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Caregiving for a loved one suffering from cognitive decline involves coping with many challenges and losses. This experience increases the risk of worsening the physical and mental health of the caregiver and has been the subject of a substantial number of studies focusing on the stress and burden of the primary caretaker. Theory and research on the grief reactions experienced by the family members, however, continues to lag in terms of the attention given to the behavioral and psychological burden of caregivers. This study aimed for a deeper understanding of the emotional processes in an individual involved in caring and caregiving for a spouse suffering from cognitive decline, through the prism of the Two-Track Model of Dementia Grief (TTM-DG). The TTM-DG emphasizes the continuous emotional attachment to the loved one suffering from cognitive decline (Track II), along with a medico-psychiatric perspective associated with stress, trauma, and changes in life (Track I). In this research project, we examined the degree to which spouses of cognitively impaired, deceased, and healthy partners showed differences and perceptible patterns considering the elements associated with the model and their interrelationship. These elements include behavioral characteristics of the clinical patients suffering from cognitive decline, objective circumstances of the caregiving situation, personality measures of attachment of the caring spouse, and a range of measures assessing psychological well-being and spousal relationship. The current study is a part of a larger ongoing project in Israel to address loss and grief among caregiving family members whose loved ones suffer from cognitive decline. The findings reported in the current paper are based on data derived from self-report questionnaires (i.e., socio-demographic variables, problematic behaviors in patients, objective burden, social support, physical health status, attachment patterns, depression, dementia grief, and relationship satisfaction). Participants in the sample size of 49 came from three groups: (a) spouses of patients suffering from cognitive decline, (b) widowers of deceased dementia sufferers, (c) and a control group of similarly aged participants whose spouses have no cognitive or functional impairment. Examination of the research hypotheses was done by running correlations and one/two-way analyses of variance (ANOVA). Behavioral disorders in the affected spouse correlated positively with the objective burden of the caring/caregiving spouse and with outcome variables. That is, biopsychosocial functioning (Track I) and the ongoing attachment bond with the ill spouse (Track II); objective burden correlated positively with depression and dementia grief, but not with relationship satisfaction; poor caregiver’s physical health was associated positively with depression and dementia grief, but not with relationship satisfaction; social support correlated positively with low levels of depression and dementia grief, as well as to the higher degree of relationship satisfaction; insecure attachment was found to correlate positively with depression and dementia grief, but not with relationship satisfaction. Spouses of cognitively impaired patients reported more difficulties in outcome variables compared to the control group; widowers of deceased dementia sufferers reported higher levels of dementia grief and depression than the control group. In terms of outcome measures, there was no difference between widowers and spouses of cognitively impaired patients. Among the control group participants, there was no difference between secure and insecure attachment on outcome variables. A significant difference between secure and insecure attachment on outcome variables was observed among spouses of cognitively impaired patients and widowers so that insecure participants reported higher levels of distress. The findings of the present study constitute the initial empirical evidence for the utility of the TTM-DG and support the transition of the field of loss and bereavement, which emphasizes the importance of the emotional attachment with the loved one as one of the primary foci of the process of coping with the loss. Furthermore, the findings highlight factors that contribute to the health and emotional resilience (secure attachment style, perceived social support, etc.) and provide a framework that can assist in the process of clinical assessment and intervention to improve the quality of life of caregivers whose loved one suffers from cognitive decline.

Spousal Dementia Grief: A Research Report from the Two-Track Model of Dementia Grief Project