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The Journals of Gerontology Series B: Psychological Sciences and Social Sciences logoLink to The Journals of Gerontology Series B: Psychological Sciences and Social Sciences
. 2024 Jul 16;79(8):gbae105. doi: 10.1093/geronb/gbae105

Felt Age and Its Psychological Correlates in Dementia Spousal Caregiving Dyads: Findings From the IDEAL Programme

Serena Sabatini 1,✉,b, Shelbie G Turner 2,b, Linda Clare 3,4
Editor: Rodlescia S Sneed5
PMCID: PMC11266982  PMID: 39011895

Abstract

Objectives

Evidence suggests spouses influence each other’s subjective views on aging. Aligned with the Theory of Dyadic Illness Management, we investigated for the first time similarities in felt age (how old people feel relative to their chronological age) between people with dementia and their spousal caregivers, and how each partner’s felt age was related to psychological correlates in the other partner.

Methods

We used baseline (2014–2016) data from 1,001 people with dementia and their spousal caregivers who participated in the British Improving the experience of Dementia and Enhancing Active Life study. We ran linear regressions to analyze the extent to which the felt age of people with dementia and their caregivers were similar, and whether relationship quality was associated with the similarity. We utilized actor–partner interdependence models to analyze whether the felt age of people with dementia and their caregivers were associated with each other’s well-being, satisfaction with life, and self-efficacy.

Results

The felt age of people with dementia was associated with the felt age of their caregivers (β = 0.10; p = .001). Caregivers and people with dementia reported a more similar felt age when caregivers rated the caregiving relationship more positively (β = 0.07; p = .04). Caregivers' felt age was associated with well-being (β = 0.07; p = .02) and satisfaction with life (β = 0.06; p = .04), but not with self-efficacy, in people with dementia.

Discussion

Felt age in caregivers and people with dementia may be interwoven, and important psychological variables in people with dementia are related to caregivers' felt age. Findings offer empirical evidence on dementia caregiving dynamics and how family relationships are related to views on aging.

Keywords: Actor–partner interdependence, Dementia caregiving, Views on aging, Well-being

Empirical evidence supports the utility and validity of using subjective views on aging to predict important health-related behaviors and psychological and health outcomes through the adult lifespan (Westerhof et al., 2023). As such, psycho-gerontological literature has prioritized research on various views on aging constructs over the past several decades. Guided by views on aging theory positing that psychosocial factors such as social support shape views on aging (Diehl et al., 2014), researchers have recently started to analyze views on aging in the context of family relationships (e.g., Kim et al., 2022). Researchers are asking how family relationship dynamics influence (a) the ways in which people think of their own aging and (b) how views on aging are connected to health and well-being outcomes. In this study, we extended this literature by dyadically analyzing the key views on aging construct of felt age, and its relationship with psychological correlates, among people with dementia and their spousal caregivers.

Felt Age: An Overview

Views on aging is an umbrella term encompassing several constructs that capture how people feel about older adulthood and their own aging. One of the most common views on aging constructs is felt age (FA), which measures how old people feel relative to their chronological age (Barrett, 2003; Kotter-Grühn & Hess, 2012). FA can be assessed by asking study participants to report whether they feel younger than, the same as, or older than their chronological age (Barak & Stern, 1986), or by subtracting the age someone feels from their chronological age to determine the extent to which someone feels older than or younger than their chronological age (Rubin & Berntsen, 2006; Stephan et al., 2013).

FA is a driver of future psychological and health outcomes. A recent meta-analysis, comprising 53 longitudinal studies on FA, concluded that a younger FA is a longitudinal predictor of better future mental, physical, and cognitive health (Westerhof et al., 2023). Theorists suggest that views on aging constructs like FA likely affect health outcomes through their impact on developmental regulation (Wurm et al., 2017). Specifically, a younger FA fosters engagement in health-promoting behaviors (e.g., physical activity and getting enough high-quality sleep, Caudroit et al., 2012; Montepare, 2020; Sabatini, Ukoumunne, Ballard, Collins, Corbett, et al., 2021; Wienert et al., 2015). Importantly, a recent study suggested that though FA is highly correlated with self-rated health, and though self-rated health mediates the relationship between FA and health outcomes, FA is an independent construct that uniquely predicts health and well-being (Stephan et al., 2021). Thus, overall, feeling younger than one’s age is considered a psychological resource fostering health in middle age and older adulthood. A younger FA may also foster adaptation to age-related challenges and, in doing so, maintenance of well-being and quality of life while growing older.

