Dementia Care

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Vol 5 No 3 June/July 2016 Australian Journal of Dementia Care 37
RESEARCH NEWS
Fiona Calvert reports on the latest published dementia
research from Australia and worldwide
Depression is an established risk factor for
dementia in later life. However, it is
unclear whether depression can directly
cause dementia. A recent Australian study
investigated whether clinically significant
depressive symptoms are likely to cause
cognitive impairment in later life.
The researchers recruited 4568 men aged
between 70 and 89 years without cognitive
impairment at the beginning of the study.
The participants were assessed for
clinically significant depressive
symptoms, which was defined as a score
of seven or more on the Geriatric
Depression Scale (15 items). Participants’
past experiences of depression were
ascertained using electronic medical
records, self-report or use of
antidepressant medication.
During the five-year follow-up, 534 of
the participants developed cognitive
impairment, 811 died and 1455 were lost
from the research.
The presence of clinically significant
depressive symptom at the beginning
of the study was associated with an
increased risk rate of cognitive
impairment and death. However,
history of past clinically significant
depressive symptoms was not associated
with cognitive impairment.
The researchers concluded that the lack
of association between past depression
and cognitive impairment suggests that
the link between depression and cognitive
impairment is not causal and that the
presence of clinically significant
depressive symptoms may instead signal
the onset of cognitive impairment in some
clients.
Almeida OP, Hankey GJ, Yeap BB, Golledge J,
Flicker L (2016) Depression as a risk factor for
cognitive impairment in later life: The Health In
Men cohort study. International Journal of
Geriatric Psychiatry 31(4) 416-424.
Fiona Calvert is
a practising
psychologist,
PhD candidate
and lecturer at
the University
of Wollongong.
Contact her at:
fcalvert@
Depression may signal onset of cognitive impairment
A number of qualitative
research studies have focused
on understanding the spousal
caregiver perspective of living
with a partner diagnosed with
dementia. Researchers from
Victoria have synthesised this
body of research, identifying 16
qualitative studies where
spousal caregiver perspectives
have been investigated
previously.
Verbatim quotes from
participants interviewed in
these studies were collected
and analysed, revealing five
major themes across the
various studies. The theme of
‘loss of partner’ was central.
Participants spoke of their
perceptions of change in their
interaction and the quality of
their relationship, feeling that
their partner had become a
different person. They
frequently reported
experiencing reduced
reciprocity and connectedness,
loss of talking to each other,
and changes in sexual intimacy.
‘Loss of partner’ was also
implicit in comments made
about participants’ transition
from being a spouse to a day-
to-day care provider.
As an additional theme,
participants also spoke of
acknowledging change as part
of the caregiving process.
Specifically, changes in the
person’s behaviours,
personality and interpersonal
skills required understanding
and adjustment by the spousal
caregiver. Linked with this, a
theme of ‘adapting and
adjusting’ emerged. Some
spouses described how they
needed to modify their mindset
and natural responses in given
situations in order to continue
as spousal caregivers, while
still maintaining some level of
emotional connection to their
partners. Spouses in seven of
the 16 studies actively chose to
perform tasks jointly with their
partner who previously had
completed these particular
activities independently.
Participant interviews also
contained a theme of being in
crisis. For most couples, talking
and sharing with their life
partner had been a routine way
of relating to each other.
Spouses reported experiencing
difficulty in maintaining
continuity in their identity as a
husband or wife. This difficulty
was often described in terms of
a crisis in self-identity, usually
reflecting on the nature of their
previously familiar spousal
partnership. Some participants
felt the need to reconstruct the
spousal relationship in ways
that continue to provide them
with meaning to them as a
couple and to their own sense
of self.
Finally, a theme of
‘acceptance of change’ emerged
from the interviews. Spouses
commonly spoke of efforts to
‘move forward’ in their
relationship. For some, this was
a conscious choice, connected
with their personal beliefs and
their previous positive history
as a couple. To keep alive their
identity of being a couple,
spouses commonly helped
their partner to reminisce on
their shared history. Some
spoke of how these efforts were
sustained by glimpses of their
partner’s former self.
Some expressed satisfaction
with caregiving and accepted
their partner unconditionally,
valuing them for their current
self. For these spouses,
reaching a level of acceptance
of their partner’s situation
helped them to find
opportunities to maintain a
connection with their partner.
The researchers concluded
that the pooled findings from
the qualitative interviews
provide insights into the daily
adjustments and experiences of
spousal caregivers, while
highlighting the importance of
considering the impact of
cognitive decline and dementia
in a relational context.
Pozzebon M, Douglas J, Ames D
(2016) Spouses’ experience of living
with a partner diagnosed with a
dementia: a synthesis of the
qualitative research. International
Psychogeriatrics 28(4) 537-556.
Study highlights spouses’ experience