Alzheimer's Disease (AD) is characterized by progressive cognitive and behavioral impairment. Over time, the patient is less able to care for him/herself, becoming more restricted to the home and the psychosocial environment of the caregiver (usually a spouse). As such, the patient's functioning may increasingly reflect the functioning of his or her spouse caregiver. Conversely, increased cognitive and behavioral decline in the patient may result in increased burden in the caregiver. This vicious cycle may lead to patient decline beyond that due to neuronal degeneration. At present, we know relatively little about how initial patient-caregiver dynamics affect long term outcomes. In our progress report we use a theoretical distress model to examine these issues. We demonstrate that caregiver risk (personality, health, distress) and resource (coping, social supports) variables at baseline predict subsequent caregiver burden, patient activities of daily living (ADLs), and nursing home placement. The proposed study will extend this work by interviewing our surviving couples twice (15-18 months apart) over the next 3 years. Although 71 couples are now available for follow-up, our power estimates have been evaluated downward from this figure because of expected attrition between now and the anticipated start date. Three hypotheses will be tested: 1) Caregivers who are most vulnerable to distress at baseline will report the most burden at follow-up; 2) AD patients living with caregivers who are the most vulnerable to distress and have the fewest resources at baseline, will have the lowest ADL levels at follow-up; 3) Caregivers who are more vulnerable to distress at baseline will, over time, admit their AD spouses into nursing homes at a higher rate than caregivers who are less vulnerable to distress. In each analysis, we will control for patient ADL levels and caregiver burden at baseline. Results of this research should have implications for public policy and intervention with caregivers of AD patients.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG010760-03
Application #
3122723
Study Section
Life Course and Prevention Research Review Committee (LCR)
Project Start
1991-09-30
Project End
1995-08-31
Budget Start
1993-09-01
Budget End
1994-08-31
Support Year
3
Fiscal Year
1993
Total Cost
Indirect Cost
Name
University of Washington
Department
Type
Schools of Medicine
DUNS #
135646524
City
Seattle
State
WA
Country
United States
Zip Code
98195
Caswell, Lisa W; Vitaliano, Peter P; Croyle, Kristin L et al. (2003) Negative associations of chronic stress and cognitive performance in older adult spouse caregivers. Exp Aging Res 29:303-18
Vitaliano, Peter P; Zhang, Jianping; Scanlan, James M (2003) Is caregiving hazardous to one's physical health? A meta-analysis. Psychol Bull 129:946-72
Vitaliano, Peter P; Scanlan, James M; Zhang, Jianping et al. (2002) A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med 64:418-35
Zhang, J; Vitaliano, P P; Lutgendorf, S K et al. (2001) Sense of coherence buffers relationships of chronic stress with fasting glucose levels. J Behav Med 24:33-55
Scanlan, J M; Vitaliano, P P; Zhang, J et al. (2001) Lymphocyte proliferation is associated with gender, caregiving, and psychosocial variables in older adults. J Behav Med 24:537-59
Siegler, I C; Vitaliano, P P (1998) Introduction to the special section: in search of a double paradigm. Health Psychol 17:483-5
Vitaliano, P P; Scanlan, J M; Siegler, I C et al. (1998) Coronary heart disease moderates the relationship of chronic stress with the metabolic syndrome. Health Psychol 17:520-9
Scanlan, J M; Vitaliano, P P; Ochs, H et al. (1998) CD4 and CD8 counts are associated with interactions of gender and psychosocial stress. Psychosom Med 60:644-53
Vitaliano, P P; Scanlan, J M; Ochs, H D et al. (1998) Psychosocial stress moderates the relationship of cancer history with natural killer cell activity. Ann Behav Med 20:199-208
Vitaliano, P P; Russo, J; Scanlan, J M et al. (1996) Weight changes in caregivers of Alzheimer's care recipients: psychobehavioral predictors. Psychol Aging 11:155-63

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