Informal Caregiving Networks of Older Adults With Dementia Superimposed on Multimorbidity: A Social Network Analysis Study

Mi-Kyung Song; Sudeshna Paul; Mary Beth Happ; Janice Lea; James L Pirkle Jr; Linda Turberville-Trujillo

doi:10.1093/geroni/igad033

Informal Caregiving Networks of Older Adults With Dementia Superimposed on Multimorbidity: A Social Network Analysis Study

Innov Aging. 2023 Apr 17;7(4):igad033. doi: 10.1093/geroni/igad033. eCollection 2023.

Authors

Mi-Kyung Song¹, Sudeshna Paul², Mary Beth Happ³, Janice Lea⁴, James L Pirkle Jr⁵, Linda Turberville-Trujillo⁶

Affiliations

¹ Center for Nursing Excellence in Palliative Care, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
² Office of Nursing Research, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA.
³ Center for Healthy Aging, Self-Management, and Complex Care, College of Nursing, The Ohio State University, Columbus, Ohio, USA.
⁴ Department of Nephrology, School of Medicine, Emory University, Atlanta, Georgia, USA.
⁵ Department of Nephrology, School of Medicine, Wake Forest University, Atlanta, Georgia, USA.
⁶ Emory Healthcare, Atlanta, Georgia, USA.

Abstract

Background and objectives: Caregiving is a social process and commonly involves more than a single caregiver, especially for older adults with multimorbidity, including dementia. This study was to characterize informal caregiving networks of older adults with dementia superimposed on multimorbidity (e.g., end-stage kidney disease) and to examine the relationships of network properties to outcomes of caregivers and older adults.

Research design and methods: An egocentric social network survey was conducted. Up to 3 family caregivers of older adults on dialysis who had moderate-to-severe irreversible cognitive impairment with or without a documented diagnosis of dementia were recruited from 11 dialysis centers in 2 states. Caregivers completed a social network survey about individuals providing caregiving to the older adult and measures of caregiving burden and rewards, depression, and financial hardship. Older adults' emergency department visits and hospital admissions during the past 12 months were abstracted from the medical records.

Results: A total of 76 caregiver informants of 46 older adults (78% Black) participated in the study. Of the 46 older adults, 65% had a multimember network (median size of 4). As the network density (the proportion of ties between members among all possible ties) increased, primary caregivers' financial hardship decreased whereas nonprimary caregivers' financial hardship increased. Further, for every 1-unit increase in mean degree (the average number of connections among members), there was a nearly fourfold increase in the odds of no hospital admission during the prior year for the older adult.

Discussion and implications: The network dynamics of informal caregiving networks may have an impact on the well-being of caregivers and older adults with dementia, but confirmatory longitudinal studies are needed.

Keywords: Alzheimer’s disease; Cognitive impairment; Family caregivers; Multiple chronic conditions.

Grants and funding

R01 NR017018/NR/NINR NIH HHS/United States