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A Review of the Psychobiology of Dementia Caregiving: A Focus on Resilience Factors

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Abstract

The recent aging trend in the United States has resulted in exponential growth in the number of informal dementia caregivers. Caring for a family member with dementia has been associated with negative health outcomes that are likely related to physiologic changes resulting from stress. However, caregiving is not always associated with health morbidity. In this review, we highlight resilience factors that appear to have a beneficial relationship with health outcomes. Specifically, we highlight 11 studies that examined the relationship of one of three broad resilience domains (personal mastery, self-efficacy, and coping style) to caregiver health outcomes. Our main findings were that higher levels of personal mastery and self-efficacy, and increased use of positive coping strategies appear to have a protective effect on various health outcomes in dementia caregivers. Continued research is warranted to help guide prospective directions for caregiver interventions focusing on increasing caregiver resilience and the corresponding impact on caregiver health.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. US Census Bureau Population Division: Sixty-five plus in the United States. Available at http://www.census.gov/population/socdemo/statbriefs/agebrief.html. Accessed 1 November 2010.

  2. National Alliance for Caregiving and AARP: Caregiving statistics. Available at http://www.thefamilycaregiver.org/who_are_family_caregivers/care_giving_statstics.cfm. Accessed 1 November 2010.

  3. Vitaliano PP, Zhang J, Scanlan JM. Is caregiving hazardous to one’s physical health? A meta-analysis. Psychol Bull. 2003;129:946–72.

    Article  PubMed  Google Scholar 

  4. Gallagher D, Rose J, Rivera P, et al. Prevalence of depression in family caregivers. Gerontologist. 1989;29:449–56.

    PubMed  CAS  Google Scholar 

  5. Anthony-Bergstone CR, Zarit SH, Gatz M. Symptoms of psychological distress among caregivers of dementia patients. Psychol Aging. 1988;3:245–8.

    Article  PubMed  CAS  Google Scholar 

  6. Schulz R, O’Brien AT, Bookwala J, et al. Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist. 1995;35:771–91.

    PubMed  CAS  Google Scholar 

  7. Shaw WS, Patterson TL, Ziegler MG, et al. Accelerated risk of hypertensive blood pressure recordings among Alzheimer caregivers. J Psychosom Res. 1999;46:215–27.

    Article  PubMed  CAS  Google Scholar 

  8. Vitaliano PP, Scanlan JM, Zhang J, et al. A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosom Med. 2002;64:418–35.

    PubMed  CAS  Google Scholar 

  9. Lee S, Colditz GA, Berkman LF, et al. Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med. 2003;24:113–9.

    Article  PubMed  Google Scholar 

  10. Mausbach BT, Patterson TL, Rabinowitz Y, et al. Depression and distress predict time to cardiovascular disease in dementia caregivers. Health Psychol. 2007;26:539–44.

    Article  PubMed  Google Scholar 

  11. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. 1999;282:2215–9.

    Article  PubMed  CAS  Google Scholar 

  12. Kiecolt-Glaser J, Glaser R, Shuttleworth EE, et al. Chronic stress and immunity in family caregivers of Alzheimer’s disease patients. Psychosom Med. 1987;49:523–35.

    PubMed  CAS  Google Scholar 

  13. Kiecolt-Glaser JK, Glaser R, Gravenstein S, et al. Chronic stress alters the immune response to influenza virus vaccine in older adults. Proc Natl Acad Sci USA. 1996;93:3043–7.

    Article  PubMed  CAS  Google Scholar 

  14. Kiecolt-Glaser JK, Marucha PT, Malarkey WB, et al. Slowing of wound healing by psychological stress. Lancet. 1995;346:1194–6.

    Article  PubMed  CAS  Google Scholar 

  15. Kiecolt-Glaser JK, Preacher KJ, MacCallum RC, et al. Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad Sci USA. 2003;100:9090–5.

    Article  PubMed  CAS  Google Scholar 

  16. • Roepke SK, Mausbach BT, Aschbacher K, et al. Personal mastery is associated with reduced sympathetic arousal in stressed Alzheimer caregivers. Am J Geriatr Psychiatry. 2008;16:310–7. Caregivers who feel more control over their lives and circumstances demonstrate reduced physiologic reactions to environmental stressors compared with those who feel they have less control. These results suggest that treatments may wish to target caregivers’ sense of control to help improve health outcomes.

