Life stress, mood disturbance, and elevated interleukin-6 in healthy older women. A High Sense of Coherence as Protection Against Adverse Health Outcomes in Patients Aged 80 Years and Older Effect of Alzheimer Caregiving on Circulating Levels of C-Reactive Protein and Other Biomarkers Relevant to Cardiovascular Disease Risk: A Longitudinal Study Patient and caregiver characteristics and nursing home placement in patients with dementia. Accelerated risk of hypertensive blood pressure recordings among Alzheimer caregivers. A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP). Spousal Caregivers of Patients With Alzheimer's Disease Show Longitudinal Increases in Plasma Level of Tissue-Type Plasminogen Activator Antigen Cognitive–behavioural group therapy improves a psychophysiological marker of stress in caregivers of patients with Alzheimer's disease Exaggerated Plasma Fibrin Formation (D-Dimer) in Elderly Alzheimer Caregivers as Compared to Noncaregiving Controls Caregiving and risk of coronary heart disease in U.S. women: a prospective study. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials Pilot controlled trial of mindfulness meditation and education for dementia caregivers.
BACKGROUND Although adverse effects of severe chronic stress on immunocompetence and physical well-being in older adults have been reported , the immune response to less severe life stress among healthy older adults , particularly among women , is not well understood . Interleukin-6 ( IL-6 ) has been considered a good overall indicator of immune functioning in older adults because of its contribution to the pathogenesis of several age-related conditions such as osteoporosis . Regulation of IL-6 is impaired in elderly adults , and levels of IL-6 increase with stress and depression . This research cross-sectionally examined levels of IL-6 in three groups of healthy older women with varying levels of life stress and mood disturbance and a healthy group of young women . METHODS Subjects included 18 caregivers of Alzheimer 's patients , 17 older women assessed one month before relocation of their residence , 15 nonmoving and noncaregiving older women , and 20 younger women . Subjects completed the  Profile of Mood States ( POMS )  and had early morning blood draws . RESULTS Alzheimer 's caregivers reported significantly greater distress than women of all other groups . IL-6 levels in caregivers were significantly higher than those of all other women . The older women had significantly higher IL-6 than young controls , but there were no significant differences in IL-6 between movers and older controls . Among all women , greater depression and distress were related to higher levels of IL-6 . CONCLUSIONS These findings suggest that in older women , chronic stressors are associated with significant elevations in IL-6 over and above the elevations associated with normal aging , but that moderate stressors may not be related to appreciable elevations in IL-6 PURPOSE We set out to assess whether a high sense of coherence ( SOC ) protects from adverse health outcomes in patients aged 80 years and older who have multiple chronic diseases . METHODS A population -based prospect i ve cohort study  in 29 primary care practice s throughout Belgium included 567 individuals aged 80 years and older . We plotted the highest tertile of SOC scores in Kaplan-Meier curves representing 3-year mortality and time to first hospitalization . Using Cox proportional hazard regression analyses and multiple logistic regression analyses adjusted for sociodemographic characteristics , depression , cognition , disability , and multimorbidity we examined the relationship between  SOC and mortality , hospitalization , and decline in performance of activities of daily living ( ADL ) . RESULTS Subjects with  high SOC scores  showed a higher cumulative survival than others ( Log rank = 0.004 ) independent of other prognostic characteristics ( adjusted hazard ratio 0.62 ( 95 % CI , 0.38–1.00 ) , P = .049 ) . For ADL decline , a high SOC was shown to be protective , and this effect tended to be independent from the covariates under study ( adjusted odds ratio 0.56 ( 95 % CI , 0.31–1.0 ) , P = .05 ) . CONCLUSION Even very elderly persons with  high SOC scores  were shown to have lower mortality rates and less functional decline . These effects were independent of multimorbidity , depression , cognition , disability , and sociodemographic characteristics Background : Providing care to a spouse with Alzheimer ’s disease ( AD ) may contribute to cardiovascular disease ( CVD ) . The acute phase reactant C-reactive protein ( CRP ) is a well-established biomarker of an increased CVD risk . Objective : To investigate the hypothesis that dementia caregiving is associated with elevated circulating levels of CRP and possibly other biomarkers of CVD risk . Methods : We examined 118 elderly spousal Alzheimer caregivers and 51 noncaregiving controls about once a year for up to 3 years .  