Informal caregiving and its impact on health: a reappraisal from population-based studies

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.

Keywords: Caregivers; Caregiving; Mortality; Population-based studies.

Figure 1.

Effect sizes from survival analyses of caregivers versus noncaregivers. Thin lines represent caregiving subgroup effects reported in the original articles. Thick lines represent overall caregiving effects either reported in the Fredman and colleagues (2010) and Roth and colleagues (2013) articles or calculated based on the subgroup information reported in the other articles. a1: 179 strained spouse caregivers; a2: 138 nonstrained spouse caregivers; a3: 317 strained and nonstrained caregivers; b1: 306 spouses providing 1–14hr of care; b2: 338 spouses providing 14 or more hours of care; b3: 644 spouses providing any care to a spouse with ADL/IADL impairment; c1: 58,075 women providing 1–19hr of care; c2: 15,141 women providing 20–49hr of care; c3: 25,757 women providing 50+ hr of care; c4: 40,606 men providing 1–19hr of care; c5: 9519 men providing 20–49hr of care; c6: 15,786 men providing 50+ hr of care; c7: 162,884 men and women providing any care; d1: 12,033 women providing 1–19hr of care; d2: 5,876 women providing 20 or more hours of care; d3: 9,751 men providing 1–19hr of care; d4: 3,744 women providing 20 or more hours of care; d5: 31,404 men and women providing any care; e1: 219 female caregivers reporting low caregiving-related stress; e2: 156 female caregivers reporting high caregiving-related stress; e3: 375 female caregivers; f1: 1,993 White caregivers; f2: 1,510 African American caregivers; f3: 1,163 caregivers reporting no strain; f4: 1,748 caregivers reporting moderate strain; f5: 578 caregivers reporting high strain; f6: 537 spouse caregivers reporting moderate or high strain; f7: 1,915 caregivers providing less than 14hr of care; f8: 1,588 caregivers providing 14 or more hours of care; f9: 2,219 female caregivers; f10: 1,284 male caregivers; f11: 786 spousal caregivers; f12: 1,197 adult child caregivers; f13: 3,503 caregivers (all subgroups included).