Caregiver-care Recipient Relationship Research Articles

Relationship Status and Quality Are Associated With Perceived Benefits of Caregiving for People With Heart Failure.

"Benefit finding" is a strengths-based strategy for coping with medical illness that may be particularly useful for caregivers of people with heart failure given the highly fluctuating disease course. The aim of this study was to investigate benefit finding's association with the caregiver-care recipient relationship, depression, and burden at baseline and longitudinally. This is a longitudinal observational study of caregivers' benefit finding, relationship quality, depression, and burden. Correlation and multiple regression analyses identify baseline associations and predictors of 12-month change in benefit finding. At baseline (n = 100; median, 60 years [interquartile range, 46-69]; 81% female, 70% partner/spouse), increased benefit finding correlated with higher relationship quality (r = 0.53; 95% confidence interval [CI], 0.38-0.67), lower depression (r = -0.33; 95% CI, -0.49 to -0.14), and lower burden (r = -0.31; 95% CI, -0.47 to -0.11). Twelve-month change in benefit finding was predicted by change in relationship quality (ß = 7.12; 95% CI, 0.62-13.61) but not depression or burden. Relationship quality and benefit finding changed together over time. Interventions strengthening the caregiver-care recipient bond may be especially impactful for heart failure caregivers.

Nurses Caring for Older Adult Family Members: Disclosing Caregiving to Work Supervisors.

Disclosure of family caregiving to work supervisors is needed for nurses to access work support for family caregiving. Little is known about characteristics of nurses who decide to/not to disclose family caregiving to supervisors. The objective was to examine characteristics of nurses based on whether they disclosed caregiving responsibilities to their nursing supervisors and describe reasons for non-disclosure. This was a secondary analysis of a cross-sectional survey. Registered nurses who had a work supervisor and cared for an older adult family member completed a survey including demographics, work and caregiving characteristics, and disclosure. Descriptive statistics and binary logistic regression were conducted. The sample included 162 nurses. Participants were on average 50 years old, 90.1% female, 65.4% married, and 80.9% were caring for a parent or parent-in-law. The disclosure was more likely among nurses who provided higher intensity care (hours of care), cared for a parent or in-law, or had a quality caregiver-care recipient relationship. Reasons for non-disclosure included wanting to separate personal and work life, discomfort, and fear of consequences. Nurses struggle with similar disclosure challenges as other family caregivers. Care intensity, caregiver-care recipient relationships, and care stress were associated with disclosure behaviors.

Insights Into Informal Caregivers' Well-being: A Longitudinal Analysis of Care Intensity, Care Location, and Care Relationship.

This study investigates the psychological well-being of informal caregivers over time. It identifies the thresholds (or "tipping points") of caring intensity at which caregiving is associated with lower psychological well-being, and how this varies by care location and caregiver-care recipient relationships. It also examines how caring location and relationship are linked to informal caregivers' psychological well-being while controlling for caring intensity. Waves 1-18 (1991-2009) of the harmonized British Household Panel Survey and Waves 1-8 (2009-2017) of the U.K. Household Longitudinal Study were analyzed. Psychological well-being was measured using the General Health Questionnaire (GHQ)-12 score. Care intensity was measured by the weekly hours of care provided. Fixed-effects estimators were applied to the GHQ-12 score of caregivers across different care intensities, caring locations, and caring relationships. All levels of informal care intensity are associated with lower psychological well-being among spousal caregivers. The thresholds to well-being are 5 hours per week when caring for a parent, and 50 hours per week when caring for a child (with a disability or long-term illness). Caring for "other relatives" or nonrelatives is not negatively associated with psychological well-being. The thresholds are 5 hours per week for both coresident and extraresident caregivers. Extraresident caregivers experience better psychological well-being compared to coresident caregivers, given relatively lower weekly care hours. Caring for primary kin (especially spouses) is linked to lower psychological well-being compared to other caregiving relationships, regardless of care intensity. Policy and practice responses should pay particular attention to spousal caregivers' well-being. Caregiving relationship has a stronger association with the caregiver's well-being than care location.

