{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T23:37:37Z","timestamp":1788478657861,"version":"build-2803163510"},"reference-count":333,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010473","name":"Alzheimer\u2019s Foundation of America Award","doi-asserted-by":"publisher","award":["AWD00004772"],"award-info":[{"award-number":["AWD00004772"]}],"id":[{"id":"10.13039\/100010473","id-type":"DOI","asserted-by":"publisher"}]},{"award":["AWD00004772"],"award-info":[{"award-number":["AWD00004772"]}],"id":[{"id":"https:\/\/ror.org\/03tkh8741","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Herb and Evelyn Abrams Family Amyloid Research Fund","award":["001"],"award-info":[{"award-number":["001"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Dementia caregiving represents a major public health challenge, with spousal caregivers assuming the greatest burden. Spouses, themselves typically older adults, provide high intensity, long-term, and largely unpaid care across all stages of cognitive decline. Despite their central role in dementia care, the health consequences experienced by spousal caregivers remain insufficiently characterized in the literature and inadequately addressed in clinical and public health practice. This structured narrative review synthesizes current evidence on the multidimensional impact of dementia caregiving on the physical, psychological, cognitive, social, and financial health of spousal caregivers. It further contextualizes these consequences within the trajectory of dementia progression, and identifies interventions, support systems, and policy considerations necessary to mitigate caregiver burden. Spousal caregivers experience disproportionate burden due to continuous, escalating responsibilities that often mirror the progressive deterioration of their partners. Emotional burdens, including uncertainty during pre-diagnostic stages, role strain, conflict, loss of intimacy, and anticipatory grief. Physically, spouses endure musculoskeletal strain, sleep disruption, poor nutrition, and heightened frailty risk. Psychologically, spousal caregivers exhibit elevated rates of depression, anxiety, loneliness, and stress-related disorders. Socially, caregivers experience substantial isolation, stigma, and erosion of social networks. Financial hardship, including early retirement, reduced employment, and uncompensated care hours, further exacerbate stress. Evidence suggests that chronic caregiving stress contributes to biological changes such as immune dysregulation, inflammation, acceleration, aging, and potential cognitive decline in caregivers themselves. Caregiver burden influences patient outcomes as evidenced by increased emergency department use, falls, and earlier institutionalization in persons with dementia whose caregiver is subjected to a high burden. Current care models rarely include routine, caregiver assessment or structured guidance following diagnosis, resulting in substantial unmet needs. Effective mitigation requires integrated, stage-sensitive interventions, including psychosocial support, caregiver education, respite services, culturally tailored programs, and digital health tools, alongside broader policy reforms to reduce financial and structural barriers.<\/jats:p>","DOI":"10.3390\/medicina62040796","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T10:38:14Z","timestamp":1776854294000},"page":"796","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The Impact of Dementia Caregiving on the Health of the Spousal Caregiver"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-6989-8941","authenticated-orcid":false,"given":"Donna","family":"de Levante Raphael","sequence":"first","affiliation":[{"name":"Alzheimer\u2019s Foundation of America, New York, NY 10001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lora J.","family":"Kasselman","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy","family":"Drewes","sequence":"additional","affiliation":[{"name":"Alzheimer\u2019s Foundation of America, New York, NY 10001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Wolff","sequence":"additional","affiliation":[{"name":"Alzheimer\u2019s Foundation of America, New York, NY 10001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luke","family":"Betlow","sequence":"additional","affiliation":[{"name":"Alzheimer\u2019s Foundation of America, New York, NY 10001, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua De","family":"Leon","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4478-2441","authenticated-orcid":false,"given":"Allison B.","family":"Reiss","sequence":"additional","affiliation":[{"name":"Department of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA"},{"name":"Department of Foundations of Medicine, NYU Grossman Long Island School of Medicine, Mineola, NY 11501, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"102001","DOI":"10.1016\/j.arr.2023.102001","article-title":"Urgent needs of caregiving in ageing populations with Alzheimer\u2019s disease and other chronic conditions: Support our loved ones","volume":"90","author":"Culberson","year":"2023","journal-title":"Ageing Res. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1097\/WAD.0000000000000647","article-title":"Dementia and Its Profound Impact on Family Members and Partners: A Large UK Cross-Sectional Study","volume":"38","author":"Shah","year":"2024","journal-title":"Alzheimer Dis. Assoc. Disord."},{"key":"ref_3","unstructured":"(2025, July 03). Alzheimer\u2019s Disease Facts and Figures. Available online: https:\/\/www.alz.org\/getmedia\/ef8f48f9-ad36-48ea-87f9-b74034635c1e\/alzheimers-facts-and-figures.pdf."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s11606-018-4377-y","article-title":"Underdiagnosis of Dementia: An Observational Study of Patterns in Diagnosis and Awareness in US Older Adults","volume":"33","author":"Amjad","year":"2018","journal-title":"J. Gen. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1146\/annurev-publhealth-040218-043758","article-title":"Causes and Patterns of Dementia: An Update in the Era of Redefining Alzheimer\u2019s Disease","volume":"40","author":"James","year":"2019","journal-title":"Annu. Rev. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"5143","DOI":"10.1002\/alz.13859","article-title":"Revised criteria for diagnosis and staging of Alzheimer\u2019s disease: Alzheimer\u2019s Association Workgroup","volume":"20","author":"Jack","year":"2024","journal-title":"Alzheimers Dement."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1016\/j.ncl.2024.05.005","article-title":"Dementia: Common Syndromes and Modifiable Risk and Protective Factors","volume":"42","author":"Jean","year":"2024","journal-title":"Neurol. Clin."},{"key":"ref_8","unstructured":"(2025, July 03). World Health Organization Dementia Fact Sheet. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/dementia."},{"key":"ref_9","unstructured":"Emmady, P.D., Schoo, C., and Tadi, P. (2022). Major Neurocognitive Disorder (Dementia). StatPearls [Internet], StatPearls Publishing."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1590\/1980-57642020dn14-020001","article-title":"Daily functioning and dementia","volume":"14","author":"Cipriani","year":"2020","journal-title":"Dement. Neuropsychol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e12923","DOI":"10.1111\/nan.12923","article-title":"Insights into the pathological basis of dementia from population-based neuropathology studies","volume":"49","author":"Wharton","year":"2023","journal-title":"Neuropathol. Appl. Neurobiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1007\/s00401-017-1717-7","article-title":"Impact of multiple pathologies on the threshold for clinically overt dementia","volume":"134","author":"Kapasi","year":"2017","journal-title":"Acta Neuropathol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1177\/1533317518791401","article-title":"Mild Cognitive Impairment in Clinical Practice: A Review Article","volume":"33","author":"Jongsiriyanyong","year":"2018","journal-title":"Am. J. Alzheimers Dis. Other Demen."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1001\/jamainternmed.2016.6807","article-title":"A Comparison of the Prevalence of Dementia in the United States in 2000 and 2012","volume":"177","author":"Langa","year":"2017","journal-title":"JAMA Intern. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e94","DOI":"10.1016\/S2666-7568(23)00022-3","article-title":"Autopsy studies are key to identifying dementia cause","volume":"4","author":"Suemoto","year":"2023","journal-title":"Lancet Healthy Longev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e70162","DOI":"10.1002\/alz.70162","article-title":"Unravelling the plasma proteome: Pioneering biomarkers for differential dementia diagnosis","volume":"21","author":"Gezegen","year":"2025","journal-title":"Alzheimers Dement."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"fcab086","DOI":"10.1093\/braincomms\/fcab086","article-title":"Biomarkers in neurological disorders: A fast-growing market","volume":"3","year":"2021","journal-title":"Brain Commun."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e70224","DOI":"10.1002\/alz.70224","article-title":"Evaluation of cognitive, functional, and behavioral effects observed in EMERGE, a phase 3 trial of aducanumab in people with early Alzheimer\u2019s disease","volume":"21","author":"Cummings","year":"2025","journal-title":"Alzheimers Dement."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"15333175221117006","DOI":"10.1177\/15333175221117006","article-title":"Cognitive Assessment in Culturally, Linguistically, and Educationally Diverse Older Populations in Europe","volume":"37","author":"Nielsen","year":"2022","journal-title":"Am. J. Alzheimers Dis. Other Demen."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1177\/1471301215626889","article-title":"How people come to recognise a problem and seek medical help for a person showing early signs of dementia: A systematic review and meta-ethnography","volume":"17","author":"Owen","year":"2018","journal-title":"Dementia"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1177\/1533317518758785","article-title":"Association Between Dementia Severity and Recommended Lifestyle Changes: A Retrospective Cohort Study","volume":"33","author":"Thoits","year":"2018","journal-title":"Am. J. Alzheimers Dis. Other Demen."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"105822","DOI":"10.1016\/j.puhe.2025.105822","article-title":"Early identification of cognitive impairment in older adults from Advanced Activities of Daily Living (AADL): A scoping review","volume":"246","author":"Gao","year":"2025","journal-title":"Public Health"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"777","DOI":"10.2174\/1567205015666180119092427","article-title":"Estimating Alzheimer\u2019s Disease Progression Rates from Normal Cognition Through Mild Cognitive Impairment and Stages of Dementia","volume":"15","author":"Davis","year":"2018","journal-title":"Curr. Alzheimer Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jocn.2020.01.015","article-title":"Which factors can we control the transition from mild cognitive impairment to dementia?","volume":"73","year":"2020","journal-title":"J. Clin. Neurosci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1017\/S1041610217001764","article-title":"Protective preparation: A process central to family caregivers of persons with mild cognitive impairment","volume":"30","author":"Wang","year":"2018","journal-title":"Int. Psychogeriatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1589","DOI":"10.1001\/jama.2019.4782","article-title":"Diagnosis and Management of Dementia: Review","volume":"322","author":"Arvanitakis","year":"2019","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e70129","DOI":"10.1002\/gps.70129","article-title":"Time to Diagnosis in Dementia: A Systematic Review with Meta-Analysis","volume":"40","author":"Kusoro","year":"2025","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.pneurobio.2013.04.005","article-title":"The impact of early dementia diagnosis and intervention on informal caregivers","volume":"110","author":"Verhey","year":"2013","journal-title":"Prog. Neurobiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.jalz.2011.03.003","article-title":"Toward defining the preclinical stages of Alzheimer\u2019s disease: Recommendations from the National Institute on Aging-Alzheimer\u2019s Association workgroups on diagnostic guidelines for Alzheimer\u2019s disease","volume":"7","author":"Sperling","year":"2011","journal-title":"Alzheimers Dement."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1017\/S1041610217000862","article-title":"Family members\u2019 experience of the pre-diagnostic phase of dementia: A synthesis of qualitative evidence","volume":"29","author":"Rogers","year":"2017","journal-title":"Int. Psychogeriatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"217","DOI":"10.31887\/DCNS.2009.11.2\/hbrodaty","article-title":"Family caregivers of people with dementia","volume":"11","author":"Brodaty","year":"2009","journal-title":"Dialogues Clin. Neurosci."