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Marques MJ. The quality of family relationships in dementia: Mixed methods to unravel mixed feelings. DEMENTIA 2024; 23:210-233. [PMID: 38100191 PMCID: PMC10807244 DOI: 10.1177/14713012231220759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Objective: Close relationships influence health and quality of life outcomes for people with dementia and their families. Yet, we know little on the role of different relationship domains with quantitative methods having proved to have limitations in this research field. We aimed to study these relationship domains over time, contrasting the views of people with dementia and their family carers, making use of both quantitative and qualitative approaches.Methods: A convergent mixed methods design was adopted, analysing longitudinal data (four time points over three years) from 66 dyads of Portuguese community-dwelling people with dementia and their primary carers, from the EU-Actifcare project sample. Quantitative assessments used sociodemographic and clinical variables, and Positive Affect Index scores, with descriptive and inferential analyses. Qualitative data, collected through individual and joint semi-structured interviews, were explored using thematic analysis.Results: Both quantitative and qualitative findings demonstrated that some domains of relationship quality are affected in different ways, with changes occurring at different stages. Some (e.g., 'communication') may even improve after initial decline. 'Closeness' was consistently altered over time, from carers' perspectives, and played an important protective role regarding institutionalisation. Overall, changes in the relationship quality were perceived differently by people with dementia and their carers, and these divergent perspectives often led to tension. Qualitative data revealed that 'mixed feelings' (ambivalence) involve complex experiences, arguably more difficult to manage than negative feelings alone. Furthermore, perceived informal support, particularly from the extended family, and receiving formal services' assistance, seemed to facilitate positive (re)appraisals of the relationship.Conclusions: A deeper understanding of relationship quality and its domains as dementia progresses may help tailoring interventions to tackle modifiable aspects of relationships, meeting the needs and cherishing the resources of dyads and families. Timely assessments could identify relationships at risk and need for support, including for alternative caring arrangements.
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Affiliation(s)
- Maria J. Marques
- Maria J. Marques, CHRC, NOVA Medical School, Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Campo Mártires da Pátria, 130, Lisbon 1169-056, Portugal.
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2
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Levenson RW. Two's company: Biobehavioral research with dyads. Biol Psychol 2024; 185:108719. [PMID: 37939868 DOI: 10.1016/j.biopsycho.2023.108719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/28/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
The development of paradigms for studying dyadic interaction in the laboratory and methods and analytics for dealing with dyadic data is described. These are illustrated with research findings from the author and others with particular focus on dyadic measures of linkage or synchrony in physiology, expressive behavior, and subjective affective experience.
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Engineer M, Kot S, Dixon E. Investigating the Readability and Linguistic, Psychological, and Emotional Characteristics of Digital Dementia Information Written in the English Language: Multitrait-Multimethod Text Analysis. JMIR Form Res 2023; 7:e48143. [PMID: 37878351 PMCID: PMC10632922 DOI: 10.2196/48143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Past research in the Western context found that people with dementia search for digital dementia information in peer-reviewed medical research articles, dementia advocacy and medical organizations, and blogs written by other people with dementia. This past work also demonstrated that people with dementia do not perceive English digital dementia information as emotionally or cognitively accessible. OBJECTIVE In this study, we sought to investigate the readability; linguistic, psychological, and emotional characteristics; and target audiences of digital dementia information. We conducted a textual analysis of 3 different types of text-based digital dementia information written in English: 300 medical articles, 35 websites, and 50 blogs. METHODS We assessed the text's readability using the Flesch Reading Ease and Flesch-Kincaid Grade Level measurements, as well as tone, analytical thinking, clout, authenticity, and word frequencies using a natural language processing tool, Linguistic Inquiry and Word Count Generator. We also conducted a thematic analysis to categorize the target audiences for each information source and used these categorizations for further statistical analysis. RESULTS The median Flesch-Kincaid Grade Level readability score and Flesch Reading Ease score for all types of information (N=1139) were 12.1 and 38.6, respectively, revealing that the readability scores of all 3 information types were higher than the minimum requirement. We found that medical articles had significantly (P=.05) higher word count and analytical thinking scores as well as significantly lower clout, authenticity, and emotional tone scores than websites and blogs. Further, blogs had significantly (P=.48) higher word count and authenticity scores but lower analytical scores than websites. Using thematic analysis, we found that most of the blogs (156/227, 68.7%) and web pages (399/612, 65.2%) were targeted at people with dementia. Website information targeted at a general audience had significantly lower readability scores. In addition, website information targeted at people with dementia had higher word count and lower emotional tone ratings. The information on websites targeted at caregivers had significantly higher clout and lower authenticity scores. CONCLUSIONS Our findings indicate that there is an abundance of digital dementia information written in English that is targeted at people with dementia, but this information is not readable by a general audience. This is problematic considering that people with <12 years of education are at a higher risk of developing dementia. Further, our findings demonstrate that digital dementia information written in English has a negative tone, which may be a contributing factor to the mental health crisis many people with dementia face after receiving a diagnosis. Therefore, we call for content creators to lower readability scores to make the information more accessible to a general audience and to focus their efforts on providing information in a way that does not perpetuate overly negative narratives of dementia.
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Affiliation(s)
- Margi Engineer
- Computer Science Department, Clemson University, Clemson, SC, United States
| | - Sushant Kot
- Computer Science Department, Clemson University, Clemson, SC, United States
| | - Emma Dixon
- Human Centered Computing Department, Clemson University, Clemson, SC, United States
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4
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Antoniou R, Toli DG, Lerner H, Callahan P, Coble R, Ortiz B, Sideman AB, Shdo SM, Levenson RW, Ferreira N, Moskowitz JT, Rankin KP. A mindfulness-based intervention adapted to dementia caregivers: A study protocol for a randomized clinical control trial. Front Psychol 2022; 13:1062452. [PMID: 36605275 PMCID: PMC9808397 DOI: 10.3389/fpsyg.2022.1062452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Dementia caregiving, besides encompassing various challenges in tandem to the diagnosis of the care recipient, is associated with decreased psychological well-being and mental health. Accordingly, caregivers' wellbeing has an impact on the quality of care they provide and on the relationship quality with the person in their care. The aim of the present study is to examine the effectiveness of a mindfulness-based intervention on relational and psychological wellbeing, tailored to the needs of dementia caregivers. This clinical trial (NCT04977245) will apply a randomized controlled mixed method design. Caregivers will be randomly allocated to either the mindfulness intervention or the active control group. The intervention arm is based on experiential learning and is targeted to promote caregivers' well-being and empowerment. Assessments will include, standardized self-report questionnaires, task performance measures, and qualitative measures. All assessments will be held at three time points (baseline; t0, 0 months, post-intervention; t1, 2 months, and after maintenance; t2, 3 months) focused on three core domains (1. relational well-being, 2. psychological well-being, and 3. dementia patient's lifestyle/activities). The primary outcome will be relational well-being, and data will be analyzed using linear mixed modelling.
