The presence of cognitive impairment has a significant impact on couples in the physical, emotional, intellectual, and spiritual realms. Although not as extensively studied, cognitive impairment also impacts intimacy and sexuality. The purpose of this study was to investigate the affective and sexual dimensions in partners who served as caregivers for a person with Alzheimer's disease. Participants in this study included 2 groups of 100 subjects who were recruited from 3 different geriatric centers in Rome, Italy. The first group comprised 33 males and 67 females who were caring for a spouse with a diagnosis of Alzheimer's disease (caregiver group). The second group comprised 100 subjects who were matched for age, gender, education, and marital status, but who were not caring for a spouse with Alzheimer's disease (control group). An interview guide was developed by the Clinical Sexology Institute of Rome and used for semistructured interviews that examined affective and sexual variables. Participants also completed the Caregiver Burden Inventory, a multiple-choice questionnaire that measures burden on 5 different dimensions of burden (time-dependent, developmental, physical, social, and emotional). Statistical analysis was conducted using SPSS 13.0. A 1-way ANOVA was used to study within group differences among caregivers related to their burden score. Student t test was used to assess for sexual and affective satisfaction. A bivariate correlation analysis was used to assess the intensity and direction between burden and affective and sexual marital satisfaction, and a [chi]2 test was used to assess categorical variables.
Results of this investigation suggest that female spouse caregivers have a higher mean burden score than male caregivers. Statistically significant differences were found between the caregiver and the control group on the items "are you satisfied with your affective life" and "are you satisfied with your sexual life." The lower levels of satisfaction with affective life and sexual satisfaction that were found in the caregiver group were also associated with higher levels of burden. There was a statistically significant difference between males and females in the caregiver group related to changes in the affective relationship. Female caregivers reported that Alzheimer's disease had a stronger influence on the affective relationship and male caregivers reported a worse influence. Male caregivers reported an increased frequency of sexual intercourse as compared with female caregivers. Caregivers with higher burden scores had a decreased frequency of sexual intercourse. This investigation demonstrates the impact that Alzheimer's disease has on the marital and sexual relationship. Sexual intimacy and marital relationships are important areas for healthcare practitioners to assess. Caregivers in this investigation indicated that their healthcare providers did not ask questions regarding sexual concerns and did not provide information on the impact that cognitive impairment has on sexuality and intimacy. Many caregivers are uncomfortable bringing up the subject of sexuality with their healthcare providers. Therefore, it is imperative that healthcare providers are open to discussing sexual concerns and take the lead in initiating discussion on this subject.
Garand L, Dew MA, Urda B, Lingler JH, DeKosky ST, Reynolds CF. Marital quality in the context of mild cognitive impairment. West J Nurs Res. 2007;29:976-992.
Although several studies have examined the impact of Alzheimer's disease on the marital relationship, there is little written on the impact of mild cognitive impairment (MCI) on the relationship. In this investigation, Garand et al examined the impact of MCI-related behaviors on the caregiver's perception of the quality of the marital relationship. The authors used a cross-sectional, descriptive correlational design with 27 caregivers who were married to persons who had been diagnosed with MCI within the last 6 months. The quality of the marital relationship was assessed using the Dyadic Adjustment Scale, a 32-item self-report that examines marital satisfaction, marital cohesion, marital consensus, and affectional expression. The memory and behavioral problem checklist was used to determine the frequency and the bothersomeness of 30 commonly occurring behaviors in dementia. Two different caregiver burden scales were used to examine subjective and objective burden. Data analysis included the product-moment correlation coefficients to determine the direction and strength of perceptions of the marital relationship and MCI-related behaviors, demographic variables, and caregiver burden variables. A linear regression was used to examine whether MCI-related behaviors were associated with marital quality after controlling for variables.
Results of this study suggest that behavioral stressors are experienced by spouse caregivers, even in the earliest stages of cognitive impairment. The highest level of caregiver distress was associated with "asking the same question over and over," "trouble remembering recent events," and "losing or misplacing things." Significantly lower marital satisfaction was associated with "asking the same question over and over," "trouble remembering recent events," "follows you around," "talking little or not at all," and "appears sad or depressed." Higher subjective caregiver burden was associated with poorer marital quality. While the small sample size and composition limits the generalizability of the findings, this research provides important data on caregiver burden and its impact on the marital relationship on couples who are in the earliest stages of cognitive impairment. Additional research will be needed to further examine these relationships and to identify best practices for supporting and protecting the marital relationship.
