Biological Pathways of Acute and Chronic Stress in Aged Hip Fracture Caregivers

项目摘要： 众所周知，急性和慢性压力对身体和认知都有不利影响。 功能，但护理相关的压力影响这些结果的机制 目前仍不清楚。这项拟议的研究将评估可能与急性呼吸道感染有关的生物过程。 以及长期照顾，给功能和认知结果带来压力。它检验了这样一种理论 应激破坏多种相互关联的动态平衡系统(HPA轴、神经内分泌和 (免疫系统)，这可能导致代谢综合征和随后的健康下降。这个 样本将包括225名老年非正式照顾者到老年髋部骨折患者，从8名 巴尔的摩地区医院(为巴尔的摩髋关节患者提供108名新的和持续的护理人员 研究，BHS-7；以及117名来自这些医院的女性患者的新护理人员和继续护理人员 他们没有被招募到BHS-7研究中)。照顾者将由患者在 出院，以便最大限度地增加新照顾者的数量，并获得基线数据 在极度紧张的时候。每年四(4)次以家庭为基础的访谈将由 训练有素的护士面试官。在每次采访中，血压，人格化测量，和 将获得生物标志物(24小时尿中儿茶酚胺和皮质醇，血清中儿茶酚胺和皮质醇 Dheas、促炎和抗炎标记物、葡萄糖、胆固醇)。血液将被储存起来以供 未来的分析。访谈数据包括与照料相关的压力源、身体健康和 活动、抑郁症状和其他潜在的混杂因素和效果修饰物。功能性 状态将基于步行速度、椅子支架和自我报告的ADL/IADL。认知 测量包括执行功能、速度/注意力、工作记忆和 类别流畅度。假设将解决：1)从照顾压力到 生理变化、代谢综合征、功能和认知障碍；2) 急性和慢性照护压力以及因以下原因而终止照护的影响的比较 患者的康复；以及3)修饰者(即社会支持和护理)的机制 因素)影响这些途径。混合效应模型将被用来检验时间 从照顾者的压力到生物变化，再到功能和认知结果， 以及随时间变化的协变量(即停止照看)的影响。结果将会进步 急、慢性照护应激对生理健康影响的研究 对成年髋部骨折或其他疾病的照顾者进行干预的意义。项目说明： 照顾者承受着很高的压力，但对其生理功能知之甚少。 护理相关压力导致不良健康后果的机制。这个 拟议的研究将在225名老年照顾者到髋部骨折患者中解决这个问题；这 该小组很少受到关注，但却是研究急性和慢性疾病影响的理想方法。 由于髋部骨折，护理压力和停止护理是一种急性事件，50%的 患者在骨折后一年内就会康复。我们将对生物过程进行评估 这可能会将照顾压力与代谢综合征的发展联系起来，并随后 功能和认知状态下降。这一结果将推动对生物多样性的研究 护理的生理和健康影响，并对设计干预措施有影响 为髋部骨折或其他疾病的照顾者提供服务。

Project abstract: It is known that acute and chronic stress have adverse effects on physical and cognitive functioning, but the mechanisms by which caregiving-related stress affects these outcomes remain unclear. The proposed study will evaluate the biological processes that may link acute and chronic caregiving stress to functional and cognitive outcomes. It tests the theory that stress disrupts multiple, interrelated homeostatic systems (HPA axis, neuroendocrine, and immune systems), which may lead to metabolic syndrome and subsequent health decline. The sample will include 225 older informal caregivers to elderly hip fracture patients recruited from 8 Baltimore area hospitals (108 new and continuing caregivers to patients in the Baltimore Hip Studies, BHS-7; and 117 new and continuing caregivers to female patients from these hospitals who were not recruited to the BHS-7 study). Caregivers will be identified by patients prior to discharge in order to maximize the number of new caregivers, and to obtain baseline data during a time of acute stress. Four (4) annual home-based interviews will be conducted by trained nurse interviewers. At each interview, blood pressure, anthropomorphic measures, and biological markers will be obtained (24-hour urine for catecholamines and cortisol, serum for DHEAS, pro- and anti-inflammatory markers, glucose, cholesterol). Blood will be stored for future analyses. Interview data include caregiving-related stressors, physical health and activity, depressive symptoms, and other potential confounders and effect modifiers. Functional status will be based on walking speed, chair stands and self-reported ADLs/IADLs. Cognitive measures include tests of executive functioning, speed/attention, working memory, and category fluency. Hypotheses will address: 1) sequential pathways from caregiving stress, to physiological changes, metabolic syndrome, and functional and cognitive outomes; 2) comparisons of the effects of acute and chronic caregiving stress, and end of caregiving due to the patient's recovery; and 3) mechanisms by which modifiers (ie, social support caregiving factors) affect these pathways. Mixed effects models will be used to examine the temporal associations from caregiver stress to biological changes, to functional and cognitive outcomes, and the effects of time-varying covariates (i.e., cessation of caregiving). Results will advance research on physiological and health effects of acute and chronic caregiving stress, and have implications for interventions for caregivers to adults with hip fracture or other conditions. Project Narrative: Caregivers experience high rates of stress, but little is known about the physiological mechanisms by which caregiving-related stress leads to adverse health outcomes. The proposed study will address this question in 225 older caregivers to hip fracture patients; this group has received little attention, but is ideal for studying the effects of acute and chronic caregiving stress and cessation of caregiving since hip fracture is an acute event, and 50% of the patients recover within a year of their fracture. We will evaluate the biological processes that may link caregiving stress to the development of metabolic syndrome, and subsequent decline in functional and cognitive status. The results will advance research on the physiological and health effects of caregiving, and have implications for designing interventions for caregivers to persons with hip fracture or other conditions.