," Eggers said in an email to the Associated Press. "It's a very generous project, in that he wrote a bunch of songs and just gives them to the world to interpret. That's a very expansive kind of generosity and inclusiveness that we're happy to be part of. On a formal level, we love projects like this, that are unprecedented, and that result in a beautiful object full of great art and great writing. And it all started with Beck. It's a testament to his groundbreaking approach to everything he does."

Beck hopes fans will record their own versions and upload them to the Internet so those songs grow into something more universal.

As for his own recorded music, that's a little more complicated.

Beck's not sure where he's headed at the moment. He recorded an album in 2008, but set it aside to work with Charlotte Gainsbourg on "IRM," which he wrote and produced. He's also been writing songs for soundtracks and special projects and producing artists like Thurston Moore, Stephen Malkmus and Dwight Yoakam. All that has left him feeling creatively satisfied, but he does acknowledge it's been a while since he released 2008's Danger Mouse-produced "Modern Guilt."

He says in many ways he's reached a crossroads he's not yet sure how to navigate.

"This last year I've been thinking about whether I'd finish those songs (from 2008), whether they're relevant or worthy of releasing. I know that doesn't sound very definitive," he said, laughing, "but that's the kind of place I'm in — in this kind of limbo — and, um, yeah."

The "Song Reader" spurred Beck to think about his own work in a new light as well. Spending six months finishing off the project after working on it sporadically over the years, he was struck by how much craft went into the creation of each song and how quickly music can come into existence today.

"There is so much music out there, to me," he said. "I don't know if it's just where I am in my own music making or if it's a product of the amount of music out there, but I feel like a piece of music does have to have a certain validity to be put out there and to ask people to listen. ... I feel like it's impossible for everyone to keep up, you know, so I guess I've been feeling like maybe there's something to picking what you're going to put out, about being more particular about what you put out."

___

Online:

http://beck.com

___

Follow AP Music Writer Chris Talbott: http://twitter.com/Chris_Talbott.

Read More..

The New Old Age Blog: In the Middle: Why Elderly Couples Fight

George and Gracie (let’s call them that because using their real names would make them even unhappier than they already appear to be) are in their 80s and have been married for more than 65 years. Until recently they seemed to ride the waves that are inevitable in any marriage that spans nearly seven decades; through good and bad, they were partners and best friends.

But lately — ever since her hospitalization and his fall — they have been arguing more bitterly than usual (“Do you have to make such a mess in the kitchen?”), criticizing each other (“Why haven’t you dealt with the insurance company yet?”), withdrawing from each other, and generally making each other more miserable, more often than ever before.

This kind of degenerative relationship is not uncommon among the elderly in even the happiest marriages, marriage therapists and geriatricians said. But that is small comfort to either the couple in the middle of the maelstrom, or the children who care for them, as evidenced by a number of postings on caregiver blogs. As some of the children have wondered there: “Why can’t we all just get along?”

Therapists and others who work with the elderly said the first step to addressing the problem is understanding where it came from.

“A key question is whether the marital bickering is part of a lifelong marital style or a change,” said Dr. Linda Waite, director of the Center on Demography and Economics of Aging at NORC/University of Chicago. Is it new behavior – or just new to the grown children who are suddenly so deeply enmeshed in their parents’ lives that they are only now noticing that something is amiss?

How much of the problem is really just the marriage style? “Some couples like to fight and argue – it keeps their adrenaline going,” said Dr. Nancy K. Schlossberg, professor emerita of counseling psychology at the University of Maryland and author of “Overwhelmed: Coping With Life’s Ups and Downs.”

Sometimes the best judges of whether there is a problem are outsiders, said Dr. William Dale, chief of geriatrics at the University of Chicago Geriatrics Medicine. Pay attention if someone says, “‘Gee, Mom seems more argumentative or withdrawn than the last time I saw her,’” Dr. Dale advised.

If the tone or severity of the marital tensions seem new, then it is important to find out why. The causes could be mental or physical, doctors say.

On the mental front, increased anger and fighting could be one of the first signs of mild cognitive impairment, a precursor of dementia or Alzheimer’s, in one or both of the spouses, said Dr. Lisa Gwyther, director of the Duke Center for Aging Family Support Program and an associate professor in the department of psychiatry and behavioral sciences.

Dr. Dale concurs: “There is good evidence that the earliest signs of cognitive impairment are often emotional changes” — anger, anxiety, depression — “rather than cognitive ones” — memory, abstract thought.

But these early signs of cognitive decline can be so subtle that neither the spouses themselves, or their grown children, recognize them for what they are, Dr. Gwyther said. So husband and wife blame each other for the changes and allow feelings of hurt and resentment to grow.