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Affiliation(s)
- Rea Antoniou
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States,*Correspondence: Rea Antoniou,
| | - Despoina Georgakopoulou Toli
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Hannah Lerner
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Patrick Callahan
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Roger Coble
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Bailey Ortiz
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
| | - Alissa Bernstein Sideman
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States,Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, United States,Department of Humanities & Social Sciences, University of California San Francisco, San Francisco, CA, United States,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, United States
| | - Suzanne M. Shdo
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States,Department of Psychology, University of California Berkeley, Berkeley, CA, United States
| | - Robert W. Levenson
- Department of Psychology, University of California Berkeley, Berkeley, CA, United States
| | - Nuno Ferreira
- Department of Social Sciences, School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Judith T Moskowitz
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Katherine P. Rankin
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, United States
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5
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Abstract
OBJECTIVE Informal carers play an essential role in the care of individuals with Parkinson's disease (PD). This role, however, is often fraught with difficulties, including emotional, physical, and financial. Coping styles and relationship quality have been hypothesized to influence the impact of stressors. The aim of this study is to examine the relationship between carers' coping style, relationship quality, and carer burden. DESIGN Cross-sectional. PARTICIPANTS Thirty-nine PD patient carer dyads were included in the study. MEASUREMENTS Participants completed self-rated questionnaires including the Dyadic Adjustment Scale, Zarit Burden Interview, and Brief Coping Orientation to Problems Experienced Inventory. RESULTS Correlational analyses found significant and positive correlation between carer burden and all three coping styles (problem-focused, emotion-focused, and dysfunctional). There was also a moderate association between carers' perceived relationship quality and satisfaction and carer burden. Regression analyses found that carer's gender, severity of PD, relationship quality, emotion-focused, and dysfunctional coping styles did not predict carer burden. Conversely, problem-focused coping style predicted carer burden. CONCLUSION The results highlight that there is no perfect way to react and care for a loved one and serves as important information for practitioners who design and implement interventions.
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Bernstein Sideman A, Wells JL, Merrilees J, Shdo SM, Yee CI, Possin KL, Levenson RW. Pronoun Use among Caregivers of People Living with Dementia: Associations with Dementia Severity Using Text Analysis of a Natural Language Sample. Dement Geriatr Cogn Dis Extra 2022; 12:60-68. [PMID: 35702160 PMCID: PMC9149456 DOI: 10.1159/000522122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction Family caregivers of persons living with dementia (PLWDs) have extensive social, physical, emotional, and financial responsibilities. However, less is known about the relationship and interpersonal connection between caregivers and PLWDs. We examined caregiver pronoun use, as an index of the connection between the caregiver and PLWD and its associations with the caregiver's and PLWD's health and well-being. Methods Caregivers of PLWDs (N = 320) were asked to describe a recent time they felt connected to the PLWD in their care. Responses were transcribed and coded to quantify pronoun use by category (we-pronouns, I-pronouns, and they-pronouns). Caregivers also reported on their depression, burden, and the PLWD's dementia severity and marital satisfaction. Sixty-eight caregivers repeated the same survey 24 months after the initial survey. Results Caregivers used less we-pronouns when the PLWD's dementia was more severe, at both timepoints. Spousal caregivers used more we-pronouns and less I- and they-pronouns than nonspousal caregivers. There was an interaction between spousal relationship and dementia severity, such that spousal caregivers exhibited a stronger negative association between dementia severity and we-pronoun use. There were no associations between pronoun category and caregiver burden or depression. Discussion Caregivers may feel increasingly disconnected from the PLWD as their dementia becomes more severe, as reflected by less we-pronoun usage. This study highlights the opportunity to explore relationship connection through text analysis.
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Affiliation(s)
- Alissa Bernstein Sideman
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Department of Humanities & Social Sciences, University of California, San Francisco, California, USA
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
| | - Jenna L. Wells
- Department of Psychology, University of California, Berkeley, California, USA
| | - Jennifer Merrilees
- Department of Neurology, University of California, San Francisco, California, USA
| | - Suzanne M. Shdo
- Department of Psychology, University of California, Berkeley, California, USA
| | - Claire I. Yee
- Department of Psychology, University of California, Berkeley, California, USA
| | - Katherine L. Possin
- Global Brain Health Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Neurology, University of California, San Francisco, California, USA
| | - Robert W. Levenson
- Department of Psychology, University of California, Berkeley, California, USA
- *Robert W. Levenson,
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7
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Hsieh CJ, Yin PF, Chiu CY, Hsiao YP, Hsiao YL. Support and Empowerment for Older Adult Spousal Caregiving of People with Mild and Moderate Dementia: A Participatory Action Research. Healthcare (Basel) 2022; 10:healthcare10030569. [PMID: 35327047 PMCID: PMC8956025 DOI: 10.3390/healthcare10030569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Little attention has been given to the older adult caregivers of spouses with mild and moderate dementia in the caring dynamics process. The aim of this action research was to develop a program for providing support and empowerment to older adult caregivers of spouses with mild and moderate dementia in the community. Methods: The researchers acted as facilitators, with a view to empowering participants. We recruited participants from a day-care center and two community service stations. Data were collected with semi-structured, in-depth interviews with 19 dementia care dyads and from the notes, reflections, and feedback of collaborative researchers. Relevant themes for content analysis were extracted. Results: Three action cycles were completed over 18 months. The results revealed goals of three cycles: to connect the home situation and effective dialogue as a bridge to the researcher, to confirm the daily needs or expectations of the caregiver and the patient, and to enhance the interactions and quality of life of family members with resources and network. This process was cyclical and repetitive, and it also generated partnerships that built relationships among the interdisciplinary team, families, and researchers. At the same time, team workers formed a cooperative and coordinated family service mechanism to reflect the professional values and practice capabilities. Conclusions: The intervention program was based on the promotion of factors for the caregiver, linking to environmental protective factors, and the stabilization of mental and neurological symptoms of dementia patients, thereby enhancing the response capabilities of home caregivers while meeting the patient’s care needs in life. It is a tool that can effectively be used for support and empowerment in this population.
