Addressing the double jeopardy of stress and hypertension among African American female caregivers of persons living with Alzheimer's disease and related dementias

项目总结 没有哪个人口群体比其他人群更容易受到照顾压力和高血压的双重威胁 照顾阿尔茨海默病和相关痴呆症(ADRD)家庭成员的非裔美国妇女。 这两种情况都会导致生活质量下降和心血管疾病--这是失控的并发症 高血压1.维持这些照顾者的健康对于支持照顾者的福祉至关重要 收件人。尽管一些多组成部分的干预措施解决了ADRD照顾者的压力和质量问题 生活中，在有针对性的干预措施方面仍然存在2，3个差距，以解决慢性护理压力和 非裔美国女性的高血压自我护理。这项初步研究建立在我们早先的工作基础上，该工作表明 压力、血压知识和复杂的饮食信息缺乏都干扰了老年非洲人 美国女性高血压的自我照顾。4-7生活方式的改变(压力管理，减少钠，饮食 水果/蔬菜和体力活动)对控制高血压是有效的。我们的第一阶段试点研究是基于 关于我们可以通过应对压力反应/压力来促进这些生活方式改变的科学理论 弹性，身体对压力的心理和生理反应，作为应对压力的潜在机制 促进行为的改变。通过这种方式，我们可以改善健康结果(照顾者的压力、生活质量、 心血管疾病风险)。一项关于28名非洲人的小规模两组随机对照(RCT)试点研究 将对40岁及以上患有高血压的美国女性照顾者进行调查。我们将确定 运动正念(MIM)加饮食控制高血压的可行性和可接受性 8参与者将被随机分为MIM DASH7干预组或阿尔茨海默病协会组 护理员培训(注意力控制)，每周8次，通过远程医疗(视频和电话)进行1小时的小组会议 访问)。在干预完成后，两组都将收到四个每两个月一次的电话 12个月。据我们所知，这是第一个)系统地使用科学之一的研究 行为改变成功采用健康行为的关键机制--压力 反应性/压力恢复力9和b)只关注非裔美国女性照顾者 痴呆症。目的是：a)确定MIM短跑和护理员培训的可行性和可接受性 患有高血压的非裔美国女性照顾者；b)探讨MIM DASH与 关于照顾者压力和生活质量的护理培训；生活质量；以及c)调查潜在的 MIM短跑或护理者训练与自理之间的应激反应/应激弹性的中介效应 行为。这项试点将为行为改变科学做出实质性贡献，通过识别基本的 采用可用于实施自我护理干预措施的健康行为的机制 缩小非裔美国人的健康差距。研究结果将为更大规模的试验提供基础设施。

PROJECT SUMMARY No demographic group is more at risk for the double jeopardy of caregiving stress and hypertension than African American women caring for a family member with Alzheimer’s disease and related dementias (ADRD). Both situations lead to reduced quality of life and cardiovascular disease—a complication of uncontrolled hypertension.1 Maintaining the health of these caregivers is critical to support the well-being of the care recipients. Although some multi-component interventions have addressed ADRD caregiver's stress and quality of life, 2,3 gaps remain in targeting interventions to address the complexity of chronic caregiving stress and hypertension self-care in African American women. This pilot study builds on our earlier work which showed that stress, blood pressure knowledge, and complex diet information deficits all interfered with older African American women’s hypertension self-care.4-7 Lifestyle changes (stress management, reducing sodium, eating fruits/vegetables, and physical activity) are effective in managing hypertension. Our Stage I pilot study is based on the scientific rationale that we can promote these lifestyle changes by addressing stress reactivity/stress resilience, the psychological and physiological response of the body to stress, as the underlying mechanism to facilitate behavioral change. In this way we can improve health outcomes (caregiver stress, quality of life, cardiovascular disease risk). A small-scale two-group randomized controlled (RCT) pilot study of 28 African American female caregivers, age 40 and older with hypertension, will be conducted. We will determine the feasibility and acceptability of Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension (DASH).8 Participants will be randomized to either the MIM DASH7 intervention or the Alzheimer’s Association Caregiver Training (attention control) in 8 weekly, 1-hour group sessions via telehealth (video and telephone access). After completion of the intervention, both groups will receive four bi-monthly follow-up calls over the 12 months. To our knowledge, this is the first study that a) systematically employs one of the Science of Behavioral Change key mechanisms underlying successful adoption of health behaviors—stress reactivity/stress resilience9 and b) focuses solely on African American female caregivers of people living with dementia. The aims are: a) determine the feasibility and acceptability of MIM DASH and Caregiver Training for African American female caregivers with hypertension; b) explore the impact of MIM DASH as compared to Caregiving Training on caregiver stress and quality of life; quality of life; and c) investigate the potential mediation effects of stress reactivity/stress resilience between MIM DASH or Caregiver Training and self-care behaviors. This pilot will make a substantive contribution to the science of behavior change by identifying basic mechanisms, in the adoption of healthy behaviors that can be used to implement self-care interventions to reduce health disparities in African Americans. Study findings will inform the infrastructure for a larger trial.