Search

Objectives Positive caregiver adaptation over time may be associated with reports of positive aspects of caregiving (PAC). We examined differences in PAC by caregiving duration and social engagement, controlling for measures of distress. Methods Participants included 283 African American or White caregivers from the Caregiving Transitions Study with a wide range of caregiving durations. PAC are defined as positive appraisals that caregivers report about their role, such as feeling appreciated or confident. We fit multivariable linear models with the total PAC score as the outcome to assess its association with years of caregiving and social engagement (social network, monthly social contact). Models were adjusted for age, sex, race, marital status, relationship to care recipient, care recipient's dementia status, perceived stress and caregiving strain. Results Caregivers with higher social engagement reported significantly higher PAC. A non-significant trend was found in most analytic models for caregivers with longer duration of care to report higher PAC. African American caregivers reported higher PAC compared to White caregivers. Dementia caregivers reported lower PAC than non-dementia caregivers in models adjusting for demographics and social network size, but the association was attenuated with the addition of caregiving strain. Discussion Higher social engagement and longer duration of care tend to be associated with higher PAC after adjusting for demographics and measures of distress. Future studies should aim to leverage longitudinal data to understand whether caregivers shift appraisal to positive aspects of their role and explore implementation of caregiving interventions targeting PAC in order to improve the caregiving experience.

One of the benefits of this large, national cohort study with black and white participants is the opportunity to involve a breadth of researchers in the science. REGARDS actively solicits and engages early career and minority investigators to lead or participate in manuscripts as well as ancillary studies. REGARDS has provided opportunities for >175 ancillary studies, including those that enrich existing outcomes, provide new outcomes, assess new exposures, link with other national data, support extended analyses, and assess genetic associations. Over 70% of the 500+ publications to date have a lead author who was not a funded REGARDS investigator. In this presentation, we will discuss some of the innovative ancillary studies and high-impact manuscripts that have grown out of REGARDS, the processes for developing an ancillary study/manuscript, and the procedures for obtaining REGARDS data. We will describe opportunities for mentored research for junior investigators, as well as independent research projects.

Major life events, such as retirement, may lead to dramatic shifts in physical activity (PA) patterns. However, there are limited empirical data quantifying the magnitude of these changes. Our aims were to objectively measure PA before and after retirement and to describe changes in participation in various types of PA. Participants were employed black and white men and women enrolled in REGARDS (REasons for Geographic and Racial Differences in Stroke), a national prospective cohort study (n=581, mean age 64 years, 25% black, 51% women). Participants met inclusion criteria if they retired between their first and second accelerometer wearing (2009-2013 and 2017-2018, respectively) and had valid accelerometer data (>4 days with >10 hours/day pre- and post-retirement). Accelerometer-based PA was categorized into average minutes per day spent in sedentary, light-intensity, and moderate-to-vigorous PA. Participants reported changes (less, same, more) in 12 types of PA. After retirement, participants decreased both sedentary time (by 36.3 minutes/day) and moderate-to-vigorous PA (by 5.6 minutes/day). Conversely, there was an increase in light-intensity PA (+18.1 minutes/day) after retirement. Participants reported changes in their participation level in various PA activities. For example, 41% reported an increased amount of TV viewing, 42% reported less walking, and 31% reported increased participation in volunteer activities. Findings indicate that retirement coincides with a change in the time spent in each intensity category and the time spent across a range of activity types. Further research is warranted to examine how these changes in physical activity patterns influence post-retirement health status.

Investigators in the NIH-funded REGARDS (REasons for Geographic and Racial Differences in Stroke) project have taken a novel approach to break the paradigm of epidemiologic studies limited to clinic-based convenience samples, by developing a national cohort of 30,239 black and white participants recruited from communities across all lower 48 US states, including 1,855 of the 3,033 counties. Mean age at enrollment (Jan 2003-Oct 2007) was 65.3 years. The four initial aims were to further understanding of: 1) geographic and racial differences in stroke risk factors; 2) geographic and racial differences in stroke incidence and mortality; 3) association of stroke risk factors and stroke risk (incidence and mortality) focusing on effect modification by race or region; and 4) establishment of a repository of serum, plasma, urine and DNA for use in future studies. When the grant was awarded, the study goals were broadened to include longitudinal remote assessment of cognitive function. A second in-home visit was completed May 2013-Dec 2016 including measures of functional status. The cohort is in its 17th year of follow-up. We will detail recruitment and enrollment methods, characteristics of the cohort and status, with brief overview of the biological, medical, psychosocial, environmental, and contextual data collected in the parent study. Speakers will discuss in more detail the stroke and cognitive data, ancillary studies focused on caregiver and heart disease outcomes, and provide examples of national and international mentoring that has leveraged REGARDS data. Finally, we will describe opportunities for additional data sharing and new ancillary studies.