FA Among People With Dementia and Their Family Caregivers

Studying views on aging among people with dementia is both informative of the cognitive processes involved in developing views on aging and, given FA’s role in shaping health outcomes, helpful to the efforts to support the overall mental, physical, and emotional health of the growing number of people diagnosed with dementia across the world. Longitudinal research analyzes how FA is predictive of developing dementia over time (Stephan et al., 2014, 2018). However, the research on views on aging among people who already have dementia is minimal and mostly aims to characterize the prevalence of certain FAs among people with dementia and to compare FA in people with and without dementia (Jaconelli et al., 2017; Sabatini, Ukoumunne, Martyr, et al., 2021).

Likewise, there is limited research on FA among the family caregivers who are increasingly being relied upon to support the day-to-day functioning of people with dementia. One study analyzing FA among spouses who were caring for people with dementia in the United Kingdom found that 35.6% of caregivers reported a younger FA (Sabatini et al., 2024). The study did not directly compare caregivers to noncaregivers. However, data from the general older UK population suggests that about 77.5% feel younger than their age (Sabatini, Ukoumunne, Ballard, Collins, Kim, et al., 2021); thus, a bigger proportion of caregivers of people with dementia—at least in the United Kingdom—may feel older than their age. Further, the study found that, as with the general population, spousal caregivers' FA was associated with depression, number of health conditions, stress, and subjective caregiving appraisals (Sabatini et al., 2024). With the exception of these studies, however, there is limited research on what psychosocial factors might shape caregivers' FA. As is true for people with dementia, a deeper understanding of FA among family caregivers of people with dementia, including the factors that are related to caregivers' FA, can help inform efforts to support the health of family caregivers, especially given the high cost of caregiving to caregivers’ health (Bremer et al., 2015).

Possible Dyadic Influences Between the FAs of Caregivers and People With Dementia

In this cross-sectional study, we hypothesized that the FA of people with dementia and the FA of their spousal caregivers may be dyadically associated. That is, the FA of people with dementia may be associated with their spousal caregivers’ FA and, likewise, spousal caregivers’ FA may be associated with the FA of people with dementia. Existing evidence from dyadic analyses suggests that partners (e.g., spouses or co-habiting partners) can influence each other’s self-perceptions of aging (Cohn-Schwartz et al., 2021; Momtaz et al., 2013), age-related beliefs (Mejía et al., 2020), and FA (Avidor et al., 2021; Levin et al., 2021). Moreover, in addition to views on aging theories, which note that factors such as social support shape people’s views on their own aging (e.g., Diehl et al., 2014), the Theory of Dyadic Illness Management (Lyons & Lee, 2018) posits that a person with an illness and their caregiver appraise the illness together, which shapes their shared illness management behaviors. Applied to dementia caregiving dyads, the ways in which people with dementia and their caregivers appraise and react to the dementia diagnosis may be related to each person’s FA. Relatedly, people with dementia and their caregivers may share similar health behaviors, supported by shared social and physical environments that reinforce those health behaviors (Pauly et al., 2021). Similar health behavior patterns could lead to similar health outcomes (including self-rated health), which could in turn result in similar FAs. However, to the best of our knowledge, there are no studies using dyadic analyses to explore questions of (dis)similarity in FA within dementia caregiving dyads.

The strength of any association between the FA of people with dementia and their caregivers likely depends on relationship closeness and satisfaction. The Developmental–Contextual Model of Couple Synchrony Across Adulthood and Old Age (Pauly et al., 2021) postulates that couples with greater couple satisfaction who have been together for longer, and/or who spend more time together show greater synchrony in health behavior and outcomes. In line with this proposition, a study showed higher similarity in couples’ views on aging (i.e., self-perceptions of aging) when partners had been together for longer time and reported higher levels of emotional closeness (Mejía et al., 2020). Greater marital satisfaction is associated with self-perceptions of aging (Fernandes-Pires et al., 2023) and relationship satisfaction also predicts greater health concordance in couples (Wilson & Novak, 2021). Hence, it may be that people with dementia and their caregivers are more likely to have similar FAs when they report higher relationship quality, though no research has explored this possibility.

Dyadic Connections Between FA and Well-Being, Satisfaction With Life, and Self-Efficacy

The research connecting family relationships with views on aging has revealed that relationship dynamics not only shape how people develop their views on aging, but also how views on aging are differentially connected to psychological correlates. Specifically, couples cocreate shared beliefs about aging that are associated with mental health indicators, such as depression (Cohn-Schwartz et al., 2021) and psychological well-being (Momtaz et al., 2013). As such, it is plausible that the ways in which the FA of people with dementia and their caregivers are dyadically associated extend to their effects on each other’s psychological correlates, especially if the family caregiver of the person with dementia is their spouse. For example, the person with dementia may develop an older FA that is reflective of their (cognitive) health difficulties. Simply being in close contact with a person with dementia who has a more negative view on their aging may make the caregiver think poorly of their own aging, similar to how mood, affect, and optimism/pessimism are shared between couples (Borenstein-Laurie et al., 2023).

