Psychobiological factors of resilience and depression in late life.

In contrast to traditional perspectives of resilience as a stable, trait-like characteristic, resilience is now recognized as a multidimentional, dynamic capacity influenced by life-long interactions between internal and environmental resources. We review psychosocial and neurobiological factors associated with resilience to late-life depression (LLD). Recent research has identified both psychosocial characteristics associated with elevated LLD risk (e.g., insecure attachment, neuroticism) and psychosocial processes that may be useful intervention targets (e.g., self-efficacy, sense of purpose, coping behaviors, social support). Psychobiological factors include a variety of endocrine, genetic, inflammatory, metabolic, neural, and cardiovascular processes that bidirectionally interact to affect risk for LLD onset and course of illness. Several resilience-enhancing intervention modalities show promise for the prevention and treatment of LLD, including cognitive/psychological or mind-body (positive psychology; psychotherapy; heart rate variability biofeedback; meditation), movement-based (aerobic exercise; yoga; tai chi), and biological approaches (pharmacotherapy, electroconvulsive therapy). Additional research is needed to further elucidate psychosocial and biological factors that affect risk and course of LLD. In addition, research to identify psychobiological factors predicting differential treatment response to various interventions will be essential to the development of more individualized and effective approaches to the prevention and treatment of LLD

A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development

The allostatic load (AL) model represents an interdisciplinary approach to comprehensively conceptualize and quantify chronic stress in relation to pathologies throughout the life cycle. This article first reviews the AL model, followed by interactions among early adversity, genetics, environmental toxins, as well as distinctions among sex, gender, and sex hormones as integral antecedents of AL. We next explore perspectives on severe mental illness, dementia, and caregiving as unique human models of AL that merit future investigations in the field of developmental psychopathology. A complimenting transdisciplinary perspective is applied throughout, whereby we argue that the AL model goes beyond traditional stress–disease theories toward the advancement of person-centered research and practice that promote not only physical health but also mental healt

Alzheimer’s and Patient Caregiver Burnout: A Comprehensive Review of the Literature

The term ‘silent epidemic’ has become fitting for Alzheimer’s disease, as it is now the sixth leading cause of death in the US. Caring for AD patients at home in the US costs billions of dollars each year. The current comprehensive literature review discusses the background/history of AD, pathology and modes of transmission of AD, behavioral and natural risk factors, prevention and treatment options, and how the aforementioned factors contribute to caregiver burnout and subsequently affect the AD patient. The extensive examination of the literature determined several gaps to be addressed. More specifically, burnout among AD caregivers has become an epidemic of its own, and caregivers are experiencing increasing fatigue, stress, and financial burden. There have been several means identified to assess caregiver burnout, as well as associated interventions that have shown effectiveness among patients and their families. Nevertheless, further longitudinal research is warranted on the implementation of more effective interventions specifically for caregivers, including stress management and social support mechanisms

Cortisol, coping familiar e sobrecarga em cuidadores informais de toxicodependentes

This study focuses on the prospective mediation role of family coping between burden and cortisol levels in informal caregivers of addicts as well as on the feasible use of two different ways to analyse the salivary cortisol levels. Participants were 120 Portuguese informal caregivers of addicts. The cortisol samples were collected at awakening, 45 minutes later and after a 30 minute presentation of images taken from the International Affective Picture System. Family coping and caregiver burden were measured using the Portuguese versions of the Caregiver Reaction Assessment, and the Family Crisis Oriented Personal Evaluation Scale. Cortisol samples were collected in salivettes and the results were computed in order to determine the Area Under the Curve scores (AUCg, AUCi). Results found family coping to be negatively correlated with burden and AUCg levels (i.e. overall intensity) and positively correlated with either AUCg and AUCi (i.e. change over time). The mediation model revealed that family coping was a partial mediator in the relationship between the burden and AUCg levels. Therefore, Family Coping appears to be an essential variable in understanding the stress response and should be considered in further studies and interventions. In addition, the use of two different formulas for calculating cortisol levels provided important new information concerning the relationship between cortisol, burden and family coping. It seems that burden has a more profound effect on the overall intensity of the neuroendocrine response to caregiver stress and not so much on the sensitivity of the system.Este estudo centrou-se na utilização viável de duas maneiras diferentes para analisar os níveis de cortisol salivar e no papel moderador do coping familiar entre níveis de cortisol e sobrecarga em cuidadores informais de toxicodependentes. A amostra incluiu 120 cuidadores informais de toxicodependentes. As amostras foram recolhidas ao acordar, 45 minutos mais tarde e depois de uma apresentação de 30 minutos de imagens retiradas do IAPS (International Affective Picture System). O coping familiar e a sobrecarga foram avaliados usando as versões em português do Caregiver Reaction Assessment (CRA) e Family Crisis Oriented Personal Evaluation Scale (F-Copes) respetivamente. As amostras de cortisol foram recolhidas em salivettes e os resultados foram computados, a fim de determinar a área sob a curva (AUCg, AUCi). Os resultados encontraram que o coping familiar encontrou-se negativamente correlacionado com a carga e os níveis AUCg (i.e. intensidade global) e positivamente correlacionada com AUCg e AUCi (ou seja, a mudança ao longo do tempo). O modelo revelou que o coping familiar foi um mediador parcial na relação entre a sobrecarga e os níveis de AUCg. Assim, o uso de duas fórmulas diferentes para calcular os níveis de cortisol forneceu novas informações importantes sobre a relação entre o cortisol, sobrecarga e coping familiar. Parece que a sobrecarga tem um efeito mais profundo sobre a intensidade global da resposta neuroendócrina ao stress do cuidador e não tanto na sensibilidade do sistema

