Health Decline in Aged Caregivers: Epidemiologic Study

描述（由申请人提供）：压力过程模型预测照顾者应该比非照顾者有更高的健康下降率，因为他们的压力水平更高。然而，最近的研究发现，老年照顾者的死亡率、虚弱率、身体和认知功能比非照顾者低。拟议的研究将探讨这些更好的健康结果的四种可能机制：炎症负担作为心理-神经免疫机制；健康照顾者假说，作为老年人成为照顾者并继续照顾的基本健康优势；积极影响是一种普遍的心理保护作用；以及从看护中获得的个人收益作为一种特定的看护机制。该修订提案是对care -SOF的竞争性更新，该研究是对骨质疏松性骨折研究（SOF）的辅助研究，这是一项针对老年妇女的多地点队列研究。护理人员-护理人员样本包括1069名护理人员参与者：375名护理人员和694名非护理人员在护理地点、年龄、种族和邮政编码上相匹配。自1999年以来，通过5次以家庭为基础的访谈（3次年度访谈和2次间隔18个月的访谈）对护理者- sof参与者进行了跟踪，包括关于护理和护理者状态转变、感知压力、身心健康状况的标准化问题；身体功能（定时行走、握力、椅架）和认知功能（手指替代测试和霍普金斯语言学习测试）的基于表现的测量。拟议的研究将与SOF联系起来，以更新死亡率数据，检验健康护理者假说，并使用SOF 8和9次访问的储存血清进行3种炎症标志物（白细胞介素-6，IL-6， c反应蛋白，CRP和肿瘤坏死因子- α， TNF-1）的检测。我们将使用混合纵向模型和Cox比例风险模型在所有参与者和仅在护理人员中检验四个假设。H1)较高的炎症负担（IL-6、CRP和TNF- 1水平的综合评分）将介导护理（包括高压力照顾者亚组（如痴呆照顾者））与不良健康结果（即死亡率、身体功能下降、认知功能下降）之间的关联。H2)在护理者-护理者研究的两次筛查访谈中都是护理者，或在第二次筛查访谈中成为护理者的护理者，其健康状况比非护理者或停止护理者更好，健康下降更少。H3)积极情绪高的被调查者的不良健康结局比其他被调查者少（基于CES-D量表的积极情绪分量表）；积极情绪高的照顾者更有可能继续照顾和适应停止照顾。H4)从照护中获得更多个人收益的照护者更有可能继续照护，炎症负担更低，不良健康结果更少。这项研究将为护理与健康衰退之间的关系提供重要的见解，并将指导干预措施，以促进老年护理者的身体和认知健康。

DESCRIPTION (provided by applicant): The Stress Process Model predicts that caregivers should have higher rates of health decline than non-caregivers because of their higher stress levels. However, recent studies have found lower rates of mortality, frailty, and physical and cognitive functioning in older caregivers than non-caregivers. The proposed study will investigate four possible mechanisms for these better health outcomes: inflammatory burden as a psycho-neuroimmunological mechanism; the Healthy Caregiver Hypothesis, as a basic health advantage in older adults who become caregivers and continue caregiving; positive affect as a general psychological protective effect; and personal gain from caregiving as a caregiving-specific mechanism. This revised proposal is a competitive renewal of Caregiver-SOF, which is an ancillary study to the Study of Osteoporotic Fractures (SOF), a multi-site cohort study of elderly women. The Caregiver-SOF sample includes 1069 SOF participants: 375 caregivers and 694 non-caregivers matched on SOF site, age, race, and zip code. Caregiver-SOF participants have been followed since 1999 through 5 home-based interviews (3 annual interviews followed by 2 at 18-month intervals) that included standardized questions on caregiving and caregiver status transitions, perceived stress, physical and psychological health status; performance- based measures of physical functioning (timed walk, grip strength, chair stands) and cognitive functioning (Digit Substitution Test and Hopkins Verbal Learning Test). The proposed study will link to SOF to update mortality data, test the Healthy Caregiver Hypothesis, and use stored serum from SOF visits 8 and 9 for assays on 3 inflammatory markers (Interleukin-6, IL-6; C-reactive protein, CRP; and Tumor Necrosis Factor- alpha, TNF-1). We will use mixed longitudinal models and Cox proportional hazards models to test four hypotheses in all participants and in caregivers only. H1) Higher inflammatory burden (a summary score of IL-6, CRP, and TNF- 1 levels) will mediate associations between caregiving, including high-stress caregiver subgroups (e.g., dementia caregivers), and adverse health outcomes (i.e., mortality, decline in physical functioning, cognitive functioning). H2) SOF participants who were caregivers at both screening interviews for the Caregiver-SOF study, or who became caregivers at the second screening interview, will have better health status and less health decline than those who remained as non-caregivers or stopped caregiving. H3) Respondents with high positive affect, based on the positive affect subscale of the CES-D scale, will have less adverse health outcomes than other respondents; caregivers with high positive affect will be more likely to continue caregiving and adapt to cessation of caregiving. H4) Caregivers with more personal gain from caregiving will be more likely to continue caregiving, have lower inflammatory burden, and fewer adverse health outcomes. This study will provide important insights into associations between caregiving and health decline and will guide interventions to promote physical and cognitive health in older caregivers.