Improving Well-Being for Older Adult Family Dementia Caregivers

Study Overview
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Brief Summary
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This study will examine the effects of the Mindfulness-Based Stress Reduction (MBSR) program and the Living Well program, compared to a control group, to see if the programs might be associated with better immune function (response to current influenza vaccine), physical and emotional health, and well-being.

Detailed Description
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A considerable literature documents that a wide variety of psychosocial interventions can lessen the psychological burden of family or spousal dementia caregiving. Some caregiver intervention studies have included measures of self-reported physical health and sleep, and others have focused on improving inflammation in caregivers. The current study will add to this literature by examining the effects of two behavioral interventions on adaptive immune responses, particularly, antibody response to influenza vaccination, in older adult family caregivers.

Official Title
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Mindfulness-Based Stress Reduction for Family Caregivers of Dementia Patients

Conditions
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Stress, Psychological

Intervention / Treatment
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* Behavioral: Mindfulness Based Stress Reduction Program
* Behavioral: Living Well Program


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 55 years of age and older English-speaking (consent process and assessments will be conducted in English only) Currently living with or in proximity to, and the primary caregiver for, a loved one with dementia who lives in the community-for the purposes of this study, loved one refers to a family member such as a spouse, ex-spouse, significant other, sibling, in-law, parent, or other type of close established relationship (e.g., close friend) regarded as family; primary caregivers provide daily informal (non-paid) in-person care. Currently experiencing moderate to high levels of perceived stress (PSS-10 ≥ 12) and/or caregiver burden (MCSI ≥ 5) Participants will be asked to stabilize medications prior to beginning the trial, and for the duration of the trial (If medication dose changes do occur, analytic models will include those changes as time-varying covariates) Exclusion Criteria: Loved one with dementia currently resides in a long-term care facility (e.g., nursing home) without the caregiver. Given the didactic and self-directed nature of the MBSR program, individuals with major, uncorrected sensory impairments and cognitive deficits, as determined by a Montreal Cognitive Assessment (MoCA) score of 23 or lower 29, will be excluded, as will participants with other neuropsychological deficits deemed significant enough to interfere with study participation. Low literacy is not an exclusion criterion; questionnaires will be orally administered when necessary. Modules from the Mini International Neuropsychiatric Exam (MINI 30) will be used to exclude subjects who have these psychiatric conditions: current alcohol dependence, current non-alcohol psychoactive substance use dependence, psychotic disorders (current and lifetime), bipolar disorder, and current mood disorder with psychotic features. Subjects will also be excluded for the following reasons: having completed an MBSR program in the past; allergy to eggs (the influenza vaccine is most commonly manufactured using an egg-based process); history of Guillain-Barré syndrome; immunodeficiency or receipt of immunosuppressive therapy; recent major surgery; and active neoplastic disease.

Ages Eligible for Study
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Minimum Age: 55 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Mindfulness Based Stress Reduction (MBSR) Program<br>The MBSR program is an eight-week-long course designed to teach subjects how to develop their inner resources in the service of taking better care of themselves. MBSR training includes the learning and refining of a range of skills aimed at increasing relaxation and awareness of physical experiences and sensations related to physical symptoms, emotions, and thoughts. Special emphasis is placed on movement, meditation, and breathing. | Behavioral: Mindfulness Based Stress Reduction Program<br>* Group-based intervention<br>* Other names: MBSR;|
| Active Comparator: Living Well (LW) Program<br>LW is an eight-week course of group presentations and discussions on topics related to the promotion of health and well-being in the context of dementia caregiving. LW is designed to teach participants how to improve their physical and emotional health as a complement to traditional medical treatments. | Behavioral: Living Well Program<br>* Group-based intervention<br>|
| No Intervention: Usual Care<br>The usual care arm is a no intervention group wherein participants experience their usual circumstances. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Antibody response to influenza vaccination | Change in amount of antibody titers following influenza vaccination | pre-vaccination to 6 weeks and 6 months post-vaccination | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Granzyme B (GrzB) activity after influenza vaccination | Change in GrzB activity, a measure of antigen-specific cytotoxic T cell activity, following influenza vaccination | pre-vaccination to 6 weeks and 6 months post-vaccination | 
| Ratio of T-cell cytokines, interferon (IFN)-gamma and IL-10 | Change in IFN:IL-10 ratio following influenza vaccination | pre-vaccination to 6 weeks and 6 months post-vaccination | 
| Inflammatory cytokines, interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha | Change in inflammatory cytokine levels over time | baseline to 6 weeks to 6 months post-intervention |