Inherited Diseases, Caregiving, and Social Networks

• ClinicalTrials.gov Identifier: NCT01498263
• Recruitment Status: Recruiting
• First Posted: December 23, 2011
• Last Update Posted: August 12, 2019
• Sponsor: National Human Genome Research Institute (NHGRI)
• Information provided by (Responsible Party): National Institutes of Health Clinical Center (CC) ( National Human Genome Research Institute (NHGRI) )

Study Description

Brief Summary:

Approximately 66 million informal caregivers care for someone who is ill, disabled, or aged. These caregivers experience significant distress associated with caregiving, which may be particularly salient in the context of inherited conditions. Previous studies have not examined caregiving from a network perspective, nor have they considered how cognitive and emotional responses, such as caregivers worry for themselves and relatives acquiring the disease or guilt related to the genetic etiology of their child s illness, as possible stressors; the current project fills this literature gap.

Caregiving processes may vary across type of illness and the life course. In illnesses that impact children, parents and grandparents may take on caregiving roles whereas in conditions that impact adults, spouses and adult children may provide care. Caregivers must adapt to the strain of caring for their affected relatives and this adaptation may differ depending on caregiver roles. The caregiver s support network may influence adaptation, impacting the health and well-being of patients, their caregivers, and other relatives.

This project, comprised of 4 substudies, will examine social contexts surrounding families involved in caring for individuals with chronic inherited conditions from a relational perspective. Surveys and interviews will assess participants cognitions and emotions about the disease, caregiving burden and caregiving/support network systems. In addition, biomarkers will be considered in 2 substudies to examine how caregiving roles and expectations impact health among caregivers.

We aim to recruit at least 3100 participants through residential/daycare centers, advocacy groups, and the NIH Clinical Center. We will recruit formal caregivers, multiple biological and non-biological adult relatives of patients and normally developing controls to construct and evaluate caregiving/support network systems. This project will use a social network framework to develop and adapt common measures of caregiving roles to evaluate burden, perceptual bias, and unmet expectations in caregiving. The psychometric properties of these new measures, characteristics of family caregiving and support networks, and how these network characteristics are associated with caregiving strain and well-being, including biomarkers of physical health, will be investigated. The moderating role of family members cognitions and emotions and disease context will be considered. Findings will guide future research to develop network-based interventions promoting positive adaptation to the presence of inherited conditions in families through improved social environments and coping skills.

Condition or disease
Alzheimer Disease and Related Dementias; Inherited Neurodegenerative Disorders; Inherited Metabolic Disorders (Inborn Errors of Metabolism); Undiagnosed Diseases; Healthy Volunteer

Detailed Description:

Approximately 66 million informal caregivers care for someone who is ill, disabled, or aged. These caregivers experience significant distress associated with caregiving, which may be particularly salient in the context of inherited conditions. Previous studies have not examined caregiving from a network perspective, nor have they considered how cognitive and emotional responses, such as caregivers worry for themselves and relatives acquiring the disease or guilt related to the genetic etiology of their child s illness, as possible stressors; the current project fills this literature gap.

Caregiving processes may vary across type of illness and the life course. In illnesses that impact children, parents and grandparents may take on caregiving roles whereas in conditions that impact adults, spouses and adult children may provide care. Caregivers must adapt to the strain of caring for their affected relatives and this adaptation may differ depending on caregiver roles. The caregiver s support network may influence adaptation, impacting the health and well-being of patients, their caregivers, and other relatives.

This project, comprised of 5 substudies, will examine social contexts surrounding families involved in caring for individuals with chronic inherited conditions from a relational perspective. Surveys and interviews will assess participants cognitions and emotions about the disease, caregiving burden and caregiving/support network systems. In addition, biomarkers will be considered in 2 substudies to examine how caregiving roles and expectations impact health among caregivers. As part of our current inquiry, we have

developed an assessment tool aimed at understanding caregiver experiences related to dietary practices in the context of metabolic conditions. To evaluate the psychometric properties of this scale, we propose a fifth substudy under the current protocol.