Withdrawing from activities that used to give them pleasure can be a telltale sign of mild cognitive impairment – and can trigger anger and arguments.

“In one couple, the husband just didn’t want to participate in the holidays — the wife got angry and said he was being lazy and stubborn,” said Dr. Gwyther. But the truth was that his cognitive decline made all the activity overwhelming, and he didn’t want anyone to know that he was anxious about not remembering everyone’s names and embarrassing himself.

Suspicion and paranoia can also accompany mild cognitive decline and precipitate distrust and hurtful accusations. Dr. Gwyther recalled another woman who “called her daughter frantic because she said her husband dropped her at her chemo appointment, went to park the car, and didn’t return to get her.” The woman couldn’t imagine that her husband could possibly have lost his sense of time and direction, Dr. Gwyther added. She took it personally, complaining to her daughter that “your father doesn’t seem to care any more.”

Dr. Dale told of a spouse who accused her mate of infidelity because “she was convinced that when he was out grocery shopping he was really having an affair.”

Hoarding, an early symptom of mild cognitive impairment, can also create tension in a marriage. (For new treatments, see this recent post by my colleague Paula Span.)

When one couple came to a counseling session with Dr. Norman Abeles, emeritus professor of psychology and former director of psychological clinic at Michigan State University, the hoarding spouse finally said she did it because she thought that they would run out of money, “even though there was enough money to go around.” Dr. Abeles said that incident led to her diagnosis of mild cognitive impairment.

Adding to the confusion, mild cognitive impairment, or M.C.I., comes and goes. “There are good days and bad days, good hours and bad hours,” said Dr. Gwyther. “Alzheimer’s and dementia don’t start on Tuesday — it’s a slow insidious onset.” But the diagnosis is becoming more common: The Institute for Dementia Research and Prevention predicts that 1 in 6 women, and 1 in 10 men, who live past the age of 55 will develop dementia in their lifetime.

“Spouses find it difficult to know when their partner with M.C.I. is acting differently, usually badly, due to the advancing illness or due to ‘willful’ personality issues,” said Dr. Dale, citing a 2007 study in the journal Family Relations exploring the problems this can create for couples.

Blaming is often easier than understanding. Another of Dr. Gwyther’s patients was furious at her husband for not filing their taxes. “He’s a C.P.A.,” she said. “How could we owe back taxes?” It did not occur to her that he might be unable to handle that task — and was too frightened about his deteriorating mental focus to let her know.

But as harmful as mental decline can be for a marriage, it is just part of the equation. Physical ailments – even those that seem completely unrelated to marital relations – “can upset the equilibrium of the marriage,” according to a study in The Canadian Medical Association Journal.

“Most men get angry at what’s happened to them when they get ill, women get angry and scared when he’s not what he used to be — so they fight,” said Dr. Schlossberg.

Chronic illnesses, like diabetes, arthritis and heart disease, can have a strong negative effect on mood, said Dr. Waite, who will soon be publishing a study on the subject. Diabetes is so often accompanied by depression that Dr. Waite said “one of my colleagues argues that that it is even part of the disease.”

And ailments can have an effect on a couple’s sex life — which can compound the marital problems, doctors said.

“Diabetes brings on neuropathy,” said Dr. Waite. “That means touching and feeling in sex is not as rewarding.” Without the pleasures of affectionate touching — whether a passing hug at the sink or more — tensions can build. That’s why, if a couple is having problems with sex, they are more likely to have problems in the relationship — and vice versa, according to a 2007 New England Journal of Medicine study of sex and health among older adults.

Other changes in circumstances — retirement, shifting roles, the loss of autonomy, disparities in health and abilities — can wreak havoc. Losing independence can feel like losing oneself — and if you don’t know who you are any more, how can you know how to relate to your spouse?

“Fighting may come from a misguided notion that you can regain power by asserting it over your spouse,” said Dr. Schlossberg, whose observations are echoed in a 1984 study in The Canadian Journal of Medicine. “It doesn’t work, it’s false power – but they’ll try anything.”

The sheer exhaustion that can come from being the caregiving spouse is also bound to “make them stressed and angry,” said Dr. Waite. Not to mention guilty and resentful — never a prescription for happy marital relations.

“Part of the trap for the caregiver is the idea that you have to do it all, and the guilt you feel when you cannot live up to it,” said Dr. Gordon Herz, a psychologist in private practice in Madison, Wisc. Not surprisingly, resentment can soon follow, Dr. Herz added, because it is hard to admit to anyone that, “‘this is too much for me.’”

What can outside caregivers — children or other loved ones — do about these golden marriages on the rocks? Should they intervene — or butt out? And can marital therapy help — or is it too late to change?

Share your thoughts and experiences — and on Tuesday we will try to provide some advice from experts.

Read More..