The 3-phase-model of dyadic adaptation to dementia: why it might sometimes be better to be worse

In the next years and decades, the number of old spousal dyads having to deal with the onset and progression of dementia in one partner will increase significantly. Existing research indicates that caregiving for an ill spouse is related to decreased caregiver well-being and high levels of caregiver stress. In this theoretical paper, we argue that three aspects deserve additional theoretical and empirical attention: (a) Some spousal caregivers seem to exhibit stable pattern of individual well-being, (b) dyads may be able to adapt their ways of supporting each other to maintain a maximum of dyadic autonomy, and (c) the progression of the dementia increasingly compromising the individual autonomy is likely to require different behaviors and skills of the dyad to achieve high levels of dyadic wellbeing. We suggest a 3-phase-model of dyadic adaptation to dementia-related losses of patients’ individual autonomy and discuss adaptive processes in three phases of dementia that may allow stable levels of well-being in caregivers over time. Thereby, our model can integrate existing findings and theories and allows deriving areas of future research

Depressive symptoms in later life: differential impact of social support and motivational processes on depression in individuals with and without cognitive impairment

This study investigates the role of a motivational process based on a composite of four subcomponents (self-efficacy, decision regulation, activation regulation and motivation regulation), as a mediator of the relationship between social support and depression assessed with the Geriatric Depression Scale in cognitively impaired and unimpaired individuals. Participants were 229 adults with a mean age of 74 years (range: 52–94 years). The sample comprised 64 participants diagnosed with mild cognitive impairment (MCI), 47 participants diagnosed with early-stage Alzheimer’s disease (AD), and a group of 118 participants without any cognitive impairment. In this cross-sectional study, bivariate correlations and linear regression models were used to assess the association between the predictor variables and depression. Linear regression models were controlled for age, gender, education, cognitive status, cognitive impairment and activities. In the total sample, social support (β = −0.15, p < 0.05) and motivational processes (β = −0.41, p < 0.001) were significantly associated with depression; the impact of social support was mediated by motivational processes. While motivational processes were associated with depression in all three groups (no impairment: β = −0.61, p < 0.001; MCI: β = −0.28, p < 0.05; early AD: β = −0.30, p < 0.06), social support lost significance (no impairment: β = −0.36, p < 0.001; MCI: β = 0.07, p = 0.59; early AD: β = −0.08, p = 0.62). Based on these findings, it can be argued that the impact of social support on depressive symptoms is attenuated by cerebral deterioration in cognitively impaired individuals, while motivational processes remain relevant