Informal caregiving for a person with dementia often takes place within a health care triad, whose members include the caregiver, the care-recipient and the health care-professional. The aim of the current study was to explore how the members work together with this triadic context. Six spousal caregiving dyads and the three Admiral Nurses who worked with the couples were interviewed. Transcripts of these interviews were analysed to form six case studies, each containing the perspectives of the three members of the triad. The processes emerging in these case studies were encompassed under an overarching dynamic process of ‘negotiating the balance’. This describes the ongoing struggle of the members to balance the views of the other members against their own needs. Coalitions could occur as members worked together to tackle problems. The findings of this study highlight the importance of exploring the perspectives of all members of the triad. This should help health care professionals to improve the quality of the support they provide to caregivers and care-recipients.
AdamsT.GardinerP. (2005) Communication and interaction within dementia care triads: Developing a theory for relationship-centred care. Dementia4(2): 185–205.
2.
AdelmanR. D.GreeneM. G.CharonR. (1987) The physician–elderly patient–companion triad in the medical encounter: The development of a conceptual framework and research agenda. The Gerontologist27(6): 729–734.
3.
AlmbergB. E.GrafströmM.WinbladB. (2000) Caregivers of relatives with dementia: Experiences encompassing social support and bereavement. Aging & Mental Health4(1): 82–89.
4.
AminzadehF.ByszewskiA.MolnarF. J.EisnerM. (2007) Emotional impact of dementia diagnosis: Exploring persons with dementia and caregivers' perspectives. Aging & Mental Health11(3): 281–290.
5.
BaikeE. (2002) The impact of dementia on the marital relationship. Sexual and Relationship Therapy17(3): 289–299.
6.
Biggs, S. (1998). Carers, clients and workers: On the relationship between policy and collusion. In A. Foster & V. Z. Roberts (Eds.), Managing mental health in the community: Chaos and containment (pp. 109–188). London: Routledge.
7.
ConnellC. M.BoiseL.StuckeyJ. C.HolesS. B.HudsonM. L. (2004) Attitudes towards the diagnosis and disclosure of dementia among family caregivers and primary care physicians. The Gerontologist44(4): 500–507.
8.
DaltonJ. (2005) Client–caregiver–nurse coalition formation in decision-making situations during home visits. Journal of Advanced Nursing52(3): 291–299.
9.
DeanS. G.SmithJ. A.PayneS.WeinmanJ. (2005) Managing time: An interpretative phenomenological analysis of patient's and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain. Disability and Rehabilitation27(11): 625–636.
10.
ElliottR.FischerC. T.RennieD. L. (1999) Evolving guidelines for publication of qualitative research studies in psychology and related fields. British Journal of Clinical Psychology38(3): 215–229.
11.
FortinskyR. H. (2001) Health care triads and dementia care: Integrative framework and future directions. Aging & Mental Health5(1): 35–48.
12.
GauglerJ. E.ZaritS. H.PearlinL. I. (2003) The onset of dementia and its longitudinal implications. Psychology and Aging18(2): 171–180.
13.
GillardG. (2001) The perspectives of people with dementia, their families, and their carers. In: CantleyC. (eds) Handbook of dementia care, Buckingham, UK: Open University Press, pp. 77–89.
14.
HasselkusB. R. (1988) Meaning in family caregiving: Perspectives on caregiver/professional relationships. The Gerontologist28(5): 686–691.
15.
HaugM. R. (1994) Elderly patients, caregivers and physicians: Theory and research on health care triads. Journal of Health and Social Behavior35(1): 1–12.
16.
HaugM. R. (1996) Elements in physician/patient interactions in late life. Research on Aging18(1): 32–51.
17.
HellströmI.NolanM.LundhU. (2007) Sustaining ‘couplehood': Spouses' strategies for living positively with dementia. Dementia6(3): 383–409.
18.
HughesC. P.BergL.DanzigerW. L.CobenL. A.MartinR. L. (1982) A new clinical scale for the staging of dementia. British Journal of Psychiatry140(6): 566–572.
19.
