Transitions to Family Caregiving and Its Impact on Health Indicators

 描述（由申请人提供）：老年人口的增长，许多残疾状况的流行率增加，以及机构护理的高成本，都对家庭成员提出了沉重的要求，为残疾成年人提供非正式的护理服务。许多先前的研究将睡眠描述为一种慢性压力体验，与健康状况较差以及炎症和免疫力受损的生物标志物指标相关。然而，绝大多数现有的研究都是基于便利样本和横断面比较，相对较少的研究使用基于人群的样本或前瞻性地检查个体参与者中向替代角色的过渡。这项拟议的研究将确定在参与一项大型前瞻性流行病学研究时从非家庭成员角色转变为家庭成员关系的个体。中风的地理和种族差异的原因（REGARDS）项目是一项正在进行的流行病学研究，截至2015年5月31日，有超过17，800名活跃的中年和老年参与者。试点数据表明，这些参与者中有1,200多人已经从REGARDS基线（8-12年前）的非家庭角色转变为目前的非正式家庭角色。从初始REGARDS家庭评估中采集并储存血清样本，目前正在采集随访血清样本作为第二次REGARDS家庭评估的一部分。我们建议从REGARDS中识别并入组300名参与者，这些参与者在这两次REGARDS家庭评估之间已经转变为家庭护理角色，并且在第二次家庭评估中继续担任护理人员。我们将这些照顾者与300名个体匹配的非照顾者进行比较。将使用多步匹配和协变量调整程序控制许多潜在混杂变量，包括人口统计学、社会经济状况、既往健康状况和家庭关系因素。一组炎症生物标志物在10年期间的变化（例如，CRP、IL-6、d-二聚体、TNF-R1）、健康生物标志物（例如，血脂，HgA 1c）和自我报告的健康结果测量（例如，健康相关的生活质量、抑郁症状、健康行为）将在事件照顾者和匹配的非照顾者之间进行比较。重要的亚组比较将包括关注30%的照顾者，他们预计将照顾患有阿尔茨海默病或其他形式的痴呆症的家庭成员。拟议的护理过渡项目将是有史以来第一个基于人群的研究，研究过渡到基于血清的生物标志物和其他重要的健康相关结果的影响。将提供重要的新知识，以更好地了解非正式医疗对健康的影响，这将是未来几年更加重要的医疗资源。

 DESCRIPTION (provided by applicant): The growth of the older adult population, increased prevalence of many disabling conditions, and high costs of institutional care are placing heavy demands on family members to provide informal caregiving services to adults with disabilities. Many previous studies have characterized caregiving as a chronic stress experience associated with poorer health and biomarker indicators of inflammation and compromised immunity. However, the vast majority of existing studies have been based on convenience samples and cross-sectional comparisons, and relatively few studies of caregiving have used population-based samples or prospectively examined transitions into the caregiving role within individual participants. The proposed study will identify individuals who have transitioned from a non-caregiving role into a family caregiving relationship while participating in a large, prospective, epidemiological study. The REasons for Geographic And Racial Differences in Stroke (REGARDS) project is an ongoing epidemiological study with over 17,800 active middle-aged and older participants as of May 31, 2015. Pilot data suggest that over 1,200 of these participants have transitioned from a non-caregiving role at REGARDS baseline (8-12 years ago) into an informal family caregiving role at the present time. Serum samples were collected and stored from an initial REGARDS in-home assessment, and follow-up serum samples are now being collected as part of a 2nd REGARDS in-home assessment. We propose to identify and enroll 300 participants from REGARDS who have transitioned into a family caregiving role between these two REGARDS in-home assessments and who continue to be caregivers at the 2nd in- home assessment. We will compare these caregivers to 300 individually-matched non-caregivers. A multi- step matching and covariate-adjustment procedure will be used to control for many potential confounding variables including demographics, socioeconomic status, prior health status, and family relationship factors. Changes over a 10-year period on a set of inflammatory biomarkers (e.g., CRP, IL-6, d-dimer, TNF-R1), health biomarkers (e.g., lipids, HgA1c), and self-reported health outcome measures (e.g., health-related quality of life, depressive symptoms, health behaviors) will be compared between incident caregivers and matched non- caregivers. Important subgroup comparisons will include a focus on the 30% of caregivers who are expected to be caring for a family member with Alzheimer's disease or another form of dementia. The proposed Caregiving Transitions Project will be the first population-based study ever conducted on the impact of transitioning into a caregiving role on serum-based biomarkers and other important health-related outcomes. Critical new knowledge will be provided for better understanding the health impact of informal caregiving, which will be an even more critical healthcare resource in the coming years.