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Affiliation(s)
- Chia-Jung Hsieh
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112303, Taiwan
- Correspondence: ; Tel.: +886-2-2822-7101-3135; Fax: +886-2-28206729
| | - Pei-Fang Yin
- Department of Long-Term Care, Camillian Saint Mary’s Hospital, Yilan 265502, Taiwan;
| | - Chi-Yi Chiu
- Lezhi Home-Based Long-Term Care Institution, New Taipei City 220043, Taiwan;
| | - Yu-Ping Hsiao
- Yue Xin Day-Care Center for Dementia and Child Development, Assessment and Intervention Center, New Taipei City 242033, Taiwan;
| | - Yu-Ling Hsiao
- Center of Geriatric Care Resource, Fu Jen Catholic University, New Taipei City 242062, Taiwan;
- Department of Nursing, College of Medicine, Fu Jen Catholic University, New Taipei City 242062, Taiwan
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Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is the second-most common cause of young-onset dementia. Personality and behavior changes lead to high caregiver stress and burden, but little support is available. Our aim is to present the evidence on the characteristics, challenges and unmet needs of caregivers as well as on possible interventions. METHODS We conducted a scoping review on caregiver burden using PubMed, Web of Science and ScienceDirect. A total of 69 articles were considered eligible and were analyzed in the present study. RESULTS Through the analysis of 69 empirical articles, our results show that caregivers of patients with FTLD are often younger in age, have children and find behavioral disturbances to be the most burdensome. Nine studies assessed the needs of and support for caregivers. Ten studies compared the burden in different forms of FTLD, 19 compared FTLD to other types of dementia, and one compared the caregiver burden between two countries. Eight studies reported on interventions for caregivers or interventions taking burden into account. One study assessed the support structure for caregivers of FTLD patients. Five case reports, eight research overviews and three reviews addressed specific needs and challenges. CONCLUSIONS Further research should reproduce and validate efficacious interventions and focus on underage children of FTLD patients and findings from non-Western countries. Additionally, support structures for FTLD caregivers should be assessed and extended. Awareness both in the wider population and among healthcare professionals is an urgent need for the future.
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9
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Wolff JL, Benge JF, Cassel CK, Monin JK, Reuben DB. Emerging topics in dementia care and services. J Am Geriatr Soc 2021; 69:1763-1773. [PMID: 34245585 DOI: 10.1111/jgs.17341] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND The National Institute on Aging (NIA), in conjunction with the Department of Health and Human Services as part of the National Alzheimer's Project Act (NAPA), convened a 2020 Dementia Care, Caregiving, and Services Research Summit Virtual Meeting Series. This review article summarizes three areas of emerging science that are likely to grow in importance given advances in measurement, technologies, and diagnostic tests that were presented at the Summit. RESULTS Dr. Cassel discussed novel ethical considerations that have resulted from scientific advances that have enabled early diagnosis of pre-clinical dementia. Dr. Monin then summarized issues regarding emotional experiences in persons with dementia and their caregivers and care partners, including the protective impact of positive emotion and heterogeneity of differences in emotion by dementia type and individual characteristics that affect emotional processes with disease progression. Finally, Dr. Jared Benge provided an overview of the role of technologies in buffering the impact of cognitive change on real-world functioning and their utility in safety and monitoring of function and treatment adherence, facilitating communication and transportation, and increasing access to specialists in underserved or remote areas. CONCLUSIONS National policy initiatives, supported by strong advocacy and increased federal investments, have accelerated the pace of scientific inquiry and innovation related to dementia care and services but have raised some new concerns regarding ethics, disparities, and attending to individual needs, capabilities, and preferences.
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Affiliation(s)
- Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jared F Benge
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, Texas, USA
| | - Christine K Cassel
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - David B Reuben
- Department of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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Happich F, König H, Hajek A. Spousal care and its effect on partnership characteristics – a longitudinal analysis of spousal caregiving and care receipt in Germany. Scand J Caring Sci 2021; 36:109-119. [DOI: 10.1111/scs.12968] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/22/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Fiona Happich
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - Hans‐Helmut König
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
| | - André Hajek
- Department of Health Economics and Health Services Research University Medical Center Hamburg‐Eppendorf Hamburg Germany
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11
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Gallagher EA, Stokes JE. Cognitive Functioning, Gender, and Marital Quality Among Older Married Couples: A Dyadic Approach. J Women Aging 2021; 33:137-152. [PMID: 33385305 DOI: 10.1080/08952841.2020.1852859] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This study examines associations of older husbands' and wives' cognitive functioning with both partners' marital quality. Generalized structural equation modeling analyzed data from 1,432 opposite-sex couples drawn from the 2016 wave of the Health and Retirement Study. Findings revealed that wives' poorer cognitive functioning was associated with wives reporting greater closeness and enjoyment of time with a spouse, whereas husbands' poorer cognitive functioning was associated with wives reporting greater marital strain, lower marital support, lower closeness, and less enjoyment of time with a spouse. This suggests that cognitive functioning has dyadic consequences for marital quality, which are highly gendered.
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Affiliation(s)
- Elizabeth A Gallagher
- Department of Gerontology, McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Jeffrey E Stokes
- Department of Gerontology, McCormack Graduate School of Policy & Global Studies, University of Massachusetts Boston, Boston, Massachusetts, USA
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12
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Abstract
Family members are the primary source of support for older adults with chronic illness and disability. Thousands of published empirical studies and dozens of reviews have documented the psychological and physical health effects of caregiving, identified caregivers at risk for adverse outcomes, and evaluated a wide range of intervention strategies to support caregivers. Caregiving as chronic stress exposure is the conceptual driver for much of this research. We review and synthesize the literature on the impact of caregiving and intervention strategies for supporting caregivers. The impact of caregiving is highly variable, driven largely by the intensity of care provided and the suffering of the care recipient. The intervention literature is littered with many failures and some successes. Successful interventions address both the pragmatics of care and the emotional toll of caregiving. We conclude with both research and policy recommendations that address a national agenda for caregiving.
