Care Transitions and Adult Day Services Moderate the Longitudinal Links between Stress Biomarkers and Family Caregivers' Functional Health.
Care Transitions and Adult Day Services Moderate the Longitudinal Links between Stress Biomarkers and Family Caregivers' Functional Health.
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作者：
Liu Y;Almeida DM;Rovine MJ;Zarit SH
压力生物标记物被认为与健康和幸福有关。然而，关于下丘脑-垂体-肾上腺(HPA)轴和交感神经系统(SNS)的失调实际上如何影响痴呆症亲属照顾者的功能健康的研究很少。此外，目前还不清楚影响护理压力源暴露的因素，如护理过渡和成人日间服务(ADS)的使用是否以及如何影响这种联系。首先，检查日常应激生物标记物与痴呆症家庭照顾者随时间推移的功能健康的关系。第二，检查护理过渡和ADS使用对基线压力生物标记物和功能健康之间随时间推移的关联的影响。在基线，照顾者在为期8天的日记研究中每天提供5个唾液样本，其中所有照顾者每周都有不同数量的广告天数。在6个月和12个月时进行了两次纵向随访，内容涉及广告使用、护理过渡和照顾者的功能健康。以基线为基准计算唾液皮质醇、脱氢表雄酮的硫酸形式(脱氢表雄酮-S)和唾液α淀粉酶(SAA)的平均日总产量，以此作为照顾者纵向功能限制轨迹的预测因子。护理过渡和基线每周广告总天数被认为是压力生物标记物与随着时间推移的健康之间关系的调节因素。功能限制轨迹和每日皮质醇和SAA的总输出量之间的关联被ADS的使用和护理过渡所改变。在经历了转变的照顾者中，每周使用的ADS天数少于平均天数的人，每日皮质醇总排出量和每日SAA总排出量的减少与功能限制的增加有关。经历了过渡但每周使用广告天数超过平均天数的照顾者没有表现出这种联系模式。对脱氢表雄酮-S无明显影响。这项研究提出了一个重要但在很大程度上尚未得到解答的问题，即压力生物标记物对功能健康的影响。对痴呆症家庭照顾者压力生物标记物与健康之间的关系的评估需要考虑压力源暴露随时间的变化，例如护理过渡和广告使用。
Stress biomarkers have been linked to health and well-being. There are, however, few studies on how dysregulation in hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system (SNS) actually affects functional health among family caregivers of relatives with dementia. Further, it is not clear whether and how factors affecting caregiving stressor exposures such as care transitions and Adult Day Services (ADS) use may affect such association. First, to examine the association of daily stress biomarkers and functional health over time among dementia family caregivers. Second, to examine effects of care transitions and ADS use on the association between baseline stress biomarkers and functional health over time. At baseline, caregivers provided five saliva samples each day during an 8-day diary study, where all caregivers were having a varying number of ADS days per week. There were two longitudinal follow-ups at 6 and 12 months on ADS use, care transitions, and caregivers’ functional health. The average daily total output across days were computed at baseline for salivary cortisol, the sulfated form of dehydroepiandrosterone (DHEA-s), and salivary alpha amylase (sAA), which were used as predictors of caregivers’ longitudinal functional limitation trajectories. Care transitions and total number of ADS days per week at baseline were considered as moderators of the associations between stress biomarkers and health over time. The associations between functional limitation trajectories and daily total outputs of cortisol and sAA were modified by ADS use and caregiving transitions. Among caregivers who experienced a transition, and who used less than average ADS days per week, lower daily cortisol total output and lower daily sAA total output were associated with increasing functional limitations. Caregivers who experienced a transition but used greater than average ADS days per week did not show such patterns of association. No significant effect was found for DHEA-s. The study contributes to an important but largely unanswered question on implications of stress biomarkers on functional health. Assessments on the association between stress biomarkers and health among dementia family caregivers need to consider changes in stressor exposures over time, such as care transitions and ADS use.
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影响因子：
3.7
作者：
Pruessner, JC;Kirschbaum, C;Hellhammer, DH
通讯作者：
Hellhammer, DH
DOI：
10.1093/geronb/gbq049
发表时间：
2010-09-01
影响因子：
6.2
作者：
Piazza, Jennifer R.;Almeida, David M.;Klein, Laura C.
通讯作者：
Klein, Laura C.
影响因子：
5.7
作者：
Gaugler, JE;Kane, RL;Newcomer, R
通讯作者：
Newcomer, R
影响因子：
4.2
作者：
Leggett, Amanda N.;Liu, Yin;Zarit, Steven H.
通讯作者：
Zarit, Steven H.
影响因子：
2.8
作者：
Liu, Yin;Kim, Kyungmin;Zarit, Steven H.
通讯作者：
Zarit, Steven H.