But, there could be other pathways through which the FA of the person with dementia is associated with their caregiver's FA. For example, an older FA may be associated with the person with dementia having poorer health and well-being, and thus needing more caregiver support. If the caregiver then faces heightened emotional stress from the additional required support, they may begin to develop their own older FA. Alternatively, the ability to care for a person with dementia may make a caregiver feel younger. Caregiving may make them feel confident and useful, and may give them a purpose, which can help them feel younger. They may also compare their own health with that of the person with dementia, which could make them feel younger. A caregiver with a younger FA may help the person with dementia feel younger themselves. Perhaps caregivers with a younger FA are able to provide higher-quality caregiving, for example, and thus people with dementia are healthier. Caregivers with a younger FA may also engage in positive health behaviors and thus support the person with dementia to do the same, which helps the person with dementia feel younger.

Additionally, self-efficacy—a person’s belief in their capacity to control aspects of their lives, reach specific goals, and complete given tasks—is a major construct within the views on aging literature. Greater self-efficacy is often associated with more positive views on aging (Turner & Hooker, 2022), and self-efficacy mediates the association between views on aging and health behaviors (Tovel et al., 2019). Moreover, self-efficacy is malleable and is thus a promising target for interventions focused on views on aging (Diehl et al., 2023).

Likewise, self-efficacy is an important construct in caregiving literature, as both general self-efficacy and caregiving-specific self-efficacy play a role in caregiving outcomes (Lamont et al., 2019; McDermott et al., 2014), and self-efficacy is often a target of caregiving interventions (Tang & Chan, 2016). Self-efficacy is known to be dyadically connected between spouses (Ayotte et al., 2013), and caregivers’ self-efficacy is known to be associated with care recipients’ well-being (Kershaw et al., 2015). There is less research on the self-efficacy of people with dementia. However, one study of people with mild cognitive impairment found that increased self-efficacy was associated with greater quality of life among participants (Tonga et al., 2020). Given the important role self-efficacy plays in views on aging and in caregiving, an important extension of research on the dyadic associations between caregiving and views on aging includes analyzing self-efficacy as a construct that could be related to the other partner’s FA.

The Current Study

In this cross-sectional study, we utilized dyadic data from people with dementia and their spousal caregivers to investigate whether people with dementia and their caregivers had similar FAs, and whether the association between their FAs depended on their relationship quality. Given existing scholarship suggesting strong associations between FA and psychological health outcomes, we also analyzed whether the FAs of people with dementia and their caregivers were associated with the other partner’s well-being, satisfaction with life (SwL), and self-efficacy. We hypothesized the following:

  • [1] There would be a significant association between the FA of people with dementia and the FA of their caregivers. Specifically, we hypothesized that the FA of people with dementia and the FA of their caregivers would be positively correlated; caregivers’ younger FA would be associated with younger FA in people with dementia.

    • (1a) The higher the relationship quality, as rated by the caregiver and people with dementia, the more similar the FA of people with dementia and their caregivers would be.

  • [2]

    The FA of people with dementia and their caregivers would be related to the well-being, SwL, and self-efficacy of the other. Caregivers who had a more positive (i.e., younger) FA would be caring for people with dementia with better well-being, greater SwL, and higher self-efficacy. Likewise, people with dementia who had a more positive (i.e., younger) FA would have caregivers with better well-being, greater SwL, and higher self-efficacy.

Method

We used baseline data (2014–2016) from Version 7 of the Improving the experience of Dementia and Enhancing Active Life (IDEAL) study (Clare et al., 2014). The IDEAL study was approved by the Wales 5 Research Ethics Committee (reference: 13/WA/0405) and the Ethics Committee of the School of Psychology, Bangor University (reference: 2014-11684). The IDEAL study was registered with UKCRN, registration number 16593.

In IDEAL, people with dementia were recruited through a network of 29 National Health Service sites in England, Scotland, and Wales. At baseline, participants had to live at home, have a confirmed diagnosis of dementia of any subtype, and have mild-to-moderate dementia as indicated by a Mini-Mental State Examination (MMSE; Folstein et al., 1975) score ≥15. (In the current study sample mean MMSE score was 23.19 [standard deviation {SD} = 3.68].) Exclusion criteria were having a comorbid terminal illness at baseline, inability to provide informed consent at baseline, and/or any known potential for home visits to pose risk to research staff.

