03320nas a2200373 4500008004100000022001400041245008300055210006900138260001600207300001100223490000800234520230600242653003102548653000902579653002202588653001502610653002102625653001102646653001802657653001702675653001102692653000902703653001402712653003202726653002402758653001702782653002602799653001202825653002602837653001802863100001402881700001602895856003502911 1999 eng d a0098-748400aCaregiving as a risk factor for mortality: the Caregiver Health Effects Study.0 aCaregiving as a risk factor for mortality the Caregiver Health E c1999 Dec 15 a2215-90 v2823 a

CONTEXT: There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality.

OBJECTIVE: To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline.

DESIGN: Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up.

SETTING: Four US communities.

PARTICIPANTS: A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses.

MAIN OUTCOME MEASURE: Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported.

RESULTS: After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls.

CONCLUSIONS: Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.

10aActivities of Daily Living10aAged10aAged, 80 and over10aCaregivers10aDisabled Persons10aFemale10aHealth Status10aHome Nursing10aHumans10aMale10aMortality10aProportional Hazards Models10aProspective Studies10aRisk Factors10aSocioeconomic Factors10aSpouses10aStress, Psychological10aUnited States1 aSchulz, R1 aBeach, S, R uhttps://chs-nhlbi.org/node/605