Dyad Members Research Articles

What are we worried about? Midlife married couples' financial concerns about their retirement

AbstractObjectiveThis study explored how marital financial collaboration and approval along with financial constructs predicted midlife couples' reports of retirement financial concerns.BackgroundRetirement is an expected time of life that many couples plan for in advance. Despite knowing that years of life without regular income are anticipated, many people experience financial strain in retirement, which can impact their marital happiness.MethodData for this study came from a sample of 324 midlife (Mage = 44 years) couples that participated in the Flourishing Families study. We examined predictors of financial worries for retirement using dyadic probit regression models.ResultsResults suggested that both husbands and wives worried about having insufficient income and heavy debt in retirement, and that husbands had particular concerns about excess spending. Findings from predictive models suggested that husbands and wives both reported that better financial collaboration, husbands' approval of partners' financial behaviors, better physical health, and to some degree higher income, higher education, and having retirement savings, were protective against financial worries for retirement. In contrast, wives' reports of having retirement benefits and working more hours per week were risk factors.ConclusionMarital financial collaboration and approval of partner financial responsibility by both members of dyads may have lifelong benefits, including as couples prepare for retirement.ImplicationsEfforts to provide greater access to retirement savings plans may also support couples from various social and economic backgrounds. Findings suggest that marital happiness in retirement could be increased as spouses work together in financial aspects of their lives.

Dreaming in patients with cancer and their partners-an underestimated factor for quality of life?

Sleep disorders are prevalent among patients with cancer and their caregivers as well, affecting their quality of life. But the relationship between sleep quality, dream experiences, and life satisfaction in patients with cancer and their partners is understudied. The present research aimed to quantitatively investigate the dream experiences of oncology patients and explore the interdependence between patients and their partners in terms of dream experiences and life satisfaction. Therefore, a cross-sectional study was conducted with 101 dyads, completing a questionnaire assessing demographic and illness-related data, dream experiences, sleep quality, and life satisfaction. Inferential statistical tests and actor-partner interdependence models were used to analyse the data. Both patients with cancer and their partners reported on average a significant decrease in sleep quality since the cancer diagnosis and for both dyad members significant dreaming predictors for life satisfaction were found. Namely, a positive association for dream stability in patients, and a positive association for positive dream affect as well as a negative association for negative dream affect in partners. Regarding the question of interdependence, dream intensity exhibited a significant group-specific partner effect, but no overall partner effect, leading to inconclusive results that call for more studies in this field. The study suggests that dreaming may affect life satisfaction beyond sleep quality and underscores the significance of acknowledging dream experiences as potential influencers of quality of life in patients with cancer. Additionally, the study stands out for its examination of the role of partners in dyadic dependency, emphasising the importance of understanding their influence on patients' experiences.

A dyadic analysis of financial toxicity and health-related quality of life among bone marrow transplant patients and their caregivers.

Relatively few dyad-based studies have evaluated the shared psychosocial and financial toxicity (FT) experiences of hematologic patients and their caregivers, especially those undergoing bone marrow transplantations (BMTs). This study evaluated the association of FT with health-related quality of life (QOL) among BMT patient-caregiver dyads. Survey and electronic health record data were collected between April 2021 and January 2022 from BMT patients and their caregivers pre- (T1) and post-intervention (T2). Thirty-four patient-caregiver dyads completed surveys; all dyads included a patient experiencing elevated T1 FT. The effect of the total FT score (i.e., the combination of psychological response, coping behaviors, and material conditions domain scores) on physical health, mental health, anxiety, depression and distress scores was evaluated using Actor-Partner Interdependence Modeling (APIM). Patients and caregivers who reported lower total FT scores had better physical and mental health, and lower anxiety, depressive symptoms, distress (APIM actor effects). None of the partner effects were significant in the APIM models. Other model findings indicated that compared with caregivers, patients had lower reported physical health; mental health scores were higher, on average, for all participants at the T2 compared with T1; and members of dyads whose caregiver took time off work reported better physical health and lower depressive symptoms and distress than those whose caregiver did not. Our study addresses a significant gap in dyad-based cancer FT studies; the findings underscore the need for additional research to help develop tailored dyad-level FT interventions for improving health-related QOL among BMT patients.