When a person with dementia joined the IDEAL study, where available, an informal caregiver was invited to take part as well. There were no specific inclusion criteria for caregivers. At baseline the IDEAL cohort comprised 1,277 caregivers, of which 1,020 were spouses. Of these, 19 did not report FA, thus the analytical sample comprised 1,001 dyads.

Measures

Measures administered to both people with dementia and caregivers

Felt age

We measured FA with the question “How old do you feel at the moment?” (Sabatini, Ukoumunne, Martyr, et al., 2021). Participants selected one of the following response items: a lot older than my age; a little older; not much older; about the same; not much younger; a little younger; a lot younger than my age. In the analyses, we treated FA as a continuous variable because participants’ scores were normally distributed.

Current relationship quality

We utilized the five optional questions from the Positive Affect Index, adapted for use with older adults, to measure relationship quality (Clare et al., 2012). The Positive Affect Index assesses the extent of positive affect that the respondent has for another person, with five questions addressing communication quality, closeness, similarity of views on life, engagement in joint activities, and overall relationship quality (Bengtson & Schrader, 1982). In the IDEAL study, people with dementia answered in relation to their caregiver and caregivers answered in relation to the person with dementia. Example questions are “How is communication between yourself and …?” and “In general, how similar are your views about life to those of …?” Each response is rated on a 6-point scale and responses are summed to obtain a total score. Possible scores range from 5 to 30, with higher scores indicating better relationship quality. In this study’s sample, Cronbach’s α for the scale was 0.74 indicating good internal reliability.

Well-being

We measured well-being with the World Health Organization-Five Well-Being Index (WHO-5 Well-Being Index; Bech, 2004). Example questions are “I have felt cheerful and in good spirits” and “I have felt calm and relaxed.” The total score can range from 0 to 25, but it was converted to a percentage score (i.e., ranging from 0 to 100), with a higher score indicating greater positive well-being. In this study’s sample, Cronbach’s α for the scale was 0.79 indicating good internal reliability.

Satisfaction with life

We measured SwL with the Satisfaction with Life Scale (Diener et al., 1985). Example questions are “In most ways my life is close to my ideal” and “The conditions of my life are excellent.” The total score ranges from 5 to 35, with a higher score indicating greater SwL. In this study’s sample, Cronbach’s α for the scale was 0.82 indicating good internal reliability.

Perceived self-efficacy

We measured self-efficacy via the 10-item Generalized Self-Efficacy Scale (Schwarzer & Jerusalem, 1995). Example questions are “I can always manage to solve difficult problems if I try hard enough” and “If someone opposes me, I can find the means and ways to get what I want.” Responses are made on a 4-point scale (1 = “not at all true”; 4 = “exactly true”). Responses to all 10 items are summed to yield the final score with a possible range from 10 to 40. A higher score indicates greater self-efficacy. In this study’s sample, Cronbach’s α for the scale was 0.88 indicating good internal reliability.

Personal characteristics

The demographic characteristics we measured for both people with dementia and caregiver included age, age group (<65; 65–69; 70–74; 75–79; 80+), sex, education level, and ethnic group. Education level was classified into four groups: no qualifications, school leaving certificate at age 16, school leaving certificate at age 18, and university level education. Ethnic group was classified as White British (including English, Welsh, Scottish, and Northern Irish), White Other (including Irish, Gypsy or Irish traveler, any other White background), and Other (including Caribbean, African, Indian, Pakistani, any other Asian background, and any other mixed background).

Measures taken from medical records for people with dementia only

Dementia type

Dementia type comprised seven diagnostic groups: Alzheimer’s disease; vascular dementia; mixed-Alzheimer’s disease and vascular dementia; frontotemporal dementia; Parkinson’s disease dementia; dementia with Lewy bodies; and unspecified/other.

Analyses

We first analyzed descriptive statistics for all study variables. Then, to test whether there was an association between the FA of people with dementia and their caregivers’ FA (Aim 1), we estimated the covariance between the FA of people with dementia and their caregivers’ FA using the structural equation modeling (SEM) interface in STATA. To explore whether people with dementia and their caregivers have a more similar FA when they rate the quality of their relationship more positively (Aim 2), we conducted the following steps: First, we computed an FA discrepancy score for use in the analyses by subtracting the FA each person with dementia from their caregiver's FA. A positive score indicated that people with dementia reported an older FA than their caregivers, and vice versa. A smaller discrepancy score between the FA of a person with dementia and their caregiver's FA indicated greater similarity in FA within the dyad. We then fit linear regression models with quality of the relationship (self-rated by the person with dementia and their caregiver) as a predictor of the FA discrepancy score.

