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Perceived stress and quality of life in dementia patients and their caregiving spouses: does dyadic coping matter?

Published online by Cambridge University Press:  21 July 2016

Andreas Häusler ,
Alba Sánchez ,
Paul Gellert ,
Friederike Deeken ,
Michael A. Rapp  and
Johanna Nordheim
Andreas Häusler*
Affiliation:
Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
Alba Sánchez
Affiliation:
Gerontology Research Group, Deparment of Medicine, Faculty of Health Sciences, University of A Coruña, A Coruña, Spain
Paul Gellert
Affiliation:
Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
Friederike Deeken
Affiliation:
Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
Michael A. Rapp
Affiliation:
Department of Social and Preventive Medicine, University of Potsdam, Potsdam, Germany
Johanna Nordheim
Affiliation:
Institute of Medical Sociology and Rehabilitation Science, Charité – Universitätsmedizin Berlin, Berlin, Germany
*
Correspondence should be addressed to: Andreas Häusler, MA, Department of Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany. Phone: +49 (0)331/9771050. Email: [email protected].
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Abstract

Background:

Given the well-established association between perceived stress and quality of life (QoL) in dementia patients and their partners, our goal was to identify whether relationship quality and dyadic coping would operate as mediators between perceived stress and QoL.

Methods:

82 dyads of dementia patients and their spousal caregivers were included in a cross-sectional assessment from a prospective study. QoL was assessed with the Quality of Life in Alzheimer's Disease scale (QoL-AD) for dementia patients and the WHO Quality of Life-BREF for spousal caregivers. Perceived stress was measured with the Perceived Stress Scale (PSS-14). Both partners were assessed with the Dyadic Coping Inventory (DCI). Analyses of correlation as well as regression models including mediator analyses were performed.

Results:

We found negative correlations between stress and QoL in both partners (QoL-AD: r = −0.62; p < 0.001; WHO-QOL Overall: r = −0.27; p = 0.02). Spousal caregivers had a significantly lower DCI total score than dementia patients (p < 0.001). Dyadic coping was a significant mediator of the relationship between stress and QoL in spousal caregivers (z = 0.28; p = 0.02), but not in dementia patients. Likewise, relationship quality significantly mediated the relationship between stress and QoL in caregivers only (z = −2.41; p = 0.02).

Conclusions:

This study identified dyadic coping as a mediator on the relationship between stress and QoL in (caregiving) partners of dementia patients. In patients, however, we found a direct negative effect of stress on QoL. The findings suggest the importance of stress reducing and dyadic interventions for dementia patients and their partners, respectively.

