Health decline in aged caregivers: epidemiologic study

Summary

Principal Investigator: Lisa Fredman
Abstract: DESCRIPTION (provided by applicant): The Stress Process Model predicts that caregivers should have higher rates of health decline than non-caregivers because of their higher stress levels. However, recent studies have found lower rates of mortality, frailty, and physical and cognitive functioning in older caregivers than non-caregivers. The proposed study will investigate four possible mechanisms for these better health outcomes: inflammatory burden as a psycho-neuroimmunological mechanism;the Healthy Caregiver Hypothesis, as a basic health advantage in older adults who become caregivers and continue caregiving;positive affect as a general psychological protective effect;and personal gain from caregiving as a caregiving-specific mechanism. This revised proposal is a competitive renewal of Caregiver-SOF, which is an ancillary study to the Study of Osteoporotic Fractures (SOF), a multi-site cohort study of elderly women. The Caregiver-SOF sample includes 1069 SOF participants: 375 caregivers and 694 non-caregivers matched on SOF site, age, race, and zip code. Caregiver-SOF participants have been followed since 1999 through 5 home-based interviews (3 annual interviews followed by 2 at 18-month intervals) that included standardized questions on caregiving and caregiver status transitions, perceived stress, physical and psychological health status;performance- based measures of physical functioning (timed walk, grip strength, chair stands) and cognitive functioning (Digit Substitution Test and Hopkins Verbal Learning Test). The proposed study will link to SOF to update mortality data, test the Healthy Caregiver Hypothesis, and use stored serum from SOF visits 8 and 9 for assays on 3 inflammatory markers (Interleukin-6, IL-6;C-reactive protein, CRP;and Tumor Necrosis Factor- alpha, TNF-1). We will use mixed longitudinal models and Cox proportional hazards models to test four hypotheses in all participants and in caregivers only. H1) Higher inflammatory burden (a summary score of IL-6, CRP, and TNF- 1 levels) will mediate associations between caregiving, including high-stress caregiver subgroups (e.g., dementia caregivers), and adverse health outcomes (i.e., mortality, decline in physical functioning, cognitive functioning). H2) SOF participants who were caregivers at both screening interviews for the Caregiver-SOF study, or who became caregivers at the second screening interview, will have better health status and less health decline than those who remained as non-caregivers or stopped caregiving. H3) Respondents with high positive affect, based on the positive affect subscale of the CES-D scale, will have less adverse health outcomes than other respondents;caregivers with high positive affect will be more likely to continue caregiving and adapt to cessation of caregiving. H4) Caregivers with more personal gain from caregiving will be more likely to continue caregiving, have lower inflammatory burden, and fewer adverse health outcomes. This study will provide important insights into associations between caregiving and health decline and will guide interventions to promote physical and cognitive health in older caregivers.
Funding Period: 1999-09-30 - 2015-06-30
more information: NIH RePORT

Top Publications

  1. ncbi Leisure-time exercise and overall physical activity in older women caregivers and non-caregivers from the Caregiver-SOF Study
    Lisa Fredman
    Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, MA 02118, USA
    Prev Med 43:226-9. 2006
  2. pmc Long-term cumulative depressive symptom burden and risk of cognitive decline and dementia among very old women
    Adina Zeki Al Hazzouri
    Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107
    J Gerontol A Biol Sci Med Sci 69:595-601. 2014
  3. pmc Depressive symptoms among dementia caregivers: role of mediating factors
    Jane L Givens
    Hebrew Senior Life Institute for Aging Research, Boston, MA Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA Electronic address
    Am J Geriatr Psychiatry 22:481-8. 2014
  4. pmc Twenty-year depressive trajectories among older women
    Amy L Byers
    Department of Psychiatry, University of California, San Francisco, CA 94121, USA
    Arch Gen Psychiatry 69:1073-9. 2012
  5. pmc When it hurts, a positive attitude may help: association of positive affect with daily walking in knee osteoarthritis. Results from a multicenter longitudinal cohort study
    Daniel K White
    Boston University, Massachusetts, USA
    Arthritis Care Res (Hoboken) 64:1312-9. 2012
  6. pmc Caregiving and cognitive function in older women: evidence for the healthy caregiver hypothesis
    Rosanna M Bertrand
    Domestic Health Division, Health Policy, Abt AssociatesInc, Cambridge, MA, USA
    J Aging Health 24:48-66. 2012
  7. pmc Association between insomnia symptoms and weight change in older women: caregiver--study of osteoporotic fractures study
    Craig Ross
    Epidemiology Department, School of Public Health, Boston University, Boston, Massachusetts, USA
    J Am Geriatr Soc 59:1697-704. 2011
  8. pmc Self-ratings of health and change in walking speed over 2 years: results from the caregiver-study of osteoporotic fractures
    Jeffrey M Ashburner
    Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
    Am J Epidemiol 173:882-9. 2011
  9. pmc Mortality associated with caregiving, general stress, and caregiving-related stress in elderly women: results of caregiver-study of osteoporotic fractures
    Lisa Fredman
    Epidemiology Department, School of Public Health, Boston University, Boston, Massachusetts 02118, USA
    J Am Geriatr Soc 58:937-43. 2010
  10. pmc Caregiving, metabolic syndrome indicators, and 1-year decline in walking speed: results of Caregiver-SOF
    Lisa Fredman
    Department of Epidemiology, Boston University School of Public Health 715 Albany Street, Boston, MA 02118, USA
    J Gerontol A Biol Sci Med Sci 65:565-72. 2010