Participant and caregiver experiences of an activities of daily living-focused cognitive stimulation program for individuals with mild-to-moderate dementia (CS-ADL)

Background: Individuals with dementia experience a progressive deterioration in their cognitive and functional abilities, and as a result, require support from informal family caregivers. Non-pharmacological interventions, such as cognitive stimulation, are increasingly being used to address this deterioration. This study explored the participant and caregiver experiences of CS-ADL (Cognitive Stimulation in Activities of Daily Living), an activities of daily living-focused group cognitive stimulation program for individuals with mild-to-moderate dementia. Methods: A descriptive qualitative design was implemented. CS-ADL participants and caregivers were recruited in dyads through a Psychiatry of Later Life service where CS-ADL was delivered. Semi-structured interviews were completed with each dyad either in-person or via the telephone. Data retrieved were analyzed through reflexive thematic analysis. Results: CS-ADL was experienced as an acceptable intervention that positively influenced the everyday life of both dyad members, with benefits reported in the memory, mood, daily routine, and social interaction of participants. Furthermore, the facilitation style of group facilitators positively influenced participants’ engagement in CS-ADL. Limited data was gathered regarding the experience of activities of daily living. Conclusion: This is the first study to explore experiences of CS-ADL, producing a preliminary addition to the evidence-base for CS-ADL. However, further research is required to confirm study findings and explore the experiences of activities of daily living in greater depth.

A case series of sage: a new couple-based intervention for borderline personality disorder

BackgroundResearch suggests that interpersonal dysfunction may be central to borderline personality disorder (BPD), and that the relationships of people with BPD are particularly impaired. Further, the significant others of people with BPD exhibit elevated psychological problems but little access to mental healthcare. Despite this, most BPD interventions are delivered individually and do not routinely incorporate significant others. This manuscript presents the first case series of Sage, a 12-session manualized intervention for people with borderline personality disorder (BPD) and their intimate partners with three targets: a) BPD severity, b) relationship conflict, and c) intimate partner mental health.FindingsFive couples of people with BPD with frequent suicidal/self-injurious behavior or high suicidal ideation and their intimate partners received Sage. Measures of Sage targets as well as tertiary outcomes were administered at pre-, mid-, and post-intervention. Four out of five dyads completed Sage, with high intervention satisfaction ratings. Improvements were generally demonstrated in BPD severity, suicidal ideation, and suicidal behavior/self-injury. Half of dyads exhibited improvements in conflict, and additional improvements in mental health outcomes for dyad members were demonstrated. One dyad exhibited poor outcomes and speculations regarding this are offered.ConclusionsFindings provide proof of concept of Sage as an intervention that can improve BPD and other mental health outcomes in those with BPD and their intimate partners. Incorporating intimate partners into BPD treatment may optimize and expedite its outcomes. However, further testing is needed.Trial registrationThis project was pre-registered at Clinicaltrials.gov (Identifier: [NCT04737252]).

An analysis of coordinated responding of pigeons.

Experimental analyses of coordinated responding (i.e., cooperation) have been derived from a procedure described by Skinner (1962) in which reinforcers were delivered to a pair of subjects (a dyad) if both responded within a short interval, thus satisfying a coordination contingency. Although it has been suggested that this contingency enhances rates of temporally coordinated responding, limitations of past experiments have raised questions concerning this conclusion. The present experiments addressed some of these limitations by holding the schedule of reinforcement (Experiment 1: fixed ratio 1; Experiment 2; variable interval 20 s) constant across phases and between dyad members and by varying, in different conditions, the number of response keys (one to three) across which coordination could occur. Greater percentages of coordinated responding occurred under the coordinated-reinforcement phases than under independent-reinforcement phases in most conditions. The one exception during the one-key condition of Experiment 1 appeared to be a consequence of variability introduced by the independent-reinforcement phase procedure. Furthermore, coordination percentages decreased with increasing response options under both schedules. These results confirm and extend the finding that coordination contingencies control higher rates of temporally coordinated responding than independent-reinforcement contingencies do.

Affectivity and satisfaction in the relationship of Pakistani couples is mediated by dyadic coping-based gratitude.

