Spouses Of Persons Research Articles

Greater Risk of Dementia When Spouse Has Dementia? The Cache County Study

To examine the effects of caring for a spouse with dementia on the caregiver's risk for incident dementia. Population-based study of incident dementia in spouses of persons with dementia. Rural county in northern Utah. Two thousand four hundred forty-two subjects (1,221 married couples) aged 65 and older. Incident dementia was diagnosed in 255 subjects, with onset defined as age when subject met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, criteria for dementia. Cox proportional hazards regression tested the effect of time-dependent exposure to dementia in one's spouse, adjusted for potential confounders. A subject whose spouse experienced incident dementia onset had a six times greater risk for incident dementia as subjects whose spouses were dementia free (hazard rate ratio (HRR)=6.0, 95% confidence interval (CI)=2.2-16.2, P<.001). In sex-specific analyses, husbands had higher risks (HRR=11.9, 95% CI=1.7-85.5, P=.01) than wives (HRR=3.7, 95% CI=1.2-11.6, P=.03). The chronic and often severe stress associated with dementia caregiving may exert substantial risk for the development of dementia in spouse caregivers. Additional (not mutually exclusive) explanations for findings are discussed.

Influence of TAAR6 and HSP-70 genes variations on major mood disorders

Background: Researchers generally agree that mental illness represents a burden to the family. The present study concerns the subjective burden of living with a person with mental disorder, more specifically the association between mental disorder in the index person and subjective well-being and symptoms of anxiety and depression in his or her spouse. Methods: Questionnaire data were obtained from 4,690 couples participating in the Nord-Trondelag Health Study; a large population based study performed in Norway in 1995-97. Mental health in spouses of persons with mental disorder was compared with mental health in spouses of persons without mental disorder using analysis of variance (ANOVA). Because of dependency in the data due to the double entry file structure in which each participant in the study was included both as an index person and as a spouse, all analyses were run stratified by sex. Results: Adjusting for several covariates, spouses of persons with mental disorder scored significantly lower on subjective wellbeing and significantly higher on symptoms of anxiety and depression compared to spouses of persons without mental disorder. Although highly significant, the effect sizes were moderate, corresponding to a difference in standard deviations ranging from .31 – .46. Conclusion: Our study supports earlier research regarding family burden and mental illness in spouses, however, our results do not indicate that a large proportion of the spouses reach a clinical level of depression.

Impact of hearing impairment on spousal mental health: the Nord-Trondelag Health Study

Previous studies indicate that hearing loss have negative emotional implications also on spouses of the hearing impaired persons. We sought to assess the relationship between hearing impairment and spousal mental health in the general population. Pure tone audiometry and questionnaires were administered to the adult population of Nord-Trøndelag County, Norway (1996-97). In the age group between 20 and 44 years, the number of cases with hearing impairment was very low; thus, this age group was excluded from analyses. In total, 8607 couples with women over 44 years and 9530 couples with men over 44 years were identified. Associations between measured and self-reported hearing impairment and spousal self-reported symptoms of anxiety and depression, and subjective well-being were estimated. Stratified by sex and adjusting for several covariates, mental health in spouses of persons with hearing impairment was compared with that of spouses of persons with normal hearing using the general linear model. Audiometrically measured hearing was not significantly associated with spousal mental health. Moderate relations between self-reported hearing and spousal mental health were observed. Contrary to previous results based on self-reported hearing loss, our results based on audiometry did not indicate severe loss of mental health among spouses of persons with impaired hearing.

