DEMENTIA CAREGIVING NEGATIVELY AFFECTS THE HEALTH OF CAREGIVER AND CARE RECIPIENT. CAREGIVING TRANSITIONS STUDY

Abstract Dementia is one of the most common reasons for needing a caregiver (CG). Few studies have compared dementia and non-dementia caregivers who have transitioned into family caregiving roles. Participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who transitioned into a significant caregiving role were recruited to participate in the Caregiving Transitions Study (CTS). Of 11,483 REGARDS participants who were not caregivers at baseline, 1229 (11%) transitioned into a family caregiving role. Eligibility criteria were met by 251 and they were enrolled along with 251 demographically-matched noncaregiving controls. Enrolled caregivers are 65% female; 36% African American; 71.8 + 8.1 years of age; caring for a spouse/partner (51%), parent (25%), or another person (24%). 47% are caring for a person with dementia. Dementia CGs provide more hours of care per day (9.3 hours versus 6.7 hours), report being under more stress and twice as much strain as non-dementia CGs (p<0.03 for all). They feel more burdened by the care recipient’s treatment (p=0.01) and report that the burden leads to delays in the care recipient receiving medical care (p<0.007). Dementia CGs are more than twice as likely as non-caregivers to report that their caregiving makes them worse at taking care of their own health (33.9% versus 15.4%, p=0.003). This prospective, population-based study confirms previous cross-sectional findings from convenience samples on the greater care burden experienced by dementia caregivers and extends this work to new measures of treatment burden and treatment delay.

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Stress, Burden, and Well-Being in Dementia and Nondementia Caregivers: Insights From the Caregiving Transitions Study

The Gerontologist ◽

10.1093/geront/gnaa108 ◽

2020 ◽

Author(s):

Orla C Sheehan ◽

William E Haley ◽

Virginia J Howard ◽

Jin Huang ◽

J David Rhodes ◽

...

Keyword(s):

Racial Differences ◽

Behavioral Problems ◽

Well Being ◽

Population Based ◽

Care Recipient ◽

Dementia Caregivers ◽

Age In Place ◽

More Care ◽

Regards Study ◽

Stress Burden

Abstract Background and Objectives Few population-based studies have directly compared caregivers of persons with dementia to caregivers of persons with other disabilities (nondementia caregivers). We enrolled dementia and nondementia caregivers who were providing substantial and sustained care and compared these groups on measures of caregiver stressors, appraisals of burden, and well-being. Research Design and Methods Caregivers (N = 251) who provided continuous care for at least 1 year and at least 5 h per week were recruited from the population-based REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Caregivers reported on dementia caregiving status, stressors, burden, and well-being. Results Forty-seven percent (n = 117) reported caring for a person with dementia. Dementia caregivers reported more stressors, providing more care for self-care and behavioral problems than nondementia caregivers. Dementia caregivers also reported higher appraisals of stress and burden, and more depressive symptoms, but did not differ from nondementia caregivers on mental and physical health quality of life. In multivariable-adjusted models, adjustment for the total number of care recipient problems attenuated differences between dementia and nondementia caregivers on burden and depression measures. Discussion and Implications Dementia and nondementia caregivers showed relatively few differences in indicators of overall well-being in this population-based sample, perhaps because both groups of caregivers in this study were providing substantial care. Dementia caregivers may require special assistance with dementia-specific problems such as behavioral problems. Clinical interventions and policy changes targeting highly burdened caregivers are needed to support them in allowing their care recipients to age in place at home.

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Performance of the NINDS-CSN 5-Minute Protocol in a National Population-Based Sample

Journal of the International Neuropsychological Society ◽

10.1017/s1355617714000733 ◽

2014 ◽

Vol 20 (8) ◽

pp. 856-867 ◽

Cited By ~ 7

Author(s):

Richard E. Kennedy ◽

Virginia G. Wadley ◽

Leslie A. McClure ◽

Abraham J. Letter ◽

Frederick W. Unverzagt ◽

...

