This study examined whether satisfaction from leisure activities moderates the relationship between caregiving demands (i.e., hours per day spent caring for a spouse with dementia) and resting levels of the catecholamines norepinephrine (NE) and epinephrine (EPI). Spousal caregivers (N=107; mean age 73.95±8.12 years) were assessed in home for plasma levels of NE and EPI, amount of care provided, and leisure satisfaction. Regression was used to determine whether leisure satisfaction moderated the relationship between hours providing care per day and catecholamine levels. A significant interaction was found between hours caregiving and leisure satisfaction for NE, but not for EPI. Post hoc regressions were conducted for both NE and EPI. At low leisure satisfaction, time spent caring for a spouse was positively associated with plasma NE (β = .41; p = .005) and EPI (β = .44; p = .003). In contrast, at high levels of satisfaction, time caregiving was not significantly associated with plasma NE (β = −.08; p = .57) or EPI (β = .23; p = .12). These findings suggest that leisure satisfaction may protect caregivers from increases in catecholamines, which have been implicated in cardiovascular risk. Further support for these findings may impact psychological treatments for distressed caregivers.
leisure satisfaction; leisure activities; catecholamine; dementia caregiving; cardiovascular disease
To conduct ananalysis of the stress, coping, and mood consequences of Alzheimer’s caregiving.
Sample included 125 Alzheimer’s caregivers and 60 demographically similar older adults with non-demented spouses (i.e., non-caregivers).
We compared caregivers and non-caregivers on stress, coping, and mood outcomes. We also examined anti-depressant use within the caregiver sample. An emphasis was placed upon effect size differences, including Cohen’s d as well as more clinically meaningful effect sizes.
Caregivers were significantly more likely to endorse depressive symptoms and to meet clinically significant cutoff for depression (40% for caregivers; 5% for non-caregivers). Approximately 25% of caregivers reported taking anti-depressant medication, although 69% of these continued to experience significant symptoms of depression. Caregivers also utilized fewer positive coping and greater negative coping strategies relative to non-caregivers.
The number of caregivers will increase dramatically over the next two decades, and caregivers will likely seek care from primary care providers. We provide an overview of the psychological issues facing caregivers so that effective screening and treatment may be recommended.
Stress and depressive symptoms have been associated with impaired endothelial function as measured by brachial artery flow-mediated dilation (FMD), possibly through repeated and heightened activation of the sympathetic nervous system (SNS). Behavioral correlates of depression, such as satisfaction with leisure activities (i.e., leisure satisfaction), may also be associated with endothelial function via their association with depressive symptoms. This study examined the longitudinal associations between stress, depressive symptoms, leisure satisfaction, and endothelial function as measured by FMD.
Participants were 116 elderly Alzheimer’s caregivers (mean age = 74.3 ± 8.1; 68% female; 87% Caucasian) who underwent three yearly assessments of FMD, stress, depressive symptoms, and leisure satisfaction. Mixed regression analyses were used to examine longitudinal relationships between constructs of interest.
A significant and positive association was found between leisure satisfaction and FMD (p = .050), whereas a negative relationship was found for stress (p = .017). Depressive symptoms were not associated with FMD (p = .432). Time (p < .001) and the number of years caregiving (p = .027) were also significant predictors of FMD, suggesting that FMD decreased over time and was worse the longer a participant had been a caregiver prior to study enrollment.
These results suggest that behavioral correlates of depression (i.e., engagement in pleasurable activities) may be related to endothelial function in caregivers, and behavioral treatments for depression may be particularly useful in improving cardiovascular outcomes in caregivers.
Behavioral Activation; Depression; Flow-Mediated Dilation; Stress
Schizophrenia (SZ) and Bipolar Disorder (BD) are associated with multidimensional disability. This study examined differential predictors of functional deficits between the disorders.
Community dwelling individuals with SZ (N=161) or BD (N=130) were administered neuropsychological tests, symptom measures, performance-based social and adaptive (i.e., everyday-living skills) functional competence measures, and rated on domains of real-world functioning: 1) Community and Household activities, 2) Work skills, and 3) Interpersonal relationships. We used confirmatory path analysis to find the best fitting models to examine the direct and indirect (as mediated by competence) prediction of the three domains of real-world functioning.
