Shared Experience of Physical Vitality and Social Participation Among Caregiving Dyads: Comparing Dyads With and Without Dementia

Abstract

Social connection is a core component of well-being. Older adults with declining physical functioning or serious health conditions are at particular risk for social isolation and loneliness, and often rely on a family caregiver to facilitate their social participation. Using data from the 2015 and 2017 National Health and Aging Trends Study and the National Survey of Caregiving, this study sought to elucidate dyadic interdependence in the relationship between physical vitality and social participation, among care recipient-caregiver dyads (152 dyads with dementia; 475 dyads without dementia). Actor-partner interdependence models reveal that physical vitality was positively associated with social participation in care recipients, regardless of their dementia status. In dyads with dementia, care recipients’ physical vitality was also positively associated with caregiver social participation. The findings demonstrate the importance of physical vitality of both older adults and their caregivers in maintaining social participation in the face of health challenges.

Keywords

physical vitality dementia social participation caregiving dyads interconnected lives

What This Paper Adds

• By using a dyadic approach, this study elucidates the interdependent relationships between physical vitality and social participation in older adults and their caregivers

• In dyads without dementia, care recipient physical vitality is only related to their own social participation

• In dyads with dementia, care recipient physical vitality is also linked to caregivers’ social participation

Applications of Study Findings

• The findings of this study underscore the importance of developing diverse strategies to maintain physical vitality, while adopting a dyadic approach.

• Providing a wide range of programs, including home-based or internet-based activities, to help improve the physical abilities of dyads living with dementia could enhance social participation.

• There should be more inclusive opportunities to enhance the social connection of dementia dyads regardless of their physical ability, ranging from low-key social engagement initiatives to creating dementia-friendly environments.

Introduction

Lack of social connection is profoundly detrimental to health and mortality, with effects comparable to risky behaviors, such as smoking, alcohol, or substance use (Holt-Lunstad et al., 2017; Laugesen et al., 2018). Accordingly, enhancing social connections has been recognized as a public health priority.

Social participation is a direct driver of an individual’s opportunity for social connection. It creates opportunities for meaningful human interaction and fostering a sense of belonging (Löfgren et al., 2022), which in turn contribute to supporting well-being and healthy aging (Lu et al., 2022). Given its significance, identifying factors that restrict social participation is essential for developing strategies to mitigate or prevent these limitations.

Physiological functioning enables older adults to engage in social activities. For example, muscle strength and gait speed have shown significant relationships with social engagement among older adults (Katayama et al., 2021; Kuang et al., 2023; Nagai et al., 2020). Declines in physiological functioning lead to additional limitations, such as balance problems or slower reaction times, which, in turn, increase fear of social participation and disengage from social activities (Duppen et al., 2020).

While declines in physiological or functional ability are often described as frailty, there is growing recognition of the need to use strengths-based language to describe frailty (Age UK, British Geriatrics Society, 2015; Durepos et al., 2022; Hopkins et al., 2024; Nicholson et al., 2017). The term “frailty” is widely used in clinical practice and is helpful for identifying people with frailty symptoms and guiding them toward interventions or management programs. However, it has been observed that among the public, particularly older adults, the term “frailty” is often associated with negative connotations, such as incurability, loss of independence, or inevitability in later life (Age UK, British Geriatrics Society, 2015; Schoenborn et al., 2018; Shafiq et al., 2023). Therefore, using the term “frailty” could undermine self-esteem, delay the diagnosis of health status, and reduce health care service utilization (Age UK, British Geriatrics Society, 2015; Durepos et al., 2022). Considering this growing discussion, this paper uses the term “physical vitality,” which emphasizes strengths, rather than deficits.

The relationship between physical vitality and social participation can extend beyond an individual issue for caregivers and care recipients. For example, when a care recipient has low physical vitality and needs more care or cannot easily leave the house, the caregiver’s social participation can be potentially constrained; and when their caregiver has low physical vitality and is less able to support outings and engagement, the care recipient’s social participation can potentially be constrained. In addition, these spillover effects may differ based on the presence of dementia of the care recipient. Besides behavioral, psychological and cognitive changes related to dementia, low physical vitality might increase the complexity of dementia caregiving, thus creating unique challenges for social participation in dyads navigating dementia.

