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Individual differences in dementia spousal caregiver burden: A biobehavioral approach

痴呆症配偶照顾者负担的个体差异：生物行为方法

基本信息

批准号：
10617191
负责人：
Christopher Paul Fagundes
金额：
$ 74.57万
依托单位：
RICE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-06-15 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10617191
关键词：
Adult Affect Aging Alzheimer&apos s Disease Alzheimer&apos s disease care Alzheimer&apos s disease patient Alzheimer&apos s disease risk Anxiety Bereavement Biological Markers Blood Caregiver Burden Caregiver well-being Caregivers Characteristics Chronic stress Coping Skills Couples Data Dementia Disease Emotional Evidence based treatment Exhibits Feeling Glucocorticoid Receptor Grief reaction Health Immune Individual Differences Inflammation Inflammatory Intervention Interview Knowledge Marital Relationships Mental Health Modeling Morbidity - disease rate Outcome Pattern Personality Character Persons Quality of life Reporting Research Research Design Research Personnel Resistance Risk Scientist Spouse Caregiver Spouses Stress Stressful Event Symptoms Work age related anxious biobehavior biological adaptation to stress care giving burden caregiving coping cytokine dementia caregiving depressive symptoms desensitization emotion regulation experience heart rate variability member mortality physical conditioning prospective psychosocial theories treatment planning

项目摘要

Project Summary/ Abstract Caregiving for a spouse with Alzheimer’s Disease (AD) is one of the most stressful experiences a person can encounter. Among married couples when one member of the dyad has AD, the disease is often described as a relational illness because every aspect of the disease necessarily involves the spouse. Poor quality of life (QOL) and caregiver burden characterize a significant proportion of AD spousal caregivers. AD spousal caregivers also experience living bereavement as they experience profound feeling of grief analogous to what one experiences when a spouse dies. The chronic stress of spousal AD caregiving magnifies age- related changes in proinflammatory cytokines, an important predictor of morbidity and mortality. Mechanistically, chronic stress promotes desensitization of glucocorticoid receptors promoting glucocorticoid receptor resistance (GCR), which allows for elevated inflammation. Of course, not all AD spousal caregivers are at the same level of risk. However, research attempting to identify which AD spousal caregivers are at greatest risk is remarkably sparse. Out of the 173 studies examining the biological markers of physical health in relation to AD spousal caregivers, there is no work, to our knowledge, that examines how relationship and/or personality characteristics affect biological markers of physical health. Determining stable individual difference characteristics is critical to developing evidence-based treatments. Attachment theory is a useful framework for understanding individual differences in close relationships as well as how people cope with stressful life events. There are two patterns of attachment insecurity: attachment anxiety and attachment avoidance. People with high attachment anxiety use "hyperactivating" emotional coping strategies that accentuate the stress response. People with high attachment avoidance are uncomfortable depending on others and use "deactivating" coping strategies in an attempt to inhibit stress. This investigatory team demonstrated that compared with bereaved adults with low attachment anxiety, recently bereaved adults with higher attachment anxiety experienced more grief, more depressive symptoms, and elevated inflammation. Those who reported more grief had elevated levels of inflammation compared with those who reported less grief. Likewise, those who reported poorer QOL had higher levels of inflammation than those who reported better QOL. Our pilot work in AD spousal caregivers echoes these findings. We have also demonstrated that the association between attachment avoidance and health outcomes is moderated by high heart rate variability (HF-HRV), an important marker of aging, and emotion regulation (HF-HRV). We build upon our findings in bereaved adults to advance our understanding of which AD spousal caregivers are most vulnerable to the deleterious physical health effects of spousal dementia caregiving as they navigate the experience of living bereavement, while coping with the burden of caregiving and trying to maintain QOL. As an exploratory aim, we will examine how these individual differences in attachment orientation affect both members of the marital relationship.

项目摘要/摘要照顾患有阿尔茨海默病(AD)的配偶是最有压力的经历之一人可以相遇。在已婚夫妇中，当二人之一患有阿尔茨海默病时，这种疾病通常是被描述为一种关系疾病，因为这种疾病的每一个方面都必然涉及配偶。穷生活质量(QOL)和照顾者负担是AD配偶照顾者的相当大比例的特征。广告配偶照顾者也经历生活中的丧亲之痛，因为他们经历了类似的深刻悲痛一个人在配偶去世时的经历。配偶照顾AD的长期压力放大了年龄-- 促炎细胞因子的相关变化，这是发病率和死亡率的重要预测因素。从机制上讲，慢性应激促进促进糖皮质激素受体的脱敏受体抵抗(GCR)，这允许增加炎症。当然，并不是所有的AD配偶照顾者都处于相同的风险水平。然而，试图确定哪些AD配偶照顾者的研究最大的风险是极其稀少。在173项检查身体健康的生物标记物的研究中关于AD的配偶照顾者，据我们所知，没有工作来审查关系和/或人格特征影响身体健康的生物标志物。确定稳定的个体差异特征对于开发循证治疗至关重要。依恋理论是一个有用的框架了解亲密关系中的个体差异以及人们如何应对紧张的生活事件。依恋不安全感有两种类型：依恋焦虑和依恋回避。人民对于高度依恋焦虑的患者，使用“过度激活”的情绪应对策略来突出压力。回应。高度依恋回避的人依赖他人和使用 “去激活”应对策略，试图抑制压力。这个调查小组证明了与依恋焦虑较低的丧亲成年人相比，最近丧亲的成年人依恋程度较高焦虑经历了更多的悲伤，更多的抑郁症状，以及更高的炎症。那些举报的人与报告较少悲伤的人相比，悲伤越多的人炎症水平越高。同样，那些报告生活质量较差的人比报告生活质量较好的人有更高的炎症水平。我们的飞行员对AD配偶照顾者的研究与这些发现相呼应。我们还证明了该协会依恋回避和健康结果之间的关系受到高心率变异性(HF-HRV)的调节，衰老和情绪调节的重要标志(HF-HRV)。我们根据对失去亲人的成年人的研究结果增进我们对哪些AD配偶照顾者最容易受到有害身体伤害的理解配偶痴呆症患者在经历丧亲之痛时照顾对健康的影响，而应对照顾的负担，并努力维持生活质量。作为一个探索性目标，我们将研究如何这些依恋取向的个体差异会影响婚姻关系的两个成员。