In all models for both groups, neurocognition’s relationship with outcomes was largely mediated by competence. Symptoms were negatively associated with outcomes but unassociated with competence, with the exception of depression, which was a direct and mediated (through social competence) predictor in BD. In both groups, neurocognition was related to Activities directly and through a mediated relationship with adaptive competence. Work Skills were directly and indirectly (through mediation with social competence) predicted by neurocognition in SZ and entirely mediated by adaptive and social competence in BD. Neurocognition was associated with Interpersonal Relationships directly in the SZ group, and mediated by social competence in both groups.
Although there was greater disability in SZ, neurocognition predicted worse functioning in all outcome domains in both disorders. Our study supports the shared role of neurocognition in BD and SZ in producing disability, with predictive differences between disorders observed in domain-specific effects of symptoms and social and adaptive competence.
Neurocognitive deficits are common in bipolar disorder and contribute to functional disability. However, the degree to which general and specific cognitive deficits affect everyday functioning in bipolar disorder is unknown. The goal of this meta-analysis was to examine the magnitude of the effect of specific neurocognitive abilities on everyday functioning in bipolar disorder.
We conducted a comprehensive meta-analysis of studies that reported associations between performance on objective neuropsychological tasks and everyday functioning among individuals with bipolar disorder. From an initial pool of 486 papers, 22 studies met inclusion criteria, comprising a total of 1344 participants. Correlation coefficients were calculated for 11 cognitive domains and four measurement modalities for functioning. We also examined effect moderators, such as sample age, clinical state, and study design.
The mean Pearson correlation between neurocognitive ability and functioning was 0.27, and was significant for all cognitive domains and varied little by cognitive domain. Correlations varied by methods of everyday functioning assessment, being lower for clinician and self-report than performance-based tasks and real-world milestones such as employment. None of the moderator analyses were significant.
Overall, the strength of association between cognitive ability and everyday functioning in bipolar disorder is strikingly similar to that seen in schizophrenia, with little evidence for differences across cognitive domains. The strength of association differed more so according to functional measurement approach.
Bipolar disorder; disability; quality of life; functioning; neuropsychology; cognition
The stress associated with providing care for a spouse diagnosed with Alzheimer’s disease can have adverse effects on cardiovascular health. One potential explanation is that chronic caregiving stress may contribute to the development of atherosclerosis. The purpose of this study was to determine if the duration that one has provided care is associated with degree of atherosclerotic burden, as measured by carotid artery intima-media thickness (IMT). One hundred and ten Alzheimer caregivers (mean age 74 ± 8 years, 69% female) underwent in-home assessment of carotid artery IMT via B-mode ultrasonography. Data regarding medical history, blood pressure, and multiple indicators of caregiving stress were also collected. Multiple regression indicated that duration of care was positively associated with IMT measured in the internal/bifurcation segments of the carotid artery (β = 0.202, p = 0.044) independent of risk factors such as age, gender, body mass index, smoking history, sleep quality, hypertension status, and caregiving stressors. Duration of care was positively associated with IMT in the common carotid artery, but the relationship was not significant. These findings provide more evidence of the link between chronic caregiving stress and cardiovascular disease and suggest that enduring the experience of caregiving over a period of years might be associated with atherosclerotic burden.
Alzheimer’s disease; Atherosclerosis; Caregiving; Chronic Stress; Coronary Heart Disease; Intima-media thickness
To estimate the glomerular filtration rate (GFR) in relation to the chronic stress of dementia caregiving and major transitions in the caregiving situation.
We longitudinally assessed 119 elderly spousal Alzheimer’s disease (AD) caregivers and 58 non-caregiving controls for a period of up to three years (mean of 2.8 assessments per participant). Random regression models with fixed and time-variant effects for psychosocial factors, risk factors of chronic kidney disease, and caregiving transitions were used to evaluate changes over time in estimated GFR.
The change in GFR did not differ between caregivers and controls during follow-up (p=.77). Further analyses revealed that GFR declined disproportionately following placement of the spouse in a nursing home at 3 months post-placement (−4.9±2.2 mL/min/1.73m2; p=.03). Post hoc analyses showed that this effect was stronger in caregivers with hypertension compared to those without hypertension (−5.7±3.1 vs. −2.4±3.4 mL/min), as well as in caregivers with diastolic BP levels at 1 standard deviation above the mean than in those with diastolic BP levels at 1 standard deviation below the mean (−8.3±2.9 vs. −1.4±2.7 mL/min).
Kidney function did not differ between caregivers and controls over time. However, GFR had impaired at 3 months after a major caregiving transition. As the effect of placement of the AD spouse on the decline in GFR was moderated by BP, it might be confined to caregivers who experience increased sympathetic activation post-placement.