    Article  PubMed  Google Scholar 

  17. Pearlin LI, Schooler C. The structure of coping. J Health Soc Behav. 1978;19:2–21.

    Article  PubMed  CAS  Google Scholar 

  18. Mausbach BT, von Känel R, Depp C, et al. The moderating effect of personal mastery on the relations between stress and plasminogen activator inhibitor-1 (PAI-1) antigen. Health Psychol. 2008;27:S172–9.

    Article  PubMed  Google Scholar 

  19. Mausbach BT, Mills PJ, Patterson TL, et al. Stress-related reductions in personal mastery are related to reduced immune cell beta2-adrenergic receptor sensitivity. Int Psychogeriatr. 2007;19:935–46.

    Article  PubMed  Google Scholar 

  20. Mausbach BT, Aschbacher K, Mills PJ, et al. A 5-year longitudinal study of the relationships between stress, coping, and immune cell beta2-adrenergic receptor sensitivity. Psychiatry Res. 2008;160:247–55.

    Article  PubMed  CAS  Google Scholar 

  21. Kohm AP, Sanders VM. Norepinephrine and beta 2-adrenergic receptor stimulation regulate CD4+ T and B lymphocyte function in vitro and in vivo. Pharmacol Rev. 2001;53:487–525.

    PubMed  CAS  Google Scholar 

  22. Kühlwein EC, Irwin MR, Ziegler MG, et al. Propranolol affects stress-induced leukocytosis and cellular adhesion molecule expression. Eur J Appl Physiol. 2001;86:135–41.

    Article  PubMed  Google Scholar 

  23. Sanders VM, Straub RH. Norepinephrine, the beta-adrenergic receptor, and immunity. Brain Behav Immun. 2002;16:290–332.

    Article  PubMed  CAS  Google Scholar 

  24. Mausbach BT, Patterson TL, Von Känel R, et al. The attenuating effect of personal mastery on the relations between stress and Alzheimer caregiver health: a five-year longitudinal analysis. Aging Ment Health. 2007;11:637–44.

    Article  PubMed  CAS  Google Scholar 

  25. Bandura A. Self-efficacy: the exercise of control. New York: W. H. Freeman; 1997.

    Google Scholar 

  26. • Mausbach BT, von Kanel R, Roepke SK, et al. Self-efficacy buffers the relationship between dementia caregiving stress and circulating concentrations of the proinflammatory cytokine interleukin-6. Am J Geriatr Psychiatry 2011;19:64–71. This was a novel study demonstrating that caregiver stress is significantly associated with the inflammatory marker IL-6 in those with low self-efficacy. However, caregiver stress was not significantly associated with IL-6 in those with high self-efficacy. This study also suggests that improving caregivers’ sense of control has benefits to physiologic markers of cardiovascular disease.

  27. Harmell AL, Mausbach BT, Roepke SK, et al. The relationship between self-efficacy and resting blood pressure in spousal Alzheimer’s caregivers. Br J Health Psychol. 2010, May 20 (Epub ahead of print).

  28. Chesney MA, Neilands TB, Chambers DB, et al. A validity and reliability study of the coping self-efficacy scale. Br J Health Psychol. 2006;11:421–37.

    Article  PubMed  Google Scholar 

  29. Rabinowitz YG, Mausbach BT, Thompson LW, et al. The relationship between self-efficacy and cumulative health risk associated with health behavior patterns in female caregivers of elderly relatives with Alzheimer’s dementia. J Aging Health. 2007;19:946–64.

    Article  PubMed  Google Scholar 

  30. Fortinsky RH, Kercher K, Burant CJ. Measurement and correlates of family caregiver self-efficacy for managing dementia. Aging Ment Health. 2002;6:153–60.

    Article  PubMed  CAS  Google Scholar 

  31. Kohout FJ, Berkman LF, Evans DA, et al. Two shorter forms of the CES-D Depression Symptoms Index. J Aging Health. 1993;5:179–93.

    Article  PubMed  CAS  Google Scholar 

  32. Derogatis LR et al. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15.

    Article  PubMed  CAS  Google Scholar 

  33. Aschbacher K, Patterson TL, von Känel R, et al. Coping processes and hemostatic reactivity to acute stress in dementia caregivers. Psychosom Med. 2005;67:964–71.

