How Couples Affected by Alzheimer's Nurture Their Bond

In a new study, researchers looked at how couples affected by Alzheimer’s disease (AD) maintained their relationships, and uncovered 10 patterns of communication that can help them sustain engagement and intimacy in their relationships.

When a spouse is suffering from AD, communication within the marriage becomes exceedingly difficult. As a result of the decline in communication, married couples affected by AD suffer from isolation, depression, and estrangement.

“There is a knowledge gap regarding how couples affected by Alzheimer’s disease manage their relationship to sustain hope, connection, meaning, and engagement,” said study author Christine L. Williams, D.N.Sc., professor and director of the Ph.D. in Nursing Program in Florida Atlantic University’s College of Nursing.

“Instead of focusing our study on what wasn’t working in their relationships, we looked at patterns that support intimacy. There is a pressing need for research on maintaining a caring relationship despite progressive decline as it may lead to interventions to foster constructive communication.”

For the study, Williams used nursing professor Jean Watson’s Theory of Human Caring, which values the human relationship as the central focus and outlines the appropriate framework to study caregiver-spouse interactions.

The researchers visited 15 couples in their home once a week for 10 weeks. Couples had long-term marriages with an average of 47 years, were middle-income, and generally well-educated.

The mean age for caregivers was 77 and 80 for spouses with AD. Most of the caregivers were female (68.8 percent) and reported that they had been acting as their spouse’s caregiver for an average of four years.

Couples were asked to discuss a topic of their choice for 10 minutes, which were recorded once the researcher left the room. Using this method, researchers were able to observe naturally occurring everyday conversations, which involved both verbal and non-verbal behavior and non-linguistic aspects of the conversation such as pauses.

Thirty conversations were analyzed with qualitative methods. Three overall themes of spousal care were identified: engaging with compassion; patiently reaching out; and trusting in the existence of deep attachment.

Ten communication patterns were identified. Communication patterns included:

  • “news of the day,” which provided caregivers and spouses normalcy and serenity by talking about the mundane activities of daily life;
  • “sharing memories,” whereby caregivers reminisced with their spouses about memories of people and past events;
  • “storytelling,” as caregivers shared a detailed story although the conversation seemed like a monologue with no verbal participation from the spouses;
  • and “delighting in the unexpected,” as caregivers were overjoyed when their spouses contributed more to the conversation than expected.

The researchers observed that caregivers often accepted a spouse’s version of the story, valuing the relationship more than being right and refrained from interrupting or interjecting.

“It was evident that caregiving spouses bore most of the responsibility in maintaining the caring relationship, but there was evidence that the spouse affected by Alzheimer’s disease actively participated as well,” said Williams.

“In one conversation, maintaining eye contact with the spouse was the only obvious evidence of engagement. In another interaction, singing familiar songs provided an avenue for active involvement between partners.”

“These caring ways of relating are of value because they provide information about what is possible in marital relationships affected by Alzheimer’s disease,” said Williams. “Illuminating ways that couples demonstrate caring can be a source of strength to those who feel hopeless, discouraged and ready to give up, and can empower nurses to reach out to couples.”

Findings from the study are published in the International Journal of Human Caring.

Source: Florida Atlantic University