SAN DIEGO — Spouses of men and women with mild cognitive impairment are assuming the role of caregiver and are experiencing the caregiver burden associated with the role, Linda Garand, Ph.D., said at the annual meeting of the American Association for Geriatric Psychiatry.
In a pilot study, nursing tasks such as administration of medication were significantly associated with symptoms of depression in the caregiver, while lifestyle constraints were significantly associated with symptoms of anxiety, she reported.
The finding suggests that spouses of people with mild cognitive impairment (MCI) “may be ideal targets for preventive interventions, to prevent the later development of psychiatric morbidity in the event that they do progress to become a dementia caregiver,” said Dr. Garand of the University of Pittsburgh.
Although the negative mental health effects of dementia caregiving are firmly established in the medical literature, she added, “We know very little about what it's like to give care to a person with milder levels of [cognitive impairment].”
In a 7-month study funded by the National Institute of Mental Health, Dr. Garand and her associates conducted a cross-sectional study of 23 women and 4 men whose spouses met Alzheimer's Disease Research Center criteria for MCI. Spouses lived with the patients at home and understood English.
Self-reported cross-sectional data were collected in the home. The investigators used a variety of measures, including the Caregiver Burden Inventory, the Memory and Behavior Problem Checklist, the Center for Epidemiologic Studies-Depression scale, and the state portion of the State-Trait Anxiety Inventory.
Most of the spousal caregivers were white, married for almost 5 decades, and lived alone with their spouse. They ranged in age from 54 to 82 years, with an average age of 70 years. About three-quarters had at least a bachelor's degree.
Spouses performed an average of four household management tasks per day and 0–1 nursing tasks per day. The amount of time to self received the highest caregiver burden rating, while the amount of privacy and the amount of vacation time received the lowest caregiver burden rating.
The most common MCI-related behaviors spouses reported of their loved ones were asking the same question over and over again, having trouble remembering recent events, and losing or misplacing things. Spouses who performed nursing tasks such as administration of medication were significantly more likely to have depressive symptoms, while those with perceived lifestyle constraints were significantly more likely to have anxiety symptoms.
“The caregiving responsibilities in this sample were very diverse,” Dr. Garand commented. “The fact that many of these responsibilities were introduced since the person had been diagnosed with MCI suggests that the burden and psychiatric morbidity are directly associated with the MCI in their spouse.”
She noted that all of the spouses who reported responsibility for transportation, running the errands, and managing business affairs also acknowledged that these were new responsibilities since their spouse developed MCI.
Nearly one-half of the spouses reported being responsible for administering medications for their loved one, and a large proportion of that subsample said that it was a new responsibility since the onset of MCI.
Dr. Garand proposes an in-home intervention with spouses of men and women with MCI that will be built into another study. The intervention will include 1 month of in-home education followed by 2 months of support via telephone. The intervention “is going to be based on problem-solving therapy,” she explained.
“I'm hoping that if I can equip these spouses with some real problem-solving tools early in their caregiving trajectory, I may be able to help them down the road as they become dementia caregivers, so they don't become so depressed or anxious.”