Attachment Behaviors in Parent Child Dyads Coping with Early Stage Alzheimer's Disease and Related Dementias

大约400万成年子女为患有阿尔茨海默病和相关疾病的父母提供无偿护理 痴呆(ADRD)。照顾患有ADRD的父母可能会有压力，并对照顾者的健康产生负面影响。 而对配偶照顾双方的研究表明，夫妻之间情感上的支持性沟通 在ADRD的早期阶段，配偶可以保护照顾者的健康，对这种人际关系知之甚少 父子二元组中的进程。这个问题需要解决，因为成年儿童照顾者和他们的父母 与夫妻二人组相比，他们面临着不同的人际关系挑战(例如，如何应对亲子角色的颠倒)。 我们在我们的配偶照看工作中表明，相互的情感支持行为，定义为照顾者 与照顾者提供和接受安全的沟通，感觉舒适的表达 脆弱性和同理心，以及给予和接受有形的援助，减少照看负担和保护 心理健康。相互的情感支持行为是可以改变的，这使它们变得适当 干预目标。我们的研究受到依恋理论的启发，该理论规定， 情感安全是亲子二人一生中的基本需要，特别是在 危机。我们的主要假设是，相互的情感支持行为可以保护成年人的健康 通过减少照顾者的压力和消极的应对策略，为儿童照顾者和父母提供帮助。我们整合了我们的 关于相互支持的假设被纳入现有的二元照顾者压力模型，该模型展示了照顾者如何 和接受照顾者的特征、主要和次要的压力源、照顾者的评价和应对 影响二元组成员的健康和关系功能。为了测试我们的创新模型，我们提出了一个 对200个二元体进行二元、纵向和观察性研究：60岁及以上的老年人早期 ADRD阶段和一名主要的成年儿童照顾者。两个二元成员都将接受采访，使用有效的和 可靠的自我报告措施，并在基线上录制了关于痴呆症相关应激源的讨论 并进行为期一年的随访。相互的情感支持行为将通过观察性编码进行衡量 由Co-I Feeney创建的系统，将监测血压。执行并元分析时将使用 混合模型和结构方程模型。目标1将考察相互情感支持 行为与较低的照顾者需求评估、照顾者感受到的压力和照顾者相关 纵向上消极应对。目标2将研究相互情感支持行为是否能保护双方 DYAD成员的健康和纵向关系功能及其是否由较低照顾者中介 需求评估、照顾者感受到的压力和照顾者的消极应对。目标3将审查相互 作为生物变量的性别和背景因素的情感支持行为差异(例如，SES， 照顾者抑郁、关系史)。这将导致阶段1应用程序创建附件- 基于干预工具，以保护患有ADRD的父母及其成年子女主要照顾者的健康。

Roughly 4 million adult children provide unpaid care to their parents with Alzheimer's disease and related dementias (ADRD). Caring for a parent with ADRD can be stressful and negatively impact caregivers' health. While research on spousal caregiving dyads shows that emotionally supportive communication between spouses in the early stages of ADRD can protect caregivers' health, little is known about such interpersonal processes in parent-child dyads. This needs to be addressed because adult child caregivers and their parents face different interpersonal challenges (e.g., navigating a reversal of the parent-child role) than spousal dyads. We have shown in our spousal caregiving work that mutual emotional support behaviors, defined as caregivers and care-recipients providing and receiving communication of safety, feeling comfortable expressing vulnerability and empathy, and giving and receiving tangible aid, decrease caregiving burden and protect psychological health. Mutual emotional support behaviors are amenable to change, making them appropriate targets for interventions. Our research is informed by attachment theory, which stipulates that the need for emotional security is a fundamental need in the parent-child dyad across the lifespan, especially in times of crisis. Our overarching hypothesis is that mutual emotional support behaviors can protect the health of adult child caregivers and parents by reducing caregiver stress and negative coping strategies. We integrate our hypotheses about mutual support into an existing dyadic caregiving stress model that shows how caregiver and care-recipient characteristics, primary and secondary stressors, caregiver appraisals and coping all influence both dyad members' health and relational functioning. To test our innovative model, we propose a Stage 0 dyadic, longitudinal, and observational study of 200 dyads: older adults aged 60 and older with early stage ADRD and one primary adult child caregiver. Both dyad members will be interviewed, using valid and reliable self-report measures, and have videotaped discussions about dementia-related stressors at baseline and a one-year follow-up. Mutual emotional support behaviors will be measured with an observational coding system created by Co-I Feeney, and blood pressure will be monitored. Dyadic analysis will be performed with mixed models and structural equation modeling. Aim 1 will examine whether mutual emotional support behaviors are associated with lower caregiver demand appraisals, caregiver perceived stress, and caregiver negative coping longitudinally. Aim 2 will examine whether mutual emotional support behaviors protect both dyad members' health and relational functioning longitudinally and whether this is mediated by lower caregiver demand appraisals, caregiver perceived stress, and caregiver negative coping. Aim 3 will examine mutual emotional support behavior differences by sex as a biological variable and contextual factors (e.g., SES, caregiver depression, relationship history). This will lead to a Stage 1 application to create an attachment- based intervention tool to protect the health of parents with ADRD and their adult child primary caregivers.