A substantial body of research supports a positive association between interpersonal gratitude and relationship satisfaction in couples; however, dyadic coping-based gratitude (DC-G) has not been investigated from a dyadic stress and coping perspective. The current study aimed to investigate the mediating role of DC-G between trait affectivity and relationship satisfaction in couples. We collected data from both members of dyads (N = 300 married couples) for the study variables as a pre-requisite for conducting dyadic data analysis using an actor-partner interdependent mediation model (APIMeM). The findings suggest that husbands' positive affect significantly predicted wives' relationship satisfaction via DC-G (actor-partner effect). However, the mediating effect of DC-G appeared to be stronger for the actor-actor and partner-partner effects compared with the cross-partner effect, which supports the actor-only effect. Further, wives' DC-G mediated between husbands' negative affect and wives' relationship satisfaction, suggesting a mediating effect of DC-G for wives but not for husbands. The implications are discussed within the context of couples' relationships.

Daily Rumination-Affect Associations in Dyads During the COVID-19 Pandemic.

Negative and repetitive self-oriented thinking (rumination) is associated with lower well-being and health. The social context of rumination remains underexplored and mostly centers on marital relationships. To embrace the diversity of older adult relationships, this study includes a range of different relationships (e.g., spouses, siblings, friends, etc.) and examines the role of rumination by close others on individual well-being during the coronavirus disease 2019 pandemic. Using daily diary data from 140 Canadian older adults (M = 72.21 years, standard deviation [SD] = 5.39, range: 63-87 years, 47% women, 71% university educated) and a close other of their choice (M = 59.95 years, SD = 16.54, range: 18-83 years, 78% women, 81% university educated), this project builds on past research examining daily life rumination dynamics from a dyadic perspective. For 10 days, both dyad members reported their daily rumination and affect quality in the evening. Multilevel models replicate past work showing that individual rumination was associated with higher negative affect (within-person: b = 0.27, p < .001, between-person: b = 0.57, p < .001) and lower positive affect (within-person: b = -0.18, p < .001, between-person: b = -0.29, p < .001). Importantly, we additionally observed that partner rumination was associated with higher negative affect (b = 0.03, p = .038) and lower positive affect (b = -0.04, p = .023), highlighting the social context of rumination. Findings illustrate the significance of rumination for the self and others and underline the merit of taking a dyadic perspective on what is typically viewed as an individual-level phenomenon.

CHALLENGES OF VERY LATE LIFE: PHYSICAL AND MENTAL HEALTH, CAREGIVING, AND AGING PERCEPTIONS

Abstract The very old are the fastest growing population in developed countries, yet research on this age group remains limited. There are, however, specific challenges of very old age that differ from those in earlier late life phases. Very old individuals and their families may thus have unique needs and may require adapted services. In this symposium, we address selected challenges associated with reaching very old age, including physical and mental health issues, as well as implications of both receiving and providing care. Ribeiro and colleagues report on centenarians’ health and morbidity profiles using the Portuguese census, by comparing individuals aged 100 years old in 2011 and 2021. Jopp and colleagues present findings from the first national Swiss centenarian study on centenarians’ health, cognition, and well-being. Gomes da Rocha and colleagues investigate depressive symptoms in Swiss centenarians during the COVID-19 pandemic, showing notably elevated scores. Kim and colleagues focus on aging perceptions and their correlates among dyads of very old parents and their old children from South Korea, highlighting the impact of the care experience for both dyad members. Gallagher and colleagues examine how old children of very old parents with dementia manage behavioral and psychological symptoms through specific strategies, offering insights on how to better support family care givers of very old dementia patients. In sum, this symposium offers novel insights on specific challenges encountered in very old age, by the individual and their families, and proposes potential pathways towards better understanding and handling of such challenges.

SELF- AND PROXY-REPORTED MET NEEDS IN PERSONS WITH DEMENTIA ARE ASSOCIATIED WITH A LOWER HEALTH-RELATED QUALITY OF LIFE

Abstract This study examined the dyadic association of self and informal caregiver proxy-reported met needs in persons living with dementia on the health-related quality of life (HRQOL). A total of 237 dementia care dyads were included from the Case Management of Persons With Dementia and Their Caregivers Study. HRQOL was assessed by the EuroQol-5D and the number of met needs by the Camberwell Assessment of Needs for the Elderly. The Actor-Partner Interdependence Model framework was used to analyze the effect of an individual’s self or proxy-reported met needs on their own HRQOL (actor effects), and an individual’s self or proxy-reported met needs on the other dyad member’s HRQOL (partner effects). The number of self-reported met needs by persons living with dementia was negatively associated with their own HRQOL (actor effect b = -0.200, p &amp;lt; 0.001), and the HRQOL of informal caregivers (partner effect b = -0.114, p = 0.001). The number of proxy-reported met needs by informal caregivers was negatively associated with their own HRQOL (actor effect b = -0.105, p &amp;lt; 0.001) but not the person living with dementia’s HRQOL (-0.025, p = 0.375). Study findings suggest that both self-reported and informal caregiver proxy-reported met needs in persons living with dementia should be considered in research and practice because they have different implications for each dyad members’ HRQOL.

