Family and Friend Support, Strain, and Loneliness Among Dementia Caregivers in Rural Appalachia

Background: Loneliness, defined as a perceived deficit in the quantity or quality of social relationships, is associated with a range of adverse physical and mental health outcomes. Understanding contributors to loneliness among caregivers of people living with dementia (PLwD) is therefore an important public health concern. Family caregivers, particularly spouses or adult children, report higher levels of loneliness compared to non-caregivers and some other caregiver groups. This vulnerability may stem from time constraints on social activities, misunderstandings within existing relationships regarding care management, and losses in shared experiences as dementia progresses. Across the life course, family and friends serve as important sources of social support and relational connection, both of which may be associated with lower loneliness. Research Questions and hypotheses: Guided by Perlman and Peplau’s definition of loneliness and the Stress Process Model, this thesis examined whether perceived support and strain from caregivers’ family and friends are associated with loneliness among spousal and adult child caregivers of PLwD living in rural Appalachia, above and beyond caregiving demands. Caregiver relationships with the PLwD (wife, husband, daughter, son) were examined categorically to account for differences in relational roles and expectations. It was hypothesized that (1) caregiver relationship type would be associated with loneliness, with wives reporting the highest levels, and (2) greater family strain would be associated with higher loneliness, whereas greater family and friend support would be associated with lower loneliness. Methodology: Data were drawn from the Families in Appalachia Caring for Elders with Alzheimer’s Disease (FACES) study (N = 141). A three-step hierarchical multiple linear regression analysis was conducted to examine associations between caregiver relationship type, perceived family and friend support, perceived family and friend strain, and loneliness, controlling for unsupervised time and assistance with personal activities of daily living. Results: Wives reported higher levels of loneliness than husbands, daughters, and sons. After accounting for caregiving demands and relationship type, higher perceived family strain was associated with higher loneliness, whereas greater perceived friend support was associated with lower loneliness. Family support and friend strain were not significantly associated with loneliness in the final model. Implications: Findings suggest that perceived relationship quality, rather than the mere presence or number of social ties, is central to understanding loneliness among caregivers of PLwD in rural Appalachia. While friend support was associated with lower loneliness, addressing familial strain in caregiver interventions and psychosocial programming may be particularly relevant for efforts aimed at reducing caregiver loneliness.