RPD201 - Daily Dynamics of Psychological Distress Among Hispanic and Latino Dementia Caregivers: A Daily Diary Study

Key Message : In Hispanic and Latino caregivers, higher baseline caregiver burden and daily experiences of stress, discrimination and perceived social isolation increase daily psychological distress (depression and anxiety symptoms). These findings emphasize the need for culturally responsive palliative and supportive care interventions promoting the caregiver's social engagement to improve their well-being.

Abstract:

Background: Hispanic and Latino(H&L) families are disproportionately impacted by Alzheimer’s disease and related dementias, often managing intensive caregiving responsibilities that elevate the risk for psychological distress (1,2). Few studies have examined daily contextual factors contributing to variations in distress.

Objective: To examine how daily stress processes influence psychological distress (anxiety and depression symptoms) among H&L family caregivers of people living with dementia.

Methods: A sample of 168 H&L caregivers from an ongoing national study completed a baseline survey followed by 21 consecutive daily diary surveys, resulting in 1678 observations. Multi-level models examined baseline caregiver burden and daily contextual factors, including daily life stress, stress related to behavioral symptoms of dementia (BSD), discrimination, and perceived social isolation, as predictors of daily depression and anxiety symptoms.

Results: Higher caregiver burden at baseline was associated with greater daily depressive (β=0.38, p< 0.001) and anxiety symptoms (β=0.35, p< 0.001). On days with higher-than-average stress (β=0.11, p< 0.001), BDS-related stress (β=0.07, p< 0.001), perceived discrimination (β=0.05, p< 0.001), or perceived social isolation (β=0.12, p< 0.001), participants reported greater depressive symptoms. The effect of social isolation on daily depression was stronger among caregivers with higher baseline burden (β=0.04, p=0.004). For anxiety, higher-than-average daily stress (β = 0.14, p < 0.001), BSD-related stress (β = 0.06, p < 0.001), and social isolation (β = 0.09, p < 0.001) were significant predictors, with social isolation having a stronger effect among those with higher baseline burden (β = 0.04, p = 0.016).

Conclusion/Implications: Caregiver burden, daily stress and daily social isolation predict greater psychological distress over other daily contextual factors, with social isolation having a slightly higher influence on distress among caregivers experiencing high burden. These findings highlight the importance of palliative and supportive care interventions that address social isolation (3) and unique daily stressors to enhance culturally responsive support for H&L caregivers.

References: (1) National Hispanic Council on Aging. 2018 Status of Hispanic Older Adults: Insights from the Field – Reframing Aging Edition. Washington, D.C.: National Hispanic Council on Aging: 2018.

(2) Azevedo LVDS, Calandri IL, Slachevsky A, et al. Impact of Social Isolation on People with Dementia and Their Family Caregivers. J Alzheimers Dis. 2021;81(2):607-617. doi: 10.3233/JAD-201580. PMID: 33814446; PMCID: PMC11185189.

(3) Liang J, Aranda MP, Jang Y, Wilber K. The Role of Social Isolation on Mediating Depression and Anxiety among Primary Family Caregivers of Older Adults: A Two-Wave Mediation Analysis. Int J Behav Med. 2024 Jun;31(3):445-458. doi: 10.1007/s12529-023-10227-5. Epub 2023 Oct 25. PMID: 37878186; PMCID: PMC11043211.