Attachment Behaviors in Parent Child Dyads Coping with Early Stage Alzheimer's Disease and Related Dementias

应对早期阿尔茨海默病和相关痴呆症的亲子二人组的依恋行为

• 批准号: 10064599
• 负责人: JOAN E. MONIN
• 金额: $ 76.36万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-15 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064599
• 关键词: Address; Adopted; Adult; Adult Children; Affect; Alzheimer' s Disease; Alzheimer' s disease related dementia; American; Behavior; Biological; Blood Pressure; Caregiver Burden; Caregivers; Caring; Characteristics; Child; Clinical; Code; Communication; Daughter; Dementia; Dementia caregivers; Elderly; Emotional; Empathy; Engineering; Equation; Face; Family; Family member; Feeling; Future; Health; Intervention; Interview; Investigation; Literature; Longevity; Longitudinal observational study; Measures; Mediating; Medicine; Mental Health; Methodology; Modeling; Monitor; Outcome; Parents; Patient Self-Report; Personal Communication; Personal Satisfaction; Persons; Process; Recommendation; Recording of previous events; Reporting; Research; Rest; Risk; Role; Safety; Security; Sex Differences; Son; Spouses; Stress; Structure; Testing; Time; United States National Academy of Sciences; United States National Institutes of Health; Videotape; Work; aged; base; care giving burden; care recipients; caregiver depression; caregiving; contextual factors; coping; dementia caregiving; follow-up; human old age (65+); indexing; innovation; instrumental activity of daily living; interest; member; multi-component intervention; perceived stress; physical conditioning; primary caregiver; stressor; theories; therapy design; tool

Roughly 4 million adult children provide unpaid care to their parents with Alzheimer's disease and related dementias (ADRD). Caring for a parent with ADRD can be stressful and negatively impact caregivers' health. While research on spousal caregiving dyads shows that emotionally supportive communication between spouses in the early stages of ADRD can protect caregivers' health, little is known about such interpersonal processes in parent-child dyads. This needs to be addressed because adult child caregivers and their parents face different interpersonal challenges (e.g., navigating a reversal of the parent-child role) than spousal dyads. We have shown in our spousal caregiving work that mutual emotional support behaviors, defined as caregivers and care-recipients providing and receiving communication of safety, feeling comfortable expressing vulnerability and empathy, and giving and receiving tangible aid, decrease caregiving burden and protect psychological health. Mutual emotional support behaviors are amenable to change, making them appropriate targets for interventions. Our research is informed by attachment theory, which stipulates that the need for emotional security is a fundamental need in the parent-child dyad across the lifespan, especially in times of crisis. Our overarching hypothesis is that mutual emotional support behaviors can protect the health of adult child caregivers and parents by reducing caregiver stress and negative coping strategies. We integrate our hypotheses about mutual support into an existing dyadic caregiving stress model that shows how caregiver and care-recipient characteristics, primary and secondary stressors, caregiver appraisals and coping all influence both dyad members' health and relational functioning. To test our innovative model, we propose a Stage 0 dyadic, longitudinal, and observational study of 200 dyads: older adults aged 60 and older with early stage ADRD and one primary adult child caregiver. Both dyad members will be interviewed, using valid and reliable self-report measures, and have videotaped discussions about dementia-related stressors at baseline and a one-year follow-up. Mutual emotional support behaviors will be measured with an observational coding system created by Co-I Feeney, and blood pressure will be monitored. Dyadic analysis will be performed with mixed models and structural equation modeling. Aim 1 will examine whether mutual emotional support behaviors are associated with lower caregiver demand appraisals, caregiver perceived stress, and caregiver negative coping longitudinally. Aim 2 will examine whether mutual emotional support behaviors protect both dyad members' health and relational functioning longitudinally and whether this is mediated by lower caregiver demand appraisals, caregiver perceived stress, and caregiver negative coping. Aim 3 will examine mutual emotional support behavior differences by sex as a biological variable and contextual factors (e.g., SES, caregiver depression, relationship history). This will lead to a Stage 1 application to create an attachment- based intervention tool to protect the health of parents with ADRD and their adult child primary caregivers.

大约有400万成年儿童为患有阿尔茨海默病和相关疾病的父母提供无偿护理。 痴呆症（ADRD）。照顾患有ADRD的父母可能会带来压力，并对照顾者的健康产生负面影响。 虽然对夫妻二人的研究表明， ADRD早期的配偶可以保护照顾者的健康，但对这种人际关系知之甚少。 在亲子二元体中的过程。这需要得到解决，因为成年儿童照顾者和他们的父母 面对不同的人际挑战（例如，引导父母-孩子角色的逆转）而不是配偶二人组。 我们已经在我们的配偶照顾工作中表明，相互的情感支持行为，定义为照顾者， 和照顾者提供和接受安全的通信，感觉舒适的表达 脆弱性和同情心，给予和接受有形的援助，减少生活负担， 心理健康相互的情感支持行为是可以改变的， 干预的目标。我们的研究受到依恋理论的启发，该理论认为， 情感安全是父母和孩子一生中的一个基本需求，特别是在 危机我们的总体假设是，相互的情感支持行为可以保护成年人的健康， 通过减少照顾者的压力和消极的应对策略，儿童照顾者和父母。我们整合我们的 关于相互支持的假设到现有的二元压力模型，显示照顾者如何 和照顾者的特点，主要和次要的压力源，照顾者的评价和应对所有 影响二分体成员的健康和关系功能。为了测试我们的创新模型，我们提出了一个 对200对患者进行的0期二联、纵向和观察性研究：60岁及以上的老年人， ADRD阶段和一名主要成年儿童照顾者。两个二元组成员将接受采访，使用有效的和 可靠的自我报告措施，并在基线时对痴呆相关压力源进行录像讨论 以及一年的随访。相互情感支持行为将通过观察编码进行测量 由Co-I Feeney创建的系统，血压将被监测。二元分析将使用 混合模型和结构方程模型。目标1将研究相互的情感支持是否 行为与较低的照顾者需求评估，照顾者感知的压力，和照顾者 纵向消极应对目标2将研究相互的情感支持行为是否能保护双方 二分体成员的健康和关系功能的纵向和这是否是介导的较低的照顾者 需求评估、照顾者知觉压力与照顾者消极因应。目标3将检查相互 作为生物变量的性别和环境因素的情感支持行为差异（例如，SES， 照顾者抑郁症，关系史）。这将导致第1阶段应用程序创建附件- 基于干预工具，以保护ADRD父母及其成年子女主要照顾者的健康。