Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-25T06:44:31.030Z Has data issue: false hasContentIssue false
  • English
  • Français

Decreasing sense of coherence and its determinants in spousal caregivers of persons with mild Alzheimer's disease in three year follow-up: ALSOVA study

Published online by Cambridge University Press:  21 March 2014

Tarja Välimäki ,
Janne Martikainen ,
Kristiina Hongisto ,
Mikael Fraunberg ,
Ilona Hallikainen ,
Juhani Sivenius ,
Katri Vehviläinen-Julkunen ,
Anna-Maija Pietilä  and
Anne M. Koivisto
Tarja Välimäki*
Affiliation:
Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
Janne Martikainen
Affiliation:
School of Pharmacy, University of Eastern Finland, Kuopio, Finland
Kristiina Hongisto
Affiliation:
School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
Mikael Fraunberg
Affiliation:
Neurosurgery of Neuro Centre, Kuopio University Hospital, Kuopio, Finland Neurology of Neuro Centre, Kuopio University Hospital, Finland
Ilona Hallikainen
Affiliation:
School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
Juhani Sivenius
Affiliation:
School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland
Katri Vehviläinen-Julkunen
Affiliation:
Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
Anna-Maija Pietilä
Affiliation:
Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
Anne M. Koivisto
Affiliation:
School of Medicine, Institute of Clinical Medicine, Neurology, University of Eastern Finland, Kuopio, Finland Neurology of Neuro Centre, Kuopio University Hospital, Finland
*
Correspondence should be addressed to: Tarja Välimäki, University of Eastern Finland, Department of Nursing Science, P.O. Box 1627, 70211 Kuopio, Finland. Phone: +358 403552267; Fax: +358 17 162632. Email: tarja.valimaki@uef.fi.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Sense of coherence (SOC) is associated with the capability to cope with caregiving. Our aims were (1) to describe the trajectory of SOC in aged spousal caregivers of persons with mild Alzheimer's disease (AD) in 3-year follow-up and (2) to identify baseline determinants influencing SOC change.

Methods:

Both AD (n = 170) (CDR-SOB, MMSE, NPI, ADCS-ADL) and caregiver- (n = 170) (BDI, SOC) related efficacy parameters were evaluated annually. Follow-up time was 3 years. The relationship of potential baseline factors with longitudinal SOC was analyzed using linear mixed models.

Results:

The mean drop-out-adjusted SOC score (148.5 at baseline) was decreased by 4.56 points (p = 0.002) during the follow-up. Caregivers’ depression at baseline predicted the significant decrease of SOC (every + 1 BDI point decreases 2.181 points in SOC, p = 0.0001). When caregiver's depression was not taken into account in the analysis, female gender, and higher age and AD patient's lower baseline MMSE were associated significantly (p < 0.05) with decreasing SOC score in the follow-up. Other studied covariates were not associated with SOC change.

Conclusions:

SOC is not as stable as expected, but decreases during long-lasting caregiving. Caregiver's depression at baseline predicts SOC decrease over time. In the future, caregiver dependent factors should be evaluated at the beginning of caregiving to target individualized support programmes to the vulnerable caregivers.