Lastly, to test whether the FA of people with dementia was related to caregivers' well-being, SwL, and self-efficacy, and to test whether caregivers' FA was related to the well-being, SwL, and self-efficacy of people with dementia (Aim 3), we used SEM. Models estimated actor and partner effects of FA using the actor–partner interdependence model framework (Cook & Kenny, 2005). The influence of independent variables or predictors on an individual’s own outcomes is referred to as the actor effect and the influence of these predictors on the partner’s outcomes is known as the partner effect. We allowed well-being, SwL, and self-efficacy of people with dementia and caregiver to correlate in the models.

For all analyses, we estimated unadjusted and adjusted (for age, sex, and dementia diagnostic type for the person with dementia, and age of the caregiver) models. We conducted all analyses in STATA version 17.

Results

Descriptive Statistics

Table 1 offers descriptive statistics for both people with dementia and their spousal caregivers. Among people with dementia, well-being was significantly correlated with SwL (r = 0.57; p < .001) and with self-efficacy (r = 0.40; p < .001). Among people with dementia, self-efficacy was significantly correlated also with SwL (r = 0.41; p < .001). Similarly, caregiver well-being was significantly correlated with SwL (r = 0.55; p < .001) and with self-efficacy (r = 0.34; p < .001). Among caregivers, self-efficacy was significantly correlated also with SwL (r = 0.35; p < .001).

Table 1.

Descriptive Statistics (N = 1,001).

People with dementia Caregivers
Age, M (SD; range) 75.03 (7.85; 43–95) 72.36 (8.34; 41–92)
Age groups, n (%)
 <65 92 (9.2) 155 (15.5)
 65–69 140 (14.0) 190 (19.0)
 70–74 197 (19.7) 245 (24.5)
 75–79 255 (25.5) 210 (21.0)
 80+ 317 (31.7) 201 (20.1)
Sex
 Female, n (%) 341 (34.1) 666 (66.5)
Education, n (%)
 No qualification 246 (24.7) 252 (25.3)
 School leaving certificate at age 16 182 (18.3) 224 (22.4)
 School leaving certificate at age 18 359 (36.0) 292 (29.3)
 University 210 (21.1) 230 (23.1)
 Missing 4 3
Ethnicity, n (%)
 White British 956 (96.8) 964 (96.3)
 White Other 24 (2.4) 30 (3.0)
 Other 8 (0.8) 7 (0.7)
 Missing 3 0
Dementia diagnostic subtype, n (%)
 Alzheimer’s disease 562 (56.1)
 Vascular dementia 100 (10.0)
 Mixed (Alzheimer’s and vascular) 193 (19.3)
 Frontotemporal dementia 41 (4.1)
 Parkinson’s disease dementia 37 (3.7)
 Dementia with Lewy bodies 38 (3.8)
 Unspecified/other dementia 30 (3.0)
Felt age, n (%)
 A lot older than my age 42 (4.2) 53 (5.3)
 A little older 94 (9.4) 123 (12.3)
 Not much older 40 (4.0) 74 (7.4)
 About the same 461 (46.1) 395 (39.5)
 Not much younger 26 (2.6) 29 (2.9)
 A little younger 221 (22.1) 189 (18.9)
 A lot younger than my age 117 (11.7) 138 (13.8)
Positive Affect Index, M (SD) 25.06 (3.64) 23.32 (4.74)
 Missing 36 9
Satisfaction with life, M (SD) 26.81 (5.88) 23.61 (6.43)
 Missing 21 17
General self-efficacy scale, M (SD) 29.16 (5.48) 31.52 (4.20)
 Missing 72 30
Well-being, M (SD) 62.14 (20.31) 54.76 (19.91)
 Missing 16 27
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Note: SD = standard deviation.

Association Between FA in People With Dementia and FA in Their Caregivers

Using SEM, the covariance between the FA of people with dementia and the FA of caregivers was 0.09 (95% confidence interval [CI]: 0.03; 0.15; p value = .01), indicating some similarity in the FA of people with dementia and their caregivers. More specifically, in 14.29% of the sample, both the caregiver and the person with dementia felt younger than their age; in 5.09% of the sample, both the caregiver and the person with dementia felt older than their age; and in 18.48% of the sample, both the caregiver and the person with dementia felt as old as their age.