Investigating interdependence and spillover effects in caregiving dyads, particularly in the context of dementia, is critical. It helps explain how or why care recipients and caregivers experience social disengagement and enhance understanding of how navigating dementia plays a role in this experience. Despite its importance, little attention has been given to investigating the relationship between physical vitality and social participation using a dyadic approach.

The purpose of this study was to examine how physical vitality and social participation are interrelated among caregiving dyads and whether this association differs by the presence of dementia in care recipients. The findings will contribute to providing insights into community-based resources aimed at enhancing physical vitality and providing a variety of opportunities for social participation, particularly for dyads navigating dementia, thereby enhancing the well-being of both care recipients and caregivers.

Methods

Data

In this study, the National Health and Aging Trends Study (NHATS) and the National Survey of Caregiving (NSOC) were utilized. Since 2011, the NHATS annually collects information on later-life disability trends with a sample of nationally representative Medicare beneficiaries aged 65 and older. The NSOC has collected data from a maximum of five eligible family and unpaid caregivers who were identified by the NHATS participants. While the NSOC was originally designed for a cross-sectional study, caregivers in 2015 were re-interviewed for a longitudinal component in 2017. To examine the causal relationship between frailty and social participation, in this study, 2015 and 2017 NHATS and NSOC were utilized. Since the NHATS and NSOC data is publicly available, the Institutional Review Board (IRB) review was exempted.

Sample

The sample consists of caregiving dyads. We first selected community-dwelling participants of the NHATS, who completed the survey in both 2015 and 2017 and were not deceased in 2017. Using the NSOC, we identified family caregivers who completed both the 2015 interview and the 2017 longitudinal follow-up interview and then linked them to the NHATS participants. In most cases, care recipients had only one family caregiver (n = 462). If there were multiple caregivers for a given NHATS participant, we selected one primary caregiver (n = 188) as the person providing the most: (1) caregiving hours, (2) regularity of care, and (3) frequency of personal care, which resulted in a total of 650 dyads.

The dementia status of care recipients was assessed using the NHATS dementia classification (Kasper et al., 2013): (1) probable dementia (reporting a diagnosis of dementia or Alzheimer’s disease (AD) from a physician; no reported diagnosis but meeting AD8 screening criteria; or scores at or below 1.5 standard deviations from the mean in at least two cognitive tests), (2) possible dementia (scores at or below 1.5 standard deviations from the mean in one cognitive test), and (3) non-dementia. We adopted a narrow definition of dementia, classifying probable dementia as having dementia and possible and non-dementia dyads as not having dementia.

After excluding dyads without information on dementia classification (n = 1 dyad) and social participation in 2017 (n = 22 dyads), a total of 627 dyads (dementia: 152 dyads; non-dementia: 475 dyads) were included in our models.

Measures

Social participation

Respondents were asked about their participation in the following four activities during the last month (1 = yes vs. 0 = no): visiting family or friends, attending religious services, attending club meetings or group activities, and going out for enjoyment. A total score was calculated by summing these four items (range: 0 to 4). High scores reflect participating in more social activities.

Physical Vitality

The following five items, informed by the Friedman Frailty Phenotype and Wennberg et al. (2022), were used: exhaustion, shrinking, weakness, slowness, and low self-rated health. We reverse-coded each item so that higher scores reflect high levels of physical vitality (energy, physical robustness, physical strength, mobility, and high self-rated health, respectively). Exhaustion/energy was dichotomized based on whether participants had low energy or exhaustion (0 = yes and 1 = no). Participants’ body mass index (less than 18.5 kg/m²) or unintentional weight loss (10 or more pounds) were used to measure shrinking/physical robustness (0 = yes and 1 = no). Weakness/physical strength was assessed based on having problems with the upper body (e.g., shoulders, arm, or hands) that limited activities (0 = yes and 1 = no), while slowness/mobility was measured based on having problems with the lower body (e.g., hips, legs, knees, or feet) that limited their activities (0 = yes and 1 = no). Lastly, self-rated health was dichotomized as fair/poor (0) vs. good/very good/excellent (1). A total score of physical vitality was calculated by summing five items (range: 0–5).

