Daily Stress, Health and Well-Being of Family Caregivers

描述(由申请人提供)：照顾痴呆症患者(PWD)被发现与健康和福祉的各种负面变化有关。然而，这项研究的大部分都是相关的，数据收集在一个或两个时间点，这可能会模糊事件的顺序，从而模糊应激源可能影响健康的潜在机制。对个体进行密集重复测量的新设计方法提供了澄清从压力源到健康标记物和幸福感的事件顺序并更准确地确定具体日常经历对健康的短期影响的可能性。拟议的研究将收集9天内关于日常压力源、日常情绪和健康症状以及三个关键生物标记物的日常测量的每日日记数据，以展示压力与健康之间的联系，以及这种关系的可能中介因素。与之前的每日日记研究不同，在日常日记研究中，暴露于压力源的范围是有限的，我们将利用一个自然发生的实验，通过比较使用成人日间服务(ADS)的照顾者在使用ADS的日子和不使用ADS的日子的亲属的压力反应。我们小组之前的工作发现，与不使用广告的日子相比，照顾者在使用广告的日子里接触到的与护理相关的压力源减少了66%。与经典的A-B-A研究设计相比，这种方法将使我们能够检查在高压力和低压力条件下应激源的即时和延迟影响。样本将是目前正在使用ADS的180名残疾患者的家庭照顾者。参与者将接受连续9天的评估，包括他们的亲属何时使用ADS(低压力日)和何时他们的亲属不使用ADS(高压力日)。日常测量包括护理相关和非护理应激源、主观痛苦和健康症状。生物标志物将从每天预定时间提供的唾液样本中获得。将获得对健康有影响的三个关键生物标志物的分析：皮质醇、α-淀粉酶和脱氢表雄酮-硫酸酯(脱氢表雄酮-S)。这项研究的结果将澄清日常压力源、幸福感和健康生物标记物之间的关系，并提出护理压力源可能影响健康的途径。这一发现表明，当暴露在压力源下时，压力反应会更低，这一发现也将提供有关照顾者服务如何降低健康风险的实用信息。

DESCRIPTION (provided by applicant): Caring for a person with dementia (PWD) has been found to be associated with a variety of negative changes in health and well-being. Much of this research, however, has been correlational, with data gathered at one or two points in time, which can blur the sequence of events and thus the underlying mechanism by which stressors may affect health. New design approaches that use intensive repeated measurement of individuals offer the potential for clarifying the sequence of events from stressors to health markers and well-being and to establish more precisely the short-term health effects of concrete daily experiences The proposed study will collect daily diary data over a 9-day period on daily stressors, daily mood and health symptoms and daily measures of three critical biomarkers to demonstrate the links between stress and health, as well as possible mediators of that relationship. In contrast to prior daily diary studies, where the range of exposure to stressors is limited, we will take advantage of a naturally-occurring experiment by comparing the stress responses of caregivers using Adult Day Services (ADS) for their relative on days they use ADS and days they do not. Prior work by our group found that caregivers experienced a 66 percent reduction in exposure to care-related stressors on days they used ADS compared to non-ADS days. Comparable to the classic A-B-A research design, this approach will enable us to examine immediate as well as delayed effects of stressors under high and low stress conditions. The sample will be 180 family caregivers of a PWD who is currently using ADS. Participants will be assessed over a period of 9 consecutive days, including when their relative uses ADS (low stress days) and when their relative does not (high stress days). Daily measures include care-related and non-care stressors, subjective distress and health symptoms. Biomarkers will be obtained from saliva samples provided at scheduled times during each day. Assays will be obtained for 3 key biomarkers with implications for health: cortisol, alphaamylase and dehydroepiandrosterone- sulfate (DHEA-S). The results of the study will clarify the relation among daily stressors, well- being and biomarkers of health, and suggest the pathways by which caregiving stressors might affect health. The finding that stress responses are lower when exposure to stressors is reduced would also yield practical information on how caregiver services could reduce health risks.