Keyword(s):

Cognitive Impairment ◽

Racial Differences ◽

Word List ◽

Vascular Cognitive Impairment ◽

Population Based ◽

Cross Sectional ◽

Populations At Risk ◽

List Learning ◽

Cerebrovascular Risk ◽

Regards Study

AbstractIn 2006, the National Institute of Neurological Disorders and Stroke-Canadian Stroke Network (NINDS-CSN) Vascular Cognitive Impairment Harmonization Standards recommended a 5-Minute Protocol as a brief screening instrument for vascular cognitive impairment (VCI). We report demographically adjusted norms for the 5-Minute Protocol and its relation to other measures of cognitive function and cerebrovascular risk factors. We performed a cross-sectional analysis of 7199 stroke-free adults in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study on the NINDS-CSN 5-Minute Protocol score. Total scores on the 5-Minute Protocol were inversely correlated with age and positively correlated with years of education, and performance on the Six-Item Screener, Word List Learning, and Animal Fluency (all p-values <.001). Higher cerebrovascular risk on the Framingham Stroke Risk Profile (FSRP) was associated with lower total 5-Minute Protocol scores (p <.001). The 5-Minute Protocol also differentiated between participants with and without confirmed stroke and with and without stroke symptom histories (p <.001). The NINDS-CSN 5-Minute Protocol is a brief, easily administered screening measure that is sensitive to cerebrovascular risk and offers a valid method of screening for cognitive impairment in populations at risk for VCI. (JINS, 2014, 20, 1–12)

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Abstract MP102: Family Caregiving is Associated with Increased Stroke Risk Among Strained Spouse Caregivers

Circulation ◽

10.1161/circ.133.suppl_1.mp102 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Sindhu Lakkur ◽

Virginia Howard ◽

Suzanne Judd ◽

William Haley ◽

David Roth

Keyword(s):

Family Caregivers ◽

Racial Differences ◽

Family Caregiving ◽

Cardiovascular Health ◽

Stroke Risk ◽

Care Recipient ◽

Health Concern ◽

Increased Risk ◽

Spouse Caregivers ◽

Regards Study

Background: As the American population ages, the number of family caregivers is expected to increase. Consequently, understanding the effects family caregiving has on the cardiovascular health of caregivers presents an important public health concern. Previous studies have observed associations between family caregiving and adverse cardiovascular health outcomes such as hypertension, coronary heart disease, and an increased Framingham Stroke Risk Score. However, the association between family caregiving and stroke risk is poorly understood. Hypothesis: We examined the association between family caregiving and risk of incident stroke in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study to test the hypotheses that 1) family caregivers have higher risk of stroke compared to noncaregivers and 2) strained caregivers have higher risk of stroke compared to noncaregivers. Methods: The REGARDS study enrolled black and white participants, aged 45 and older, from 2003-2007. Participants were categorized as caregivers if they answered affirmatively to the baseline interview question, “Are you currently providing care on an on-going basis to a family member with a chronic illness or disability?” Caregivers were asked their relationship to the care recipient and the amount of perceived physical and mental strain they associated with care (none, some, a lot). Using a propensity score matching procedure based on 16 demographic, lifestyle, and stroke risk factors, caregivers (n=3,055) were individually matched with noncaregivers (n=3,055). Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for incident stroke risk were calculated using Cox proportional hazards models. Results: During an average 8.5-year follow up period, 114 (3.73%) caregivers and 112 (3.67%) matched noncaregivers had an incident stroke. Caregivers did not have a higher risk of stroke compared to non-caregivers (HR=1.006, 95% CI=0.775, 1.306). The HRs (95% CIs) for incident stroke risk were 1.427 (0.938, 2.171) for caregivers reporting no caregiving strain, 0.918 (0.628, 1.341) for moderate strain, and 1.963 (0.977, 3.946) for high strain. Strained spouse caregivers who reported high or moderate strain had a 95% higher risk of stroke than matched noncaregivers (HR=1.958, 95% CI=1.002, 3.828). Conclusion: We observed that perceived caregiving strain, particularly among spouse caregiviers, is associated with increased risk of stroke. This group of caregivers may need targeted support. Further studies examining the nuanced effects of caregiver burden on cardiovascular health are required.

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Enrolling Incident Caregivers and Matched Controls From a Nationwide Epidemiological Study

Innovation in Aging ◽

10.1093/geroni/igaa057.2272 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 658-658

Author(s):

David Roth ◽

William Haley ◽

Orla Sheehan ◽

J David Rhodes ◽

Virginia Howard

Keyword(s):

Blood Sample ◽

Epidemiological Study ◽

Racial Differences ◽

Family Caregiving ◽

Regards Study

Abstract Participants in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were asked about family caregiving responsibilities at enrollment (2003-2007). Among the 88% of participants who were not caregivers at enrollment, 1,229 reported becoming caregivers before a follow-up interview 12 years later. The Caregiving Transitions Study screened these participants and enrolled 251 as incident caregivers. All reported 5 or more hours of care per week, provided assistance with at least one ADL or IADL, and were caregivers for at least 3 months before a 2nd blood sample was obtained in the REGARDS study. A total of 251 noncaregiving control participants who reported no caregiving responsibilities over this 12-year period were also enrolled. Each control was matched to a caregiver on age (+ 5 years), sex, race, other demographics, and baseline (pre-caregiving) health variables. Descriptive analyses confirm the unique comparability of the samples compared to previous caregiving studies.

