The rate of Alzheimer?s Disease and related dementias (AD/ADRD) is nearly twice as high among African Americans when compared to Whites. African Americans are more likely than others to age with ADRD in the community and rely heavily on family members or other informal sources for support. African American caregivers spend more time providing care than their White counterparts, and report need for daytime respite care. The greater time spent providing care to relatives and unmet need for respite services may accelerate aging and the negative health effects of stress associated with caregiving among African Americans. Adult day services (ADS) may offer respite to alleviate caregiving-related stressors among African American dementia caregivers. Adult day services offer community-based, out-of-home, supervised support for persons with dementia. Guided by the NIH-Stage Model, this NIA-K01 award will allow completion of the initial stage of the model to identify the mechanisms which ADS influence caregiving-related stressors and needs for African American ADRD caregivers. A convergent parallel mixed methods design will be used.
The aims will employ quantitative methods of survey assessment of psychosocial stress (caregiver stress, perceived stress), the collection of salivary biologics (Alpha-Amylase, dehydroepiandrosterone sulfate, cortisol and telomere length) to assess physiological stress, and descriptive interviews and daily diaries to explore African American caregivers? daily stressors, health seeking and coping behaviors. Over a 5-day period, 50 African American caregivers? will be asked to keep a daily diary of stressful events they encounter during the day, and strategies used to manage stress. During this period, the caregivers will also be asked to self-collect salivary biomarkers four times a day (upon waking, 30-minutes are waking, before dinner, and bedtime) for five consecutive days (20 samples per caregiver), to include at least two days of ADS use and a weekend day. Descriptive interviews will also be used to elicit caregivers? experiences with daily stressors and coping behaviors. The specific research aims of this study are focused on African American ADRD caregivers, who utilize ADS at least twice a week for a person with dementia. The three specific aims are to: 1) Identify daily stressors, health seeking and coping behaviors among African American dementia caregivers, 2) Identify the association between caregiver stress and physiological stress, and 3) Evaluate diurnal patterns in physiological stress on ADS vs non-ADS day usage. Outcomes of this proposed project will inform a R01 award to develop a culturally-tailored stress reduction intervention for African American dementia-caregivers at the ADS site, to be submitted during year 4. The candidate?s training plan capitalizes on the expertise of a diverse mentoring team, and lays out a comprehensive plan to gain training in mixed-methods, intervention development, and the integration of physiological indicators of stress into dementia-related research.
The focus of the proposed study contributes to National Institute on Aging?s goals of promoting research that utilizes multilevel approaches to elucidate mechanisms that contribute to health disparities in Alzheimer?s disease and related disorders (ADRD), and to identify malleable targets for interventions to ameliorate health disparities. Guided by the NIH-Stage Model, this study will complete the initial stage of the model to identify the mechanisms which ADS influence caregiving-related stressors and needs for African American dementia caregivers. Findings from the study will be used to inform the development of a culturally-tailored stress reduction intervention for African American dementia caregivers.
