Intra-Individual Dynamics of Stress and Health Among Informal Dementia Caregivers

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PROJECT SUMMARY The essential and costly care provided by informal caregivers to persons with Alzheimer’s disease and related dementias (PWDs) continues to increase, often to the detriment of the informal caregiver’s physical and mental health. A major obstacle to developing new therapies and tools to support informal caregivers is the lack of objectively-measured evidence for which specific stressors are most important to target, and under what conditions. Addressing this critical unmet need, through the proposed research and mentored training of the applicant, is the overall goal of this project. The Life Laboratory Home Assessment Platform (Life Lab) is a paradigm shift toward studying the behaviors and patterns of change among individuals using objective, ecologically-valid measurement in real time (pervasive computing, sensors, and other technologies within participants own homes). The Life Lab is part of the Oregon Center for Aging and Technology, both under the direction of Dr. Kaye (proposed primary mentor), who is currently deploying the platform in homes of older adults, a portion of whom have early-stage dementia. The scientific goals of this proposal are to isolate specific, objectively-measured stressors; model the intra-individual dynamics between objective stressors and subjective burden (i.e. volatility of stress exposure and reactivity) along the trajectory of caring for a PWD; and determine the impact of these dynamics upon the physical and mental health of informal caregivers, and the success of aging in place among PWDs. Intensive longitudinal data (daily and weekly assessments for up to 18 months) from 120 informal caregivers of PWDs from Life Lab projects will be used to characterize the intensity and volatility of individual caregivers’ exposure to objectively-measured daily stressors, and the intra-individual dynamics between stress and burden. Additional data on the physical and mental health of informal caregivers will also be collected and analyzed as a part of this ancillary study. The applicant will gain a new set of skills in order to conduct the proposed study and prepare for an independent research career by training in: (1) Life Lab design and technologies; (2) methods for analyzing intensive longitudinal data and intra-individual variability; (3) identifying digital biomarkers of caregiver stress that will be relevant for use in a technological intervention. The proposed team of mentors and consultant each provide expertise in one or more of these areas and are together committed to collaboratively facilitating the candidate’s training. The detailed training plan includes multi-modal learning (e.g. research immersions, one-on-one analytic training, formal coursework and seminars, and national scientific meetings). The candidate will apply these new skills to the proposed research project and obtain R21/R01 support in order to detect informal dementia caregivers’ stress through digital biomarkers and create just-in-time therapies accordingly. These findings are likely to lead to improved methods for detecting and responding to informal caregivers’ stress and burden; and, ultimately help protect informal caregivers’ physical and mental health while improving dementia care in the home.