Objectives

Heavy demands upon dementia caregivers can lead to a number of poor health outcomes including declines in physical, mental, and brain health. Although dementia affects people from all backgrounds, research in the US has largely focused on European American caregivers. This has made providing culturally-competent care more difficult. This study begins to address this issue by empirically examining how culturally-shaped beliefs can influence loneliness in family caregivers of people with dementia.

Methods

We conducted a preliminary questionnaire study with Chinese American and European American family caregivers of people with dementia (N = 72).

Results

Chinese American caregivers were more concerned than European American caregivers about losing face, which in turn, was associated with greater loneliness. This pattern remained when accounting for caregiver gender, age, and relationship to the person with dementia.

Conclusions

These preliminary findings highlight the role that cultural beliefs can play in adverse caregiver outcomes, and suggest that addressing concerns about losing face may be an important way for healthcare providers to help reduce loneliness among Chinese American caregivers.

Clinical implications

Understanding how cultural beliefs influence caregiver outcomes is critical as healthcare professionals work to provide culturally-competent care and design culturally-sensitive interventions.

Responding prosocially to the emotion of others may become increasingly important in late life, especially as partners and friends encounter a growing number of losses, challenges, and declines. Facial expressions are important avenues for communicating empathy and concern, and for signaling that help is forthcoming when needed. In a study of young, middle-aged, and older adults, we measured emotional responses (facial expressions, subjective experience, and physiological activation) to a sad, distressing film clip and a happy, uplifting film clip. Results revealed that, relative to younger adults, older adults showed more sadness and confusion/concern facial expressions during the distressing film clip. Moreover, for older adults only, more sadness and fewer disgust facial expressions during the distressing film clip were associated with higher levels of relational connectedness. These findings remained stable when accounting for subjective emotional experience, physiological activation, and trait empathy in response to the film clip. When examining the uplifting film clip, older adults showed more happiness facial expressions relative to younger adults at trend levels. More facial expressions of happiness were associated with higher levels of relational connectedness, but unlike the effect of sadness expressions, this was not moderated by age. These findings underscore an important adaptive social function of facial expressions-particularly in response to the distress of others-in late life. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Dementia and other neurodegenerative diseases cause profound declines in functioning; thus, many patients require caregivers for assistance with daily living. Patients differ greatly in how long they live after disease onset, with the nature and severity of the disease playing an important role. Caregiving can also be extremely stressful, and many caregivers experience declines in mental health. In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient-caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). These findings highlight the importance of caring for caregivers as well as patients when attempting to improve patients' lives.

Interpersonal distance is central to communication and complex social behaviors but the neural correlates of interpersonal distance preferences are not defined. Previous studies suggest that damage to the orbitofrontal cortex (OFC) is associated with impaired interpersonal behavior. To examine whether the OFC is critical for maintaining appropriate interpersonal distance, we tested two groups of patients with OFC damage: Patients with OFC lesions and patients with behavioral variant frontotemporal dementia. These two groups were compared to healthy controls and to patients with lesions restricted to the dorsolateral prefrontal cortex. Only patients with OFC damage showed abnormal interpersonal distance preferences, which were significantly different from both controls and patients with dorsolateral prefrontal damage. The comfortable distances these patients chose with strangers were significantly closer than the other groups and resembled distances normally used with close others. These results shed light on the role of the OFC in regulating social behavior and may serve as a simple diagnostic tool for dementia or lesion patients.

Dementia and other neurodegenerative diseases cause profound declines in functioning; thus, many patients require caregivers for assistance with daily living. Patients differ greatly in how long they live after disease onset, with the nature and severity of the disease playing an important role. Caregiving can also be extremely stressful, and many caregivers experience declines in mental health. In this study, we investigated the role that caregiver mental health plays in patient mortality. In 176 patient-caregiver dyads, we found that worse caregiver mental health predicted greater patient mortality even when accounting for key risk factors in patients (i.e., diagnosis, age, sex, dementia severity, and patient mental health). These findings highlight the importance of caring for caregivers as well as patients when attempting to improve patients' lives.

Interpersonal distance is central to communication and complex social behaviors but the neural correlates of interpersonal distance preferences are not defined. Previous studies suggest that damage to the orbitofrontal cortex (OFC) is associated with impaired interpersonal behavior. To examine whether the OFC is critical for maintaining appropriate interpersonal distance, we tested two groups of patients with OFC damage: Patients with OFC lesions and patients with behavioral variant frontotemporal dementia. These two groups were compared to healthy controls and to patients with lesions restricted to the dorsolateral prefrontal cortex. Only patients with OFC damage showed abnormal interpersonal distance preferences, which were significantly different from both controls and patients with dorsolateral prefrontal damage. The comfortable distances these patients chose with strangers were significantly closer than the other groups and resembled distances normally used with close others. These results shed light on the role of the OFC in regulating social behavior and may serve as a simple diagnostic tool for dementia or lesion patients.