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1563","DOI":"10.1093\/geronb\/gbz065","article-title":"Change Over Time in Caregiving Networks for Older Adults with and Without Dementia","volume":"75","author":"Spillman","year":"2020","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e70013","DOI":"10.1002\/alz.70013","article-title":"A look at caregivers for community-living persons with dementia: Implications for the GUIDE model","volume":"21","author":"Burgdorf","year":"2025","journal-title":"Alzheimers Dement."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e597","DOI":"10.1093\/geront\/gny049","article-title":"Depression and Anxiety Among Partner and Offspring Carers of People with Dementia: A Systematic Review","volume":"59","author":"Watson","year":"2019","journal-title":"Gerontologist"},{"key":"ref_35","unstructured":"(2025, September 01). Caregiving Centers for Disease Control and Prevention, Available online: https:\/\/www.cdc.gov\/caregiving\/about\/?CDC_AAref_Val=https:\/\/www.cdc.gov\/aging\/caregiving\/alzheimer.htm."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Wang, S., Luo, Y., Shan, Q., Liu, M., Wang, P., Huang, C., and Isaac Leung, S.H. (2025). Unraveling the subjective well-being of formal and informal caregivers for people with dementia: A comparative analysis. BMC Geriatr., 25.","DOI":"10.1186\/s12877-024-05640-8"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Johansson, M.F., McKee, K.J., Dahlberg, L., Summer Meranius, M., Williams, C.L., and Marmst\u00e5l Hammar, L. (2022). Negative Impact and Positive Value of Caregiving in Spouse Carers of Persons with Dementia in Sweden. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031788"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"108815","DOI":"10.1016\/j.pec.2025.108815","article-title":"Determinants of shared decision-making between people with dementia and informal caregivers: A systematic review","volume":"137","author":"Liu","year":"2025","journal-title":"Patient Educ. Couns."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2147\/CIA.S60574","article-title":"Family caregivers\u2019 role implementation at different stages of dementia","volume":"10","author":"Huang","year":"2015","journal-title":"Clin. Interv. Aging"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Ashbourne, J., Boscart, V., Meyer, S., Tong, C.E., and Stolee, P. (2021). Health care transitions for persons living with dementia and their caregivers. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02235-5"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Law, S., Ormel, I., Babinski, S., Kuluski, K., and Quesnel-Vall\u00e9e, A. (2021). \u201cCaregiving is like on the job training but nobody has the manual\u201d: Canadian caregivers\u2019 perceptions of their roles within the healthcare system. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02354-z"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"104742","DOI":"10.1016\/j.archger.2022.104742","article-title":"Providing informal care to a person living with dementia: The experiences of informal carers in Australia","volume":"102","author":"Engel","year":"2022","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"104757","DOI":"10.1016\/j.ijnurstu.2024.104757","article-title":"Life experience and identity of spousal caregivers of people with dementia: A qualitative systematic review","volume":"154","author":"Zhu","year":"2024","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1377\/hlthaff.2019.00087","article-title":"Spousal Caregivers Are Caregiving Alone In The Last Years Of Life","volume":"38","author":"Ornstein","year":"2019","journal-title":"Health Aff."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Gorostiaga, A., Etxeberria, I., Salaberria, K., and Kortabitarte, I. (2022). Primary and Secondary Caregivers of People with Dementia (PwD): Differential Patterns and Implications for Psychological Support. Healthcare, 10.","DOI":"10.3390\/healthcare10061102"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1947","DOI":"10.1093\/geronb\/gbac067","article-title":"The Effect of Support From Secondary Caregiver Network on Primary Caregiver Burden: Do Men and Women, Blacks and Whites Differ?","volume":"77","author":"Liang","year":"2022","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1080\/13607863.2025.2534406","article-title":"What are the unmet needs in people affected by dementia? A scoping review of reviews","volume":"29","author":"Koh","year":"2025","journal-title":"Aging Ment. Health"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Johnson, E., Lewis, M., Nordyke, A., Lee, M., Roberts, S., Gaugler, J.E., and Borson, S. (2025). Community health workers: Developing roles in public health dementia efforts in the United States. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1616404"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1111\/jocn.16301","article-title":"Caregiver training: Evidence of its effectiveness for cognitive and functional improvement in older adults","volume":"32","author":"Navarro","year":"2023","journal-title":"J. Clin. Nurs."},{"key":"ref_50","first-page":"90","article-title":"Cognitive Stimulation in Older Adults: An Innovative Good Practice Supporting Successful Aging and Self-Care","volume":"19","author":"Gil","year":"2019","journal-title":"Transl. Med. UniSa"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Lindeza, P., Rodrigues, M., Costa, J., Guerreiro, M., and Rosa, M.M. (2020). Impact of dementia on informal care: A systematic review of family caregivers\u2019 perceptions. BMJ Support. Palliat. Care, online ahead of print.","DOI":"10.1136\/bmjspcare-2020-002242"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3928\/19404921-20241211-02","article-title":"Comprehensive Dementia Care Models: State of the Science and Future Directions","volume":"18","author":"Murali","year":"2025","journal-title":"Res. Gerontol. Nurs."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1016\/j.healthpol.2017.03.013","article-title":"RightTimePlaceCare Consortium Informal and formal care: Substitutes or complements in care for people with dementia? Empirical evidence for 8 European countries","volume":"121","author":"Bremer","year":"2017","journal-title":"Health Policy"},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Kaufmann, L., Gruenbaum, T., Janssen, R., Weiss, E.M., Benke, T., Dal-Bianco, P., Defrancesco, M., Ransmayr, G., Schmidt, R., and St\u00f6gmann, E. (2024). Predictive value of somatic and functional variables for cognitive deterioration for early-stage patients with Alzheimer\u2019s Disease: Evidence from a prospective registry on dementia. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0307111"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"h3029","DOI":"10.1136\/bmj.h3029","article-title":"Dementia: Timely diagnosis and early intervention","volume":"350","author":"Robinson","year":"2015","journal-title":"BMJ"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1007\/s11136-016-1471-7","article-title":"Patient and caregiver goals for dementia care","volume":"26","author":"Jennings","year":"2017","journal-title":"Qual. Life Res."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1016\/j.gerinurse.2021.10.015","article-title":"The early stages of caregiving: A qualitative study into the caregiving experiences of Asian family caregivers of persons with newly-diagnosed dementia","volume":"42","author":"Heng","year":"2021","journal-title":"Geriatr. Nurs."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1212\/WNL.0000000000012079","article-title":"Ethics, Law, and Humanities Committee (a joint committee of the American Academy of Neurology, American Neurological Association, and Child Neurology Society). Ethical Considerations in Dementia Diagnosis and Care: AAN Position Statement","volume":"97","author":"Chiong","year":"2021","journal-title":"Neurology"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.socscimed.2015.02.014","article-title":"How family members manage risk around functional decline: The autonomy management process in households facing dementia","volume":"130","author":"Berry","year":"2015","journal-title":"Soc. Sci. Med."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"113026","DOI":"10.1016\/j.socscimed.2020.113026","article-title":"\u201cI know best:\u201d women caring for kin with dementia","volume":"256","year":"2020","journal-title":"Soc. Sci. Med."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1111\/hsc.12880","article-title":"\u2018I know they are not trained in dementia\u2019: Addressing the need for specialist dementia training for home care workers","volume":"28","author":"Polacsek","year":"2020","journal-title":"Health Soc. Care Community"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1016\/j.archger.2019.02.006","article-title":"Is training for informal caregivers and their older persons helpful? A systematic review","volume":"83","author":"Aksoydan","year":"2019","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1111\/scs.12626","article-title":"Burden of caregivers of patients with Alzheimer\u2019s disease","volume":"33","author":"Pudelewicz","year":"2019","journal-title":"Scand. J. Caring Sci."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1080\/08870446.2011.637559","article-title":"Leisure activities, caregiving demands and catecholamine levels in dementia caregivers","volume":"27","author":"Chattillion","year":"2012","journal-title":"Psychol. Health"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1111\/psyg.12736","article-title":"Caregivers\u2019 experiences of patients with moderate-stage Alzheimer\u2019s disease: A qualitative study","volume":"21","author":"Ozcan","year":"2021","journal-title":"Psychogeriatrics"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/j.sapharm.2017.05.005","article-title":"Medication management activities performed by informal caregivers of older adults","volume":"14","author":"Look","year":"2018","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1177\/1054773816678979","article-title":"Patient and Caregiver Interplay in Behavioral and Psychological Symptoms of Dementia: Family Caregiver\u2019s Experience","volume":"27","author":"Song","year":"2016","journal-title":"Clin. Nurs. Res."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Lagan\u00e0, V., Bruno, F., Altomari, N., Bruni, G., Smirne, N., Curcio, S., Mirabelli, M., Colao, R., Puccio, G., and Frangipane, F. (2022). Neuropsychiatric or Behavioral and Psychological Symptoms of Dementia (BPSD): Focus on Prevalence and Natural History in Alzheimer\u2019s Disease and Frontotemporal Dementia. Front. Neurol., 13.","DOI":"10.3389\/fneur.2022.832199"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"82","DOI":"10.5152\/npa.2017.11304","article-title":"Caregiver Burden in Different Stages of Alzheimer\u2019s Disease","volume":"54","author":"Koca","year":"2017","journal-title":"Noro Psikiyatr. Ars."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"685","DOI":"10.3233\/ADR-220040","article-title":"Anger and Dementia Caregiving: A Systematic Review of the Effects of Anger and Hostility on Caregivers\u2019 Physical Health","volume":"6","author":"See","year":"2022","journal-title":"J. Alzheimers Dis. Rep."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Eskola, P., Jolanki, O., and Aaltonen, M. (2022). Through Thick and Thin: The Meaning of Dementia for the Intimacy of Ageing Couples. Healthcare, 10.","DOI":"10.3390\/healthcare10122559"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1177\/14713012211073205","article-title":"Dementia and its impacts on the intimate, sexual couple relationship: A systematic review of qualitative research studies","volume":"21","author":"Albert","year":"2022","journal-title":"Dementia"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1177\/1471301212473882","article-title":"Impact of dementia on marriage: A qualitative systematic review","volume":"13","author":"Evans","year":"2014","journal-title":"Dementia"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/07317115.2017.1380102","article-title":"The Impact of Dementia on Relationships, Intimacy, and Sexuality in Later Life Couples: An Integrative Qualitative Analysis of Existing Literature","volume":"41","author":"Holdsworth","year":"2018","journal-title":"Clin. Gerontol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1177\/14713012241286559","article-title":"Understanding the impact of dementia on spousal relationships: A qualitative study with female spousal carers of people living with dementia","volume":"24","author":"Contreras","year":"2025","journal-title":"Dementia"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"S58","DOI":"10.1093\/geront\/gnx162","article-title":"Meeting the Informational, Educational, and Psychosocial Support Needs of Persons Living with Dementia and Their Family Caregivers","volume":"58","author":"Whitlatch","year":"2018","journal-title":"Gerontologist"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1111\/scs.12627","article-title":"The caregiving phenomenon and caregiver participation in dementia","volume":"33","author":"Dahlrup","year":"2019","journal-title":"Scand. J. Caring Sci."