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

老年髋部骨折护理人员急性和慢性应激的生物途径

• 批准号: 8286899
• 负责人: Lisa Fredman
• 金额: $ 60.46万
• 依托单位: BOSTON UNIVERSITY MEDICAL CAMPUS
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8286899
• 关键词: Acute; Address; Adult; Adverse effects; Affect; Alzheimer' s Disease; Anti-Inflammatory Agents; Anti-inflammatory; Area; Attention; Baltimore; Biological; Biological Markers; Biological Markers; Biological Process; Blood; Blood Pressure; Caregiver Burden; Caregivers; Caring; Catecholamines; Categories; Cessation of life; Cholesterol; Chronic; Chronic stress; Cognitive; Communities; Data; Development; Disease; Elderly; Epidemiologic Studies; Epinephrine; Event; Female; Fracture; Future; Glucose; Health; Hip Fractures; Hip region structure; Home environment; Hospitalization; Hospitals; Hour; Hydrocortisone; Immune; Immune system; Impaired cognition; Impairment; Incidence; Inflammatory; Inorganic Sulfates; Interleukin-10; Interleukin-6; Intervention; Interview; Interviewer; Lead; Link; Measures; Mental Depression; Mental Health; Metabolic syndrome; Modeling; Morbidity - disease rate; Neurosecretory Systems; Norepinephrine; Nurses; Outcome; Pathway interactions; Patient Self-Report; Patients; Performance; Persons; Physical Function; Physical activity; Physiological; Physiological Processes; Process; Prospective Studies; Recovery; Recruitment Activity; Research; Respondent; Risk Factors; Role; Sampling; Serum; Short-Term Memory; Social Network; Social support; Speed; Stress; Stress Fractures; Supervision; System; TNF gene; Testing; Theoretical model; Time; Training; Tumor Necrosis Factor-alpha; Unspecified or Sulfate Ion Sulfates; Urine; Walking; abstracting; acute stress; aged; base; caregiving; cognitive function; cohort; depressive symptoms; executive function; experience; functional status; improved; inflammatory marker; instrumental activity of daily living; mortality; physical conditioning; psychosocial; stressor; theories; therapy design

Project abstract: 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. Project Narrative: 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.

项目摘要： 众所周知，急性和慢性压力对身体和认知具有不利影响 功能，但是与护理相关的压力影响这些结果的机制 保持不清楚。拟议的研究将评估可能连接急性的生物学过程 以及对功能和认知结果的长期护理压力。它检验了以下理论 压力破坏了多个相互关联的稳态系统（HPA轴，神经内分泌和 免疫系统），这可能导致代谢综合征和随后的健康下降。这 样本将包括225名年龄较大的非正式护理人员，从8岁起招募的老年髋部骨折患者 巴尔的摩地区医院（巴尔的摩臀部的患者108名新的和持续的护理人员 研究，BHS-7；还有117名来自这些医院的女性患者的新的和持续的护理人员 没有被招募到BHS-7研究）。护理人员将在患者之前确定 出院以最大化新护理人员的数量并获得基线数据 在急性应力的时期。四（4）个年度家庭访谈将由 训练有素的护士面试官。在每次访谈，血压，拟人措施和 将获得生物标记物（儿茶酚胺和皮质醇的24小时尿液，血清 DHEAS，促和抗炎标记，葡萄糖，胆固醇）。血液将存储 未来分析。访谈数据包括与护理相关的压力源，身体健康和 活动，抑郁症状和其他潜在的混杂因素以及作用修饰符。功能 身份将基于步行速度，椅子架和自我报告的ADL/IADL。认知的 措施包括执行功能，速度/注意力，工作记忆和 类别流利。假设将解决：1）从护理应力到的顺序途径 生理变化，代谢综合征以及功能性和认知异构体； 2） 比较急性和慢性照顾压力的影响以及由于 患者的康复； 3）修饰符（即社会支持护理）的机制 因素）影响这些途径。混合效应模型将用于检查时间 从照顾者压力到生物学变化，功能和认知结果的关联， 以及随时间变化的协变量（即停止护理）的影响。结果将进步 研究急性和慢性护理压力的生理和健康影响，并具有 对患有髋部骨折或其他疾病的成年人的护理人员的干预措施的影响。项目叙述： 护理人员的压力率很高，但对生理知之甚少 与护理相关的压力导致不良健康结果的机制。这 拟议的研究将在225名年长的护理人员中解决这个问题，以使髋部骨折患者患有。这 小组很少受到关注，但非常适合研究急性和慢性的影响 护理压力和停止护理以来，髋部骨折是一个急性事件，50％ 患者在骨折的一年内恢复。我们将评估生物过程 这可能将护理压力与代谢综合征的发展联系起来，随后 功能和认知状况的下降。结果将推进对 护理的生理和健康影响，并对设计干预有影响 为患有髋部骨折或其他情况的人提供护理人员。