title: Differences in stress-related ratings between research center and home environments in dementia caregivers using ecological momentary assessment.
abstract: BACKGROUND
  Clinicians and researchers working with dementia caregivers typically assess caregiver stress in a clinic or research center, but caregivers' stress is rooted at home where they provide care. This study aimed to compare ratings of stress-related measures obtained in research settings and in the home using ecological momentary assessment (EMA).
  
  
  METHODS
  EMA of 18 caregivers (mean age 66.4 years ±7.8; 89% females) and 23 non-caregivers (mean age 66.4 years ±7.9; 87% females) was implemented using a personal digital assistant. Subjects rated their perceived stress, fatigue, coping with current situation, mindfulness, and situational demand once in the research center and again at 3-4 semi-random points during a day at home. The data from several assessments conducted at home were averaged for statistical analyses and compared with the data collected in the research center.
  
  
  RESULTS
  The testing environment had a differential effect on caregivers and non-caregivers for the ratings of perceived stress (p < 0.01) and situational demand (p = 0.01). When tested in the research center, ratings for all measures were similar between groups, but when tested at home, caregivers rated their perceived stress as higher than non-caregivers (p = 0.02). Overall, caregivers reported higher perceived stress at home than in the research center (p = 0.02), and non-caregivers reported greater situational demand in the research center than at home (p < 0.01).
  
  
  CONCLUSIONS
  The assessment method and environment affect stress-related outcomes. Evaluating participants in their natural environment provides a more sensitive measure of stress-related outcomes. EMA provides a convenient way to gather data when evaluating dementia caregivers.
authors.affiliation: Department of Behavioral Neuroscience, Oregon Health & Science University, Portland, Oregon 97239, USA.
authors.forename: Irina
authors.initials: I
authors.lastname: Fonareva
authors.forename: Alexandra M
authors.initials: AM
authors.lastname: Amen
authors.forename: Roger M
authors.initials: RM
authors.lastname: Ellingson
authors.forename: Barry S
authors.initials: BS
authors.lastname: Oken
mesh_terms: D000368:Aged; D035841:Behavioral Research / Q000379:methods; D017028:Caregivers / Q000523:psychology*; D003704:Dementia / Q000628:therapy*; D004777:Environment; D005260:Female; D006699:Home Care Services; D006801:Humans; D008297:Male; D057566:Self Report; D013315:Stress, Psychological / Q000175:diagnosis* / Q000209:etiology / Q000523:psychology