A Couplehood Typology for Spouses of Institutionalized Persons With Alzheimer's Disease: Perceptions of “We”–“I”*

A Couplehood Typology for Spouses of Institutionalized Persons With Alzheimer's Disease: Perceptions of "-We"-"I"* A qualitative analysis of 68 community-dwelling spouses of institutionalized patients with Alzheimer's disease was conducted. The goal was to ascertain to what degree they perceived themselves as married Five groups representing different degrees of couplehood emerged. Ranging from strong couplehood to no couplehood, groups were given the following terms: ... Til Death Do Us Parts, " "We, but . . . ,"Husbandless Wives/Wifeless Husbands," "Becoming an 1," and "Unmarried Marrieds." Ways to interpret this typology and implications for both further research and practitioners are described. What degree of couplehood does a community-dwelling spouse perceive with an institutionalized spouse with Alzheimer's disease (AD)? The term "couplehood" is used here to describe the extent to which a community-dwelling spouse perceives oneself as married (feelings of belonging to a "We" or feeling like an "I"). The goal is to use symbolic interactionism to understand couplehood and the impact of separation through institutionalization on one's sense of feeling married. Furthermore, if a community-dwelling spouse becomes unable to define the self as a "We" or an "I", then ambiguous boundaries regarding feeling married become more likely. Understanding how nursing home placement impacts the marital relationship is the goal of this article. Toward that end, this research builds on a past study that examined the notion of couplehood and identified preliminary perceptions of "We" versus "I" (Kaplan, Ade-Ridder, Hermon, Brubaker, & Brubaker, 1995). Using a larger sample, this study aims to tease out a finer typology of couplehood. Qualitative interviews with 68 spouses of institutionalized AD patients revealed five groups of community-dwelling spouses (to be outlined in the Findings section). First, statistics projecting the incidence of AD and nursing home placement of the elderly are described. Then, past caregiver and couplehood literature is explored. Background and Literature Review According to U.S. Census data, the aging of the oldest old segment of the population (those over 85 years of age) is particularly important because when examining AD, estimates are that about four million Americans currently have the disease (U.S. Department of Health and Human Services, 1998), and the risk increases with age. Of those age 65 and older, Evans and colleagues (1989) calculate an estimated 10.3% as having probable AD. Broken down by age group, approximately 3% of elderly persons between 65 and 74 years of age have AD, whereas almost half of the 85+ group experience symptoms. We know that the 85+ group is the fastest growing segment of our population, with increases in this age group accounting for most of the projected increase in the prevalence of AD in the coming century (Evans et al., 1990). The aging of the population and the increasing prevalence of AD by age suggests that many AD patients will require assistance with daily care. Although spouses are often the preferred caregiver (if available), these spousal caregivers are aging themselves. An AD patient is usually cared for in the home, at least in the beginning stages of the illness. As the disease progresses, however, home caregiving may not always be a viable option. Although the decision to institutionalize a mate is a difficult one, care is sometimes preferred in an institutional setting rather than in the home. When examining marital status among nursing home residents, we find 16.5% to be married (i.e., more than 229,000 nursing home residents, or 37% of institutionalized men and 9.8% of institutionalized women; Dey, 1997). Therefore, there is an increased chance for spouses to be separated because of dissimilar declines in health. Despite a sizable number of spouses who institutionalize a mate with AD, few caregiver studies actually focus on this group. …