Table 3

Associations between relationship factors and institutionalisation (10 studies)

Risk factorStudynFollow-upResults (95% CI; P value)Analysis adjusted for*
Factors relating to the interaction between the person with dementia and their caregiver
Quality of relationshipSpruytte et al381446–9 mOR 0.92 (P=0.02)NR
Pruchno et al5022012 mOR 1.31 (P>0.05)a, g, s, r, t, c, bp, ADL, ci, m, hs, cb
Marital happiness
At baseline
Wright422924 mPoV 0.313 (P<0.01)NR
Before dementia onsetPoV 0.045 (P>0.05)NR
Emotional closenessFisher and Lieberman3916424 mOR 1.64 (1.09, 2.46; P=0.02)d, ba, nf, oc, fe
Emotional distancing/boundary ambiguityFisher and Lieberman3916424 mOR 1.25 (0.85, 1.83; P=0.26)d, ba, nf, oc, fe
Wells and Over479312–18 mOR 1.3 (P>0.05)a, d, t
CohesionTorossian and Ruffins4819724 mMD NR (P>0.05)NR
Wright422924 mPoV 0.472 (P<0.001)NR
AffectionWright2924 mPoV 0.144 (P>0.05)NR
Warmth†Spruytte et al381446–9 mNR (P<0.05)NR
Anxious-ambivalent attachment (carer)Markiewicz et al4910824 mOR 1.27 (P=0.36)NR
Avoidant attachment (carer)Markiewicz et al4910824 mOR 2.39 (P<0.001)NR
Stevens et al4021524 mHR 1.011 (P=0.37)NR
High levels of tensionWright422924 mPoV 0.162 (P>0.05)NR
Excessive criticism*†Spruytte et al381446–9 mNR (P>0.05)NR
Factors mainly relating to the caregiver
Limited adaptabilityTorossian and Ruffins4819724 mMD NR (P>0.05)NR
Approach copingStevens et al4021524 mHR 0.997 (P=0.77)NR
Directing relative’s behaviourBannister et al4511612 mMD 0.2 (P=0.40)NR
Keeping relative busyBannister et al4511612 mMD 0.5 (P=0.02)NR
Learning about the illnessBannister et al4511612 mMD 0.3 (P=0.42)NR
PrioritisingBannister et al4511612 mMD 0.1 (P=0.52)NR
Reducing expectationsBannister et al4511612 mMD 0.4 (P=0.19)NR
Consistent larger sense of the illnessBannister et al4511612 mMD 0.4 (P=0.35)NR
PositivityBannister et al4511612 mMD 0.5 (P=0.57)NR
Wells and Over479312–18 mOR 1.03 (P>0.05)a,d
Seeking social supportWells and Over479312–18 mOR 1.91 (P<0.05)a,d
Snyder53233NRHR 1.159(0.718 to 1.87; P=0.55)a, d, g, nc
Accepting responsibilityWells and Over479312–18 mOR 0.28 (P<0.01)a, d
ConfrontationalWells and Over479312–18 mOR 2.12 (P<0.05)a, d
Negative feelingsFisher and Lieberman3916424 mOR 1.47 (0.99 to 2.19; P=0.05)d, ba, oc, ec, fe
  • *Prespecified key confounders: a, age; d, dementia severity; g, gender; s, socioeconomic status. All other confounders:  ADL, activities of  daily living; ba, boundary ambiguity;  bp, behaviour problems;  c,  number of children; cb, caregiver burden;  ci,  caregiver illness; ec,  emotional closeness; fe,  family efficiency;  hs,  help services used; m,  medication; nc,  non-coresidency; nf,  negative feeling; oc, organised cohesiveness; r,  religion; t,  time spent (duration of) caregiving.

  • †These are the subscales of the relationship quality scale.

  • HR > 1  indicates increased risk, HR < 1 indicates decreased risk. OR > 1 indicates increased odds of outcome, OR < 1 indicates decreased odds of outcome.

  • Corr, correlation (This is a number between −1 to +1 and indicates the degree to which the exposure and outcome vary together. Positive numbers indicate that exposure and outcome increase together, while negative numbers indicate that the outcome increases as the exposure decreases. Larger numbers indicate stronger correlation); MD, mean difference in outcome (Large differences between groups suggests that the exposure might affect the outcome. For continuous exposures, mean difference represents the change in the outcome for one unit increase in the exposure.); NR, information not reported (where possible results and 95% CIs were calculated from raw data); PoV, proportion of variance (This is a number between 0–1 indicating the proportion of variance in the outcome explained by the exposure. Higher numbers indicate greater explanatory power of the exposure.)