PHYSICAL ACTIVITY BARRIERS AND INTENTIONS OF ALZHEIMER’S DISEASE (AD) AND RELATED DEMENTIAS (AD/ADRD) CAREGIVERS

Abstract Caregivers of people living with AD/ADRD often experience negative biopsychosocial health outcomes and have reduced capacity to engage in healthy behaviors (e.g., exercise). Physical activity is an established intervention for promoting physical and mental health across many populations. This research explored physical activity intentions and barriers among AD/ADRD caregivers, as well as potential relationships between physical activity intentions, cohabitation status, and caregiver/care recipient relationship. Data were collected via online survey from family caregivers of people living with AD/ADRD (n=117). The sample was predominantly women (n=89; 76.1%), white (n= 89, 76.1%), and averaged 55.3 (SD= 16.45) years old. Participants averaged 56.31 (SD= 49.15) hours per week on care responsibilities. Caregivers expressed strong desire to be more active (M=4.42 / 5; SD= .71) and that caregiving demands were a strong barrier (M=3.85 / 5; SD= 1.15). Significant differences were observed between caregivers who lived, or did not live with, care recipients across both physical activity intention (p= .022) and burden perceptions (p=.002), measured by the short form Burden Scale for Family Caregivers (BSFC-SF). No differences were observed based on caregiver-care recipient relationship (e.g., parent, partner). Primary themes among open-ended responses to physical activity barriers included: lack of time and energy, inability to leave care recipient, and competing responsibilities. Our findings suggest a need for behavioral interventions to facilitate physical activity among AD/ADRD caregivers, particularly those who live with their care recipient. Social network interventions that leverage social connections to support caregivers may increase physical activity by reducing barriers associated with care responsibilities.

Family caregiver's willingness to care from the perspective of altruism.

The willingness of family members to take care of older relatives directly affects the quality of life of disabled older adults, so it is necessary to understand the status quo of willingness to care and its influencing factors. This has been extensively studied in other countries, but, it is rarely studied in China. Based on the theory of altruism, employing a unique sample from Shanghai, China in 2017 and 2022, we attempt to reveal the influencing factors of the care willingness of family caregivers during the transition period. To measure caregiver burden and functional disability of the care recipient, we employ the Zarit Burden Interview (ZBI) and the Barthel Index, respectively. Then we utilized the ordinary least squares (OLS) methodology and estimated four regression models. Models 1, 2, and 3 examined the impact of the variables of the caregiver burden, responsibility and love, and the quality of the caregiver-caregiver recipient relationship, respectively, on family caregivers' willingness to care. Model 4 was the full model. To testify whether the caregiver burden is likely to act as a mediator, path analysis was used, and the path was adjusted and verified. According to the survey, in Shanghai, only half of the caregivers had a very high care willingness to care for disabled older relatives, while nearly one-tenth of the caregivers had a low willingness. It was the caregiver burden rather than the functional disability of older adults that harms family caregivers' willingness to care. Responsibility and caring out of love were positively related to care willingness. Relationship quality was the most important influencing factor, explaining 10.2% of the variance in care willingness. Path analysis demonstrated that responsibility, caring out of love, and relationship quality directly and through the mediation of caregiver burden indirectly affected care willingness. Our results revealed that reciprocal altruism presented by the quality of the caregiver-care recipient relationship had a significantly positive impact on family caregivers' willingness to care. In addition, the caregiver burden was found not only directly affected care willingness, but also acted as a mediator. To promote the perfection of laws and policies, comprehensive samples of different types of cities should be included and the measurement of key variables could be further improved in future studies.

Caring for a Relative With Dementia in Long-Term Care During the COVID-19 Pandemic: A Prospective Longitudinal Study.

The coronavirus disease 2019 (COVID-19) pandemic introduced unprecedented threats and disruptions for caregivers of people with dementia living in residential long-term care (LTC) facilities. Qualitative and cross-sectional studies have reported substantial negative effects of the pandemic on dementia caregivers' well-being, but little to no prospective research has examined the impact of COVID-19 on caregiver well-being using pre-pandemic assessments. The present study used longitudinal data from an ongoing randomized controlled trial of a psychosocial intervention to support family caregivers whose relatives had entered LTC. Data collection began in 2016 and continued through 2021. Caregivers (N = 132) completed up to 7 assessments measuring their depressive symptoms, self-efficacy, and burden. Latent growth curve models testing preregistered hypotheses revealed no significant effects of the pandemic on caregiver outcomes on average, though caregivers varied in terms of individual intercepts and slopes. Furthermore, factors such as caregiver-care recipient relationship closeness, care recipient's COVID-19 infection status, and caregivers' ratings of LTC facilities' COVID-19 policies did not significantly moderate trajectories of well-being. Findings highlight the heterogeneity of caregivers' experiences during the pandemic, and suggest caution when interpreting cross-sectional findings on the impacts of the COVID-19 pandemic on caregiver well-being and distress.

