Addressing the double jeopardy of stress and hypertension among African American female caregivers of persons living with Alzheimer's disease and related dementias

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PROJECT SUMMARY No demographic group is more at risk for the double jeopardy of caregiving stress and hypertension than African American women caring for a family member with Alzheimer’s disease and related dementias (ADRD). Both situations lead to reduced quality of life and cardiovascular disease—a complication of uncontrolled hypertension.1 Maintaining the health of these caregivers is critical to support the well-being of the care recipients. Although some multi-component interventions have addressed ADRD caregiver's stress and quality of life, 2,3 gaps remain in targeting interventions to address the complexity of chronic caregiving stress and hypertension self-care in African American women. This pilot study builds on our earlier work which showed that stress, blood pressure knowledge, and complex diet information deficits all interfered with older African American women’s hypertension self-care.4-7 Lifestyle changes (stress management, reducing sodium, eating fruits/vegetables, and physical activity) are effective in managing hypertension. Our Stage I pilot study is based on the scientific rationale that we can promote these lifestyle changes by addressing stress reactivity/stress resilience, the psychological and physiological response of the body to stress, as the underlying mechanism to facilitate behavioral change. In this way we can improve health outcomes (caregiver stress, quality of life, cardiovascular disease risk). A small-scale two-group randomized controlled (RCT) pilot study of 28 African American female caregivers, age 40 and older with hypertension, will be conducted. We will determine the feasibility and acceptability of Mindfulness in Motion (MIM) plus the Dietary Approaches to Stop Hypertension (DASH).8 Participants will be randomized to either the MIM DASH7 intervention or the Alzheimer’s Association Caregiver Training (attention control) in 8 weekly, 1-hour group sessions via telehealth (video and telephone access). After completion of the intervention, both groups will receive four bi-monthly follow-up calls over the 12 months. To our knowledge, this is the first study that a) systematically employs one of the Science of Behavioral Change key mechanisms underlying successful adoption of health behaviors—stress reactivity/stress resilience9 and b) focuses solely on African American female caregivers of people living with dementia. The aims are: a) determine the feasibility and acceptability of MIM DASH and Caregiver Training for African American female caregivers with hypertension; b) explore the impact of MIM DASH as compared to Caregiving Training on caregiver stress and quality of life; quality of life; and c) investigate the potential mediation effects of stress reactivity/stress resilience between MIM DASH or Caregiver Training and self-care behaviors. This pilot will make a substantive contribution to the science of behavior change by identifying basic mechanisms, in the adoption of healthy behaviors that can be used to implement self-care interventions to reduce health disparities in African Americans. Study findings will inform the infrastructure for a larger trial.