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Affiliation(s)
- Richard Schulz
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA; .,University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Scott R Beach
- University Center for Social and Urban Research, University of Pittsburgh, Pittsburgh, Pennsylvania 15260, USA
| | - Sara J Czaja
- Center on Aging and Behavioral Research, Weill Cornell Medicine, Cornell University, New York, NY 10065, USA
| | - Lynn M Martire
- College of Health and Human Development, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - Joan K Monin
- School of Public Health, Yale University, New Haven, Connecticut 06520, USA
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13
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Wang J, Corazzini KN, McConnell ES, Ding D, Xu H, Wei S, Wu B. Living With Cognitive Impairment in China: Exploring Dyadic Experiences Through a Person-Centered Care Lens. Res Aging 2020; 43:177-187. [PMID: 32677553 DOI: 10.1177/0164027520935597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
China has experienced a substantial increase in the number of older adults with dementia and milder forms of cognitive impairment. Being spouses of Persons with cognitive impairment (PWCI) and living with them for several decades does not necessarily mean that it is easier for them to provide person-centered care and maintain a valued and healthy relationship. The current study explored how elements of PCC, as operationalized by the Senses Framework, operate or fail to operate in the dyadic experiences of PWCI and their spousal care partners within the socio-cultural context of China. Our findings suggest that PWCI and their spouses experience the six senses through the person-centeredness in their daily interactions with each other. It also indicated successes and challenges to being person-centered early in the disease and identified their unmet needs as well as barriers and facilitators to improve their well-being.
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Affiliation(s)
- Jing Wang
- 3065Fudan University, China.,3065Duke University School of Nursing, USA
| | | | - Eleanor S McConnell
- 3065Duke University School of Nursing, USA.,Department of Veterans Affairs, Geriatric Research, Education and Clinical Center (GRECC), Durham, North Carolina, USA
| | - Ding Ding
- Institute of Neurology, 159397Huashan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | - Hanzhang Xu
- 3065Duke University School of Nursing, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, North Carolina, USA
| | - Sijia Wei
- 3065Duke University School of Nursing, USA
| | - Bei Wu
- Rory Meyers College of Nursing, 5894New York University, NY, USA.,NYU Aging Incubator, New York, NY, USA
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14
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Abstract
BACKGROUND Behavioral variant frontotemporal dementia (bvFTD) is characterized by marked deficits in empathy and social behavior; however, the effect of these symptoms on partner relationships has not been quantitatively measured. OBJECTIVE We aimed to determine the effect of empathy loss and behavioral symptoms on partner and familial relationship status in bvFTD. We ascertained whether patients were currently in marriage/partner relationships or were separated/divorced, the timing and duration of these relationships, and whether the patients had relationship infidelity. We investigated the relationship status of 483 patients (156 with bvFTD, 38 with nonfluent variant primary progressive aphasia, 72 with semantic variant primary progressive aphasia, 49 with corticobasal syndrome, 45 with progressive supranuclear palsy syndrome, and 123 with Alzheimer disease) over the course of follow-up, and correlated relationship status with patients' first visit Interpersonal Reactivity Index and Neuropsychiatric Inventory. RESULTS Relationship dissolution and infidelity were significantly more frequent among patients with bvFTD than in the other groups. Across all patients, empathy loss was associated with relationship dissolution. In the bvFTD group, patients who experienced relationship dissolution or infidelity had significantly lower empathy than those who did not. CONCLUSIONS Changes in relationship status differed across dementia groups and were associated with empathy decline.
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15
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Lwi SJ, Casey JJ, Verstaen A, Connelly DE, Merrilees J, Levenson RW. Genuine Smiles by Patients During Marital Interactions are Associated with Better Caregiver Mental Health. J Gerontol B Psychol Sci Soc Sci 2020; 74:975-987. [PMID: 29385515 DOI: 10.1093/geronb/gbx157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/08/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Providing care for a spouse with dementia is associated with an increased risk for poor mental health. To determine whether this vulnerability in caregivers is related to the expression of positive emotion, we examined 57 patients with Alzheimer's disease and behavioral variant frontotemporal dementia and their spouses as they discussed a marital conflict. METHOD Facial behavior during the discussion was objectively coded to identify Duchenne (i.e., genuine) smiles and non-Duchenne (i.e., polite) smiles. Caregiver mental health was measured using the Medical Outcomes Survey. RESULTS Greater expression of Duchenne smiles by patients was associated with better caregiver mental health, even when accounting for covariates (i.e., diagnosis, patient cognitive functioning, and caregiver marital satisfaction). Greater expression of non-Duchenne smiles by patients was associated with worse caregiver health, but only when covariates were entered in the model. Expression of Duchenne and non-Duchenne smiles by caregivers was not associated with caregiver mental health. DISCUSSION Patients' expression of Duchenne and non-Duchenne smiles may reveal important aspects of the emotional quality of the patient-caregiver relationship that influence caregiver burden and mental health.
