Predicting Risk for Adverse Outcomes in Dementia Caregivers

预测痴呆症护理人员不良后果的风险

• 批准号: 10012937
• 负责人: Robert Wayne Levenson
• 金额: $ 70万
• 依托单位: UNIVERSITY OF CALIFORNIA BERKELEY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-15 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10012937
• 关键词: Address; Adverse effects; Adverse event; Affect; Affective; Aggressive behavior; Agitation; Alzheimer' s Disease; Anger; Anxiety; Behavioral; Behavioral Symptoms; Biological; Caregiver research; Caregivers; Caring; Cognitive; Data; Dementia; Dementia caregivers; Diagnosis; Discipline of Nursing; Disease; Economics; Emotional; Emotions; Family; Family member; Formal caregiver; Formal caregiving; Frontotemporal Dementia; Health; Health Benefit; Health Status; Impairment; Individual; Individual Differences; Intervention; Laboratories; Lead; Life; Link; Loneliness; Low income; Measures; Mental Depression; Mental Health; Methodology; Methods; Morbidity - disease rate; Neurology; Outcome; Pathway interactions; Patients; Personal Satisfaction; Persons; Physiological; Progressive Disease; Psychology; Public Health; Quality of Care; Questionnaires; Research; Risk; Risk Factors; Role; Sampling; Science; Sleep disturbances; Source; Spouses; Surveys; Training; Weight Gain; Work; adverse outcome; base; caregiver functioning; caregiving; dementia caregiving; dementia risk; effective intervention; emotion regulation; emotional behavior; emotional factor; emotional functioning; emotional reaction; experience; informal caregiver; informal caregiving; innovation; interdisciplinary approach; interest; mortality; physical conditioning; positive emotional state; prevent; psychologic; psychological symptom; response; self esteem; skills; statistics; Address; Adverse effects; Adverse event; Affect; Affective; Aggressive behavior; Agitation; Alzheimer' s Disease; Anger; Anxiety; Behavioral; Behavioral Symptoms; Biological; Caregiver research; Caregivers; Caring; Cognitive; Data; Dementia; Dementia caregivers; Diagnosis; Discipline of Nursing; Disease; Economics; Emotional; Emotions; Family; Family member; Formal caregiver; Formal caregiving; Frontotemporal Dementia; Health; Health Benefit; Health Status; Impairment; Individual; Individual Differences; Intervention; Laboratories; Lead; Life; Link; Loneliness; Low income; Measures; Mental Depression; Mental Health; Methodology; Methods; Morbidity - disease rate; Neurology; Outcome; Pathway interactions; Patients; Personal Satisfaction; Persons; Physiological; Progressive Disease; Psychology; Public Health; Quality of Care; Questionnaires; Research; Risk; Risk Factors; Role; Sampling; Science; Sleep disturbances; Source; Spouses; Surveys; Training; Weight Gain; Work; adverse outcome; base; caregiver functioning; caregiving; dementia caregiving; dementia risk; effective intervention; emotion regulation; emotional behavior; emotional factor; emotional functioning; emotional reaction; experience; informal caregiver; informal caregiving; innovation; interdisciplinary approach; interest; mortality; physical conditioning; positive emotional state; prevent; psychologic; psychological symptom; response; self esteem; skills; statistics

