title: Decreasing sense of coherence and its determinants in spousal caregivers of persons with mild Alzheimer's disease in three year follow-up: ALSOVA study.
abstract: BACKGROUND
  Sense of coherence (SOC) is associated with the capability to cope with caregiving. Our aims were (1) to describe the trajectory of SOC in aged spousal caregivers of persons with mild Alzheimer's disease (AD) in 3-year follow-up and (2) to identify baseline determinants influencing SOC change.
  
  
  METHODS
  Both AD (n = 170) (CDR-SOB, MMSE, NPI, ADCS-ADL) and caregiver- (n = 170) (BDI, SOC) related efficacy parameters were evaluated annually. Follow-up time was 3 years. The relationship of potential baseline factors with longitudinal SOC was analyzed using linear mixed models.
  
  
  RESULTS
  The mean drop-out-adjusted SOC score (148.5 at baseline) was decreased by 4.56 points (p = 0.002) during the follow-up. Caregivers' depression at baseline predicted the significant decrease of SOC (every + 1 BDI point decreases 2.181 points in SOC, p = 0.0001). When caregiver's depression was not taken into account in the analysis, female gender, and higher age and AD patient's lower baseline MMSE were associated significantly (p < 0.05) with decreasing SOC score in the follow-up. Other studied covariates were not associated with SOC change.
  
  
  CONCLUSIONS
  SOC is not as stable as expected, but decreases during long-lasting caregiving. Caregiver's depression at baseline predicts SOC decrease over time. In the future, caregiver dependent factors should be evaluated at the beginning of caregiving to target individualized support programmes to the vulnerable caregivers.
authors.affiliation: Department of Nursing Science,University of Eastern Finland,Kuopio,Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Välimäki
authors.affiliation: School of Pharmacy,University of Eastern Finland,Kuopio,Finland.
authors.forename: Janne
authors.initials: J
authors.lastname: Martikainen
authors.affiliation: School of Medicine,Institute of Clinical Medicine,Neurology,University of Eastern Finland,Kuopio,Finland.
authors.forename: Kristiina
authors.initials: K
authors.lastname: Hongisto
authors.affiliation: Neurosurgery of Neuro Centre,Kuopio University Hospital,Kuopio,Finland.
authors.forename: Mikael
authors.initials: M
authors.lastname: Fraunberg
authors.affiliation: School of Medicine,Institute of Clinical Medicine,Neurology,University of Eastern Finland,Kuopio,Finland.
authors.forename: Ilona
authors.initials: I
authors.lastname: Hallikainen
authors.affiliation: School of Medicine,Institute of Clinical Medicine,Neurology,University of Eastern Finland,Kuopio,Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Sivenius
authors.affiliation: Department of Nursing Science,University of Eastern Finland,Kuopio,Finland.
authors.forename: Katri
authors.initials: K
authors.lastname: Vehviläinen-Julkunen
authors.affiliation: Department of Nursing Science,University of Eastern Finland,Kuopio,Finland.
authors.forename: Anna-Maija
authors.initials: AM
authors.lastname: Pietilä
authors.affiliation: School of Medicine,Institute of Clinical Medicine,Neurology,University of Eastern Finland,Kuopio,Finland.
authors.forename: Anne M
authors.initials: AM
authors.lastname: Koivisto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000523:psychology / Q000628:therapy*; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D060685:Sense of Coherence; D012720:Severity of Illness Index; D018454:Spouses / Q000523:psychology*; D013997:Time Factors