Caregiving as a Risk Factor for Mortality

Abstract

One of society's great assets is the many family members who provide care to ill or disabled relatives. By some estimates, more than 15 million adults currently provide care to relatives,^1,2 saving the formal health care system billions of dollars annually. The majority of caregivers are middle-aged adult children and older spouses who care for a parent or spouse with functional limitations. Although family caregivers perform an important service for society and their relatives, they do so at considerable cost to themselves. There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members,^3,4 and contributes to psychiatric morbidity in the form of increased depression. Researchers have also suggested that the combination of loss, prolonged distress, physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for health problems.^4,5 Some support for this hypothesis is found in studies showing that caregivers are less likely to engage in preventive health behaviors,⁶ decrements in immunity measures compared with controls,^5,7,8 exhibit greater cardiovascular reactivity,⁹ and experience slow wound healing.¹⁰ Some caregivers are at increased risk for serious illness.^5,11 Overall, these studies show that a subgroup of caregivers is at risk for negative health outcomes. They are characterized as having high levels of caregiving demands, experiencing chronic stress associated with caregiving, and being physiologically compromised. By extension, they may also be at risk for increased mortality, although researchers have not been able to test this hypothesis because study samples have been too small and follow-up periods have been too brief.