Health Decline in Aged Caregivers: Epidemiologic Study

描述（由申请人提供）：压力过程模型预测，照顾者的健康下降率应该高于非照顾者，因为他们的压力水平较高。然而，最近的研究发现，老年照顾者的死亡率，虚弱，身体和认知功能比非照顾者低。拟议的研究将调查这些更好的健康结果的四种可能机制：炎症负担作为一种心理-神经免疫学机制;健康照顾者假设，作为老年人成为照顾者并继续照顾的基本健康优势;积极影响作为一般的心理保护作用;从照顾中获得的个人收益作为一种特殊的机制。该修订提案是Caregiver-SOF的竞争性更新，这是骨质疏松性骨折研究（SOF）的辅助研究，这是一项针对老年女性的多中心队列研究。护理人员SOF样本包括1069 SOF参与者：375名护理人员和694名非护理人员在SOF网站，年龄，种族和邮政编码上匹配。自1999年以来，通过5次家庭访谈，对护理员-SOF参与者进行了随访（每年3次访谈，随后每隔18个月进行2次访谈），包括关于育儿和照顾者身份转变、感知压力、身心健康状况的标准化问题;身体机能的表现为基础的措施（计时步行、握力、椅子站立）和认知功能（数字替代测试和霍普金斯言语学习测试）。拟定研究将与SOF相关联，以更新死亡率数据，检验健康护理者假设，并使用SOF访视8和9的储存血清进行3种炎症标志物（白细胞介素-6，IL-6; C反应蛋白，CRP;和肿瘤坏死因子-α，TNF-1）的测定。我们将使用混合纵向模型和考克斯比例风险模型来测试所有参与者和照顾者的四个假设。H1）较高的炎症负荷（IL-6、CRP和TNF- 1水平的综合评分）将介导包括高压力护理者亚组（例如，痴呆症护理者），和不利的健康结果（即，死亡率、身体功能、认知功能下降）。H2）在护理者-SOF研究的两次筛选访谈中都是护理者的SOF参与者，或者在第二次筛选访谈中成为护理者的SOF参与者，与那些仍然是非护理者或停止护理的人相比，健康状况更好，健康下降更少。H3）根据CES-D量表的积极情感分量表，积极情感高的受访者的不良健康结果比其他受访者少;积极情感高的照顾者更有可能继续照顾和适应停止照顾。H4）从分娩中获得更多个人收益的护理人员将更有可能继续分娩，炎症负担较低，不良健康后果较少。这项研究将提供重要的见解之间的关联，老年人和健康下降，并将指导干预措施，以促进身体和认知健康的老年照顾者。

DESCRIPTION (provided by applicant): The Stress Process Model predicts that caregivers should have higher rates of health decline than non-caregivers because of their higher stress levels. However, recent studies have found lower rates of mortality, frailty, and physical and cognitive functioning in older caregivers than non-caregivers. The proposed study will investigate four possible mechanisms for these better health outcomes: inflammatory burden as a psycho-neuroimmunological mechanism; the Healthy Caregiver Hypothesis, as a basic health advantage in older adults who become caregivers and continue caregiving; positive affect as a general psychological protective effect; and personal gain from caregiving as a caregiving-specific mechanism. This revised proposal is a competitive renewal of Caregiver-SOF, which is an ancillary study to the Study of Osteoporotic Fractures (SOF), a multi-site cohort study of elderly women. The Caregiver-SOF sample includes 1069 SOF participants: 375 caregivers and 694 non-caregivers matched on SOF site, age, race, and zip code. Caregiver-SOF participants have been followed since 1999 through 5 home-based interviews (3 annual interviews followed by 2 at 18-month intervals) that included standardized questions on caregiving and caregiver status transitions, perceived stress, physical and psychological health status; performance- based measures of physical functioning (timed walk, grip strength, chair stands) and cognitive functioning (Digit Substitution Test and Hopkins Verbal Learning Test). The proposed study will link to SOF to update mortality data, test the Healthy Caregiver Hypothesis, and use stored serum from SOF visits 8 and 9 for assays on 3 inflammatory markers (Interleukin-6, IL-6; C-reactive protein, CRP; and Tumor Necrosis Factor- alpha, TNF-1). We will use mixed longitudinal models and Cox proportional hazards models to test four hypotheses in all participants and in caregivers only. H1) Higher inflammatory burden (a summary score of IL-6, CRP, and TNF- 1 levels) will mediate associations between caregiving, including high-stress caregiver subgroups (e.g., dementia caregivers), and adverse health outcomes (i.e., mortality, decline in physical functioning, cognitive functioning). H2) SOF participants who were caregivers at both screening interviews for the Caregiver-SOF study, or who became caregivers at the second screening interview, will have better health status and less health decline than those who remained as non-caregivers or stopped caregiving. H3) Respondents with high positive affect, based on the positive affect subscale of the CES-D scale, will have less adverse health outcomes than other respondents; caregivers with high positive affect will be more likely to continue caregiving and adapt to cessation of caregiving. H4) Caregivers with more personal gain from caregiving will be more likely to continue caregiving, have lower inflammatory burden, and fewer adverse health outcomes. This study will provide important insights into associations between caregiving and health decline and will guide interventions to promote physical and cognitive health in older caregivers.