Keywords

dementiadyadic copingperceived stressquality of life
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 11 , November 2016 , pp. 1857 - 1866
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Amendola, F., Oliveira, M. A. and Alvarenga, M. R. (2011). Influence of social support on the quality of life of family caregivers while caring for people with dependence. Revista da Escola de Enfermagem da USP, 45, 884–889.Google Scholar
Arsenault-Lapierre, G., Whitehead, V., Lupien, S. and Howard, C. (2012). Effects of anosognosia on perceived stress and cortisol levels in Alzheimer's disease. International Journal of Alzheimer's Disease, 2012, 209570.CrossRefGoogle ScholarPubMed
Balducci, C., Melchiorre, M. G., Quattrini, S. and Lamura, G. (2008). Caring for a family members with dementia: evidence from a cross sectional compartative study on caregiver burden and psychological well-being. European Papers on the New Welfare, 9, 182–197.Google Scholar
Bertrand, R. M., Fredman, L. and Saczynski, J. (2006). Are all caregivers created equal? Stress in caregivers to adults with and without dementia. Journal of Aging and Health, 18, 534–551.Google Scholar
Bickel, H. (2012). Epidemiologie und Gesundheitsökonomie. In Wallesch, C. W. and Förstl, H. (eds.), Demenzen (pp. 18–35). Auflage Stuttgart: Georg Thieme Verlag.Google Scholar
Bodenmann, G. (1997). [Stress and coping as process] Stress und coping als prozess. In Tesch-Römer, C., Salewski, C. and Schwarz, G. (eds.), [Psychology of Coping] Psychologie der Bewältigung (pp. 74–92). Weinheim: Beltz.Google Scholar
Bodenmann, G. (2000). Stress und Coping bei Paaren. Göttingen: Hogrefe.Google Scholar
Bodenmann, G. (2008a). [Dyadic coping inventory: manual] dyadisches coping inventar: testmanual. Bern, Switzerland, Huber Atlas of Craniomaxillofacial Fixation. Philadelphia, PA: Lippincott.Google Scholar
Bodenmann, G. (2008b). Dyadic coping and the significance of this concept for prevention and therapy. Zeitschrift für Gesundheitspsychologie 16, 108–111.Google Scholar
Bodenmann, G. and Widmer, K. (2000). [Coping with stress in old age] stressbewältigung im Alter: ein vergleich von paaren jüngeren, mittleren und höheren Alters. Zeitschrift für Gerontologie und Geriatrie, 33, 217–228.Google Scholar
Braun, M., Scholz, U., Bailey, B., Perren, S., Hornung, R. and Martin, M. (2009). Dementia caregiving in spousal relationships: a dyadic perspective. Aging & Mental Health, 13, 426–436.Google Scholar
Brodaty, H. and Hadzi-Pavlovic, D. (1990). Psychosocial effects on carers of living with persons with dementia. Australian and New Zealand Journal of Psychiatry, 24, 351–361.Google Scholar
Bruvik, F. K., Ulstein, I. D., Ranhoff, A. H. and Engedal, K. (2012). The Quality of Life of People with Dementia and Their Family Carers. Dementia and Geriatric Cognitive Disorders, 34, 7–14.Google Scholar
Cheung, D. S., Chien, W. T. and Lai, C. K. (2010). Conceptual framework for cognitive function enhancement in people with dementia. Journal of Clinical Nursing, 20, 1533–1541.Google Scholar
Clare, L. et al. (2012). Marital relationship quality in early-stage dementia: perspectives from people with dementia and their spouses. Alzheimer Disease and Associated Disorders, 26, 148–158.Google Scholar
Cohen, S. and Williamson, G. M. (1988). Perceived stress in a probability sample of the United States. In Spacapan, S. and Oskamp, S. (Eds.), The Social Psychology of Health (pp. 31–67). Newbury Park, CA: Sage.Google Scholar
Cohen, S., Kamarck, T. and Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.Google Scholar
Conde-Sala, J. L., Garre-Olmo, J., Turró-Garriga, O., López-Pousa, S. and Vilalta-Franch, J. (2009). Factors related to perceived quality of life in patients with Alzheimer's disease: the patient's perception compared with that of caregivers. International Journal of Geriatric Psychiatry, 24, 585–594.Google Scholar
de Lima, M. L., Santos, J. L., Sawada, N. O. and de Lima, L. A. (2014). Quality of life of individuals with stroke and their caregivers in a city of Triângulo Mineiro. Revista Brasileira de Epidemiologia, 17, 453–464.Google Scholar
