Mortality Associated with Caregiving, General Stress, and Caregiving-Related Stress in Elderly Women: Results of Caregiver-Study of Osteoporotic Fractures

Epidemiology Department, School of Public Health, Boston University, Boston, Massachusetts 02118, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 03/2010; 58(5):937-43. DOI: 10.1111/j.1532-5415.2010.02808.x
Source: PubMed


To investigate the separate and combined effects of caregiver status and high stress on mortality risk over 8 years in elderly women.
Prospective cohort study conducted in four U.S. communities followed from 1999/01 (baseline) to December 31, 2007.
Home-based interviews.
Three hundred seventy-five caregiver and 694 noncaregiver participants from the Caregiver-Study of Osteoporotic Fractures (Caregiver-SOF) who participated in the baseline Caregiver-SOF interview.
Caregiver status was based on SOF respondents' self-report of performing one or more instrumental or basic activities of daily living for a relative or friend with impairments. Two measures of stress were used: Perceived Stress Scale and stress related to caregiving tasks. All-cause mortality was the outcome.
Caregivers were more stressed than noncaregivers; 19.7% of caregivers and 27.4% of noncaregivers died. Mortality was lower in caregivers than noncaregivers (adjusted hazard ratio, (AHR)=0.74, 95% confidence interval (CI)=0.56-0.89). High-stress respondents had greater mortality risk than low-stress respondents over the first 3 years of follow-up (AHR=1.81, 95% CI=1.16-2.82) but not in later years. Likewise, high-stress caregivers and noncaregivers had higher mortality risk than low-stress noncaregivers, although low-stress caregivers had significantly lower mortality than did noncaregivers, whether perceived stress or caregiving-related stress was measured (AHR=0.67 and 0.57). Similar results were observed in analyses comparing spouse caregivers with married noncaregivers.
Short-term effects of stress, not caregiving per se, may increase the risk of health decline in older caregivers.

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Available from: Gheorghe Doros, Oct 21, 2014
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    • "Those studies should be included in policy reports and research articles to present a more balanced and comprehensive view of the current state of caregiving research. Moreover, findings that show stress, but not caregiving status, is associated with poorer health outcomes (Fredman et al., 2010; Litzelman et al., 2014 "
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    ABSTRACT: Considerable research and public discourse on family caregiving portrays it as a stressful and burdensome experience with serious negative health consequences. A landmark study by Schulz and Beach that reported higher mortality rates for strained spouse caregivers has been widely cited as evidence for the physical health risks of caregiving and is often a centerpiece of advocacy for improved caregiver services. However, 5 subsequent population-based studies have found reduced mortality and extended longevity for caregivers as a whole compared with noncaregiving controls. Most caregivers also report benefits from caregiving, and many report little or no caregiving-related strain. Policy reports, media portrayals, and many research reports commonly present an overly dire picture of the health risks associated with caregiving and largely ignore alternative positive findings. As the pool of traditional family caregivers declines in the coming years, a more balanced and updated portrayal of the health effects of caregiving is needed to encourage more persons to take on caregiving roles, and to better target evidence-based services to the subgroup of caregivers who are highly strained or otherwise at risk. Recommendations are discussed for research that will better integrate and clarify both the negative and potential positive health effects of informal caregiving. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail:
    The Gerontologist 04/2015; 55(2):309-319. DOI:10.1093/geront/gnu177 · 3.21 Impact Factor
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    • "However, there is conflicting evidence that caregivers have an increased risk of physical health decline or mortality [4,9,10]. In fact, older women caregivers had fewer medical conditions and functional limitations than their non-caregiver peers [4], suggesting that older caregivers may attempt to maintain good health in order to continue providing care to their care recipient. "
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    ABSTRACT: Background Informal caregiving is increasingly common as the U.S. population ages, and there is concern that caregivers are less likely than non-caregivers to practice health-promoting behaviors, including cancer screening. We examined caregiving effects on cancer risk behaviors and breast and cervical cancer screening in the 2009 Behavioral Risk Factor Surveillance System. Methods Women age ≥41 with data on breast and cervical cancer screening were included (weighted frequency 3,478,000 women). Cancer screening was classified according to American Cancer Society guidelines. We evaluated the association of caregiving with cancer risk behaviors (obesity, physical activity, alcohol intake, smoking status, and fruit/vegetable consumption) and cancer screening (mammography, clinical breast exam [CBE], and Pap test) using logistic regression overall and with stratification on age (<65, ≥65) or race (white, non-white). Results Caregivers had greater odds of being obese, physically active, and current smokers. Subgroup analyses revealed that caregiving was associated with obesity in younger women and whites, and with less obesity in older women. Also, caregiving was associated with smoking only among younger women and non-whites. Caregivers had greater odds of ever having had a mammogram or CBE, yet there was no association with mammogram, CBE, or Pap test within guidelines. Conclusions Caregiving was associated with some health behaviors that increase cancer risk, yet not with cancer screening within guidelines. Effects of caregiving by age and race require confirmation by additional studies.
    BMC Public Health 08/2012; 12(1):685. DOI:10.1186/1471-2458-12-685 · 2.26 Impact Factor
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    • "However, even in this area, there are mixed results. For example, while Schulz and Beach [28] showed an increased risk of mortality among caregivers, Fredman et al. [29] found a decreased risk—perhaps because those who are healthier are more likely to take on the arduous task of caregiving. Allostatic load (AL; [30]) is a construct assessed across multiple biosystems, including cardiovascular, metabolic, neuroendocrine, and inflammatory markers that are presumed to reflect chronic psychosocial stress. "
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    ABSTRACT: We examined long-term patterns of stressful life events (SLE) and their impact on mortality contrasting two theoretical models: allostatic load (linear relationship) and hormesis (inverted U relationship) in 1443 NAS men (aged 41-87 in 1985; M = 60.30, SD = 7.3) with at least two reports of SLEs over 18 years (total observations = 7,634). Using a zero-inflated Poisson growth mixture model, we identified four patterns of SLE trajectories, three showing linear decreases over time with low, medium, and high intercepts, respectively, and one an inverted U, peaking at age 70. Repeating the analysis omitting two health-related SLEs yielded only the first three linear patterns. Compared to the low-stress group, both the moderate and the high-stress groups showed excess mortality, controlling for demographics and health behavior habits, HRs = 1.42 and 1.37, ps <.01 and <.05. The relationship between stress trajectories and mortality was complex and not easily explained by either theoretical model.
    Journal of aging research 09/2011; 2011:896109. DOI:10.4061/2011/896109
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