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Decreasing sense of coherence and its determinants in spousal caregivers of persons with mild Alzheimer's disease in three year follow-up: ALSOVA study

  • Tarja Välimäki (a1), Janne Martikainen (a2), Kristiina Hongisto (a3), Mikael Fraunberg (a4) (a5), Ilona Hallikainen (a3), Juhani Sivenius (a3), Katri Vehviläinen-Julkunen (a1), Anna-Maija Pietilä (a1) and Anne M. Koivisto (a3) (a5)...



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.


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.


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.


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.


Corresponding author

Correspondence should be addressed to: Tarja Välimäki, University of Eastern Finland, Department of Nursing Science, P.O. Box 1627, 70211 Kuopio, Finland. Phone: +358 403552267; Fax: +358 17 162632. Email:


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Andrén, S. and Elmståhl, S. (2005). Family caregiver's subjective experiences of satisfaction in dementia care: aspects of burden, subjective health and sense of coherence. Scandinavian Journal of Caring Sciences, 19, 157168. doi: 10.1111/j.1471-6712.2005.00328.x.
Andrén, S. and Elmståhl, S. (2008). The relationship between caregiver burden, caregivers’ perceived health and their sense of coherence in caring for elders with dementia. Journal of Clinical Nursing, 17, 790799. doi: 10.1111/j.1365-2702.2007.02066.x.
Antonovsky, A. (1987). Unravelling the Mystery of Health. How people manage stress and stay well. San Francisco: Jossey-Bass.
Antonovsky, A. (1998). The Sense of Coherence: a Historical and Future Perspective. In McCubbin, H., Thompson, E., Thompson, A. and Fromer, J., (Eds.), (Stress, coping, and health in families (pp. 320). London: Sage Publications, Inc.
Antonovsky, A. (1993). Complexity, conflict, chaos, coherence, coercion and civility. Social Science and Medicine, 37, 969981. doi: 10.1016/0277-9536(93)90427-6.
APA. (1994) Diagnostic and Statistical manual of Mental Disorders. Washington, DC: American Psychiatric Association.
Beck, A., Ward, C., Mendelson, M., Mock, J. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 571. doi:10.1001/archpsyc.1961.01710120031004.
Berger, G., Bernhardt, T., Weimer, E., Peters, J., Kratzsch, T. and Frolich, L. (2005). Longitudinal study on the relationship between symptomatology of dementia and levels of subjective burden and depression among family caregivers in memory clinic patients. Journal of Geriatric Psychiatry and Neurology, 18, 119128. doi: 10.1177/0891988704273375.
Brodaty, H. and Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217228.
Chumbler, N. R., Rittman, M. R. and Wu, S. S. (2008). Associations in sense of coherence and depression in caregivers of stroke survivors across 2 years. Journal of Behavioral Health Services and Research, 35, 226234. doi: 10.1007/s11414-007-9083-1.
Cummings, J., Mega, M., Gray, K., Rosenberg-Thompson, S., Carusi, D. and Gornbein, J. (1994). The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology, 44, 23082314. doi: 10.1212/WNL.44.12.2308.
Dezutter, J., Wiesmann, U., Apers, S. and Luyckx, K. (2013). Sense of coherence, depressive feelings and life satisfaction in older persons: a closer look at the role of integrity and despair. Aging and Mental Health, 17, 839843. doi: 10.1080/13607863.2013.792780
Ekwall, A. K. and Hallberg, I. R. (2007.) The association between caregiving satisfaction, difficulties and coping among elderly family caregivers. Journal of Clinical Nursing, 16, 832844. doi: 10.1111/j.1365-2702.2006.01382.x.
Eriksson, M. and Lindström, B. (2005). Validity of Antonovsky's sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health, 59, 460466. doi: 10.1136/jech.2003.018085.
