Examining Elevated Stress Levels Among African American Caregivers of Relatives with Dementia Öffentlichkeit

Abstract

Background: Alzheimer's disease is an incurable condition characterized by irreversible biological and cognitive changes. African Americans are at higher risk for Alzheimer's disease compared to non-Hispanic whites as multiple research studies have identified an incidence rate among African Americans to be 2 to 2.5 times that of whites (Demirovic et al., 2003; Froehlich, Bogardus, & Inouye, 2001; Gurland et al., 1999; Husaini et al., 2003; Krishnan et al., 2005; Tang et al., 2001). Research on dementia caregiving has consistently portrayed that the caregiving role entails sustained levels of stress, higher rates and levels of depression, burden, and mood disorders (Pinquart & Sorensen, 2003; Schulz, O'Brien, Bookwala, & Fleissner, 1995; Schulz & Sherwood, 2008), and higher risk for mortality (Schulz & Beach, 1999).

Objective: The objectives of this study were to 1) identify predisposing factors among caregivers that were associated with higher levels of stress and 2) analyze self-efficacy, knowledge, and coping in the stress process, in relation to perceived stress and IL-6.

Methods: This study was a secondary, cross-sectional analysis of the baseline data from a randomized-control trial testing interventions to improve well-being among 142 African American caregivers in Atlanta, Georgia. The following statistically analyses were conducted to test for associations with perceived stress and IL-6: Pearson and Spearman's Rho correlation tests, One-Way ANOVAs, and Multiple Linear Regressions.

Results: The study found a statistically positive significant association between gender, family help, co-residence, family cohesion (communication, problem solving, global family functioning), coping, anxiety, burden, depression and perceived stress. A statistically negative association was found between the caregiver/care-recipient relationship, self-efficacy, and perceived stress. The multiple linear regressions indicated that there was a statistically significant association between gender, a little family help, self-efficacy, ways of coping, and perceived stress.

Conclusions: African American dementia caregivers experience many disparities that are compounded by the additive effects of chronic daily stressors and pre-existing health conditions. These findings illustrate the need for targeted interventions focusing on increasing caregivers' self-efficacy and positive coping. These findings can also inform healthcare professionals of the increased health risks caregivers face in comparison to the general population.

Table of Contents

CHAPTER 1. INTRODUCTION 1
Introduction 1
Theoretical Framework 5
The Transactional Model of Stress and Coping 5
Figure 1. Diagram of Transactional Model of Stress and Coping 6
Self-Efficacy 7
Study Purpose 8
Figure 2. Caregiver Stress: Interventions to Promote Health and Wellbeing 9
Research Question 10
Theoretical Application 10
Figure 3. Examining Elevated Stress Levels Among African American Caregivers of a Relative with Dementia Concept Map. 11
Significance of the Study 11

CHAPTER 2. REVIEW OF RELATED LITERATURE 13
Introduction 13
Dementia versus Alzheimer's disease 14
Dementia Etiology 15
Dementia Diagnosis and Treatment 16
African Americans and Dementia 16
Caregiving Role and Responsibilities 17
Health Effects of Caregiving on Caregivers 19
Stress 21
Biomarkers of Stress 22
Theoretical Framework 22
Self-efficacy 23
Context-Specific Knowledge 24
Coping Styles 24
Summary 25

CHAPTER 3. DATA COLLECTION AND PROCEDURES 26
Introduction 26
Design 27
Participants 28
Participant Recruitment 28
Measures 29
Demographic Information 29
Care Recipient Problems 29
Family Functioning 31
Dementia caregiver self-efficacy 32
Alzheimer's Disease Specific Knowledge 32
Coping 33
Depression 33
Anxiety 33
Burden 34
Perceived Stress 34
Interleukin-6 (IL-6) 35
Data Collection Procedures 35
Treatment of the Data 36
Preliminary Analysis 36
Addressing each hypothesis 38

CHAPTER 4. RESULTS 40
Sample Characteristics 40
Caregiving Characteristics 40
Caregiving Duration and Patient Condition 41
Psychosocial Assessment Scores 41
Correlations between predictor variables and perceived stress and IL-6 41
Differences between categorical/dichotomous variables and perceived stress 43
Associations between predictor variables and perceived stress 45
Summary of Findings 48
Demographic Characteristics 48
Caregiver/Care recipient relationship and Patient Condition 48
Psychosocial Scores 49
Perceived Stress 50

CHAPTER 5. FINDINGS, CONCLUSIONS, IMPLEMENTATIONS AND RECOMMENDATIONS, AND SUMMARY 51
Findings 51
Demographic Characteristics 51
Caregiver/Care recipient relationship 52
Caregiving Duration and Patient Condition 52
Psychosocial Assessment Scores 53
Perceived Stress 56
Conclusions 60
Strengths and Limitations 61
Recommendations and Implications 62

LIST OF TABLES 65
Table 1: COOL AD Descriptive Statistics (N=142) 65
Table 2. Psychosocial Scales 66
Table 3. Outcome Variables 66
Table 4. Pearson Correlations of Psychosocial Scales and Dependent Variables 67
Table 5: Pearson Correlations Between Demographic and Dependent Variables 68
Table 6: Spearman's Rho Correlations Between Demographic and Dependent Variables 69
Table 7: Hypothesis Specific Sequential Multiple Linear Regression 70
Table 8: Sequential Multiple Linear Regression Among Psychosocial Scales and Perceived Stress 71

REFERENCES 72

APPENDICES 82
Emory IRB Determination Letter 82
COOL-AD Study Surveys 80
Author Resume 110

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Aging Gerontology
Stichwort	Stress African American Caregiver Dementia Mental Health Alzheimer's disease
Committee Chair / Thesis Advisor	Nehl, Eric J., Emory University
Committee Members	Hepburn, Kenneth, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs National or regional non-profit organization (e.g., American Cancer Society)

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