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Associations between pleasant events, activity restriction, stressors, and blood pressure in caregivers of persons with dementia

Published online by Cambridge University Press:  17 June 2021

Carlos Vara-García Open the ORCID record for Carlos Vara-García [Opens in a new window] ,
Rosa Romero-Moreno Open the ORCID record for Rosa Romero-Moreno [Opens in a new window] ,
Roland von Känel Open the ORCID record for Roland von Känel [Opens in a new window] ,
Brent Mausbach Open the ORCID record for Brent Mausbach [Opens in a new window] ,
Javier Olazarán Open the ORCID record for Javier Olazarán [Opens in a new window] ,
María del Sequeros Pedroso-Chaparro Open the ORCID record for María del Sequeros Pedroso-Chaparro [Opens in a new window] ,
Maria Márquez-González Open the ORCID record for Maria Márquez-González [Opens in a new window]  and
Andrés Losada-Baltar Open the ORCID record for Andrés Losada-Baltar [Opens in a new window]
Carlos Vara-García*
Affiliation:
Universidad Rey Juan Carlos, Department of Psychology, Alcorcón, Spain
Rosa Romero-Moreno
Affiliation:
Universidad Rey Juan Carlos, Department of Psychology, Alcorcón, Spain
Roland von Känel
Affiliation:
University Hospital Zurich, Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, Zurich, Switzerland
Brent Mausbach
Affiliation:
University of California, San Diego, Department of Psychiatry, La Jolla, USA
Javier Olazarán
Affiliation:
Hospital General Universitario Gregorio Marañón, Department of Neurology, Madrid, Spain
María del Sequeros Pedroso-Chaparro
Affiliation:
Universidad Rey Juan Carlos, Department of Psychology, Alcorcón, Spain
Maria Márquez-González
Affiliation:
Universidad Autónoma de Madrid, Department of Biological and Health Psychology, Madrid, Spain
Andrés Losada-Baltar
Affiliation:
Universidad Rey Juan Carlos, Department of Psychology, Alcorcón, Spain
*
Correspondence should be addressed to: Carlos Vara García, Campus de Ciencias de la Salud, Universidad Rey Juan Carlos, Departamental II, Avenida de Atenas, s/n, 28922Alcorcón, Spain. Phone: +34 610 28 16 99. Email carlos.vara@urjc.es
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Abstract

Objectives:

Caring for a relative with dementia is associated with adverse consequences for cardiovascular health. Cognitive and behavioral factors, such as high perceived activity restriction and low frequency of pleasant events have been found to be associated with higher levels of blood pressure, but the role these variables play in the stress and coping process remains understudied. The objective of this study is to analyze the associations between behavioral and psychological symptoms of dementia, activity restriction, frequency of pleasant events, and mean arterial pressure.

Design:

Face-to-face interviews and cross-sectional analyses.

Setting:

Social services, healthcare centers, and adult day services of Comunidad de Madrid, Spain.

Participants:

One hundred and two family caregivers of a spouse or parent with dementia.

Measurements:

Apart from various sociodemographic and health-related variables, behavioral and psychological symptoms of dementia, activity restriction, and frequency of leisure activities were assessed. In addition, measurement of blood pressure levels was conducted through an electronic sphygmomanometer.

Results:

The obtained model suggests that there is a significant indirect association between behavioral and psychological symptoms of dementia and mean arterial pressure through activity restriction and frequency of pleasant events.

Conclusions:

The findings of this study provide preliminary support for a potential indirect effect between behavioral and psychological symptoms of dementia and blood pressure, through the effects of behavioral and psychological symptoms of dementia on the caregivers’ levels of activity restriction and frequency of pleasant activities. Our manuscript provides additional support for the pleasant events and activity restriction model (Mausbach et al., 2011; Chattillion et al., 2013), by highlighting the importance of considering caregiving stressors as a source of caregivers’ activity restriction in the theoretical framework of the model.

