Personality Vulnerability and Protective Factors in Dementia- Related Stress

Personality traits may act as either vulnerability or protective factors for stress in general. Earlier in the chapter, we provided examples of how caregivers’ personality traits may influence dementia outcomes. There is also evidence that neuroticism and introversion are associated with caregiver depression and burden, and that personality characteristics indirectly influence BPSD-related distress in caregivers [63]. We would now like to focus on other personality dispositions that are probably protective for both caregivers and patients. Resilience, for instance, helps to adapt in the face of adversity [64]. Adopting a salutogenic perspective, Antonovsky tried to explain how coping resources may contribute to health [65]. He defined sense of coherence (SOC) as a global orientation expressing the extent to which one has a pervasive, enduring, and dynamic confidence that environmental stimuli are structured, predictable, or explicable (“comprehensibility”); that resources are available to meet those challenges (“manageability”); and that the challenges are worthy of engagement (“meaningfulness”). SOC has been recognized as an important health determinant [66, 67]. In dementia, SOC research has thus far focused on caregivers [68]. It is useful for identifying caregivers at risk, through associations with their patterns of coping and subjective burden [69]. Matsushita et al. reported that SOC was significantly related to “personal strain” (“how personally stressful the experience is”) but not to the “role strain” (“stress due to role conflict or overload”) generated by caregiving [70]. Although we lack direct evidence in persons with dementia, SOC can play a role in buffering both the manifestations of BPSD in patients and reactions to them in caregivers. Studying couples, Marques [71] highlighted the role of “comprehensibility” (one component of SOC - i.e., “life makes sense”) in adapting to a diagnosis of dementia in the family. Good pre-caregiving and current type of relationship were associated with the “manageability” (ability to cope constructively) and “meaningfulness” (viewing life as a challenge, not as a threat) aspects of caregiver SOC. In addition, relationship quality was related to more positive patterns of caregiving and fostered successful adaptation to changing needs in dementia [71] - an observation that leads us on to the next topic.

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