Is expressed emotion related to estimates of ability made by older people with cognitive impairments and their partners?

Abstract

Objectives: Discrepancies in ratings of ability are used to assess awareness in people with cognitive impairments, and previously have been found to be associated with comorbid depression and carer distress. This study explored how the degree of discrepancy between self-ratings of ability made by older people with a cognitive impairment and informant ratings made by their partners relates to aspects of their relationship quality. It was hypothesised that discrepancies between self- and partner ratings would be associated with partner's expressed emotion (EE), and replicate previous findings for associations with depression and carer distress.

Method: Forty-six people aged over 65 with mild cognitive impairment or early-stage dementia were recruited through NHS mental health services for older people. In a semi-structured interview, they and their partners gave separate ratings of cognitive abilities and instrumental activities of daily living (IADL). Partners also completed a 5-minute speech sample task to assess the type of EE. Depression in cognitively impaired participants and partner distress were also measured.

Results: High EE, depression and carer distress were associated with larger discrepancies in ratings of ability on the cognitive measure. EE was not associated with self-ratings or partner ratings of cognitive or IADL ability.

Conclusion: The findings suggest that where disagreement about the abilities of an older person with cognitive impairments is greater, the affective environment around that person is more likely to be characterised by criticism and/or emotional over-involvement. The implications of this for assessment, diagnosis, and helping couples adjust to cognitive deterioration are discussed.

Keywords:

• relationships
• spouses
• awareness
• discrepancy
• dementia

Acknowledgements

The authors would like to thank the staff at the Older People's Mental Health Service and the Memory Clinic involved in this research for their help with recruitment, Dr Eric Gardiner for statistical advice, and Preethi Premkumar (PP) for assisting with the scoring of the FMSS. The authors would also like to thank the reviewers for their helpful comments.

Notes

^a n = 44, ^b n = 35.

PwCI = people with cognitive impairment.

DV = dependent variable, NS = nonsignificant.