The REGARDS study enrolled 30,239 whites and blacks aged >45 from 2003 – 2007, with oversampling of blacks and residents of the Stroke Belt. Potential participants were mailed a letter/brochure followed by telephone call. After verbal consent, telephone interview assessed cardiovascular health and cognitive function. In a home visit, measurements of risk factors, biological samples, EKG, written consent were obtained; during the in-home visit, self-administrated questionnaires were left to be completed and returned. Participants are followed for hospitalizations via telephone at 6-month intervals. Annually and biennially, brief and more comprehensive assessments of global cognitive function are conducted. Medical records for suspected strokes are collected with adjudication by stroke experts. A 2nd in-home and telephone assessment was conducted 2013-2016, approximately 10 years after baseline. This presentation will describe the methodological details of REGARDS, progress on the specific aims of the current grant, and establish the context for the remaining presentations.

Maintaining social engagement is important for the health and well-being of older adults who become caregivers. We assessed the association between incident caregiving and leisure satisfaction as well as the 10-year change in social network size among 245 incident caregivers and 248 matched controls. Multiple linear regression analyses were used to adjust for age, gender, race, education level, income, and geographic region. Compared to controls, incident caregivers had significantly lower levels of leisure satisfaction (p

Participants in the national Reasons for Geographic and Racial Differences in Stroke (REGARDS) study were asked about family caregiving responsibilities at enrollment (2003-2007). Among the 88% of participants who were not caregivers at enrollment, 1,229 reported becoming caregivers before a follow-up interview 12 years later. The Caregiving Transitions Study screened these participants and enrolled 251 as incident caregivers. All reported 5 or more hours of care per week, provided assistance with at least one ADL or IADL, and were caregivers for at least 3 months before a 2nd blood sample was obtained in the REGARDS study. A total of 251 noncaregiving control participants who reported no caregiving responsibilities over this 12-year period were also enrolled. Each control was matched to a caregiver on age (+ 5 years), sex, race, other demographics, and baseline (pre-caregiving) health variables. Descriptive analyses confirm the unique comparability of the samples compared to previous caregiving studies.

Dementia is one of the most common reasons for needing a caregiver (CG). Few studies have compared dementia and non-dementia caregivers who have transitioned into family caregiving roles. Participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study who transitioned into a significant caregiving role were recruited to participate in the Caregiving Transitions Study (CTS). Of 11,483 REGARDS participants who were not caregivers at baseline, 1229 (11%) transitioned into a family caregiving role. Eligibility criteria were met by 251 and they were enrolled along with 251 demographically-matched noncaregiving controls. Enrolled caregivers are 65% female; 36% African American; 71.8 + 8.1 years of age; caring for a spouse/partner (51%), parent (25%), or another person (24%). 47% are caring for a person with dementia. Dementia CGs provide more hours of care per day (9.3 hours versus 6.7 hours), report being under more stress and twice as much strain as non-dementia CGs (p

Social support may be important for cognitive aging, but studies incorporating life course data are rare. Latent growth curve models estimated 10-year cognitive trajectories in 9,538 participants (baseline ages 45–94; mean=64) in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) project. Retrospective report of greater childhood social support was associated with better initial episodic memory (standardized estimate=0.08; 95% CI=0.05–0.10) and verbal fluency (standardized estimate=0.05; 95% CI=0.03–0.07), but not with subsequent rates of cognitive decline. Childhood social support effects on initial cognition were larger than or similar to independent effects of self-reported parental education. Effects were partially or fully mediated by higher education, lower body mass index, less perceived stress, and fewer depressive symptoms later in life. Childhood social support was more strongly associated with memory in Black participants, compared with White participants. These results suggest broad and enduring effects of childhood social support across the life course.

Background/Objectives Social support can prevent or delay long-term nursing home placement (NHP). The purpose of our study was to understand how the availability of a caregiver can affect NHP after ischemic stroke and how this affects different subgroups differently. Design Nested cohort study. Setting Nationally based REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Participants Stroke survivors aged 65 to 100 (256 men, 304 women). Measurements Data were from Medicare claims from January 2003 to December 2013 and REGARDS baseline interviews conducted from January 2003 to October 2007. Caregiver support was measured by asking, “If you had a serious illness or became disabled, do you have someone who would be able to provide care for you on an on-going basis?” Diagnosis of ischemic stroke was derived from inpatient claims. NHP was determined using a validated claims algorithm for stays of 100 days and longer. Risk was estimated using Cox regression. Results Within 5 years of stroke, 119 (21.3%) participants had been placed in a nursing home. Risk of NHP was greater in those lacking available caregivers (log-rank P = .006). After adjustment for covariates, lacking an available caregiver increased the risk of NHP after stroke within 1 year by 70% (hazard ratio (HR) = 1.70, 95% confidence interval (CI) = 0.97–2.99) and within 5 years by 68% (HR = 1.68, 95% CI = 1.10–2.58). The effect of caregiver availability on NHP within 5 years was limited to men (HR = 3.15, 95% CI = 1.49–6.67). Conclusion In men aged 65 and older who have survived an ischemic stroke, the lack of an available caregiver is associated with triple the risk of NHP within 5 years.