Keywords

Alzheimer's diseasecarersdepressionsense of coherence
Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 7 , July 2014 , pp. 1211 - 1220
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Andrén, S. and Elmståhl, S. (2005). Family caregiver's subjective experiences of satisfaction in dementia care: aspects of burden, subjective health and sense of coherence. Scandinavian Journal of Caring Sciences, 19, 157–168. doi: 10.1111/j.1471-6712.2005.00328.x.CrossRefGoogle ScholarPubMed
Andrén, S. and Elmståhl, S. (2008). The relationship between caregiver burden, caregivers’ perceived health and their sense of coherence in caring for elders with dementia. Journal of Clinical Nursing, 17, 790–799. doi: 10.1111/j.1365-2702.2007.02066.x.CrossRefGoogle ScholarPubMed
Antonovsky, A. (1987). Unravelling the Mystery of Health. How people manage stress and stay well. San Francisco: Jossey-Bass.Google Scholar
Antonovsky, A. (1998). The Sense of Coherence: a Historical and Future Perspective. In McCubbin, H., Thompson, E., Thompson, A. and Fromer, J., (Eds.), (Stress, coping, and health in families (pp. 3–20). London: Sage Publications, Inc. Google Scholar
Antonovsky, A. (1993). Complexity, conflict, chaos, coherence, coercion and civility. Social Science and Medicine, 37, 969–981. doi: 10.1016/0277-9536(93)90427-6.CrossRefGoogle ScholarPubMed
APA. (1994) Diagnostic and Statistical manual of Mental Disorders. Washington, DC: American Psychiatric Association.Google Scholar
Beck, A., Ward, C., Mendelson, M., Mock, J. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 571. doi:10.1001/archpsyc.1961.01710120031004.CrossRefGoogle ScholarPubMed
Berger, G., Bernhardt, T., Weimer, E., Peters, J., Kratzsch, T. and Frolich, L. (2005). Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients. Journal of Geriatric Psychiatry and Neurology, 18, 119–128. doi: 10.1177/0891988704273375.CrossRefGoogle ScholarPubMed
Brodaty, H. and Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217–228.CrossRefGoogle ScholarPubMed
Chumbler, N. R., Rittman, M. R. and Wu, S. S. (2008). Associations in sense of coherence and depression in caregivers of stroke survivors across 2 years. Journal of Behavioral Health Services and Research, 35, 226–234. doi: 10.1007/s11414-007-9083-1.CrossRefGoogle Scholar
Cummings, J., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 2308–2314. doi: 10.1212/WNL.44.12.2308.CrossRefGoogle ScholarPubMed
Dezutter, J., Wiesmann, U., Apers, S. and Luyckx, K. (2013). Sense of coherence, depressive feelings and life satisfaction in older persons: a closer look at the role of integrity and despair. Aging and Mental Health, 17, 839–843. doi: 10.1080/13607863.2013.792780 CrossRefGoogle Scholar
Ekwall, A. K. and Hallberg, I. R. (2007.) The association between caregiving satisfaction, difficulties and coping among elderly family caregivers. Journal of Clinical Nursing, 16, 832–844. doi: 10.1111/j.1365-2702.2006.01382.x.CrossRefGoogle Scholar
Eriksson, M. and Lindström, B. (2005). Validity of Antonovsky's sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health, 59, 460–466. doi: 10.1136/jech.2003.018085.CrossRefGoogle ScholarPubMed
Eriksson, M. and Lindström, B. (2006). Antonovsky's sense of coherence and relation with health: a systematic review. Journal of Epidemiology and Community Health, 60, 376–381. doi:10.1136/jech.2005.041616.CrossRefGoogle ScholarPubMed
Eriksson, M. (2007). Unravelling the mystery of salutogenesis. Research report 2007:1, Turku: Folkhälsan research centre. Health promotion research programme.Google Scholar
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state”. a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198. doi: 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Galasko, D., Bennet, D., Sano, M., Ernesto, C., Thomas, R., Grundman, M. and Ferris, S. (1997). An Inventory to assess activities of daily living for clinical trials in Alzheimer's disease. Alzheimer Disease and Associated Disorders, 11, S33–39.CrossRefGoogle ScholarPubMed
Germain, S. et al. (2009). Does cognitive impairment influence burden in caregivers of patients with Alzheimer's disease? Journal of Alzheimer's Disease, 17, 105–114. doi: 10.3233/JAD-2009-1016.CrossRefGoogle ScholarPubMed
Goldberg, D. and Hillier, V. (1979) A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139–145. doi:10.1017/S0033291700021644.CrossRefGoogle ScholarPubMed
Helvik, A.-S., Engedal, K. and Selbæk, G. (2013). Change in sense of coherence (SOC) and symptoms of depression among old non-demented persons 12 months after hospitalization. Archives of Gerontology and Geriatrics, 56, 314–320. doi:10.1016/j.archger.2012.10.010.CrossRefGoogle ScholarPubMed
Hughes, C., Berg, L., Danziger, W., Coben, L. and Martin, R. (1982). A New clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566–572. doi:10.1192/bjp.140.6.566.CrossRefGoogle ScholarPubMed
Karttunen, K. et al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. Journal of Geriatric Psychiatry, 26 (5), 473–482.CrossRefGoogle ScholarPubMed
Lindmark, U., Stenström, U., Gerdin, E. W. R. and Hugoson, A. (2010). The distribution of “sense of coherence” among Swedish adults: a quantitative cross-sectional population study. Scandinavian Journal of Public Health, 38, 1–8. doi: 10.1177/1403494809351654.CrossRefGoogle ScholarPubMed
Lindström, B. and Eriksson, M. (2005). Salutogenesis. Journal of Epidemiology and Community Health, 59, 440–442. doi:10.1136/jech.2005.034777.CrossRefGoogle ScholarPubMed