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1177\/07334648211005594","article-title":"CommunityRx: Optimizing a Community Resource Referral Intervention for Minority Dementia Caregivers","volume":"41","author":"Abramsohn","year":"2022","journal-title":"J. Appl. Gerontol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"169","DOI":"10.3233\/JAD-210609","article-title":"Dementia Caregivers\u2019 Experiences Engaging Supportive Services While Residing in Under-Resourced Areas","volume":"84","author":"Cotton","year":"2021","journal-title":"J. Alzheimers Dis."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Warren, A. (2021). Preserved Consciousness in Alzheimer\u2019s Disease and Other Dementias: Caregiver Awareness and Communication Strategies. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.790025"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/jan.15809","article-title":"The enrichment process for family caregivers of persons living with dementia: A grounded theory approach","volume":"80","author":"Bai","year":"2024","journal-title":"J. Adv. Nurs."},{"key":"ref_82","first-page":"e12530","article-title":"Navigating late-stage dementia: A perspective from the Alzheimer\u2019s Association","volume":"16","author":"Clifford","year":"2024","journal-title":"Alzheimers Dement."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jpainsymman.2018.10.494","article-title":"Triggered Palliative Care for Late-Stage Dementia: A Pilot Randomized Trial","volume":"57","author":"Hanson","year":"2019","journal-title":"J. Pain Symptom Manag."},{"key":"ref_84","doi-asserted-by":"crossref","unstructured":"Chew, E.Y.H., Ong, Z.L., Glass, G.F., and Chan, E.Y. (2022). \u201824\/7\u2019 Caregiving: A Qualitative Analysis of an Emerging Phenomenon of Interest in Caregiving. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph192417046"},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"6","DOI":"10.2174\/1874434601307010006","article-title":"Informal caregivers of people with dementia: Problems, needs and support in the initial stage and in subsequent stages of dementia: A questionnaire survey","volume":"7","author":"Zwaanswijk","year":"2013","journal-title":"Open Nurs. J."},{"key":"ref_86","doi-asserted-by":"crossref","unstructured":"Ferrero-Sereno, P., Palomo-L\u00f3pez, P., Mendoza-Mu\u00f1oz, M., Carlos-Vivas, J., Urbano-Mairena, J., and Mu\u00f1oz-Bermejo, L. (2024). Role of Overload and Psychoemotional Variables on Health-Related Quality of Life in Informal Caregivers of People with Alzheimer\u2019s Disease. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206188"},{"key":"ref_87","doi-asserted-by":"crossref","unstructured":"van Knippenberg, R.J.M., de Vugt, M.E., Ponds, R.W., Verhey, F.R.J., and Myin-Germeys, I. (2018). Emotional reactivity to daily life stress in spousal caregivers of people with dementia: An experience sampling study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0194118"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1017\/S1041610221002787","article-title":"Grief in family carers of people living with dementia: A systematic review","volume":"35","author":"Crawley","year":"2023","journal-title":"Int. Psychogeriatr."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1080\/13607863.2020.1753014","article-title":"The prevalence and predictors of loneliness in caregivers of people with dementia: Findings from the IDEAL programme","volume":"25","author":"Victor","year":"2021","journal-title":"Aging Ment. Health"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1080\/13607863.2023.2286618","article-title":"Dyadic perspectives on loneliness and social isolation among people with dementia and spousal carers: Findings from the IDEAL programme","volume":"28","author":"Rippon","year":"2024","journal-title":"Aging Ment. Health"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"e86","DOI":"10.1017\/S1478951525000082","article-title":"A systematic review of coping and pre-death grief among dementia family caregivers","volume":"23","author":"Wangliu","year":"2025","journal-title":"Palliat. Support. Care"},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1177\/1471301218774937","article-title":"Providing care for a person with late-stage dementia at home: What are carers\u2019 experiences?","volume":"19","author":"Dempsey","year":"2018","journal-title":"Dementia"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"gnad165","DOI":"10.1093\/geront\/gnad165","article-title":"Understanding Experiences of Caregivers of Spouses with Dementia During Caregiver Health Care Emergencies","volume":"64","author":"Daddato","year":"2024","journal-title":"Gerontologist"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1177\/1049909120931468","article-title":"Improving Care Experiences for Patients and Caregivers at End of Life: A Systematic Review","volume":"38","author":"Quigley","year":"2021","journal-title":"Am. J. Hosp. Palliat. Care"},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1007\/s11920-018-0915-x","article-title":"Dementia Care at End of Life: Current Approaches","volume":"20","author":"Bartley","year":"2018","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1177\/0269216317736033","article-title":"End-of-life care: A qualitative study comparing the views of people with dementia and family carers","volume":"32","author":"Poole","year":"2018","journal-title":"Palliat. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1136\/bmjspcare-2014-000794","article-title":"The preferences and perspectives of family caregivers towards place of care for their relatives at the end-of-life. A systematic review and thematic synthesis of the qualitative evidence","volume":"6","author":"Woodman","year":"2016","journal-title":"BMJ Support. Palliat. Care"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"2288","DOI":"10.1111\/jgs.16648","article-title":"Family Caregiving at the End of Life and Hospice Use: A National Study of Medicare Beneficiaries","volume":"68","author":"Kumar","year":"2020","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Bijnsdorp, F.M., Onwuteaka-Philipsen, B.D., Boot, C.R.L., van der Beek, A.J., and Pasman, H.R.W. (2022). Caregiver\u2019s burden at the end of life of their loved one: Insights from a longitudinal qualitative study among working family caregivers. BMC Palliat. Care, 21.","DOI":"10.1186\/s12904-022-01031-1"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"260","DOI":"10.3390\/psych6010016","article-title":"The Impact of Dementia on the Psychosocial Well-Being of Informal Caregivers in Asia: A Scoping Review Comparing High-Income and Low\u2013Middle-Income Countries","volume":"6","author":"Abayon","year":"2024","journal-title":"Psych"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1017\/S0144686X22000885","article-title":"Socioeconomic inequality of long-term care for older people with and Without dementia in England","volume":"44","author":"Hu","year":"2024","journal-title":"Ageing Soc."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"afaf168","DOI":"10.1093\/ageing\/afaf168","article-title":"End-of-life dementia care: A qualitative study of the experiences and perceptions of minority ethnic and economically disadvantaged groups","volume":"54","author":"Tomkow","year":"2025","journal-title":"Age Ageing"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"gbad166","DOI":"10.1093\/geronb\/gbad166","article-title":"Insights Into Informal Caregivers\u2019 Well-being: A Longitudinal Analysis of Care Intensity, Care Location, and Care Relationship","volume":"79","author":"Zhang","year":"2024","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1080\/07481187.2022.2113479","article-title":"The Two-Track Model of Dementia Grief and spousal response to illness and death","volume":"47","author":"Manevich","year":"2023","journal-title":"Death Stud."},{"key":"ref_105","doi-asserted-by":"crossref","unstructured":"H\u00e4iki\u00f6, K., Sagbakken, M., and Rugk\u00e5sa, J. (2019). Dementia and patient safety in the community: A qualitative study of family carers\u2019 protective practices and implications for services. BMC Health Serv. Res., 19.","DOI":"10.1186\/s12913-019-4478-2"},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1037\/cfp0000150","article-title":"\u201cWe Moved Her Too Soon\u201d: Navigating Guilt Among Adult Child and Spousal Caregivers of Persons Living with Dementia Following a Move into Residential Long-Term Care","volume":"11","author":"Statz","year":"2022","journal-title":"Couple Fam. Psychol."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"e12227","DOI":"10.1111\/opn.12227","article-title":"Guilt experienced by caregivers to individuals with dementia: A concept analysis","volume":"14","author":"Prunty","year":"2019","journal-title":"Int. J. Older People Nurs."},{"key":"ref_108","first-page":"1294","article-title":"\u201cI Feel Guilty\u201d. Exploring Guilt-Related Dynamics in Family Caregivers of People with Dementia","volume":"45","author":"Losada","year":"2020","journal-title":"Clin. Gerontol."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"e12","DOI":"10.1017\/SJP.2023.12","article-title":"Perceived Caregiving Trajectories and their Relationship with Caregivers\u2019 Burdens and Gains","volume":"26","author":"Villar","year":"2023","journal-title":"Span. J. Psychol."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1093\/geronb\/gbz028","article-title":"Mastery and Longevity in Spousal Caregivers of Persons with Dementia","volume":"75","author":"Savla","year":"2020","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_111","unstructured":"National Alliance for Caregiving in Partnership with the Alzheimer\u2019s Association (2024, December 15). Dementia Caregiving in the U.S. Bethesda, MD. Available online: https:\/\/www.caregiving.org\/wp-content\/uploads\/2020\/05\/Dementia-Caregiving-in-the-US_February-2017.pdf."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1080\/13607863.2014.977771","article-title":"What are the factors that facilitate or hinder resilience in older spousal dementia carers? A qualitative study","volume":"19","author":"Donnellan","year":"2014","journal-title":"Aging Ment. Health"},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"afae128","DOI":"10.1093\/ageing\/afae128","article-title":"Impact of care-recipient relationship type on quality of life in caregivers of older adults with dementia over time","volume":"53","author":"Kin","year":"2024","journal-title":"Age Ageing"},{"key":"ref_114","doi-asserted-by":"crossref","unstructured":"Zhang, J., Wang, J., Liu, H., and Wu, C. (2023). Association of dementia comorbidities with caregivers\u2019 physical, psychological, social, and financial burden. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-03774-9"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"e70033","DOI":"10.1111\/psyg.70033","article-title":"Caregiver burden in mild cognitive impairment due to Alzheimer\u2019s disease-a longitudinal study","volume":"25","author":"Rebolo","year":"2025","journal-title":"Psychogeriatrics"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"512","DOI":"10.1016\/j.jalz.2019.09.085","article-title":"Neuropsychological decline up to 20 years before incident mild cognitive impairment","volume":"16","author":"Caselli","year":"2020","journal-title":"Alzheimers Dement."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1080\/13607863.2017.1341468","article-title":"Caring for an individual with mild cognitive impairment: A qualitative perspective of health-related quality of life from caregivers","volume":"22","author":"Carlozzi","year":"2018","journal-title":"Aging Ment. Health"},{"key":"ref_118","doi-asserted-by":"crossref","unstructured":"Clemmensen, F.K., Hoffmann, K., Siersma, V., Sobol, N., Beyer, N., Andersen, B.B., Vogel, A., Lolk, A., Gottrup, H., and H\u00f8gh, P. (2020). The role of physical and cognitive function in performance of activities of daily living in patients with mild-to-moderate Alzheimer\u2019s disease\u2014A cross-sectional study. BMC Geriatr., 20.","DOI":"10.1186\/s12877-020-01926-9"},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"2167","DOI":"10.1111\/jan.13710","article-title":"The impact of early psychosocial intervention on self-efficacy of care recipient\/carer dyads living with early-stage dementia-a mixed-methods study","volume":"74","author":"Moyle","year":"2018","journal-title":"J. Adv. Nurs."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1017\/S0144686X18001320","article-title":"Spousal care-giving arrangements in Europe. The role of gender, socio-economic status and the welfare state","volume":"40","author":"Bertogg","year":"2020","journal-title":"Ageing Soc."},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Sabatini, S., Martyr, A., Hunt, A., Gamble, L.D., Matthews, F.E., Thom, J.M., Jones, R.W., Allan, L., Knapp, M., and Quinn, C. (2024). Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: Longitudinal findings from the IDEAL programme. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04707-w"},{"key":"ref_122","doi-asserted-by":"crossref","unstructured":"Pertl, M.M., Sooknarine-Rajpatty, A., Brennan, S., Robertson, I.H., and Lawlor, B.A. (2019). Caregiver Choice and Caregiver Outcomes: A Longitudinal Study of Irish Spousal Dementia Caregivers. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.01801"},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1177\/02654075211058084","article-title":"Caregiving spouses\u2019 experiences of relational uncertainty and partner influence in the prolonged relational transition of Alzheimer\u2019s disease and related dementias","volume":"39","author":"Cooper","year":"2021","journal-title":"J. Soc. Pers. Relatsh."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.1002\/gps.4430","article-title":"Time to diagnosis in young-onset dementia and its determinants: The INSPIRED study","volume":"31","author":"Draper","year":"2016","journal-title":"Int. J. Geriatr. Psychiatry."},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"3250","DOI":"10.1111\/jgs.18078","article-title":"Time to dementia diagnosis by race: A retrospective cohort study","volume":"70","author":"Davis","year":"2022","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1177\/14713012221128448","article-title":"Living in uncertainty while a spouse is undergoing a cognitive assessment: Voices of women care partners","volume":"21","author":"Hedman","year":"2022","journal-title":"Dementia"},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1177\/1471301212447157","article-title":"Understanding the dementia diagnosis: The impact on the caregiving experience","volume":"13","author":"Stokes","year":"2014","journal-title":"Dementia"},{"key":"ref_128","doi-asserted-by":"crossref","unstructured":"Molvik, I., Kjelvik, G., Selb\u00e6k, G., and Rokstad, A.M.M. (2024). Exploring the lived experience: Impact of dementia diagnosis on individuals with cognitive impairment\u2014A qualitative study. BMC Geriatr., 24.","DOI":"10.1186\/s12877-024-04665-3"},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1111\/hex.12964","article-title":"Communicating uncertainties when disclosing diagnostic test results for (Alzheimer\u2019s) dementia in the memory clinic: The ABIDE project","volume":"23","author":"Visser","year":"2020","journal-title":"Health Expect."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"23779608211029073","DOI":"10.1177\/23779608211029073","article-title":"Becoming a Family Caregiver to a Person with Dementia: A Literature Review on the Needs of Family Caregivers","volume":"7","author":"Steenfeldt","year":"2021","journal-title":"SAGE Open Nurs."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1177\/14713012211056461","article-title":"Long-term care placement: The transitional support needs and preferences of spousal dementia caregivers","volume":"21","author":"Brooks","year":"2022","journal-title":"Dementia"},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1093\/geront\/gnx204","article-title":"Predictors of Secondary Role Strains Among Spousal Caregivers of Older Adults with Functional Disability","volume":"59","author":"Polenick","year":"2019","journal-title":"Gerontologist"},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jagp.2025.08.011","article-title":"Daily Associations Between Caregiving Time and Spousal Caregivers\u2019 Well-Being: The Moderating Roles of Daily Marital Interactions","volume":"34","author":"Yang","year":"2026","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_134","doi-asserted-by":"crossref","unstructured":"Monin, J.K., McAvay, G., Zang, E., Vander Wyk, B., Carri\u00f3n, C.I., and Allore, H. (2023). Associations between dementia staging, neuropsychiatric behavioral symptoms, and divorce or separation in late life: A case control study. PLoS ONE, 18.","DOI":"10.2139\/ssrn.4368066"},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1177\/14777509231218565","article-title":"Caregiving and role conflict distress","volume":"19","author":"MacKenzie","year":"2023","journal-title":"Clin. Ethics"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1080\/13607863.2022.2089630","article-title":"Influence of spousal caregiving and living arrangement on depression among husband caregivers in rural China","volume":"27","author":"Zhao","year":"2023","journal-title":"Aging Ment. Health"},{"key":"ref_137","doi-asserted-by":"crossref","unstructured":"Garc\u00eda-Mart\u00edn, V., de Hoyos-Alonso, M.C., Delgado-Puebla, R., Ariza-Cardiel, G., and Del Cura-Gonz\u00e1lez, I. (2023). Burden in caregivers of primary care patients with dementia: Influence of neuropsychiatric symptoms according to disease stage (NeDEM project). BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04234-0"},{"key":"ref_138","first-page":"e72","article-title":"Kinship and cohabitation in relation to caregiver burden in the context of Alzheimer\u2019s disease: A 24-month longitudinal study","volume":"32","year":"2017","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_139","doi-asserted-by":"crossref","unstructured":"Savla, J., Roberto, K.A., and Fontaine, L.A. (2025). Gender differences in spousal caregiver strain and paid service use among dementia caregivers in rural Appalachia. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1620744"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"537","DOI":"10.1017\/S1041610215002239","article-title":"Spouses\u2019 experience of living with a partner diagnosed with a dementia: A synthesis of the qualitative research","volume":"28","author":"Pozzebon","year":"2016","journal-title":"Int. Psychogeriatr."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1177\/1533317517691121","article-title":"Relationship Quality and Distress in Caregivers of Persons with Dementia: A Cross-Sectional Study","volume":"32","author":"Kvaal","year":"2017","journal-title":"Am. J. Alzheimers Dis. Other Demen."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1177\/1359105317699682","article-title":"The impact of both spousal caregivers\u2019 and care recipients\u2019 health on relationship satisfaction in the Caregiver Health Effects Study","volume":"24","author":"Monin","year":"2019","journal-title":"J. Health Psychol."},{"key":"ref_143","doi-asserted-by":"crossref","unstructured":"Chang, C.Y.M., Baber, W., Dening, T., and Yates, J. (2021). \u201cHe Just Doesn\u2019t Want to Get Out of the Chair and Do It\u201d: The Impact of Apathy in People with Dementia on Their Carers. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18126317"},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"663","DOI":"10.3233\/JAD-215670","article-title":"The Impact of Agitation in Dementia on Caregivers: A Real-World Survey","volume":"88","author":"Schein","year":"2022","journal-title":"J. Alzheimers Dis."},{"key":"ref_145","doi-asserted-by":"crossref","first-page":"S4","DOI":"10.1111\/jgs.15343","article-title":"State of the Science: Apathy As a Model for Investigating Behavioral and Psychological Symptoms in Dementia","volume":"66","author":"Massimo","year":"2018","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1002\/gps.4704","article-title":"The relationship of specific items on the Neuropsychiatric Inventory to caregiver burden in dementia: A systematic review","volume":"32","author":"Terum","year":"2017","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"907","DOI":"10.3233\/JAD-142337","article-title":"Risk factors of caregiver burden among patients with Alzheimer\u2019s disease or related disorders: A cross-sectional study","volume":"44","author":"Dauphinot","year":"2015","journal-title":"J. Alzheimers Dis."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1177\/02654075221118095","article-title":"Lasting impact of relationships on caregiving difficulties, burden, and rewards","volume":"40","author":"Huo","year":"2023","journal-title":"J. Soc. Pers. Relatsh."},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"1026","DOI":"10.1093\/geronb\/gbab235","article-title":"The Impact of Marital Quality as Older Couples Adjust to Dementia Onset","volume":"77","author":"Huo","year":"2022","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1080\/15427609.2020.1750293","article-title":"Early Cognitive Decline and its Impact on Spouse\u2019s Loneliness","volume":"17","author":"Leggett","year":"2020","journal-title":"Res. Hum. Dev."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"e563","DOI":"10.1016\/j.jpainsymman.2024.02.357","article-title":"A National Study of Psychosocial Well-being of Spouses of Persons Living with Dementia in the Last Years of Life","volume":"67","author":"Kotwal","year":"2024","journal-title":"J. Pain Symptom Manag."},{"key":"ref_152","first-page":"647","article-title":"Experiences and perceptions of spousal\/partner caregivers providing care for community-dwelling adults with dementia: A qualitative systematic review","volume":"18","author":"Macdonald","year":"2020","journal-title":"JBI Evid. Synth."},{"key":"ref_153","doi-asserted-by":"crossref","unstructured":"Hazzan, A.A., Dauenhauer, J., Follansbee, P., Hazzan, J.O., Allen, K., and Omobepade, I. (2022). Family caregiver quality of life and the care provided to older people living with dementia: Qualitative analyses of caregiver interviews. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-02787-0"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"104717","DOI":"10.1016\/j.psyneuen.2020.104717","article-title":"Spousal bereavement after dementia caregiving: A turning point for immune health","volume":"118","author":"Wilson","year":"2020","journal-title":"Psychoneuroendocrinology"},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1177\/00302228221142632","article-title":"Spousal Mourning for Partners Living with Cognitive Impairment: The Interplay of Attachment and the Two-Track Model of Dementia Grief","volume":"91","author":"Manevich","year":"2025","journal-title":"Omega"},{"key":"ref_156","doi-asserted-by":"crossref","unstructured":"Cheung, D.S.K., Ho, K.H.M., Cheung, T.F., Lam, S.C., and Tse, M.M.Y. (2018). Anticipatory grief of spousal and adult children caregivers of people with dementia. BMC Palliat. Care, 17.","DOI":"10.1186\/s12904-018-0376-3"},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1002\/gps.5014","article-title":"Contrasting the risk factors of grief and burden in caregivers of persons with dementia: Multivariate analysis","volume":"34","author":"Liew","year":"2019","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_158","doi-asserted-by":"crossref","first-page":"104981","DOI":"10.1016\/j.jamda.2024.03.001","article-title":"Caregivers\u2019 Burden and Anticipatory Grief Increases Acute Health Care Use in Older Adults with Severe Dementia","volume":"25","author":"Malhotra","year":"2024","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_159","first-page":"688","article-title":"Caregivers dying before care recipients with dementia","volume":"12","author":"Gaugler","year":"2018","journal-title":"Alzheimers Dement."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"170","DOI":"10.14283\/jfa.2018.11","article-title":"Spousal Caregiving Is Associated with an Increased Risk of Frailty: A Case-Control Study","volume":"7","author":"Potier","year":"2018","journal-title":"J. Frailty Aging"},{"key":"ref_161","doi-asserted-by":"crossref","first-page":"afaf148","DOI":"10.1093\/ageing\/afaf148","article-title":"Impact of spousal caregiving on frailty index: Longitudinal evidence from China Health and Retirement Longitudinal Study","volume":"54","author":"Li","year":"2025","journal-title":"Age Ageing"},{"key":"ref_162","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1093\/geronb\/gbx118","article-title":"Multiple Chronic Conditions in Spousal Caregivers of Older Adults with Functional Disability: Associations with Caregiving Difficulties and Gains","volume":"75","author":"Polenick","year":"2020","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1177\/07334648211014352","article-title":"Is Dementia- Specific Caregiving Compared with Non-Dementia Caregiving Associated with Physical Difficulty Among Caregivers for Community-Dwelling Adults?","volume":"41","author":"Parker","year":"2022","journal-title":"J. Appl. Gerontol."},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"101295","DOI":"10.1016\/j.lanepe.2025.101295","article-title":"The Burden of Informal Family Caregiving in Europe, 2000\u20132050: A Microsimulation Modelling Study","volume":"53","author":"Cattaneo","year":"2025","journal-title":"Lancet Reg. Health Eur."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1177\/0733464813496464","article-title":"Musculoskeletal Discomfort, Physical Demand, and Caregiving Activities in Informal Caregivers","volume":"34","author":"Darragh","year":"2015","journal-title":"J. Appl. Gerontol."