Studies have shown that caregivers to elderly persons are stressed, but no study has assessed whether caregiving is more stressful for one caregiving situation than another, the factors that make it more stressful, or the relative risk of stress among caregivers to elderly with different caregiving needs. The proposed study will evaluate the risk factors, relative risks, and outcomes of stress among caregivers to elderly persons with dementia, frail elderly, and stroke, compared to a control group. Patients will be recruited from clinical sites in Baltimore, MD: the Bon Jecours Hospital; the Supportive Care and Acute Rehabilitation Units at James L. Kernan Hospital; and Washington Village Medical Center (controls). Patients will be eligible if they are 55+ years, being discharged to the community, have a designated caregiver and an admission diagnosis of: dementia, conditions indicative of frail elderly, or stroke. A caregiver will be defined as a non-paid adult who is available to assist the patient to ensure that daily needs are met. Patients will be recruited consecutively until 85 patient-caregiver pairs are included in each of the 4 groups, for a total of 340 patients and 340 caregivers. Data on patients and caregivers will be collected through interviewer- administered questionnaires. Patients and caregivers will be interviewed 4 times, at six month intervals over a 2-year period. The questionnaire contains standardized measures of stress (Perceived Stress Scale), burden (Burden Interview), depression (Geriatric Depression Scale), health and mental status, and other factors that might be associated with caregiver stress. The status of respondents who do not participate in follow-up interviews will be obtained, including mortality status, nursing home placement, and other reasons for non-participation. Cross-sectional, multiple logistic regression, and longitudinal analyses will be performed to test hypotheses comparing the prevalence, 6- and 12- month incidence of stress (measured by the Perceived Stress Scale) in caregivers to elderly with dementia, recent stroke, and frail elderly, compared to controls. These analyses will evaluate associations between patients' caregiving needs (e.g., ADL needs and cognitive impairment), caregiver tasks (e.g., performance of ADLs, hours per day provides care), and situational factors (e.g., living arrangement, social support) with caregiver stress. Additional analyses will investigate: how caregiver stress changes, based on changes in patient caregiving needs (e.g., ADL needs, cognitive status) and caregiver tasks; and relationships among caregiver stress, burden, and depression over time. This study will lay the groundwork for methodologic and intervention studies to prevent and reduce stress and other adverse outcomes of caregiving to elderly persons.
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