Physiological Stress and Health Outcomes in Frail Elder*

Freedman, Vicki

Abstract

This pilot research project provides for new Data Collection in Population Aging (topic #21). Specifically, the pilot data will enhance our understanding of a previously unstudied aspects of biodemography and population aging: the link between physiological reactions to stress and subsequent health outcomes among physically and cognitively frail elderly persons. The new data collection effort will take advantage of a unique, naturally occurring, experimental design: the relocation of approximately 225 residents of the Philadelphia Geriatric Center from its existing nursing home to a new facility. Resident will be moved in two randomly assigned groups, one in the fall of 2001 and the second in the spring of 2002. The second group of movers will serve as the control group for the first. To evaluate the physiological reaction to this external challenge, we will obtain 10,000 saliva specimens (from both the experimental and control groups) over an eight-month period before and after the fall move. In addition, observational and interview-based measures of cognitive and psychosocial functioning and other psysiological measures will be collected multiple times before and after the fall move. Comparisons of diurnal patterns of salivary cortisol between experimental and control groups over time will allow us to evaluate the physiological reaction of an extremely frail population to environmental stress. We will also explore how the reaction is mediated by internal and external coping resources. The repeated collection of saliva samples, observation, interview data, and other physiological measures, before and after the move, coupled with planned follow-up linkages to medical, pharmaceutical, and administrative records, will provide a rich and highly unique data set for further analyses of 1) the role of salivary cortisol in predicting mortality and health outcomes within a frail elderly population; 2) the usefulness of a comprehensive measure of cumulative wear-and -tear on the body in predicting mortality and health outcomes in a frail elderly population; and 3) a follow-up intervention designed to alleviate physiological stress for an additional group of movers.