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Eligibility of the Systolic Blood Pressure Intervention Trial (SPRINT) to the Chinese Adults

BioMed Research International ◽

10.1155/2020/4751756 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Liping Chen ◽

Yiyan Zhang ◽

Juan Jin ◽

Nannan Li ◽

Dan Liu ◽

...

Keyword(s):

Blood Pressure ◽

Systolic Blood Pressure ◽

Antihypertensive Medication ◽

Population Based ◽

Intervention Trial ◽

Treatment Intensification ◽

Chinese Adults ◽

Eligibility Criteria ◽

Cross Sectional ◽

Framingham Risk

Objective. To explore the proportion and characteristic of Chinese adults meeting The Systolic Blood Pressure Intervention Trial (SPRINT) eligibility criteria and assess its generalizability. Method. Our study was based on a cross-sectional, population-based survey with a sample of 26,093 participants aged over 20 years. The SPRINT eligibility criteria were age ≥ 50 years, elevated SBP of 130 to 180 mmHg depending on the number of antihypertensive medication classes being taken, and increased cardiovascular disease (CVD) but without diabetes, history of stroke and estimated glomerular filtration rate < 20 ml / min / 1.73 m 2 , or receiving dialysis. Results. Overall, we estimated that 4,036 (15.5%) participants would meet the SPRINT eligibility criteria. They were generally older, likely to be female, lower educational level, tended to be more overweight, and had higher Framingham risk score compared with overall population or subjects aged ≥ 50 years. Of participants eligible for SPRINT, most (56.2%) of them were not treated for hypertension, and 542 (13.4%) were not previously considered to have hypertension or need for antihypertension therapy. Among the 11,637 adults with hypertension, 3,494 (30.0%) would potentially benefit from treatment intensification. The most common antihypertensive medication class being taken was diuretic agents. Conclusion. A substantial percentage of Chinese subjects meet the SPRINT eligibility criteria. Further studies are needed to assess the cost-effectiveness from treatment intensification in Chinese setting.

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The association between informal caregiving and behavioral risk factors: a cross-sectional study

International Journal of Public Health ◽

10.1007/s00038-020-01402-6 ◽

2020 ◽

Vol 65 (6) ◽

pp. 911-921 ◽

Cited By ~ 1

Author(s):

Sophie Gottschalk ◽

Hans-Helmut König ◽

Christian Brettschneider

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Smoking Behavior ◽

Care Recipient ◽

Behavioral Risk Factors ◽

Behavioral Risk ◽

Dementia Caregivers ◽

Related Factors ◽

Cross Sectional ◽

Insufficient Physical Activity

Abstract Objectives This study aimed to compare informal caregivers/dementia caregivers to non-caregivers regarding alcohol consumption, smoking behavior, obesity, and insufficient physical activity and to identify caregiving-related factors (caregiving intensity, length of caregiving, relationship to the care recipient, and type of caregiving task) which are associated with behavioral risk factors in caregivers/dementia caregivers. Methods Using cross-sectional data from the Behavioral Risk Factor Surveillance System, we performed the statistical analyses applying logistic regression models and accounted for confounding using the entropy balancing approach. Results For caregivers (n = 12,044), the odds of overweight/obesity and smoking were higher (OR = 1.14/1.34, p < 0.05) and the odds of binge drinking and insufficient physical activity were lower (OR = 0.86/0.83, p < 0.05) than for non-caregivers (n = 45,925). For dementia caregivers, results point in the same direction. Caregiving-related variables tend to influence the likelihood of behavioral risk factors, but depending on the kind of factor considered, in different directions. Conclusions Being a caregiver is associated with risky and health-promoting behavior. However, the effects are relatively low. Future studies should study potential pathways between caregiving characteristics, psychological impacts of caregiving, health behavior, and mental or physical health.

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N-Terminal Pro-B-Type Natriuretic Peptide and Longitudinal Risk of Hypertension

American Journal of Hypertension ◽

10.1093/ajh/hpaa224 ◽

2020 ◽

Author(s):

C D Nicoli ◽

T B Plante ◽

D L Long ◽

S E Judd ◽

L A McClure ◽

...