The discrepancy score between the FA of people with dementia and the FA of their caregivers was −0.12 (SD = 2.24), suggesting that people with dementia felt younger than their age to a greater extent than their caregivers. Quality of the relationship between people with dementia and their caregivers, as rated by people with dementia, was not significantly associated with the discrepancy score between the FA of people with dementia and the FA of their caregivers either before (B = −0.01; 95% CI: −0.05, 0.03; p = .67; β = −0.01) or after adjusting for age, sex, and diagnosis subtype of people with dementia, and age of the caregiver (B = −0.01; 95% CI: −0.05, 0.03; p = .52; β = −0.02). However, the quality of the relationship between people with dementia and their caregivers, as rated by caregivers, was significantly associated with the discrepancy score between the FA of people with dementia and the FA of caregivers both before (B = 0.05; 95% CI: 0.02, 0.08; p = .001; β = 0.11) and after adjusting for age, sex, and diagnosis subtype of the person with dementia, and age of the caregiver (B = 0.03; 95% CI: 0.001, 0.06; p = .04; β = 0.07).

Actor–Partner Interdependence Models

Main adjusted actor–partner interdependence model results are presented in Figure 1. Full model results from actor–partner interdependence models, including both adjusted and unadjusted models, are available in Supplementary Table 1.

Figure 1.

Alt Text: Figure with boxes and arrows indicating correlations between felt age and well-being, satisfaction with life, and self-efficacy in people with dementia and their caregivers, with varying significance levels.

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Illustration of actor–partner interdependence models for felt age and well-being, satisfaction with life, and self-efficacy. * = p < .05; *** = p < .001.

Well-being

The FA of people with dementia was significantly associated with their own well-being, such that the younger a person with dementia felt, the greater their well-being (adjusted model β = 0.21; p < .001). Caregivers’ FA was significantly associated with the well-being of people with dementia, such that the younger a caregiver felt, the greater the well-being of a person with dementia (adjusted model β = 0.07; p = .02). Caregivers’ FA was significantly associated with their own well-being (adjusted model β = 0.34; p < .001). However, the FA of people with dementia was not significantly associated with caregivers’ well-being.

Satisfaction with life

The FA of people with dementia was significantly associated with their own SwL, such that the younger a person with dementia felt, the greater their life satisfaction (adjusted model β = 0.26; p < .001). Caregivers’ FA was significantly associated with the SwL of people with dementia, such that the younger a caregiver felt, the greater was the SwL of the person with dementia (adjusted model β = 0.06; p = 0.04). Caregivers’ FA was significantly associated with their own SwL (adjusted model β = 0.25; p < .001). However, the FA of people with dementia was not significantly associated with caregivers’ SwL.

Self-efficacy

The FA of people with dementia was significantly associated with their own self-efficacy, such that the younger a person with dementia felt, the greater their self-efficacy (adjusted model β = 0.21; p < .001). Caregiver’s FA was not significantly associated with the self-efficacy of people with dementia. Caregivers’ FA was significantly associated with their own self-efficacy, such that the younger a caregiver felt, the greater their self-efficacy (adjusted model β = 0.19; p < .001). However, the FA of people with dementia was not significantly associated with caregivers’ self-efficacy.

Discussion

In this cross-sectional study, we used data from a large sample of community-dwelling people with mild-to-moderate dementia and their spousal caregivers to investigate similarities in FA (i.e., how old people feel relative to their chronological age) between people with dementia and their spousal caregivers, as well as how each partner’s FA was related to the other’s well-being, SwL, and self-efficacy. Overall, as expected and in line with the Theory of Dyadic Illness Management (Lyons & Lee, 2018), we found that people with dementia and caregiver FA were associated with each other, especially when caregivers rated their relationship with the person with dementia as of better quality. At cross-sectional level, we also found partner effects between caregivers’ FA and the well-being, SwL, and self-efficacy of people with dementia.

Key Findings

The FAs of people with dementia and their caregivers are associated

We found that the FAs of people with dementia and their caregivers are interwoven with each other. This finding that there is similarity in the FA of people with dementia and their caregivers is in line with previous literature investigating FA in older spouses (Avidor et al., 2021; Levin et al., 2021). However, to the best of our knowledge, we extended these results for the first time to the clinical sample of people with dementia and their spousal caregivers; we offer evidence that the mutual dyadic processes involved in views on aging are apparent in spousal dementia caregiving dyads. In so doing, our research both sheds light on dementia caregiving dynamics and offers further empirical evidence on the links between family relationship dynamics and views on aging. Our findings about the association between the FA of people with dementia and caregivers should prompt future studies that analyze the mechanisms underpinning these dyadic connections. For example, shared environment and similar levels of engagement with health-enhancing behaviors in people with dementia and caregivers may explain similarities in their FA.

