A Systematic Review of the Impact of Caregiving for Spouses with Dementia on Marital Relationship

Background: This paper provided a systematic review of existing peer-reviewed articles examining the impact of caregiving for a spouse with dementia on marital relationship. Spousal caregivers of patients with dementia play an increasingly important role in keeping the cost of heath care system under control and allowing people to "age in place" in their preferred environment. Many studies have examined the impact of caregiving on spousal caregivers' physical and mental health, but few examined the impact on marital relationship. It is important to examine the distorted marital relationship as one of the caregiving outcomes, because dysfunctional marital relationship and its extreme versions, like separation and divorce, may lead to diminishing or termination of the caregiving relationship and increased likelihood of institutionalization.

Methods: A literature search was performed to locate relevant papers with five electronic databases: PsycINFO, MEDLINE, CINAHL, Social Sciences Abstracts (H.W. Wilson), Social Work Abstracts using smart search strings with keywords of "spouse", "spousal", "caregiver", "carer", "caregiving", "marriage", "marital", "divorce", "separation", "dementia". Papers were included if they were: (1) published in peer-review journals between 1950 and 2014, and (2) qualitative or quantitative empirical studies. Title review, abstract review and full-text review were conducted and thirteen journal articles were found to be relevant. Reference lists of these articles were also reviewed from which three additional articles were included. Findings were summarized into six categories: the research question of the study, study design, study sample, geographic location, measurements and scales used, and findings from the study pertaining to the present topic area.

Results: A total of sixteen papers were included with nine quantitative studies and seven qualitative studies. From the quantitative studies, four major predictors of the quality of marital relationship were identified: (1) the caregiving burden; (2) patients’ impairment and behavioral problems; (3) compromised affective and sexual intimacy; (4) positive gain. The qualitative studies primarily explored the process of how marital life was reconstructed in the process of spousal caregiving, including role transitions, change of self-identity, feelings of guilt and ethical concerns about intimacy. Findings from quantitative studies consistently showed that caregiving was significantly associated with lower level of marital satisfaction, poorer quality of marital relationship. Findings from qualitative studies illustrated how the trajectory of dementia changed dyadic interactions. Findings about the interaction of gender and caregiving experiences on marital relationship were also summarized.

Implications: Marital relationship is an important predictor of changing in living arrangements among couples affected by the course of dementia, but the studies examining the impact of caregiving on marital relationship are few and of great heterogeneity. More rigorous empirical research is needed and social work researchers and practitioners should pay special attention to changes in marital relationship caused by the caregiving dynamics so as to help the affected couples adjust to new roles and develop realistic expectations of marital relationship to improve caregivers' well-being and reduce institutionalization rate.