Effects of placement and bereavement on psychological well-being and cardiovascular risk in Alzheimer's caregivers: a longitudinal analysis.

OBJECTIVE

We examined the impact of Alzheimer caregiver transitions (i.e., placement and bereavement) on psychological outcomes and on plasma D-dimer levels, an end product of the coagulation cascade associated with increased cardiovascular risk.

METHODS

This was a prospective study in which 126 spousal caregivers of Alzheimer's patients were assessed each year for 5 years. We used random regression models to evaluate discontinuous change in our outcomes over time, with emphasis on the impact of caregiver transitions on psychological and physical well-being.

RESULTS

Caregivers experienced immediate improvement in overload and mastery following transitions, and these improvements were maintained over time. There was also a significant drop in depressive symptoms immediately following placement of spouses. D-dimer rose significantly over time but began to significantly decline at 6-months posttransitions.

CONCLUSIONS

Caregiver transitions appear to produce immediate and long-term "normalization" of psychological health in caregivers. This normalization also appears related to "downstream" reductions in D-dimer.