Caregiving contexts

NHATS and NSOC includes a suite of items about the caregiving context including: the relationship between the care recipient and caregiver (i.e., spouse/partner and children vs. others), the number of total helpers who provided any help for a household activity or medical care-related activity for a given NHATS participant, the status of living with the care recipient (i.e., living in the same household vs. not), caregiving hours per month, total duration of caregiving years, and regularity of caregiving (regular schedule vs. varied). These variables were applied to both the care recipient and caregiver.

Covariates

Socio-demographic characteristics (i.e., gender, age, race/ethnicity, education, marital status, working status, and household income), the number of chronic conditions (e.g., cancer, heart disease, and stroke), and depression in 2015 were included. Respondents were asked to rate the importance of each social participation on a scale from 1 (very important) to 3 (not so important). The item was reverse-coded and then averaged. A higher score reflects more importance (range: 1–3). We included the importance of social participation as reported in 2017.

Analysis

Descriptive statistics (i.e., frequency or mean and standard deviation) were calculated to understand the characteristics of the sample and caregiving contexts. To assess the association between care recipient and caregiver physical vitality at baseline with both care recipient and caregiver social participation at follow-up, Actor-Partner Interdependence models (APIM) were employed, using two-intercept multi-level models. Dyads are distinguishable by their role (care recipient vs. caregiver). These models produce four estimates of interest: the actor effects of the care recipient’s independent variables at baseline on his/her social participation at follow-up; the actor effects of the caregiver’s independent variables at baseline on his/her social participation at follow-up; the partner effect of the care recipient’s independent variables at baseline on the caregiver’s social participation at follow-up; and the partner effect of the caregiver’s independent variables at baseline on the care participant’s social participation at follow-up (Kenny et al., 2006). For primary independent variables, baseline physical vitality (2015) and changes in physical vitality (different scores between 2017 and 2015) were included to examine their independent effects on social participation. Continuous variables were grand-mean centered.

Multiple imputations were adopted to handle missing values in control and independent variables using the PROC MI procedure in SAS. To handle missing data on income, the twenty datasets provided by the NHATS and NSOC team were used. Missing data on other control and independent variables were imputed with twenty estimated values. Final estimates were obtained by pooling results across twenty datasets using the MIANALYZE procedure. All analyses were conducted in SAS 9.4.

Results

Table 1 presents the characteristics of our sample. Overall, the majority of care recipients and caregivers were female (66% and 70%, respectively) and non-Hispanic White (61% and 58%, respectively). The average ages of care recipients and caregivers were 80.6 years old (SD = 8.0) and 62.4 years old (SD = 13.7). Less than 1 in 4 reported clinically significant depressed mood (23% of care recipients and 15% of caregivers).

Table 1.

