Health decline in aged caregivers: epidemiologic study

描述（由申请人提供）：由于不一致的研究结果和方法限制，护理是否对护理者的身体和认知功能有不利影响仍不确定，包括：仅在基线评估护理者状态-未纳入随访期间护理者状态的变化；在一次随访中评估健康结果；缺乏感知压力的测量和生物标记，可以直接测试与护理相关的压力和健康衰退的生物-社会心理模型。本研究是对Caregiver-SOF的竞争性更新，该研究是对骨质疏松性骨折（SOF）研究的辅助研究，这是一项针对老年妇女骨折和跌倒风险的多地点研究。护理人员-护理人员样本有1069名护理人员参与者（平均年龄=81岁），他们是非正式护理人员（n=375）和非护理人员（n=694），他们在护理地点、年龄、种族和邮政编码上相匹配。他们每年进行三次基于家庭的访谈，包括关于护理情况和护理者状态转变、感知压力、抑郁症状和自我报告的adl和ladl的标准化问题；基于表现的身体功能测量（定时行走、握力、椅子站立）；速度/注意力认知测试（数字替换测试）和言语记忆测试（霍普金斯言语学习测试）；测量体重。本研究将增加两次以家庭为基础的访谈，访谈对象为734名幸存的护理者- sof参与者。训练有素的SOF采访者将重新管理先前管理过的问卷和物理和认知测量，总共有五个评估点。这些数据将与SOF的死亡率和白细胞介素-6 （IL-6）数据联系起来，这些数据使用的是在两个SOF部位同时进行的SOF检查中储存的血清。将检验以下假设：1)使用重复测量和Cox比例风险模型比较照顾者和非照顾者，以及照顾者状态的转变，对身体（即自我报告和基于绩效的功能状态、体重变化和死亡率）和认知健康状态的变化；2)研究IL-6在照顾和慢性应激导致身体和认知健康下降的通路中的中介作用；3)评估最近研究中观察到的配偶照顾者健康下降率较高的方法学原因；4)使用生长曲线模型分析压力和健康结果的变化轨迹。本研究将通过深入了解护理压力与身体和认知健康结果之间的病因学、生物学和方法学因素，复制和扩展先前研究的结果。研究结果将指导干预措施，以减少压力对老年照顾者和一般老年人身体和认知健康的影响。

DESCRIPTION (provided by applicant): Whether care giving has adverse effects on the caregiver's physical and cognitive functioning remains uncertain due to inconsistent research findings and methodological limitations that include: assessment of caregiver status at baseline only - not incorporating changes in caregiver status over the follow up period; evaluation of health outcomes at a single follow up time; and absence of measures of perceived stress and biological markers that would allow direct tests of bio-psychosocial models of care giving-related stress and health decline. The proposed study is a competitive renewal of Caregiver-SOF, which is an ancillary study to the Study of Osteoporotic Fractures (SOF), a multi-site study of the risk of fractures and falls in elderly women. The Caregiver-SOF sample has 1069 SOF participants (mean age=81 years) who were informal caregivers (n=375) and non-caregivers (n=694) matched on SOF site, age, race, and zip code. They have had three annual home-based interviews that included standardized questions on the care-giving situation and caregiver status transitions, perceived stress, depressive symptoms, and self-reported ADLs and lADLs; performance-based measures of physical functioning (timed walk, grip strength, chair stands); cognitive tests of speed/attention (Digit Substitution Test) and verbal memory (Hopkins Verbal Learning Test); and measured weight. This proposed study will add two home-based interviews with 734 surviving Caregiver-SOF participants. Trained SOF interviewers will re-administer the questionnaires and physical and cognitive measures that have been administered previously, for a total of five assessment points. These data will be linked to SOF data on mortality and lnterleukin-6 (IL-6) using stored serum from a concurrent SOF exam at two SOF sites. Hypotheses will be tested that 1) compare caregivers and non-caregivers, and transitions in caregiver status, on change in physical (namely, self-reported and performance-based functional status, weight change, and mortality) and cognitive health status using repeated measures and Cox proportional hazards modeling; 2) examine the role of IL-6 as a mediator in the pathway from care-giving and chronic stress to physical and cognitive health decline; 3) evaluate methodologic reasons for higher rates of health decline in spouse caregivers that have been observed in recent studies; and 4) use growth curve modeling to analyze trajectories of change in stress and health outcomes. This study will replicate and extend the results of previous studies by providing insight into etiologic, biological, and methodological factors in the associations of care-giving stress with physical and cognitive health outcomes. Study results will guide interventions to reduce effects of stress on physical and cognitive health in older caregivers, and older adults in general.