de Vugt, M. E. et al. (2003). Behavioural disturbances in dementia patients and quality of the marital relationship. International Journal of Geriatric Psychiatry, 18, 149–154.Google Scholar
Etters, L., Goodall, D. and Harrison, B. E. (2008). Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners, 20, 423–428.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, D. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D., Dal Canto, P. G., Jacob, T. and Thompson, L. W. (2001). A comparison of marital interaction patterns between couples in which the husband does or does not have Alzheimer's disease. The Journal of Gerontology, Series B: Psychological Sciences & Social Sciences, 56, 140–150.Google Scholar
Gmelch, S., Bodenmann, G., Meuwly, N., Ledermann, T., Steffen-Sozinova, O. and Striegl, K. (2008). Dyadisches coping inventar (DCI): ein fragebogen zur erfassung des partnerschaftlichen Umgangs mit Stress. Zeitschrift für Familienforschung, 20, 185–203.Google Scholar
Grazziano, E. S., Reis, E., Leda, S. and Lopes, L. F. D. (2014). Impact by care guidelines and perception of the quality of life in caregivers of the elderly. Journal of Nursing UFPE on Line, 8, 2823–2832.Google Scholar
Hall, G. R. and Buckwalter, K. C. (1987). Progressively lowered stress threshold: a conceptual model for care of adults with Alzheimer's disease. Archives of Psychiatric Nursing, 1, 399–406.Google Scholar
Hallauer, J. (2004). Home nursing of demented patients as an economic factor in public health. Krankenpflege - Journal, 42, 109–110.Google Scholar
Hayes, A. F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis. A Regression Based Approach. New York: Guilford Press.Google Scholar
Innes, K. E., Selfe, T. K., Brown, C. J., Rose, K. M. and Thompson-Heisterman, A. (2012). The effects of meditation on perceived stress and related indices of psychological status and sympathetic activation in persons with Alzheimer's disease and their caregivers: a pilot study. Evidence-Based Complementary and Alternative Medicine, 2012, 927509.Google Scholar
Kaufman, Y., Anaki, D., Binns, M. and Freedman, M. (2007). Cognitive decline in Alzheimer disease: impact of spirituality, religiosity, and QOL. Neurology, 68, 1509–1514.Google Scholar
Knop, D. S., Bergman-Evans, B. and McCabe, B. W. (1998). In sickness and in health: an exploration of the perceived quality of the marital relationship, coping, and depression in caregivers of spouses with Alzheimer's disease. Journal of Psychosocial Nursing and Mental Health Services, 36, 16–21.Google Scholar
Lawrence, R. H., Tennstedt, S. L. and Assmann, S. F. (1998). Quality of the caregiver–care recipient relationship: does it offset negative consequences of caregiving for family caregivers? Psychology and Aging, 13, 150–158.Google Scholar
Lazarus, R. S. and Folkman, S. (1984). Stress, Coping, and Adaptation. New York: McGraw-Hill.Google Scholar
Ledermann, T. et al. (2010). Psychometrics of the dyadic coping inventory in three language groups. Swiss Journal of Psychology, 69, 201–212.Google Scholar
Lee, D. R., McKeith, I., Mosimann, U., Ghosh-Nodyal, A. and Thomas, A. J. (2013). Examining carer stress in dementia: the role of subtype diagnosis and neuropsychiatric symptoms. International Journal of Geriatric Psychiatry, 28, 135–141.Google Scholar
Lewis, M. L, Hepburn, K., Narayan, S. and Kirk, L. N. (2005). Relationship matters in dementia caregiving. American Journal of Alzheimer's Disease & Other Dementias, 20, 341–347.Google Scholar
Logsdon, R. G., Gibbons, L. E., McCurry, S. M. and Teri, L. (1999). Quality of life in Alzheimer's disease: patient and caregiver reports. Journal of Mental Health and Aging, 5, 21–32.Google Scholar
Majerovitz, S. D. (1995). Role of family adaptability in the psychological adjustment of spouse caregivers to patients with dementia. Psychology and Aging, 10, 447–457.Google Scholar
Martin, M., Peter-Wight, M., Braun, M. R. and Scholz, U. (2009). The 3-phase-model of dyadic adaptation to dementia: why it might sometimes be better to be worse. European Journal of Ageing, 6, 291–301.Google Scholar