Introduction

Caring for a spouse with dementia can be extremely challenging. Many caregivers experience profound declines in well-being; however, others remain healthy.

Objective

This study determined whether the personal pronouns used in interactions between persons with dementia (PWDs) and their spousal caregivers were associated with caregiver well-being.

Methods

Fifty-eight PWDs and their spousal caregivers engaged in a 10-min conversation about an area of disagreement in a laboratory setting. Verbatim transcripts of the conversation were coded using text analysis software, and caregivers and PWDs each received scores for (a) I-pronouns, (b) you-pronouns, and (c) we-pronouns. Caregivers' well-being was assessed using a composite measure of depression, anxiety, burden, and strain.

Results

Results revealed that less use of we-pronouns by caregivers and PWDs and greater use of I-pronouns by PWDs were -associated with lower caregiver well-being.

Conclusions

These findings indicate that less use of pronouns that refer to the couple (we-pronouns used by either partner) and greater use of pronouns that refer to the PWD (I-pronouns used by the PWD) are indicative of caregivers at heightened risk for lower well-being.

We examined age-related changes in emotional behavior in a sample of middle-aged and older long-term married couples over a 13-year period. Data were collected at 3 waves, each occurring 5 to 6 years apart. For the present study, only couples who participated in all 3 waves were examined (n = 87). Couples were either in the middle-aged group (40-50 years old, married at least 15 years) or the older group (60-70 years old, married at least 35 years). At each wave, couples engaged in 15-min unrehearsed conversations about an area of disagreement in their marriage. Emotional behaviors during the conversation were objectively coded using the Specific Affect Coding System. Latent growth curve analyses revealed that, for both husbands and wives, negative emotional behavior (primarily belligerence, defensiveness, fear/tension, and whining) decreased and positive emotional behavior (primarily humor, enthusiasm, and validation) increased with age. Findings generalized across middle-aged and older cohorts and levels of marital satisfaction. These findings support theories that suggest that positive emotion increases and negative emotion decreases with age, expanding upon previous findings by examining objectively coded emotional behaviors longitudinally in an interpersonal context. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objectives

To investigate whether deficits in empathic accuracy (i.e., ability to recognize emotion in others) in patients with neurodegenerative disease are associated with greater depression in their caregivers.

Design

Two cross-sectional studies.

Setting

Academic medical center and research university.

Participants

Two independent samples (N = 172, N = 63) of patients with a variety of neurodegenerative diseases and their caregivers; comparison group of healthy couples.

Measurement

Patients' empathic accuracy was assessed in the laboratory using a novel dynamic tracking task (rating another person's changing emotions over time) and more traditional measures (recognizing the emotion expressed in photographs of facial expressions and by characters in films). Caregivers completed self-report inventories of depression.

Results

Lower empathic accuracy in patients was associated with greater depression in caregivers in both studies. In study 1, this association was found when empathic accuracy was measured using the dynamic tracking measure but not when measured using the more traditional photograph and film measures. In study 2, we found preliminary support for our theoretical model wherein lower empathic accuracy in patients is associated with increased caregiver stress (loneliness, strain, and burden), which in turn is associated with greater caregiver depression.

Conclusions

Caring for a patient with deficits in empathic accuracy is associated with greater loneliness, strain, and burden for caregivers, and increased depression. Caregivers may benefit from interventions designed to compensate for the stress and interpersonal loss associated with patients' declining empathic accuracy.

Objective

To determine whether diagnoses of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and depression, alone or in combination, increase dementia risk among older female veterans.

Methods

This cohort study included data from 109,140 female veterans ≥55 years of age receiving care from Veterans Health Administration medical centers in the United States between October 2004 and September 2015 with at least 1 follow-up visit. TBI, PTSD, depression, and medical conditions at study baseline and incident dementia were determined according to ICD-9-CM codes. Fine-Gray proportional hazards models were used to determine the association between military-related risk factors and dementia diagnosis, accounting for the competing risk of death.

Results

During follow-up (mean 4.0 years, SD 2.3), 4% of female veterans (n = 4,125) developed dementia. After adjustment for demographics and medical conditions, women with TBI, PTSD, and depression had a significant increase in risk of developing dementia compared to women without these diagnoses (TBI-adjusted subdistribution hazard ratio [adjusted sHR] 1.49, 95% confidence interval [CI] 1.01-2.20; PTSD adjusted sHR 1.78, 95% CI 1.34-2.36; and depression-adjusted sHR 1.67, 95% CI 1.55-1.80), while women with >1 diagnosis had the highest risk for dementia (adjusted sHR 2.15, 95% CI 1.84-2.51).

Conclusions

We found that women with military-related risk factors had an ≈50% to 80% increase in developing dementia relative to women without these diagnoses, while female veterans with multiple risk factors had a >2-fold risk of developing dementia. These findings highlight the need for increased screening of TBI, PTSD, and depression in older women, especially female veterans.