Caring for caregivers: The role of attributions and past relationship quality in predicting caregiver outcomes


One in 11 Canadians over the age of 65 is affected by Alzheimer’s disease, a progressive, degenerative neurological disorder. Alzheimer’s disease is the leading cause of dementia among the elderly and it is estimated that Alzheimer’s accounts for between 75%-85% of all cases of dementia among older adults. Furthermore, it is estimated that by the year 2034, over one million Canadians will be diagnosed with Alzheimer’s. An increasing number of family members are providing in-home care for Alzheimer’s patients. This is partly a reflection of changes in the Canadian health care system, which have led to shorter hospital stays, greater use of outpatient treatment, and longer waiting periods for admission to long-term care facilities. Although in-home care for persons with Alzheimer’s results in less patient mortality and is less costly to the health care system, it has been associated with elevated levels of depression in caregivers (Mahoney, Regan, Katona, & Livingston, 2005). For example, compared to caregivers of people without dementia, depression rates are nearly twice as high among caregivers of people with dementia. Furthermore, caregivers of people with dementia pay 50% more visits to their physicians and use 86% more prescribed medication than those who are not responsible for in-home care. Most importantly, one study found that spousal caregivers who reported feeling strained by the caregiving role had 63% greater mortality than did non-caregivers (Schulz & Beach, 1999). In fact, the personal costs of providing in-home care can be so high that caregivers have been referred to as the “hidden patient” or the “forgotten client”. In the proposed project we focus on potential risk factors and protective factors that influence the quality of life and mental health outcomes of caregivers of patients with Alzheimer’s.

Although a number of studies have documented elevated rates of depression among caregivers of persons with Alzheimer’s, there is considerable variability in terms of the psychological impact on caregivers (Dupuis, Epp, & Smale, 2004). For example, some caregivers continue to experience high levels of life satisfaction, and report good physical and psychological well-being. 


The first goal of our proposed project is to examine whether a caregiver’s perceptions of the cause of the patient’s negative interpersonal behaviour play a role in the caregiver’s quality of life and mental health outcomes. In the psychological literature, such perceptions are referred to as attributions. We predict that, compared to caregivers who attribute the patient’s behaviour to personality factors, caregivers who attribute the behaviour to the illness will have lower levels of depression and anxiety and a better quality of life.

Past research has also shown that caregivers who report a strong and positive relationship with the patient before the onset of illness have better mental health outcomes as compared to caregivers who report poorer relationship quality prior to the onset of illness.  Our second goal is to examine whether past relationship quality is the mechanism that explains why some individuals make more positive attributions for the patient’s behaviour.

This research will help us identify factors that place certain caregivers at higher risk for experiencing negative health outcomes as a result of their caregiving role. 

Summary of findings

We will recruit 75 spousal caregivers of individuals with Alzheimer’s Disease (AD).  The caregivers will be asked to complete a series of well-validated measured related to: (a) their own physical health status; (b) their partner’s stage of AD; (c) their own symptoms of depression and anxiety; (d) current quality of life; (e) current relationship satisfaction; and (f) relationship quality before onset of illness. We will also administer an Attribution Interview, designed to assess whether caregivers view problematic interpersonal behaviour to be the cause of the illness or the personality attributes of their partner. Specifically, caregivers will also be asked to recall three events in the past two weeks where they felt upset or frustrated by something their partner (the individual diagnosed with AD) had said or done. The caregiver will then be asked why, in their opinion, this behaviour occurred. They will also be asked whether their partner’s behaviour was: (a) intentional or unintentional; (b) motivated by selfish or unselfish concerns, and (c) whether the partner deserved to be blamed for what happened.  The qualitative data will be coded using an established attribution coding protocol.  Data analyses will be conducted using SPSS.

Project members: 
Undergraduate Fellow
Faculty Supervisor
Last updated: January 08, 2017