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Affiliation(s)
- Sandy J Lwi
- Department of Psychology, University of California, Berkeley
| | - James J Casey
- Department of Psychology, University of California, Berkeley
| | - Alice Verstaen
- Department of Psychology, University of California, Berkeley
| | - Dyan E Connelly
- Department of Psychology, University of California, Berkeley
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Connelly DE, Verstaen A, Brown CL, Lwi SJ, Levenson RW. Pronoun Use during Patient-Caregiver Interactions: Associations with Caregiver Well-Being. Dement Geriatr Cogn Disord 2020; 49:202-209. [PMID: 32610328 PMCID: PMC7805608 DOI: 10.1159/000508095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/22/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Caring for a spouse with dementia can be extremely challenging. Many caregivers experience profound declines in well-being; however, others remain healthy. OBJECTIVE This study determined whether the personal pronouns used in interactions between persons with dementia (PWDs) and their spousal caregivers were associated with caregiver well-being. METHODS Fifty-eight PWDs and their spousal caregivers engaged in a 10-min conversation about an area of disagreement in a laboratory setting. Verbatim transcripts of the conversation were coded using text analysis software, and caregivers and PWDs each received scores for (a) I-pronouns, (b) you-pronouns, and (c) we-pronouns. Caregivers' well-being was assessed using a composite measure of depression, anxiety, burden, and strain. RESULTS Results revealed that less use of we-pronouns by caregivers and PWDs and greater use of I-pronouns by PWDs were -associated with lower caregiver well-being. CONCLUSIONS These findings indicate that less use of pronouns that refer to the couple (we-pronouns used by either partner) and greater use of pronouns that refer to the PWD (I-pronouns used by the PWD) are indicative of caregivers at heightened risk for lower well-being.
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Affiliation(s)
- Dyan E. Connelly
- Department of Psychology, University of California, Berkeley, CA US
| | - Alice Verstaen
- VA Puget Sound Healthcare System, Seattle Division, Seattle, WA US
| | - Casey L. Brown
- Department of Psychology, University of California, Berkeley, CA US
| | - Sandy J. Lwi
- VA Northern California Health Care System, Martinez, CA US
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Monin JK, Levy B, Doyle M, Schulz R, Kershaw T. The impact of both spousal caregivers' and care recipients' health on relationship satisfaction in the Caregiver Health Effects Study. J Health Psychol 2019; 24:1744-1755. [PMID: 28810439 PMCID: PMC5786494 DOI: 10.1177/1359105317699682] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This study examined, with a sample of older adult, caregiving couples, whether each spouse's health was associated with their own and their partner's relationship satisfaction. Dyads (n = 233; age = 64-99 years) in the Caregiver Health Effects Study, ancillary to the Cardiovascular Health Study, reported relationship satisfaction, depressive symptoms, disability, and self-reported health. The cross-sectional Actor-Partner Interdependence Model showed that for both caregivers and care recipients, greater depressive symptoms and lower self-reported health related to lower relationship satisfaction (actor effects). Caregivers had lower relationship satisfaction when they were more disabled (actor effect) and when care recipients were more depressed (partner effect).
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Hua AY, Wells JL, Haase CM, Chen KH, Rosen HJ, Miller BL, Levenson RW. Evaluating Patient Brain and Behavior Pathways to Caregiver Health in Neurodegenerative Diseases. Dement Geriatr Cogn Disord 2019; 47:42-54. [PMID: 30630168 PMCID: PMC6568322 DOI: 10.1159/000495345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/12/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Caregivers of patients with neurodegenerative diseases are at heightened risk for serious health problems, but health differences between individual caregivers abound. AIMS To determine whether atrophy in patient brains could be used to identify caregivers at heightened risk for health problems and which patient variables mediate this relationship. METHODS In 162 patient-caregiver dyads, we assessed patient atrophy using structural MRI, caregiver health, and patient behavior and cognitive symptoms. RESULTS Patient atrophy in the right insula and medial frontal gyrus was associated with worse caregiver health; this relationship was partially mediated by patient neuropsychiatric symptoms, and assessing atrophy in these regions improved predictions of poor caregiver health above and beyond patient behavioral symptoms. CONCLUSIONS This study shows the value of patients' brain data in identifying caregivers at risk for becoming sick themselves.
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Affiliation(s)
- Alice Y. Hua
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Jenna L. Wells
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Claudia M. Haase
- School of Education and Social Policy, Northwestern University, Evanston, IL, USA
| | - Kuan-Hua Chen
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
| | - Howard J. Rosen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Robert W. Levenson
- Department of Psychology, University of California, Berkeley, Berkeley, CA, USA
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Rasmussen H, Hellzen O, Stordal E, Enmarker I. Family caregivers experiences of the pre-diagnostic stage in frontotemporal dementia. Geriatr Nurs 2018; 40:246-251. [PMID: 30424902 DOI: 10.1016/j.gerinurse.2018.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/12/2018] [Accepted: 10/19/2018] [Indexed: 12/17/2022]
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disease with symptoms that differs from other dementias. Commonly early symptoms in FTD are changes in personality and behavior, which can be interpreted as psychiatric disease. The delay in FTD diagnosis contributes to the burden of family caregivers. Therefore, it is important to have more knowledge about the pre-diagnostic stage. In this qualitative interview study, we explored fourteen family caregiver's experiences of the pre-diagnostic stage of frontotemporal dementia (FTD). Our findings suggest that the family caregivers experienced the pre-diagnostic stage of FTD as changes in the interpersonal relationship with their loved one. These changes were often subtle and difficult for family caregivers to explain to others. The findings from our study illuminate the importance of medical staff paying attention when a next of kin is concerned about subtle changes in a loved one. The findings also illuminate that awareness of FTD should be raised.
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Affiliation(s)
- Hege Rasmussen
- Clinic for Mental Health and Substance Abuse, Nord-Trndelag Hospital Trust, Namsos Hospital, Norway; Department of Mental Health, Norwegian University of Science and Technology, Norway.
| | - Ove Hellzen
- Department of Nursing Scienses, Mid Sweden University, Sundsvall, Sweden
| | - Eystein Stordal
- Clinic for Mental Health and Substance Abuse, Nord-Trndelag Hospital Trust, Namsos Hospital, Norway; Department of Mental Health, Norwegian University of Science and Technology, Norway
| | - Ingela Enmarker
- Faculty of Health and Occupational Studies, University of Gvle, Sweden
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Abstract
UNLABELLED ABSTRACTBackground:The care of community-dwelling people with dementia often occurs in the context of pre-existing family relationships. The presence of dementia can result in changes to the quality of those relationships. The purpose of this systematic review is to identify factors that enhance or challenge the quality of spousal or offspring relationships in the context of dementia. METHODS Both qualitative and quantitative studies were included in a systematic review of the literature. Thematic analysis of results was conducted that examined factors related to the relationship quality of community dwelling people with dementia and their spousal or offspring carer. Meta-analysis was not possible due to the heterogeneity of the included studies. RESULTS Four themes were extracted from seven qualitative studies: connection to the carer role; identity of the people with dementia; current efforts to maintain relationship connection; and the dyads response to dementia. Each of these four themes incorporated positive and negative facets that impacted on relationship quality. An analysis of nine quantitative and one mixed methods studies identified four domains: influence of dementia characteristics; connection within the dyad; relationship response to stress and carer burden; and carer demographic factors. CONCLUSIONS The findings of this review highlight relationship factors that are important for supporting relationship quality for the people with dementia and the carer individually, as well as for the dyad together. These findings extend an existing framework of relationship quality in dementia. Implications for interventions to enhance relationship quality in the dementia context are discussed.
