Lou Yifan, Gong Jiaowei, Zang Emma
School of Social Work, Virginia Commonwealth University, Richmond, Virginia, USA.
T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA.
Gerontologist. 2025 Mar 25;65(4). doi: 10.1093/geront/gnaf024.
The heterogeneity of population-based trajectories of care recipients' (CRs) cognitive functioning and how they are associated with their caregivers' mental health is less studied in the United States. Informed by the stress process model, this study examines the relationship between care recipients' cognitive trajectories and caregivers' depressive symptoms, and the mediating role of caregiving burden.
Data were from the National Health and Aging Trends Study (2011-2020) for 1,086 care recipients and their 1,675 caregivers from the 2021 National Study of Caregiving. We applied Bayesian group-based trajectory modeling to identify distinct cognitive trajectory groups among care recipients. Hierarchical linear models were then used to examine the associations between these trajectory group memberships and caregivers' depressive symptoms. Finally, Gelbach decomposition analysis was conducted to investigate the mediating role of physical, emotional, and financial caregiving burden.
Five cognitive trajectories were identified among care recipients: "high start, stable" (11.81%), "medium-high start, slight decline" (31.83%), "medium start, slight decline" (27.72%), "medium-low start, sharp decline" (20.60%), and "low start, sharp decline" (8.04%). Worse cognitive trajectories (e.g., lower baselines and steeper slopes) were associated with increasing caregivers' depressive symptoms; financial, emotional, and physical caregiving burdens jointly explained 63.5% of this association. Emotional caregiving difficulty is the most important contributing caregiving burden, explaining 49.6% of the observed association.
When understanding caregiving experiences, it is critical to consider longitudinal cognitive course among care recipients. Interventions targeting multiple aspects of caregiving burden, especially emotional burden, should be prioritized.
在美国，基于人群的护理接受者（CRs）认知功能轨迹的异质性以及这些轨迹与他们的照料者心理健康之间的关联较少受到研究。本研究以压力过程模型为依据，考察护理接受者的认知轨迹与照料者抑郁症状之间的关系，以及照料负担的中介作用。
数据来自2011 - 2020年全国健康与老龄化趋势研究，以及2021年全国照料研究中的1086名护理接受者及其1675名照料者。我们应用基于贝叶斯分组的轨迹模型来识别护理接受者中不同的认知轨迹组。然后使用分层线性模型来考察这些轨迹组成员身份与照料者抑郁症状之间的关联。最后，进行格尔巴赫分解分析以研究身体、情感和经济照料负担的中介作用。
在护理接受者中识别出五种认知轨迹：“高起点，稳定”（11.81%）、“中高起点，轻微下降”（31.83%）、“中等起点，轻微下降”（27.72%）、“中低起点，急剧下降”（20.60%）和“低起点，急剧下降”（8.04%）。较差的认知轨迹（例如，较低的基线和较陡的斜率）与照料者抑郁症状的增加相关；经济、情感和身体照料负担共同解释了这种关联的63.5%。情感照料困难是最重要的照料负担因素，解释了观察到的关联的49.6%。
在理解照料经历时，考虑护理接受者的纵向认知过程至关重要。应优先针对照料负担的多个方面，尤其是情感负担进行干预。