Keywords

behavioral and psychological symptoms of dementiacarers
Type
Original Research Article
Information
International Psychogeriatrics , Volume 34 , Special Issue 3: Issue Theme: Positive Psychiatry Factors and Health , March 2022 , pp. 275 - 285
Copyright
© International Psychogeriatric Association 2021

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References

Atienza, A. A., Henderson, P. C., Wilcox, S. and King, A. C. (2001). Gender differences in cardiovascular response to dementia caregiving. The Gerontologist, 41, 490–498. https://doi.org/10.1093/geront/41.4.490 CrossRefGoogle ScholarPubMed
Bollen, K. A. (1989). A new incremental fit index for general structural equation models. Sociological Methods & Research, 17, 303–316. https://doi.org/10.1177/0049124189017003004 CrossRefGoogle Scholar
Bollen, K.A and Stine, RA. (1992) Bootstrapping goodness-of-fit measures in structural equation models. Sociological Methods & Research, 21, 205–229. https://doi.org/10.1177/0049124192021002004 CrossRefGoogle Scholar
Byrne, B. M. (2016). Structural Equation Modeling with AMOS: Basic Concepts, Applications, and Programming. New York: Routledge.CrossRefGoogle Scholar
Capistrant, B. D., Moon, J. R., Berkman, L. F. and Glymour, M. M. (2012). Current and long-term spousal caregiving and onset of cardiovascular disease. Journal of Epidemiology & Community Health, 66, 951–956. http://dx.doi.org/10.1136/jech-2011-200040 CrossRefGoogle ScholarPubMed
Chattillion, E. A. et al. (2013). Pleasant events, activity restriction, and blood pressure in dementia caregivers. Health Psychology, 32, 793–801. http://doi.org/10.1037/a0029412 CrossRefGoogle ScholarPubMed
Fernández-Fernández, V., Losada-Baltar, A., Márquez-González, M., Paniagua-Granados, T., Vara-García, C. and Luque-Reca, O. (2020). Emotion regulation processes as mediators of the impact of past life events on older adults’ psychological distress. International Psychogeriatrics, 32(2), 199–209. https://doi.org/10.1017/S1041610219002084 CrossRefGoogle ScholarPubMed
Haley, W. E., Levine, E. G., Brown, S. L. and Bartolucci, A. A. (1987). Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers. Psychology and Aging, 2, 323–330. https://doi.org/10.1037/0882-7974.2.4.323 CrossRefGoogle ScholarPubMed
Harmell, A. L., Chattillion, E. A., Roepke, S. K. and Mausbach, B. T. (2011). A review of the psychobiology of dementia caregiving: a focus on resilience factors. Current Psychiatry Reports, 13, 219–224. https://doi.org/10.1007/s11920-011-0187-1 CrossRefGoogle ScholarPubMed
Ho, J. S. et al. (2013). Reduced activity restriction buffers the relations between chronic stress and sympathetic nervous system activation. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 69, 408–416. https://doi.org/10.1093/geronb/gbt028 CrossRefGoogle ScholarPubMed
Hu, L. T. and Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1–55. https://doi.org/10.1080/10705519909540118 CrossRefGoogle Scholar
Jöreskog, K. G. and Sörbom, D. (1993). LISREL 8: Structural Equation Modeling with the SIMPLIS Command Language. Chicago, IL: Scientific Software International.Google Scholar
Kiecolt-Glaser, J.K., McChire, L., Robles, T.F. and Glaser, R. (2002). Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annual Review of Psychology, 53, 83–107. https://doi.org/10.1146/annurev.psych.53.100901.135217 CrossRefGoogle Scholar
Kim, H. and Millsap, R. (2014). Using the bollen-stine bootstrapping method for evaluating approximate fit indices. Multivariate Behavioral Research, 49, 581–596. https://doi.org/10.1080/00273171.2014.947352 CrossRefGoogle ScholarPubMed
Kim, J. H. and Knight, B. G. (2008). Effects of caregiver status, coping styles, and social support on the physical health of Korean American caregivers. The Gerontologist, 48, 287–299. https://doi.org/10.1093/geront/48.3.287 CrossRefGoogle ScholarPubMed
