International psychogeriatrics · 2026
Caregiving dyad typologies and trajectories of care partner burden following hospitalization in persons living with dementia.
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Boltz Marie, Liu Yin, Yahaya Ahmed-Rufai, Al-Harrasi Azza Mubarak, Wellington Jessica, Kuzmik Ashley
Аннотация
OBJECTIVE: To identify subtypes of care partner-person living with dementia dyads and examine how dyad subtype membership was associated with trajectories of care partner burden during the post-hospitalization transition period.
DESIGN: Secondary analysis of longitudinal observational data from the Family-Centered Function-Focused Care (Fam-FFC) study using latent class analysis (LCA) and multilevel growth curve modeling.
SETTING: Post-hospitalization transition period among community-dwelling persons living with dementia and their informal care partners.
PARTICIPANTS: The sample included 461 dyads of persons living with dementia and their informal care partners (i.e., 922 individuals).
MEASUREMENTS: Dyad-level indicators included care partner and care recipient demographic, relational, and clinical characteristics. Care partner indicators included age, sex, kin relationship, co-residence, and self-rated health. Person living with dementia indicators included age, sex, cognitive status (Montreal Cognitive Assessment), comorbidities, functional status, and neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire [NPI-Q]). Care partner burden was measured using the 12-item Zarit Burden Interview (ZBI-12) at discharge and at 2 and 6 months post-discharge.
RESULTS: Four dyad classes were identified: adult child care partner-low NPI (33%), adult child care partner-high NPI (36%), wife/female care partner (21%), and husband/male care partner (10%). Across classes, mean burden scores increased from discharge to 2 months and declined by 6 months. The adult child-high NPI class had the highest burden levels at discharge, 2 months, and 6 months (1.75, 1.88, and 1.70, respectively), compared with the adult child-low NPI (1.35, 1.79, 1.31), wife/female care partner (1.64, 1.84, 1.46), and husband/male care partner (1.46, 1.69, 1.18) classes. In growth curve models, the adult child-high NPI class had higher overall burden than the husband/male care partner reference class (β = 0.421, SE = 0.153, p = .006) and showed less decline over time, as indicated by a significant quadratic interaction (β = 0.267, SE = 0.120, p = .027). Although the four-class solution was not statistically superior to the three-class solution based on the Lo-Mendell-Rubin test (p = .971), it was retained for clinical meaningfulness and interpretability.
CONCLUSIONS: Distinct dyadic caregiving subtypes were identified, which were associated with different trajectories of care partner burden at discharge and 6-month post-hospitalization. In particular, adult-child dyads characterized by higher neuropsychiatric symptoms appeared most vulnerable to sustained care burden. These findings highlight heterogeneity in dementia caregiving during hospital-to-home transitions and may help inform future dyad-centered transitional care assessment and intervention development.
DESIGN: Secondary analysis of longitudinal observational data from the Family-Centered Function-Focused Care (Fam-FFC) study using latent class analysis (LCA) and multilevel growth curve modeling.
SETTING: Post-hospitalization transition period among community-dwelling persons living with dementia and their informal care partners.
PARTICIPANTS: The sample included 461 dyads of persons living with dementia and their informal care partners (i.e., 922 individuals).
MEASUREMENTS: Dyad-level indicators included care partner and care recipient demographic, relational, and clinical characteristics. Care partner indicators included age, sex, kin relationship, co-residence, and self-rated health. Person living with dementia indicators included age, sex, cognitive status (Montreal Cognitive Assessment), comorbidities, functional status, and neuropsychiatric symptoms (Neuropsychiatric Inventory Questionnaire [NPI-Q]). Care partner burden was measured using the 12-item Zarit Burden Interview (ZBI-12) at discharge and at 2 and 6 months post-discharge.
RESULTS: Four dyad classes were identified: adult child care partner-low NPI (33%), adult child care partner-high NPI (36%), wife/female care partner (21%), and husband/male care partner (10%). Across classes, mean burden scores increased from discharge to 2 months and declined by 6 months. The adult child-high NPI class had the highest burden levels at discharge, 2 months, and 6 months (1.75, 1.88, and 1.70, respectively), compared with the adult child-low NPI (1.35, 1.79, 1.31), wife/female care partner (1.64, 1.84, 1.46), and husband/male care partner (1.46, 1.69, 1.18) classes. In growth curve models, the adult child-high NPI class had higher overall burden than the husband/male care partner reference class (β = 0.421, SE = 0.153, p = .006) and showed less decline over time, as indicated by a significant quadratic interaction (β = 0.267, SE = 0.120, p = .027). Although the four-class solution was not statistically superior to the three-class solution based on the Lo-Mendell-Rubin test (p = .971), it was retained for clinical meaningfulness and interpretability.
CONCLUSIONS: Distinct dyadic caregiving subtypes were identified, which were associated with different trajectories of care partner burden at discharge and 6-month post-hospitalization. In particular, adult-child dyads characterized by higher neuropsychiatric symptoms appeared most vulnerable to sustained care burden. These findings highlight heterogeneity in dementia caregiving during hospital-to-home transitions and may help inform future dyad-centered transitional care assessment and intervention development.