Chaudhry Isha, Poco Louisa, Balasubramanian Ishwarya, Andres Ellie Bostwick, Malhotra Chetna
Lien-Centre for Palliative Care (IC, LP, IB, EBA, CM), Duke-NUS Medical School, Singapore.
Lien-Centre for Palliative Care (IC, LP, IB, EBA, CM), Duke-NUS Medical School, Singapore; Program in Health Services and Systems Research (CM), Duke-NUS Medical School, Singapore.
Am J Geriatr Psychiatry. 2025 Feb;33(2):143-152. doi: 10.1016/j.jagp.2024.07.017. Epub 2024 Aug 5.
Family caregivers of older adults with severe dementia often experience anticipatory grief. We aimed to investigate the temporal association of caregiving stressors (older adults' behavioral symptoms, and caregiver-older adult co-residence and emotional closeness) and caregivers' anticipatory grief, and its mediation by positive and negative caregiving experiences.
Prospective cohort.
Singapore.
About 169 family caregivers of older adults with severe dementia were surveyed every 4 months for 4 years (up to 13 surveys).
We measured anticipatory grief using the Marwit Meuser Caregiver Grief Inventory-Short Form, negative caregiving experiences using the Caregiver Reaction Assessment scale, positive caregiving experiences using Gain in Alzheimer Care Instrument and behavioral symptoms using the Cohen-Mansfield Agitation Inventory. We implemented a cross-lagged panel model to test mediation, a form of longitudinal path analysis.
About 35% of the caregivers reported high anticipatory grief at least once during the study period. Older adults' behavioral symptoms had a significant direct effect (Standardized coefficient [95% confidence interval]: 0.12 [0.04, 0.21]) on caregivers' anticipatory grief. Negative experiences mediated the significant indirect effect of older adults' behavioral symptoms (0.16 [0.06, 0.25]) and coresidence (0.16 [0.07, 0.25]) on caregivers' anticipatory grief. Positive caregiving experiences did not mediate any path.
Findings indicate a temporal association between caregiving stressors and anticipatory grief, mediated by negative caregiving experiences. Routine screening for anticipatory grief, and interventions to address caregiver stressors and negative caregiving experiences may alleviate caregivers' grief.
患有严重痴呆症的老年人的家庭照顾者常常经历预期性悲伤。我们旨在调查照顾压力源（老年人的行为症状、照顾者与老年人的共同居住情况及情感亲密度）与照顾者预期性悲伤之间的时间关联，以及积极和消极照顾经历对其的中介作用。
前瞻性队列研究。
新加坡。
约169名患有严重痴呆症的老年人的家庭照顾者，在4年时间里每4个月接受一次调查（最多13次调查）。
我们使用Marwit Meuser照顾者悲伤量表简版测量预期性悲伤，使用照顾者反应评估量表测量消极照顾经历，使用阿尔茨海默病护理获益量表测量积极照顾经历，使用科恩-曼斯菲尔德激越量表测量行为症状。我们采用交叉滞后面板模型来测试中介作用，这是一种纵向路径分析形式。
约35%的照顾者在研究期间至少有一次报告有高度的预期性悲伤。老年人的行为症状对照顾者的预期性悲伤有显著的直接影响（标准化系数[95%置信区间]：0.12[0.04，0.21]）。消极经历介导了老年人行为症状（0.16[0.06，0.25]）和共同居住情况（0.16[0.07，0.25]）对照顾者预期性悲伤的显著间接影响。积极照顾经历未介导任何路径。
研究结果表明照顾压力源与预期性悲伤之间存在时间关联，且由消极照顾经历介导。对预期性悲伤进行常规筛查，以及针对照顾者压力源和消极照顾经历的干预措施可能会减轻照顾者的悲伤。
