Momentary and Longitudinal Effects of Loneliness on Dementia Caregiver Well-Being

TL;DR

This study shows that loneliness affects the well-being of dementia caregivers both daily and over time, with attachment styles influencing the impact.

Contribution

The study identifies loneliness as a dynamic and long-term risk factor for dementia caregivers, mediated by attachment insecurity.

Findings

Higher loneliness predicts greater depressed affect on a daily basis.

Baseline loneliness increases caregiver burden and anticipatory grief over time.

Attachment anxiety amplifies the negative effects of loneliness, while attachment avoidance buffers them.

Abstract

Spousal caregivers of individuals with Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) often experience profound loneliness, which contributes to persistent psychological distress and elevated risk for morbidity and mortality. Yet the mechanisms through which loneliness shapes their emotional well-being and caregiving outcomes remain unclear. Guided by stress process and attachment frameworks, we tested both momentary and longitudinal effects of loneliness in AD/ADRD spousal caregivers. Participants (N = 69; mean age = 71.5 years; 64% female; 62% White) completed ecological momentary assessments of loneliness and affect, along with baseline and follow-up surveys of caregiver burden, depressive symptoms, and anticipatory grief. Multilevel models showed that within-person increases in loneliness predicted greater depressed affect (b = 0.72, p < .001), controlling for demographics. Longitudinally, higher baseline loneliness predicted increases in caregiver burden (b = 0.21, p = .02) and anticipatory grief (b = 0.01, p = .01), but not depressive symptoms, beyond prior levels. Moderation analyses indicated that attachment anxiety heightened vulnerability to depressed affect, whereas attachment avoidance buffered the within-person daily link between loneliness and depressed affect. Findings demonstrate that loneliness functions as both a dynamic daily process and a long-term vulnerability factor in AD/ADRD spousal caregiving. By identifying attachment insecurity as a risk amplifier, this work provides mechanistic insight into when and for whom loneliness is most detrimental and highlights loneliness as a promising intervention target to reduce burden, mitigate anticipatory grief, and promote resilience among AD/ADRD spousal caregivers.