Characteristics of caregiving dyads

	All (n = 569 dyads)		Dementia (n = 138 dyads)		Non-dementia (n = 431 dyads)
	Care recipient	Caregiver	Care recipient	Caregiver	Care recipient	Caregiver
Gender (%)
Male	34.3	29.5	38.4	19.6	33.0	32.7
Female	65.7	70.5	61.6	80.4	67.1	67.3
Age (mean (SD))	80.6 (±7.95)	62.4 (±13.7)	85.1 (±7.39)	63.6 (±12.11)	79.2 (±7.59)	62.0 (±14.19)
Race and ethnicity (%)
White (non-Hispanic)	61.0	57.8	50.7	46.4	64.3	61.5
Black, Hispanic, or others	39.0	42.2	49.3	53.6	35.7	38.5
Education (%)
High school or less	63.3	41.1	73.2	42.0	60.1	40.8
Some college, vocational or associates degree	23.6	35.0	13.8	32.6	26.7	35.7
Bachelors or higher	13.2	23.9	13.0	25.4	13.2	23.4
Marital status (%)
Married/partnered	46.6	61.2	38.4	52.9	49.2	63.8
Not married/partnered	53.4	38.8	61.6	47.1	50.8	36.2
Employment (%)
Employed	4.0	37.1	0.7	34.1	5.1	38.1
Not employed	96.0	62.9	99.3	65.9	94.9	62.0
Household income^a (mean (SD))	35,089 (±36,991)	48,026 (±43,732)	28,121 (±29,386)	43,700 (±37,571)	37,320 (±38,881)	49,411 (±45,483)
Number of health conditions^b (mean (SD)) (range: 0–5)	2.84 (±1.19)	1.65 (±1.28)	2.62 (±1.27)	1.77 (±1.22)	2.91 (±1.15)	1.61 (±1.30)
Cardiovascular	85.8		83.3		86.5
Arthritis	76.9		68.6		79.6
Osteoporosis	33.6		31.9		34.1
Diabetes	36.6		35.5		36.9
Lung	26.9		20.3		29.0
Stroke	11.1		12.3		10.7
Cancer	13.5		10.9		14.4
Depression (%)
Clinically significant depressed mood	22.7	15.3	29.0	21.0	20.7	13.5
Physical vitality at R5 (mean (SD)) (range: 0–5)	2.68 (1.43)	3.82 (1.30)	2.95 (1.57)	3.65 (1.41)	2.59 (1.38)	3.87 (1.26)
Physical vitality at R7 (mean (SD)) (range: 0–5)	2.72 (1.46)	3.75 (1.37)	2.85 (1.57)	3.60 (1.40)	2.68 (1.42)	3.79 (1.36)
Social participation at R5 (mean (SD)) (range: 0–4)	2.24 (±1.08)	2.52 (±1.06)	1.81 (±1.05)	2.45 (±1.05)	2.38 (±1.05)	2.54 (±1.06)
Importance of social participation (mean (SD)) (range: 1–3)	2.04 (±0.55)	2.06 (±0.53)	1.79 (±0.56)	2.08 (±0.56)	2.12 (±0.52)	2.05 (±0.53)
Social participation at R7 (mean (SD)) (range: 0–4)	2.08 (±1.16)	2.54 (±1.07)	1.59 (±1.09)	2.37 (±1.07)	2.23 (±1.14)	2.59 (±1.07)

Descriptive statistics are based on complete cases only.

Longitudinal data from the National Health and Aging Trends Study and National Study of Caregiving (2015 [R5] and 2017 [R7]).

^aThe first imputed income provided by NHATS/NSOC team was used.

^bDementia was not included in the calculation of total number of health conditions.

On average, care recipients participated in 2.2 social activities (SD = 1.1), with an average physical vitality score of 2.7 (SD = 1.4, range: 0–5) at baseline. Caregivers participated in 2.5 social activities (SD = 1.1) and their physical vitality score was 3.8 (SD = 1.3) at baseline. Care recipients living with dementia reported lower social participation (1.8, SD = 1.1) than those without dementia (2.4, SD = 1.1).

Overall, about half of caregivers were a child of the care recipient, and provided help on a regular schedule (56%). More than half of caregivers (63%) lived in the same household with care recipients. On average, 2.5 helpers (SD = 1.3) were involved in caregiving. Caregivers spent an average of 98 hours per month on care tasks. The average duration of care was 8.7 years (SD = 10.5) (Table 2)

Table 2.

