Caring for older dependent people in low and middle-income countries: the effect of age on mental health in caregivers

Abstract

Background: Older people worldwide are living with chronic health problems, of whom 80% are from low and middle-income countries. Caregiver stress is a complex interplay of health and socio-economic factors with older caregivers; however, the effects of caregiver age upon their mental health have not been well-described. This study aimed to examine whether caregiver age predicts their mental health outcomes in terms of psychological morbidity and care burden in Latin America and China. Methods: The present study was based on cross-sectional baseline data of seven low and middle-income countries: Cuba, the Dominican Republic, Peru, Venezuela, Mexico, China, and Puerto Rico. Data were collected between February 2003 and June 2009 by the 10/66 Dementia Research Group. Data from 1348 households where the caregiver provided care for one older person in the household were included in the current analysis. Psychological morbidity was assessed through the Self-Reporting Questionnaire. The Zarit Burden Inventory was used to measure the levels of care burden of caregivers. Multivariate logistic regression was used to investigate the effects of caregiver age upon psychological morbidity and care burden. Meta-analysis was performed to obtain a pooled estimate of overall odd ratios and 95% confidence intervals of the analyses from the different countries, using the inverse-variance weighted fixed-effect method.Results: The prevalence of households with older caregivers is almost at the same level as that of households with younger caregivers in Puerto Rico and China. The models unadjusted and adjusted for all potential covariates (household size, number of household assets, caregiver sex, caregiver marital status, caregiver education, cognitive impairment of older person, functional dependency of older person, behavioural problems of older person, and caregiving hours) showed that there was no statistically significant difference in psychological morbidity and care burden between older caregivers and non-older caregivers across countries. The adjusted pooled estimates, however, indicated lower psychological morbidity among older caregivers (OR = 0.61, 95% CI: 0.41–0.93, I2 = 0.0%).Conclusions: Older caregivers are at lower risk of mental health problem than younger caregivers. This information may help to provide a greater understanding for service support, policy makers, and health care providers.