Unmet Support Service Needs Among Rural Family Caregivers: A Population-Based U.S. Study a population-based U.S. study

Background: In rural communities around the world, individuals with serious health problems and their family caregivers often experience greater barriers to healthcare access. Identifying unmet support service needs of rural-dwelling caregivers can reveal intervention and policy targets. We examined unmet needs reported by rural caregivers in the U.S. Methods: We used data from the 2015-2018 U.S. Behavioral Risk Factor Surveillance System that included the optional caregiving module (32 U.S. states, D.C. and Puerto Rico). We identified rural caregivers using metropolitan statistical area (rural) and the item, "During the past 30 days, did you provide regular care or assistance to a friend or family member who has a health problem or disability?" Logistic regression models incorporating sampling weights provided adjusted odds ratios (adjusted ORs) of factors associated with having any unmet support service needs, and specific need types: classes about giving care, help with service access, support groups, individual counseling, respite. Factors included sociodemographic (gender, race/ethnicity, age, education, income, employment, marital status) and caregiving-related (intensity [±20 hours/week and ±2-year duration], caregiver-care recipient relationship, and main health problem) variables. Results: Of the 8,651 rural caregivers (representing 2.3 million) included, 16% endorsed unmet needs. Help accessing services was the most common need, followed by support groups and individual counseling. Factors associated with higher odds of any unmet need included Black vs. White race (adjusted OR: 1.74 [95%CI: 1.21-2.50]), college vs. high school graduate (adjusted OR: 1.85 [1.37-2.52]), and higher vs. lower intensity caregiving (adjusted OR: 2.18 [1.27-3.73]). Conclusions: Many U.S. rural caregivers report unmet support service needs. Future interventions to benefit rural caregivers should target individuals and communities with the highest unmet needs.

Listening skills in dementia care

Developing strategies to provide effective supportive messages for people with dementia that also promote the wellbeing of active listeners is essential for healthy caregiver–care-recipient relationships. We work to identify, critique and explore the pragmatics of language patterns between caregiving listeners and care-recipient listeners who experience dementia, with a focus on cultivating a more inclusive conceptualization of active listening verbal behaviors. Through content analysis of 66 conversations in the Alzheimer’s and dementia context utilizing an adapted Active Listening Observation Scale (ALOS), our findings create a baseline from which to explore listening behaviors and the wellbeing of both caregivers and care-recipients. The results point to caregivers exhibiting higher active listening behaviors than care-recipients on every measure, and that across the duration of the conversation caregivers’ active listening on a global level decreases and care-recipients’ active listening increases. Ultimately, we hope that this research will decrease negative impacts on caregivers of the caregiving role, by addressing communication challenges; increase the agency and voice of care-recipients as listeners who contribute to communication events; create more inclusive conceptualizations of active listening verbal processes; and improve the quality of active listening in Alzheimer’s and dementia caregiving contexts.

A Narrative Review Examining the Utility of Interpersonal Synchrony for the Caregiver-Care Recipient Relationship in Alzheimer's Disease and Related Dementias.

The stressful nature of caring for an older adult with a chronic disease, such as Alzheimer’s disease (AD), can create barriers between the caregiver-care recipient, as they try to navigate their continuously changing social relationship. Interpersonal synchrony (i.e., matching or similarity of movement, emotions, hormones, or brain activity), is an innovative approach that could help to sustain caregiving relationship dynamics by promoting feelings of connection and empathy through shared behavior and experiences. This review investigates the current literature on interpersonal synchrony from an interdisciplinary perspective by examining interpersonal synchrony through psychological, neural, and hormonal measures across the adult lifespan. We then present a case for examining the degree to which interpersonal synchrony can be used to facilitate affiliation and well-being in the caregiver-care recipient relationship. We find that there is significant evidence in healthy adult populations that interpersonal synchrony can support affiliative feelings, prosocial behavior, and well-being. Characterizing the psychological, neural, and hormonal mechanisms of interpersonal synchrony is a first step towards laying the groundwork for the development of tools to support relational closeness and empathy in the caregiving context. Finally, we explore the strengths and limitations of using interpersonal synchrony to support relational well-being, and discuss possible avenues for future research.

