Interaction of caregiver-expressed emotions and neuropsychiatric symptoms in persons with dementia: a longitudinal cohort study

Neuropsychiatric symptom-related role and activity restrictions by relatives: focusing on the gender of older adults with suspected dementia

BACKGROUND

As cognitive function declines, relatives may restrict the roles and activities they consider older adults unable to continue independently performing. We examined the characteristics of these role and activity restrictions by relatives among older adults prior to their first visit to a memory clinic for an official diagnosis, focusing on gender and the diagnosis of dementia. Additionally, we examined the relationship between role and activity restrictions by relatives and the presence of neuropsychiatric symptoms (NPS) controlling for older adults' gender.

METHODS

We retrospectively reviewed the medical charts of 213 older adults. First, we calculated descriptive statistics for the characteristics of role and activity restrictions by relatives. Second, we examined the association between these roles and activity restrictions and NPS using multivariate logistic regression analysis controlling for older adults' gender, diagnosis, and presence of a cohabitant.

RESULTS

The rate of role and activity restrictions by relatives was 21.6%. Of the older adults experiencing these restrictions, 78.3% were women, and 34.8% had mild cognitive impairment. The most common role and activity restriction was money-related. Role and activity restrictions were associated with the NPS of hyperactivity, psychosis. Hyperactivity was related to men.

CONCLUSIONS

Hyperactivity psychosis may be more strongly related to family involvement than other NPS. These findings highlight the importance of avoiding premature role and activity restrictions among older adults with suspected dementia.

Expressed emotion mediates the association between caregiver relationship closeness and psychological symptoms in people with dementia

AIM

This study examines whether expressed emotion (EE) mediates the association between caregiver relationship closeness and behavioural and psychological symptoms of dementia (BPSD).

METHODS

We recruited 64 families with dementia in Osaka and collected data for 3 months. Caregiver-patient relationship closeness was assessed using the Relationship Closeness Scale (RCS), and BPSD was measured with the Neuropsychiatric Inventory Questionnaire (NPI-Q). EE was evaluated using the Family Attitude Scale (FAS).

RESULTS

The results indicated significant correlations between EE, relationship closeness, and BPSD, showing that higher caregiver intimacy levels were associated with lower aggression in dementia people. Mediation analysis revealed that EE significantly and mainly mediated the relationship between RCS and BPSD.

CONCLUSIONS

The findings underscore the importance of interventions focused on improving caregiver-patient relationships and managing caregiver emotional expressions to mitigate BPSD. These insights are valuable for developing targeted support programs for dementia care.

Characteristics of relatives with high expressed emotion and related factors: a study of relatives of people with dementia in China

BACKGROUND

China has the highest number of people with dementia globally, and the responsibility of caring for people with dementia primarily falls on relatives, who bear heavy caregiving burdens and pressure. Providing care for an individual with dementia is emotionally and physically demanding, particularly due to the frequent manifestation of behavioral and psychological symptoms associated with dementia (BPSD). This underscores the crucial need to comprehend and address caregivers' emotional expression (EE).

AIM

To explore the characteristics of relatives with high expressed emotion of people with dementia and related factors in mainland China.

METHODS

A survey using cross-sectional questionnaires conducted with 165 relatives of individuals with dementia in China.

RESULTS

A significant number of relatives had high EE (n = 61, 39%). The variation in EE, about 37.8%, is explained by seven independent variables. The proportion of psychological distress among relatives in EE variation is 14.5%. (b = 0.387, p < 0.001). Length of care-taking, active coping, and chronic diseases accounted for 6.5% (b = 0.264, p < 0.001), 5.1% (b=-0.239, p = 0.001) and 4.1% (b = 0.211, p = 0.002) of the variance in EE, respectively.

CONCLUSIONS

Chinese health care providers can identify high-risk groups for assistance based on the severity of dementia, age, health status and duration of care. Enhancing coping styles and alleviating emotional distress among relatives could be advantageous in decreasing EE.

CLINICAL EVIDENCE

Understanding the risk factors for high EE in different cultures can help guide practice on a global scale to improve the quality of life of people with dementia.

Expressed Emotion in Families of People With Dementia: A Review of Scale-Based Measures

PURPOSE

Research on the concept of expressed emotion (EE) has expanded in recent years but its role in dementia still requires elucidation. Understanding the role of EE in the dementia context could help in the development of appropriate interventions.

METHOD

The current review synthesized relevant literature to investigate the prevalence and correlates of EE status in families of people with dementia. A comprehensive search of four databases from inception to 2022 produced 2,683 papers; 18 studies met inclusion criteria.

RESULTS

The use of EE criteria differed not only across cultural contexts, but even within the same cultural context. Overall, the prevalence of EE in families with dementia compared with other psychiatric conditions was not high.

CONCLUSION

Specific changes in EE over time remain to be explored, and findings emphasize the need to carefully discriminate High EE status based on the cultural background of family members with dementia. [Journal of Gerontological Nursing, 50(2), 17-25.].

Psychological well-being in persons with dementia: The role of caregiver expressed emotion

OBJECTIVES

Dementia is a growing health concern. Persons with dementia experience higher levels of anxiety and depression, which correlates with poorer quality of life, disability and hospitalization. This is one of the few studies to use a longitudinal design to assess the impact of expressed emotion (EE) on well-being in dementia over time.

METHODS

Sixty-one people with dementia and their main informal caregiver were recruited from memory services. Caregiver EE was coded from a Camberwell Family Interview conducted at time one. Person with dementia's outcome measures (quality of life, depression and anxiety) were collected at time one and at 6-months follow-up.

RESULTS

Caregiver high EE was associated with higher levels of depression in people with dementia and greater anxiety at follow-up. Emotional over involvement predicted greater anxiety and critical comments predicted greater depression. Low EE appeared to have a protective effect on well-being in people with dementia. People with dementia with low EE caregivers experienced a small reduction in depression and anxiety over time, whereas those with high-EE caregivers maintained baseline levels of depression and anxiety.

CONCLUSIONS

Caregiver high EE is associated with poorer psychological outcomes for people with dementia over time. Psychological therapies, such as cognitive behavioural therapy informed family interventions should be used to reduce high EE within carer and person with dementia relationships.