Kim, J.H., Knight, B.G. and Flynn-Longmire, C.V. (2007). The role of familism in stress and coping processes among African American and White dementia caregivers: effects on mental and physical health. Health Psychology, 26, 564–576. https://doi.org/10.1037/0278-6133.26.5.564 CrossRefGoogle ScholarPubMed
Knight, B. G. and Sayegh, P. (2010). Cultural values and caregiving: the updated sociocultural stress and coping model. The Journals of Gerontology: Series B, 65, 5–13. https://doi.org/10.1093/geronb/gbp096 CrossRefGoogle Scholar
Lazarus, R. and Folkman, S. (1984). Stress, Appraisal and Coping. New York: Springer.Google Scholar
Lewinsohn, P. M. (1975). Engagement in pleasant activities and depression level. Journal of Abnormal Psychology, 84, 729–731. https://psycnet.apa.org/doi/10.1037/0021-843X.84.6.729 CrossRefGoogle ScholarPubMed
Lewinsohn, P. M. and Graf, M. (1973). Pleasant activities and depression. Journal of Consulting and Clinical Psychology, 41, 261–268. https://doi.org/10.1037/h0035142 CrossRefGoogle ScholarPubMed
Logsdon, R. G. and Teri, L. (1997). The pleasant events schedule-AD: psychometric properties and relationship to depression and cognition in Alzheimer’s disease patients. The Gerontologist, 37, 40–45. https://doi.org/10.1093/geront/37.1.40 CrossRefGoogle ScholarPubMed
Losada, A. et al. (2010). Leisure and distress in caregivers for elderly patientes. Archives of Gerontology and Geriatrics, 50, 347–350. https://doi.org/10.1016/j.archger.2009.06.001 CrossRefGoogle Scholar
Mausbach, B. et al. (2017). Engagement in pleasant leisure activities and blood pressure: a 5-year longitudinal study in Alzheimer caregivers. Psychosomatic Medicine, 79, 735–741. https://doi.org/10.1097/PSY.0000000000000497 CrossRefGoogle Scholar
Mausbach, B. T., Roepke, S. K., Depp, C. A., Moore, R., Patterson, T. L. and Grant, I. (2011). Integration of the pleasant events and activity restriction models: development and validation of a “PEAR” model of negative outcomes in Alzheimer’s caregivers. Behavior Therapy, 42, 78–88. https://doi.org/10.1016/j.beth.2009.11.006 CrossRefGoogle ScholarPubMed
Mausbach, B.T. et al. (2012). A longitudinal analysis of the relations among stress, depressive symptoms, leisure satisfaction, and endothelial function in caregivers. Health Psychology, 31, 433–440. https://doi.org/10.1037/a0027783 CrossRefGoogle ScholarPubMed
Moore, R. C. et al. (2013). A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP). Behaviour Research and Therapy, 51, 623–632. https://doi.org/10.1016/j.brat.2013.07.005 CrossRefGoogle Scholar
Nieboer, A. P., Schulz, R., Matthews, K. A., Scheier, M. F., Ormel, J. and Lindenberg, S. M. (1998). Spousal caregivers’ activity restriction and depression: a model for changes over time. Social Science & Medicine, 47, 1361–1371. https://doi.org/10.1016/S0277-9536(98)00214-7 CrossRefGoogle Scholar
Nogales-González, C., Losada, A. and Romero-Moreno, R. (2015). Confirmatory factor analysis of the Spanish version of the revised memory and behavior problems checklist. International Psychogeriatrics, 27, 683–692. https://doi.org/10.1017/S1041610214002476 CrossRefGoogle ScholarPubMed
Pinquart, M. and Sörensen, S. (2007). Correlates of physical health of informal caregivers: a meta-analysis. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 62, 126–137. https://doi.org/10.1093/geronb/62.2.P126 CrossRefGoogle ScholarPubMed
Preacher, KJ and Hayes, AF. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavioral Research & Methods, 36, 717–731. https://doi.org/10.3758/BF03206553 CrossRefGoogle ScholarPubMed
Prospective Studies Collaboration. (2002). Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. The Lancet, 360, 1903–1913. https://doi.org/10.1016/S0140-6736(02)11911-8 CrossRefGoogle Scholar
Reisberg, B., Ferris, S. H., de Leon, M. J. and Crook, T. (1982). The Global Deterioration Scale for assessment of primary degenerative dementia. The American Journal of Psychiatry, 139, 1136–1139. https://psycnet.apa.org/doi/10.1176/ajp.139.9.1136 Google ScholarPubMed
