Health decline in aged caregivers: epidemiologic study

描述（由申请人提供）：由于研究结果不一致和方法上的局限性，提供护理是否对护理者的身体和认知功能产生不良影响仍不确定，这些局限性包括：仅评估基线时的护理者状态-不包括随访期间护理者状态的变化;在单一随访时间评估健康结局;缺乏可用于直接测试与护理有关的压力和健康下降的生物心理社会模型的感知压力和生物标志物的措施。拟定的研究是护理员-SOF的竞争性更新，护理员-SOF是骨质疏松性骨折研究（SOF）的辅助研究，SOF是老年女性骨折和福尔斯风险的多中心研究。护理人员SOF样本有1069 SOF参与者（平均年龄=81岁），他们是非正式护理人员（n=375）和非护理人员（n=694），在SOF网站，年龄，种族和邮政编码上匹配。他们进行了三次年度家庭访谈，包括关于护理情况和护理者状态转换、感知压力、抑郁症状和自我报告的ADL和IADL的标准化问题;基于表现的身体功能测量（定时行走、握力、椅子站立）;速度/注意力的认知测试（数字替代测试）和言语记忆（霍普金斯言语学习测试）;以及测量体重。这项拟议的研究将增加两个家庭为基础的采访734幸存的照顾者SOF的参与者。经过培训的SOF面试官将重新管理以前管理的问卷以及身体和认知测量，总共有五个评估点。这些数据将与SOF关于死亡率和白细胞介素-6（IL-6）的数据（使用来自两个SOF研究中心同时进行的SOF检查的储存血清）相关联。将检验以下假设：1）比较护理人员和非护理人员，以及护理人员状态的转变，（即自我报告和基于表现的功能状态、体重变化和死亡率）和认知健康状态，使用重复测量和考克斯比例风险模型; 2）检查IL-6在从照顾和慢性压力到身体和认知健康下降的途径中作为介质的作用; 3）评估最近研究中观察到的配偶照顾者健康下降率较高的方法学原因; 4）使用增长曲线模型分析压力和健康结果变化的轨迹。这项研究将复制和扩展以往的研究结果，提供深入了解病因，生物学和方法学因素的护理压力与身体和认知健康结果的关联。研究结果将指导干预措施，以减少压力对老年照顾者和一般老年人身体和认知健康的影响。

DESCRIPTION (provided by applicant): Whether care giving has adverse effects on the caregiver's physical and cognitive functioning remains uncertain due to inconsistent research findings and methodological limitations that include: assessment of caregiver status at baseline only - not incorporating changes in caregiver status over the follow up period; evaluation of health outcomes at a single follow up time; and absence of measures of perceived stress and biological markers that would allow direct tests of bio-psychosocial models of care giving-related stress and health decline. The proposed study is a competitive renewal of Caregiver-SOF, which is an ancillary study to the Study of Osteoporotic Fractures (SOF), a multi-site study of the risk of fractures and falls in elderly women. The Caregiver-SOF sample has 1069 SOF participants (mean age=81 years) who were informal caregivers (n=375) and non-caregivers (n=694) matched on SOF site, age, race, and zip code. They have had three annual home-based interviews that included standardized questions on the care-giving situation and caregiver status transitions, perceived stress, depressive symptoms, and self-reported ADLs and lADLs; performance-based measures of physical functioning (timed walk, grip strength, chair stands); cognitive tests of speed/attention (Digit Substitution Test) and verbal memory (Hopkins Verbal Learning Test); and measured weight. This proposed study will add two home-based interviews with 734 surviving Caregiver-SOF participants. Trained SOF interviewers will re-administer the questionnaires and physical and cognitive measures that have been administered previously, for a total of five assessment points. These data will be linked to SOF data on mortality and lnterleukin-6 (IL-6) using stored serum from a concurrent SOF exam at two SOF sites. Hypotheses will be tested that 1) compare caregivers and non-caregivers, and transitions in caregiver status, on change in physical (namely, self-reported and performance-based functional status, weight change, and mortality) and cognitive health status using repeated measures and Cox proportional hazards modeling; 2) examine the role of IL-6 as a mediator in the pathway from care-giving and chronic stress to physical and cognitive health decline; 3) evaluate methodologic reasons for higher rates of health decline in spouse caregivers that have been observed in recent studies; and 4) use growth curve modeling to analyze trajectories of change in stress and health outcomes. This study will replicate and extend the results of previous studies by providing insight into etiologic, biological, and methodological factors in the associations of care-giving stress with physical and cognitive health outcomes. Study results will guide interventions to reduce effects of stress on physical and cognitive health in older caregivers, and older adults in general.