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 well-being. 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 researc

Dyadic Coping Among Couples with COPD: A Pilot Study

COPD (chronic obstructive pulmonary disease) is associated with psychological distress for patients as well as their partners. Dyadic coping can be negatively impacted by stressors. This study's objective was to compare the dyadic coping of couples in which one partner suffered from COPD with healthy couples of the same age. A total of 43 complete couples with COPD and 138 healthy couples participated in this pilot study. The surveys were sent by mail. The response rate of the COPD sample was 24.3%. In order to analyze the effect of gender and role (patient vs. partner) on dyadic coping, linear mixed models were calculated. To analyze the effect of gender and group (COPD group vs. normative comparison group) on dyadic coping, two-way analyses of variance were calculated for independent samples. COPD patients and their partners indicated that the patients received more support and were less able to provide support to their partners. This difference was also evident in comparison with the normative comparison group. In addition, couples with COPD perceived higher levels of negative coping and provided a considerably lower assessment of their positive dyadic coping. The dyadic coping of couples with COPD is unbalanced and more negative when compared to that of healthy couples. Interventions aimed at supporting COPD couples should seek to improve couples' dyadic coping in addition to individual coping strategie

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5–5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4–10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32–4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification

Older spouses' long-term relationships : dyadic interaction as a resource for cognitive performance and relationship satisfaction

The present thesis focuses on adaptation processes of spousal social support in couples aged 60 and older. The two main questions are in what way spousal cognitive collaboration (i.e., dyadic cognition) can be seen as a resource for older couples’ cognitive performance and to what extent spousal mutual emotional support (i.e., dyadic coping) is a resource for older couples’ relationship satisfaction. Even though the focus of this thesis is on healthy couples’ resources, I also briefly discuss adaptation processes in dyads confronted with severe illness. The thesis begins with a definition of the central constructs followed by an overview of the development of dyadic cognition and dyadic coping over the lifespan. Based on this summary of the current state of the art, four open questions are identified. These questions are addressed in the following four studies of which study 1 reviews paradigms that have been used to study cognitive collaboration in old dyads. Study 2 is an experimental study focusing on older long-term married couples’ dyadic cognition on a complex problem solving task and examining to what extent dyadic cognition is a resource for these couples’ cognitive performance. Based on findings showing that cognition also depends on emotional processes (for example Blessing, Martin, Wenz, & Zöllig, 2006) and because when analyzing intimate dyads such as couples, emotional aspects demand attention, in study 3 the focus will be on the question if dyadic coping can be a resource for older couples’ relationship satisfaction. Study 4 then is an extension into the field of older couples who are confronted with dementia. The paper presents a conceptual model that shows possible adaptation processes in caregiver – care receiver dyads. The last part of this thesis consists of a general discussion relating the findings of the four studies to each other as well as considering methodological and practical implications and consequences for future studies. In der vorliegenden Dissertation liegt der Fokus auf Adaptationsprozessen der partnerschaftlichen sozialen Unterstützung bei älteren Ehepaaren. Die beiden Hauptfragestellungen sind, inwiefern die partnerschaftliche kognitive Zusammenarbeit (dyadische Kognition) als Ressource für die kognitive Leistungsfähigkeit älterer Ehepaare angesehen werden kann und inwiefern die partnerschaftliche emotionale Unterstützung (dyadisches Coping) eine Ressource für die Partnerschaftszufriedenheit sein kann. Obwohl der Schwerpunkt dieser Dissertation auf körperlich und psychisch gesunden älteren Paaren liegt, gehe ich auch kurz auf Adaptionsprozesse solcher Dyaden ein, die von einer schweren Erkrankung betroffen sind. Die Dissertation beginnt mit der Definition zentraler Begriffe gefolgt von einem Überblick über die Entwicklung der dyadischen Kognition und des dyadischen Copings über die Lebensspanne. Auf der Grundlage dieser Zusammenfassung des aktuellen Forschungsstandes werden vier offene Fragestellungen herausgearbeitet. Im Folgenden widmen sich vier verschiedene Studien den vier Fragestellungen, wobei die erste Studie ein Überblicksartikel über die wichtigsten Paradigmen zur Analyse von dyadischer Kognition ist und die zweite Studie aus einem Experiment zur Untersuchung der dyadischen Kognition älterer, langverheirateter Ehepaare bei einer komplexen Problemlöseaufgabe besteht. Basierend auf Ergebnissen, die zeigen, dass Kognition auch von emotionalen Prozessen abhängt (z. B. Blessing, Martin, Wenz, & Zöllig, 2006) und weil es bei der Erforschung von Partnerschaften der Beachtung emotionaler Prozesse bedarf, wird in der dritten Studie analysiert, inwiefern dyadisches Coping als Ressource für die Partnerschaftszufriedenheit angesehen werden kann. Die vierte Studie ist mit der Betrachtung von Ehepaaren, die von einer Demenz betroffen sind, eine Erweiterung dieser Dissertation ins Forschungsgebiet der klinischen Psychologie. In dem theoretischen Artikel wird ein konzeptuelles Modell vorgestellt, welches mögliche Adaptionsprozesse in sogenannten „caregiver – care receiver“ Dyaden aufzeigt. Der letzte Teil der Dissertation besteht aus einer abschliessenden Diskussion in welcher die Resultate der vier Studien miteinander in Verbindung gesetzt werden. Methodologische und praktische Implikationen sowie Konsequenzen für zukünftige Studien werden in diesem letzten Teil ebenfalls beschrieben