Spouses of persons with dementia: Attachment, loss and coping

ABSTRACTThe purpose is to study how spouses of persons with dementia cope with losses and caregiving tasks during thedementia process and how their coping is related to the individual's and the couple's history of attachment. Thesample consists of 28 couples where one of the spouses has dementia. The caregiving spouses, aged 60-87, areinterviewed at an early stage of dementia and are followed up every 6-9 months over a periode of three years.The life situation is continually changing, and coping methods are repeatedly challenged. Coping with lossesand readjustments are dependent upon their need of the partner to feel safe. Different patterns of attachment behaviourare seen. Compulsive caregiving spouses attend to their spouse beyond their needs. Spouses in anxiousattachment often panic and try to fight back the symptoms of dementia. A pattern of compulsive self-sufficiencymanifests itself as arguing or withdrawal from the partner. Secure attachment makes it easier to accept thechanges, keep in contact and care. To understand the strains and coping of the spouses, we need to understandhow dementia triggers patterns of attachment behaviour. They need more than information on dementia andtraining in handling various symptoms. They need empathy and individually adapted interventions.INTRODUCTIONEmerging dementia with gradual mental deterioriationand increasing dependency ending in death, is frighteningto those involved, both to the person himself andto the family. The new situation disturbes an establishedbalance in the relationship and interferes withcommunication. Meaningful mutual contact and sharedmeaning is gradually lost.In the book ‘Living in the Labyrinth’ Diana FrielMcGowin, who had received a diagnosis of dementia,writes: ’My every molecule seems to scream out that Ido, indeed, exist, and that existence must be valued bysomeone! Without someone to walk this labyrinth bymy side, without the touch of a fellow traveller whounderstands my need of self-worth, how can I endurethe rest of this uncharted journey?’ (Cited after Kitwood1997, p. 15). This person is in desperate need ofa secure attachment figure to recognize, help and guideher. In this paper we are focusing on the situation ofthe fellow traveller, the chart reader; the spouse.The burdens of family caregiving for persons withdementia are documented in a great number of studies(Morris &amp; Morris 1993). The tasks of a fellow travellerand navigator in the labyrinth of dementia are, not leastdue to strong personal involvement, also hard toendure. Research does not reveal any clear and simpleconclusions on how coping stategies, social support orprofessional interventions may ease the burden (Zaritet al. 1986). By including attachment theory in theframework of analysis, we hope to come closer tounderstanding changing relationships and how burdensmay be eased.From an outside position it is difficult to ascertainwhat the most heavy burdens are. A distinction has tobe made between objective and subjective burden(Duijnstee 1992, Morris &amp; Morris 1993). The objectiveburden, often measured by severity of dementia symptoms,is not strongly associated with subjective burdenas experienced by the caregiver (George &amp; Gwyther1986, Zarit et al. 1986). ‘Over time the meaning givento a stressor seems more important than its occurence’(Lévesque et al. 1998, p. 253). When the goal of the effortsnot only is to give good care, but also to maintaina relationship, burden may have to be measured bydifferent standards. Objective burden, or elements ofobjective burden, may even be evaluated in positiveterms by the caregiver (Farran et al. 1991, Grafström1994, Motenko 1989). Caregivers may need elementsof ‘the burden’ in order to maintain attachment bondsor to fulfill their obligations. Interventions to take suchburdens away, without considering the underlyingneeds or goals, may interfere with the best interests ofthe caregiver – and of the person with dementia.This article is based upon a study with the purposeof finding

Empathic and Nonempathic Interaction in Chronic Pain Couples

Empathy and empathic response are receiving greater attention in pain research as investigators acknowledge that other forms of interaction may impact the pain process. The purpose of this study was to examine validation and invalidation as forms of empathic and nonempathic responses in chronic pain couples. Participants were 92 couples in which at least one spouse reported chronic musculoskeletal pain. Each couple participated in 2 videotaped interactions about the ways in which the pain has impacted their lives together. Trained raters then coded interactions for each partner's use of validation and invalidation. Couples also completed surveys on spouse responses to pain, marital satisfaction, and perceived spousal support. Correlations demonstrated validation by spouses of persons with pain was associated with punishing, solicitous, and distracting spouse responses to pain, marital satisfaction, and perceived spousal support. In contrast, spouses' invalidation scores were correlated with punishing spouse responses. Exploratory factor analyses were then conducted to determine the extent to which spouses' responses to pain and spouse validation and invalidation loaded on similar factors. Validation and invalidation are more closely related to punishing spouse responses than to solicitous or distracting spouse responses. This work suggests that empathic and nonempathic communication are distinct from solicitous spouse responses. The findings have implications for theoretical and clinical work on social factors in pain.