THE READYR PROGRAM FOR WELL-BEING IN DEMENTIA: PILOT STUDY AND SIX-MONTH FOLLOW-UP RESULTS AMONG SPOUSE–PARTNER DYADS

Abstract The READyR Program assesses and targets everyday routines of care dyads (older adults with cognitive impairment and their co-habiting partners) using in-home sensors and video-conference sessions in order to understand future care needs, and promote greater well-being. This study aimed to evaluate the feasibility, acceptability, and pilot test of efficacy for READyR. Fifteen dyads (96% married) were enrolled in the 6-month study, and randomized to immediately join READyR (n=8 dyads) or to complete READyR after an educational control condition (n=7 dyads). Feasibility was high: 100% of enrolled dyads completed ≥1 session; 80% completed all sessions. Acceptability was also high: responding participants (n=26) reported that READyR helped them express their care values and understand their care needs (92%), that they were comfortable sharing their views (92%) and doing so with their partner present (96%). Hearing and visual impairments were reported to interfere with online sessions for 4 and 6 participants, respectively, but 93% of participants reported that the digital components were easy to use and understand. After receiving the READyR sessions, awareness of future care needs among care partners increased (d = 0.85) and relationship strain for both dyad members decreased (d = 0.58–0.82), when compared to changes among participants in the active control group. No effect was observed on participants’ quality of life, mood, or care-related strain at post-test or at 6 month follow-up. As a remote dyadic intervention, READyR is feasible, acceptable, and may help dyads decrease strain in the care relationship and prepare for future care needs.

An ecological study protocol for the multimodal investigation of the neurophysiological underpinnings of dyadic joint action.

A novel multimodal experimental setup and dyadic study protocol were designed to investigate the neurophysiological underpinnings of joint action through the synchronous acquisition of EEG, ECG, EMG, respiration and kinematic data from two individuals engaged in ecologic and naturalistic cooperative and competitive joint actions involving face-to-face real-time and real-space coordinated full body movements. Such studies are still missing because of difficulties encountered in recording reliable neurophysiological signals during gross body movements, in synchronizing multiple devices, and in defining suitable study protocols. The multimodal experimental setup includes the synchronous recording of EEG, ECG, EMG, respiration and kinematic signals of both individuals via two EEG amplifiers and a motion capture system that are synchronized via a single-board microcomputer and custom Python scripts. EEG is recorded using new dry sports electrode caps. The novel study protocol is designed to best exploit the multimodal data acquisitions. Table tennis is the dyadic motor task: it allows naturalistic and face-to-face interpersonal interactions, free in-time and in-space full body movement coordination, cooperative and competitive joint actions, and two task difficulty levels to mimic changing external conditions. Recording conditions-including minimum table tennis rally duration, sampling rate of kinematic data, total duration of neurophysiological recordings-were defined according to the requirements of a multilevel analytical approach including a neural level (hyperbrain functional connectivity, Graph Theoretical measures and Microstate analysis), a cognitive-behavioral level (integrated analysis of neural and kinematic data), and a social level (extending Network Physiology to neurophysiological data recorded from two interacting individuals). Four practical tests for table tennis skills were defined to select the study population, permitting to skill-match the dyad members and to form two groups of higher and lower skilled dyads to explore the influence of skill level on joint action performance. Psychometric instruments are included to assess personality traits and support interpretation of results. Studying joint action with our proposed protocol can advance the understanding of the neurophysiological mechanisms sustaining daily life joint actions and could help defining systems to predict cooperative or competitive behaviors before being overtly expressed, particularly useful in real-life contexts where social behavior is a main feature.