Characteristics of caregiving contexts

	All (n = 569 dyads)	Dementia (n = 138 dyads)	Non-dementia (n = 431 dyads)
Relationship to care recipient (%)
Spouse/partner	35.0	26.8	37.6
Child	49.6	60.9	45.9
Others	15.5	12.3	16.5
Total number of helpers (mean (SD)) (range: 1–8)	2.46 (±1.29)	2.58 (±1.37)	2.42 (±1.26)
Co-resident (%)
Yes	62.7	65.2	62.0
No	37.3	34.8	38.1
Caregiving hours per month (mean (SD))	98.3 (±120.7)	155.1 (±161.9)	80.2 (±97.7)
Duration of care (years) (mean (SD))	8.64 (±10.5)	8.68 (±8.92)	8.62 (±11.03)
Regularity of caregiving (%)
Regular schedule	56.2	65.2	53.4
Varied	43.8	34.8	46.6

Descriptive statistics are based on complete cases only.

Longitudinal data from the National Health and Aging Trends Study and National Study of Caregiving (2015 and 2017).

Figure 1 presents the results of the APIM. For dyads with dementia, the actor effects were found for both care recipients and caregivers, such that in care recipients, baseline physical vitality scores were positively associated with their own social participation at follow-up (actor effect, β = 0.12, S.E. = 0.05, p = 0.028) and in caregivers, increase in physical vitality was associated with their higher social participation (actor effect, β = 0.16, S.E. = 0.06, p = 0.011). In addition, a partner effect on caregivers’ social participation was observed, such that change in care recipients’ physical vitality scores was positively associated with social participation in the caregiver (partner effect, β = 0.18, S.E. = 0.05, p = 0.001) in dyads with dementia.

Figure 1.

APIM results.

In dyads without dementia only the actor effects were observed, and only in care recipients. That is, both baseline and change in care recipients’ physical vitality scores were positively associated with their own social participation at follow-up (β = 0.08, S.E. = 0.03, p = 0.022, and β = 0.09, S.E. = 0.03, p = 0.006 respectively), while caregiver physical vitality scores were not associated with care recipient social participation and neither caregiver nor care recipient physical vitality scores were associated with caregiver social participation in dyads without dementia.

Discussion

In this study, we sought to examine the interdependent relationship between physical vitality and social participation in caregiving dyads, and how this relationship differs depending on the presence of dementia in care recipients. To the best of our knowledge, this is the first study to examine the interdependent relationships between physical vitality and social participation in caregiving dyads. The findings extend prior individual-level findings to the dyadic level. Specifically, the findings show that physical vitality was positively associated with social participation in care recipients, regardless of their dementia status. Interestingly, a partner effect was observed only in dyads living with dementia, specifically indicating that better care recipient physical vitality was positively associated with greater caregiver social participation.

Within dyads living with dementia, we found actor effects for both the care recipient and caregiver. Specifically, in our study, baseline physical vitality of care recipients living with dementia was positively related to their social participation at follow-up, but change in physical vitality was not. This finding implies that, while physical vitality could play a role in social participation in care recipients living with dementia, over time, their social participation might be affected by other factors beyond physical functioning. For example, people living with dementia voluntarily or involuntarily reduce their social participation and put a priority on solitary activities, likely due to challenges with social interaction or fear of problematic social interaction (Clemerson et al., 2014; Vikström et al., 2008). Conversely, our finding suggests that change in physical vitality of caregivers was associated with their own social participation, indicating loss of physical vitality limited their social participation. One previous study indicates that caregivers of care recipients living with dementia were more likely to experience increased frailty compared to non-dementia caregivers (Dassel & Carr, 2016). Therefore, it is possible that dementia caregivers are at risk of decline in physiological functioning that may further restrict their social participation.

