JMIR Publications

ABSTRACT

Background:

Family caregiving for people living with Alzheimer disease and related dementias is associated with substantial psychological and physiological stress. Black family caregivers provide a considerable proportion of dementia care in the United States but remain underrepresented in studies examining biological stress processes. Adult Day Services (ADS) provide community-based care to people living with dementia and respite to family caregivers; however, less is known about how ADS use relates to daily subjective and physiological stress among Black family caregivers. Examining stress across self-reported, physiological, and experiential domains may provide a more comprehensive understanding of caregiver stress processes.

Objective:

The Providing Evidence-Based Approaches for Caregiver Stress (PEACE) Study aims to characterize daily stress processes among Black family caregivers who use ADS. Specifically, the study examines daily stressors and coping and health-seeking behaviors; associations between subjective stress measures and physiological indicators of stress; and differences in diurnal physiological stress patterns on ADS and non-ADS days.

Methods:

PEACE is an exploratory convergent mixed-methods observational study with a planned enrollment of 50 Black family caregivers recruited through community-based ADS programs. Eligible participants are adults who self-identify as Black or African American, serve as the primary unpaid caregiver for a family member with physician-diagnosed dementia, reside with the care recipient, and use ADS at least twice weekly. Participants complete a baseline survey, 5 consecutive days of a Daily Saliva and Stress Diary and home-based saliva collection, and a semi structured qualitative interview. Salivary cortisol and alpha-amylase are collected at 4 standardized time points per day, and telomere length is assessed from salivary DNA. Quantitative analyses include person-centered daily stress scores, multivariable regression, and multilevel models comparing ADS and non-ADS days. Qualitative data are analyzed thematically. Integration occurs during interpretation by comparing qualitative, diary, survey, and biomarker findings to identify convergence, complementarity, and divergence across data sources.

Results:

The PEACE Study was funded by the National Institute on Aging on January 15, 2021. Recruitment began in February 2024 and ended in May 2025 before reaching the planned sample of 50. The final sample includes 41 caregivers who completed the baseline survey; 33 completed semi structured interviews, and 17 completed the home-based salivary biomarker protocol. Data analysis is planned for completion by January 2027, with study findings subsequently disseminated through peer-reviewed publications and scientific and community-facing presentations.

Conclusions:

PEACE integrates subjective, physiological, and qualitative data to characterize stress processes among Black family caregivers using ADS. The study will provide foundational evidence concerning relationships among daily caregiving experiences, ADS use, and physiological stress regulation and will inform the design and measurement approaches of future caregiver research. Clinical Trial: ClinicalTrials.gov Identifier: NCT06451250