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

项目摘要 没有一个人口统计学群体比其他人更容易遭受压力和高血压的双重危险。 照顾患有阿尔茨海默病和相关痴呆症（ADRD）的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--一种不受控制的 1保持这些护理人员的健康对于支持护理人员的福祉至关重要。 受惠人士虽然一些多成分干预措施已经解决了ADRD照顾者的压力和质量 2.3在针对性干预措施方面仍存在差距，以解决慢性压力的复杂性， 非裔美国妇女高血压自我护理。这项试点研究建立在我们早期的工作基础上， 压力、血压知识和复杂的饮食信息缺陷都干扰了老年非洲人， 美国女性高血压自我护理。4 - 7生活方式改变（压力管理、减少钠、饮食 水果/蔬菜和体力活动）是有效的管理高血压。我们的第一阶段试点研究是基于 基于科学原理，我们可以通过解决压力反应/压力来促进这些生活方式的改变 弹性，身体对压力的心理和生理反应，作为潜在的机制， 促进行为改变。通过这种方式，我们可以改善健康结果（照顾者压力，生活质量， 心血管疾病风险）。一项在28名非洲人中进行的小规模两组随机对照（RCT）试点研究 美国女性照顾者，年龄40岁及以上的高血压，将进行。康贝特人将以 运动中的正念（MIM）加上饮食方法来阻止高血压的可行性和可接受性 8参与者将被随机分配到MIM DASH 7干预组或阿尔茨海默病协会干预组。 通过远程保健（视频和电话），每周8次，每次1小时的小组会议，对护理人员进行培训（注意力控制） 访问）。在完成干预后，两组都将接受四次每两个月一次的随访电话， 12个月据我们所知，这是第一个研究，a）系统地采用了科学之一， 行为改变成功采用健康行为的关键机制-压力 反应性/压力耐受性9和B）仅关注非裔美国女性照顾者， 痴呆目的是：a）确定MIM DASH和护理人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）探索MIM DASH与 护理人员压力和生活质量的护理培训;生活质量;和c）调查潜在的 MIM DASH或护理人员培训与自我护理之间的压力反应性/压力恢复力的中介作用 行为。这项试验将通过确定基本的行为改变， 机制，在采取健康的行为，可用于实施自我保健干预措施， 减少非裔美国人的健康差距。研究结果将为更大规模试验的基础设施提供信息。

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.