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Halpin SN, Dillard RL, Puentes WJ. Socio-Emotional Adaptation Theory: Charting the Emotional Process of Alzheimer's Disease. THE GERONTOLOGIST 2018; 57:696-706. [PMID: 27048704 DOI: 10.1093/geront/gnw046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 11/21/2015] [Indexed: 11/13/2022] Open
Abstract
Purpose of the Study The emotional reactions to the progression of Mild Cognitive Impairment and Alzheimer's disease (MCI/AD) oftentimes present as cognitive or behavioral changes, leading to misguided interventions by Formal Support (paid health care providers). Despite a rich body of literature identifying cognitive and behavioral staging of MCI/AD, the emotional changes that accompany these diagnoses have been largely ignored. The objective of this study was to develop a model of the emotional aspects of MCI/AD. Design and Methods One hour, semistructured interviews, with 14 patient-Informal Support Partner dyads (N = 28) interviewed concurrently; patients were in various stages of MCI/AD. An interdisciplinary team employed a grounded theory coding process to detect emotional characteristics of the participants with MCI/AD. Results Emotional reactions were categorized into depression/sadness, apathy, concern/fear, anger/frustration, and acceptance. The emotions did not present linearly along the course of the disease and were instead entwined within a set of complex (positive/negative) interactions including: relationship with the Informal Support Partner (i.e., teamwork vs infantilization), relationship with the Formal Support (i.e., patient vs disengaged), coping (i.e., adaptive vs nonadaptive), and perceived control (i.e., internal vs external locus-of-control). For example, a person with poor formal and informal support and external locus-of-control may become depressed, a condition that is known to negatively affect cognitive status. Implications Understanding the emotional reactions of individuals diagnosed with MCI/AD will provide clinicians with information needed to develop treatments suited to current needs of the patient and provide Informal Support Partners insight into cognitive and physical changes associated with MCI/AD.
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Affiliation(s)
- Sean N Halpin
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Rebecca L Dillard
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Emory University School of Medicine, Atlanta, Georgia
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22
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Williams CL, Newman D, Hammar LM. Preliminary study of a communication intervention for family caregivers and spouses with dementia. Int J Geriatr Psychiatry 2018; 33:e343-e349. [PMID: 29105129 DOI: 10.1002/gps.4816] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 09/13/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study was to designed to examine the feasibility and preliminary outcomes of CARE: Caring About Relationships and Emotions, a 10-week, home-based, intervention to support married couples affected by dementia. METHODS Fifteen older couples participated in a single group repeated measures feasibility study. Weekly, video-recorded conversations over 10 weeks were used to rate communication using the Verbal/Nonverbal Interaction Scale for caregivers and care receivers. RESULTS Accounting for mental status of care recipients, the ratio of social to unsocial communication showed a significant improvement across sessions-an average of 4.46 points per session [β = 4.46, t(10) = 1.96, p = .039]. Spouse caregiver (CG) communication showed a significant decrease in the number of disabling communications with approximately .65 decreased comments per session [β = 0.654, t(11) = -2.61, p = .024]. CONCLUSIONS At home dyadic, relationship-focused psychoeducational intervention to improve communication in spouses affected by dementia has the potential to improve communication outcomes. Creative ways of working with couples are needed to help them sustain their relationships and maintain their health.
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Affiliation(s)
| | - David Newman
- College of Nursing, Florida Atlantic University, Boca Raton, FL, USA
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23
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The impact of younger-onset dementia on relationships, intimacy, and sexuality in midlife couples: a systematic review. Int Psychogeriatr 2018; 30:15-29. [PMID: 28927483 DOI: 10.1017/s1041610217001806] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of dementia on relationships, intimacy, and sexuality has been documented in later life couples. However, little is known about the experiences of couples living with younger-onset dementia. The aim of this systematic review was to analyze the literature describing the impact of younger-onset dementia on relationships, intimacy, and sexuality in midlife couples. METHODS A systematic literature search was conducted in July 2016 for relevant research papers. Five databases were searched: Web of Science, PsycINFO, MedLine, Scopus, and CINAHL. A quality appraisal checklist was used to assess the methodological quality of included studies. RESULTS Eleven studies were identified that explored relationships, intimacy, and sexuality from the perspective of the spouse, the person with dementia or both members of the dyad. Several themes were identified including shifts in roles and responsibilities, declines in relationship quality, changes in identity, and self-esteem, increasing social isolation and loneliness, shifts in intimacy, and changes in sexual activity. CONCLUSIONS Many of the reviewed studies were subject to a range of methodological issues including small sample sizes, small number of studies, and a reliance on the perspective of only one member of the dyad. Future research should follow couples longitudinally to gain a clearer picture of the impact of younger-onset dementia on the couple relationship over time. The inclusion of people living with younger-onset dementia in research will assist in developing a deeper understanding of the experiences of the individual and dyad.
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Merrilees J. The Impact of Dementia on Family Caregivers: What Is Research Teaching Us? Curr Neurol Neurosci Rep 2017; 16:88. [PMID: 27541750 DOI: 10.1007/s11910-016-0692-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dementia family caregiving has been the focus of research for decades. Much has been learned about the negative impact of caregiving as well as characteristics that may be protective. This paper explores themes in caregiving pertinent to clinicians and researchers working with dementia family caregivers: the psychological, subjective, and physical outcomes of caregiving, ways in which dementia alters relationships between the patient and caregiver, and strategies for improving outcomes for caregivers. Suggestions for next steps in research and clinical care are made.