Alzheimer’s disease (AD) and frontotemporal dementia (FTD) lead to profound cognitive, emotional, and functional deficits. As the disease progresses, the person with dementia (PWD) becomes increasingly dependent on a caregiver (CG) for functional, psychological, and economic assistance. Caring for a PWD is a highly meaningful part of family life but can have adverse consequences for CGs including increased economic hardships, reduced health and well-being, and greater mortality. When CGs suffer these effects, their ability to provide high quality care for PWDs can become comprised, leading to an accelerating cycle of decline. Importantly, beneath these sobering group-level data are striking differences among individual caregivers in how profoundly they experience adverse effects, which raises the possibility that adverse effects of caregiving could be predicted, modified, or even prevented. The proposed research focuses on CG risk associated with emotional functioning in PWDs, CGs, and PWD-CG relationships. This focus reflects the profound impact that problematic emotional behaviors and psychological symptoms in PWDs have on CGs, the strong links between emotions and health, and our previous research linking emotional factors with adverse CG outcomes. CGs and PWDs will undergo a comprehensive, laboratory-based assessment of: (a) emotional reactivity—ability to generate emotional responses to significant challenges and opportunities; (b) emotion regulation—ability to adjust emotional responses to meet situational demands; and (c) emotion recognition—ability to detect emotions accurately in others and respond appropriately. Five studies are proposed to address four specific aims: Aim 1: To determine how emotional functioning in PWDs, CGs, and PWD-CG relationships is associated with individual differences in adverse CG outcomes (i.e., lower CG mental health, physical health, and well- being) during active caregiving (Study 1, N=180) and after caregiving has ended (Study 2, N=200). Aim 2: To use longitudinal assessments to evaluate hypothesized biological and behavioral pathways connecting risk factors with adverse CG outcomes during active caregiving (Study 3, N=84 studied for 3 years). Aim 3: To examine relationships between changes in CG health and PWD mortality (Study 4, N=400). Aim 4: To identify an optimal set of laboratory-based measures of emotional functioning for predicting adverse CG outcomes both during and after active caregiving and to determine their incremental validity compared to other established risk factors and traditional survey measures of emotional functioning (Study 5, N=350). Innovations include: (a) multidisciplinary approach (psychology, neurology, and nursing); (b) translational application of laboratory-based methods used in basic affective science methodology to CG research; (c) including CGs of individuals with both AD and FTD; (d) focusing on interpersonal functioning; (e) examining individual differences in adverse CG outcomes both during and after active caregiving; (f) examining adverse outcomes for both CGs and PWDs; and (g) longitudinal behavioral and biological assessments of CG functioning.

阿尔茨海默氏病（AD）和额颞痴呆（FTD）导致认知，情感和 功能不足。随着疾病的发展，痴呆症患者（PWD）变得越来越多 取决于护理人员（CG）的功能，心理和经济援助。照顾PWD是 家庭生活中高度有意义的一部分，但可能会对CG造成不利的后果，包括经济增长 艰辛，健康和福祉减少以及更大的死亡率。当CG遭受这些影响时，它们的能力 为PWD提供高质量的护理可能会构成，从而导致下降的加速周期。 重要的是，在这些醒目的小组级别的数据下，个人护理人员之间的差异很大 他们对不利影响的深刻影响，这增加了照料的不利影响 可以预测，修改甚至可以预防。拟议的研究重点是与 PWD，CGS和PWD-CG关系中的情感功能。这种重点反映了深远的影响 PWD中有问题的情绪行为和心理症状在CGS上，与 情绪和健康，以及我们以前的研究将情绪因素与不良CG结果联系起来。 CGS和 PWD将接受以下全面的，基于实验室的评估：（a）情感反应性 - 对重大挑战和机遇产生情感反应； （b）情绪调节 - 调整情绪反应以满足情境需求； （c）情感认可 - 检测能力 对他人的情绪准确，并做出适当的回应。提出了五项研究来解决四个特定 目的：目标1：确定PWD，CGS和PWD-CG关系中的情感功能如何 与个体差异提前差异CG结果（即，CG心理健康，身体健康和良好 在主动照顾期间（研究1，n = 180）和护理后结束（研究2，n = 200）。目标2：到 使用纵向评估评估有假设的生物学和行为途径，连接风险 活跃护理期间CG结果不良的因素（研究3，n = 84研究3年）。目标3：到 检查CG健康和PWD死亡率变化之间的关系（研究4，n = 400）。目标4：确定 一套最佳的基于实验室的情绪功能的度量，以预测不良CG结果 在主动护理期间和之后，与其他 建立的危险因素和情绪功能的传统调查措施（研究5，n = 350）。创新 包括：（a）多学科方法（心理学，神经病学和护士）； （b）翻译应用 基于实验室的方法用于CG研究中的基本情感科学方法； （c）包括CG 具有AD和FTD的人； （d）专注于人际功能； （e）检查个人 在主动护理期间和之后，CG结果的差异； （f）检查不良结果 对于CGS和PWD； （g）CG功能的纵向行为和生物学评估。