Process and Outcomes: the Influence of Gains in Knowledge and Socioemotional Skills on Caregivers’ Well-being

To assess the validity of intervention programs, we need to understand how they work and for whom. We evaluated a program for caregivers, ComTato, using a quasi-experimental design (pretest, posttest), to determine (a) which specific program-related gains are associated with improvements in well-being and (b) whether participants’ initial repertoire influences program benefits. All 37 participants (average age of 52.7 years) cared for a family member with Alzheimer’s disease. Participants completed instruments to evaluate their caregiving repertoire and their socioemotional well-being (use of constructive coping strategies, perceptions of burden, and quality of the caregiver-care recipient relationship). Caregivers learned about dementia, stress management, principles of social skills, the use of specific social skills, and principles of cognitive stimulation. We observed that (a) the greater the increase in knowledge and skills, the greater the increase in caregivers’ use of constructive coping strategies (r = .30, p = .037), with use of social skills being the component with the strongest association (r = .36, p = .014); (b) the greater the improvements in knowledge about social skills, the larger the reductions in conflicts with the care recipient (rho = − .28, p = .048); and (c) seven correlations indicated that the lower the caregivers’ initial repertoire, the greater their socioemotional health gains. Thus, increases in caregivers’ knowledge and socioemotional skills seem to contribute to improvements in their socioemotional well-being, and the lower their pre-existing repertoire, the more they benefitted from the program. In future studies, researchers should investigate how other socioemotional factors influence program benefits.

Exploring the experiences of domiciliary caregivers simulating the role of care recipients.

To find out if an immersive simulation intervention would be feasible in a domiciliary care context, and to explore what effect, if any, the intervention would have on the domiciliary caregivers who participated. This was an immersive simulation pilot project in which six domiciliary caregivers (simulants) assumed the profile of people receiving domiciliary care. Second-year and third-year nursing students provided domiciliary care to the simulants, with support from a registered nurse. Thematic analysis was used to identify themes from post-intervention semi-structured interviews and a focus group with the simulants. Five main themes were identified: recognising the need for stimulation; reflecting on the importance of person-centred communication; the value of companionship and confidence in caregivers; understanding boundaries and vulnerabilities; and empathy and practice changes. Following the intervention, most of the simulants reported that they re-examined the care they provide from the care recipient's perspective, and were increasingly attuned to the wishes of care recipients. The findings of this pilot project suggest that immersive simulation could be a valuable intervention in the domiciliary care context. The feedback from simulants suggests that it is beneficial to provide domiciliary caregivers with the opportunity to assume the role of care recipients, and enables them to reflect on the complexity and value of the care that they provide. The findings indicate that important elements of ethical care include domiciliary caregivers having adequate time to deliver care and develop trust, which can assist in fostering effective caregiver-care recipient relationships.

The Impact of a Care Recipient’s Pet on Caregiving Burden, Satisfaction, and Mastery: A Pilot Investigation

Abstract Older adults who require assistance with their own self-care most likely need assistance with pet care. These pet care tasks are likely taken on by their family caregivers (i.e., informal caregivers). However, the potential impact of an older adult’s pet on caregivers’ emotional experiences has not been explored. Role theory was used to model the impact of a care recipient’s pet (i.e., number of pet care tasks performed and the perceived costs of care recipients’ pet ownership) on caregivers’ levels of caregiving burden, satisfaction, and mastery. The moderating role of the perceived bond between the care recipient and their pet, the caregiver’s closeness to the pet, and mutuality in the caregiver-care recipient relationship were also examined. Forty-nine caregivers who did not consider themselves to be co-owner of their care recipients’ pet completed a one-time on-line survey. Path analyses controlling for perceptions of inadequate help were conducted separately for each outcome variable using the maximum likelihood for missing values. The perceived costs of the care recipients’ pet ownership were directly associated with lower caregiving mastery. The perceived bond between the care recipient and their pet moderated the association between the number of pet care tasks and satisfaction. The caregivers’ closeness to the pets moderated the association between the perceived costs and satisfaction. Caregiver-care recipient mutuality moderated the relationships between pet care tasks and burden, pet care tasks and mastery, and costs and mastery. Care recipients’ pets are likely to have an impact on the subjective experiences within the role of caregiver. These impacts are likely qualified by the human-animal bond, and to a larger extent, the caregiver-care recipient relationship.