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"2853","DOI":"10.1111\/jgs.19037","article-title":"Physical pain among family caregivers to older adults: A scoping review of the literature","volume":"72","author":"Turner","year":"2024","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_167","doi-asserted-by":"crossref","first-page":"1760","DOI":"10.1080\/13607863.2024.2354888","article-title":"Sleep quality differences among caregivers for persons living with and Without dementia","volume":"28","author":"Petrovsky","year":"2024","journal-title":"Aging Ment. Health"},{"key":"ref_168","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1111\/ppc.12307","article-title":"Factors associated with sleep in family caregivers of individuals with dementia","volume":"55","author":"Peng","year":"2019","journal-title":"Perspect. Psychiatr. Care"},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"e199891","DOI":"10.1001\/jamanetworkopen.2019.9891","article-title":"Sleep Duration and Sleep Quality in caregivers of patients with dementia: A systematic review and meta-analysis","volume":"2","author":"Gao","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"igae017","DOI":"10.1093\/geroni\/igae017","article-title":"Profile of Caregiving Activities and Association with Physical Health Among Dementia Spousal Caregivers","volume":"8","author":"Cho","year":"2024","journal-title":"Innov. Aging"},{"key":"ref_171","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.jpsychires.2017.10.001","article-title":"Depression, sleep problems, and perceived stress among informal caregivers in 58 low-, middle-, and high-income countries: A cross-sectional analysis of community-based surveys","volume":"96","author":"Koyanagi","year":"2018","journal-title":"J. Psychiatr. Res."},{"key":"ref_172","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1016\/j.jagp.2018.01.206","article-title":"Medical Care Tasks among Spousal Dementia Caregivers: Links to Care-Related Sleep Disturbances","volume":"26","author":"Polenick","year":"2018","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"igae005","DOI":"10.1093\/geroni\/igae005","article-title":"Sleep and Caregiver Burden Among Caregivers of Persons Living with Dementia: A Scoping Review","volume":"8","author":"Mattos","year":"2024","journal-title":"Innov. Aging"},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1093\/geronb\/gbaa197","article-title":"Social Isolation Among Spousal and Adult-Child Caregivers: Findings From the Canadian Longitudinal Study on Aging","volume":"76","author":"Li","year":"2021","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"2330233","DOI":"10.1080\/17482631.2024.2330233","article-title":"Living with a person with young onset dementia\u2014Spousal experience","volume":"19","author":"Svensson","year":"2024","journal-title":"Int. J. Qual. Stud. Health Well-Being"},{"key":"ref_176","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1177\/10664807221104110","article-title":"Caring for Caregivers: Multiple Losses, Diminished Social Support, and their Associations with Depression in Family Caregivers","volume":"30","author":"Moh","year":"2022","journal-title":"Fam. J."},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"gnae014","DOI":"10.1093\/geront\/gnae014","article-title":"\u201cRelationships, Very Quickly, Turn to Nothing\u201d: Loneliness, Social Isolation, and Adaptation to Changing Social Lives Among Persons Living with Dementia and Care Partners","volume":"64","author":"Kotwal","year":"2024","journal-title":"Gerontologist"},{"key":"ref_178","doi-asserted-by":"crossref","unstructured":"McCann, B.R., Roberto, K.A., Savla, J., and Blieszner, R. (2024). Social worlds of Appalachian women caregivers of older relatives living with dementia. Front. Glob. Womens Health, 5.","DOI":"10.3389\/fgwh.2024.1461626"},{"key":"ref_179","doi-asserted-by":"crossref","unstructured":"Hajek, A., Kretzler, B., and K\u00f6nig, H.H. (2021). Informal Caregiving, Loneliness and Social Isolation: A Systematic Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph182212101"},{"key":"ref_180","doi-asserted-by":"crossref","unstructured":"Grycuk, E., Chen, Y., Almirall-Sanchez, A., Higgins, D., Galvin, M., Kane, J., Kinchin, I., Lawlor, B., Rogan, C., and Russell, G. (2022). Care burden, loneliness, and social isolation in caregivers of people with physical and brain health conditions in English-speaking regions: Before and during the COVID-19 pandemic. Int. J. Geriatr. Psychiatry, 37.","DOI":"10.1002\/gps.5734"},{"key":"ref_181","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1080\/13607863.2017.1364344","article-title":"The family caregiver experience\u2014Examining the positive and negative aspects of compassion satisfaction and compassion fatigue as caregiving outcomes","volume":"22","author":"Lynch","year":"2018","journal-title":"Aging Ment. Health"},{"key":"ref_182","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1080\/01634372.2018.1505796","article-title":"Fear, Defensive Strategies and Caring for Cognitively Impaired Family Members","volume":"62","author":"Spencer","year":"2019","journal-title":"J. Gerontol. Soc. Work."},{"key":"ref_183","first-page":"120","article-title":"Inappropriate sexual behavior in the context of dementia and neurodegenerative disorders: A review of the literature","volume":"37","author":"Sourdeau","year":"2025","journal-title":"Psychiatr. Danub."},{"key":"ref_184","doi-asserted-by":"crossref","unstructured":"Ponsoda, J.M., Bele\u00f1a, M.A., and D\u00edaz, A. (2023). Psychological Distress in Alzheimer\u2019s Disease Family Caregivers: Gender Differences and the Moderated Mediation of Resilience. Healthcare, 11.","DOI":"10.3390\/healthcare11233084"},{"key":"ref_185","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1177\/13634615211001707","article-title":"\u201cWhen I hear my language, I travel back in time and I feel at home\u201d: Intersections of culture with social inclusion and exclusion of persons with dementia and their caregivers","volume":"58","author":"Bresba","year":"2021","journal-title":"Transcult. Psychiatry"},{"key":"ref_186","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1080\/07317115.2022.2137448","article-title":"Cultural differences in caring for people with dementia: A pilot study of concern about losing face and loneliness in Chinese American and European American caregivers","volume":"46","author":"Lwi","year":"2023","journal-title":"Clin. Gerontol."},{"key":"ref_187","doi-asserted-by":"crossref","first-page":"2432","DOI":"10.1017\/S0144686X25100111","article-title":"Ageing-in-place care preferences of persons living with dementia and informal caregivers with a migration background: A qualitative interview study","volume":"30","author":"Vullings","year":"2025","journal-title":"Ageing Soc."},{"key":"ref_188","first-page":"e46537","article-title":"Cultural Diversity Impacts Caregiving Experiences: A Comprehensive Exploration of Differences in Caregiv-er Burdens, Needs, and Outcomes","volume":"15","author":"Tran","year":"2023","journal-title":"Cureus"},{"key":"ref_189","doi-asserted-by":"crossref","first-page":"12663","DOI":"10.1038\/s41598-022-16400-2","article-title":"Analysis of Family Stigma and Socioeconomic Factors Impact among Caregivers of Patients with Early- and Late-Onset Alzheimer\u2019s Disease and Frontotemporal Dementia","volume":"12","author":"Velilla","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_190","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.3233\/JAD-201004","article-title":"Social Stigma of People with Dementia","volume":"78","author":"Rejdak","year":"2020","journal-title":"J. Alzheimers Dis."},{"key":"ref_191","doi-asserted-by":"crossref","unstructured":"Shi, Y., Dong, S., Liang, Z., Xie, M., Zhang, H., Li, S., and Li, J. (2024). Affiliate Stigma among family caregivers of individuals with dementia in China: A cross-sectional study. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1366143"},{"key":"ref_192","doi-asserted-by":"crossref","first-page":"9","DOI":"10.21037\/mhealth-24-19","article-title":"A state-of-the-art narrative review of peer support for family caregivers of people with dementia: From in-person to digital delivery","volume":"11","author":"Cui","year":"2024","journal-title":"Mhealth"},{"key":"ref_193","doi-asserted-by":"crossref","unstructured":"Masoud, S.S., Meyer, K.N., Martin Sweet, L., Prado, P.J., and White, C.L. (2021). \u201cWe Don\u2019t Feel so Alone\u201d: A Qualitative Study of Virtual Memory Caf\u00e9s to Support Social Connectedness Among Individuals Living with Dementia and Care Partners During COVID-19. Front. Public Health, 9.","DOI":"10.3389\/fpubh.2021.660144"},{"key":"ref_194","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1016\/j.jamda.2023.08.005","article-title":"Technology-Based Interventions to Address Social Isolation and Loneliness Among Informal Dementia Caregivers: A Scoping Review","volume":"24","author":"Mao","year":"2023","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_195","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1017\/S0714980823000314","article-title":"Understanding Acceptability of Group Leisure Activities Used to Address Loneliness Among People Living with Dementia: An Exploratory Mixed-Methods Study","volume":"42","author":"Jeffery","year":"2023","journal-title":"Can. J. Aging"},{"key":"ref_196","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1177\/14713012211056288","article-title":"Themes describing social isolation in family caregivers of people living with dementia: A scoping review","volume":"21","author":"Lee","year":"2022","journal-title":"Dementia"},{"key":"ref_197","doi-asserted-by":"crossref","first-page":"1949","DOI":"10.1080\/13607863.2021.1950614","article-title":"Living well with dementia: The role volunteer-based social recreational programs in promoting social connectedness of people with dementia and their caregivers","volume":"26","author":"Sun","year":"2022","journal-title":"Aging Ment. Health"},{"key":"ref_198","first-page":"e43052","article-title":"Understanding Caregiver Challenges: A Comprehensive Exploration of Available Resources to Alleviate Caregiving Burdens","volume":"15","author":"Theng","year":"2023","journal-title":"Cureus"},{"key":"ref_199","doi-asserted-by":"crossref","unstructured":"Lalani, N., Osei, E.A., Yang, S., Katare, B., and Wagle, S. (2025). Financial health and well-being of rural female caregivers of older adults with chronic illnesses. BMC Geriatr., 25.","DOI":"10.1186\/s12877-025-05853-5"},{"key":"ref_200","unstructured":"(2025, October 03). Family Caregiver Alliance, Caregiver Statistics: Demographics. Available online: https:\/\/www.caregiver.org\/resource\/caregiver-statistics-demographics\/."},{"key":"ref_201","doi-asserted-by":"crossref","first-page":"1650","DOI":"10.1002\/alz.12550","article-title":"A day in the life of caregivers to older adults with and Without dementia: Comparisons of care time and emotional health","volume":"18","author":"Freedman","year":"2022","journal-title":"Alzheimers Dement."},{"key":"ref_202","doi-asserted-by":"crossref","first-page":"100386","DOI":"10.1016\/j.jeoa.2022.100386","article-title":"Opportunity costs of unpaid caregiving: Evidence from panel time diaries","volume":"22","author":"Miller","year":"2022","journal-title":"J. Econ. Ageing"},{"key":"ref_203","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.jval.2022.06.014","article-title":"Caregiving-Related Work Productivity Loss Among Employed Family and Other Unpaid Caregivers of Older Adults","volume":"26","author":"Samuel","year":"2023","journal-title":"Value Health"},{"key":"ref_204","doi-asserted-by":"crossref","first-page":"2969","DOI":"10.1111\/jgs.19174","article-title":"More than dollars: Healthcare utilization among spouses of persons with dementia","volume":"72","author":"Horstman","year":"2024","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_205","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/0091415015574181","article-title":"Spousal Caregiving and Financial Strain Among Middle-Aged and Older Adults","volume":"79","author":"Lee","year":"2014","journal-title":"Int. J. Aging Hum. Dev."},{"key":"ref_206","doi-asserted-by":"crossref","first-page":"481","DOI":"10.2147\/CIA.S451833","article-title":"Understanding the Support Needs and Challenges Faced by Family Caregivers in the Care of Their Older Adults at Home","volume":"19","author":"Hailu","year":"2024","journal-title":"A Qual. Study Clin. Interv. Aging"},{"key":"ref_207","doi-asserted-by":"crossref","first-page":"e70518","DOI":"10.1002\/alz.70518","article-title":"Relationship between cellular aging, perceived stress, and cardiometabolic disease risk in Black family caregivers of persons with dementia","volume":"21","author":"Watson","year":"2025","journal-title":"Alzheimers Dement."},{"key":"ref_208","doi-asserted-by":"crossref","first-page":"105359","DOI":"10.1016\/j.neubiorev.2023.105359","article-title":"The impact of life stress on hallmarks of aging and accelerated senescence: Connections in sickness and in health","volume":"153","author":"Lyons","year":"2023","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_209","doi-asserted-by":"crossref","unstructured":"Janson, P., Willeke, K., Zaibert, L., Budnick, A., Bergh\u00f6fer, A., Kittel-Schneider, S., Heuschmann, P.U., Zapf, A., Wildner, M., and Stupp, C. (2022). Mortality, Morbidity and Health-Related Outcomes in Informal Caregivers Compared to Non-Caregivers: A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19105864"},{"key":"ref_210","unstructured":"(2025, October 08). Caregiver Statistics: Health, Technology, and Caregiving Resources. Available online: https:\/\/www.caregiver.org\/resource\/caregiver-statistics-health-technology-and-caregiving-resources."