Caregiver Coping Strategies Predict Cognitive and Functional Decline in Dementia: The Cache County Dementia Progression Study

• Published in: The American journal of geriatric psychiatry Vol. 21; no. 1; pp. 57 - 66
• Main Authors: Tschanz, JoAnn T., Ph.D, Piercy, Kathleen, Ph.D, Corcoran, Chris D., Sc.D, Fauth, Elizabeth, Ph.D, Norton, Maria C., Ph.D, Rabins, Peter V., M.D., M.P.H, Tschanz, Brian T., Ph.D, Deberard, M. Scott, Ph.D, Snyder, Christine, B.A, Smith, Courtney, B.S, Lee, Lester, B.S, Lyketsos, Constantine G., M.D., M.H.S
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 2013; Elsevier Limited
• Subjects: Adaptation, Psychological; Aged; Aged, 80 and over; Alzheimer disease; caregiver coping; Caregivers - psychology; Cognition Disorders - complications; Cognition Disorders - psychology; cognitive decline; Dementia; Dementia - complications; Dementia - nursing; Dementia - psychology; dementia caregiving; dementia progression; Disease Progression; Female; functional decline; Humans; Internal Medicine; Male; problem-focused coping; Prospective Studies; Severity of Illness Index; stress coping; functional decline; dementia caregiving; stress coping; Alzheimer disease; problem-focused coping; dementia; cognitive decline; dementia progression; caregiver coping
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2012.10.005

Objectives Few longitudinal studies have studied the influence of the care environment on the clinical progression of dementia. We examined whether caregiver coping strategies predict dementia progression in a population-based sample. Design Longitudinal, prospective cohort study. Setting Cache County (Utah) population. Participants A total of 226 persons with dementia, and their caregivers, were assessed semiannually for up to 6 years. Measurements Ways of Coping Checklist–Revised, Mini-Mental State Examination (MMSE), and Clinical Dementia Rating (CDR). Results Mean (SD) age of dementia onset in persons with dementia was 82.11 (5.84) years and mean caregiver age was 67.41 (13.95) years. Mean (SD) follow-up was 1.65 (1.63) years from baseline. In univariate linear mixed-effects models, increasing use of problem-focused and counting blessings by caregivers was associated with slower patient worsening on the MMSE. Problem-focused coping, seeking social support, and wishful thinking were associated with slower Clinical Dementia Rating Scale sum of boxes (CDR-sb) worsening. Considering covariates, increasing use of problem-focused coping was associated with 0.70 points per year less worsening on the MMSE and 0.55 points per year less worsening on the CDR-sb. Compared with no use, the “regular” use of this strategy was associated with 2 points per year slower worsening on the MMSE and 1.65 points per year slower worsening on the CDR-sb. Conclusions Caregiver coping strategies are associated with slower dementia progression. Developing interventions that target these strategies may benefit dementia patients.