Blood pressure; caregivers; dementia; kidney disease; psychological stress
This study tested a model for explaining how stress is associated with depressive symptoms in a sample of spouse caregivers of patients with Alzheimer’s disease. It was hypothesized that more depressive symptoms would be significantly correlated with both “primary” caregiver stressors (i.e., care recipient problem behaviors) and “secondary” stress (i.e., role overload), but that this relationship would be significantly mediated by 4 variables: a) personal mastery, b) coping self-efficacy, c) activity restriction, and d) avoidance coping.
We used an asymptotic and resampling strategy for simultaneously testing multiple mediators of the stress-to-depressive symptoms pathway.
Greater stress was significantly related to more depressive symptoms. Increased stress was also associated with reduced personal mastery and self-efficacy, as well as increased activity restriction and avoidance coping. Finally, these four mediators accounted for a significant amount of the relationship between stress and depressive symptoms.
These results suggest multiple pathways by which both primary and secondary caregiver stresses may be associated with increased depressive symptoms, and may argue for multiple treatment targets for caregiver interventions.
Alzheimer’s Disease; Depression; Coping; Behavioral Activation; Self Efficacy; Stress-Process
Providing care to a spouse with Alzheimer’s disease (AD) may contribute to cardiovascular disease (CVD). The acute phase reactant C-reactive protein is a well-established biomarker of an increased CVD risk.
To investigate the hypothesis that dementia caregiving is associated with elevated circulating levels of CRP and possibly other biomarkers of CVD risk.
We examined 118 elderly spousal Alzheimer caregivers and 51 non-caregiving controls about once a year for up to three years. Random regression models with fixed and time-variant effects for a range of covariates known to affect biomarker levels were used to evaluate changes in CRP and in twelve additional measures of inflammation, cellular adhesion, endothelial function, and hemostasis in relation to caregiving status, years of caregiving, and major transitions in the caregiving situation.
During the study period longer duration of caregiving was associated with elevated CRP levels (p=0.040) and caregivers showed greater tumor necrosis factor alpha (TNF-α) levels than controls (p=0.048). Additionally, three months after the death of the AD spouse, caregivers showed a significant drop in CRP levels (p=0.003) and also in levels of soluble intercellular adhesion molecule (sICAM)-1 (p=0.008).
Duration of caregiving, and being a caregiver per se, were both associated with chronic low-grade inflammation as indicated by elevated CRP and TNF-α levels, respectively. Conversely, death of the AD spouse was associated with lower CRP and sICAM-1 levels. The findings indicate that chronic caregiving of those with dementia may result in increased inflammation and thereby, possibly increased CVD risk.
Alzheimer disease; biomarkers; cardiovascular disease; caregiver; cytokines; inflammation; psychological stress
Behavioral activation and avoidance are well studied in depression, yet the relationship of these constructs to symptoms, cognitive ability and functioning in schizophrenia is poorly understood. In a sample of 73 middle-aged and older outpatients with schizophrenia (mean age=50.3, sd=6.3), we examined the relationship of the Activation and Avoidance subscales of the Behavioral Activation for Depression Scale with measures of psychopathology (Positive and Negative Symptoms, Depression), global cognitive ability, and global cognitive ability, and functioning (observer-rated, performance-based, and subjective functioning). Neither activation nor avoidance related to sociodemographic variables, age of onset, or anti-psychotic dose. Although activation and avoidance were significantly inter-correlated, only behavioral activation was significantly associated with depression and subjective functioning, whereas only avoidance related to negative symptoms. Avoidance accounted for significant variation in observer-rated functioning after adjusting for cognitive ability. These results suggest that activation and avoidance may be important therapeutic targets in schizophrenia, with somewhat divergent pathways among psychopathologic features to functional impairment.
Schizophrenia; psychosis; activation; avoidance; depression; functioning
Schizophrenia is a highly debilitating illness that often results in disruption to independent living and employment. However, “gold standard” methods of assessing functional abilities to achieve these milestones are still lacking. In a sample of 367 individuals with schizophrenia, we examined the sensitivity and specificity of the Brief UCSD Performance-based Skills Assessment (UPSA-B) to predict both residential and employment status. Of all individuals residing independently, 75.9% scored 78 or above on the UPSA-B, and of all individuals not residing independently, 59% scored below 78 on the UPSA-B. Of individuals who were employed, 73.9% scored above 82 on the UPSA-B, and of those not employed, 57.8% scored below 82. These results expand upon both the population base and functional milestones with which the UPSA-B is validated, although future work should examine whether the UPSA-B can be used as a decision aid in the likelihood of success in a longitudinal study, such as at critical transitions (post-hospitalization, cessation of supported housing).