For caregivers, but not people with dementia, the association was dependent on relationship quality

We found partial support for our hypothesis that relationship quality would be associated with the extent to which the FA of people with dementia and the FA of their caregivers were similar. The similarity between the FAs of people with dementia and thier caregivers was stronger when caregivers, but not people with dementia, rated the quality of the relationship more positively. Though we were surprised that rating of relationship quality by people with dementia was not associated with the similarity between the FA of people with dementia and their caregivers, the finding can be explained by long-standing literature on caregiving dyad discrepancies. Namely, Lyons et al. (2002) found that relationship strain perceived by the caregiver, but not the person with dementia, was significantly associated with disagreement about the needs of people with dementia. As with the Lyons et al. (2002) study, our results in this study suggest that relationship quality mattered for FA similarity for caregivers, but quality did not matter for similarity for people with dementia. Specific to our study, caregivers who experience a poor-quality relationship with the person with dementia may seek to distance themselves from the person with dementia and they may do so in ways that make them feel younger or older than the person with dementia. Alternatively, caregivers who experience a good quality relationship with the person with dementia may seek to remain close or increase closeness with the person with dementia, especially through the management of the dementia diagnosis, and they may do so in ways that make them feel the same age as the person with dementia. Another possibility is that, when people with dementia have an older FA, their more negative feelings toward their own aging may spread to caregivers more deeply when caregivers feel closer to the person with dementia.

Caregivers’ FA is associated with the well-being and SwL of people with dementia

A previous study using IDEAL data suggested that the FA of people with dementia was associated with their well-being and SwL (Sabatini, Ukoumunne, Martyr, et al., 2021). The current novel study is the first to link FA with self-efficacy of people with dementia and the first to link FA with well-being, SwL, and self-efficacy among their paired spousal caregivers. Our findings that the FA of people with dementia and their caregivers were both associated with their own well-being, SwL, and self-efficacy are unsurprising; they are in line with existing research in the general population, which notes that FA is associated with these constructs (Debreczeni & Bailey, 2021; Montepare & Lachman, 1989; Sabatini et al., 2020; Westerhof et al., 2023).

More notable, however, were the results for the cross-sectional partner effects. The FA of people with dementia was not associated with the investigated psychological correlates in caregivers. Yet, our study offers evidence that caregivers' FA may have implications that extend beyond themselves and, specifically, that caregivers’ FA may be related to the well-being of people with dementia. This finding offers new evidence that caregiving outcomes may be related to caregivers’ views on their own aging. Though a plethora of literature suggests that caregivers’ own health has implications for the health of people with dementia (e.g., Stall et al., 2019), this is the first study to show that subjective views on aging are also a caregiving factor that may be related to the well-being of people with dementia. Nonetheless, because our study has a cross-sectional design, we cannot rule out the possibility that the well-being, SwL, and self-efficacy of people with dementia have an effect on caregivers’ FA, rather than the other way around. We urge longitudinal analyses to investigate the causality of these novel association we identified here.

We also urge longitudinal studies to identify the mechanisms connecting caregiver FA to psychological correlates in people with dementia. We hypothesize that caregivers with younger FA have the resources to make caregiving less stressful. Because views on aging are connected to greater physical and mental health, caregivers with a younger FA may have less physical or emotional difficulty providing care or, at the very least, maybe their health allows them to sufficiently manage physical and emotional caregiving difficulty. FA is also connected to other views on aging constructs, such as old age stereotypes. It is possible that caregivers who have a younger FA also have more positive perceptions of older adulthood and therefore treat people with dementia with less ageism. These examples are all speculative, however, and should be evaluated in their own right.

Implications for Translational and Clinical Research

Caregiving interventions may benefit from harnessing the dyadic connections between caregivers’ FA and the well-being of people with dementia that we identified in this study. Specifically, though there are hundreds of interventions designed to support dementia family caregivers, there is limited evidence that these interventions have strong effectiveness on caregiving outcomes (Butler et al., 2020). Thus, caregiving researchers are searching for new ways to support dementia caregiving dyads. It is possible that targeting FA in caregivers may be a novel way to benefit both the caregiver and the person with dementia. Indeed, interventions to promote positive views on aging are effective (Diehl et al., 2020), but they have not yet been delivered dyadically to couples nor to caregiving dyads. However, because our study only analyzed associations cross-sectionally, longitudinal research that investigates possible causal pathways between FA and psychological outcomes among caregiving dyads is needed to more confidently identify FA as a promising intervention target for this group.

Strengths and Limitations

The most notable strength of this study is that it is the first study using actor–partner interdependence models to investigate FA among dementia caregiving dyads. Further, it maintained a large sample size (1,001 caregiving dyads) and incorporated measures that were completed by both people with dementia and their caregivers. However, there are some limitations to address. First, we conducted a cross-sectional study, which was important for setting the foundation for this emerging scholarship but did not allow us to test causality. As noted elsewhere in this Discussion section, we encourage future studies that characterize the mechanisms driving the associations we identified, which should include longitudinal analyses. Further, our sample was limited to spousal dyads. Because we aimed to extend the existing literature on dyadic views about aging among spouses, our sample of spousal caregiving dyads was intentional. Yet, future studies comparing spousal caregiving dyads to other types of caregiving dyads (e.g., adult-child caregiving dyads) would be informative as to how different types of family relationships uniquely contribute to views on aging. Moreover, studies that compare caregiving dyads directly to noncaregiving dyads would offer insight into how caregiving might uniquely affect views on aging.