Detail Information

Publications19

  1. ncbi Leisure-time exercise and overall physical activity in older women caregivers and non-caregivers from the Caregiver-SOF Study
    Lisa Fredman
    Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, MA 02118, USA
    Prev Med 43:226-9. 2006
    ..However, through caregiving tasks, caregivers may be as physically active as non-caregivers. This study compared leisure-time exercise and overall physical activity in elderly women caregivers and non-caregivers...
  2. pmc Long-term cumulative depressive symptom burden and risk of cognitive decline and dementia among very old women
    Adina Zeki Al Hazzouri
    Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107
    J Gerontol A Biol Sci Med Sci 69:595-601. 2014
    ..This study examines the association of nearly 20 years of cumulative depressive symptoms with cognitive outcomes in a cohort of older women...
  3. pmc Depressive symptoms among dementia caregivers: role of mediating factors
    Jane L Givens
    Hebrew Senior Life Institute for Aging Research, Boston, MA Division of Gerontology, Beth Israel Deaconess Medical Center, Boston, MA Electronic address
    Am J Geriatr Psychiatry 22:481-8. 2014
    ..To compare depressive symptoms between caregivers to persons with dementia and other illnesses and determine whether caregiver role captivity and care recipient disruptive behaviors mediate this association...
  4. pmc Twenty-year depressive trajectories among older women
    Amy L Byers
    Department of Psychiatry, University of California, San Francisco, CA 94121, USA
    Arch Gen Psychiatry 69:1073-9. 2012
    ..Despite the frequent occurrence of depressive symptoms among older adults, especially women, little is known about the long-term course of late-life depressive symptoms...
  5. pmc When it hurts, a positive attitude may help: association of positive affect with daily walking in knee osteoarthritis. Results from a multicenter longitudinal cohort study
    Daniel K White
    Boston University, Massachusetts, USA
    Arthritis Care Res (Hoboken) 64:1312-9. 2012
    ..This study investigated this association among adults with knee osteoarthritis (OA) and examined whether knee pain modified this association...
  6. pmc Caregiving and cognitive function in older women: evidence for the healthy caregiver hypothesis
    Rosanna M Bertrand
    Domestic Health Division, Health Policy, Abt AssociatesInc, Cambridge, MA, USA
    J Aging Health 24:48-66. 2012
    ..In a cross-sectional study, we tested the HCH on two cognitive domains: verbal memory and processing speed...
  7. pmc Association between insomnia symptoms and weight change in older women: caregiver--study of osteoporotic fractures study
    Craig Ross
    Epidemiology Department, School of Public Health, Boston University, Boston, Massachusetts, USA
    J Am Geriatr Soc 59:1697-704. 2011
    ..To determine whether self-reported insomnia symptoms were associated with weight change in older women and whether caregiving, comorbidities, sleep medication, or stress modified this association...
  8. pmc Self-ratings of health and change in walking speed over 2 years: results from the caregiver-study of osteoporotic fractures
    Jeffrey M Ashburner
    Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA
    Am J Epidemiol 173:882-9. 2011
    ..88%), whereas low-intensity caregivers in excellent/good SRH had no decline (2.61%). In summary, poorer SRH was associated with decline in walking speed in older women, and the stress of caregiving may have exacerbated its impact...
  9. pmc Mortality associated with caregiving, general stress, and caregiving-related stress in elderly women: results of caregiver-study of osteoporotic fractures
    Lisa Fredman
    Epidemiology Department, School of Public Health, Boston University, Boston, Massachusetts 02118, USA
    J Am Geriatr Soc 58:937-43. 2010
    ..To investigate the separate and combined effects of caregiver status and high stress on mortality risk over 8 years in elderly women...
  10. pmc Caregiving, metabolic syndrome indicators, and 1-year decline in walking speed: results of Caregiver-SOF
    Lisa Fredman
    Department of Epidemiology, Boston University School of Public Health 715 Albany Street, Boston, MA 02118, USA
    J Gerontol A Biol Sci Med Sci 65:565-72. 2010
    ..Chronic stress may lead to health decline through metabolic syndrome. Thus, persons in stressful caregiving situations who also have more indicators of metabolic syndrome may experience more decline than other caregivers or noncaregivers...
  11. pmc 25-Hydroxyvitamin D levels and cognitive performance and decline in elderly men
    Y Slinin
    One Veterans Dr 111J, Minneapolis, MN 55417, USA
    Neurology 74:33-41. 2010
    ..To test the hypothesis that lower 25-hydroxyvitamin D [25(OH)D] levels are associated with a greater likelihood of cognitive impairment and risk of cognitive decline...
  12. pmc Caregiving intensity and change in physical functioning over a 2-year period: results of the caregiver-study of osteoporotic fractures
    Lisa Fredman
    Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts 02118, USA
    Am J Epidemiol 170:203-10. 2009
    ..Higher levels of physical performance persisted over 2 years among high-intensity caregivers, which did not support the traditional stress hypothesis...
  13. pmc Positive affect and incidence of frailty in elderly women caregivers and noncaregivers: results of Caregiver-Study of Osteoporotic Fractures
    Eunice Park-Lee
    Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland, USA
    J Am Geriatr Soc 57:627-33. 2009
    ....
  14. pmc Racial differences in self-rated health at similar levels of physical functioning: an examination of health pessimism in the health, aging, and body composition study
    S Melinda Spencer
    Department of Health Promotion, Education, and Behavior and the Institute for Southern Studies, University of South Carolina, Columbia, 29208, USA
    J Gerontol B Psychol Sci Soc Sci 64:87-94. 2009
    ..The current analysis examined the factors associated with SRH and tested the health pessimism hypothesis among older adults at similar levels of physical functioning...
  15. pmc Caregiving, mortality, and mobility decline: the Health, Aging, and Body Composition (Health ABC) Study
    Lisa Fredman
    Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
    Arch Intern Med 168:2154-62. 2008
    ..We hypothesized that caregivers may be more physically active than noncaregivers, which may protect them from health decline...
  16. ncbi Sleep problems in elderly women caregivers depend on the level of depressive symptoms: results of the Caregiver--Study of Osteoporotic Fractures
    Jinesh Kochar
    Division of Aging, Department of Medicine, Brigham and Women s Hospital, Boston, Massachusetts, USA
    J Am Geriatr Soc 55:2003-9. 2007
    ..To determine whether depressive symptoms modify the association between caregiving and sleep problems in elderly women...
  17. ncbi Elderly patients with hip fracture with positive affect have better functional recovery over 2 years
    Lisa Fredman
    Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts 02118, USA
    J Am Geriatr Soc 54:1074-81. 2006
    ..To evaluate whether patients with hip fracture with high positive affect had better functioning than those with low positive affect or depressive symptoms in three performance-based measures over 2 years after the fracture...
  18. ncbi Are all caregivers created equal? Stress in caregivers to adults with and without dementia
    Rosanna M Bertrand
    Boston University School of Public Health, USA
    J Aging Health 18:534-51. 2006
    ..This study of 349 elderly caregivers explored mediators of the caregiving / stress relationship for caregivers to adults with (n = 106), and without (n = 243) dementia...

