Caregiving, Mortality, and Mobility Decline<subtitle>The Health, Aging, and Body Composition (Health ABC) Study</subtitle>

Abstract

Background: Although caregivers report more stress than noncaregivers, few studies have found greater health decline in older caregivers. We hypothesized that caregivers may be more physically active than noncaregivers, which may protect them from health decline. Methods:The sample included 3075 healthy adults from the Health, Aging, and Body Composition (Health ABC) Study. They were aged 70 to 79 years in April 1997 to June 1998 and resided in Memphis, Tennessee, or Pittsburgh, Pennsylvania. Caregivers (680 [22.1%]) were participants who provided regular care or assistance for a child or a disabled or sick adult. Outcomes included allcause mortality and incident mobility limitation (defined as difficulty walking one-quarter mile or climbing 10 steps on 2 consecutive semiannual contacts) during 8 years. Total physical activity included daily routine, exercise, and caregiving activity.Results: Overall, 20.6% of caregivers died and 50.9% de-veloped mobility limitations vs 22.0% and 48.9% of noncaregivers, respectively. Associations differed by race and sex. Mortality and mobility limitation rates were 1.5 times higher in white caregivers (eg, among white female caregivers, adjusted hazard ratio for mortality, 1.6; 95% confidence interval, 1.0-2.5) but not for black female caregivers vs noncaregivers (adjusted hazard ratio for mortality, 0.9; 95% confidence interval, 0.5-1.4). Physical activity mediated these associations in most race-sex groups. High-intensity caregivers (ie, caregiving Ն24 hours per week) had elevated rates of decline when adjusted for physical activity but lower rates when not adjusted for activity. Conclusion:Older white caregivers have poorer health outcomes than black female caregivers. Physical activity appears to mask the adverse effects of high-intensity caregiving in most race-sex groups.

Work and Well-Being of Informal Caregivers in Europe

“…For another, caregiving may increase physical activity and lead to health improvements. This view is expressed by the "healthy caregiver hypothesis" (Fredman et al, 2008). Further, caregiving can be rewarding as it conveys the feeling that the caregiver is needed, yet it might lead to loneliness if caregiving prevents other social activities, which can lead to positive or negative effects for mental health, respectively.…”

Instruments to Assess Mobility Limitation in Community-Dwelling Older Adults: A Systematic Review

“…"), while others assessed the need for help with walking (e.g., "Do you need special equipment or aids to help you with walking?"). Table 4 lists all standardized instruments for mobility limitation that were found Bannerman et al, 2002;Boudreau et al, 2009;Cappola et al, 2003;Cesari et al, 2005Cesari et al, , 2012Chaves et al, 2002;Davison et al, 2002;Fredman et al, 2008;Gray et al, 2011;Hardy et al, 2010Hardy et al, , 2011Hoffman et al, 2007;Houston et al, 2009Houston et al, , 2013Jylha et al, 2001;Keeler et al, 2010;Kim et al, 2010;Koster et al, 2005Koster et al, , 2007Koster et al, , 2008; Lee et al, 2005;Leveille et al, 2007;Lihavainen et al, 2012;Manini et al, 2007Manini et al, , 2009<...>…”

Effect of Educational and Supportive Strategies on the Ability of Caregivers of People With Dementia to Maintain Participation in That Role

“…Depressive symptoms significantly predict the decline in health status of caregivers of people with dementia (Campbell et al, 2008) and are associated with amount of time missed from work and loss of wages, which further contribute to caregiver stress and poor health (Wilson, van Houtven, Sterns, & Clipp, 2007). As many as 90% of caregivers report sleep disturbances (Rausch, Baker, & Boonmee, 2007), nearly 50% develop mobility disorders, and 20% die from cardiovascular problems potentially exacerbated by stress (Fredman et al, 2008).…”

“…Caregivers feeling stress and experiencing mental health problems are at risk for engaging in abusive acts against older care recipients (Macneil et al, 2010). Although caregiver health status is significantly influenced by where the person with AD resides, total burden does not significantly differ between caregivers of community-dwelling patients and caregivers of institutionalized patients (Fredman et al, 2008). People with AD whose caregivers are in poor health may be at risk for not benefiting from intervention, suggesting that efforts, including instruction in preventive care and allocating time to attend to their own health care needs, must be directed toward caregivers as part of a comprehensive AD service program (Campbell et al, 2008;Chee, Gitlin, Dennis, & Hauck, 2007;Zarit & Femia, 2008).…”