Daily Stress, Health and Well-Being of Family Caregivers

描述（由申请人提供）：已发现照顾痴呆症（PWD）患者与健康和幸福的各种负面变化有关。然而，大部分研究都是相关的，在一两个时间点收集的数据可能会模糊事件的顺序，从而模糊压力源可能影响健康的潜在机制。新的设计方法，使用密集的重复测量的个人提供了澄清的事件序列的压力，健康指标和福祉的潜力，并建立更精确的短期健康影响的具体日常经验，拟议的研究将收集每日日记数据超过9天的时间内对日常压力，日常情绪和健康症状以及三个关键生物标志物的日常测量，以证明压力和健康之间的联系，以及这种关系的可能介质。与之前的日常日记研究相比，暴露于压力源的范围有限，我们将利用自然发生的实验，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的日子的压力反应。我们小组之前的工作发现，与非ADS日相比，护理人员在使用ADS的日子里接触护理相关压力源的几率降低了66%。与经典的A-B-A研究设计相比，这种方法将使我们能够在高压力和低压力条件下研究压力源的即时和延迟效应。样本将是目前正在使用ADS的PWD的180名家庭照顾者。参与者将在连续9天的时间内接受评估，包括他们的亲属使用ADS（低压力日）和他们的亲属不使用ADS（高压力日）。日常措施包括护理相关和非护理压力，主观痛苦和健康症状。将从每天计划时间提供的唾液样本中获得生物标志物。将获得对健康有影响的3种关键生物标志物的测定：皮质醇、α淀粉酶和硫酸脱氢表雄酮（DHEA-S）。研究结果将阐明日常压力源、幸福感和健康生物标志物之间的关系，并提出压力源可能影响健康的途径。当接触压力源减少时，压力反应降低的发现也将产生关于护理服务如何减少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.