Spouses' grief before the patient's death: Retrospective experiences related to palliative home care in urban Sweden

Based on the lived experience research model, this study retrospectively explores the experiences of spouses of persons who died after being admitted to palliative home care, in order to achieve a deeper understanding of the meaning(s) of spouses' grief before the patient's death. The context for the study was palliative home care in urban Sweden. The transcripts from interviews with 12 spouses were analysed according to a hermeneutic phenomenological method. Six themes were found: realizing that the partner would soon die, changed relationship, fear-inducing feelings, focusing on doing the utmost for the sick partner, trying to live as usual, and time slipping away while also standing still. These themes were interpreted as aspects of grief: initializing grief, the emergence of grief, lacking the space to grieve, holding grief at a distance, handling grief, and a temporality paradox of grief. Among the most salient aspects of this research was the finding that spouses often put their own feelings at a distance, and endured suffering in silence. This suggests the need for support for spouses that not only aims to enhance their ability to facilitate the end-of-life situation for the sick partner, but also helps them to master their own lives.

Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment

While the deleterious psychosocial and mental health effects of dementia caregiving are firmly established, very little is known about the burdens or psychiatric outcomes of providing care to a spouse with less severe cognitive impairment, such as mild cognitive impairment (MCI). We characterized the nature and level of caregiver burden and psychiatric morbidity in spouses of persons diagnosed with MCI. Interview assessments were completed on a cohort of 27 spouses of persons with a recent diagnosis of MCI. Patient medical records were reviewed to collect information regarding the MCI patient's medical history. Respondents endorsed elevated levels of both task-related responsibilities and subjective caregiver burden. Depression and anxiety symptom levels also showed some elevations. Measures of caregiver burden were significantly associated with depression and anxiety levels. In particular, even after controlling for demographic risk factors for distress, nursing task burden was correlated with elevated depressive symptoms, and greater lifestyle constraints were correlated with higher anxiety levels. Although caregiver burden and psychiatric morbidity levels were lower than those typically observed in family dementia caregiving samples, our findings suggest that MCI caregivers have already begun to experience distress in association with elevated caregiving burden. These individuals may be ideal targets for selective preventive interventions to maximize their psychological well-being as caregiving burdens related to their spouses' cognitive impairment increase.

Clear Speech for Adults with a Hearing Loss: Does Intervention with Communication Partners Make a Difference?

Spouses of persons with hearing loss served as talkers to examine the benefits of clear speech intervention. One talker received intervention on clear speech. A second talker was simply instructed to speak clearly. Each talker was recorded reading sentences in three conditions: conversational speech, clear speech one week postintervention, and clear speech one month postintervention. Speech acoustic measures were obtained. Then the sentences were presented to subjects with normal hearing and subjects with hearing loss to measure speech recognition. Results showed that simply asking a talker to speak clearly was effective in eliciting clear speech; however, providing intervention yielded changes in more speech parameters, more stable changes, and better speech recognition. When listening to the talker who received intervention, subjects with hearing loss achieved the same performance as subjects with normal hearing. However, they performed worse than subjects with normal hearing when listening to the talker who received clear speech instructions only. Individuals with hearing loss would receive speech recognition benefits if their partners were provided with clear speech intervention.

Factors associated with spouse marital satisfaction and mood among persons with chronic back pain

The impact of chronic pain on the spouse has been studied little, despite suggestions that spousal reponses to pain can significantly impact the afflicted person. In the present study, we examined the factors associated with marital satisfaction and affective distress among spouses of persons with chronic back pain. Patient pain and disability in 110 couples were rated by both the spouse and the patient. Using simultaneous multiple regression analysis, disability and pain as rated by both the patient and spouse, employment status of the patient, patient gender, and patient compensation status were examined in terms of their ability to predict spouse affective distress and marital satisfaction.

Lifeworld perspectives on assistive devices: Lived experiences of spouses of persons with stroke

The purpose of this study was to explore how spouses of persons with a disability following stroke describe their lived experiences regarding assistive devices in everyday life. A phenomenological lifeworld approach was used and conversational interviews were conducted with 12 spouses. Their lived experiences of assistive devices were explored in relation to four lifeworld existentials intertwined in everyday life. The results showed that lived body concerns aspects of feelings, habits, and incorporation of the devices with one's own body. The devices are, from the spouses’ perspective, a prerequisite for their partner with stroke living at home. Successively the devices are incorporated into the couples’ homes, and they provide a new view of the environment, aspects related to lived space. The devices bring about a changed relation to lived time, related to past, present, and future. Further, lived human relation concerns changed relationships to husbands/wives with stroke, including a great responsibility due to the devices and their usage. The results also included stigmatizing aspects and a twofold relationship to health professionals regarding participation in decisions about prescribing assistive devices. Understanding the unique meaning of assistive devices from the spouses’ perspective is vital for occupational therapists prescribing such devices.

