Pathways from Stress to Metabolic Syndrome and Health Decline in Aged Caregivers

老年护理人员从压力到代谢综合征和健康下降的途径

• 批准号: 8078017
• 负责人: Lisa Fredman
• 金额: $ 48.74万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-08-15 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8078017
• 关键词: Address; Adult; Adverse effects; Affect; Aging; Alzheimer' s Disease; Area; Behavior; Biological; Biological Markers; Biological Process; Blood Pressure; Boston; Caregiver Burden; Caregivers; Caring; Catecholamines; Characteristics; Chronic; Chronic stress; Clinical Research; Cognitive; Data; Elderly; Epidemiologic Studies; Epinephrine; Evaluation; Glucose; Growth; Health; High Density Lipoprotein Cholesterol; Hour; Hydrocortisone; Immune; Immune system; Impaired cognition; Incidence; Individual; Inorganic Sulfates; Interleukin-6; Intervention; Interview; Interviewer; Lead; Link; Massachusetts; Measurement; Measures; Medical center; Mental Depression; Metabolic syndrome; Modeling; Neurosecretory Systems; Norepinephrine; Outcome; Pathway interactions; Patient Self-Report; Performance; Persons; Physical Function; Physical activity; Physiological; Physiological Processes; Process; Questionnaires; Recruitment Activity; Registries; Reporting; Research Design; Research Personnel; Respondent; Serum; Short-Term Memory; Social support; Socioeconomic Status; Speed; Stress; System; Testing; Time; Triglycerides; Universities; Unspecified or Sulfate Ion Sulfates; Urine; Walking; aged; base; caregiving; cognitive change; cognitive function; cohort; executive function; functional decline; functional status; hypothalamic-pituitary-adrenal axis; insight; instrumental activity of daily living; metropolitan; middle age; physical conditioning; programs; prospective; psychosocial; stressor; theories

DESCRIPTION (provided by applicant): Informal caregivers consistently report higher rates of stress than non-caregivers, and there is evidence that chronic stress has adverse effects on physical health and cognitive functioning. However, no study has evaluated the biological processes between caregiving-related stress and health decline. Recent theories of stress-induced metabolic syndrome and health decline suggest a plausible mechanism: chronic stress disrupts several interrelated homeostatic systems (neuroendocrine, HPA axis, and immune systems), which lead to metabolic syndrome and subsequent health decline. The proposed study will evaluate these associations over a 3-year period in 400 elderly caregivers and non-caregivers from the Boston, MA metropolitan area. Caregivers will be recruited from the Boston University Alzheimer's Disease Core Center Registry (n=200). Non-caregivers will be recruited from the Harvard Cooperative Program on Aging Registry (n=200). Data will be collected during 4 annual interviews at the BU General Clinical Research Center. Biological measures will be obtained from 24-hour urine (catecholamines and cortisol), serum (DHEAS, IL-6, glucose, triglycerides and HDL cholesterol); blood pressure and anthropomorphic measures will be taken. Data on stressors, the caregiving situation (measures from Pearlin's Caregiver Stress model), and potential confounders and effect modifiers will be collected through interviewer-administered questionnaires at each interview. Functional status will be based on walking speed, chair stands and self-reported ADLs. Cognitive status will be based on multiple domains (e.g., executive functioning, working memory). Hypotheses will address: 1) the sequential pathway from stress, to physiological changes, metabolic syndrome, and functional and cognitive decline; 2) comparisons of these outcomes in non-caregivers and non-caregivers; and 3) the mechanisms by which modifiers, such as social support and caregiving characteristics, affect this pathway. Mixed effects models will be used to analyze the longitudinal process between caregiver stress and functional and cognitive changes. Latent growth curve modeling will be used to examine the effects of time-varying covariates (i.e., caregiver transitions) on intra-individual change across the four measurement points. Results will provide insight into biological pathways underlying health decline in aged caregivers, and have implications for interventions to reduce adverse effects of chronic stress.

描述（申请人提供）：非正式护理人员始终报告的压力率比非照料者更高，并且有证据表明，慢性压力对身体健康和认知功能有不利影响。但是，尚无研究评估与护理相关的压力与健康下降之间的生物学过程。压力诱导的代谢综合征和健康下降的最新理论表明了一种合理的机制：慢性应激破坏了几种相互关联的稳态系统（神经内分泌，HPA轴和免疫系统），这会导致代谢综合征和随后的健康下降。拟议的研究将在3年的400名老年护理人员和来自马萨诸塞州大都会地区的400名老年护理人员和非照顾者中评估这些关联。护理人员将被从波士顿大学阿尔茨海默氏病核心中心注册中心招募（n = 200）。非保养者将从哈佛大学的衰老注册表计划中招募（n = 200）。数据将在BU通用临床研究中心的4次年度访谈中收集。生物学措施将从24小时尿液（儿茶酚胺和皮质醇），血清（DHEAS，IL-6，葡萄糖，甘油三酸酯和HDL胆固醇）中获得；将采取血压和拟人措施。有关压力源，护理状况（Pearlin的护理人员压力模型的衡量标准）以及潜在的混杂因素和效果修饰符的数据，将在每次访谈中通过访谈者管理的问卷收集。功能状态将基于步行速度，椅子支架和自我报告的ADL。认知状态将基于多个域（例如，执行功能，工作记忆）。假设将解决：1）从应力到生理变化，代谢综合征以及功能和认知能力下降的顺序途径； 2）在非照料者和非照料者中比较这些结果； 3）修饰符（例如社会支持和照料特征）会影响这一途径的机制。混合效应模型将用于分析护理人员应力与功能和认知变化之间的纵向过程。潜在的生长曲线建模将用于检查随时间变化的协变量（即护理人员过渡）对四个测量点之间个体内部变化的影响。结果将提供对老年护理人员健康下降的生物学途径的洞察力，并对干预措施产生影响，以减少慢性压力的不良影响。

项目成果

Feasibility of 24-Hr Urine Collection for Measurement of Biomarkers in Community-Dwelling Older Adults.

收集 24 小时尿液以测量社区老年人生物标志物的可行性。

• DOI: 10.1177/0733464815624153
• 发表时间: 2017
• 期刊: Journal of applied gerontology : the official journal of the Southern Gerontological Society
• 作者: Stuver,SherriO;Lyons,Jennifer;Coviello,Andrea;Fredman,Lisa
• 通讯作者: Fredman,Lisa