Spousal Discrepancies in Perceived Needs of People Living with Alzheimer’s Disease: A Mixed-Methods Study of Caregivers' Perspective Taking and Dyadic Communication

People living with Alzheimer's disease (PLWD) often face unmet care needs, which may arise as caregivers and PLWD differ in their perceptions of PLWD's needs. To understand how these discrepancies vary by caregivers' perspective taking (i.e., their ability to understand PLWD's thoughts and feelings), we conducted a sequential mixed-methods study with 67 couples managing Alzheimer's disease. Both spouses completed semi-structured interviews to describe PLWD's needs and discussed how they communicated about needs. Caregivers' perspective taking was negatively associated with discrepancies in PLWD's needs. Thematic analysis of a subgroup parallel sample demonstrated that, when caregivers reported high perspective taking, couples described navigating PLWD's needs through open dialogue and caregivers adopted respectful communication practices. When caregivers reported low perspective taking, couples described misaligned expectations and communication efforts; caregivers initiated communication to identify PLWD needs and acknowledged employing insensitive language. Findings can inform interventions to improve the quality of dementia care and promote health.