This proposal is for the continuation of the study, """"""""sources and Mediators of Alzheimer's Caregiver Stress"""""""". A sample of 555 spousal and adult-child caregivers to people with Alzheimer's or a related cognitive disorder was recruited from the rosters of the Bay Area and Los Angeles Alzheimer's Disease and Related Disorders Associations. Beginning in 1988, they have been interviewed three times at yearly intervals, with about 5% attrition at each wave. Three additional waves and four more years of support are requested in this proposal. At the core of the initial investigation was an interest in elucidating the stress process as it is intertwined with caregiving to a demented relative. Because caregiving activities are potential sources of enduring demand and hardship, they are quintessential chronic stressors. Consequently, they provide the opportunity to observe in an important population the long-term consequences of such stressors as well as caregivers' attempts to deal with the stressors. Although the elucidation of the stress process will remain central in the continuing study, we are now in a position to approach it in a more elaborated fashion. At the time of the first interview, all caregiving was provided in the home. Subsequently, there was a natural division of the sample into three groups: those who continue to provide home care, those who have placed their relatives in institutions, and those who are bereaved as a result of the death of their impaired relatives. The rationale for the proposed continuation to a large extent rests on this division. Specifically, it has prompted us to recognize caregiver careers, which begin with the onset of caregiving and, for most, extend through placement, death, bereavement, and recovery. Thus, we propose to examine the entirety of this career trajectory, examining the impact of transitions across its components or stages and the conditions that influence this impact, especially conditions indicative of stressors. We shall also focus on the emergence of stress full conditions within each of the three major stages of the career. The extension of the current work to include, in all, six waves in a five year period is appropriate to the new aims that have grown out of the original investigation.
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