Understanding the impact of family relationships on people with dementia: a systematic review

What we did

We systematically searched for studies on people with dementia and their family carers, to see what lessons we could learn.

We looked at aspects relating to the quality of the relationship between the person with dementia and their family carer, including:

• whether the carer showed warmth or attachment to the person with dementia
• asking for help from those around them
• using different coping styles

What we found and what this means

We found 20 studies but they were all poorly conducted and the results weren’t reliable. Many studies didn’t give full details of which aspects of the quality of relationships they assessed or what they found. Most relationship quality aspects have only been researched once or twice and each study found different results from the other studies. This makes it very difficult to understand exactly how relationship quality affects dementia patients.

Another problem was that when studying the effect of one factor, the studies didn’t make sure that other factors weren’t having an effect too. For example, a high quality relationship was associated with a better quality of life for a person with dementia, but this could be because of some other factor, such as being younger or having a milder type of dementia than those they were compared to.

We didn’t find any relationship quality factors that affected the chances of the person with dementia being put in a care home. But we did see that a better quality relationship with a family carer was related to delay in the worsening of the patient’s dementia.

These findings don’t offer a basis for GPs and other health professionals to use relationship factors to identify people with dementia who are at high risk of going into a care home early, hospitalisation or low quality of life.

Though we found poor evidence about the role of relationship factors, relationships with family carers are nevertheless likely to be very important for people with dementia. It could be that ‘challenging behaviour’ in a person with dementia is affected by the relationship with the carer, for example if the carer is emotionally distant, it could be an attempt to find an emotional connection. A care-giver who copes by constantly ‘correcting’, rather than accepting their difficulties with mental processing, could lower the self-esteem of the person with dementia.

We need higher quality research into relationship factors to provide more effective support for people with dementia and their families.