Biological Pathways of Acute and Chronic Stress in Aged Hip Fracture Caregivers

描述（由申请人提供）： 众所周知，急性和慢性压力对身体和认知功能有不利影响，但与工作相关的压力影响这些结果的机制仍不清楚。这项拟议的研究将评估可能将急性和慢性应激与功能和认知结果联系起来的生物过程。它测试了压力破坏多个相互关联的稳态系统（HPA轴，神经内分泌和免疫系统）的理论，这可能导致代谢综合征和随后的健康下降。样本将包括从8家巴尔的摩地区医院招募的225名老年髋部骨折患者的老年非正式护理人员（108名巴尔的摩髋部研究BHS-7中患者的新护理人员和持续护理人员;以及117名来自这些医院的未招募到BHS-7研究的女性患者的新护理人员和持续护理人员）。患者在出院前将确定护理人员，以最大限度地增加新护理人员的数量，并在急性压力期间获得基线数据。将由经过培训的护士访谈员进行四（4）次年度家庭访谈。在每次访谈时，将获得血压、拟人测量和生物标志物（24小时尿液中的儿茶酚胺和皮质醇、血清中的DHEAS、促炎和抗炎标志物、葡萄糖、胆固醇）。血液将被储存用于未来的分析。访谈数据包括与工作相关的压力源、身体健康和活动、抑郁症状以及其他潜在的混杂因素和影响因素。功能状态将基于步行速度、椅子站立和自我报告的ADL/IADL。认知测量包括执行功能、速度/注意力、工作记忆和类别流畅性的测试。假设将涉及：1）从应激到生理变化、代谢综合征、功能和认知异常的连续途径; 2）急性和慢性应激的影响的比较，以及由于患者的恢复而导致的应激结束; 3）调节剂（即，社会支持应激因素）影响这些途径的机制。混合效应模型将用于检查从护理人员压力到生物变化、功能和认知结果的时间关联，以及随时间变化的协变量（即，停止生产）。研究结果将推动对急性和慢性应激的生理和健康影响的研究，并对髋部骨折或其他疾病的成年人的护理人员的干预措施产生影响。公共卫生相关性护理人员经历高比例的压力，但很少有人知道的生理机制，其中相关的压力导致不良的健康结果。拟议的研究将在225名老年髋部骨折患者的护理人员中解决这个问题;这一组很少受到关注，但对于研究急性和慢性压力和停止压力的影响是理想的，因为髋部骨折是急性事件，50%的患者在骨折后一年内恢复。我们将评估的生物过程，可能链接到代谢综合征的发展，以及随后的功能和认知状态下降的压力。研究结果将推动对髋关节骨折的生理和健康影响的研究，并对设计髋关节骨折或其他疾病的护理人员的干预措施具有影响。

DESCRIPTION (provided by applicant): It is known that acute and chronic stress have adverse effects on physical and cognitive functioning, but the mechanisms by which caregiving-related stress affects these outcomes remain unclear. The proposed study will evaluate the biological processes that may link acute and chronic caregiving stress to functional and cognitive outcomes. It tests the theory that stress disrupts multiple, interrelated homeostatic systems (HPA axis, neuroendocrine, and immune systems), which may lead to metabolic syndrome and subsequent health decline. The sample will include 225 older informal caregivers to elderly hip fracture patients recruited from 8 Baltimore area hospitals (108 new and continuing caregivers to patients in the Baltimore Hip Studies, BHS-7; and 117 new and continuing caregivers to female patients from these hospitals who were not recruited to the BHS-7 study). Caregivers will be identified by patients prior to discharge in order to maximize the number of new caregivers, and to obtain baseline data during a time of acute stress. Four (4) annual home-based interviews will be conducted by trained nurse interviewers. At each interview, blood pressure, anthropomorphic measures, and biological markers will be obtained (24-hour urine for catecholamines and cortisol, serum for DHEAS, pro- and anti-inflammatory markers, glucose, cholesterol). Blood will be stored for future analyses. Interview data include caregiving-related stressors, physical health and activity, depressive symptoms, and other potential confounders and effect modifiers. Functional status will be based on walking speed, chair stands and self-reported ADLs/IADLs. Cognitive measures include tests of executive functioning, speed/attention, working memory, and category fluency. Hypotheses will address: 1) sequential pathways from caregiving stress, to physiological changes, metabolic syndrome, and functional and cognitive outomes; 2) comparisons of the effects of acute and chronic caregiving stress, and end of caregiving due to the patient's recovery; and 3) mechanisms by which modifiers (ie, social support caregiving factors) affect these pathways. Mixed effects models will be used to examine the temporal associations from caregiver stress to biological changes, to functional and cognitive outcomes, and the effects of time-varying covariates (i.e., cessation of caregiving). Results will advance research on physiological and health effects of acute and chronic caregiving stress, and have implications for interventions for caregivers to adults with hip fracture or other conditions. PUBLIC HEALTH RELEVANCE Caregivers experience high rates of stress, but little is known about the physiological mechanisms by which caregiving-related stress leads to adverse health outcomes. The proposed study will address this question in 225 older caregivers to hip fracture patients; this group has received little attention, but is ideal for studying the effects of acute and chronic caregiving stress and cessation of caregiving since hip fracture is an acute event, and 50% of the patients recover within a year of their fracture. We will evaluate the biological processes that may link caregiving stress to the development of metabolic syndrome, and subsequent decline in functional and cognitive status. The results will advance research on the physiological and health effects of caregiving, and have implications for designing interventions for caregivers to persons with hip fracture or other conditions.