Sponsors. National Institute of Mental Health, National Institute on Aging, National Heart, Lung and Blood Institute, Oregon State University.
Purpose. This study was designed to examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for demographic factors, prevalent clinical disease, and subclinical disease at baseline.
Description. The sample for this study was drawn from the Cardiovascular Health Study (CHS), a large population-based study of older persons designed to determine the risk factors and consequences of cardiovascular disease in older adults. For this ancillary study, the CHES, the focus was on examining the relationship between caregiving and mortality. Caregivers were defined as "individuals whose spouse had difficulty with at least one activity of daily living or instrumental activity of daily living due to physical or health problems or problems with confusion."9 The noncaregiving group included individuals whose spouses did not have any difficulty with ADL or IADL. A total of 819 persons (392 caregivers and 427 noncaregivers) were selected among the four recruitment sites enrolled into the study.
Caregiver status was subdivided into four mutually exclusive categories based on responses to a combination of questions about caregiver status and the emotional or mental strain involved with taking care of a disabled spouse. The four categories were defined as (1) spouse not disabled (control subjects), (2) spouse disabled but not helping him/her, (3) spouse disabled and helping but no reports of caregiving strain, and (4) spouse disabled and helping and reports of caregiving strain.
Study participants were followed for an average of 4.5 years. Death was confirmed through reviews of obituaries, medical records, death certificates, and the Health Care Financing Administration's health care utilization data base for hospitalizations.
Results. After more than 4 years of follow up, 103 deaths had occurred among the total sample. After adjusting for sociodemographic factors and physical health status, participants who were providing care and experiencing caregiver strain had a relative mortality risk 63 percent higher than the relative risk for those whose spouses were not disabled.
The other two groups (spouse disabled but not helping him/her, and spouse disabled and helping but no reports of caregiving strain) did not have significantly higher adjusted mortality risks. Therefore, the caregiver-mortality link found in this study applied only to the subset of the caregiving population that experienced higher levels of strain and burden when caring for a disabled spouse.
These findings were consistent with other outcomes reported for this cohort showing that strained caregivers compared with age- and sex-matched noncaregiving controls had significantly higher levels of depressive symptoms, higher levels of anxiety, and lower levels of perceived health. They were also much less likely to get enough rest in general, have time to rest when they were sick, or have time to exercise relative to age- and sex-matched noncaregivers.14
The authors recommended that primary care physicians who care for community-residing older adults need to identify caregivers at risk. They stated that older married couples should be evaluated as a unit, in terms of both their health status and the caregiving demands that exist in the home environment. Finally, they reported that it is essential for medical care providers to develop treatment approaches for older marital dyads that focus on the needs of both individuals simultaneously.9
Next Steps. The study has been completed.
Dr. Richard Schulz
University Center for Social and Urban Research
University of Pittsburgh
121 University Place, Room 607
Pittsburgh, PA 15260
Phone: (412) 624-5442
Fax: (412) 624-4810