Dementia Caregiving Status and Psychological Health: The Mediating Role of Coping Resources

Background and Purpose

It is well-documented that providing care to an older person with dementia (PwD) can negatively affect caregivers’ psychological health. Compared to the general caregiver population, caregivers of PwD experience higher levels of distress and lower levels of well-being given PwD’s behavioral issues and cognitive decline. Caregivers’ coping resources, such as resilience and perceived gains, can significantly protect against the detrimental effect of dementia caregiving. Given the growing prevalence of PwD and the substantial, adverse effect of dementia caregiving on caregivers’ well-being, it is imperative to understand how caregivers of PwD and caregivers of older adults without dementia differ in coping resources, and how this nuanced difference could affect caregivers’ psychological health. This study aims to examine the mediating role of coping resources in the relationship between dementia caregiving status and psychological health.

Methods

This study used a cross-sectional research design. Data were drawn from the 2017 National Study of Caregiving, which included caregivers of Medicare enrollees aged 65 and older in the United States (N = 2652). Dementia caregiving status was dichotomized as (1) providing care to a PwD and (2) providing care to an older adult without dementia. Two dimensions of psychological health were assessed: psychological distress (the Patient Health Questionnaire) and psychological well-being (the Ryff Scales of Psychological Well-Being). Caregivers’ coping resources included resilience and perceived gains. Resilience was assessed using the Connor-Davidson Resilience Scale. Perceived gains were measured using an index of 4 items describing the benefits of caregiving. Path analysis was used to examine the study aim, adjusting for caregivers’ age, gender, race, primary caregiver status, and self-rated health.

Results

Resilience significantly mediated the relationship between dementia caregiving status and psychological distress (indirect effect = -.08, p < .05). Specifically, compared to providing care to an older adult with other conditions, providing care to an older adult with dementia was associated with higher levels of resilience (B = .19, p < .05), which in turn, was associated with lower levels of psychological distress (B = -.43, p < .001). Additionally, perceived gains was negatively associated with psychological distress (B = -.10, p < .05) but positively associated with psychological well-being (B = .16, p < .001). Resilience was negatively associated with psychological distress (B = -.43, p < .001) but positively associated with psychological well-being (B = .28, p < .001).

Conclusions and Implications

The study emphasizes the important roles of resilience and perceived gains in alleviating psychological distress and enhancing psychological well-being among caregivers of older adults. Strategies that promote resilience and positive aspects of caregiving can be integrated into counseling sessions and support groups to facilitate better psychological health for caregivers. Moreover, the mediating role of resilience suggests that resilience can be a modifiable factor associated with enhanced well-being among caregivers of PwD. underscoring the importance of interventions aimed at maintaining and enhancing resilience for this population. The findings also highlight the need for a paradigm shift in policies from reducing stress to optimizing coping resources when developing dementia caregiving services.