Alexandra Wuttke-Linnemann

BACKGROUND Informal caregivers (ICs) provide the majority of care for community-dwelling people living with dementia (PwD) and are at increased risk of mental and physical illness themselves. Previous studies have indicated associations between stress and various characteristics of daily caregiving. The majority of these findings derives from retrospective self-reports and laboratory studies. Multidimensional stress assessment in the daily life of ICs of PwD could provide important information about underlying mechanisms of the increased risk of illnesses in ICs. OBJECTIVE Aim of this study was to identify predictors of the psychobiological stress response in ICs of PwD in daily life. METHODS In total, 20 ICs (17 women, average age 66.8 ± 12.4 years) of PwD participated in a prospective observational study with 14 days of ambulatory assessment study. Four times a day, they were asked about their experiences in daily caregiving (including subjective stress, quality of the relationship and contact with the PwD, mood, social support, self-care, and neuropsychiatric symptoms of the PwD). Moreover, they provided saliva samples to determine cortisol secretion and alpha-amylase concentrations. Prior to the ambulatory assessment, the ICs and PwD completed a psychometric test battery, including the Neuropsychiatric Inventory, the Geriatric Depression Scale, the short version of the German-language Partnership Questionnaire, the Brief Resilience Scale and the Mini-Mental State Examination (PwDs only). Mixed-effect models were used to analyze correlations between characteristics of daily caregiving and psychobiological stress. RESULTS In daily life, significant positive correlations were found between salivary cortisol concentrations in ICs and the occurrence of neuropsychiatric symptoms in PwD (p = 0.023) as well as positive mood of ICs (p = 0.018). Higher subjective stress was associated with negative mood (p ≤ 0.001) and less self-care (p ≤ 0.001), but also better relationship quality (p = 0.042). There were no significant correlations between characteristics of daily caregiving and salivary alpha-amylase concentrations. CONCLUSIONS In light of demographic change, it appears particularly relevant to support ICs of PwD, given their key role in the healthcare system. Interventions to promote mood, self-care, and coping with neuropsychiatric symptoms could be especially useful to reduce stress in daily life of ICs. At the same time, further studies are needed to understand the counterintuitive associations found between positive mood and higher cortisol concentration and between higher subjective stress and good relationship quality. CLINICALTRIAL German Clinical Trials Register DRKS: registration number DRKS00025269, https://drks.de/search/en/trial/DRKS00025269/details

Music listening may decrease pain via psychobiological mechanisms. Music listening style (MLS) influences music processing: Music empathizers (ME) focus on emotional aspects of music, whereas music systemizers (MS) focus on structural aspects, potentially affecting processes of music-induced analgesia. The effects of the MLS on music-induced analgesia might depend on the source of music selection (i.e. who selects the music) and gender. Different psychological mechanisms, such as stimulus-induced emotions and subjective stress, might mediate the effects of an empathizing versus systemizing MLS on pain. The purpose of this study was (a) to test how MLS influences pain during music listening, depending on the source of music selection and gender, and (b) to explore underlying psychological mechanisms. 61 participants (age: M = 24.23, SD = 3.85; four groups: male/female ME/MS) listened to stimuli (participant-selected/researcher-selected music/control) during cold pressor tests. Pain intensity, pain tolerance, and psychological mechanisms (stimulus-induced emotions, subjective stress) were repeatedly measured. Multilevel and mediation analyses were conducted. The MLS did not directly influence pain, but female ME were most pain sensitive with participant-selected music. Pain was tolerated longest for participant-selected music. The effect of MLS on pain intensity was not mediated by stimulus-induced emotions but by subjective stress. Our results indicate that music increases pain tolerance the most when participants select it. However, we found initial evidence that women scoring high on ME show increased pain when listening to their self-selected music. We also found initial evidence for the importance of subjective stress as a potential mechanism in the context of music-based pain management.

Objectives: We investigated salivary biomarkers of stress, more specifically, cortisol and alpha-amylase, to evaluate effects of individualized music listening (IML) in people with dementia. Method: Participants were N = 64 nursing home residents with dementia (mean_age = 83.53 ± 7.71 years, 68.8% female). Participants were randomly assigned to either listening to their favorite music every other day for a period of six weeks (intervention), or standard care (control). Using the Saliva Children`s Swab (SCS), saliva was collected before, after, and 20 min after IML sessions at the beginning and end of the intervention period for the analysis of salivary alpha-amylase and cortisol. Results: Using the SCS was feasible in people with dementia. Nevertheless, there was no effect of IML on salivary stress markers. Discussion: Although using SCS was feasible, active patient engagement is required. Future studies need to corroborate findings in larger samples. Trial registration: German Clinical Trials Register: DRKS00015641, ISRCTN registry: ISRCTN59052178.

This study aimed to examine the influence of COVID-specific stressors on cross-sectional and longitudinal bereavement outcomes. According to the Dual Process Model of grief these stress-inducing factors can relate to the loss (loss-oriented stressors) or to manage everyday life (restoration-oriented stressors) and require coping in the grief process. A total of 491 participants (94.1% female; 43.92 years on average; 44.4% loss of a parent) were included at the first measurement time point (T0), of whom 99 individuals also participated in a follow-up assessment 6 months later (T1). Participants frequently reported loss-oriented (on average 7.30 out of 21 queried) and restoration-oriented stressors (on average 6.99 out of 19 queried). Cross-sectionally, higher acute grief intensity was associated with a higher number of loss-oriented stressors, poorer mental well-being, and sociodemographic variables. This effect disappeared longitudinally, with only acute grief intensity and poorer mental well-being at T0 predicting higher prolonged grief at T1. Common resilience factors did not buffer the effects of the pandemic on grief. Loss-oriented stressors seem to be especially relevant for understanding grief and might be a mediator of higher long-term grief. The findings suggest that COVID-specific strains need to be specifically taken into account in the support of bereaved individuals.