Contributors to sleep disturbances in caregivers and care recipients with dementia

AbstractBackgroundSleep disturbances in Alzheimer’s disease impact people with dementia (PWD) and caregivers (CGS) who have primary responsibility for care provision. However, it is unknown which aspects of dementia including cognitive decline and behavioral disturbance contribute most to sleep disturbances in patients and caregivers. This pilot study aims to discover what contributes most to sleep deficits, and whether these factors are consistent across both PWD and CGS.MethodPatients: Six dyads with PWD and their primary CGS. Cognitive/behavioral variables: the Montreal Cognitive Assessment (MoCA) (PWD) and the Neuropsychiatric Inventory Questionnaire (NPI‐Q) completed by CGS. Polysomnography: recorded and scored for 1 night for each dyad member separately. Actigraphy: Wrist actigraphy recorded for 14 days in both members of the dyad divided into fixed rest (2200‐0600) and activity (0600‐2200) periods. Sleep variables: total sleep time (TST), sleep onset latency (SOL), nighttime activity as measured by actigraphy.ResultPreliminary results indicate that severity of cognitive dysfunction measured by the MoCA correlates with sleep time (CG r = 0.6224, PWD r = 0.5421). However, presence of neuropsychiatric symptoms and caregiver distress as measured by the NPIQ correlate with sleep onset latency (CG r = 0.9432*, PWD r = 0.7819) and nighttime activity in both CGs and PWD (CG r = 0.8467, PWD r = 0.8708). * = p&lt;0.05.ConclusionThis pilot study of six PWD/CGS dyads examines the relationship between cognition, behavioral disturbance, CGS response to the behavioral disturbance, and sleep. This data indicates that sleep disturbances in PWD and their CGs cannot be explained exclusively by worsening cognitive function and likely have stronger dependence on the neuropsychiatric well‐being of the PWD and CGS emotional response. This dyadic model is unique in that it looks at the interdependence of the PWD/CGS dyad using both objective measures of sleep, cognition, and behavioral disturbance as well as subjective CGS stress. Data from additional dyads is currently being collected to increase the sample size along with the inclusion of additional variables in order to increase understanding of the relationship between PWD characteristics, caregiver burden and sleep disturbances.

Quantifying caregiver sleep disturbances using a dyadic model of dementia

AbstractBackgroundSleep disturbances including insomnia, poor sleep quality, and sleep fragmentation appear to play a role in the development and progression of Alzheimer’s disease (AD) in older adults, but may also affect the health of caregivers. The purpose of this pilot study was to objectively quantify daily rest: activity patterns and polysomnography of the sleep of people with dementia (PWD) and their caregivers (CGS).MethodParticipants: Six dyads with PWD and their primary CGS. Actigraphy: Wrist actigraphy recorded for 14 days divided into fixed rest (2200‐0600) and activity (0600‐2200) periods. Polysomnography: recorded and scored for 1 night for each dyad member separately. Variables: sleep onset latency (SOL), total sleep time (TST).ResultAverage activity measures showed no differences within dyads for average daytime or nighttime activity, indicating the activity levels of CGS are highly reflective of the activity of their PWD partners. Despite similar activity levels, CGS displayed sleep deficits compared to their partners, with significantly increased SOL (p = 0.004). Additionally, with the exclusion of one outlier, all CGS received less TST than their demented partners. These deficits were present even when sleeping separately from their partners.ConclusionThe main findings of this pilot dyadic study reveal that the daily rest:activity patterns of CGS reflect that of their partners. Importantly, despite similar day‐ and nighttime activity, CGS had worse overall sleep than their demented partners, with lowered TST and significantly increased SOL. These findings occurred even when dyads were sleeping separately, indicating that sleep disruptions in CGS cannot be exclusively attributed to nighttime activity of the PWD. Our dyadic model currently is being applied to studies with larger sample sizes in order to determine the impacts of caregiving on sleep.

Self-care Problems and Management Strategies Experienced by Rural Patient/Caregiver Dyads Living With Heart Failure: A Qualitative Study.

