Clinical Trials Aim to Reduce Stress Burden for Dementia Caregivers

Mar. 5, 2017
caregiver with older patient
Caring for a loved one with dementia can be very stressful, but two URMC research studies are exploring ways to help caregivers manage stress and improve their own health.

Caring for a loved one with Alzheimer’s disease or dementia can not only be very stressful, but can negatively affect the well-being of the caregiver. A pair of studies at the University of Rochester Medical Center is exploring ways to help caregivers manage stress and improve their own health so they can more effectively provide care for their loved one.

Kathi Heffner, Ph.D., associate professor in the School of Nursing and Department of Psychiatry, and Jan Moynihan, Ph.D., the George L. Engel Professor in Psychosocial Medicine in the Departments of Psychiatry and Microbiology and Immunology, were awarded more than $5.66 million in NIH funding for two five-year randomized clinical intervention trials focusing on reducing the effects of caregiving on immune health.

Heffner is principal investigator on a cognitive training intervention trial looking at different types of brain training activities and whether they have an effect on the aging of the caregiver’s immune system. Moynihan is leading a study on mindfulness-based stress reduction (MBSR), to see if mindfulness can lead to better immune response to the influenza vaccine.

Kathi Heffner
Kathi Heffner

“In both cases, the interventions are really aimed at trying to strengthen stress resilience in caregivers,” said Heffner. “With MBSR, the idea is that you’re tapping into attention processes and that’s going to help with emotion regulation. We also know that the neurological supports for cognitive function, stress physiology, and emotion regulation are common among those three – that there are shared pathways in the brain that regulate each – so we’re trying to see if we can target cognitive function to have an impact on all of these domains.

“Because ultimately it’s the same idea for both studies – we want to improve emotion regulation and the ability to adapt to stress in order to minimize the effects of caregiving on immune function.”

“We’re also both looking at the inflammatory profile, which is the amount of inflammation that goes on in your body that is associated with the normal diseases of aging, such as atherosclerosis, arthritis, cancer, diabetes. The more inflamed you are, the more likely you are to develop one of those morbidities,” Moynihan said. “So we’re hoping, in the best of all possible worlds, that by reducing stress and increasing the caregivers’ feeling of well-being, we’ll be able to dampen that sort of inflammatory response.”

Jan Moynihan
Jan Moynihan

The well-being of caregivers is a growing concern as public health approaches aim to keep individuals independent as long as possible, placing primary home care responsibility in the hands of family members. The studies focus on caregivers for dementia patients in particular because of the well-documented stress levels associated with that level of caregiving and the increasingly aging population which will fuel a rise in the number of older adults who develop cognitive impairment or diseases of dementia, such as Alzheimer’s.

“We’ve heard stories from caregivers that are heartbreaking, and we want to do something to help,” said Moynihan. “You can imagine that if you’re dealing with a population that’s very stressed and not operating in optimum balance, you might actually be able to have a larger impact on those people.”

“The impetus for a lot of the funding going into this is that we need to keep the caregivers healthy so that they can provide good care to patients,” Heffner said. “There are a number of studies that focus solely on self-care of caregivers, and it’s a big problem. There’s just not self-care happening among caregivers.”

The MBSR training centers on mindfulness and developing a non-judgmental outlook and includes self-focused activities such as yoga, breathing exercises and meditation. In the cognitive training study, participants perform brain training exercises for 30 minutes, three times per week, often right in their homes. The activities may include watching videos, doing puzzles, or other mentally stimulating activities. After the training period ends, there are several follow-up contacts with the caregivers as researchers track their immune systems over time. For the cognitive training trail, the main interest is in slowing immune aging, as indicated by both profiles of specific immune cells and markers of inflammation in the blood. For the MBSR study, the primary outcome is adaptive immune response to the flu vaccine, as well as inflammation.

Heffner and Moynihan are each targeting 200 caregivers from Monroe County and surrounding counties for participation in the interventions over the course of their terms.

“Wouldn’t it be awesome if we did these interventions and we kind of reset people’s clocks so that they were the equivalent age – psychologically, biologically – as their peers who aren’t caregivers?” Moynihan said. “I would be happy if they just reported to us at the end that they feel better, psychologically, which should translate into biological responses, as well.”

“That’s the big challenge with caregiver intervention work. People are trying to come up with ways to make caregivers feel better and improve their health, but there haven’t been really good interventions developed,” Heffner said. “What I like about our interventions is that we’re taking a more innovative approach that targets the psychological and psychophysiological factors contributing to their poor health.

“We think that these approaches are needed to have a strong impact on caregivers’ health.”

Co-investigators on the cognitive training caregivers study include Moynihan and Carol Podgorski, Ph.D., M.P.H., of the Department of Psychiatry; Hugh Crean, Ph.D., and Feng (Vankee) Lin, Ph.D., R.N., from the School of Nursing; Silvia Sorensen, Ph.D., of Warner School for Education; and Miriam Weber, Ph.D., of the Department of Neurology.

Co-investigators on the MBSR study include Heffner, Sorensen, Wendi Cross, Ph.D., (Psychiatry), Michael Krasner, M.D., (School of Medicine), and Anthony Almudevar, Ph.D. (Department of Biostatistics and Computational Biology).

For more information about these caregiver studies, please call 585-275-6835 or email