Wisdom and psychological well-being of Chinese dementia caregivers

Abstract

Population ageing is affecting many societies across the world including Hong Kong. The number of people with dementia is expected to rise as a consequence. An estimated 46.8 million people worldwide were living with dementia in 2015. Because most people with dementia live in the community and are being cared for by their family, family caregiving has become an essential element of safeguarding their well-being. Previous literature indicates that dementia caregiving has both positive and negative impacts on the caregivers. While some research has focused on positive aspects such as meaningful relationships, life enrichment and self-affirmation, other work has sought to show the negative effects on the mental health of caregivers. Negative impacts are problematic not only for the hardship on caregivers, but also because of the associated higher possibilities of poor quality of care, maltreatment, and even abuse and/or premature institutional placement for the care recipients.

Risk factors for negative impacts have been extensively explored in dementia caregiving. However, less emphasis has been placed on identifying and testing variables that enrich caregivers’ resources. Resource factors that might contribute to fewer negative effects have been largely neglected. A potential resource is wisdom because of its positive association with psychological well-being. As wise people are more intuitive and insightful in dealing with life’s vicissitudes, this study investigated this unique multidimensional psycho-quality construct as an additional resource for caregivers to cope with the hardships in family caregiving.

This study measured the wisdom level among Chinese family caregivers in Hong Kong and tested the hypothetical relationships between wisdom and depressive symptoms. The aim was to investigate wisdom as a caregiving resource to buffer the effect of burden, leading to fewer depressive symptoms. The findings were used to propose a resource model of caregivers’ psychological well-being. Interviews using structured questionnaires were carried out with 98 family caregivers of older adults with dementia in this cross-sectional study. Depressive symptoms were the main measure for caregivers’ outcome. Predictors such as level of wisdom, perceived burden, social support and coping strategies were also measured in the study.

The average wisdom score measured by the three-dimensional wisdom scale (3D-WS) for all caregivers was 3.26 (SD±.35; range 1-5). Hierarchical multiple regression analyses indicated that a higher level of cognitive wisdom was associated with fewer depressive symptoms (β=-.25; p<.01). The reflective dimension of wisdom was found to moderate significantly with the problem-focused coping strategy in reducing depressive symptoms (β=-.18; p<.05). Further investigation revealed that the affective dimension of wisdom moderated the effect of caregiving burden to mitigate depression significantly (β=-.15; p<.05).

These results were suggestive of the capability of wisdom to reduce the amount of depressive symptoms among caregivers for people with dementia. This study adds to current literature by proposing wisdom as a resource model of dementia caregiver’s well-being (WARM-DCW). Findings imply that interventions that aim to enhance the psychological well-being of dementia caregivers should consider the benefit of wisdom, so that greater exposure to burden does not translate into greater distress.