Conclusion

Utilizing a large sample of 1,001 spousal dementia caregiving dyads, we identified for the first time that the FA of people with dementia and their spousal caregivers are interwoven, especially when caregivers rated their relationship with the person with dementia more positively. We further found that caregivers’ younger FAs may not only be a psychological resource for their own outcomes, but may also be related to psychological correlates in the person with dementia. Indeed, caregivers’ FA was associated with the well-being and SwL of people with dementia. These results bring new evidence to how the family relationship dynamic of caregiving and care receiving is related to views on aging, and should thus encourage future scholarship on views on aging in the context of caregiving.

Supplementary Material

gbae105_suppl_Supplementary_Table
gbae105_suppl_supplementary_table.docx (17KB, docx)

Acknowledgments

We would like to acknowledge the support of the following research networks: NIHR Dementias and Neurodegeneration Specialty (DeNDRoN) in England, the Scottish Dementia Clinical Research Network, and Health and Care Research Wales. We gratefully acknowledge the local principal investigators and researchers involved in participant recruitment and assessment within these networks. We are grateful to the IDEAL study participants for their participation in the study and to members of the ALWAYs group and the Project Advisory Group for their support throughout the study. For the purpose of open access, the authors have applied a Creative Commons Attribution (CC BY) license to any author-accepted manuscript version arising.

Contributor Information

Serena Sabatini, School of Psychology, University of Surrey, Guildford, UK.

Shelbie G Turner, Weill Cornell Medical College, Division of Geriatrics and Palliative Medicine, New York City, New York, USA.

Linda Clare, University of Exeter Medical School, University of Exeter, Exeter, UK; NIHR Applied Research Collaboration South-West Peninsula, Exeter, UK.

Rodlescia S Sneed, (Psychological Sciences Section).

Funding

“Improving the experience of Dementia and Enhancing Active Life: living well with dementia. The IDEAL study” was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health and Care Research (NIHR) through grant ES/L001853/2. Investigators: L. Clare, I. R. Jones, C. Victor, J. V. Hindle, R. W. Jones, M. Knapp, M. Kopelman, R. Litherland, A. Martyr, F. E. Matthews, R. G. Morris, S. M. Nelis, J. A. Pickett, C. Quinn, J. Rusted, J. Thom. ESRC is part of UK Research and Innovation (UKRI). “Improving the experience of Dementia and Enhancing Active Life: a longitudinal perspective on living well with dementia. The IDEAL-2 study” is funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001. Investigators: L. Clare, I. R. Jones, C. Victor, C. Ballard, A. Hillman, J. V. Hindle, J. Hughes, R. W. Jones, M. Knapp, R. Litherland, A. Martyr, F. E. Matthews, R. G. Morris, S. M. Nelis, C. Quinn, J. Rusted. This report is independent research supported by the NIHR Applied Research Collaboration South-West Peninsula. The views expressed in this publication are those of the authors and not necessarily those of the ESRC, UKRI, NIHR, the Department of Health and Social Care, the National Health Service, or Alzheimer’s Society. The support of ESRC, NIHR, and Alzheimer’s Society is gratefully acknowledged. L. Clare acknowledges support from the NIHR Applied Research Collaboration South-West Peninsula. S. G. Turner acknowledges support from the National Institute on Aging of the U.S. National Institutes of Health (T32AG049666).

Conflict of Interest

None.

Data Availability

IDEAL data were deposited with the UK Data Archive in April 2020. Details of how to access the data can be found here: https://reshare.ukdataservice.ac.uk/854293/. This study was not preregistered.

Author Contributions

S. Sabatini and S. G. Turner developed the research questions, conducted study analyses, and drafted the manuscript. L. Clare designed and conducted the IDEAL study and reviewed and commented on the draft of the manuscript.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

gbae105_suppl_Supplementary_Table
gbae105_suppl_supplementary_table.docx (17KB, docx)

Data Availability Statement

IDEAL data were deposited with the UK Data Archive in April 2020. Details of how to access the data can be found here: https://reshare.ukdataservice.ac.uk/854293/. This study was not preregistered.

Articles from The Journals of Gerontology Series B: Psychological Sciences and Social Sciences are provided here courtesy of Oxford University Press

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