Rural patients with heart failure (HF) have higher mortality and hospitalization rates compared with their urban counterparts. Although research supports the inclusion of informal caregivers in daily self-care activities, data are limited regarding the problems encountered by rural patient/caregiver dyads living with HF in managing HF in the home and how these problems are managed. The aim of this study was to identify and describe HF self-care problems experienced by rural dyads in the home and how these problems are managed. Using a descriptive qualitative design, data were collected from rural patient/caregiver dyads living with HF via individual, semistructured, telephone interviews and analyzed using schematic content analysis. Interviews and data analysis occurred concurrently until data saturation was reached. Thematic data saturation was obtained with 11 dyads. On average, patients were 65.3 (±13.9) years old, and caregivers were 62 (±12.37) years old. Four themes illustrating dyadic HF self-care problems and management strategies emerged: (1) HF self-care components, namely, maintenance, symptom monitoring, and management (diet, exercise, activities, strategies); (2) environment (rural barriers, COVID-19); (3) caregiver contributors (confidence, role); and (4) dyadic contributors (dyadic relationship). Dyads described various self-care problems, with the type of relationship and presence of mutuality influencing the problem-solving process and development of management strategies. The identified themes emphasize the self-care problems experienced by rural dyads living with HF and the contributions of both dyad members to effectively manage these challenges. Findings support the need for culturally sensitive, tailored interventions targeting self-care in rural dyads living with HF.

Abstract 15705: Perceived Control Over Own Health Buffers the Negative Impact of Patient Symptom Burden on Quality of Life in Patient-Caregiver Dyads: A Dyadic Mediation Analysis

Introduction: Patients with heart failure (HF) experience multiple physical and psychological symptoms that are associated with poor quality of life (QoL) for patients and family caregivers. Perceived control is known to buffer the adverse consequences of symptom burden on QoL among patients and caregivers at the individual level. However, there is limited knowledge about these associations within dyad members. Our aim was to determine whether perceived control over one’s personal health mediated the association of patient symptom burden and QoL in each member of the dyad. Methods: In this cross-sectional study, patients with HF (N= 154, 65% male, 50% NYHA III/V) reported physical and psychological symptom burden (Memorial Symptom Assessment Scale-HF). Informal caregivers (N = 154, 76% female) and patients completed surveys of perceived control (Control Attitudes Scale-Revised) and physical and mental well-being (MOS Health Survey-36v2). Dyadic data were analyzed using four multilevel Actor Partner Independence Mediation Models. Results: Symptom burden was associated with perceived control of each dyad member (P &lt;.05). Physical symptom burden was directly associated with physical well-being for patients, not caregivers. Physical and psychological symptom burden was directly associated with mental well-being for each dyad member. Perceived control significantly mediated the association of physical symptom burden with physical and mental well-being in each dyad member (Figures A &amp; C). Similarly, perceived control mediated the association of psychological symptom burden with physical and mental well-being in each dyad member (Figures B &amp; D). Perceived control did not influence QoL in partners. Conclusions: Physical and psychological symptoms in HF patients were linked with each dyad member's QoL through perceived control over their health. Fostering perceived control may minimize the negative impact of symptom burden on the QoL of dyad members.

"You would think she would hug me": Micropractices of Care Between First-Generation College Students and Their Parents During Covid-19.

The Covid-19 pandemic has greatly disrupted the education of first-generation college students (first-gens)-those whose parents did not complete a college degree. With campuses closed, activities canceled, and support services curtailed, many first-gens have increasingly relied on their parents for mental, emotional, and logistical support. At the same time, their parents face compounding stresses and challenges stemming from the prolonged effects of the Covid pandemic. We examined the role that relational dynamics between first-gens and their parents played in how they weathered the first 2 years of the Covid pandemic together. We draw upon journals submitted by self-identified first-gens and parents of first-gens to the Pandemic Journaling Project between October 2021 and May 2022 as part of a pilot study of first-gen family experiences of Covid-19, along with a series of interviews conducted with three student-parent dyads. We argue that what we term the micropractices of care-the "little things," like a kind word, small gift, or car ride, that were regularly exchanged between parents and students-played a key role in mental wellness and educational persistence. We find that when there is synchrony between practices offered by one dyad member and their reception by the other, mental wellbeing is preserved. When there is asynchrony, mental health is destabilized. These findings reflect the strategies on which first-gen families have creatively relied to maintain shared mental wellness and student success during a time of crisis. We show how everyday mental wellness is forged in the intersubjective space between two people engaged in achieving shared life goals.

A Live Video Dyadic Resiliency Intervention to Prevent Chronic Emotional Distress Early After Dementia Diagnoses: Protocol for a Dyadic Mixed Methods Study.