Eriksson, M. and Lindström, B. (2006). Antonovsky's sense of coherence and relation with health: a systematic review. Journal of Epidemiology and Community Health, 60, 376381. doi:10.1136/jech.2005.041616.
Eriksson, M. (2007). Unravelling the mystery of salutogenesis. Research report 2007:1, Turku: Folkhälsan research centre. Health promotion research programme.
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state”. a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198. doi: 10.1016/0022-3956(75)90026-6.
Galasko, D., Bennet, D., Sano, M., Ernesto, C., Thomas, R., Grundman, M. and Ferris, S. (1997). An Inventory to assess activities of daily living for clinical trials in Alzheimer's disease. Alzheimer Disease and Associated Disorders, 11, S3339.
Germain, S. et al. (2009). Does cognitive impairment influence burden in caregivers of patients with Alzheimer's disease? Journal of Alzheimer's Disease, 17, 105114. doi: 10.3233/JAD-2009-1016.
Goldberg, D. and Hillier, V. (1979) A scaled version of the General Health Questionnaire. Psychological Medicine, 9, 139145. doi:10.1017/S0033291700021644.
Helvik, A.-S., Engedal, K. and Selbæk, G. (2013). Change in sense of coherence (SOC) and symptoms of depression among old non-demented persons 12 months after hospitalization. Archives of Gerontology and Geriatrics, 56, 314320. doi:10.1016/j.archger.2012.10.010.
Hughes, C., Berg, L., Danziger, W., Coben, L. and Martin, R. (1982). A New clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572. doi:10.1192/bjp.140.6.566.
Karttunen, K. et al. (2011). Neuropsychiatric symptoms and quality of life in patients with very mild and mild Alzheimer's disease. Journal of Geriatric Psychiatry, 26 (5), 473482.
Lindmark, U., Stenström, U., Gerdin, E. W. R. and Hugoson, A. (2010). The distribution of “sense of coherence” among Swedish adults: a quantitative cross-sectional population study. Scandinavian Journal of Public Health, 38, 18. doi: 10.1177/1403494809351654.
Lindström, B. and Eriksson, M. (2005). Salutogenesis. Journal of Epidemiology and Community Health, 59, 440442. doi:10.1136/jech.2005.034777.
Lindström, B. and Eriksson, M. (2010). The Hitchiker's guide to salutogenesis. Research report 2101:2, Helsinki: Folkhälsan research center. Health promotion research.
Lindström, B. and Eriksson, M. (2010). A Salutogenic Approach to tackling health Inequalities. In Morgan, A., Davies, M., Ziglio, E., (Eds.), Health Assets in a Global Context: Theory, Methods, Action. New York: Springer. doi: 10.1007/978-1-4419-5921-8.
Lundman, B. et al. (2010). Sense of coherence (SOC) related to health and mortality among the very old: The Umeå 85+ study. Archives of Gerontology and Geriatrics, 51, 329332. doi: 10.1016/j.archger.2010.01.013
Lövheim, H., Graneheim, U. H., Jonsén, E., Strandberg, G. and Lundman, B. (2013). Changes in sense of coherence in old age - a 5-year follow-up of the Umeå 85+ study. Scandinavian Journal of Caring Sciences, 27, 1319. doi: 10.1111/j.1471-712.2012.00988.x.
McKhann, G., Drachman, D. and Folstein, M. (1984). Clinical diagnosis of Alzheimer's disease: Report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939944. doi: 10.1212/WNL.34.7.939.
Mittelman, M. S., Brodaty, H., Wallen, A. S. and Burns, A. (2008). A three-country randomized controlled trial of a psychosocial intervention for caregivers combined with pharmacological treatment for patients with Alzheimer disease: Effects on caregiver depression. American Journal of Geriatric Psychiatry, 16, 893904. doi: 10.1097/JGP.0b013e3181898095.
Morris, J. (1993) The CDR: current version and scoring rules. Neurology, 43, 24122413.
Nilsson, B., Holmgren, L., Stegmayr, B. and Westman, G. (2003). Sense of coherence - Stability over time and relation to health, disease, and psychosocial changes in a general population: a longitudinal study. Scandinavian journal of Public Health, 31, 297304. doi: 10.1080/14034940210164920.