It is notable that among dyads with dementia, physical vitality scores in care recipients were positively associated with social participation in caregivers, but not the reverse. The partner effect was modest, but statistically significant. This finding likely reflects characteristics of dementia caregiving. Caregiving for people living with dementia often requires complex and continuous responsibilities due to behavioral, psychological, and cognitive symptoms. In this highly dependent situation, increases in care recipients’ physical vitality might reduce the intensity of caregiving, thus allowing them to engage in more social activities. Conversely, besides the behavioral, psychological, and cognitive symptoms related to dementia (Kahle-Wrobleski et al., 2017; Van Wijngaarden et al., 2018), declines in physical vitality limit care recipients’ ability to perform daily living activities (Abreu et al., 2019). Their increased dependency on caregivers might limit caregivers’ social participation. The absence of partner effects from caregivers to care recipients may be due to the overall low tendency for social participation among care recipients living with dementia. Prior research shows that people living with dementia tend to view being less social as a normal path of aging and express their satisfaction with their reduced social participation (Donkers et al., 2019). Therefore, caregivers’ physical vitality might not play a meaningful role in care recipients’ social participation if their participation is already significantly limited by dementia-related symptoms.

Among dyads without dementia, only the actor effect was observed in care recipients, indicating that their baseline and change in physical vitality were positively associated with their own social participation. This finding aligns with previous studies presenting that, among older adults, functional decline or physical change limits their social participation (Duppen et al., 2020; Hanlon et al., 2024; Rand et al., 2022). For example, Duppen et al. (2020) show that a decline in mobility and functional ability, increases fear of going out among community-dwelling older adults.

Interestingly, there was no actor effect among caregivers in dyads without dementia. This finding might reflect the heterogeneity of this group. Caregivers in this group support older adults with a wide spectrum of chronic conditions, including cancer, stroke, diabetes, osteoporosis, or arthritis, which may present unique challenges for caregivers. Although we sought to control for caregiving contexts, it still remains challenging to disentangle these heterogeneities. Future study is needed to investigate the factors that restrict social participation in diverse caregiving contexts.

Lastly, there were no partner effects in dyads without dementia. It is possible that, even when such care recipients have symptoms of declines in physical vitality, they might not require the intensive assistance from a caregiver due to their lower care dependency than those living with dementia (Doroszkiewicz, 2022). Therefore, the partner effect from care recipients to caregivers might not emerge in these dyads. Similar to dyads with dementia, there was no partner effect from caregivers to care recipients. This finding implies that, regardless of dementia status, caregivers’ physical vitality itself may not be directly related to care recipients’ social participation. Future studies should further investigate the underlying mechanisms.

Limitations

This study has several limitations. First, the sample of this study may not be representative of the U.S. older adults aged 65 or older and their family caregivers. As the unit of this study is the older adult-family caregiver dyad in a community-dwelling setting, non-participation or nonresponse in NSOC may have influenced sample selection. For example, it is possible that NHATS participants with severe health problems were excluded if their caregivers were not able to participate in NSOC due to complex caregiving situations. While NHATS and NSOC provide survey weights to account for the complex design and nonresponse, to the best of our knowledge, it was not feasible to apply survey weights in the APIM models estimated in SAS.

In this study, physical vitality was evaluated by combining self-reported responses. While NHATS includes both objective and subjective measures, NSOC has only self-reported measures. These self-reported measures may be affected by types of chronic health conditions (e.g., arthritis, osteoporosis, or cancer) and may not exactly reflect objective status of physical vitality. Future studies would benefit from examining both objective and subjective physical vitality, and how they affect diverse aspects of lives.

The reverse effects of social participation on physical vitality were not assessed. Previous studies suggest that social participation can help older adults remain active and maintain physical functioning (Abe et al., 2020; Huang et al., 2021; Makizako et al., 2018). Future studies might investigate the bi-directional longitudinal relationship between physical vitality and social participation in caregiving dyads.

In this study, social participation was measured using activities that require direct and actual connections with others outside the home. However, Levasseur et al. (2010) highlight that social participation is not limited to engaging in activities with others. Rather, it broadly includes any form of activities, including preparing for social connection (e.g., consuming media or daily living activities), being around others without direct connection (e.g., walking in the neighborhood or shopping), and contributing to society through helping others or participating in organizations (Levasseur et al., 2010). In addition, existing studies have found that weak ties (Lam et al., 2023; Pan & Chee, 2020) and virtual connections (Sen et al., 2022; Zhao et al., 2022) can also bring benefits. Future studies should take into account diverse types of social engagement.

