Article

Caregiver-Recipient Closeness and Symptom Progression in Alzheimer Disease. The Cache County Dementia Progression Study

The Journals of Gerontology Series B Psychological Sciences and Social Sciences (Impact Factor: 3.21). 08/2009; 64(5). DOI: 10.1093/geronb/gbp052
Source: OAI

ABSTRACT

Applying Rusbult's investment model of dyadic relationships, we examined the effect of caregiver–care recipient relationship closeness (RC) on cognitive and functional decline in Alzheimer's disease. After diagnosis, 167 participants completed up to six visits, observed over an average of 20 months. Participants were 64% women, had a mean age of 86 years, and mean dementia duration of 4 years. Caregiver-rated closeness was measured using a six-item scale. In mixed models adjusted for dementia severity, dyads with higher levels of closeness (p < .05) and with spouse caregivers (p = .01) had slower cognitive decline. Effect of higher RC on functional decline was greater with spouse caregivers (p = .007). These findings of attenuated Alzheimer's dementia (AD) decline with closer relationships, particularly with spouse caregivers, are consistent with investment theory. Future interventions designed to enhance the caregiving dyadic relationship may help slow decline in AD.

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    • "Ultimately negative experience then exacerbates the presentation of dementia. This creates a vicious circle whereby dementia is exacerbated, worsening the relationship as the cycle continues (Cheston & Bender, 1999; Kitwood, 1997; Norton et al., 2009). A greater understanding of these complex relational patterns is therefore warranted. "
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    ABSTRACT: There is a growing recognition of dementia as a condition that affects both members of a couple individually while also influencing the relational bond between them. This is an area which potentially has important service implications. Accordingly, the aim of this review was to elaborate the experience of dementia on partner/spousal relationships through a synthesis of pertinent qualitative literature. A systematic literature search for qualitative research papers was undertaken in November 2013. Five databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES and PsycINFO) were searched using terms for dementia, partner and qualitative data analysis. Meta-synthesis was conducted on the data within the found papers. A line-of-argument synthesis of 10 studies yielded four overarching themes, which highlight couples' efforts to maintain their sense of togetherness; shifts in balance and power within their relationship which can impact upon both partners' sense of identity; the empathy and sensitive attunement between couples as they work to protect each other's sense of role and identity; and the resilience couples demonstrate in the face of great fear, uncertainty and hopelessness. Findings have important implications for both research and practice, particularly the need for services to support couples' efforts to enhance couplehood in spite of dementia. Ultimately, this review adds further weight to arguments to refocus dementia care on relationships in addition to individuals.
    Full-text · Article · Mar 2015 · Aging and Mental Health
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    • "Ultimately negative experience then exacerbates the presentation of dementia. This creates a vicious circle whereby dementia is exacerbated, worsening the relationship as the cycle continues (Cheston & Bender, 1999; Kitwood, 1997; Norton et al., 2009). A greater understanding of these complex relational patterns is therefore warranted. "
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    ABSTRACT: Objectives: There is a growing recognition of dementia as a condition that affects both members of a couple individually while also influencing the relational bond between them. This is an area which potentially has important service implications. Accordingly, the aim of this review was to elaborate the experience of dementia on partner/spousal relationships through a synthesis of pertinent qualitative literature. Method: A systematic literature search for qualitative research papers was undertaken in November 2013. Five databases (Academic Search Complete, CINAHL, MEDLINE, PsycARTICLES, and PsycINFO) were searched using terms for dementia, partner and qualitative data analysis. Meta-synthesis was conducted on the data within the found papers. Results: A line-of-argument synthesis of 10 studies yielded four overarching themes, which highlight couples’ efforts to maintain their sense of togetherness; shifts in balance and power within their relationship which can impact upon both partners’ sense of identity; the empathy and sensitive attunement between couples as they work to protect each other’s sense of role and identity; and the resilience couples demonstrate in the face of great fear, uncertainty and hopelessness. Conclusion: Findings have important implications for both research and practice, particularly the need for services to support couples’ efforts to enhance couplehood in spite of dementia. Ultimately, this review adds further weight to arguments to refocus dementia care on relationships individuals. Keywords: Couples; dementia; meta-synthesis; qualitative; review.
    Full-text · Article · Jan 2015 · Aging and Mental Health
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    • "The nature of the spousal relationship also independently affects spouses’ mortality when their partners become seriously ill or die [11,49]. These observations are conspicuously true of cognitive impairment: Dementia in one spouse greatly increases the risk of dementia in the other, and spousal closeness decreases dementia progression in the affected partner [50,51]. "
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    ABSTRACT: Background The burden experienced by spouses of patients with Alzheimer’s disease (AD) may have negative consequences for their physical health. We describe here a method for analyzing United States Medicare records to determine the changes in health service use and costs experienced by spouses after their marital partner receives an AD diagnosis. Methods We initially identified all beneficiaries in the 2001–2005 Medicare 5% sample who had multiple claims listing the ICD-9 diagnostic code for AD, 331.0. The 5% sample includes spouses who share a Medicare account with their marital partners because they lack a sufficient work history for full eligibility on their own. A matched cohort study assessed incremental health costs in the spouses of AD patients versus a control group of spouses of non-AD patients. Longitudinal and cross-sectional analyses tracked the impact of a patient’s AD diagnosis on his or her spouse’s healthcare costs. Results Our method located 54,593 AD patients of whom 11.5% had spouses identifiable via a shared Medicare account. AD diagnosis in one member of a couple was associated with significantly higher monthly Medicare payments for the other member’s healthcare. The spouses’ elevated costs commenced 2 to 3 months before their partners’ AD diagnosis and persisted over the follow-up period. After 31 months, the cumulative additional Medicare reimbursements totaled a mean $4,600 in the spouses of AD patients. This excess was significant even after accounting for differences in baseline health status between the cohorts. Conclusion The study methodology provides a framework for comprehensively evaluating medical costs of both chronically ill patients and their spouses. This method also provides monthly data, which makes possible a longitudinal evaluation of the cost effects of specific health events. The observed correlations provide a coherent demonstration of the interdependence between AD patients’ and spouses’ health. Future research should examine caregiving burden and other possible factors contributing to the AD spouses’ health outcomes. It should also extend the method presented here to evaluations of other chronic diseases of the elderly.
    Full-text · Article · Jul 2014 · BMC Health Services Research
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