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Affiliation(s)
- Jennifer Merrilees
- UCSF Department of Neurology, Memory and Aging Center, 675 Nelson Rising Lane, Suite 190, San Francisco, CA, 94158-1207, USA.
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25
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Autio T, Rissanen S. Positive emotions in caring for a spouse: a literature review. Scand J Caring Sci 2017; 32:45-55. [PMID: 28543793 DOI: 10.1111/scs.12452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 01/31/2017] [Indexed: 11/28/2022]
Abstract
This article aimed at identifying the positive emotions connected to spouse caregiving and the advantages for spouse carers. Theoretically, the article is based on the concept of emotion and the assumptions of positive psychology. Data search is conducted via electronic literature databases and the analysis method is partly theory-driven and partly inductive content classification. Our analyses discover and clarify the concepts associated with positive emotions in caring, such as the gains of caregiving, benefit-finding, finding meaning, personal growth, post-traumatic growth and resilience. We also utilise a conceptual framework to describe positive emotions in caregiving, and the identified advantages of positive emotions in spouse caregiving include distress buffering, mediation in coping with stress, increased quality of life and well-being, and finding a sense of purpose. Finally, spouse care is seen in this article as a challenging life situation which at best can support personal growth, if the processing of both positive and negative emotions is included in daily life. Hence, the service and support system should be developed further by utilising the findings of positive psychology as well as studies of personal growth.
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Affiliation(s)
- Tiina Autio
- Socca - The Centre of Excellence on Social Welfare in the Helsinki Metropolitan Area, Helsinki, Finland
| | - Sari Rissanen
- Department of Social Sciences, University of Eastern Finland, Kuopio, Finland
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26
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Otero MC, Levenson RW. Lower Visual Avoidance in Dementia Patients Is Associated with Greater Psychological Distress in Caregivers. Dement Geriatr Cogn Disord 2017; 43:247-258. [PMID: 28395276 PMCID: PMC5496766 DOI: 10.1159/000468146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 02/28/2017] [Indexed: 11/19/2022] Open
Abstract
Caring for a spouse with dementia can lead to increased health problems in caregivers. The present study examined whether patient deficits in visual avoidance, a common form of emotion regulation, are related to greater psychological distress in caregivers. Participants were 43 Alzheimer disease (AD) patients, 43 behavioral variant frontotemporal dementia (bvFTD) patients, and their spousal caregivers. Patient visual avoidance (e.g., gaze aversion) was measured using behavioral coding of head, body, and eye position while viewing a disgusting film. Caregiver psychological distress was measured using a standard self-report symptom inventory. Lower use of visual avoidance by patients was associated with greater psychological distress in their caregivers. This relationship was partially mediated by patient overall emotional functioning (as reported by caregivers), such that patients with less visual avoidance were seen as having worse emotional functioning, which in turn related to greater caregiver psychological distress. Dementia diagnosis moderated this effect, with diminished patient visual avoidance particularly detrimental to psychological distress of bvFTD caregivers. Findings suggest that the use of visual avoidance may serve as a marker of overall emotional functioning in patients and that preservation of this emotion regulatory behavior may help reduce the negative effects of caregiving.
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Affiliation(s)
- Marcela C Otero
- Institute of Personality and Social Research, University of California, Berkeley, CA, USA
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27
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Goodkind MS, Sturm VE, Ascher EA, Shdo SM, Miller BL, Rankin KP, Levenson RW. Emotion recognition in frontotemporal dementia and Alzheimer's disease: A new film-based assessment. ACTA ACUST UNITED AC 2015; 15:416-27. [PMID: 26010574 DOI: 10.1037/a0039261] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Deficits in recognizing others' emotions are reported in many psychiatric and neurological disorders, including autism, schizophrenia, behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD). Most previous emotion recognition studies have required participants to identify emotional expressions in photographs. This type of assessment differs from real-world emotion recognition in important ways: Images are static rather than dynamic, include only 1 modality of emotional information (i.e., visual information), and are presented absent a social context. Additionally, existing emotion recognition batteries typically include multiple negative emotions, but only 1 positive emotion (i.e., happiness) and no self-conscious emotions (e.g., embarrassment). We present initial results using a new task for assessing emotion recognition that was developed to address these limitations. In this task, respondents view a series of short film clips and are asked to identify the main characters' emotions. The task assesses multiple negative, positive, and self-conscious emotions based on information that is multimodal, dynamic, and socially embedded. We evaluate this approach in a sample of patients with bvFTD, AD, and normal controls. Results indicate that patients with bvFTD have emotion recognition deficits in all 3 categories of emotion compared to the other groups. These deficits were especially pronounced for negative and self-conscious emotions. Emotion recognition in this sample of patients with AD was indistinguishable from controls. These findings underscore the utility of this approach to assessing emotion recognition and suggest that previous findings that recognition of positive emotion was preserved in dementia patients may have resulted from the limited sampling of positive emotion in traditional tests.
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Affiliation(s)
- Madeleine S Goodkind
- Mental Illness Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System
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28
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Painter JM, Kring AM. Back to the Future: Similarities and Differences in Emotional Memories and Prospections. APPLIED COGNITIVE PSYCHOLOGY 2014. [DOI: 10.1002/acp.3105] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Ann M. Kring
- Department of Psychology; University of California; Berkeley USA
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29
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Hsieh S, Irish M, Daveson N, Hodges JR, Piguet O. When one loses empathy: its effect on carers of patients with dementia. J Geriatr Psychiatry Neurol 2013; 26:174-84. [PMID: 23857888 DOI: 10.1177/0891988713495448] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The effects of empathy loss in frontotemporal dementia (FTD) and Alzheimer disease (AD) on carer symptomatology were investigated. Carers of patients with 2 clinical subtypes of FTD (behavioral-variant FTD [bvFTD] = 18; semantic dementia [SD] = 14) and AD (n = 18) completed the Interpersonal Reactivity Index (IRI), a standardized questionnaire of empathy as well as a measure of perceived burden (Zarit Burden Interview) and the quality of the marital relationship (Intimate Bond Measure). Patient ratings were also obtained on the IRI. Loss of empathy was most striking in the bvFTD group with a marked discrepancy observed between carer and patient ratings for change in emotional warmth and the ability to take the perspective of others. Empathy loss in bvFTD was associated with a loss of a caring marital relationship. Empathic deficits in SD were milder by comparison to bvFTD and correlated with disease severity and increased perceived carer burden. The behavioral pattern observed in AD differed from the FTD syndromes; deficits were observed only for measures of personal distress with carers reporting that patients were less able to handle emotionally evocative situations. Results highlight that changes in aspects of empathy differ across dementia syndromes and are associated with differing carer and clinical variables. These findings might be explained by the progression of atrophy in regions that are known to be critical for empathy and social behavior and has implications for the delivery and planning of services in dementia.