Keyword(s):

Blood Pressure ◽

Sensitivity Analysis ◽

Racial Differences ◽

Natriuretic Peptide ◽

Cross Sectional ◽

Hypertension Risk ◽

Myocardial Stretch ◽

Regards Study ◽

Demographic Covariates ◽

Rate Ratios

Abstract Background Hypertension is a common condition that increases risk for future cardiovascular disease. N-terminal B-type natriuretic peptide (NT-proBNP) is higher in individuals with hypertension, but studies of its association with hypertension risk have been mixed. Methods The REasons for Geographic And Racial Differences in Stroke (REGARDS) study enrolled 30,239 Black or White adults aged ≥45 years from 2003-2007. A subcohort included 4,400 participants who completed a second assessment in 2013-2016. NT-proBNP was measured by immunoassay in 1,323 participants without baseline hypertension, defined as blood pressure ≥140/90 or self-reported antihypertensive prescriptions. Two robust Poisson regression models assessed hypertension risk, yielding incidence rate ratios (IRRs): Model 1 included behavioral & demographic covariates and Model 2 added risk factors. A sensitivity analysis using a less conservative definition of hypertension (blood pressure ≥130/80 or self-reported antihypertensive prescriptions) was conducted. Results 466 participants developed hypertension after mean follow-up of 9.4 years. NT-proBNP was not associated with hypertension (Model 2 IRR per SD log NT-proBNP 1.01, 95% CI 0.92-1.12), with no differences by sex, BMI, age, or race. Similar findings were seen in lower-threshold sensitivity analysis. Conclusions NT-proBNP was not associated with incident hypertension; this did not differ by race or sex. Cross-sectional associations of natriuretic peptides with hypertension are likely due to myocardial stretch due to increased afterload.

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Abstract P091: Early Life Stressors and Adult Cardiovascular Health in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.137.suppl_1.p091 ◽

2018 ◽

Vol 137 (suppl_1) ◽

Author(s):

Virginia J Howard ◽

Leann Long ◽

Aleena Bennett ◽

Leslie A McClure ◽

Dawn O Kleindorfer ◽

...

Keyword(s):

Family Violence ◽

Racial Differences ◽

Early Life ◽

Cardiovascular Health ◽

Population Based ◽

Life Stressors ◽

Behavioral Risk ◽

Serious Illness ◽

Black And White ◽

Regards Study

Introduction: Prior research suggests early life stressors (ELS) influence development of cardiovascular (CV) risk over the lifecourse, but few national studies have evaluated this. We examined the association of ELS with adult CV defined by Life’s Simple 7 (LS7) score within a national US population-based cohort. Methods: We used data on 7,469 REGARDS participants (black and white adults, aged > 45 in 2003-2007), with clinical and behavioral risk factor data from questionnaires and direct measurement. Levels of LS7 components (blood pressure, total cholesterol, fasting glucose, physical activity, smoking, diet, body mass index) were coded as poor (0 points), intermediate (1 point) or ideal (2 points); the primary outcome, LS7 score, was the sum of the components. In 2012-2013, 7 ELS (death of parent, parents separated/divorced, family serious illness, witnessed family violence, family substance abuse, parent’s loss of job and parent incarcerated) were retrospectively assessed by mail questionnaire to active participants. Linear regression was used to characterize the relationship between each ELS and LS7 after adjustment for demographics and region of birth. Mediation by adult income and education was examined. Results: ELS were common, ranging from 3% for parent incarcerated to 29% for family serious illness. Lower LS7 was associated with each ELS, with significant association with witnessing family violence (-0.15; 95% CI: -0.29 to -0.02) (see figure.) Additional adjustment for adult education partially attenuated the effect estimates for witnessed family violence by 20.6% (95% CI: 2.0%, 39.1%); adjustment for adult income and education mediated the non-significant estimates for parental death, family illness and separation/divorce. Conclusions: Exposure to ELS was associated worse adult cardiovascular health; these associations were partially but not fully mediated by adult socioeconomic status. Further work is needed in categorization of ELS and examination of pathways underlying the associations.

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Prevalence Of Vitamin B Complex Deficiencies In Women In Reproductive Age, Pregnant Or Lactating Woman In Brazil: A Systematic Review And Meta-Analysis Protocol

10.21203/rs.3.rs-340975/v1 ◽

2021 ◽

Author(s):

Michel Carlos Mocellin ◽

Cintia Chaves Curioni ◽

Alessandra da Silva Pereira ◽

Simone Augusta Ribas ◽

Michelle Teixeira Teixeira ◽

...