Caregiver-Care Recipient Relationship Closeness is Associated With Neuropsychiatric Symptoms in Dementia

Closer caregiver-care recipient (CG-CR) relationships are associated with better cognitive and functional abilities, activities of daily living (in persons with dementia), and lower informal care costs. Due to the difficulty in treating neuropsychiatric symptoms (NPSs) and their detrimental effects on caregivers and care recipients, we examined whether closeness of CG-CR relationships was associated with overall NPS severity or with specific NPS symptom domains in care recipients. In a longitudinal population-based study in Cache County, Utah, the 12-item Neuropsychiatric Inventory (NPI-12) was assessed in 300 CG-CR dyads. Caregivers reported current relationship closeness using the Whitlatch Relationship Closeness Scale. Linear mixed models examined associations between CG-CR closeness and NPI-12 total score or selected symptom domains over time (observation period: 2002-2012). In unadjusted linear mixed models, higher closeness scores were associated with a five-point lower NPI-12 score and a one-point lesser increase in NPI-12 per year. NPI scores also showed lower affective cluster scores (two points) and lesser increase in psychosis cluster (approximately 0.5 points per year) and agitation/aggression (0.16 points per year) for each unit increase in closeness. When controlling for NPI caregiver distress, associations between closeness and NPSs diminished to a 0.5-point lesser increase in total NPI-12 score per year. Adjusted models for NPI domains/clusters showed -0.32 points per year for the psychosis cluster, -0.11 points per year for agitation/aggression, and -0.67 overall for the affective cluster. Higher CG-CR closeness, a potentially modifiable factor, is associated with lower NPS severity and may provide a target for intervention.

An Exploration of Resilience among Family Carers of People with Dementia

Background : The majority of people with dementia living in the community receive care from family members or other informal carers. Each family carer experiences caregiving differently, all family carers have varying levels of personal resilience when acting in the caregiving role. Defined as a set of personal qualities, resources and factors which allow an individual to maintain normal or enhanced functioning during times of adversity (1), resilience contributes to the carer’s well-being and can influence the quality of care provided to the person with dementia. The aim of this study was to investigate the concepts and interventions related to resilience in dementia caregivers and explore models of resilience applicable to dementia caregiving. Methods : A systematic literature review was conducted to explore resilience, as it applies to and impacts on caregiving. Peer-reviewed articles and grey literature published from 2006-2016 were included in the systematic search criteria, and searched using a range of scholarly databases. Two independent reviewers pre-screened the search results and conducted formal assessments and quality appraisals of the retrieved articles. Results : A total of 13,863 studies were identified from the initial search and, following screening, 89 studies were included in the systematic review exploration of resilience. Based on narrative synthesis of the literature, the study reports a model of resilience for dementia caregivers which focuses on social and cultural factors, aspects of the caregiver-care recipient relationship and the caregiver’s psychological resources. Conclusions : While many studies focus on the area of caregiving, very few examine resilience as an independent construct. The findings build a model of resilience, which can facilitate the design and development of interventions aimed at enhancing resilience in family carers of people with dementia. Strengthening the resilience of families to take care of their loved ones is highly relevant for an integrated approach to caring for people with dementia. This research will help health and social care professionals to enable family caregivers to continue to provide care and facilitate people with dementia to remain in their homes.7 References : 1. Windle G. What is resilience? A review and concept analysis. Reviews in Clinical Gerontology. 2011 May 1;21(02):152-69.

Invisible Care: Friend and Partner Care Among Older Lesbian, Gay, Bisexual, and Transgender (LGBT) Adults.

