CAREGIVER MENTAL HEALTH AND AD PATIENT OUTCOMES

阿尔茨海默病（AD）的特征在于进行性认知和 行为障碍 随着时间的推移，病人越来越不能照顾 他/她自己，变得更加局限于家庭和社会心理 照顾者的环境（通常是配偶）。 因此，患者的 功能可能越来越反映他或她的配偶的功能 照顾者 相反地，增加的认知和行为下降， 患者可能会导致护理人员的负担增加。 这种恶性 周期可能导致患者衰退超出由于神经元变性。 目前，我们对最初的病人照顾者如何了解相对较少 动态影响长期结果。 在我们的进度报告中， 理论困境模型来研究这些问题。 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）变量在基线预测随后的照顾者负担， 患者日常生活活动（ADL）和疗养院安置。 这项拟议中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）。 虽然71 夫妇现在可以进行随访，我们的功率估计已经 由于预期的人员流失， 现在和预计的开始日期。 将检验三个假设：1） 在基线时最容易受到痛苦影响的护理人员将报告 随访时负担最重; 2）AD患者与照顾者生活在一起， 最容易受到困扰，并且在基线上拥有最少的资源， 随访时ADL水平最低; 3）照顾者更多 随着时间的推移，在基线时容易受到困扰的人会承认他们的AD配偶 进入疗养院的比率高于那些不那么脆弱的照顾者 苦恼。 在每次分析中，我们将控制患者ADL水平， 基线时的照顾者负担。 这项研究的结果应该对公共政策和 对AD患者的照顾者进行干预。

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.