Keyword(s):

Systematic Review ◽

Data Extraction ◽

Meta Analysis ◽

Population Based ◽

B Vitamins ◽

Reproductive Age ◽

Vitamin B ◽

Prevalence Rates ◽

Eligibility Criteria ◽

Cross Sectional

Abstract Background: Complex B vitamin deficiency are involved with several outcomes in fertility and pregnancy. In Brazil, the national prevalence rates of these micronutrients deficiencies in women at reproductive age was not known. Therefore, this study aims to systematically identify, select, evaluate, analyze and report the prevalence rates of complex B vitamins deficiencies in women at reproductive age in Brazil, and identify variables that may modify the outcome rates.Methods: A systematic review will be conducted guided by the following question: “What is the prevalence of vitamin B complex deficiencies in women at reproductive age in Brazil?”. The studies will be identified and selected from a literature search using electronic databases, consultation to researchers/specialists, as well as reference lists of eligible studies and reviews on the topic. Major eligibility criteria include observational cross-sectional and cohort studies performed in women with 10-49 years old from Brazil; pregnant and lactating mothers; and which that investigated the deficiency of complex B vitamins by laboratorial test. Two reviewers independently will perform the screening and selection of studies, to subsequently perform data extraction and risk assessment of bias. For data report, a narrative approach will be used to summarize the characteristics of the included studies and the individual prevalence found for each micronutrient tested, and if the studies are sufficiently homogeneous, a quantitative synthesis (meta-analysis) will be performed.Discussion: Identify the national and regional prevalence rates of complex B vitamins deficiencies allow the policy makers discuss, plan and implement public policy to prevent and/or reduces the rates, if they are larger, or at least highlight discussions about a program of screening the vitamins deficiencies in this specific population for to know the epidemiologic scenario among the years, serving as an indirect indicator of the socioeconomic and dietary patterns of this population. Also, specifically for folates, this study allows to compare the prevalence rates of deficiency of this vitamin before and after the mandatory fortification of wheat and corn flours implemented since 2004. Nevertheless, the evidence gathered may highlight the need for population-based studies to investigate the deficiency of these vitamins.Systematic review registration: PROSPERO registration number: CRD42020188474

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Caregivers of people with dementia and mental health during COVID-19: findings from a cross-sectional study

BMC Geriatrics ◽

10.1186/s12877-022-02752-x ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Anna Messina ◽

Martina Lattanzi ◽

Emiliano Albanese ◽

Maddalena Fiordelli

Keyword(s):

Cross Sectional Study ◽

Anxiety Symptoms ◽

Care Recipient ◽

Mental Wellbeing ◽

Mild Stress ◽

Cross Sectional Survey ◽

Cross Sectional ◽

People With Dementia ◽

Person With Dementia ◽

The Impact

Abstract Background There is sparse evidence on the impact on vulnerable populations of the COVID-19 pandemic. The aim of our study was to explore burden and mental wellbeing (including depressive, anxiety, and stress symptoms) in caregivers of people with dementia during the first wave of the pandemic in Italy and southern Switzerland, two bordering regions severely hit by the COVID-19 pandemic. Methods We conducted an online cross-sectional survey with family carers of people with dementia between May and June 2020. We registered socio-demographic characteristics, and information about the relationship with the care recipient, dementia subtype, care inputs from others, and the need of care of the person with dementia. We measured caregiver burden with the Zarit Burden Interview (ZBI), psychological distress with the Depression, Anxiety and Stress Scale (DASS-21), and perceived isolation with the 3-item UCLA Loneliness Scale (UCLALS3). Results Caregivers (N =571) reported moderate to severe care-related burden (mean=54.30; SD=18.33), moderate anxiety symptoms (mean=10.04; SD=6.93), mild depressive symptoms (mean=11.79; SD=6.12) and mild stress (mean=12.95; SD=5.53), and 72.3% of participants reported to feel lonely. All scores were significantly more severe in Swiss compared to Italian caregivers (all p values<0.001). Conclusions We found that caregivers’ burden, anxiety symptoms, depression and perceived loneliness were marked during the first wave of the COVID-19 pandemic, in two severely hit bordering countries. Regional differences in the impact of the epidemic on caregivers could be due to contextual, societal, and cultural circumstances. As the pandemic endures, support to caregivers of people with dementia should be proportionate and tailored to needs and adapted to contextual factors.

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