JoAnn Tschanz, psychologist at Utah State University, recently published research connecting specific family caregiver strategies with decreased dementia in their loved ones. Dr Tschanz discusses her groundbreaking study in this interview with Randall Reitz.
Randall Reitz: Your data indicate that people with dementia tend to have better outcomes if their family caregivers use certain coping strategies. The coping strategies that made a difference were: problem-focused coping, counting blessings, seeking social support, and wishful thinking. What are these coping strategies and how do you believe they translate to improved outcomes for people with dementia?
JoAnn Tschanz:These coping strategies are from a larger set of eight strategies in what researchers indicate either address the source of the problem (problem-focused) or seek to manage distress. Counting blessings would be similar to looking at the bright side of things, seeking social support would be akin to talking out your problem with a friend, and wishful thinking would be similar to hoping for the best.
The majority of the strategies did not predict the rate of cognitive or functional decline in the person with dementia. Problem-focused coping and seeks social support predicted slower cognitive decline in dementia participants; problem-focused coping, seeks social support and wishful thinking were associated with slower functional decline. However, because we also saw evidence that use of the coping strategies were associated (e.g., someone who used problem-focused coping may also have a tendency to use the other coping strategies as well), we ran additional statistical models to see which were independent predictors. This is where caregiver problem-focused coping was the strongest predictor of slower cognitive and functional decline in the person with dementia.
Although we do not yet know how problem-focused coping was associated with slower decline, we hypothesize this could reflect a caregiver who is able to adapt flexibly to meeting new challenges and tries to solve problems as the dementia progresses. For example, a troubling behavior (wandering) might emerge. A caregiver using problem-focused strategies might operate under the hypothesis that the patient doesn't recognize their surroundings and so displays, familiar items like family pictures and other decorations that the patient recognizes. Other possibilities include engaging the patient in stimulating activities as other research has found an association between cognitively stimulating activities and slower progression of dementia.
RR:What surprised you most in your analysis?
JT: We hypothesized that problem-focused coping was associated with slower progression and our findings were consistent with that hypothesis. However, we also thought that other coping strategies like Avoidance and Blames Self or Others would be associated with worse outcomes, but this was not the case. These strategies were not associated with rate of cognitive or functional decline.
RR: Your sample comes mostly from one county in rural Utah, do you have any concerns that your data are community-specific?
JT: This is a great question. Although our sample consists of residents of one county in Utah, in some ways our data may actually generalize more broadly to others since the study was based on a population-based sample rather than a clinic-based sample. The latter tend to include individuals who are younger, more highly educated, and those who may have more severe symptoms. That said, the majority of our participants were Caucasian and averaged over 12 years of education, so the results may not generalize to populations with greater ethnic or educational diversity. Studies in other samples are needed to determine whether our results are replicated.
RR: How do you hope your findings will impact the field of collaborative family healthcare?
JS: Many health care providers have not thoroughly looked to the care environment as a place to intervene, other than to help reduce caregiver distress and stress-related illnesses. Our findings suggest that the care environment may be a place to intervene to promote the highest level of functioning in the person with dementia. In this way, caregivers could be trained to problem solve various care management issues that arise, and feel empowered to make a difference in the care of their loved ones.
Rather than looking at dementia as a progressive condition where the caregiver and patient are helpless, ideally, the caregiver and patient could take an active role to work with their health care providers and devise a care management plan. In that plan might be ideas to address challenges that commonly arise for many patients, and likely would include use of formal resources available in the community.
Our findings suggest that the care environment may be a place to intervene to promote the highest level of functioning in the person with dementia.
RR: How do you see your research evolving and in what direction would you like the field to go?
JT: We've found other aspects of the care environment (such as closer relationships and participant engagement in stimulating activities) to be associated with overall better cognitive and functional abilities in dementia. We'd like to follow-up our results to get a better understanding of potential mechanisms and whether they're also predictive of important clinical milestones such as severe disability or institutionalization. Additionally, our results are observational only so we cannot draw cause-effect conclusions.
Ultimately, I'd like to develop an intervention and test that intervention in a study that randomizes treatment to participants and has an appropriate control group so we can draw firmer conclusions from this line of research. I would really like to see the field emphasize non-medical and non-pharmacological approaches to treating all aspects of dementia and really engage the caregiver as a primary source participant in the patient's treatment.
RR: JoAnn, thanks for your contributions to collaborative family healthcare and to the Families and Health blog!
JoAnn Tschanz is Professor in the Department of Psychology and faculty in the Center for Epidemiologic Studies at Utah State University. She is a clinical neuropsychologist and has studied risk factors for Alzheimer's disease and other dementias as well as factors that influence the clinical expression of dementia after disease onset. She has published over 80 papers in scientific journals and books, and is the recipient of grant funding from the National Institute on Aging.