By 2030, approximately 75 million adults will be living with Alzheimer disease and related dementias (ADRDs). ADRDs produce cognitive, emotional, and behavioral changes for persons living with dementia that undermine independence and produce considerable stressors for persons living with dementia and their spousal care-partners-together called a "dyad." Clinically elevated emotional distress (ie, depression and anxiety symptoms) is common for both dyad members after ADRD diagnosis, which can become chronic and negatively impact relationship functioning, health, quality of life, and collaborative management of progressive symptoms. This study is part of a larger study that aims to develop, adapt, and establish the feasibility of Resilient Together for Alzheimer Disease and Related Dementias (RT-ADRD), a novel dyadic skills-based intervention aimed at preventing chronic emotional distress. This study aims to gather comprehensive information to develop the first iteration of RT-ADRD and inform a subsequent open pilot. Here, we describe the proposed study design and procedures. All procedures will be conducted virtually (via phone and Zoom) to minimize participant burden and gather information regarding feasibility and best practices surrounding virtual procedures for older adults. We will recruit dyads (up to n=20) from Mount Sinai Hospital (MSH) clinics within 1 month of ADRD diagnosis. Dyads will be self-referred or referred by their treating neurologists and complete screening to assess emotional distress and capacity to consent to participate in the study. Consenting dyads will then participate in a 60-minute qualitative interview using an interview guide designed to assess common challenges, unmet needs, and support preferences and to gather feedback on the proposed RT-ADRD intervention content and design. Each dyad member will then have the opportunity to participate in an optional individual interview to gather additional feedback. Finally, each dyad member will complete a brief quantitative survey remotely (by phone, tablet, or computer) via a secure platform to assess feasibility of assessment and gather preliminary data to explore associations between proposed mechanisms of change and secondary outcomes. We will conduct preliminary explorations of feasibility markers, including recruitment, screening, live video interviews, quantitative data collection, and mixed methods analyses. This study has been approved by the MSH Institutional Review Board. We anticipate that the study will be completed by late 2023. We will use results from this study to develop the first live video telehealth dyadic resiliency intervention focused on the prevention of chronic emotional distress in couples shortly after ADRD diagnoses. Our study will allow us to gather comprehensive information from dyads on important factors to address in an early prevention-focused intervention and to explore feasibility of study procedures to inform future open pilot and pilot feasibility randomized control trial investigations of RT-ADRD. PRR1-10.2196/45532.

Factor structure and dyadic measurement invariance of the English version of the dyadic coping inventory measuring low-income couples in the United States

The Dyadic Coping Inventory (DCI) is used widely in research with couples as a measure of stress coping between dyads. While several studies examined the factor structure of the DCI, as well as invariance with individual samples, no studies have examined the dyadic measurement invariance. Thus, we conducted a dyadic measurement invariance analysis with a community sample of 1,368 opposite-gendered couples. The DCI displayed a factor structure of five factors for dyadic coping by self or partner and two factors for common dyadic coping. Full configural, metric, scalar, and residual variance invariance were identified for the DCI across dyad members. The latent means comparison showed differences in dyadic coping behavior across dyad members.

Self- reported and informal caregiver proxy-reported met needs in persons living with dementia are associated with lower health-related quality of life: a dyadic, cross-sectional study

Objective This study examined the dyadic association of self and informal caregiver proxy-reported met needs in persons living with dementia on the health-related quality of life (HRQOL). Methods A total of 237 persons with dementia and their caregivers were included from a previous observational study. HRQOL was assessed by the EuroQol-5D and the number of met needs by the Camberwell Assessment of Needs for the Elderly. The Actor-Partner Interdependence Model framework was used to analyze the effect of an individual’s self or proxy-reported met needs on their own HRQOL (actor effects), and an individual’s self or proxy-reported met needs on the other dyad member’s HRQOL (partner effects). Results The number of self-reported met needs by persons living with dementia was negatively associated with their own HRQOL (actor effect b = −0.200, p < 0.001), and the HRQOL of informal caregivers (partner effect b = −0.114, p = 0.001). The number of proxy-reported met needs by informal caregivers was negatively associated with their own HRQOL (actor effect b = −0.105, p < 0.001) but not the person living with dementia’s HRQOL (-0.025, p = 0.375). Conclusion Study findings suggest that both self-reported and informal caregiver proxy-reported met needs in persons living with dementia should be considered in research and practice because they have different implications for each dyad members’ HRQOL.