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

老年髋部骨折护理人员急性和慢性应激的生物途径

• 批准号: 7835534
• 负责人: Lisa Fredman
• 金额: $ 62.5万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2013-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7835534
• 关键词: Acute; Address; Adult; Adverse effects; Affect; Alzheimer' s Disease; Anti-Inflammatory Agents; Anti-inflammatory; Area; Attention; Baltimore; Biological; Biological Markers; Biological Markers; Biological Process; Blood; Blood Pressure; Caregiver Burden; Caregivers; Caring; Catecholamines; Categories; Cessation of life; Cholesterol; Chronic; Chronic stress; Cognitive; Communities; Data; Development; Disease; Elderly; Epidemiologic Studies; Epinephrine; Event; Female; Fracture; Future; Glucose; Health; Hip Fractures; Hip region structure; Home environment; Hospitalization; Hospitals; Hour; Hydrocortisone; Immune; Immune system; Impaired cognition; Impairment; Incidence; Inorganic Sulfates; Interleukin-6; Intervention; Interview; Interviewer; Lead; Link; Measures; Mental Depression; Mental Health; Metabolic syndrome; Modeling; Morbidity - disease rate; Neurosecretory Systems; Norepinephrine; Nurses; Outcome; Pathway interactions; Patient Self-Report; Patients; Performance; Persons; Physical Function; Physical activity; Physiological; Physiological Processes; Process; Prospective Studies; Recovery; Recruitment Activity; Research; Respondent; Risk Factors; Role; Sampling; Serum; Short-Term Memory; Social Network; Social support; Speed; Stress; Stress Fractures; Supervision; System; Testing; Theoretical model; Time; Training; Tumor Necrosis Factor-alpha; Unspecified or Sulfate Ion Sulfates; Urine; Walking; acute stress; aged; base; caregiving; cognitive function; cohort; depressive symptoms; executive function; experience; functional status; improved; inflammatory marker; mortality; physical conditioning; psychosocial; public health relevance; stressor; theories; therapy design

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.

描述（由申请人提供）： 众所周知，急性和慢性压力会对身体和认知功能产生不利影响，但护理相关压力影响这些结果的机制仍不清楚。拟议的研究将评估可能将急性和慢性护理压力与功能和认知结果联系起来的生物过程。它检验了这样的理论：压力会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），从而可能导致代谢综合征和随后的健康状况下降。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（巴尔的摩髋关节研究 BHS-7 中的 108 名新的和继续的患者护理人员；以及来自这些医院的未招募到 BHS-7 研究的 117 名女性患者的新的和继续的护理人员）。患者在出院前将确定护理人员，以便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。受过培训的护士访谈员将进行四 (4) 次年度家庭访谈。每次访谈时，都会获得血压、拟人化测量值和生物标记物（24 小时尿液中的儿茶酚胺和皮质醇、血清中的 DHEAS、促炎和抗炎标记物、葡萄糖、胆固醇）。血液将被储存以供将来分析。访谈数据包括与护理相关的压力源、身体健康和活动、抑郁症状以及其他潜在的混杂因素和效应调节剂。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测试。假设将解决：1）从护理压力到生理变化、代谢综合征以及功能和认知结果的顺序途径； 2) 急性和慢性护理压力的影响比较，以及因患者康复而结束护理的情况； 3）调节因素（即社会支持照顾因素）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，以及时变协变量的影响（即停止护理）。结果将推进对急性和慢性护理压力的生理和健康影响的研究，并对患有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 护理人员承受着很高的压力，但人​​们对护理相关压力导致不良健康结果的生理机制知之甚少。拟议的研究将针对 225 名髋部骨折患者的老年护理人员来解决这个问题；该组很少受到关注，但非常适合研究急性和慢性护理压力以及停止护理的影响，因为髋部骨折是一种急性事件，50% 的患者在骨折后一年内康复。我们将评估可能将护理压力与代谢综合征的发展以及随后的功能和认知状态下降联系起来的生物过程。研究结果将推进关于护理对生理和健康影响的研究，并对为髋部骨折或其他疾病患者设计护理干预措施具有重要意义。