Communication Currents

New Series, Vol. 1, No. 11 

Most individuals give and/or receive unpaid care to or from a loved one at some point in their lifetime. In fact, up to 92% of individuals with dementia, a set of progressive terminal illnesses characterized by worsening cognitive decline over time, receive support from a family member or some close other with up to 66% percent of these caregivers living with the inflicted to provide fulltime care. These caregivers experience significant strain associated with caregiving demands and often sacrifice time, financial wellbeing, and other personal costs in lieu of providing such care, often leading to increased stress, depression, and other indicators of decreased wellbeing. These authors used structural equation modeling to test two competing theories, the Theory of Resilience and Relational Load (TRRL) and the Investment Model, to explore how relational investments and quality between the caregiver and care recipient prior to the onset of the disease may influence both relational and caregiver wellbeing. 

As the symptoms of dementia progress, many caregivers experience increasingly intense feelings of gradual relational loss as their loved one loses the abilities to make decisions and complete daily tasks, the caregiver-care recipient relationship changes and relational identities and roles are lost, and uncertainty about how to manage both the relationship and provision of care increases. There is also ambiguity in this unique experience of loss as the loved is physically present but cognitively absent causing prolonged pre-death, anticipatory grief all while the caregiver has continued, increasingly difficult, interactions with their loved one. 

The TRRL proposes that relational investments made prior to the experience of some hardship in a relationship (e.g., caregiving) help to buffer the negative impact of such hardships on the relationship and the individuals in it. According to this theory, these investments may come in the form of relationship maintenance, or positive communicative behaviors such words or affirmation, quality time, assurances, and openness; and communal orientation, or ongoing and explicit effort by individuals to cognitively frame their relationship with a loved one as a cohesive unit, especially in the face of present or anticipated hardship. TRRL states that these relational investments will result in the accumulation of positive emotional reserves, or resources that promote sustainability of the relationship during difficult times and experiences. Following TRRL’s logic, caregivers who performed more maintenance behaviors and have stronger communal orientations should experience greater wellbeing personally and in the context of the relationship with the care recipient than those who did not. 

Alternatively, the Investment Model explains that people are motivated to maintain their commitment to ongoing interdependent relationships based on 1) how satisfied they are with that relationship, 2) perceptions of quality relational alternatives, and, most relevant to this study, 3) how much resources an individual has invested into a given relationship. These resources might be direct or indirect, tangible (e.g., money) or intangible (e.g., time), and are thought to increase commitment because if an individual terminates a relationship that they have invested in, those investments are considered lost. Thus, following the logic of the Investment Model, dementia caregivers experience an involuntary loss of these investments as the disease progresses, which might be comparable to the loss of resources experienced when someone willfully chooses to end a relationship with a loved one.  

A total of 454 primary caregivers for a family member with dementia participated in this study. Participants were mostly white, middle-aged, heterosexual, female adults with some college education. About half of these individuals were retired and about a third were currently employed, with most reporting fair to comfortable financial wellbeing. Most were providing care for a parent, spouse, or partner with diagnoses including Alzheimer’s disease, unspecified dementia, vascular dementia, mixed dementias, Parkinson’s disease, dementia with Lewy bodies, and other for varying lengths of time and many living with the care recipient or interacting with them daily or close to daily. Most also reported that they either had no help with the caregiving, or help limited to 1-2 other family members. 

Overall, the authors found greater support for explanations in line with the TRRL in that pre-onset relational investments seemed to support an accumulation of positive emotional reserves that supported more positive communication between the caregiver and care recipient, possibly helping the caregiver frame various behaviors by the care recipient in a new, more positive light than they might have in absence of the disease. In addition to two competing theoretical explanations according to the logic of the TRRL and the Investment Model, the authors also tested mediating mechanisms of relational deprivation and ongoing relational maintenance and explored disease severity as a potential moderator. They found that, among caregivers caring for loved ones whose conditions were highly severe, pre-onset relational maintenance was associated with higher experiences of relational deprivation, which was not supported in the low severity group or when the relationships between variables were tested amongst the entire sample of participants. They also found that pre-onset relational maintenance was positively associated with caregiver (and relational) wellbeing, especially when these investments promote ongoing relational maintenance between the caregiver and care recipient.  

The authors speculate that the lack of broad support for the Investment Model in this context may be due to distinct types of investments in family relationships and thus distinct experiences of their loss or a lack of perceiving these investments as truly lost by caregivers in the face of their loved one’s gradual decline. However, findings among the high severity group were more in line with this theoretical perspective, suggesting that it is perhaps more applicable in later stages of dementia caregiving. Authors also consider the impact of possible limitations of their study including its cross-sectional nature, inflated participant perceptions of pre-onset relational investments, a mood-dependent memory effect, and limited generalizability due to the homogeneity of their sample. Nonetheless, insights from this study can be used to inform pre-onset interventions in families where there is a known genetic predisposition to the disease to increase relational investments as well as interventions during the disease to promote ongoing relational maintenance in the midst of caregiving.   

Communication Currents Discussion Questions 

1. Reflecting on your own experiences, what has helped you or others around you get through difficult times in relationships with loved ones? How did these strategies impact the relationship overall? How might you prepare or invest in your relationships now to make them more resilient in difficult times? 

2. What privileges or obstacles might affect a person's ability to provide care? To what extent do you think our society values caregiving, both formal and informal? How might this affect people who provide unpaid care, especially family members? With care labor emerging as a key topic in recent political discussions, what additional challenges do you think caregivers might face due to changes in public policy? 

3. Have you ever been in a caregiving role, or observed someone close to you giving or receiving care? What challenges and rewards did you notice? What role did communication play in that experience? The study highlights the unique challenges of caring for a loved one with dementia, including anticipatory grief and relational loss. How do these experiences differ from other types of caregiving? 

For additional suggestions about how to use this and other Communication Currents in the classroom, see: https://www.natcom.org/publications/communication-currents/integrating-communication-currents-classroom  

ABOUT THE AUTHORS

R. Amanda Cooper is an Assistant Professor in the Department of Communication at the University of Connecticut. 

Chris Segrin is a Regents Professor and Head of the Department of Communication at the University of Arizona. 

This essay, by R. E. Purtell, translates the scholarly journal article, R. Amanda Cooper & Chris Segrin (2024): Pre-onset relational investments and dementia caregiver wellbeing: Comparing theorizing from the investment model and the theory of resilience and relational load. Communication Monographs. Advance online publication. https://doi.org/10.1080/03637751.2024.2354872 

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