Examining subjective and physiological stress among Black dementia caregivers using adult day services: protocol for the PEACE mixed-methods study (Preprint)

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. CLINICALTRIAL ClinicalTrials.gov Identifier: NCT06451250