Psychosis; Functional Capacity; Functioning; Employment; Independence; Well-being
Alzheimer’s Disease (AD) caregiving stress may contribute to increased cardiovascular disease risk in spousal caregiving through physiological changes characteristic of the metabolic syndrome (MetS).
We tested the hypothesis that cardiometabolic risk is attenuated when caregivers are relieved from caregiving stress when the caregiving recipient transitions out of the home.
One hundred and nineteen spousal caregivers of a patient with AD and 55 non-caregiving controls (mean age 75±8 years of entire sample, 68% women).
Participants underwent up to three yearly assessments of MetS factors related to adiposity, dyslipidemia, hypertension, and hyperglycemia. Changes in the total number of MetS factors (range 0–5) at 3 months after caregiver transitions were evaluated using random regression models with fixed and time-variant effects for sociodemographic and health-related covariates.
Compared to non-caregivers, caregivers had a greater number of MetS factors over time (1.78±0.13 vs. 1.36±0.18, p=0.008), which, after the death of the spouse, dropped by 0.46±0.16 (p=0.003) being no longer different from non-caregivers; this effect was most prominently related to decreases in triglycerides (−22.2±11.0 mg/dl, p=0.032), systolic BP (−6.2±2.6 mmHg, p=0.019), and diastolic BP (−3.4±1.5 mmHg, p=0.026). Placement of the spouse decreased the number of MetS factors only in caregivers with lower levels of depressive symptoms (−0.48±0.18, p=0.010) and sleeping difficulties (−0.42±0.18, p=0.021), but not in caregivers with higher levels in these measures at post-placement.
Elevated cardiometabolic risk in caregivers decreased to the level of non-caregivers within three months of death of the AD spouse. Placement, a transition in the course of dementia caregiving, however, did not benefit cardiovascular health in highly distressed caregivers.
Cardiovascular disease; caregivers; dementia; metabolic syndrome; psychological stress
Sleep disturbance is a common consequence of providing care to a loved one with Alzheimer’s Disease (AD). We explored the usefulness of the Pleasant Events and Activity Restriction (PEAR) model for predicting multiple domains of sleep disturbance.
Our sample consisted of 125 spousal Alzheimer’s disease (AD) caregivers. Participants completed the Pittsburg Sleep Quality Index (PSQI) and were queried regarding the frequency with which they engage in pleasant events and the extent to which they felt restricted in engaging in social and recreational activities in the past month. Participants were classified into one of three groups: HPLR = High Pleasant Events + Low Activity Restriction (i.e., reference group; N = 38); HPHR/LPLR = Either High Pleasant Events + High Activity Restriction or Low Pleasant Events + Low Activity Restriction (N = 52); and LPHR: Low Pleasant Events + High Activity Restriction (N = 35). These three groups were compared on the 7 subscales of the PSQI.
Significant differences were found between the HPLR and LPHR groups on measures of subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, and daytime dysfunction. Additionally, significant differences were found between the HPLR and HPHR/LPLR groups on subjective sleep quality, sleep latency, and habitual sleep efficiency, and between the HPHR/LPLR and LPHR groups on sleep disturbance and daytime dysfunction.
This study provides broad support for the PEAR model and suggests that interventions focusing on behavioral activation may potentially provide benefits to non-affective domains including sleep.
Behavioral Activation; Sleep Quality; Dementia; Stress
Depression commonly occurs in conjunction with a variety of medical conditions. In addition, family members who care for patients with medical diagnoses often suffer from depression. Therefore, in addition to treating illnesses, physicians and other healthcare professionals are often faced with managing secondary mental health consequences. We conducted a systematic review and meta-analysis of the association between activity restriction and depression in medical patients and their caregivers. A total of 34 studies (N = 8,053) documenting the relationship between activity restriction and depression were identified for the period between January 1980 and June 2010. Effect sizes were calculated as Pearson r correlations using random-effects models. The correlation between activity restriction and depression was positive and of large magnitude (r = 0.39; 95% CI, .34–.44). Activity restriction was most strongly correlated with depression in medical patients (r = 0.45; 95% CI, 0.42–0.48), followed by caregivers (r = 0.34; 95% CI, 0.28–0.41) and community-dwelling adults (r = 0.28; 95% CI, 0.25–0.31). Activity restriction associated with medical conditions is a significant threat to well-being and quality of life, as well as to the lives of their caregivers. Assessment and treatment of activity restriction may be particularly helpful in preventing depression.