Ross, K.M. and Carroll, J.E. (2017). Alzheimer’s disease caregivers’ health and important resources: next steps in intervention research. Psychosomatic Medicine, 79, 732–734. https://doi.org/10.1097/PSY.0000000000000518 CrossRefGoogle Scholar
Shaw, W. S., Patterson, T. L., Semple, S. J., Dimsdale, J. E., Ziegler, M. G. and Grant, I. (2003). Emotional expressiveness, hostility and blood pressure in a longitudinal cohort of Alzheimer caregivers. Journal of Psychosomatic Research, 54, 293–302. https://doi.org/10.1016/S0022-3999(02)00412-9 CrossRefGoogle Scholar
Shaw, W. S., Patterson, T. L., Ziegler, M. G., Dimsdale, J. E., Semple, S. J. and Grant, I. (1999). Accelerated risk of hypertensive blood pressure recordings among Alzheimer caregivers. Journal of Psychosomatic Research, 46, 215–227. https://doi.org/10.1016/S0022-3999(98)00084-1 CrossRefGoogle ScholarPubMed
Tabachnick, B. and Fidell, L. (2001). Using Multivariate Statistics. 4th ed. Needham Heights, MA: Allyn & Bacon.Google Scholar
Teri, L., Truax, P., Logsdon, R., Uomoto, J., Zarit, S. and Vitaliano, P. P. (1992). Assessment of behavioral problems in dementia: the revised memory and behavior problems checklist. Psychology and Aging, 7, 622–631. https://doi.org/10.1037/0882-7974.7.4.622 CrossRefGoogle ScholarPubMed
van der Lee, J., Bakker, T. J., Duivenvoorden, H. J. and Dröes, R. M. (2014). Multivariate models of subjective caregiver burden in dementia: a systematic review. Ageing Research Reviews, 15, 76–93. https://doi.org/10.1016/j.arr.2014.03.003 CrossRefGoogle ScholarPubMed
Vara-García, C. et al. (2019). Stress and blood pressure in dementia caregivers: The moderator role of mindfulness. Clinical Gerontologist, 42, 512–520. https://doi.org/10.1080/07317115.2018.1554611 CrossRefGoogle ScholarPubMed
Vitaliano, P. P., Scanlan, J. M., Zhang, J., Savage, M. V., Hirsch, I. B. and Siegler, I. C. (2002). A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosomatic Medicine, 64, 418–435.CrossRefGoogle ScholarPubMed
von Känel, R. et al. (2006). Effect of Alzheimer caregiving stress and age on frailty markers interleukin-6, C-reactive protein, and D-dimer. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 61(9), 963–969. https://doi.org/10.1093/gerona/61.9.963 CrossRefGoogle ScholarPubMed
von Känel, R. et al. (2010). Sleep and biomarkers of atherosclerosis in elderly Alzheimer caregivers and controls. Gerontology, 56(1), 41–50. https://doi.org/10.1159/000264654 CrossRefGoogle ScholarPubMed
von Känel, R. et al. (2011). Regular physical activity moderates cardiometabolic risk in Alzheimer’s caregivers. Medicine and Science in Sports and Exercise, 43, 181. https://doi.org/10.1249/MSS.0b013e3181e6d478 CrossRefGoogle ScholarPubMed
von Känel, R. et al. (2012). Effect of Alzheimer caregiving on circulating levels of C-reactive protein and other biomarkers relevant to cardiovascular disease risk: a longitudinal study. Gerontology, 58, 354–365. https://doi.org/10.1159/000334219 CrossRefGoogle ScholarPubMed
von Känel, R. et al. (2008). Increased Framingham coronary heart disease risk score in dementia caregivers relative to non-caregiving controls. Gerontology, 54, 131–137. https://doi.org/10.1159/000113649 CrossRefGoogle ScholarPubMed
Williamson, G. M. and Shaffer, D. R. (2000). The activity restriction model of depressed affect: antecedents and consequences of restricted normal activities. In: Williamson, G. M., Shaffer, D. R. and Parmelee, P. A. (Eds.), Physical Illness and Depression in Older Adults: A Handbook of Theory, Research, and Practice (pp. 173–200). New York: Kluwer Academic/Plenum.CrossRefGoogle Scholar
Williamson, G.M. and Schulz, R. (1992). Pain, activity restriction, and symptoms of depression among community-residing elderly adults. Journal of Gerontology, 47, 367–372. https://doi.org/10.1093/geronj/47.6.P367 CrossRefGoogle ScholarPubMed