R and om regression models with fixed and time-variant effects for a range of covariates known to affect biomarker levels were used to evaluate changes in CRP and in 12 additional measures of inflammation , cellular adhesion , endothelial function , and hemostasis in relation to caregiving status , years of caregiving , and major transitions in the caregiving situation . Results : During the study period , longer duration of caregiving was associated with elevated CRP levels ( p = 0.040 ) and caregivers showed greater tumor necrosis factor (TNF)-α levels than controls ( p = 0.048 ) . Additionally , 3 months after the death of the AD spouse , caregivers showed a significant drop in CRP levels ( p = 0.003 ) and levels of soluble intercellular adhesion molecule (sICAM)-1 ( p = 0.008 ) . Conclusion : Duration of caregiving and being a caregiver per se were both associated with chronic low- grade inflammation as indicated by elevated CRP and TNF-α levels , respectively . Conversely , death of the AD spouse was associated with lower CRP and sICAM-1 levels . The findings indicate that chronic caregiving of those with dementia may result in increased inflammation and , thereby , possibly increased CVD risk CONTEXT The decision to institutionalize a patient with dementia is complex and is based on patient and caregiver characteristics and the sociocultural context of patients and caregivers . Most studies have determined predictors of nursing home placement primarily according to patient or caregiver characteristics alone . OBJECTIVE To develop and vali date a prognostic model to determine the comprehensive predictors of placement among an ethnically diverse population of patients with dementia . DESIGN , SETTING , AND PARTICIPANTS The Medicare Alzheimer 's Disease Demonstration and Evaluation study , a prospect i ve study at 8 sites in the United States , with enrollment between December 1989 and December 1994 of 5788 community-living persons with advanced dementia . MAIN OUTCOME MEASURES Time to nursing home placement throughout a 36-month follow-up period , assessed by interview and review of Medicare records , and its association with patient and caregiver characteristics , obtained by interview at enrollment . RESULTS Patients were divided into a development ( n = 3859 ) and validation ( n = 1929 ) cohort . In the development cohort , the Kaplan-Meier estimates of nursing home placement throughout 1 , 2 , and 3 years were 22 % , 40 % , and 52 % , respectively . After multivariate adjustment , patient characteristics that were associated with nursing home placement were as follows : black ethnicity ( hazard ratio , 0.60 ; 95 % confidence interval [ CI ] , 0.48 - 0.74 ) , Hispanic ethnicity ( HR , 0.40 ; 95 % CI , 0.28 - 0.56 ) ( both ethnicities were inversely associated with placement ) , living alone ( HR , 1.74 ; 95 % CI , 1.49 - 2.02 ) , 1 or more dependencies in activities of daily living ( HR , 1.38 ; 95 % CI , 1.20 - 1.60 ) , high cognitive impairment ( for Mini-Mental Status Examination score < or = 20 : HR , 1.52 ; 95 % CI , 1.33 - 1.73 ) , and 1 or more difficult behaviors ( HR , 1.30 ; 95 % CI , 1.11 - 1.52 ) . Caregiver characteristics associated with patient placement were age 65 to 74 years ( HR , 1.17 ; 95 % CI , 1.01 - 1.37 ) , age 75 years or older ( HR , 1.55 ; 95 % CI , 1.31 - 1.84 ) , and high Zarit Burden Scale score ( for highest quartile : HR , 1.73 ; 95 % CI , 1.49 - 2.00 ) . Patients were assigned to quartiles of risk based on this model . In the development cohort , patients in the first , second , third , and fourth quartile had a 25 % , 42 % , 64 % , and 91 % rate of nursing home placement at 3 years , respectively . In the validation cohort , the respective rates were 21 % , 50 % , 64 % , and 89 % . The C statistic for 3-year nursing home placement was 0.66 in the development cohort and 0.63 in the validation cohort . CONCLUSIONS Patient and caregiver characteristics are both important determinants of long-term care placement for patients with dementia . Interventions directed at delaying placement , such as reduction of caregiver burden  or  difficult patient behaviors  , need to take into account the patient and caregiver as a unit The purpose of this study was to determine whether the stress of caregiving for the Alzheimer 's disease ( AD ) patient accelerates the likelihood of exceeding hypertensive blood pressure ( BP ) criteria in periodic longitudinal home assessment s. In this cohort study , participants consisted of spousal caregivers of AD patients ( n = 144 ) and demographically equivalent non-caregiving controls ( n = 47 ) . Thirty percent of caregivers and 33 % of controls were receiving antihypertensive treatment at study entry .  Supine systolic and diastolic blood pressure ( SBP and DBP ) was assessed by semi-automated recordings taken in the home every 6 months for 2 to 6 years . Survival analyses ( Cox proportional hazards models ) were used to determine whether the hazard for developing hypertension ( DBP>140 , SBP>90 ) was greater in caregivers than in controls , and whether increased hazards were related to background characteristics or the extent of caregiving dem and s. Based on periodic 6-month assessment s of BP over 6 years , the hazards of meeting criteria for borderline hypertension were greater for caregivers than for controls ( Cox Proportional Hazards , chi2 [ 1 , N = 174 ] = 4.86 , p = 0.03 ) . This difference remained statistically significant ( p<0.05 ) after controlling for age , gender , education , socioeconomic status , body mass index , and use of antihypertensive medications . Increased risk of hypertension was not related to the extent of daily living assistance provided , patient problem behaviors , or caregiver distress . The chronic stress of caring for an AD spouse may have adverse effects on blood pressure ; however , the mechanism for this relationship remains unclear Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases ( CVD ) . This study evaluated the efficacy of the