Quality of family relationships and outcomes of dementia: a systematic review

Hannah Edwards, Sharea Ijaz, Penny Whiting, Verity Leach, Alison Richards, Sarah Cullum, Cheston Richard, Jelena Savović

Research output: Contribution to journalArticle (Academic Journal)peer-review

15 Citations (Scopus)
273 Downloads (Pure)


Objectives: Evaluation of the association between the quality of relationship between a person with dementia and their family carer and outcomes for the person with dementia.

Design: Systematic review.

Eligibility criteria: Cohort studies of people with clinically diagnosed dementia and their main carers. Exposures of interest were any elements of relationship quality, e.g. attachment style, expressed emotion, coping style. Our primary outcome was institutionalisation, and secondary outcomes were hospitalisation, death, quality of life, and behavioural and psychiatric symptoms of dementia (‘challenging behaviour’).

Data sources: Medline, Embase, Web of Science, PsycInfo, the Cochrane Library and Opengrey were searched from inception to May 2017.

Study appraisal and synthesis methods: The Newcastle-Ottawa Scale was used to assess risk of bias. A narrative synthesis of results was performed due to differences between studies.

Results: Twenty studies were included. None of the studies controlled for all pre-specified confounding factors (age, gender, socio-economic status, and severity of dementia). Reporting of results was inadequate with many studies simply reporting whether or not associations were ‘statistically significant’ without providing effect size estimates or confidence intervals. There was a suggestion of an association between relationship factors and global challenging behaviour. All studies evaluating global challenging behaviour provided statistical evidence of an association (most p-values below 0.02). There was no consistent evidence for an association for any other outcome assessed.

Conclusions: There is currently no strong or consistent evidence on the effects of relationship factors on institutionalisation, hospitalisation, death or quality of life for people with dementia. There was a suggestion of an association between relationship factors and challenging behaviour, although the evidence for this was weak. To improve our ability to support those with dementia and their families further robust studies are needed.
Original languageEnglish
Article numbere015538
Number of pages14
JournalBMJ Open
Issue number1
Early online date21 Jan 2018
Publication statusPublished - Jan 2018


  • Dementia
  • carers
  • family relationships
  • institutionalisation
  • challenging behaviour


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