KahanaE.YoungR. (1990) Clarifying the caregiving paradigm: Challenges for the future. In: BiegelD. E.BlumA. (eds) Aging and caregiving: Theory, research, and policy, London, UK: Sage, pp. 76–97.
20.
KeadyJ.NolanM. (2003) The dynamics of dementia: Working together, working separately, or working alone? In: NolanM.LundhU.GrantG.KeadyJ. (eds) Partnerships in family care, Buckingham, UK: Open University Press, pp. 15–32.
21.
KeadyJ.Ashcroft-SimpsonS.HalliganK.Williams (2007) Admiral nursing and the family care of a parent with dementia: Using autobiographical narrative as grounding for negotiated clinical practice and decision-making. Scandinavian Journal of Caring Sciences21(3): 345–353.
22.
OrrellM.HancockG. A.Galboda LiyanageK. C.WoodsR. T.ChallisD.HoeJ. (2008) The needs of people with dementia in care homes: The perspectives of users, staff and family caregivers. International Psychogeriatrics20(5): 941–951.
23.
PatonJ.JohnstonK.KatonaC.LivingstoneG. (2004) What causes problems in Alzheimer's disease: Attributions by caregivers. A qualitative study. International Journal of Geriatric Psychiatry19(6): 527–532.
24.
PolkD. M. (2005) Communication and family caregiving for Alzheimer’s disease: Linking attributions and problematic integration. Health Communication18(3): 257–273.
25.
Quinn, C., & Clare. L. (2008). Interpretative phenomenological analysis. In R. Watson, H. McKenna., S. Cowman, & J. Keady (Eds), Nursing research: Designs and methods. Edinburgh, UK: Elsevier.
26.
QuinnC.ClareL.PearceA.van DijkhuizenM. (2008) The experience of providing care in the early stages of dementia: An interpretative phenomenological analysis. Aging & Mental Health12(6): 769–778.
27.
QuinnC.ClareL.WoodsR. T. (2009) The impact of the quality of relationship on the experiences and wellbeing of caregivers of people with dementia: A systematic review. Aging & Mental Health13(2): 143–154.
28.
Quinn, C., Clare, L., & Woods, R. T. (2012). Balancing needs: The role of motivations, meanings, and relationship dynamics in the experience of family caregivers of people with dementia. Manuscript submitted for publication.
29.
RobertoK. A.RichterJ. M.BottenbergD. J.CampbellS. (1998) Communication patterns between caregivers and their spouses with Alzheimer’s disease: A case study. Archives of Psychiatric Nursing12(4): 202–208.
30.
RobinsonL.ClareL.EvansK. (2005) Making sense of dementia and adjusting to loss: Psychological reactions to a diagnosis of dementia in couple. Aging & Mental Health9(4): 337–347.
31.
SchmidtK. L.LinglerJ. H.SchulzR. (2009) Verbal communication among Alzheimer’s disease patients, their caregivers, and primary care physicians during primary care office visits. Patient Education and Counselling77(2): 197–201.
32.
SmithJ. A. (2004) Reflecting on the development of interpretative phenomenological analysis and its contribution to qualitative research in psychology. Qualitative Research in Psychology1(1): 39–54.
33.
TwiggJ. (1989) Models of carers: How do social care agencies conceptualise their relationship with informal carers?Journal of Social Policy18(1): 53–66.
34.
WhitemoreR.ChaseS. K.MandleC. L. (2001) Validity in qualitative research. Qualitative Health Research11(4): 522–537.
35.
WhitlatchC.JudgeK.ZaritS. H.FemiaE. E. (2006) Dyadic intervention for family caregivers in early-stage dementia. The Gerontologist46(5): 688–694.
36.
WoodsR. T.WillsW.HigginsonI.HobbinsJ.WhitbyM. (2003) Support in the community for people with dementia and their carers: A comparative outcome study of specialist mental health service interventions. International Journal of Geriatric Psychiatry18(4): 298–307.
37.
ZaritS. H.EdwardsA. B. (2008) Family caregiving: Research and clinical intervention. In: WoodsR. T.ClareL. (eds) Handbook of the clinical psychology of ageing, (2nd Edn,. Chichester, UK: Wiley, pp. 255–288.