Although we controlled for caregiving contexts, there still might be other factors that affect the relationship between physical vitality and social participation in caregiving dyads. For example, Duppen et al. (2020) found that when provided appropriate opportunities for social connection, people can still engage in activities regardless of their physical functioning. Future studies should explore possible factors that mediate or moderate this relationship.

Lastly, as noted earlier, there is growing recognition of the need for strengths-based language to describe frailty (Age UK, British Geriatrics Society, 2015; Durepos et al., 2022; Hopkins et al., 2024; Nicholson et al., 2017). While this paper uses the term “physical vitality,” future studies should further investigate how terminology affects one’s perceptions and health-related behaviors and develop strengths-based language that complements the concept of frailty.

Implication

People living with dementia and their family caregivers often face a loss of social connections, which in turn brings detrimental effects on their health and well-being. The findings of this study highlight the interconnected relationship between physical vitality and social participation in dyads with dementia. It underscores the importance of developing strategies that improve physiological functioning of both people living with dementia and their family caregivers. Given the significant contribution of social participation to diverse aspects of life, it also emphasizes the need to create supportive environments that provide diverse types of social participation regardless of physical ability.

Specifically, prevention or intervention programs aimed at maintaining physical ability or preventing declines in physiological function will be beneficial. Those programs could be delivered in diverse settings, including home-based or internet-based activities. For example, in one study, physical exercise with cognitive stimulation in a virtual environment shows its effectiveness in reducing frailty among older adults with dementia (Karssemeijer et al., 2019). Opportunities to include both caregivers and care recipients in such programs have the potential to increase program uptake and improve physical and social functioning of both dyad members.

It is also important to provide more inclusive opportunities to enhance the social connection of dementia dyads regardless of their physical ability. This could include low-key social engagement initiatives, such as providing brief contact moments (Duppen et al., 2020), chat-bench or home-delivered book club (Coyle & Massihzadegan, 2021), and Memory Cafés (Dementia Friendly America, n.d.), to high levels of participation, such as volunteering (Mountain & Craig, 2012). In addition, creating dementia-friendly community initiatives could enable dyads with dementia to participate in a variety of social activities regardless of their levels of physical vitality. Such initiatives may include increasing accessibility to transportation, creating barrier-free spaces, providing staff training to increase knowledge about dementia (Innes et al., 2016), and promoting public understanding of dementia, such as ‘Dementia Supporter Caravan’ in Japan (Aihara & Maeda, 2021).

In conclusion, this study highlights the interconnected lives of caregiving dyads with dementia. Specifically, physical vitality of care recipients living with dementia was positively related to their own and caregivers’ social participation. This finding highlights the importance of adopting a dyadic lens to better understand dementia dyad’s lives and develop support programs or policies that enhance both care recipient’s and caregiver’s well-being.

Supplemental Material

Supplemental Material - Shared Experience of Physical Vitality and Social Participation Among Caregiving Dyads: Comparing Dyads With and Without Dementia

Supplemental Material for Shared Experience of Physical Vitality and Social Participation Among Caregiving Dyads: Comparing Dyads With and Without Dementia by Hyojin Choi, Maija Reblin, and Kristin Litzelman in Journal of Applied Gerontology.

Footnotes

ORCID iDs

Hyojin Choi

Kristin Litzelman

Ethical Considerations

Since this study used publicly available data, NHATS and NSOC, the Institutional Review Board (IRB) review was exempted.

Author Contributions

Hyojin Choi: Conceptualization, methodology, data curation, formal analysis, writing—original draft, and writing—reviewing and editing.

Maija Reblin: Writing—reviewing and editing.

Kristin Litzelman: Conceptualization, methodology, supervision, and writing—reviewing and editing.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the National Institute on Aging (R01AG062477).

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

Publicly available data from the National Health and Aging Trends Study (NHATS) and the National Survey of Caregiving (NSOC) were used for this research ().

Supplemental Material

Supplemental material for this article is available online.

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