DEMENTIA CAREGIVING OUTCOMES: THE IMPACT OF CAREGIVING ONSET, ROLE OCCUPANCY, AND CARE-RECIPIENT DECLINE

Dementia is characterized as a progressive loss of brain function that results in the deterioration of many cognitive and physical abilities. Alzheimer’s disease (AD) is the most common form of dementia, causing steady declines in memory, functional abilities, and mental functioning. With a projected increase of degenerative illnesses, such as AD, family caregiving for individuals with the disease is also steadily increasing. Caring for an individual with AD has been characterized as a “career,” and within this career are a number of key transitions, including the onset of caregiving. Preexisting caregiving research reveals a number of negative consequences for AD family caregivers, including depression, overload, and physical health complications. The purpose of this study was to examine how different patterns of caregiving onset (gradual and abrupt) and role occupancy (how many roles the caregiver is holding) impact mental health and physical health outcomes for AD caregivers. This study also explored how cognitive decline and behavioral problems found within the care-recipient have the potential to moderate these relationships. Cross-sectional, quantitative data from one hundred participants completing self-administered surveys was used in this study. A series of one-way ANOVAS and multiple regression analyses were conducted to address the study’s aims. Results indicated that care-recipient cognition and behavioral problems moderated the relationship between caregiving onset and mental health outcomes, including depression, role overload, and role captivity for caregivers who experienced a more abrupt entry into the caregiving role. Results suggest the importance of considering moderating factors within the caregiving career, as well as different caregiving onset transitions. Clinical implications of the findings are discussed, as well as directions for future research, including prospective caregiving research

Impact of Caregiving Role in the Quality of Life of Family Caregivers for Persons with Alzheimer\u27s Disease

This study investigated quality of life of family caregivers of persons with Alzheimer\u27s disease (AD). Caregiving is a strenuous and challenging job. Family caregivers experience poor quality of life after they take the role of caregiving which might be related to depression. Purpose of this study was to find if caregiving duration and depression has any role in affecting family caregivers\u27 emotional, physical, and general health. Data for this study were collected through electronic and mailed survey methods. The questionnaires completed by subjects: Medical Outcomes Study Short Form 36 (MOS-36) and Center for Epidemiologic Studies Depression Scale (CES-D). Descriptive statistics including mean, standard deviation, minimum and maximum values were calculated on demographics. Correlation statistics were calculated for emotional health, physical health, general health, depression and caregiving duration in the target population to find if there is presence or absence of any significant relationship that affects quality of life of family caregivers of persons with AD. Data were collected in Minnesota through Alzheimer\u27s Association Minnesota-North Dakota Chapter, Lyngblomsten Care Center, St. Paul, MN, Lyngblomsten Home and Community Based Services, St. Paul, MN and Ecumen Seasons at Apple Valley, MN. The agencies were contacted in-person for recruitment of subjects. Total of 207 family caregivers responded where 25 were males and 182 females. Statistical analyses were computed which resulted in four statistically significant findings: emotional and physical health was significantly related to each other; emotional and physical health was significantly related to depression; general health was significantly related to depression; and caregiving duration was significantly related to depression. Study presented new information on family caregivers\u27 quality of life. The conclusion drawn from the current study may help future researchers to investigate improvement in quality of life of family caregivers with AD. It is hoped that the data will help health professionals and support groups to plan and develop better programs to improve quality of life of family caregivers for persons with Alzheimer\u27s disease