Lindström, B. and Eriksson, M. (2010). The Hitchiker's guide to salutogenesis. Research report 2101:2, Helsinki: Folkhälsan research center. Health promotion research.Google Scholar
Lindström, B. and Eriksson, M. (2010). A Salutogenic Approach to tackling health Inequalities. In Morgan, A., Davies, M., Ziglio, E., (Eds.), Health Assets in a Global Context: Theory, Methods, Action. New York: Springer. doi: 10.1007/978-1-4419-5921-8.Google Scholar
Lundman, B. et al. (2010). Sense of coherence (SOC) related to health and mortality among the very old: The Umeå 85+ study. Archives of Gerontology and Geriatrics, 51, 329–332. doi: 10.1016/j.archger.2010.01.013 CrossRefGoogle ScholarPubMed
Lövheim, H., Graneheim, U. H., Jonsén, E., Strandberg, G. and Lundman, B. (2013). Changes in sense of coherence in old age - a 5-year follow-up of the Umeå 85+ study. Scandinavian Journal of Caring Sciences, 27, 13–19. doi: 10.1111/j.1471-712.2012.00988.x.CrossRefGoogle ScholarPubMed
McKhann, G., Drachman, D. and Folstein, M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939–944. doi: 10.1212/WNL.34.7.939.CrossRefGoogle ScholarPubMed
Mittelman, M. S., Brodaty, H., Wallen, A. S. and Burns, A. (2008). A three-country randomized controlled trial of a psychosocial intervention for caregivers combined with pharmacological treatment for patients with Alzheimer disease: Effects on caregiver depression. American Journal of Geriatric Psychiatry, 16, 893–904. doi: 10.1097/JGP.0b013e3181898095.CrossRefGoogle ScholarPubMed
Morris, J. (1993) The CDR: current version and scoring rules. Neurology, 43, 2412–2413.CrossRefGoogle ScholarPubMed
Nilsson, B., Holmgren, L., Stegmayr, B. and Westman, G. (2003). Sense of coherence - Stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study. Scandinavian journal of Public Health, 31, 297–304. doi: 10.1080/14034940210164920.CrossRefGoogle Scholar
Nilsson, K., Leppert, J., Simonsson, B. and Starrin, B. (2010). Sense of coherence and psychological well-being: improvement with age. Journal of Epidemiology and Community Health, 64, 347–352. doi:10.1136/jech.2008.081174.CrossRefGoogle ScholarPubMed
O'Bryant, S. E. et al. (2008). Staging dementia using clinical dementia rating scale sum of boxes scores: a Texas Alzheimer's research consortium study. Archives of Neurology, 65, 1091–1095. doi:10.1001/archneur.65.8.1091.CrossRefGoogle ScholarPubMed
Orgeta, V. and Lo Sterzo, E. (2013). Sense of Coherence, burden, and affective symptoms in family carers of people with dementia. International Psychogeriatrics, 25, 973–980. doi: 10.1017/S1041610213000203.CrossRefGoogle ScholarPubMed
Pinquart, M. and Sörensen, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 58B, P112–28. doi: 10.1093/geronb/58.2.P112.CrossRefGoogle Scholar
Pretorius, C., Walker, S. and Heyns, PM. (2009). Sense of coherence amongst male caregivers in dementia: a South African perspective. Dementia, 8, 79–94. doi: 10.1177/1471301208099046.CrossRefGoogle Scholar
Quinn, C., Clare, L. and Woods, B. (2009). The impact of the quality of relationship on the experiences and wellbeing of caregivers of people with dementia: a systematic review. Aging & Mental Health, 13, 143–154. doi:10.1080/13607860802459799.CrossRefGoogle ScholarPubMed
Raitasalo, R. (2007). Mood questionnaire. Finnish modification of the short form of the Beck Depression Inventory measuring depression symptoms and self-esteem. The Social Insurance Institution, Finland, Studies in social security and health 86. Vammala: Vammalan kirjapaino.Google Scholar
Sintonen, H. (2001) The 15D instrument of health-related quality of life: properties and applications. Annals of Medicine, 33, 328–336. doi: 10.3109/07853890109002086.CrossRefGoogle ScholarPubMed
Suominen, S., Helenius, H., Blomberg, H., Uutela, A. and Koskenvuo, M. (2001). Sense of coherence as a predictor of subjective state of health results of 4 years of follow-up of adults. Journal of Psychosomatic Research, 50, 77–86. doi: 10.1016/S0022-3999(00)00216-6.CrossRefGoogle ScholarPubMed
Volanen, S.-M., Suominen, S., Lahelma, E., Koskenvuo, M and Silventoinen, K. (2007). Negative life events and stability of sense of coherence: a five-year follow-up study of Finnish women and men. Scandinavian Journal of Psychology, 48, 433–441. doi: 10.1111/j.1467-9450.2007.00598.x CrossRefGoogle ScholarPubMed
Välimäki, T., Vehviläinen-Julkunen, K., Pietilä, A-M. and Pirttilä, T. (2009). Caregiver depression is associated with a low sense of coherence and health-related quality of life. Aging & Mental Health, 13, 799–807. doi: 10.1080/13607860903046487.CrossRefGoogle ScholarPubMed
Wiesmann, U., Niehärster, G. and Hannich, H. (2009). Subjective health in old age from a salutogenic perspective. British Journal of Health Psychology, 14, 767–787. doi: 10.1348/135910709X413124.CrossRefGoogle ScholarPubMed
Wiesmann, U. and Hannich, H. (2010). A Salutogenic Analysis of Healthy Aging in Active Elderly Persons. Research on Aging, 32, 349–371. doi: 10.1177/0164027509356954.CrossRefGoogle Scholar
Wiesmann, U. and Hannich, H.-J. (2011). A salutogenic analysis of developmental tasks and ego integrity vs. despair. International Journal of Aging and Human Development, 73, 351–369. doi: 10.2190/AG.73.4.e CrossRefGoogle ScholarPubMed
Zarit, S. H., Femia, E. E., Kim, K. and Whitlatch, C. J. (2010). The structure of risk factors and outcomes for family caregivers: implications for assessment and treatment, Aging & Mental Health, 14, 220–231. doi: 10.1080/13607860903167861.CrossRefGoogle ScholarPubMed