We aim to recruit at least 3300 participants through residential/daycare centers, advocacy groups, and the NIH Clinical Center. We will recruit formal caregivers, multiple biological and non-biological adult relatives of affected individuals and typically developing controls to construct and evaluate caregiving/support network systems. This project will use a social network framework to develop and adapt common measures of caregiving roles to evaluate burden, perceptual bias, and unmet expectations in caregiving. The psychometric properties of these new measures, characteristics of family caregiving and support networks, and how these network characteristics are associated with caregiving strain and well-being, including biomarkers of physical health, will be investigated. The moderating role of family members cognitions and emotions and disease context will be considered. Findings will guide future research to develop network-based interventions promoting positive adaptation to the presence of inherited conditions in families through improved social environments and coping skills.

Study Design

• Study Type: Observational
• Estimated Enrollment: 3300 participants
• Observational Model: Family-Based
• Time Perspective: Cross-Sectional
• Official Title: Inherited Diseases, Caregiving, and Social Networks
• Actual Study Start Date: January 9, 2012

Groups and Cohorts

Group/Cohort
Alzheimers related dementias (family); Enrollment open to family members of persons diagnosed with Alzheimers (/related dementia) in specific communities around Memphis, TN
Healthy Volunteers; Enrollment open to parents of healthy children <18yrs (when child is full-time resident of parent's home). Participation at NIH; request referral of family members for remote participation.
Inborn metabolic conditions (family); Enrollment open to family members of persons diagnosed with inborn errors of metabolism. Participation at NIH or remote (internet/phone); request referral of family members for remote participation.
Inherited inflammatory conditions (family); Enrollment open to family members of persons diagnosed with inherited inflammatory conditions. Participation at NIH or remote (internet/phone); request referral of family for remote participation.
Neurodegenerative genetic conditions (family); Enrollment open to family members of persons diagnosed with genetic neurodegenerative conditions. Participation at NIH or (internet/phone); request referral of family members forremote participation.
Undiagnosed condition: severe/chronic (family); Enrollment open to family members referred in from the Undiagnosed Disease Network. Participation at NIH or remote (internet/phone); request referral of family members for remote participation.

Outcome Measures

Primary Outcome Measures :

1. Measures of caregiving processes [ Time Frame: Interim, completion ]
   Develop measures of caregiving processes within family social network systems
2. Family network characteristics [ Time Frame: Interim, completion ]
   Identify family network characteristics associated with positive adaptation

Secondary Outcome Measures :

1. Role and impact of individual [ Time Frame: Interim, completion ]
   Investigate the role and impact of individual cognitions, beliefs, and emotions on caregiving roles, expectations, and social support processes
2. Identify points of intervention [ Time Frame: Interim, completion ]
   Identify points of intervention that may facilitate adaptation to caregiving burden and health of caregivers

Eligibility Criteria

• Ages Eligible for Study: 18 Years to 118 Years (Adult, Older Adult)
• Sexes Eligible for Study: All
• Accepts Healthy Volunteers: Yes
• Sampling Method: Non-Probability Sample

Study Population

This is a study has family-based enrollment of caregivers and their social support networks. Specific context of recruitment may vary depending upon the health condition of the affected family member; number of severe, chronic conditions with genetic basis are among the inclusion criteria. For the substudy of caregivers of persons affected by Alzheimer s disease and related dementias (AD), recruitment took place in residential facilities in Memphis, TN [substudy1; data analysis only]. Caregivers of persons affected by inborn errors of metabolism or with severe chronic undiagnosed conditions may be referred in to the protocol by NIH collaborators or through advocacy groups. Healthy volunteers (parents of healthy child/ren) are recruited through NIH and in the community. The study uses snowball sampling of self-referral: each participant is invited to refer in support network members who also provide support/care for the focus-relative.

