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Health Decline in Aged Caregivers: Epidemiologic Study

老年护理人员的健康状况下降：流行病学研究

基本信息

批准号：
8676608
负责人：
Lisa Fredman
金额：
$ 34.72万
依托单位：
BOSTON UNIVERSITY MEDICAL CAMPUS
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-09-30 至 2018-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8676608
关键词：
Address Affect Age Ancillary Study Biological Assay Biological Markers C-reactive protein Caregiver Burden Caregivers Caring Chronic stress Code Cognitive Cohort Studies Comorbidity Constitution Coronary heart disease Cox Proportional Hazards Models Data Dementia Digit structure Elderly Elderly woman Epidemiologic Studies Friends Health Health Status Home environment Impaired cognition Impairment Individual Inflammation Inflammatory Interleukin-6 Intervention Interview Knowledge Link Measures Mediating Mediation Mental Health Meta-Analysis Modeling Mortality Decline Outcome Participant Performance Persons Physical Function Process Race Relative (related person)Reporting Respondent Risk Role Sampling Serum Site Stress Study of serum Subgroup TNF gene Testing Time Tumor Necrosis Factor-alpha Update Verbal Learning Visit Walking Woman aged base caregiving cognitive function cohort eligible participant frailty grasp inflammatory marker insight mortality older women osteoporosis with pathological fracture physical conditioning protective effect psychologic screening therapy design

项目摘要

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.

描述（由申请人提供）：压力过程模型预测，由于护理人员的压力水平较高，因此护理人员的健康下降率应高于非护理人员。然而，最近的研究发现，老年护理人员的死亡率、虚弱率以及身体和认知功能低于非护理人员。拟议的研究将调查这些更好的健康结果的四种可能机制：作为心理神经免疫机制的炎症负担；健康看护者假说，作为成为看护者并继续看护的老年人的基本健康优势；积极情感作为一般心理保护作用；以及作为特定护理机制的护理带来的个人收益。这项修订后的提案是 Caregiver-SOF 的竞争性更新，它是骨质疏松性骨折研究 (SOF) 的一项辅助研究，这是一项针对老年妇女的多中心队列研究。 Caregiver-SOF 样本包括 1069 名 SOF 参与者：375 名护理人员和 694 名非护理人员，在 SOF 网站、年龄、种族和邮政编码上进行匹配。自 1999 年以来，我们通过 5 次家庭访谈（每年 3 次，随后每 18 个月进行 2 次）对看护者-SOF 参与者进行跟踪，其中包括关于看护和看护者状态转变、感知压力、身体和心理健康状况的标准化问题；基于表现的身体功能（定时步行、握力、椅子站立）和认知功能（数字替换测试和霍普金斯言语学习测试）的测量。拟议的研究将与 SOF 联系起来更新死亡率数据，测试健康护理人员假设，并使用 SOF 第 8 次和第 9 次就诊时储存的血清来检测 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）。我们将使用混合纵向模型和 Cox 比例风险模型来测试所有参与者和仅护理人员的四个假设。 H1) 较高的炎症负担（IL-6、CRP 和 TNF-1 水平的总分）将介导护理（包括高压力护理者亚组（例如痴呆症护理者））与不良健康结果（即死亡率、身体功能下降、认知功能）之间的关联。 H2) 在看护者-SOF 研究的两次筛选访谈中担任看护者的 SOF 参与者，或者在第二次筛选访谈中成为看护者的 SOF 参与者，将比那些仍然作为非看护者或停止看护的人拥有更好的健康状况和更少的健康下降。 H3) 根据 CES-D 量表的积极影响子量表，具有高积极影响的受访者将比其他受访者遭受更少的不良健康结果；具有高积极影响的护理人员将更有可能继续护理并适应护理的停止。 H4) 从护理中获得更多个人收益的护理人员更有可能继续护理，炎症负担较低，不良健康结果也较少。这项研究将为了解护理与健康衰退之间的关联提供重要见解，并将指导促进老年护理人员身体和认知健康的干预措施。