McKhann, G. M. et al. (2011). The diagnosis of dementia due to Alzheimer's disease: recommendations from the national institute on aging – Alzheimer's association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer´s & Dementia, 7, 263–269.Google Scholar
Mitchell, A. J., Bird, V., Rizzo, M. and Meader, N. (2010). Which version of the geriatric depression scale is most useful in medical settings and nursing homes? Diagnostic validity meta-analysis. American Journal of Geriatric Psychiatry, 18, 1066–1077.Google Scholar
Moraes, S. R. and Silva, L. S. (2009). An evaluation of the burden of Alzheimer patients on family caregivers. Cadernos de Saúde Pública, 25, 1807–1815.Google Scholar
Norton, R. (1983). Measuring marital quality: a critical look at the dependent variable. Journal of Marriage and the Family, 45, 141–151.Google Scholar
Oken, B. S., Fonareva, I. and Wahbeh, H. (2011). Stress-related cognitive dysfunction in dementia caregivers. Journal of Geriatric Psychiatry and Neurology, 24, 191–198.Google Scholar
Ory, M. G., Hoffman, R. R. 3rd, Yee, J. L., Tennstedt, S. and Schulz, R. (1999). Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. Gerontologist, 39, 177–185.Google Scholar
Perneczky, R., Wagenpfeil, S., Komossa, K., Grimmer, T., Diehl, J. and Kurz, A. (2006). Mapping scores onto stages: mini-mental state examination and clinical dementia rating. American Journal of Geriatric Psychiatry, 14, 139–144.Google Scholar
Perneger, T. V. (1998). What's wrong with Bonferroni adjustments? British Medical Journal, 316, 1236.Google Scholar
Perren, S., Schmid, R. and Wettstein, A. (2006). Caregivers' adaptation to change: the impact of increasing impairment of persons suffering from dementia on their caregivers' subjective well-being. Aging & Mental Health, 10, 539–548.Google Scholar
Pinquart, P. and Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis. Psychology and Aging, 18, 250–267.Google Scholar
Pinquart, P. and Sörensen, S. (2007). Correlates of physical health of informal caregivers: a meta-analysis. Journal of Gerontology: Psychological Sciences, 62B, 126–137.Google Scholar
Polk, D. M. (2005). Communication and family caregiving for Alzheimer's dementia: linking attributions and problematic integration. Health Communication, 18, 257–273.Google Scholar
Quinn, C., Clare, L. and Woods, B. (2009). The impact of the quality of relationship on the experiences and wellbeing of caregivers of people with dementia: a systematic review. Aging Mental Health, 13, 143–154.Google Scholar
Rainer, M., Jungwirth, S., Krüger-Rainer, C., Croy, A., Gatterer, G. and Haushofer, M. (2002). Pflegende angehörige von demenzerkrankten: belastungsfaktoren und deren auswirkungen. Psychiatrische Praxis, 29, 142–147.Google Scholar
Schulz, R. and Martire, L. (2004). Family caregiving of persons with dementia. Prevalence, health effects, and support strategies. The American Journal of Geriatric Psychiatry, 12, 240–249.Google Scholar
Sedgwick, P. (2012). Multiple significance tests: the Bonferroni correction. British Medical Journal, 344, e509.Google Scholar
Sheikh, J. I. and Yesavage, J. A. (1986). Geriatric depression scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist, 5, 165–173.Google Scholar
Shin, I. S., Carter, M., Masterman, D., Fairbanks, L. and Cummings, J. L. (2005). Neuropsychiatric symptoms and quality of life in Alzheimer disease. The American Journal of Geriatric Psychiatry, 13, 469–474.Google Scholar
Thompson, R. L. et al. (2004). Are there sex differences in emotional and biological responses in spousal caregivers of patients with Alzheimer's disease? Biological Research For Nursing, 5, 319–330.Google Scholar
WHOQOL Group (1998). Development of the world health organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28, 551–558.Google Scholar
Woods, R. T. et al. (2014). What contributes to a good quality of life in early dementia? Awareness and the QoL-AD: a cross-sectional study. Health and Quality of Life Outcomes, 12, 94.Google Scholar
World Health Organisation (2015). Dementia. Fact sheet N°362. Available at: http://www.who.int/mediacentre/factsheets/fs362/en/; last access date: 22 January 2016.Google Scholar