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Examining subjective and physiological stress among Black dementia caregivers using adult day services: protocol for the PEACE mixed-methods study
ABSTRACT
Background:
Family caregiving for individuals living with Alzheimer’s disease and related dementias is associated with chronic psychological and physiological stress. Black/African American caregivers are disproportionately engaged in dementia caregiving and experience cumulative social and health-related stressors, yet remain underrepresented in studies examining biological stress mechanisms. Adult Day Services (ADS) provide respite and support for caregivers; however, little is known about how daily use of ADS relates to subjective and physiological stress in this population.
Objective:
The Providing Evidence-Based Approaches for Caregiver Stress (PEACE) Study aims to characterize daily stress processes among Black dementia caregivers by integrating subjective, biological, and qualitative data, with a focus on understanding associations between daily stressors, caregiving context, and physiological stress markers.
Methods:
PEACE is an ongoing Stage 0, convergent mixed-methods study enrolling 50 Black/African American dementia caregivers who use ADS at least twice weekly. Participants complete a baseline survey, five consecutive days of daily stress diaries and home-based salivary biomarker collection, and a follow-up semi-structured qualitative interview. Salivary biomarkers include cortisol, alpha-amylase, and telomere length, collected at four standardized time points per day. Daily stressors are assessed using an abbreviated Inventory of Small Life Events. A within-person analytic framework compares ADS and non-ADS days. Quantitative data are analyzed using descriptive statistics, multilevel modeling, and regression analyses, while qualitative data are analyzed thematically. Findings are integrated during interpretation.
Results:
This paper describes the study protocol. Participant recruitment and data collection are ongoing at the time of submission
Conclusions:
The PEACE Study will generate foundational evidence on stress mechanisms among Black dementia caregivers and inform future research aimed at supporting caregiver health and equity in dementia care. Clinical Trial: ClinicalTrials.gov Identifier: NCT06451250
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