Effect of caregiving on cardiovascular risk in caregivers of a relative with dementia: study of modulating variables

Abstract

Drawing upon the sociocultural stress and coping model (Knight y Sayegh, 2010), the general aim of this doctoral dissertation has been to analyze, through a cross-sectional approach, the role of different psychosocial modulating variables in the explanation of dementia family caregivers’ cardiovascular risk, measured through indicators of blood pressure. For this purpose, four different studies were conducted. Even though each study is described and discussed independently, a general introduction is included in order to describe the theoretical and empirical framework in which the dissertation has been made. The general objective of this dissertation is also described, followed by the specific objectives and hypotheses of each of the studies. Then, overall methodological characteristics of the studies are presented. Afterwards, each of the independent studies is presented, with their own introduction, method, results, discussion and references. Finally, a general discussion and the main conclusions of this doctoral dissertation are included. Participants in all the studies consisted of family caregivers of persons with dementia, caring for a parent or a spouse. They were recruited through different Health and Social Services and Day Care centers from Madrid (Spain). Face to face interviews were conducted, assessing the following variables: sociodemogaphic and contextual variables (e.g., caregivers’ age and gender, time since being a caregiver, daily hours devoted to caregiving, knowledge about Alzheimer), stressors (frequency of behavioral and psychological problems of dementia, severity of dementia), reaction to stressors (caregiver’s reaction to behavioral and psychological problems of dementia), resources (trait mindfulness, dysfunctional thoughts, experiential avoidance, activity restriction, frequency of pleasant and leisure activities and personal values) and health outcomes (blood pressure). The objective of the first study was to analyze the moderating role of caregivers’ trait mindfulness in the effects of stressors on cardiovascular risk. Specifically, the moderating role of trait mindfulness was analyzed on the relationship between stressors (frequency of disruptive behaviors) and blood pressure. Results showed a significant moderating effect of trait mindfulness on the relationship between stressors and diastolic BP, but not for systolic BP. Post-hoc analyses suggested that the relationship between stressors and diastolic BP was stronger and positive when trait mindfulness was low, but not when it was high.. The study suggests that a high level of trait mindfulness may have protective effect on BP when caregivers face high levels of stress. The purpose of the second study was to analyze the mediation effects of dysfunctional thoughts about caregiving and experiential avoidance in the relationship between caregivers’ knowledge about Alzheimer’s disease and blood pressure. Results showed that higher knowledge about Alzheimer’s disease was associated to higher dysfunctional thoughts about caregiving and higher experiential avoidance, and this association was linked with higher systolic blood pressure, suggesting a potential mediation effect of dysfunctional thoughts and experiential avoidance in the relationship between knowledge about Alzheimer and blood pressure. The study provides support to the idea that a lack of knowledge about Alzheimer’s disease may contribute to maladaptive ways of thinking about caregiving, increasing caregivers’ cardiovascular risk.