Evaluation of a Psychoeducational Group for Seronegative Partners and Spouses of Persons with HIV/AIDS

This study evaluated the effectiveness of a time-limited psychoeducational group intervention for cohabiting partners and spouses of persons with HIV/AIDS. The goals of the intervention were to decrease feelings of depression, anxiety, perceived stress, and stigma and to increase perceived social support. A pretest-posttest, quasi-experimental research design was used. A total of 19 partners or spouses received treatment, and 9 partners or spouses were on a waiting list. Multivariate analysis of covariance provided inconclusive evidence of the model’s effectiveness for noninfected spousal and partner caregivers. Despite these results, treatment effect and power analyses support the viability of this treatment method.

The consequences of severe aphasia on the spouses of aphasic people: A description of the adaptation process

Background : Aphasia changes the links an individual has with his/her social milieu. However, information about these changes is sparse as most research on aphasia has been centred on understanding this language disorder and testing treatment methods. Moreover, information about the psycho-social consequences of severe aphasia is even rarer. Aims : To determine the consequences of severe aphasia as experienced by spouses of persons with aphasia. Methods & Procedures : A qualitative phenomenological approach was adopted. Spouses of five persons with relatively longstanding severe aphasia were interviewed with a semi-structured qualitative schedule. The analysis was guided by the data and by a model of the adaptation process. Outcomes & Results : Spouses' perceived sources of stress related to various changes in lifestyle habits more or less explicitly related to the aphasic person's communication impairment. These consequences were experienced in the realms of communication, interpersonal relationships, responsibilities, leisure activities, and finances. Spouses employed coping strategies. These strategies were directly based on the problems they encountered or on the control of the significance of these problems. Spouses experienced various indicators of adaptation such as fatigue, anxiety, discouragement, loss of privacy, social isolation and burden. These consequences, coping strategies, and indications of adaptation were functions of the contextual stimuli of these couples. Conclusions : These results serve to describe how spouses experience lifestyle changes associated to the aphasia in their partner. Speech-language therapy could contribute to minimise the impact of aphasia on both spouses and aphasic people by considering how spouses adapt to aphasia.

Spousal resemblance for history of major depressive episode in the previous year.

There is discrepancy in findings on spousal concordance for major depression. Here we report the risk of depression and its determinants in spouses of persons with or without depression, taking into account several known risk factors for major depression. A random sample of non-institutionalized Finnish individual aged 15-75 years was interviewed in the 1996 National Health Care Survey. The sample included 1708 male-female spouse pairs. Major depressive episode (MDE) during the last 12 months was assessed using the Short Form of the University of Michigan version of the Composite International Diagnostic Interview (the UM-CIDI Short Form). Risk factors were assessed in the same interview. Factors associating with MDE were spouse's MDE, own alcohol intoxication at least once a week and own chronic medical conditions. In addition, there was a strong association between female's current smoking and male's MDE, independently of other risk factors and spousal MDE. The association of MDE with spouses's MDE was not affected by taking into account other assessed risk factors (own or spouse's). The results indicate elevated spouse concordance for MDE independent of the risk factors assessed in the present study.

Perceived Control, Coping, and Expressed Burden among Spouses of Suspected Dementia Patients: Analysis of the Goodness-of-Fit Hypothesis

ABSTRACTThe goodness-of-fit hypothesis contends that distress results due to incongruence between choice of coping strategies and perceived ability to change stressful stimuli. Goal-directed or active coping responses are believed to be most efficacious when the individual believes s/he can change or control perceived threats (i.e., problem-focused coping). Instances in which stressors must be accepted, however, would dictate reliance upon strategies to regulate distress (i.e., emotion-focused coping). Inconsistent support for this facet of Lazarus and Folkman's cognitive phenomenological model was obtained in this study of spouses of suspected dementia patients. The distinction between emotion- and problem-focused coping appears less germane than overall coping efforts relative to perceived control and caregiver burden. In addition, perceived ability to control dementia-related stressors appears to be somewhat independent of coping by caregivers. These findings are discussed in terms of the unique and chronic demands faced by spouses of persons with dementia.