Depression; Activity Restriction; Chronic disease; Older adults; Aging; Behavioral Activation; Behavior Therapy
Objective. To investigate the relationship between coping and atherothrombotic biomarkers of an increased cardiovascular disease (CVD) risk in the elderly. Methods. We studied 136 elderly caregiving and noncaregiving men and women who completed the Ways of Coping Checklist to assess problem-focused coping, seeking social support (SSS), blamed self, wishful thinking, and avoidance coping. They had circulating levels of 12 biomarkers measured. We also probed for potential mediator and moderator variables (chronic stress, affect, health behavior, autonomic activity) for the relation between coping and biomarkers. Results. After controlling for demographic and CVD risk factors, greater use of SSS was associated with elevated levels of serum amyloid A (P = 0.001), C-reactive protein (CRP) (P = 0.002), vascular cellular adhesion molecule (VCAM)-1 (P = 0.021), and D-dimer (P = 0.032). There were several moderator effects. For instance, greater use of SSS was associated with elevated VCAM-1 (P < 0.001) and CRP (P = 0.001) levels in subjects with low levels of perceived social support and positive affect, respectively. The other coping styles were not significantly associated with any biomarker. Conclusions. Greater use of SSS might compromise cardiovascular health through atherothrombotic mechanisms, including elevated inflammation (i.e., serum amyloid A, CRP, VCAM-1) and coagulation (i.e., D-dimer) activity. Moderating variables need to be considered in this relationship.
The recent aging trend in the United States has resulted in an exponential growth in the number of informal dementia caregivers. Caring for a family member with dementia has been associated with negative health outcomes likely associated with physiologic changes resulting from stress. Yet caregiving is not always associated with health morbidity. In this review, we highlight resilience factors that appear to have a beneficial relationship with health outcomes. We highlight eleven studies that examined the relationship of one of three broad resilience domains (personal mastery, self-efficacy, and coping style) to caregiver health outcomes. Our main findings were that higher levels of personal mastery and self-efficacy, and increased use of positive coping strategies appear to have a protective effect on various health outcomes in dementia caregivers. Continued research is warranted to help guide prospective directions for caregiver interventions focusing on increasing caregiver resilience and the corresponding impact on caregiver health.
Biomarkers; caregivers; resilience; health; coping; stress; morbidity
This study examined attitudes about condoms as a moderator of the relationship between methamphetamine use and sexual risk behavior in a sample of 297 HIV-positive, methamphetamine-using men who have sex with men (MSM). To test for a moderating effect of attitudes towards condoms, an interaction term was included in multiple regression analysis along with age, income, negative condom attitudes, frequency of methamphetamine use, and Beck depression score. A post hoc analysis was conducted to determine the relations between methamphetamine use and unprotected sex for persons with more vs. less negative attitudes toward condoms. These analyses indicated that when individuals had more negative attitudes toward condoms, the relation between methamphetamine frequency and unprotected sex was significant, while among participants with less negative attitudes toward condoms, no significant association was found. Addressing methamphetamine-using MSM's attitudes about condoms can serve as a form of harm reduction for those who are not yet ready or willing to discontinue methamphetamine use.
Methamphetamine; Attitudes; Condoms; Sexual risk; Men who have sex with men
This study examined an activity restriction/pleasurable activities mismatch model for psychosocial and health-related outcomes. A total of 108 spousal caregivers of patients with Alzheimer’s Disease (AD) were assessed for their experience of social and recreational activities over the past month as well as their perception of how restricted they were for engaging in social and recreational activities. Participants were divided into three groups based on their reported activities and activity restriction: HPLR = High Pleasant Events + Low Activity Restriction (i.e., reference group; N = 28); HPHR/LPLR = Either High Pleasant Events + High Activity Restriction or Low Pleasant Events + Low Activity Restriction (N = 43); LPHR = Low Pleasant Events + High Activity Restriction (N = 37). We hypothesized that participants reporting low pleasant events combined with high activity restriction (LPHR) would demonstrate greater disturbance relative to other two groups in multiple outcome domains including: a) greater mood disturbance, b) greater use of negative coping factors, c) reduced use of positive coping strategies, d) reduced report of psychological resource factors (e.g., personal mastery, self-efficacy), and increased report of subjective health difficulties (e.g., sleep disturbance). Results generally supported our hypotheses, suggesting that assessment of both constructs is important for best predicting quality of well-being in AD caregivers, and potentially for establishing maximal effect in behavior therapy for caregivers.
Behavioral Activation; Activity Restriction; Alzheimer’s Disease; Well-Being; Coping
The pro-inflammatory cytokine interleukin (IL)-6 has been linked with health morbidity, particularly risk for cardiovascular disease. The purpose of this study was to investigate the potential protective role of coping self-efficacy on the relationship between caregiving stress and circulating concentrations of IL-6.
A total of 62 elderly Alzheimer’s caregivers (mean age = 74 years) were assessed for plasma concentrations of IL-6, caregiving-related overload, and coping self-efficacy. Multiple regression was used to examined the main effects of stress and self-efficacy, as well as the interaction between stress and self-efficacy, in predicting plasma IL-6 after controlling for age, gender, resting blood pressure, and obesity.
There was a significant interaction between stress and self-efficacy in predicting IL-6. Post-hoc examination indicated that when self-efficacy was low, stress was significantly related to IL-6 (β = .43). However, when self-efficacy was high, stress was not significantly related to IL-6 (β = -.10).
Caregiving stress in combination with low coping self-efficacy is significantly related to IL-6, a known risk marker for health morbidity, particularly CVD. However, stress was not associated with IL-6 with high self-efficacy. While limited and preliminary, these results point to a potential protective effect of self-efficacy on caregiver health that can be tested in longitudinal studies.
Coping; Personal Control; Cardiovascular Disease; Inflammation; Elderly
Much research has focused on behavioral activation and its effect on depression, but less is known about the effects of leisure activities on the two distinct affective domains of depression: positive affect (PA) and negative affect (NA). Furthermore, individual factors (i.e., stress level) may moderate the impact of behavioral activation on affect. The present study utilized a daily diary approach to examine the moderating effect of stress on the relationship between leisure satisfaction and both PA and NA. Twenty-five dementia caregivers completed activity and affect measures four times daily for 14 days. Results were analyzed using multilevel modeling, an approach that considers intra-individual differences in activity and affect over time. Results supported the hypothesis that caregivers with higher burden display a stronger association between leisure satisfaction and affect than caregivers with lower burden. Specifically, caregivers with higher burden had a stronger positive relationship between leisure satisfaction and PA and a stronger negative relationship between leisure satisfaction and NA. These findings suggest that screening caregivers for level of burden may help identify those most likely to benefit from behavioral interventions.
Stress; mood; behavior therapy; behavioral activation; depression
This study aimed to determine if Alzheimer caregivers have increased allostatic load compared to non-caregivers. Potential psychological moderators (mastery, depression, and role overload) of the relationship between caregiving status and allostatic load were also explored. Eighty-seven caregivers and 43 non-caregivers underwent biological assessment of allostatic load and psychological assessments. Caregivers had significantly higher allostatic load compared to non-caregivers(p<.05). Mastery, but not depression and overload, moderated the relationship between caregiving status and allostatic load. In conclusion, allostatic load may represent a link explaining how stress translates to downstream pathology, but more work is necessary to understand the role of psychological factors.
allostatic load; Alzheimer’s disease; caregiving; chronic stress; coping
Dementia caregivers have an increased risk of cardiovascular disease (CVD), and it is possible that metabolic disturbances contribute to this risk. Regular physical exercise reduces cardiometabolic risk, but caregivers may have less opportunity to engage in such activity. We hypothesized that regular physical activity would moderate cardiometabolic risk in dementia caregivers.
115 Alzheimer’s caregivers and 54 non-caregiving controls were assessed for medical history and health habits. Physical activity was defined as the number of days per week participants performed light (score 0–4), moderate (score 0–4), or vigorous (score 0–4) exercise (total score 0–12). A cardiometabolic risk score was calculated by adding standardized z-scores of five metabolic syndrome (MetS) components: body mass index, triglycerides, high-density lipoprotein cholesterol, systolic blood pressure and glucose.
Caregivers were less physically active than non-caregivers (5.1±3.0 vs. 6.3±2.7, p=0.008). A significant caregiver status-by-physical activity interaction was found for the standardized cardiometabolic risk score controlling for gender, age, education, smoking, alcohol consumption, health problems, cholesterol-lowering medication, negative affect, role overload, and fasting state (p=0.035). Among participants with low levels of physical activity, caregivers had greater cardiometabolic risk score than non-caregivers (0.58±0.31 vs. −1.23±0.54, p=0.017); no group difference emerged in participants with high levels of physical activity (p=0.81).
Cardiometabolic risk was particularly high in caregivers reporting reduced level of regular physical activity. Intervention studies aimed at increasing physical activity in caregivers seem warranted to examine whether that would possibly lower cardiometabolic risk to the level of non-caregivers.
Alzheimer’s disease; cardiovascular disease; exercise; metabolic syndrome; psychological stress
To examine whether increased self-efficacy for using problem-focused coping was significantly related to several resting blood pressure measures in spousal Alzheimer’s disease caregivers.
Participants included 100 older caregivers (mean age= 73.8 ± 8.14 years) providing in home care for a spouse with Alzheimer’s disease (AD). All participants completed a 13 item short form of the coping self-efficacy scale and underwent an in-home assessment where a visiting nurse took the average of three serial blood pressure readings. Multiple regression was used to examine the relationship between self-efficacy and mean arterial pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) after controlling for age, gender, smoking history, body mass index, the care recipient’s clinical dementia rating (CDR), diabetes, alcohol use, and the use of anti-hypertensive medications.
Overall, increased self-efficacy (as measured by the Coping Self-efficacy scale) was significantly related to lower resting MAP (β = −.26, t(90) = −2.47, p = .016) and SBP (β=−.28, t(90)= −2.74, p= .007) . Self-efficacy was marginally associated with resting DBP, but not significant (β = −.20, t(90) = −1.91, p= .06). Lastly, self-efficacy was significantly related to pulse pressure (β = −.21, t(90) = −2.31 p= .023). In addition, 1 standard deviation increase in self-efficacy was associated with a decrease of approximately 4 mmHg in SBP.
These results suggest an association between high self-efficacy on resting blood pressure. Because psychosocial interventions for Alzheimer’s caregivers have potential to increase self-efficacy, it appears possible that these interventions could have a beneficial impact on caregivers’ cardiovascular function.
self-efficacy; caregiver; coping; blood pressure; Alzheimer’s
The present investigation examined the validity of a new cognitive test intended to assess organizational skills. Participants were 180 middle-aged or older participants with a DSM-IV diagnosis of schizophrenia or schizoaffective disorder. Participants’ organizational skills were measured using our newly developed UCSD Sorting Test (U-SORT); a performance-based test of organizational ability in which subjects sort objects (e.g., battery, pens) from a “junk drawer” into “keep” vs. “trash” piles. Significant correlations between U-SORT scores and theoretically similar constructs (i.e. functional capacity, cognitive functioning, and clinical symptoms), were acceptable (mean r = |.34|), and weak correlations were found between U-SORT scores and theoretically dissimilar constructs (e.g., health symptoms, social support, gender; mean r = |.06|). The correlation between assessment scores provides preliminary support for the U-SORT test as a brief, easily transportable, reliable and valid measure of functioning for this population.
Organizational skills; performance-based tests; schizophrenia and schizoaffective disorder; functional capacity
The current study explored the relationship between three dimensions of religiosity: (a) organizational religiosity (e.g. attendance at religious events), (b) non-organizational religiosity (e.g. prayer), and (c) subjective religiosity (e.g. importance of religion) and caregiver health behavior patterns in a sample of Latina and Caucasian female caregivers of older adult relatives with dementia. It was hypothesized that religiosity would have a significant association with reduced cumulative health risk as determined by an index of health behaviors. It was also hypothesized that, when examining the individual health behaviors subsumed in the overarching index, religiosity would be positively associated with adaptive health behaviors like exercise and negatively associated with health risk behaviors like smoking. Amongst Caucasians, increased subjective religiosity was related to increased cumulative health risk. Conversely, in Latinas, non-organizational religiosity was positively correlated with improved dietary practices (reduced dietary restriction). Increased levels of subjective religiosity were significantly associated with decreased maintenance of a routine exercise regimen across ethnic groups. Recommendations for clinicians and religious leaders, and avenues of future research are discussed.
caregiver; health behaviors; religiosity; Alzheimer’s disease; stress/burden; physical health measures