Nilsson, K., Leppert, J., Simonsson, B. and Starrin, B. (2010). Sense of coherence and psychological well-being: improvement with age. Journal of Epidemiology and Community Health, 64, 347352. doi:10.1136/jech.2008.081174.
O'Bryant, S. E. et al. (2008). Staging dementia using clinical dementia rating scale sum of boxes scores: a Texas Alzheimer's research consortium study. Archives of Neurology, 65, 10911095. doi:10.1001/archneur.65.8.1091.
Orgeta, V. and Lo Sterzo, E. (2013). Sense of Coherence, burden, and affective symptoms in family carers of people with dementia. International Psychogeriatrics, 25, 973980. doi: 10.1017/S1041610213000203.
Pinquart, M. and Sörensen, S. (2003). Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: a meta-analysis. Journals of Gerontology Series B: Psychological Sciences & Social Sciences, 58B, P112–28. doi: 10.1093/geronb/58.2.P112.
Pretorius, C., Walker, S. and Heyns, PM. (2009). Sense of coherence amongst male caregivers in dementia: a South African perspective. Dementia, 8, 7994. doi: 10.1177/1471301208099046.
Quinn, C., Clare, L. and Woods, B. (2009). The impact of the quality of relationship on the experiences and wellbeing of caregivers of people with dementia: a systematic review. Aging & Mental Health, 13, 143154. doi:10.1080/13607860802459799.
Raitasalo, R. (2007). Mood questionnaire. Finnish modification of the short form of the Beck Depression Inventory measuring depression symptoms and self-esteem. The Social Insurance Institution, Finland, Studies in social security and health 86. Vammala: Vammalan kirjapaino.
Sintonen, H. (2001) The 15D instrument of health-related quality of life: properties and applications. Annals of Medicine, 33, 328336. doi: 10.3109/07853890109002086.
Suominen, S., Helenius, H., Blomberg, H., Uutela, A. and Koskenvuo, M. (2001). Sense of coherence as a predictor of subjective state of health results of 4 years of follow-up of adults. Journal of Psychosomatic Research, 50, 7786. doi: 10.1016/S0022-3999(00)00216-6.
Volanen, S.-M., Suominen, S., Lahelma, E., Koskenvuo, M and Silventoinen, K. (2007). Negative life events and stability of sense of coherence: a five-year follow-up study of Finnish women and men. Scandinavian Journal of Psychology, 48, 433441. doi: 10.1111/j.1467-9450.2007.00598.x
Välimäki, T., Vehviläinen-Julkunen, K., Pietilä, A-M. and Pirttilä, T. (2009). Caregiver depression is associated with a low sense of coherence and health-related quality of life. Aging & Mental Health, 13, 799807. doi: 10.1080/13607860903046487.
Wiesmann, U., Niehärster, G. and Hannich, H. (2009). Subjective health in old age from a salutogenic perspective. British Journal of Health Psychology, 14, 767787. doi: 10.1348/135910709X413124.
Wiesmann, U. and Hannich, H. (2010). A Salutogenic Analysis of Healthy Aging in Active Elderly Persons. Research on Aging, 32, 349371. doi: 10.1177/0164027509356954.
Wiesmann, U. and Hannich, H.-J. (2011). A salutogenic analysis of developmental tasks and ego integrity vs. despair. International Journal of Aging and Human Development, 73, 351369. doi: 10.2190/AG.73.4.e
Zarit, S. H., Femia, E. E., Kim, K. and Whitlatch, C. J. (2010). The structure of risk factors and outcomes for family caregivers: implications for assessment and treatment, Aging & Mental Health, 14, 220231. doi: 10.1080/13607860903167861.


Decreasing sense of coherence and its determinants in spousal caregivers of persons with mild Alzheimer's disease in three year follow-up: ALSOVA study

  • Tarja Välimäki (a1), Janne Martikainen (a2), Kristiina Hongisto (a3), Mikael Fraunberg (a4) (a5), Ilona Hallikainen (a3), Juhani Sivenius (a3), Katri Vehviläinen-Julkunen (a1), Anna-Maija Pietilä (a1) and Anne M. Koivisto (a3) (a5)...


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