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

描述(由申请人提供)： 众所周知，急性和慢性压力对身体和认知功能有不利影响，但与照顾相关的压力影响这些结果的机制尚不清楚。这项拟议的研究将评估可能将急性和慢性护理压力与功能和认知结果联系起来的生物学过程。它测试了压力破坏多个相互关联的动态平衡系统(HPA轴、神经内分泌和免疫系统)的理论，这可能会导致代谢综合征和随后的健康下降。样本将包括从8家巴尔的摩地区医院招募的225名老年髋部骨折患者的非正式老年护理人员(BHS-7巴尔的摩髋关节研究患者的108名新护理人员和继续护理人员；以及来自这些医院的117名未被招募到BHS-7研究的女性患者的新护理人员和继续护理人员)。患者将在出院前确定照顾者的身份，以便最大限度地增加新照顾者的数量，并在急性应激期间获得基线数据。每年四(4)次的家庭访谈将由训练有素的护士面试者进行。在每次访谈中，将获得血压、拟人化测量和生物标记物(24小时尿儿茶酚胺和皮质醇、血清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，以及其他潜在的混杂因素和影响因素。功能状态将基于步行速度、椅子支架和自我报告的ADL/IADL。认知测量包括对执行功能、速度/注意力、工作记忆和类别流畅性的测试。假说将涉及：1)从护理压力到生理变化、代谢综合征、功能和认知外向的顺序路径；2)急性和慢性护理压力的影响比较，以及由于患者的康复而导致的护理结束；3)调节剂(即社会支持护理因素)影响这些路径的机制。混合效应模型将被用来检验从照顾者压力到生物学变化、到功能和认知结果的时间关联，以及时变协变量(即停止照看)的影响。研究结果将推动对急性和慢性护理压力对生理和健康影响的研究，并对护理人员对患有髋部骨折或其他疾病的成年人进行干预具有指导意义。与公共健康相关的照顾者经历了高比例的压力，但对与照顾相关的压力导致不利健康结果的生理机制知之甚少。这项拟议的研究将在225名老年护理者到髋部骨折患者中解决这个问题；这一群体几乎没有受到关注，但由于髋部骨折是一种急性事件，50%的患者在骨折后一年内康复，因此是研究急性和慢性护理压力和停止护理的理想选择。我们将评估可能将照顾压力与代谢综合征的发展以及随后的功能和认知状态下降联系起来的生物学过程。这一结果将推动对照看的生理和健康影响的研究，并对为髋部骨折或其他疾病的照顾者设计干预措施具有指导意义。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE 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.