},{"key":"ref_211","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1093\/geront\/gnz090","article-title":"Applying Relational Turbulence Theory to Adult Caregiving Relationships","volume":"60","author":"Knobloch","year":"2020","journal-title":"Gerontologist"},{"key":"ref_212","doi-asserted-by":"crossref","first-page":"119547","DOI":"10.1016\/j.jad.2025.119547","article-title":"Decomposing the association between caregiver burden and depressive symptoms in family caregivers of older adults: A network analysis","volume":"387","author":"Wrede","year":"2025","journal-title":"J. Affect. Disord."},{"key":"ref_213","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1080\/08870446.2018.1496250","article-title":"The psychosocial impact of caregiving in dementia and quality of life: A systematic review and meta-synthesis of qualitative research","volume":"33","author":"Cross","year":"2018","journal-title":"Psychol. Health"},{"key":"ref_214","doi-asserted-by":"crossref","unstructured":"Chakraborty, R., Jana, A., and Vibhute, V.M. (2023). Caregiving: A risk factor of poor health and depression among informal caregivers in India- A comparative analysis. BMC Public Health, 23.","DOI":"10.1186\/s12889-022-14880-5"},{"key":"ref_215","doi-asserted-by":"crossref","first-page":"1562","DOI":"10.1002\/alz.13555","article-title":"Spouses of individuals living with mild cognitive impairment or dementia in the United States: A descriptive, population-based study","volume":"20","author":"Torres","year":"2024","journal-title":"Alzheimers Dement."},{"key":"ref_216","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1093\/geronb\/gbad064","article-title":"Impacts of Caregiving on Health of New Spousal Caregivers to Older Adults in the United States: A Coarsened Exact Matching Analysis","volume":"78","author":"Liu","year":"2023","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_217","doi-asserted-by":"crossref","unstructured":"Gagliardi, C., Piccinini, F., Lamura, G., Casanova, G., Fabbietti, P., and Socci, M. (2022). The Burden of Caring for Dependent Older People and the Resultant Risk of Depression in Family Primary Caregivers in Italy. Sustainability, 14.","DOI":"10.3390\/su14063375"},{"key":"ref_218","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1159\/000341584","article-title":"The Quality of Life of People with Dementia and Their Family Carers","volume":"34","author":"Bruvik","year":"2012","journal-title":"Dement. Geriatr. Cogn. Disord."},{"key":"ref_219","doi-asserted-by":"crossref","unstructured":"Ask, H., Langballe, E.M., Holmen, J., Selb\u00e6k, G., Saltvedt, I., and Tambs, K. (2014). Mental health and wellbeing in spouses of persons with dementia: The Nord-Tr\u00f8ndelag Health Study. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-413"},{"key":"ref_220","doi-asserted-by":"crossref","unstructured":"Del-Pino-Casado, R., Priego-Cubero, E., L\u00f3pez-Mart\u00ednez, C., and Orgeta, V. (2021). Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247143"},{"key":"ref_221","doi-asserted-by":"crossref","unstructured":"Hsieh, C.J., Yin, P.F., Chiu, C.Y., Hsiao, Y.P., and Hsiao, Y.L. (2022). Support and Empowerment for Older Adult Spousal Caregiving of People with Mild and Moderate Dementia: A Participatory Action Research. Healthcare, 10.","DOI":"10.3390\/healthcare10030569"},{"key":"ref_222","doi-asserted-by":"crossref","first-page":"100061","DOI":"10.1016\/j.ahr.2022.100061","article-title":"Experience of the healthcare system for caregivers of persons with dementia","volume":"2","author":"Gately","year":"2022","journal-title":"Aging Health Res."},{"key":"ref_223","doi-asserted-by":"crossref","first-page":"2220","DOI":"10.1111\/jgs.15039","article-title":"Association Between Spousal Caregiver Well-Being and Care Recipient Healthcare Expenditures","volume":"65","author":"Ankuda","year":"2017","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_224","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/HGTQ8159","article-title":"How lived experiences of illness trajectories, burdens of treatment, and social inequalities shape service user and caregiver participation in health and social care: A theory-informed qualitative evidence synthesis","volume":"13","author":"May","year":"2025","journal-title":"Health Soc. Care Deliv. Res."},{"key":"ref_225","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1001\/jamaneurol.2019.1820","article-title":"Association Between Caregiver Depression and Emergency Department Use Among Patients with Dementia","volume":"76","author":"Guterman","year":"2019","journal-title":"JAMA Neurol."},{"key":"ref_226","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1007\/s11606-008-0711-0","article-title":"Acute care utilization by dementia caregivers within urban primary care practices","volume":"23","author":"Schubert","year":"2008","journal-title":"J. Gen. Intern. Med."},{"key":"ref_227","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.jalz.2013.12.018","article-title":"Health-care use and cost in dementia caregivers: Longitudinal results from the Predictors Caregiver Study","volume":"11","author":"Zhu","year":"2015","journal-title":"Alzheimers Dement."},{"key":"ref_228","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1017\/S1478951522001249","article-title":"Dementia caregiver burdens predict overnight hospitalization and hospice utilization","volume":"21","author":"Sullivan","year":"2023","journal-title":"Palliat. Support. Care"},{"key":"ref_229","doi-asserted-by":"crossref","first-page":"e78","DOI":"10.1093\/geront\/gnx202","article-title":"Falls and Hospitalizations Among Persons with Dementia and Associated Caregiver Emotional Difficulties","volume":"58","author":"Leggett","year":"2018","journal-title":"Gerontologist"},{"key":"ref_230","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1177\/01939459211002907","article-title":"The Differential Effects of Caregiving Intensity on Overnight Hospitalization","volume":"44","author":"Meyer","year":"2022","journal-title":"West. J. Nurs. Res."},{"key":"ref_231","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1177\/10848223241309013","article-title":"A Review of Studies That Measured the Mental Health Outcomes of Spouse Caregivers Caring for a Spouse with Disabling Health Conditions","volume":"38","author":"Oduche","year":"2026","journal-title":"Home Health Care Manag. Pract."},{"key":"ref_232","doi-asserted-by":"crossref","first-page":"e283","DOI":"10.1093\/geront\/gnaa043","article-title":"Systematic Review of Exercise for Caregiver-Care Recipient Dyads: What Is Best for Spousal Caregivers-Exercising Together or Not at All?","volume":"61","author":"Doyle","year":"2021","journal-title":"Gerontologist"},{"key":"ref_233","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.ypmed.2006.04.009","article-title":"Leisure-time exercise and overall physical activity in older women caregivers and non-caregivers from the Caregiver-SOF Study","volume":"43","author":"Fredman","year":"2006","journal-title":"Prev. Med."},{"key":"ref_234","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1037\/hea0001212","article-title":"Effects of physical activity interventions for caregivers of adults: A meta-analysis","volume":"41","author":"Marshall","year":"2022","journal-title":"Health Psychol."},{"key":"ref_235","doi-asserted-by":"crossref","unstructured":"Cardoso, C., Lumini, M.J., and Martins, T. (2025). Effects of physical exercise in reducing caregivers burden: A systematic review. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1474913"},{"key":"ref_236","doi-asserted-by":"crossref","unstructured":"Bravo-Vazquez, A., Anarte-Lazo, E., Gonzalez-Gerez, J.J., Rodriguez-Blanco, C., and Bernal-Utrera, C. (2025). Effects of Physical Exercise on the Physical and Mental Health of Family Caregivers: A Systematic Review. Healthcare, 13.","DOI":"10.3390\/healthcare13101196"},{"key":"ref_237","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1177\/01939459251341197","article-title":"Effects of Physical Activity on Health Among Informal Caregivers of People with Cognitive Decline: A Systematic Review and Meta-Analysis","volume":"47","author":"Ahn","year":"2025","journal-title":"West. J. Nurs. Res."},{"key":"ref_238","doi-asserted-by":"crossref","unstructured":"Boon, J.T., Maxwell, C.A., and Layne, D.M. (2025). Caring While Moving: Case Studies on Physical Activity and Dementia Caregiver Well-Being. Healthcare, 13.","DOI":"10.3390\/healthcare13172205"},{"key":"ref_239","doi-asserted-by":"crossref","first-page":"e56739","DOI":"10.2196\/56739","article-title":"Mobile App (CareFit) Supporting Physical Activity for Informal Carers of People with Dementia: Mixed Methods Feasibility and Adaptation Study","volume":"27","author":"Egan","year":"2025","journal-title":"J. Med. Internet Res."},{"key":"ref_240","doi-asserted-by":"crossref","first-page":"e068646","DOI":"10.1136\/bmjopen-2022-068646","article-title":"Effectiveness of interventions designed to mitigate the negative health outcomes of informal caregiving to older adults: An umbrella review of systematic reviews and meta-analyses","volume":"13","author":"Kirvalidze","year":"2023","journal-title":"BMJ Open"},{"key":"ref_241","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1111\/psyg.13053","article-title":"Physical activity and its relationship to burden and health concerns in family caregivers of people with dementia","volume":"24","author":"Garcia","year":"2024","journal-title":"Psychogeriatrics"},{"key":"ref_242","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1111\/psyg.13064","article-title":"Factors associated with reduced sleep among spouses and caregivers of older adults with varying levels of cognitive decline","volume":"24","author":"Gallagher","year":"2024","journal-title":"Psychogeriatrics"},{"key":"ref_243","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1093\/geronb\/gbac096","article-title":"Characteristics and Predictors of Sleep Among Spousal Care Dyads Living with Chronic Conditions","volume":"78","author":"Liu","year":"2023","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_244","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1080\/07317115.2022.2139655","article-title":"Correlates of Sleep Disturbance Experienced by Informal Caregivers of Persons Living with Dementia: A Systematic Review","volume":"47","author":"Brewster","year":"2024","journal-title":"Clin. Gerontol."},{"key":"ref_245","doi-asserted-by":"crossref","first-page":"e299","DOI":"10.1097\/jnr.0000000000000582","article-title":"Predictors of Sleep Quality in Spouse Caregivers of Community-Dwelling People with Dementia Using Propensity Score Matching Analysis","volume":"31","author":"Chu","year":"2023","journal-title":"J. Nurs. Res."},{"key":"ref_246","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1111\/jgs.18720","article-title":"The feasibility of a sleep education program for informal dementia care dyads: A pilot randomized controlled trial","volume":"72","author":"Song","year":"2024","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_247","doi-asserted-by":"crossref","first-page":"995","DOI":"10.3233\/JAD-210694","article-title":"Caregiving for a Spouse with Cognitive Impairment: Effects on Nutrition and Other Lifestyle Factors","volume":"84","author":"Jeon","year":"2021","journal-title":"J. Alzheimers Dis."},{"key":"ref_248","doi-asserted-by":"crossref","first-page":"2132","DOI":"10.1080\/13607863.2020.1805722","article-title":"What\u2019s eating you? Risk factors for poor health behaviors among family caregivers","volume":"25","author":"Koumoutzis","year":"2021","journal-title":"Aging Ment. Health"},{"key":"ref_249","doi-asserted-by":"crossref","unstructured":"Potier, F., Degryse, J.M., Bihin, B., Debacq-Chainiaux, F., Charlet-Renard, C., Martens, H., and de Saint-Hubert, M. (2018). Health and frailty among older spousal caregivers: An observational cohort study in Belgium. BMC Geriatr., 18.","DOI":"10.1186\/s12877-018-0980-3"},{"key":"ref_250","doi-asserted-by":"crossref","first-page":"17","DOI":"10.11606\/s1518-8787.2020054001655","article-title":"Pre-frailty, frailty and associated factors in older caregivers of older adults","volume":"54","author":"Lopes","year":"2020","journal-title":"Rev. Saude Publica"},{"key":"ref_251","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/j.gerinurse.2024.08.039","article-title":"Impact of caregiving on frailty in older spousal caregivers: A retrospective cohort study","volume":"59","author":"Cai","year":"2024","journal-title":"Geriatr. Nurs."