CAREGIVER MENTAL HEALTH AND AD PATIENT OUTCOMES

阿尔茨海默病(AD)的特点是进行性认知和 行为障碍。随着时间的推移，患者的护理能力会下降 他/她，变得更加局限于家庭和心理社会 照顾者(通常是配偶)的环境。因此，病人的 功能可能越来越多地反映出他或她的配偶的功能 护理员。相反，老年人认知和行为能力的下降 患者可能会增加照顾者的负担。这很恶毒 周期可能会导致患者衰退，超过这一点是由于神经元退化。 目前，我们对最初的患者照顾者是如何 动态会影响长期结果。在我们的进度报告中，我们使用 理论困境模型来考察这些问题。我们证明了 照顾者风险(个性、健康、痛苦)和资源(应对、社会 支持)基线上的变量预测随后的照顾者负担， 患者日常生活活动能力(ADL)和养老院安置。 拟议的研究将通过采访我们的幸存者来扩展这项工作 在接下来的3年里，两对夫妇(相隔15-18个月)结婚。虽然71岁 情侣们现在可以进行后续跟进，我们的力量估计是 从这一数字向下评估，因为预计 现在和预期的开工日期。将检验三个假设：1) 在基线水平上最容易受到痛苦影响的照顾者将报告 2)AD患者与照顾者生活在一起，他们是 最容易受到痛苦和拥有最少基线资源的人，将 在随访时ADL水平最低；3)照顾者 在基线上易受痛苦的人，随着时间的推移，会承认他们的AD配偶 进入养老院的比率高于不那么脆弱的照顾者 变得很痛苦。在每项分析中，我们将控制患者的ADL水平和 照顾者在基线上的负担。 这项研究的结果应该对公共政策和 对AD患者照顾者的干预。

Alzheimer's Disease (AD) is characterized by progressive cognitive and behavioral impairment. Over time, the patient is less able to care for him/herself, becoming more restricted to the home and the psychosocial environment of the caregiver (usually a spouse). As such, the patient's functioning may increasingly reflect the functioning of his or her spouse caregiver. Conversely, increased cognitive and behavioral decline in the patient may result in increased burden in the caregiver. This vicious cycle may lead to patient decline beyond that due to neuronal degeneration. At present, we know relatively little about how initial patient-caregiver dynamics affect long term outcomes. In our progress report we use a theoretical distress model to examine these issues. We demonstrate that caregiver risk (personality, health, distress) and resource (coping, social supports) variables at baseline predict subsequent caregiver burden, patient activities of daily living (ADLs), and nursing home placement. The proposed study will extend this work by interviewing our surviving couples twice (15-18 months apart) over the next 3 years. Although 71 couples are now available for follow-up, our power estimates have been evaluated downward from this figure because of expected attrition between now and the anticipated start date. Three hypotheses will be tested: 1) Caregivers who are most vulnerable to distress at baseline will report the most burden at follow-up; 2) AD patients living with caregivers who are the most vulnerable to distress and have the fewest resources at baseline, will have the lowest ADL levels at follow-up; 3) Caregivers who are more vulnerable to distress at baseline will, over time, admit their AD spouses into nursing homes at a higher rate than caregivers who are less vulnerable to distress. In each analysis, we will control for patient ADL levels and caregiver burden at baseline. Results of this research should have implications for public policy and intervention with caregivers of AD patients.