The Longitudinal Effects of Caregiver Grief in Dementia and the Modifying Effects of Social Services: A Prospective Cohort Study

​Background
Caregivers of persons with dementia (PWD) can experience loss and grief long before the death of thePWD, with such caregiver grief postulated to affect the well-being of the PWD-carefiver dyads. However, the longitudinal effects of caregiver grief and the moderating effects of social services are not yet clear.

Objectives

We investigated the longitudinal effects of caregiver grief on caregiver depression, caregivers' quality of life (QoL), and caregivers' perceived positive aspects of caregiving (PAC); and examined potential effect modification of social service utilization (dementia care services, caregiver programs, and paid caregivers).

Deisgn and Setting

A prospective cohort study with three time points of assessments (at 0, 6, and 12 months).

Participants

Family caregivers of community-dwelling PWD (n = 178).

Measurements

At time point 1 (baseline), participants completed questionnaires that captured caregiver grief, burden, and social service utilization. Outcomes that were captured over time were: depression (time point 1 -3), QoL (time point 2), and PAC (time point 3). Caregiver grief as well as interaction terms with social service utilization were incliuded in Tobit regression to examine the association with outcomes.

Results
After accounting for the effect of caregiver burden, caregiver grief remained associated with depressive symptoms (P < .001) and poorer QoL (P < .001). However, compared with burden, grief contributed to larger magnitudes of the adverse effects. gried, not burden, was associated with less PAC (P = .006 and P = .746, respectively). Dementia care services attenuated the effect of burden but not griefl caregiver programs did not affect burden but appeared to aggravate the effect of grief; and paid caregivers attenuated the effect of burden, and partially attenuated the effect of grief.

Conclusion
Caregiver grief has an impact on dementia caregivers, likely through a distinct mechanism from that of caregiver burden. However, prevailing social services may not be sufficient to address grief, highlighting the need to further train care workers in this respect.

SOURCE:
Journal of the American Geriatrics Society

DOI:
https://doi.org/10.1111/jgs.16717

AUTHOR(S):
Liew TM, Tai BC, Wee SL, Koh GC, Yap PLK