Caregivers Perceived Reciprocity Reduces Behavioral Symptoms in Patients With Alzheimer Disease


According to diary data, caregiver's perceived reciprocity showed a substantial direct influence on the occurrence of behavioral symptoms on both the current day and the subsequent day for patients with Alzheimer disease and related dementias.

Darina Petrovsky, PhD, RN, assistant professor, Rutgers University, and core member, Rutgers Institute for Health, Health Care Policy and Aging Research

Darina Petrovsky, PhD, RN

In a recent multi-time series longitudinal study presented at the 2023 Alzheimer’s Association International Conference, July 16-20, in Amsterdam, the Netherlands, findings showed that caregivers’ perceived reciprocity may reduce the number of behavioral symptoms a patient with Alzheimer disease and related dementias (ADRD) experiences.1 These results support the increasing amount of theoretical and empirical literature that suggests caregivers impact the environment and behavioral symptoms in patients with AD.

Among 7783 once-day diaries completed by 453 caregivers in 21 days, perceived reciprocity showed a direct, significant effect on the amount of behavioral symptoms that patients with ADRD experienced in the same day and the next day after. Notably, there were no significant main or cross-lagged effects observed between shared activity and behavioral symptoms, with estimates suggesting the impact was negligible, represented by a 0.7% increase.

“On a daily level, we found that on days caregivers enjoyed or engaged in an activity with a person with dementia, the person with dementia was less likely to experience these behaviors,” lead author Darina Petrovsky, PhD, RN, assistant professor, Rutgers University, and core member, Rutgers Institute for Health, Health Care Policy and Aging Research, told NeurologyLive®. In the study, Petrovsky and colleagues assessed whether potential protective factors, caregiver reciprocity, and shared activity, were associated with the number of behavioral symptoms experienced in patients with ADRD.

In the community-dwelling sample of adult caregivers for patients with ADRD, 87.4% were women, 51.4% were nonHispanic White with a mean age of 53 years (SD, 14). The participants were also caring for a parent/parent-in-law/stepparent (61.5%) with a mean age of 79 years (SD,9). Investigators asked the question, “How satisfied were you with amount of affection or appreciation your relative with dementia showed towards you?” to assess caregiver perceived reciprocity. All responses from the caregivers on caregiver perceived reciprocity were coded using a Likert scale with 1 meaning “Not at all” and 5 meaning “Very much”.

The caregivers were also questioned about whether they engaged in a pleasant noncare activity with the patient, as well as the presence of 8 different behavioral symptoms in patients with ADRD. A 2-level dynamic structural equation model was used to analyze the relationship between the number of different behavioral symptoms, caregiver reciprocity and a shared activity on a given day, and the following next day.

“One hypothesis could be that maybe this bonding through a doing that activity together that the caregivers may feel maybe less burden or closer to the other person. I think doing activities together has been a component of several prior, bigger tested interventions,” Petrovsky told NeurologyLive®. “I think the mechanism by which it has positive effects, we haven’t tested that yet. I think they’ll be interesting to know, but I think it has benefits to both members of the dyad. Or perhaps relationship quality, something that they experience together.”

The authors noted that research shows that most patients with ADRD experience behavioral symptoms because of exposure to stressors in their environment.1 Thus, in the study, researchers were able to capture the fluctuations in behavioral symptoms in response to any environmental stressors patients with ADRD experienced from the perspective of the caregivers.

“My colleague, Carolyn Pickering, PhD, RN, does have some data looking at the relationship quality, how the caregivers perceive relation quality. So, we could potentially test this hypothesis in another separate study, that it is through perceived improved relationship quality that the caregivers and the person with dementia perhaps reap the benefits of these activities. I would say that’s the next immediate step, though she and I were thinking about taking advantage of the several studies that she has been doing in this area,” Petrovsky added.

In 2021, Petrovsky conducted a systematic review on the effects of music interventions on sleep in older adults at least 50 years old in age.2 Petrovsky and colleagues yielded 16 studies from 5 databases centered on 2 types of music interventions: music listening (n = 11) and multi-component (n = 5). Results showed a mix of evidence in the efficacy of music interventions to help improve sleep outcomes among older adults, including sleep quality, objective and subjective sleep characteristics. The music listening intervention studies had personalized music according to the patient’s preferences whereas the multi-component studies included music with an additional approach, for example, tai chi.

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1. Petrovsky D, Pickering CE, Yildiz M. Examining Environmental Predictors of Behavioral Symptoms of Dementia Using Dynamic Structural Equation Modelling. Presented at: 2022 Alzheimer’s Association International Conference; July 16 to July 20; Amsterdam, the Netherlands.
2. Petrovsky DV, Ramesh P, McPhillips MV, Hodgson NA. Effects of music interventions on sleep in older adults: A systematic review. Geriatr Nurs. 2021;42(4):869-879. doi:10.1016/j.gerinurse.2021.04.014
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