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

项目摘要 非正式护理人员向阿尔茨海默病患者和相关的 失智症（残疾人）继续增加，往往损害非正式照顾者的身心健康。 健康开发新疗法和工具以支持非正式护理人员的一个主要障碍是缺乏 客观衡量的证据，具体的压力源是最重要的目标，在什么 条件通过拟议的研究和指导培训， 申请人，是本项目的总体目标。生命实验室家庭评估平台（Life Lab）是一个 范式转移到研究行为和个人之间的变化模式， 生态有效的测量在真实的时间（普适计算，传感器和其他技术， 参与者有自己的房子）。生命实验室是俄勒冈州老龄化和技术中心的一部分， Kaye博士（建议的主要导师）的指导，他目前正在老年人的家中部署该平台， 其中一部分患有早期痴呆症。这项提案的科学目标是分离出特定的， 客观测量的压力源;模拟客观压力源和主观压力源之间的个体内部动态 沿着照顾残疾人的轨迹的负担（即压力暴露和反应的波动性）;并确定 这些动态对非正式照顾者身心健康的影响，以及 在残疾人中老化。密集的纵向数据（长达18个月的每日和每周评估） 来自生命实验室项目的120名残疾人非正式护理人员的研究将用于表征 个体照顾者暴露于客观测量的日常压力源的波动性，以及个体内 压力和负担之间的关系。关于非正规照料者身心健康的补充数据 也将作为本辅助研究的一部分进行收集和分析。申请人将获得一套新的技能， 为了进行拟议的研究，并准备通过培训独立的研究生涯：（1）生命实验室 设计和技术;（2）分析密集纵向数据和个体内变异的方法;（3） 识别护理者压力的数字生物标志物，其将与在技术干预中使用相关。的 建议的导师和顾问团队各自提供一个或多个领域的专业知识， 致力于合作促进候选人的培训。详细的培训计划包括多模式 学习（例如研究沉浸，一对一的分析培训，正式的课程和研讨会，以及国家 科学会议）。候选人将把这些新技能应用于拟议的研究项目，并获得 R21/R 01支持，以便通过数字生物标志物检测非正式痴呆症护理人员的压力，并创建 及时治疗。这些发现可能会导致改进的检测方法， 应对非正式照顾者的压力和负担;并最终帮助保护非正式照顾者的身体健康 和心理健康，同时改善痴呆症护理在家里。

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.