Research Grants30

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    Kyriakos S Markides; Fiscal Year: 2013
    ..Our findings thus far suggest that this is a population characterized by rising life expectancy which is accompanied by increased disease burden and increasing disability rates. ..
  2. Hopkins Center for Eliminate Cardiovascular Health Disparities
    Lisa A Cooper; Fiscal Year: 2013
    ..abstract_text> ..
  3. STUDIES OF JOINT AGING AND OSTEOARTHRITIS
    Martin K Lotz; Fiscal Year: 2013
    ..Sah) will analyze biomechanical mechanisms of early and advanced cartilage degeneration and determine consequences for chondrocyte function and survival. ..
  4. Early Phase Psychosis: Informing Treatment Decisions
    John M Kane; Fiscal Year: 2013
    ..Our ability to intervene appropriately, effectively and consistently in this population can have profound long-term public health consequences. ..
  5. Course and Outcome of Bipolar Disorder in Youth
    Boris Birmaher; Fiscal Year: 2013
    ..abstract_text> ..
  6. Notch-Mediated Expansion of Cord Blood Progenitors for Stem Cell Transplant
    Colleen Delaney; Fiscal Year: 2013
    ..Our goal is to now determine the clinical efficacy of this approach in a phase II clinical trial. ..
  7. Promoting Independence Through Pain and Symptom Management
    Albert L Siu; Fiscal Year: 2013
    ..The proposed Center will bridge geriatrics and palliative care and serve as a model for a new focused area of research within geriatrics. ..
  8. Mechanisms of Ethnic/Racial Differences in Lung Cancer Due to Cigarette Smoking
    Stephen S Hecht; Fiscal Year: 2013
    ..The unique combination of expertise in this program project forms a powerful team arguably unmatched in its ability to address mechanisms of lung cancer development in smokers from different ethnic/racial groups. ..
  9. NBER CENTER FOR AGING AND HEALTH RESEARCH
    DAVID A WISE; Fiscal Year: 2013
    ..Understanding the complexities of this situation and the relationships between demographics, policy, behavior, economics, and health is the substantive aim of the Center. ..