},{"key":"ref_252","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1093\/geront\/gnu078","article-title":"Does Dementia Caregiving Accelerate Frailty? Findings From the Health and Retirement Study","volume":"56","author":"Dassel","year":"2016","journal-title":"Gerontologist"},{"key":"ref_253","first-page":"433","article-title":"Frailty syndrome: An overview","volume":"19","author":"Chen","year":"2014","journal-title":"Clin. Interv. Aging"},{"key":"ref_254","doi-asserted-by":"crossref","first-page":"igac058","DOI":"10.1093\/geroni\/igac058","article-title":"Positive Aspects of Caregiving Are Associated with Lower Risk of Frailty and Sleep Disruption in the National Study of Caregiving","volume":"6","author":"Wennberg","year":"2022","journal-title":"Innov. Aging"},{"key":"ref_255","doi-asserted-by":"crossref","unstructured":"von K\u00e4nel, R., Mausbach, B.T., Dimsdale, J.E., Ziegler, M.G., Mills, P.J., Allison, M.A., Patterson, T.L., Ancoli-Israel, S., and Grant, I. (2019). Refining caregiver vulnerability for clinical practice: Determinants of self-rated health in spousal dementia caregivers. BMC Geriatr., 19.","DOI":"10.1186\/s12877-019-1033-2"},{"key":"ref_256","doi-asserted-by":"crossref","first-page":"E80","DOI":"10.5888\/pcd17.200010","article-title":"Baby Boomers as Caregivers: Results From the Behavioral Risk Factor Surveillance System in 44 States, the District of Columbia, and Puerto Rico, 2015-2017","volume":"17","author":"Miyawaki","year":"2020","journal-title":"Prev. Chronic Dis."},{"key":"ref_257","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1093\/ageing\/afy098","article-title":"Transitioning into spousal caregiving: Contribution of caregiving intensity and caregivers\u2019 multiple chronic conditions to functional health","volume":"48","author":"Liu","year":"2019","journal-title":"Age Ageing"},{"key":"ref_258","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1093\/geront\/gnv148","article-title":"Does Caring for a Spouse with Dementia Accelerate Cognitive Decline? Findings From the Health and Retirement Study","volume":"57","author":"Dassel","year":"2017","journal-title":"Gerontologist"},{"key":"ref_259","doi-asserted-by":"crossref","first-page":"1591","DOI":"10.15585\/mmwr.mm7046a1","article-title":"Prevalence and Characteristics of Subjective Cognitive Decline Among Unpaid Caregivers Aged \u226545 Years\u201422 States, 2015-2019","volume":"70","author":"Jeffers","year":"2021","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_260","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3928\/00989134-20201106-04","article-title":"Informal Caregiving, Poor Mental Health, and Subjective Cognitive Decline: Results From a Population-Based Sample","volume":"46","author":"Brown","year":"2020","journal-title":"J. Gerontol. Nurs."},{"key":"ref_261","doi-asserted-by":"crossref","first-page":"igad056","DOI":"10.1093\/geroni\/igad056","article-title":"How Does Exposure to Dementia Relate to Subjective Cognition? A Systematic Review","volume":"7","author":"Turner","year":"2023","journal-title":"Innov. Aging"},{"key":"ref_262","doi-asserted-by":"crossref","first-page":"104487","DOI":"10.1016\/j.neubiorev.2021.12.010","article-title":"Spousal caregiving, widowhood, and cognition: A systematic review and a biopsychosocial framework for understanding the relationship between interpersonal losses and dementia risk in older adulthood","volume":"134","author":"Leal","year":"2022","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_263","first-page":"507","article-title":"Cognition in informal caregivers: Evidence from an English population study","volume":"26","author":"Bendayan","year":"2021","journal-title":"Aging Ment. Health"},{"key":"ref_264","doi-asserted-by":"crossref","unstructured":"Kokorelias, K.M., Stall, N.M., Wasilewski, M., Gignac, M.A.M., Rittenberg, N., Singh, H., Dove, E., Harris, M., Beleno, R., and Naglie, G. (2025). Navigating the dementia caregiving journey: A scoping review protocol of interventions and their responsiveness to caregivers\u2019 evolving needs across the illness trajectory. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0333475"},{"key":"ref_265","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1177\/07334648241312999","article-title":"Effective Solutions for Caregivers of Older Adults: A Review of Systematic Reviews","volume":"44","author":"McHugh","year":"2025","journal-title":"J. Appl. Gerontol."},{"key":"ref_266","doi-asserted-by":"crossref","unstructured":"Fernandez-Bueno, L., Torres-Enamorado, D., Bravo-Vazquez, A., Rodriguez-Blanco, C., and Bernal-Utrera, C. (2024). Technological Innovations to Support Family Caregivers: A Scoping Review. Healthcare, 12.","DOI":"10.3390\/healthcare12232350"},{"key":"ref_267","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1111\/wvn.12736","article-title":"The effect of mindfulness-based interventions on caregiver burden, quality of life and psychological distress in caregivers of adults with chronic diseases: Systematic review and meta-analysis of randomized controlled trials","volume":"21","author":"Bilgin","year":"2024","journal-title":"Worldviews Evid.-Based Nurs."},{"key":"ref_268","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijnurstu.2017.10.008","article-title":"Unravelling Positive Aspects of Caregiving in Dementia: An Integrative Review of Research Literature","volume":"79","author":"Yu","year":"2018","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_269","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1007\/s40520-017-0844-2","article-title":"Alzheimer Caf\u00e9: An approach focused on Alzheimer\u2019s patients but with remarkable values on the quality of life of their caregivers","volume":"30","author":"Merlo","year":"2018","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_270","doi-asserted-by":"crossref","first-page":"18","DOI":"10.12688\/hrbopenres.13040.2","article-title":"Family carers\u2019 perspectives of the Alzheimer Caf\u00e9 in Ireland","volume":"3","author":"Teahan","year":"2020","journal-title":"HRB Open Res."},{"key":"ref_271","doi-asserted-by":"crossref","first-page":"2474","DOI":"10.1080\/10410236.2023.2270248","article-title":"Reflections on Dementia-Related Stigma and Direct Support Seeking by Family Caregivers as Mediating Associations Between Caregiver Stress, Burden, and Well-Being","volume":"39","author":"Schlag","year":"2024","journal-title":"Health Commun."},{"key":"ref_272","doi-asserted-by":"crossref","unstructured":"Siette, J., Meka, A., and Antoniades, J. (2023). Breaking the barriers: Overcoming dementia-related stigma in minority communities. Front. Psychiatry, 14.","DOI":"10.3389\/fpsyt.2023.1278944"},{"key":"ref_273","first-page":"2191","article-title":"Brief mentalizing imagery therapy reduces stress and enhances positive psychological traits in family dementia caregivers: Mediation by mindfulness","volume":"29","author":"Zea","year":"2025","journal-title":"Aging Ment. Health"},{"key":"ref_274","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1159\/000521950","article-title":"Four-Week Mentalizing Imagery Therapy for Family Dementia Caregivers: A Randomized Controlled Trial with Neural Circuit Changes","volume":"91","author":"Jain","year":"2022","journal-title":"Psychother. Psychosom."},{"key":"ref_275","first-page":"100721","article-title":"Family dementia caregivers with suicidal ideation improve with mentalizing imagery therapy: Results from a pilot study","volume":"16","author":"Madarasmi","year":"2024","journal-title":"J. Affect. Disord. Rep."},{"key":"ref_276","doi-asserted-by":"crossref","unstructured":"Yang, J., Fearn, C., John, A., Hoare, S., Chang, S., Zammitt, D., and Stott, J. (2025). A systematic review and thematic synthesis on the experiences of accessing and attending psychological therapy for informal carers of people living with dementia. BMC Geriatr., 25.","DOI":"10.1186\/s12877-025-05986-7"},{"key":"ref_277","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s41155-025-00342-5","article-title":"Towards a comprehensive psychosocial profile of the family caregiver of people with dementia","volume":"38","year":"2025","journal-title":"Psicol. Reflex. Crit."},{"key":"ref_278","doi-asserted-by":"crossref","first-page":"3085","DOI":"10.1007\/s40520-023-02610-9","article-title":"Psychobiological effects of an eHealth psychoeducational intervention to informal caregivers of persons with dementia: A pilot study during the COVID-19 pandemic in Italy","volume":"35","author":"Cattane","year":"2023","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_279","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1002\/gps.4208","article-title":"Effectiveness of educational interventions for informal caregivers of individuals with dementia residing in the community: Systematic review and meta-analysis of randomised controlled trials","volume":"30","author":"Jensen","year":"2015","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_280","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/10547738251340883","article-title":"Meeting Carer Health Information Needs in Mental Health: An Integrative Review","volume":"34","author":"Bogunovic","year":"2025","journal-title":"Clin. Nurs. Res."},{"key":"ref_281","doi-asserted-by":"crossref","unstructured":"Hodgson, N.A., Talwar, S., Aryal, S., Finegan, K., and Fazio, S. (2025). Beyond single support calls: Efficacy of follow-up callbacks for dementia caregivers using the Alzheimer\u2019s association helpline. PLoS ONE, 20.","DOI":"10.1371\/journal.pone.0333535"},{"key":"ref_282","doi-asserted-by":"crossref","first-page":"1746","DOI":"10.1080\/13607863.2024.2369652","article-title":"Application of the solution-focused brief strategies via telephone for family caregivers of persons with dementia: The Alzheimer\u2019s Association National Helpline","volume":"28","author":"Hodgson","year":"2024","journal-title":"Aging Ment. Health"},{"key":"ref_283","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1016\/j.pec.2020.09.026","article-title":"One call makes a difference: An evaluation of the Alzheimer\u2019s Association National Helpline on dementia caregiver outcomes","volume":"104","author":"Hodgson","year":"2021","journal-title":"Patient Educ. Couns."},{"key":"ref_284","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1093\/geront\/46.5.620","article-title":"The effectiveness of a telephone support program for caregivers of frail older adults","volume":"46","author":"Smith","year":"2006","journal-title":"Gerontologist"},{"key":"ref_285","doi-asserted-by":"crossref","first-page":"661","DOI":"10.3934\/publichealth.2022047","article-title":"The physician\u2019s Alzheimer\u2019s disease management guide: Early detection and diagnosis of cognitive impairment, Alzheimer\u2019s disease and related dementia","volume":"9","author":"Reiss","year":"2002","journal-title":"AIMS Public Health"},{"key":"ref_286","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1186\/s13690-018-0316-y","article-title":"Barriers and enablers in the use of respite interventions by caregivers of people with dementia: An integrative review","volume":"76","author":"Leocadie","year":"2018","journal-title":"Arch. Public Health"},{"key":"ref_287","doi-asserted-by":"crossref","unstructured":"Caetano, P., Querido, A., and Laranjeira, C. (2024). Preparedness for Caregiving Role and Telehealth Use to Provide Informal Palliative Home Care in Portugal: A Qualitative Study. Healthcare, 12.","DOI":"10.3390\/healthcare12191915"},{"key":"ref_288","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1002\/gps.4504","article-title":"Effectiveness of respite care in supporting informal caregivers of persons with dementia: A systematic review","volume":"31","author":"Vandepitte","year":"2016","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_289","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1016\/S0168-8510(01)00215-9","article-title":"Health status and work burden of Alzheimer patients\u2019 informal caregivers: Comparisons of five different care programs in the European Union","volume":"60","author":"Colvez","year":"2002","journal-title":"Health Policy"},{"key":"ref_290","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1046\/j.1365-2524.2000.00221.x","article-title":"\u2018Time and space\u2019: Carers\u2019 views about respite care","volume":"8","author":"Ashworth","year":"2000","journal-title":"Health Soc. Care Community"},{"key":"ref_291","doi-asserted-by":"crossref","first-page":"e21264","DOI":"10.2196\/21264","article-title":"Barriers and Facilitators to Implementing Web-Based Dementia Caregiver Education From the Clinician\u2019s Perspective: Qualitative Study","volume":"3","author":"Levinson","year":"2020","journal-title":"JMIR Aging"},{"key":"ref_292","doi-asserted-by":"crossref","unstructured":"Kenning, C., Daker-White, G., Blakemore, A., Panagioti, M., and Waheed, W. (2017). Barriers and facilitators in accessing dementia care by ethnic minority groups: A meta-synthesis of qualitative studies. BMC Psychiatry, 17.","DOI":"10.1186\/s12888-017-1474-0"},{"key":"ref_293","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1111\/scs.13155","article-title":"\u2018I Wish I Had Asked for Support Earlier\u2019 \u2212 Immigrant Family Caregivers\u2019 Experiences of Living with a Person with Dementia","volume":"37","author":"Goodyear","year":"2023","journal-title":"Scand. J. Caring Sci."