Neighborhood Characteristics and the Mental Health of Caregivers Cohabiting with Care Recipients Diagnosed with Alzheimer’s Disease

Abstract

While studies have documented the influence of caregiver and care recipient factors on caregiver health, it is important to address the potential impact of neighborhood contexts. This study estimated the cross-sectional associations between neighborhood characteristics and mental health among caregivers cohabiting with Alzheimer’s disease care recipients that were experiencing severe or non-severe neuropsychiatric symptoms (NPSs) (e.g., aggression/anxiety). We obtained data collected in 2010 on caregivers and care recipients (n = 212) from a subset of South Carolina’s Alzheimer’s Disease Registry. Neighborhood measures (within 1 mile of the residence) came from the American Community Survey and the Rural-Urban Commuting Area Code. We categorized the neighborhood median household income into tertiles, namely, “low” (<$31,000), “medium” ($31,000–40,758), and “high” (>$40,758), and rurality as “large urban,” “small urban,” and “rural.” We used negative binomial regression to estimate the prevalence ratios (PRs) and 95% confidence intervals (CIs) for caregiver mental health using neighborhood characteristics. The mean age was 58 ± 10.3 years, 85% were women, and 55% were non-Hispanic Black. Among the caregivers cohabiting with a recipient experiencing severe NPS, higher distress was experienced by caregivers living in low- (PR = 1.61 (95% CI = 1.26–2.04)) and medium- (PR = 1.45 (95% CI = 1.17–1.78)) vs. high-income neighborhoods after an adjustment. These results suggest that neighborhood characteristics may amplify other social stressors experienced by caregivers.

2022 Alzheimer's disease facts and figures

“…Among dementia caregivers of care recipients who have experienced severe psychiatric symptoms, those who live in low-or medium-income neighborhoods indicated higher distress than those caregivers living in high-income neighborhoods. 419 A more positive perceived relationship between the caregiver and person with dementia was associated with better self-rated health among Black and White caregivers. 411 Dementia caregiving is clearly common, regardless of race or ethnicity.…”

“…Support from family and friends is associated with better self‐rated health for Black dementia caregivers but not for White or Hispanic caregivers. Among dementia caregivers of care recipients who have experienced severe psychiatric symptoms, those who live in low‐ or medium‐income neighborhoods indicated higher distress than those caregivers living in high‐income neighborhoods 419 . A more positive perceived relationship between the caregiver and person with dementia was associated with better self‐rated health among Black and White caregivers 411 …”

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“…In addition, lower SES with low income and financial stress is associated with increased risk of dementia in older persons, and the correlations are similar to those found in older adults with lower education in the United States ( Samuel et al, 2020 ). Also, caregivers who share a home with AD patients with severe neuropsychiatric symptoms (e.g., aggression and anxiety) while living in lower SES areas had more caregiver stress, further showing that different physical and social environmental factors have distinct effects on the likelihood of AD ( Alhasan et al, 2021 ).…”

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“…Alguns estudos sugerem que desvantagens nos locais de residência e fatores sociais podem interferir no estado de saúde mental dos cuidadores. Não apenas fatores externos como também fatores internos ao local de moradia possuem conexão ao estado de bem-estar do cuidador 4 .…”

“…Foi visto que moradias em zona rural oferecem grandes impasses por possuírem acesso limitado à saúde, recursos escassos e isolamento geográfico, cuidadores de zonas rurais experimentam menor taxa de emprego, menor realização educacional e, consequentemente, menor renda mensal. Todos esses fatores são lacunas que sugerem uma maior probabilidade de sobrecarga do cuidador em áreas rurais quando comparados a cuidadores de áreas urbanas 4 .…”