Caregivers’ relationship closeness with the person with dementia predicts both positive and negative outcomes for caregivers’ physical health and psychological well-being

Abstract

Closer relationships between caregivers and care recipients with dementia are associated with positive outcomes for care recipients, but it is unclear if closeness is a risk or protective factor for the health and psychological well-being of caregivers. We examined 234 care dyads from the population-based Cache County Dementia Progression Study. Caregivers included spouses (49%) and adult offspring (51%). Care recipients mostly had dementia of the Alzheimer's type (62%). Linear mixed models tested associations between relationship closeness at baseline or changes in closeness prior to versus after dementia onset, with baseline levels and changes over time in caregiver affect (Affect Balance Scale, ABS), depression (Beck Depression Inventory, BDI), and mental and physical health (components of the Short-Form Health Survey, SF-12). After controlling for demographic characteristics of the caregiver, number of caregiver health conditions, and characteristics of the care recipient (type of dementia, functional ability, and behavioral disturbances), we found that higher baseline closeness predicted higher baseline SF-12 mental health scores (better mental health) and lower depression. Higher baseline closeness also predicted greater worsening over time in ABS and SF-12 mental health. In addition, caregivers who reported a loss of closeness in their relationship with the care recipient from pre- to post-dementia displayed improved scores on ABS and SF-12 mental health, but worse SF-12 physical health over the course of the study. These results suggest that closeness and loss of closeness in the care dyad may be associated with both positive and adverse outcomes for caregivers, both cross-sectionally and over time.

Keywords:

• Alzheimer's disease
• other dementias
• mental health
• caregiving
• stress/burden

Acknowledgments

The authors are indebted to Dr Ronald Munger for his unqualified support of the DPS. We also acknowledge the contributions of the following individuals whose activities have helped ensure the success of the project: John C.S. Breitner, MD, MPH, Cara Brewer, BA, Tony Calvert, RN, BA, Michelle Carlson, PhD, Kimberly Graham, BA, Robert C. Green, MD, MPH, Hochang Ben Lee, MD, Jeanne-Marie Leoutsakos, PhD, Carol Leslie, MS, Lawrence S. Mayer, PhD, Michelle M. Mielke, PhD, Chiadi U. Onyike, MD, Roxane Pfister, MS, Georgiann Sanborn, MS, Nancy Sassano, PhD, Sarah Schwartz, MS, Ingmar Skoog, MD, Martin Steinberg, MD, Katherine Treiber, PhD, Yorghos Tripodis, PhD, Kathleen A. Welsh-Bohmer, PhD, Heidi Wengreen, PhD, RD, James Wyatt, and Peter P. Zandi, PhD, MPH. Finally, we thank the participants and their families for their participation and support. This study is funded by NIA Grant Nos. R01AG21136 and R01AG11380.

Notes

Contributed equally as co-senior authors.

Contributed equally as co-senior authors.

Additional information

Notes on contributors

Constantine Lyketsos

Contributed equally as co-senior authors.

JoAnn Tschanz

Contributed equally as co-senior authors.