This longitudinal study will examine spouses' adjustment to the nursing home placement of a partner with dementia, focussing on the relationship between spouses' level of adaptability, their ability to acknowledge the change in their marital role brought about by placement, and spouses' psychological adjustment. Family adaptability, a construct derived from the family systems literature, encompasses the level of flexibility versus structure within the marital relationship, and the couple's propensity to make changes in their role relationships and approach to problem solving in response to situational demands. Previous research by the principal investigator suggests that spouses low in adaptability, may not readjust their role expectations in response to their partner's condition. Thus, less adaptable caregivers may also have difficulty in accepting the role changes associated with nursing home placement. The research will be conducted at the United Presbyterian Residence, a 672-bed, suburban long term care facility affiliated with Winthrop- University Hospital, a major teaching affiliate of the State University of New York, Stony Brook School of Medicine. In-person, structured interviews will be conducted with up to 60 spouses of new residents with chronic, irreversible dementia. Spouses will answer questions regarding their level of adaptability, marital role, depression, and caregiver burden, and their perception of the patient's level of functional and behavioral impairment. Spouses will be interviewed three times - within one week of their partner's nursing home placement (Time l), one month following admission (Time 2), and three months following admission (Time 3). At the time of each interview, the patient will also be assessed for cognitive, functional, and behavioral impairments. The following hypotheses will be tested: l) Spouses scoring higher in adaptability will experience better adjustment over time to their partner's placement, evidenced by lower levels of depression and caregiver burden, than less adaptable spouses: 2) More adaptable spouses will be more likely to change their role from """"""""caregiver"""""""" at Time l to """"""""care manager' by Time 3, reflecting changes in the marital relationship brought about by placement. In contrast, less adaptable spouses will be more likely to maintain roles that do not reflect their current marital relationship (""""""""spouse"""""""" or """"""""caregiver""""""""), even several months after placement (Time 3): and 3) Spouses who are low in adaptability and who continue to choose unrealistic roles (""""""""spouse"""""""" or """"""""caregiver"""""""") at Time 3 will experience higher levels of depression and burden than other spouses in the sample. Identifying factors that may help spouses to adapt when their partner with dementia enters a long term care facility will have important implications for both family members and service providers. If greater adaptability or more realistic role expectations are related to better psychological adjustment, then providers can assist the healthy spouse in understanding and accepting the changes in their marital relationship that are inherent in the placement process, and developing more realistic expectations of their own role in their partner's life. Providers could also identify spouses low in adaptability that may be at higher risk for adjustment difficulties, and work with them early in the placement process to better understand and accept inevitable changes in their marital relationships.
