ALZHEIMER CAREGIVER COPING--MENTAL AND PHYSICAL HEALTH

阿尔茨海默病照护者的应对措施——心理和身体健康

• 批准号: 6022366
• 负责人: IGOR GRANT
• 金额: $ 2.13万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 1999
• 资助国家: 美国
• 起止时间: 1999-03-01 至 2001-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6022366
• 关键词: Alzheimer's disease; adrenal medulla; adrenocorticotropic hormone; behavioral /social science research tag; blood chemistry; blood pressure; caregivers; coping; cortisol; home health care; human subject; hypothalamic pituitary adrenal axis; longitudinal human study; marriage /marital status; natural killer cells; neuroendocrine system; neuropeptide Y; norepinephrine; psychological stressor; psychoneuroimmunology; psychosomatic disorders; radioimmunoassay; self concept; social support network; stress; stress management

In this competing renewal we request five years of support to continue our inquiry into adaptation and health outcomes among Alzheimer caregivers (CG). Our major hypotheses are: 1) that the chronic stress of caregiving will be reflected in physiologic measures of activation - altered hypothalmic-pituitary-adrenal (HPA) axis sensitivity, increased sympathoadrenal medullary (SAM) activity, and reduced natural killer (NK) cell activity; and 2) that over time those CG with highest caregiver stress will show the most significant physiological alterations which will be predictive of worsening CG health. The research is guided by a conceptual model which postulates that to understand the effect of stressors on CG health we must consider the influence of certain mediators and background characteristics. Stressors can be patient-derived (dementia, problem behaviors, help required) or environmental (life events) leading to CG role overload. Mediators are interpersonal (supports) and intrapersonal (self-concept, coping activity). Background characteristics include age, gender socioeconomic status, and past health. The outcomes of caregiving are conceptualized at 3 levels: physiologic (HPA alteration., SAM activation, NK activity), psychologic (anxiety, depression), and physical (symptoms, illness episodes). The study has two components. In the "field" study 200 spousal CG and 80 noncaregiving controls (NC) will be examined every 6 months for 5 years. Data will be gathered on state and needs of the patient, life stresses, resources, supports, medical events, and psychological state of CG. Blood samples for NK, cortisol, ACTH, norepinephrine, epinephrine and neuropeptide Y will be drawn in the CG home during a blood pressure postural reactivity protocol. Nested in the field study is our 'laboratory' study which will, for the first time, attempt to probe HPA axis sensitivity and SAM activation in CG experiencing varying levels of caregiver stress. Here we shall perform corticotropin releasing factor (CRF) infusion studies, as well as sympathetic reactivity studies with 60 CG and 30 NC "selected" to be free of major medical confounds (including medications). The data from this phase should move caregiver research closer to understanding mechanisms linking caregiver stress, physiological response, and health.

在这次竞争更新中，我们请求五年的支持以继续我们的 调查阿尔茨海默病护理人员的适应和健康结果 （CG）。 我们的主要假设是： 1) 护理带来的慢性压力 将反映在激活的生理测量中 - 改变 下丘脑-垂体-肾上腺 (HPA) 轴敏感性增加 交感肾上腺髓质 (SAM) 活性，并减少自然杀伤 (NK) 细胞活性； 2) 随着时间的推移，那些照顾者压力最大的 CG 将显示出最显着的生理变化 预测 CG 健康状况恶化。 该研究以概念模型为指导，该模型假设 了解压力源对 CG 健康的影响，我们必须考虑 某些中介和背景特征的影响。 压力源 可能是患者引起的（痴呆、问题行为、需要帮助）或 环境（生活事件）导致 CG 角色超载。 调解员是 人际（支持）和内心（自我概念、应对活动）。 背景特征包括年龄、性别、社会经济地位以及 过去的健康状况。 护理的结果分为三个层次： 生理学（HPA 改变、SAM 激活、NK 活性）、心理 （焦虑、抑郁）和身体（症状、疾病发作）。 这 研究有两个组成部分。 在“现场”研究200配偶CG和80 非护理控制 (NC) 将每 6 个月检查一次，持续 5 年。 将收集有关患者的状态和需求、生活压力、 CG 的资源、支持、医疗事件和心理状态。 血 NK、皮质醇、ACTH、去甲肾上腺素、肾上腺素和 血压期间将在 CG 主页中绘制神经肽 Y 姿势反应协议。 嵌套在实地研究中的是我们的“实验室”研究，它将为 第一次尝试在CG中探测HPA轴敏感性和SAM激活 经历不同程度的照顾者压力。 这里我们要表演的是 促肾上腺皮质激素释放因子（CRF）输注研究，以及 “选择”免费的 60 CG 和 30 NC 交感神经反应性研究 主要医疗问题（包括药物）。 数据来自于此 阶段应该使护理人员的研究更接近于理解机制 将护理人员的压力、生理反应和健康联系起来。