Pleasant Events Program ( PEP ) , a 6-week Behavioral Activation intervention design ed to reduce CVD risk and depressive symptoms in caregivers . One hundred dementia family caregivers were r and omized to either the 6-week PEP intervention ( N = 49 ) or a time-equivalent Information-Support ( IS ) control condition ( N = 51 ) . Assessment s were completed pre- and post-intervention and at 1-year follow-up . Biological assessment s included CVD risk markers Interleukin-6 ( IL-6 ) and D-dimer . Psychosocial outcomes included depressive symptoms , positive affect , and negative affect . Participants receiving the PEP intervention had significantly greater reductions in IL-6 ( p = .040 ) , depressive symptoms ( p = .039 ) , and negative affect ( p = .021 ) from pre- to post-treatment . For IL-6 , clinical ly significant improvement was observed in 20.0 % of PEP participants and 6.5 % of IS participants . For depressive symptoms , clinical ly significant improvement was found for 32.7 % of PEP vs 11.8 % of IS participants . Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes . The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers . Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention 's effects Objective : To determine if  caregivers of spouses with Alzheimer 's disease demonstrate greater increase in tissue plasminogen activator ( t-PA ) antigen relative to noncaregiving controls . Caring for a spouse with Alzheimer 's disease has been associated with increased mortality and reduced time to developing cardiovascular disease ( CVD ) , possibly due to impaired fibrinolysis result ing from chronic stress . Methods : Annual in-home assessment s of plasma t-PA antigen were collected from 165 participants ( 112 caregivers and 53 noncaregivers ) enrolled in the University of California , San Diego Alzheimer caregiver study . Participants were married , living with their spouses , at least 55 years of age , and free of serious medical conditions ( e.g. , cancer ) . Caregivers provided in-home care for their spouse with Alzheimer 's disease  at the time of enrollment . Exclusion criteria included taking anticoagulant medication or evidence d severe hypertension ( > 200/120 mm Hg ) . Mixed ( r and om effects ) regression was used to assess slopes for t-PA antigen over the study period at the same time controlling for medical and demographic characteristics associated with t-PA antigen . Results : Caregivers demonstrated significantly greater increases in t-PA antigen over the 5-year study period compared with noncaregiving controls ( p = .02 ) , even when controlling for body mass index , mean blood pressure , age , gender , and use of CVD medication . Conclusions : The accelerated rate of developing a prothrombotic environment including elevated t-PA antigen may provide one mechanism by which caregiving is associated with greater morbidity and mortality and the development of CVD . CVD = cardiovascular disease ; IL-6 = interleukin-6 ; t-PA = tissue plasminogen activator ; PAI-1 = plasminogen activator inhibitor ; CHD = coronary heart disease ; MAP = mean arterial pressure ; BMI = body mass index ; BP = blood pressure ; HAM-D = Hamilton Scale for Depression Background : Family caregivers of patients with dementia frequently experience psychological stress , depression and disturbed psychophysiological activity , with increased levels of diurnal cortisol secretion . Objectives : To compare the effects of a cognitive – behavioural group therapy ( CBT ) to a psychoeducation group programme ( EDUC ) on cortisol secretion in caregivers of patients with moderate Alzheimer 's disease ( AD ) . Method : Caregivers of AD out patients were semi-r and omly allocated to one of two intervention programmes ( CBT or EDUC ) consisting of eight weekly sessions . Twenty-six participants completed the study . Before and after intervention , salivary cortisol was collected at four different times of the day . Effects of the interventions were evaluated with self-report psychological scales and question naires related to functional abilities and neuropsychiatric symptoms of the AD relative . Results : Only in the CBT group did salivary cortisol levels significantly decrease after intervention , with a large effect size and high achieved power . Both groups reported a reduction of neuropsychiatric symptoms of their AD relative after intervention . Conclusion : Psychoeducation for caregivers may contribute to a reduction of neuropsychiatric symptoms of AD patients while CBT additionally attenuates psychophysiological responses to stressful situations in caregivers , by reducing diurnal cortisol levels . This may lead to a positive impact in the general health of the caregiver , eventually result ing in better care of the AD patient Background : The chronic stress of providing care for a spouse suffering from Alzheimer ’s disease has been associated with an increased risk for coronary artery disease and overall mortality . Procoagulant changes are kindled by mental stress , and they are prospect ively associated with atherothrombotic events . Objective : To examine whether dementia caregivers would show greater coagulation activity and less fibrinolytic capacity than noncaregiving controls . Methods : Subjects were 48 ( 30 female and 18 male ) elderly ( mean age ± SD , 72 ± 9 years ) community-dwelling spousal Alzheimer caregivers and 20 noncaregiving age- and gender-matched  controls . Plasma levels of thrombin-antithrombin III , fibrin D-dimer , von