Risk and protective factors for psychosocial resilience in spousal caregivers for spouses with cognitive decline

This $562,314 federal Project Grant awarded by the National Institute on Aging under the Aging Research program (CFDA 93.866) supports a 3-year study to identify risk and protective factors associated with psychosocial resilience in spousal caregivers for spouses with Alzheimer's disease and related dementias. The study leverages data from several large, longitudinal cohort studies, including the Health and Retirement Study, to examine how caregivers' well-being, mental health, and cognitive function change over time. Advanced statistical techniques will be applied to determine what individual, societal, and policy factors influence caregivers' ability to maintain their health and well-being. The findings are expected to inform priorities for social services and community supports to enhance resilience and cognition in both caregivers and care recipients.

Abstract

Family caring plays an essential role in sustaining health systems, but can place social, financial, physical, and emotional demands on carers. Understanding what caregivers need to support them is key to facilitating family care. Spousal carers for spouses with alzheimer's and alzheimer's-related dementia (ad/adrd) are particularly subject to additional stress and burden. Why some carers seem to manage their long-term well-being better than others is less understood. Differences in well-being observed between caregivers may be an indicator of how they differ in adapting to changing circumstances and their ability to maintain or recover their mental health and well-being following an adverse event (psychosocial resilience). This study leverages data from international harmonized cognitive assessment protocol (hcap) studies and longitudinal data from the health and retirement study (HRS) framework of biennial aging cohort studies. The HRS (15 waves), the irish longitudinal study on ageing (tilda) (6 waves), the english longitudinal study of ageing (elsa) (9 waves) and the survey of health, ageing and retirement in europe (share) (8 waves) are large, nationally representative, prospective cohort studies that examine the social, economic and health circumstances of community-dwelling adults aged ≥50 years from which spousal carer- dyads can be drawn. Cognitive assessments are available from hcap and detailed measurements of well- being and mental health and cognition from the individual longitudinal cohort studies (including measures of depressive symptoms, quality of life and life satisfaction), in addition to well-characterized social, economic and health data, formal care provision, and policy context. This study aims to: (1) identify changes over time in psychosocial resilience in mental health and well-being, and cognitive health in spousal caregivers for spouses with normal cognition/ad/ARD; (2) determine the risk and protective factors associated with resilient groups and investigate what role societal and policy contexts play in shaping these trajectories; (3) investigate how the needs of both the caregiver and the care recipient influence psychosocial resilience. To address these aims, multiple waves of HRS framework survey data combined with hcap data will be investigated and advanced longitudinal statistical techniques (growth mixture models, multilevel analysis and actor-partner interdependence models) will be applied. Given the complex nature of this study, we have assembled an outstanding multi-disciplinary team of clinical and academic researchers with expertise in each of the constituent parts of the project. Study results will identify important risk and protective factors for psychosocial resilience in carer-dyads that are amenable to intervention. In doing so, the study will inform the priorities for social and community-level services and supports for spousal caregivers to enhance resilience and maintain cognition in both caregivers and their spouses, as well as aid in the design of new policies and programs to meet these needs.