Dyadic coping and marital satisfaction of older spouses in long-term marriage

The present study examines the association between coping behavior and their relationship satisfaction in older spousal dyads. We examined N = 132 couples (M age = 68 years) and found that their dyadic coping strategies – a prime indicator of functional adaptation to daily stress in marital context – were significantly linked to relationship satisfaction. Our findings suggest that the partner’s subjective perception of their spouse’s supportive behavior was more strongly linked to their relationship satisfaction than to their self-reported support. Furthermore, individual support perception was more important for marital satisfaction than coping congruency. Overall, the dyadic coping of older adults may serve as an effective tool to stabilize relationship satisfaction when facing the challenges of older age and long-term marriage

Commitment and Dyadic Coping in Long-Term Relationships

Landis M, Bodenmann G, Bradbury TN, et al. Commitment and Dyadic Coping in Long-Term Relationships. GeroPsych: The Journal of Gerontopsychology and Geriatric Psychiatry. 2014;27(4):139-149

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

Dyadic coping among couples with COPD: a pilot study

COPD (chronic obstructive pulmonary disease) is associated with psychological distress for patients as well as their partners. Dyadic coping can be negatively impacted by stressors. This study's objective was to compare the dyadic coping of couples in which one partner suffered from COPD with healthy couples of the same age. A total of 43 complete couples with COPD and 138 healthy couples participated in this pilot study. The surveys were sent by mail. The response rate of the COPD sample was 24.3%. In order to analyze the effect of gender and role (patient vs. partner) on dyadic coping, linear mixed models were calculated. To analyze the effect of gender and group (COPD group vs. normative comparison group) on dyadic coping, two-way analyses of variance were calculated for independent samples. COPD patients and their partners indicated that the patients received more support and were less able to provide support to their partners. This difference was also evident in comparison with the normative comparison group. In addition, couples with COPD perceived higher levels of negative coping and provided a considerably lower assessment of their positive dyadic coping. The dyadic coping of couples with COPD is unbalanced and more negative when compared to that of healthy couples. Interventions aimed at supporting COPD couples should seek to improve couples' dyadic coping in addition to individual coping strategies

Transforming knowledge systems for life on Earth : Visions of future systems and how to get there

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent.Peer reviewe

Transforming knowledge systems for life on Earth: Visions of future systems and how to get there

Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent