Many patients with Alzheimer's disease are cared for in the community by their family members, and these family caregivers are at risk for negative psychosocial and health consequences due to the chronic stress experienced. Relatively understudied issues include the longitudinal course of caregiver stress and coping, and individual differences which influence caregiver long-term adjustment. The present project will utilize a stress and coping model to study the psychosocial and health consequences of caregiving, with special emphasis on racial differences and the longitudinal course of caregiver adjustment. Specifically, the project will recruit samples of 100 white caregivers demographically matched with 100 white noncaregiving controls, and 80 black caregivers demographically matched with 80 black noncaregiving controls, and collect data from these individuals on an annual basis over the course of the project with a battery of measures assessing caregiver psychological, social, and health adjustment, stressful life events, patient objective impairment and caregiver appraisal, and caregiver coping responses. Additional specialized assessments will be done in the event of patient death or institutionalization. This data will provide information relevant to: 1) the effect of the stress of caregiving on caregiver psychosocial and health outcomes among black and white families, beyond those experienced by appropriate controls, 2) the longitudinal pattern of negative effects on the caregiver, e.g. whether """"""""wear and tear"""""""" versus adaptation occur over time, 3) variables which predict individual differences in caregiver adjustment over time, including severity of patient impairment and stressful life events, appraisal, social support, and coping variables, 4) assessing whether long-term patient outcomes (nursing home placement and death) are related to caregiver stress and coping, and 5) ascertaining prospectively the effects of nursing home placement and patient death on caregiver adjustment. The data will provide information relevant to clinicians involved in the management of dementia patients and their families, policy makers concerned with addressing the needs of caregivers, and researchers interested in stress and coping processes. The emphasis on assessing the special strengths and problems experienced by black families, and the long-term course of caregiving stress among black and white families, will be of particular importance.
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