Willebr and factor , tissue-type plasminogen activator , and plasminogen activator inhibitor 1 were measured . Results : D-dimer , a marker of fibrin formation and degradation , was significantly higher in caregivers than in controls ( 688 ± 575 vs. 406 ± 157 ng/ml , p = 0.021 ) . Plasma levels of the four other hemostasis variables were not significantly different between the two groups . Controlling for the classic cardiovascular risk factors body mass index , hypertension status , smoking status , hypercholesterolemia , type II diabetes , and medication potentially affecting hemostasis did not change results . Conclusion : The findings suggest that Alzheimer caregivers have an increased fibrin turnover as compared to noncaregiving controls independent of common confounders of hemostasis . Such an elevated clotting diathesis might contribute to increased cardiovascular risk and overall mortality  with dementia caregiving strain BACKGROUND A growing number of women provide care to disabled or ill relatives . Many studies have linked caregiving to psychiatric morbidity , lower perceived health status , elevated blood pressure , and poorer immune function . However , no studies have examined the association between caregiving and cardiovascular disease incidence . METHODS We conducted the study in 54,412 women from the Nurses ' Health Study , a prospect i ve cohort of female registered nurses residing in 11 U.S. states . These women were aged 46 to 71 years and did not have diagnosed coronary heart disease ( CHD ) , stroke , or cancer at baseline ( 1992 ) . We collected information on caregiving responsibilities in 1992 and coronary heart disease between baseline ( June 1 , 1992 ) and return of the 1996 question naire . RESULTS During 4 years of follow-up , we documented 321 incident cases of CHD ( 231 nonfatal cases of myocardial infa rct ion and 90 CHD deaths ) . In multivariate analyses controlling for age , smoking , exercise , alcohol intake , body mass index , history of hypertension , diabetes mellitus , and other covariates , caregiving for disabled or ill spouse for > or = 9 hours per week was associated with increased risk of CHD ( RR , 1.82 ; 95 % confidence interval , 1.08 - 3.05 ) . However , caregiving for disabled or ill parents or disabled or ill others was not significantly associated with increased risks of CHD . CONCLUSION These data indicate that high levels of caregiving burden for ill spouses may increase the risk of CHD among women The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials OBJECTIVES The objectives of this study were to evaluate whether a mindfulness meditation intervention may be effective in caregivers of close relatives with dementia and to help refine the protocol for future larger trials . DESIGN The design was a pilot r and omized trial to evaluate the effectiveness of a mindfulness meditation intervention adapted from the Mindfulness-Based Cognitive Therapy program in relation to two comparison groups : an education class based on Powerful Tools for Caregivers serving as an active control group and a respite-only group serving as a pragmatic control . SETTING S/LOCATION This study was conducted at the Oregon Health & Science University , Portl and , OR . SUBJECTS The subjects were community-dwelling caregivers aged 45 - 85 years of close relatives with dementia . INTERVENTIONS The two active interventions lasted 7 weeks , and consisted of one 90-minute session per week along with at-home implementation of knowledge learned . The respite-only condition provided the same duration of respite care that was needed for the active interventions . OUTCOME MEASURES Subjects were assessed prior to r and omization and again after completing classes at 8 weeks . The primary outcome measure was a self-rated measure of caregiver stress , the Revised Memory and Behavior Problems Checklist ( RMBPC ) . Secondary outcome measures included mood , fatigue , self-efficacy , mindfulness , salivary cortisols , cytokines , and cognitive function . We also evaluated self-rated stress in the subjects ' own environment , expectancy of improvement , and credibility of the interventions . RESULTS There were 31 caregivers r and omized and 28 completers . There was a significant effect on RMBPC by group covarying for baseline RMBPC , with both active interventions showing improvement compared with the respite-only group . Most of the secondary outcome measures were not significantly affected by the interventions . There was an intervention effect on the caregiver self-efficacy measure and on cognitive measures . Although mindfulness was not impacted by the intervention , there were significant correlations between mindfulness and self-rated mood and stress scores . CONCLUSIONS Both mindfulness and education interventions decreased the self-rated caregiver stress compared to the respite-only control
Introduction Evidence suggests that providing care for an older loved one may present a risk to the health of the caregiver .
To underst and the link between the psychosocial stress of caregiving and damage to the health of caregivers , numerous studies have assessed the presence of inflammatory biomarkers among caregivers .
These biomarkers are measured to underst and the relationships between the social stress of caregiving and the health of caregivers .
Objective To provide a complete summary of the current literature regarding the most clinical ly relevant pro-inflammatory biomarkers associated with caregiving .