Problem definition: Firms increasingly use augmented reality (AR) devices to improve their production ramp-up processes. These devices appear useful, yet little is known about their broader impact on worker productivity and behavior. Academic/practical relevance: Efficient production ramp-ups are particularly important when product life cycles are short. An ongoing debate among academics and practitioners pertains to how Industry 4.0, and AR devices in particular, can accelerate the ramp-up. The current study provides empirical evidence related to AR in the production ramp-up context, examines the strengths and weaknesses of AR, and tests four hypotheses, leading to a more nuanced view of AR use in the manufacturing ramp-up. Methodology: A framed field experiment in a manufacturing plant provides a test of how quickly workers can perform new tasks with and without AR support and how the use of AR affects their ability to suggest process improvements. Results: When faced with a new task, workers instructed by AR smart glasses use 43.8% less time to complete the task compared with a control group that relies on paper-based instructions. However, workers that use AR glasses consistently use 23% more time than the control group when both groups repeat the task without either AR or paper-based instructions. Task difficulty moderates this relationship; workers assigned to a more difficult task benefit the most from AR instructions. After the devices are removed, workers instructed based on paper improve their productivity faster through learning than those instructed by AR. In addition, the former group suggests better process improvements than the latter one. Managerial implications: Although these results indicate substantially higher productivity resulting from AR devices, they also support the view that, once instructed through AR devices, workers come to rely on this new technology without fully internalizing the task. This failure to internalize their task then leads workers to suggest less useful process improvements.

Background: Hospitalization is often stressful and burdensome for people living with dementia (PwD) and their informal caregivers (ICs). Day clinic treatment may provide a suitable alternative, but is often precluded by a diagnosis of dementia. Furthermore, it is often caregiver-based ratings that measure treatment success as the validity of self-reports in PwD is critically discussed. We therefore set out to examine the feasibility of psychobiological stress measures in PwD and ICs and to evaluate treatment trajectories considering both the day clinic context and the daily life of the dyads.Method: A total of 40 dyads of PwD (mean age: 78.15 ± 6.80) and their ICs (mean age: 63.85 ± 13.09) completed paper-and-pencil questionnaires (covering stress, depressive symptoms, and caregiver burden among others) in addition to the measurement of hair cortisol concentrations (HCC) at admission, discharge, and follow-up 6 months after day clinic treatment. As part of an ambulatory assessment, for 2 days at the beginning and 2 days at the end of the day clinic treatment, PwD and ICs collected six saliva samples per day for the analysis of salivary cortisol (sCort) and alpha-amylase (sAA).Results: Paper-and-pencil questionnaires and HCC assessments were more feasible than the ambulatory assessment. We found discrepancies between subjective and physiological markers of stress in PwD. Whereas HCC decreased over time, self-reported stress increased. Child–parent dyads reported decreases in neuropsychiatric symptoms, associated burden, and self-reported stress from admission to follow-up. In daily life, both PwD and ICs showed characteristic diurnal profiles of sAA and sCort, however, we found no differences in summary indicators of salivary stress markers over time.Discussion: The psychobiological evaluation was feasible and added informative value, underlining the potential of physiological stress markers to complement self-reports on stress in PwD and to objectively evaluate treatment trajectories. In this sample, HCC was more feasible and acceptable as biological marker of stress compared to saliva samples. Concerning treatment trajectories, differential effects on the dyads were found, with child–parent dyads benefiting more from day clinic treatment compared to spousal dyads.

Informal caregivers of people living with dementia (PwD) are at increased risk for the development of stress-related physical and mental illness. Nevertheless, because of differing resilience, they show interindividual differences in their ability to cope. Particularly during the COVID-19 pandemic, with the associated pandemic control measures and pandemic-related changes to daily life, resilience might be further challenged, and stress might consequently increase. Therefore, we review the evidence on informal caregivers’ experience during the COVID-19 pandemic regarding effects of the pandemic control measures on (a) the caregiver’s health, (b) the care recipient’s health, (c) the stability of the care situation, and (d) coping in daily life. We conclude with implications on how to strengthen resilience and reduce stress in terms of environmental, social, and individual resources.

Background: Informal caregivers are a particularly vulnerable population at risk for adverse health outcomes. Likewise, there are many scales available assessing individual caregiver burden and stress. Recently, resilience in caregivers gained increasing interest and scales started to assess resilience factors as well. Drawing on a homeostatic model, we developed a scale assessing both caregivers' stress and resilience factors. We propose four scales, two covering stress and two covering resilience factors, in addition to a sociodemographic basic scale. Based on the stress:resilience ratio, the individual risk of adverse health outcomes and suggestions for interventions can be derived.Methods: A total of 291 informal caregivers filled in the ResQ-Care as part of a survey study conducted during the second wave of the COVID-19 pandemic in Germany. Exploratory factor analysis was performed. Validity analyses were examined by correlations with the Brief Resilience Scale (BRS), the Perceived Stress Scale (PSS-4) and the Geriatric Depression Scale (GDS-15).Results: The data fitted our proposed four-factor solution well, explaining 43.3% of the variance. Reliability of each scale was at least acceptable with Cronbach's α ≥0.67 and MacDonald's ω ≥0.68 for all scales. The two strain scales weighed more than the resilience scales and explained 65.6% of the variance. Convergent and discriminant validity was confirmed for the BRS and PSS-4, whereas the GDS-15 correlation pattern was counterintuitive.Conclusion: The factor structure of the ResQ-Care scale was confirmed, with good indications of reliability and validity. Inconsistent correlations of the scales with the GDS-15 might be due to a reduced validity of GDS-15 assessment during the COVID-19 lockdown.