    Article  PubMed  Google Scholar 

  34. von Känel R, Dimsdale JE. Fibrin D-dimer: a marker of psychosocial distress and its implications for research in stress-related coronary artery disease. Clin Cardiol. 2003;26:164–8.

    Article  Google Scholar 

  35. Rabinowitz YG, Hartlaub MG, Saenz EC, et al. Is religious coping associated with cumulative health risk? An examination of religious coping styles and health behavior patterns in Alzheimer’s dementia caregivers. J Relig Health 2010;49:498–512.

    Google Scholar 

  36. Pargament KI. Religious/spiritual coping, in multidimensional measurement of religiousness, spirituality for use in health research: a report of the Fetzer Institute and the National Institute on Aging Working Group. Kalamazoo: Fetzer Institute; 2003. p. 43–56.

    Google Scholar 

  37. Gallagher-Thompson D, Coon DW. Evidence-based psychological treatments for distress in family caregivers of older adults. Psychol Aging. 2007;22:37–51.

    Article  PubMed  Google Scholar 

  38. Coon DW, Thompson L, Steffen A, et al. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist. 2003;43:678–89.

    PubMed  Google Scholar 

  39. • Williams V, Bishop-Fitzpatrick L, Lane J, et al. Video-based coping skills to reduce health risk and improve psychological and physical well-being in Alzheimer’s disease family caregivers. Psychosom Med. 2010;72:897–904. This was one of the first-ever psychosocial treatment studies for caregivers to examine concomitant change in distress, coping, and biomarkers. Caregivers in a coping skills intervention showed greater decreases in BP relative to those in a control condition, suggesting that improved coping response may have benefits to cardiovascular health.

    Article  PubMed  Google Scholar 

  40. Franks M, Stephens A. Social support in the context of caregiving: husbands’ provision of support to wives involved in parent care. J Gerontol 1996;51:P43–52.

    Google Scholar 

  41. Kim J, Knight B. Effects of caregiver status, coping styles, and social support on the physical health of Korean American caregivers. Gerontologist. 2008;48:287–99.

    PubMed  Google Scholar 

  42. Pressman S, Matthews K, Cohen S, et al. Association of enjoyable leisure activities with psychological and physical well-being. Psychosom Med. 2009;71:725–32.

    Article  PubMed  Google Scholar 

  43. O’Donnell K, Brydon L, Wright C, et al. Self-esteem levels and cardiovascular and inflammatory responses to acute stress. Brain Behav Immun. 2008;22:1241–7.

    Article  PubMed  Google Scholar 

  44. Hilgeman M, Allen R, DeCoster J, et al. Positive aspects of caregiving as a moderator of treatment outcome over 12 months. Psychol Aging. 2007;22:361–71.

    Article  PubMed  Google Scholar 

  45. Barnum DD, Snyder CR, Rapoff MA, et al. Hope and social support in the psychological adjustment of pediatric burn survivors and matched controls. Child Health Care 1998;27:15–30.

    Google Scholar 

  46. Roy B, Diez-Roux AV, Seeman T, et al. Association of optimism and pessimism with inflammation and hemostasis in the Multi-Ethnic Study of Atherosclerosis (MESA). Psychosom Med. 2010;72:134–40.

    Article  PubMed  Google Scholar 

  47. Dilworth-Anderson P, Williams I, Gibson B. Issues of race, ethnicity, and culture in caregiving research: a 20-year review (1980–2000). Gerontologist. 2002;42:237–72.

    PubMed  Google Scholar 

  48. Connell CM, Gibson GD. Racial, ethnic, and cultural differences in dementia caregiving: review and analysis. Gerontologist. 1997;37:355–64.

    PubMed  CAS  Google Scholar 

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Acknowledgment

Support for this article was provided by the National Institute on Aging through award R01 AG031090.

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No potential conflicts of interest relevant to this article were reported.

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Correspondence to Brent T. Mausbach.

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Harmell, A.L., Chattillion, E.A., Roepke, S.K. et al. A Review of the Psychobiology of Dementia Caregiving: A Focus on Resilience Factors. Curr Psychiatry Rep 13, 219–224 (2011). https://doi.org/10.1007/s11920-011-0187-1

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