Criteria

• INCLUSION CRITERIA:
• Adult family members of the individuals affected by an inherited disease (e.g. Alzheimer s disease, inborn errors of metabolism and mitochondrial disease, lysosomal storage disorder, genetic neurodegenerative disorder, undiagnosed diseases, and inherited

inflammatory conditions) OR

• Informal caregivers of the affected individual OR
• Caregivers family members OR
• Formal caregivers who are identified as part of patients caregiving networks will be eligible for recruitment in the study OR
• For the control group in Substudy 2, adult family members of normally developing children, informal caregivers, caregivers family members and formal caregivers who are identified as part of the child s caregiving network will be eligible for recruitment in the study.

(For better matching across groups: in the Healthy Volunteer controls, the normally developing focus child must live in the parent/caregiver household on a full-time basis.)

• Participants are eligible for biospecimen collection in Substudies 3 only if two parents/caregivers are present in the household, eligible, and willing to provide biospecimens.
• Fluency in English

EXCLUSION CRITERIA:

• Those who are unable to complete the survey and interviews
• Affected individuals/Patients with condition being studied
• Individuals under the age of 18
• Those who have fever or signs of acute infection on the collection day, have been hospitalized in the past 3 months, and women who are currently pregnant or nursing will not be eligible for the biospecimen collection portion of Substudies 2 and 3 but will be eligible for the survey/interview portion of the substudies.
• Control group individuals will be excluded if they serve as a caregiver for anyone in their family affected by any major medical condition.
• Staff of NHGRI (National Human Genome Research Institute)

Contacts and Locations

Contacts

Contact: Mindy J Perilla; (866) 585-7192; CaregivingStudy@mail.nih.gov

Contact: Laura M. Koehly, Ph.D.; (301) 451-3999; koehlyl@mail.nih.gov

Locations

United States, Maryland

National Institutes of Health Clinical Center, 9000 Rockville Pike; Recruiting

Bethesda, Maryland, United States, 20892

United States, Tennessee

University of Memphis; Recruiting

Memphis, Tennessee, United States

Contact: Sato Ashida, Ph.D. 319-384-1477 sato-ashida@uiowa.edu

Sponsors and Collaborators

National Human Genome Research Institute (NHGRI)

Investigators

• Principal Investigator: Laura M. Koehly, Ph.D.; National Human Genome Research Institute (NHGRI)

More Information

Additional Information:

NIH Clinical Center Detailed Web Page 

Publications:

Liew TM, Luo N, Ng WY, Chionh HL, Goh J, Yap P. Predicting gains in dementia caregiving. Dement Geriatr Cogn Disord. 2010;29(2):115-22. doi: 10.1159/000275569. Epub 2010 Feb 11.

Ory MG, Hoffman RR 3rd, Yee JL, Tennstedt S, Schulz R. Prevalence and impact of caregiving: a detailed comparison between dementia and nondementia caregivers. Gerontologist. 1999 Apr;39(2):177-85.

Poulin MJ, Brown SL, Ubel PA, Smith DM, Jankovic A, Langa KM. Does a helping hand mean a heavy heart? Helping behavior and well-being among spouse caregivers. Psychol Aging. 2010 Mar;25(1):108-17. doi: 10.1037/a0018064.

• Responsible Party: National Human Genome Research Institute (NHGRI)
• ClinicalTrials.gov Identifier: NCT01498263 History of Changes
• Other Study ID Numbers: 120022; 12-HG-0022
• First Posted: December 23, 2011
• Last Update Posted: August 12, 2019
• Last Verified: July 17, 2019

• Studies a U.S. FDA-regulated Drug Product: No
• Studies a U.S. FDA-regulated Device Product: No

Keywords provided by National Institutes of Health Clinical Center (CC) ( National Human Genome Research Institute (NHGRI) ):

Genetic Condition; Family Network; Social Support; Alzheimer's Disease; AD; Family Systems

Additional relevant MeSH terms:

Alzheimer Disease; Neurodegenerative Diseases; Metabolism, Inborn Errors; Metabolic Diseases; Disease; Pathologic Processes; Dementia; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Tauopathies; Neurocognitive Disorders; Mental Disorders; Genetic Diseases, Inborn