As a progressive neurocognitive disorder, Alzheimer’s disease not only erodes an individual's cognitive and behavioral functioning but also subjects the family—and family caregivers in particular—to a prolonged, painful experience with no clear endpoint. The key concept of "ambiguous loss," introduced by Pauline Boss, refers to a situation where an individual is physically present yet gradually becomes psychologically, cognitively, and emotionally absent. This state is characterized by chronic uncertainty and the absence of formal mourning rituals, leading to "disenfranchised grief." Concurrently, "coping strategies" encompass problem-focused and emotion-focused cognitive and behavioral efforts to manage the stress associated with caregiving. Research indicates that caregivers of Alzheimer’s patients often resort to emotion-focused strategies—such as acceptance, avoidance, or spiritual engagement—though the efficacy of these approaches in mitigating ambiguous loss remains a subject of debate.



Various studies have highlighted the heavy psychological burden borne by caregivers, noting issues such as depression, anxiety, guilt, and emotional burnout. Interventions such as mindfulness-based cognitive therapy and problem-focused coping training have demonstrated positive effects on well-being and stress reduction. Internationally, research has also addressed ambiguous loss, anticipatory grief, and interventions like psychodrama. Nevertheless, significant gaps remain: most Iranian studies have been quantitative and questionnaire-based, thereby overlooking the lived experience of caregivers; furthermore, concepts such as ambiguous loss and anticipatory grief have received limited examination within the Iranian cultural context. There is a contradiction in the findings regarding the effectiveness of problem-focused and emotion-focused strategies. Therefore, qualitative, culture-based research is essential for a deeper understanding of this experience.

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