Coping with spinal cord injury: personal and marital adjustment in the Hong Kong Chinese setting.

A cross-sectional retrospective study was carried out with structured questionnaires and semi-structured interviews on 66 persons with spinal cord injury (SCI) and 40 spouses. The study aimed to explore the psychosocial adjustment of Hong Kong Chinese couples at the post SCI stage. An important study interest was the impact of care-giving in spouses of persons with SCI. Three major regional rehabilitation centres and one community resource centre in Hong Kong. A set of psychometric measures tapping different aspects of psychological functioning was included. These were locus of control (Levenson's Internality, Powerful Others, and Chance Scale), perceived social support (Provision of Social Relationship), coping strategies (Ways of Coping Checklist), marital adjustment (Dyadic Adjustment Scale), caregiving burden (Caregiver Burden Inventory), depression (Beck Depression Inventory), life satisfaction (Satisfaction with Life Situation), and social role adjustment (Katz Adjustment Scale - Relative Form). Persons with SCI with pre-injury marriage were more depressed (P<0.05) as compared with those with post-injury marriage. However, the two groups did not differ in terms of satisfaction with life situation and social role dissatisfaction. The spouses in the preinjury marriage reported a significantly higher score in time-dependent burden than those in the post-injury marriage (P<0.05). Care-giving burden was associated with locus of control, social support, and modes of coping (P<0.05). The impact of SCI is a long-lasting effect not limited to the patients but also extending to their spouses. Findings from the adjustment outcomes and coping styles of persons with SCI and their spouses indicate that they are not passive victims. A similar injury may produce different outcomes in different individuals. Rehabilitation professionals should thus be alert to both the couple's differing needs and idiosyncrasies in their helping process.

The Perceived Stress Model of Caregiver Burden: Evidence from spouses of persons with brain injuries.

The Perceived Stress Model of Caregiver Burden: Evidence from spouses of persons with brain injuries.

The Perceived Stress Model of Caregiver Burden: Evidence from spouses of persons with brain injuries.

The Perceived Stress Model of Caregiver Burden: Evidence from spouses of persons with brain injuries.

Designing psychoeducational services for spouses of persons with serious mental illness.

Psychoeducational and support groups for families of mentally ill adults may not be adequately addressing the needs of spouses with mentally ill partners. This paper describes a group psychoeducational approach which has been developed and implemented through collaboration between professionals and well spouses. The high attrition of spouses in a general family psychoeducational group was dramatically reduced in this spouse psychoeducational group. Significant improvements were found in well spouse knowledge about the illness and coping strategies, personal distress, and negative attitudes towards the ill spouse over the 3-month intervention and at 1-year followup. Implications for practitioners and researchers are discussed.

The caregiver career.

The family caregiver role undertaken by spouses of persons with dementia is described as a fatalistic career process with identifiable stages. In the first or Encounter Stage, the caregivers confront the diagnosis and losses of previous lifestyle patterns and acquire home nursing skills. In the middle, or Enduring Stage, caregivers manage extensive care routines and try to cope with social isolation and their mental pain. In the final, or Exit Stage, the career is relinquished to some degree either from death of the ill spouse or institutionalization. The career perspective of caregiving provides a framework for guiding nursing research and practice.

Silent Casualties: Partners, Families, and Spouses of Persons With AIDS

When AIDS is diagnosed, more than one person are affected. Partners, families, and spouses of persons with AIDS (PWAs) also find their lives irrevocably changed by the disease. To date, however, most of the counseling, psychological, and psychiatric literature has focused on the diagnosed PWA and his or her psychosocial needs, with only brief mention of significant others. Although some descriptive literature has recently been published, research on specific programs and types of interventions with significant others of PWAs is virtually nonexistent. This article surveys the literature currently available on needs and support of partners, families, and spouses of PWAs and urges that greater services be provided for these persons, and greater attention be paid to them by researchers.