Many patients with AD 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. The long- term effects of caregiving stress after patients death, nursing home placement, or continual caregiving, are poorly understood, particularly among African-American caregivers. 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,a the project will conduct longitudinal follow-ups of samples of White caregivers (demographically matched with White noncaregiving controls) African=American caregivers (demographically matched with White noncaregiving controls) and African-American caregivers (demographically matched with African-American noncaregiving controls). Most of these subjects have already been recruited, but 80 additional subjects will be added to the sample during the first two years of the proposed project. Data from these individuals will be collected on an annual basis over athe 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 patients death or institutionalization. Longitudinal follow-up procedures have already been successfully established and pilot data is available from the ongoing caregiver research study. This data will provide information relevant to: 1) the longitudinal effects of the stress of continued caregiving on caregiver psychosocial and health outcomes among African-American and White families, beyond those experienced by 2) ascertaining prospectively the long-term effects of nursing home placement and patient death on caregiver adjustment, and 3) exploring variables which predict individual differences in caregiver adjustment, and 3) exploring variables which predict individual differences in caregiver adjustment over time, including severity of patient impairment and stressful life events, appraisal, social support, and coping. The emphasis on assessing the special strengths and problems experienced by African-American families, and the long-term course of caregiving stress among African-American and White families, will be of particular importance.
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