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Affiliation(s)
- Sharpley Hsieh
- Neuroscience Research Australia, Hospital Road, Randwick, Australia
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30
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Kumfor F, Piguet O. Emotion recognition in the dementias: brain correlates and patient implications. Neurodegener Dis Manag 2013. [DOI: 10.2217/nmt.13.16] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Changes in behavior, personality and the ability to interact in social situations have been reported to varying extents across dementia syndromes. Deficits in the ability to recognize emotion in others probably contribute to these socioemotional changes. This article reviews the patterns of emotion recognition impairments and their underlying brain correlates in four dementia syndromes: Alzheimer’s disease; frontotemporal dementia; Huntington’s disease; and progressive supranuclear palsy. Despite emotion recognition deficits being observed in all these patient groups, a limited understanding exists on how these deficits translate into everyday behavior. The adoption of ecologically valid tasks is likely to improve our understanding of these deficits in everyday settings, and will help to provide guidance for management strategies for patients and their carers.
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Affiliation(s)
- Fiona Kumfor
- Neuroscience Research Australia, PO Box 1165, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Australian Research Council Centre of Excellence in Cognition & its Disorders, University of New South Wales, Sydney, Australia
| | - Olivier Piguet
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- Australian Research Council Centre of Excellence in Cognition & its Disorders, University of New South Wales, Sydney, Australia
- Neuroscience Research Australia, PO Box 1165, Randwick, New South Wales, Australia.
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31
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Oyebode JR, Bradley P, Allen JL. Relatives' experiences of frontal-variant frontotemporal dementia. QUALITATIVE HEALTH RESEARCH 2013; 23:156-166. [PMID: 23150527 DOI: 10.1177/1049732312466294] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In this article we address how relatives of people with frontal-variant frontotemporal dementia (fvFTD) experience the illness and how it impacts their lives. We interviewed 6 participants and carried out interpretative phenomenological analysis. We report on 11 themes that reflect distinctive challenges. Five themes relate to witnessing bizarre and strange changes: changed appetites and drives, loss of planning ability, loss of inhibition leading to social embarrassment, risky behavior, and communication problems. Four relate to managing these changes and two to the impact on the person and his or her relationships. Relatives must live with unusual changes in the person with fvFTD and the stigma this carries in social settings. They learn to act assertively for their relatives and put effort into promoting quality of life, using strategies adapted for fvFTD. Relatives grieve the loss of the person with fvFTD and their mutual relationship, but nonetheless find sources of solace and hope.
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Affiliation(s)
- Jan R Oyebode
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, United Kingdom.
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32
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Caregivers of patients with frontotemporal lobar degeneration: a review of burden, problems, needs, and interventions. Int Psychogeriatr 2012; 24:1368-86. [PMID: 22717212 DOI: 10.1017/s104161021200035x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) is a relatively rare disease compared to Alzheimer' disease (AD), but nevertheless causes higher burden and stress to caregivers. Only little is known about the problems and needs of the caregivers of patients with FTLD. Such information is crucial for the development of caregiver support interventions. The aim of the current study is to systematically review publications on (1) burden, problems, and needs of FTLD caregivers, and (2) the feasibility and efficacy of caregiver interventions in FTLD. METHODS A systematic review was conducted. Medical, psychological, and social sciences databases were searched for publications on burden, problems, needs of FTLD caregivers, and support interventions. RESULTS Very little published data are available on burden, problems, and needs of FTLD caregivers. Burden among FTLD caregivers is higher than among AD caregivers and correlated with neuropsychiatric symptoms. Specific problems include delayed diagnosis, young age of patients, behavioral disturbances, lack of information and suitable care facilities, caregivers' depression, social isolation, and neglect of personal needs. Hardly any literature is available on the actual needs of FTLD caregivers. Regarding interventions for caregivers, no randomized controlled trials exist. Eight publications could be identified that provide narrative reports on structured caregiver support groups or respite care in combination with caregiver support intervention or advanced practice nursing. CONCLUSION More research and funding are needed to elucidate the complex construct of burden of FTLD caregivers to identify and quantify their problems and needs in order to develop helpful interventions and services.
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Sturm VE, McCarthy ME, Yun I, Madan A, Yuan JW, Holley SR, Ascher EA, Boxer AL, Miller BL, Levenson RW. Mutual gaze in Alzheimer's disease, frontotemporal and semantic dementia couples. Soc Cogn Affect Neurosci 2010; 6:359-67. [PMID: 20587598 DOI: 10.1093/scan/nsq055] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Alzheimer's disease (AD), frontotemporal dementia (FTD) and semantic dementia (SD) are neurodegenerative diseases that differ in their socioemotional presentations. Mutual gaze (i.e. when two individuals make eye contact) is a building block of social behavior that may be differentially affected by these diseases. We studied 13 AD patients, 11 FTD patients, 9 SD patients and 22 normal controls as they engaged in conversations with partners about relationship conflicts. Physiological reactivity was monitored during the conversations and trained raters coded mutual gaze from videotaped recordings. Results indicated that mutual gaze was preserved in AD couples. Mutual gaze was diminished in FTD couples while SD couples showed evidence of greater mutual gaze. SD couples also showed lower physiological reactivity compared to controls. Across patient groups, reduced mutual gaze was associated with greater behavioral disturbance as measured by the Neuropsychiatric Inventory, especially on the disinhibition and apathy subscales. These results point to subtle differences between the three types of dementia in the social realm that help to illuminate the nature of the disease process and could aid in differential diagnosis.
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Affiliation(s)
- Virginia E Sturm
- Department of Psychology, University of California, Berkeley, CA 94720-1650, USA
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