},{"key":"ref_294","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1080\/13607863.2025.2478521","article-title":"\u2018That feels alien to me, to be honest\u2019: Using Applied Thematic Analysis to co-produce a culturally adapted psychosocial intervention with Sikh carers of people living with dementia","volume":"29","author":"Dowson","year":"2025","journal-title":"Aging Ment. Health"},{"key":"ref_295","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1038\/s41746-022-00567-z","article-title":"Smartphone Applications for Informal Caregivers of Chronically Ill Patients: A Scoping Review","volume":"5","author":"Shah","year":"2022","journal-title":"NPJ Digit. Med."},{"key":"ref_296","doi-asserted-by":"crossref","unstructured":"Scerbe, A., O\u2019Connell, M.E., Astell, A., Morgan, D., Kosteniuk, J., Panyavin, I., DesRoches, A., and Webster, C. (2023). Digital tools for delivery of dementia education for caregivers of persons with dementia: A systematic review and meta-analysis of impact on caregiver distress and depressive symptoms. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0283600"},{"key":"ref_297","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1097\/JGP.0b013e3180437d87","article-title":"E-care: A telecommunications technology intervention for family caregivers of dementia patients","volume":"15","author":"Finkel","year":"2007","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_298","doi-asserted-by":"crossref","first-page":"e55132","DOI":"10.2196\/55132","article-title":"The Olera.care Digital Caregiving Assistance Platform for Dementia Caregivers: Preliminary Evaluation Study","volume":"7","author":"Fan","year":"2024","journal-title":"JMIR Aging"},{"key":"ref_299","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1093\/geront\/45.3.347","article-title":"Measurement of assistive device use: Implications for estimates of device use and disability in late life","volume":"45","author":"Cornman","year":"2005","journal-title":"Gerontologist"},{"key":"ref_300","doi-asserted-by":"crossref","unstructured":"Cho, H., Cho, E., You, S.B., Sefcik, J.S., Hodgson, N.A., and Demiris, G. (2025). Understanding Digital Literacy of Persons with Dementia and Their Caregivers: A Scoping Review and an Evolutionary Concept Analysis of Empirical Studies. J. Appl. Gerontol., Epub ahead of print.","DOI":"10.1177\/07334648251348703"},{"key":"ref_301","doi-asserted-by":"crossref","first-page":"e66212","DOI":"10.2196\/66212","article-title":"Developing a Dyadic Immersive Virtual Environment Technology Intervention for Persons Living with Dementia and Their Caregivers: Multiphasic User-Centered Design Study","volume":"8","author":"Rochon","year":"2025","journal-title":"JMIR Aging"},{"key":"ref_302","first-page":"e64082","article-title":"Use of Virtual Reality and Augmented Reality Technologies to Support Resilience and Skill-Building in Caregivers of Persons with Dementia: A Scoping Review","volume":"16","author":"Kokorelias","year":"2024","journal-title":"Cureus"},{"key":"ref_303","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1111\/1468-0009.12567","article-title":"The Landscape of State Policies Supporting Family Caregivers as Aligned with the National Academy of Medicine Recommendations","volume":"100","author":"Miller","year":"2022","journal-title":"Milbank Q."},{"key":"ref_304","first-page":"19","article-title":"Addressing the Diverse Needs of Unpaid Caregivers Through New Health-Care Policy Opportunities","volume":"31","author":"Reyes","year":"2020","journal-title":"Public Policy Aging Rep."},{"key":"ref_305","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1093\/ppar\/prac002","article-title":"Unpaid Dementia Caregiving: A Policy and Public Health Imperative","volume":"32","author":"Gaugler","year":"2022","journal-title":"Public Policy Aging Rep."},{"key":"ref_306","doi-asserted-by":"crossref","unstructured":"Phillipson, L., Johnson, K., Cridland, E., Hall, D., Neville, C., Fielding, E., and Hasan, H. (2019). Knowledge, help-seeking and efficacy to find respite services: An exploratory study in help-seeking carers of people with dementia in the context of aged care reforms. BMC Geriatr., 19.","DOI":"10.1186\/s12877-018-1009-7"},{"key":"ref_307","doi-asserted-by":"crossref","unstructured":"Beach, B., B\u00e9langer-Hardy, L., Harding, S., Rodrigues Perracini, M., Garcia, L., Tripathi, I., Gillis, M., and Dow, B. (2022). Caring for the caregiver: Why policy must shift from addressing needs to enabling caregivers to flourish. Front. Public Health, 10.","DOI":"10.3389\/fpubh.2022.997981"},{"key":"ref_308","first-page":"e70087","article-title":"Supporting dementia caregivers: The role of \u201clived experience\u201d and public health collaboration","volume":"11","author":"Kline","year":"2025","journal-title":"Alzheimers Dement"},{"key":"ref_309","doi-asserted-by":"crossref","first-page":"S98","DOI":"10.1093\/geronb\/gbac031","article-title":"The Impact of Care Intensity and Work on the Mental Health of Family Caregivers: Losses and Gains","volume":"77","author":"Kolodziej","year":"2022","journal-title":"J. Gerontol. B Psychol. Sci. Soc. Sci."},{"key":"ref_310","doi-asserted-by":"crossref","unstructured":"Wagle, S., Yang, S., Osei, E.A., Katare, B., and Lalani, N. (2024). Caregiving Intensity, Duration, and Subjective Financial Well-Being Among Rural Informal Caregivers of Older Adults with Chronic Illnesses or Disabilities. Healthcare, 12.","DOI":"10.3390\/healthcare12222260"},{"key":"ref_311","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1002\/hec.4908","article-title":"Mental health impacts of spousal caregiving intensity in the US","volume":"34","author":"Ailshire","year":"2025","journal-title":"Health Econ."},{"key":"ref_312","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1016\/S2468-2667(23)00206-2","article-title":"Mental and physical health changes around transitions into unpaid caregiving in the UK: A longitudinal, propensity score analysis","volume":"9","author":"Lacey","year":"2024","journal-title":"Lancet Public Health"},{"key":"ref_313","doi-asserted-by":"crossref","first-page":"igad046","DOI":"10.1093\/geroni\/igad046","article-title":"Co-Design of a Financial and Legal Planning Tool for Care Partners of People Living with Alzheimer\u2019s Disease and Related Dementias","volume":"7","author":"Jolliff","year":"2023","journal-title":"Innov. Aging"},{"key":"ref_314","doi-asserted-by":"crossref","first-page":"e20230030","DOI":"10.1590\/1980-5764-dn-2023-0030","article-title":"The relationship between burden and caregiver\u2019s sleep disturbances in dementia: A systematic review","volume":"17","author":"Monteiro","year":"2023","journal-title":"Dement. Neuropsychol."},{"key":"ref_315","doi-asserted-by":"crossref","first-page":"14","DOI":"10.3928\/00989134-20200527-01","article-title":"Fatigue in Family Caregivers of Individuals with Dementia: Associations of Sleep, Depression, and Care Recipients\u2019 Functionality","volume":"46","author":"Chang","year":"2020","journal-title":"J Gerontol Nurs."},{"key":"ref_316","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1001\/archinternmed.2011.503","article-title":"Growth in dementia-associated hospitalizations among the oldest old in the United States: Implications for ethical health services planning","volume":"171","author":"Zilberberg","year":"2011","journal-title":"Arch. Intern. Med."},{"key":"ref_317","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/jgs.16945","article-title":"Assessing and Addressing Family Caregivers\u2019 Needs and Risks in Primary Care","volume":"69","author":"Riffin","year":"2021","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_318","doi-asserted-by":"crossref","unstructured":"Yoo-Jeong, M., Singer, J., Bergeron, C.D., Southerland, J.L., Chai, H.W., Pickett, A.C., Zhou, Y., Vazquez, C.E., Bacsu, J.D., and Kwong, K. (2025). Factors related to social disconnectedness among older unpaid caregivers. Front. Public Health, 13.","DOI":"10.3389\/fpubh.2025.1589103"},{"key":"ref_319","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1177\/0733464813520222","article-title":"Factor Analysis of the 12-Item Zarit Burden Interview in Caregivers of Persons Diagnosed with Dementia","volume":"35","author":"Branger","year":"2016","journal-title":"J. Appl. Gerontol."},{"key":"ref_320","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1177\/0269215515570378","article-title":"Measuring negative and positive caregiving experiences: A psychometric analysis of the Caregiver Strain Index Expanded","volume":"29","author":"Kruithof","year":"2015","journal-title":"Clin. Rehabil."},{"key":"ref_321","doi-asserted-by":"crossref","first-page":"e5916","DOI":"10.1002\/gps.5916","article-title":"Experiences of people with dementia and informal caregivers with post-diagnostic support: Data from the international COGNISANCE study","volume":"38","author":"Hevink","year":"2023","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_322","doi-asserted-by":"crossref","unstructured":"L\u00f3pez-Ant\u00f3n, R. (2024). Recent Advances in Alzheimer\u2019s Disease Research: From Biomarkers to Therapeutic Frontiers. Biomedicines, 12.","DOI":"10.3390\/biomedicines12122816"},{"key":"ref_323","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1007\/s40520-017-0765-0","article-title":"Impact of caregiving for older people and pro- inflammatory biomarkers among caregivers: A systematic review","volume":"30","author":"Potier","year":"2018","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_324","first-page":"1715","article-title":"Association between inflammatory cytokines and caregiving distress in family caregivers of cancer patients","volume":"30","author":"Kim","year":"2022","journal-title":"Support. Care Cancer"},{"key":"ref_325","doi-asserted-by":"crossref","first-page":"107140","DOI":"10.1016\/j.psyneuen.2024.107140","article-title":"LPS-Induced Whole-Blood Cytokine Production and Depressive Symptoms in Dementia Spousal Caregivers: The Moderating Effect of Childhood Trauma","volume":"168","author":"Argueta","year":"2024","journal-title":"Psychoneuroendocrinology"},{"key":"ref_326","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.bbi.2024.12.039","article-title":"Burden, Grief, and Depression in Dementia Spousal Caregivers: The Roles of Inflammation and Attachment Security","volume":"122","author":"Argueta","year":"2024","journal-title":"Brain Behav. Immun."},{"key":"ref_327","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.apmr.2025.02.015","article-title":"Association Between Depressive Symptoms in Spousal Caregivers and Falls in Care Recipients with Disability: A Nationwide Population-Based Cohort Study","volume":"106","author":"Xu","year":"2025","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_328","doi-asserted-by":"crossref","unstructured":"Feng, Z., Chen, Q., Li, Y., Xue, Z., and Hao, X. (2023). The association between falls and depressive symptoms among older adults: Evidence from the China Health and Retirement Longitudinal Study. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1248551"},{"key":"ref_329","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/1533317519826217","article-title":"Caregiver Burden and Desire for Institutional Placement-The Roles of Positive Aspects of Caregiving and Religious Coping","volume":"34","author":"Fields","year":"2019","journal-title":"Am. J. Alzheimer\u2019s Dis. Other Demen."},{"key":"ref_330","doi-asserted-by":"crossref","unstructured":"Boucher, A., Haesebaert, J., Freitas, A., Adekpedjou, R., Landry, M., Bourassa, H., Stacey, D., Croteau, J., Genevi\u00e8ve, P.G., and L\u00e9gar\u00e9, F. (2019). Time to move? Factors associated with burden of care among informal caregivers of cognitively impaired older people facing housing decisions: Secondary analysis of a cluster randomized trial. BMC Geriatr., 19.","DOI":"10.1186\/s12877-019-1249-1"},{"key":"ref_331","doi-asserted-by":"crossref","unstructured":"Mutoniwase, E., Cheng, Z., Cai, X., and Li, Y. (2025). Better State Support for Family Caregivers Linked to Lower Hospitalization Rates Among Older Adults Living with Dementia. J. Appl. Gerontol.","DOI":"10.1177\/07334648251365673"},{"key":"ref_332","doi-asserted-by":"crossref","unstructured":"Steinsheim, G., Malmedal, W., Follestad, T., Olsen, B., and Saga, S. (2023). Factors associated with subjective burden among informal caregivers of home-dwelling people with dementia: A cross-sectional study. BMC Geriatr., 23.","DOI":"10.1186\/s12877-023-04358-3"},{"key":"ref_333","doi-asserted-by":"crossref","first-page":"3277","DOI":"10.2169\/internalmedicine.0911-22","article-title":"Caregiver Burdens, Health Risks, Coping and Interventions among Caregivers of Dementia Patients: A Review of the Literature","volume":"62","author":"Goto","year":"2023","journal-title":"Intern. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/796\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T11:34:59Z","timestamp":1776857699000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/796"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":333,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["medicina62040796"],"URL":"https:\/\/doi.org\/10.3390\/medicina62040796","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}