Lesbian, gay, bisexual, and transgender (LGBT) older adult caregivers may encounter obstacles in obtaining health and aging services due to discrimination in service and legal systems. The caregiving relationships in LGBT communities also differ from the general population in that friends are providing a large portion of informal care. This article examines how the relational context of caregiving relates to caregiving demands and resources, which in turn, influence perceived stress and depressive symptomatology among older LGBT caregivers. Using data from the National Health, Aging, and Sexuality Study: Caring and Aging with Pride, this study examines 451 participants who are providing caregiving to partners and friends. Structural equation modeling was applied to estimate the associations among the caregiver-care recipient relationship and caregiving demands, resources, perceived stress, and depressive symptomatology. On average, as compared with those caring for partners, those who provided care to friends reported experiencing lower levels of caregiving demands and lower levels of social support. The lower caregiving demands correlated positively with both lower perceived stress and less severe depressive symptomatology; however, the lower levels of social support were related to higher perceived stress and higher depressive symptomatology. Caregiving provided by friends, which has long been under recognized, plays an important role in the LGBT community. Because lower levels of caregiving demands are offset by less social support, LGBT friend-caregivers experience similar levels of perceived stress and depressive symptomatology to those providing care to spouses and partners. Policy and service reforms are needed to better acknowledge the continuum of informal caregiving relationships.

Poster Number: EI 40 - The Association between Caregiver-Care Recipient Relationship and Caregiver Burden and Depressive Symptoms among Community-Dwelling Older Adults with Dementia

Poster Number: EI 40 - The Association between Caregiver-Care Recipient Relationship and Caregiver Burden and Depressive Symptoms among Community-Dwelling Older Adults with Dementia

Well-being of Sibling Caregivers: Effects of Kinship Relationship and Race.

This study examined whether caregiving has a differential effect on the well-being of sibling caregivers relative to other caregiving groups and whether race moderates this effect. Using the National Survey of Midlife Development in the United States, 631 family caregivers (including 61 sibling caregivers) and 4,944 noncaregivers were identified. Hierarchical regression analyses were conducted to estimate the effect of the caregiver-care recipient relationship and its interaction with race on caregivers' well-being (i.e., depressive symptoms, self-rated health, life satisfaction, and perceived control over life). Caregivers in general reported poorer well-being than noncaregivers, but sibling caregivers were less affected by caregiving than parent or spouse caregivers. Among sibling caregivers, caregiving took a significantly greater toll on non-Hispanic White caregivers than those from minority groups with respect to depressive symptoms and life satisfaction. The findings suggest that the experience of sibling caregivers is significantly shaped by their cultural background.

地域包括ケアにおける「自助」「互助」の課題

地域包括ケアにおける「自助」「互助」の課題

Relationship between expectancy/credibility and early response to telephone-based dementia caregiver interventions

Mechanisms that account for the effectiveness of psychosocial interventions for dementia caregivers are poorly understood. Credibility of an intervention and an individual's expectancy that the intervention will improve their distress are potentially important predictors of treatment response. This study explored whether specific dementia caregiver characteristics were related to credibility and expectancy. We also examined whether these variables were related to caregivers’ early response to two different telephone-based, psychosocial interventions. Participants were 133 dementia caregivers randomly assigned to receive 6 months of either an active, problem-solving intervention (Family Intervention: Telephone Tracking - Caregiver; FITT n = 68) or nondirective Telephone Support (TS; n = 65). They completed the Zarit Burden Interview, Center for Epidemiologic Studies Depression scale at baseline and after 2 months of the intervention (7 telephone calls). Caregivers completed the Credibility and Expectancy Questionnaire (CEQ) after 2 months of the intervention. Age, education, gender, relationship type (spouse vs. other), or length of caregiving were not associated with any CEQ scores. For the FITT, higher levels of depression at the start of treatment were associated with lower expectancy scores, although this relationship was not seen in the TS group. Higher levels of self-efficacy for managing dementia symptoms and better caregiver-care recipient relationship at start of treatment were associated with greater expectancy in the TS condition, but not in FITT. At the 2-month assessment point, caregivers assigned to FITT showed significantly improved burden and depression scores compared to caregivers assigned to TS (p < .01 and p = .05, respectively). There were no significant group differences in caregivers’ report of intervention credibility or expectation for improvement, with both groups reporting high levels. Change in depression and burden was also unrelated to CEQ scores in either intervention group. Even though the two interventions in the study had differential effects on caregiver burden and depression, we did not find any differences in caregivers’ beliefs about credibility of the intervention or expectancy for improvement. Caregiver distress, relationship satisfaction, and confidence in managing behaviors prior to initiating treatment are important predictors of whether an individual believes a treatment will be effective.

Caregiver-recipient closeness and symptom progression in Alzheimer disease. The Cache County Dementia Progression Study.

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.