Rural‐urban differences in informal caregiving and health‐related quality of life

Abstract

Objectives Rural‐urban health disparities are pervasive among older adults. Rural US locations have a disproportionately high population of older adults, have reduced access to services, and are therefore more reliant on family and friends for care. However, little is known about rural‐urban disparities among the 40+ million informal caregivers nationwide. There is a critical need to understand how rural‐urban disparities impact caregiving experiences and health‐related quality of life (HRQoL). The objectives of this study were to assess rural‐urban differences in informal caregiving status, caregiving intensity (caregiving hours/week and types of care provided), and caregiver HRQoL. Methods Data were abstracted from the 2018 Behavioral Risk Factor Surveillance System. The primary measure of rural‐urban status was “metropolitan status.” Associations between rural‐urban status and caregiving and rural‐urban differences in caregiving intensity and HRQoL were examined using generalized linear models, controlling for confounding and accounting for complex sampling. Results Rural respondents were more likely to be caregivers than urban respondents (OR = 1.17, 95% CI: 1.02‐1.34). After adjustment for confounders, rural caregivers were more likely than urban caregivers to provide 20 or more hours of caregiving per week (OR 1.38, 95% CI: 1.07‐1.77), although the findings for health and HRQoL were somewhat mixed. Conclusion Results indicate that rural older adults offer more care than urban counterparts, which may have implications for caregiver health, well‐being, and quality of life. These results can inform policies designed to improve caregiver health, and facilitate the translation and adaptation of existing policies, programs, and interventions to address rural caregivers’ needs.

The Impact of Physical Activity Levels and Functional Fitness Status on the Quality of Life Perceived by Older Adults Living in Rural and Urban Areas: The Portuguese Inland Case

“…Besides the well-known influence of these variables on HRQoL and physical health status in older people, there is some evidence that older rural residents experience a health disadvantage compared to urban residents [ 34 ]. Nonetheless, there is no consistent evidence that older people living in rural areas have low scores of physical fitness, PA, and HRQoL compared to those living in urban areas [ 35 , 36 , 37 , 38 ]. For instance, in studies performed in China ( n = 1029) and Brazil ( n = 2292), the urban older residents showed greater HRQoL than their rural counterparts [ 39 , 40 ].…”

Rural‐urban differences in family and paid caregiving utilization in the United States: Findings from the Cornell National Social Survey

“…This may be particularly helpful among rural caregivers, who are known to experience more caregiver burden and strain than their urban counterparts. 13,18 Additionally, a Canadian study of older adults found that those receiving both family and paid care reported greater autonomy and social connectedness, and a reduced sense of being a burden on their family members, than those without shared care. 23 These studies suggest that shared care may be beneficial for caregivers and care recipients alike.…”

“…7,15 Prior studies have also shown that family caregiving is more prevalent in rural areas compared to urban ones and that rural family caregivers experience higher levels of caregiver strain compared to their urban counterparts. 13,[16][17][18] This suggests that rural family caregivers, as well as those in certain geographic regions, may benefit from sharing the care of their loved ones with paid caregivers; however, the extent to which they do so is currently unknown. That is, despite its rising prevalence, less is known about patterns of shared caregiving, and whether differences exist by rurality and region in the United States.…”

“…Additionally, the utilization of formal home care services has been shown to vary by region in the United States, with certain areas (eg, Northeast), utilizing home care services more than others 7,15 . Prior studies have also shown that family caregiving is more prevalent in rural areas compared to urban ones and that rural family caregivers experience higher levels of caregiver strain compared to their urban counterparts 13,16–18 . This suggests that rural family caregivers, as well as those in certain geographic regions, may benefit from sharing the care of their loved ones with paid caregivers; however, the extent to which they do so is currently unknown.…”

Sleep Quality Among Informal Caregivers During the COVID-19 Pandemic: A Cross-Sectional Study

“…The number of informal caregivers will likely grow due to the increasing prevalence of chronic diseases and population aging ( Reinhard et al, 2019 ). Research conducted in the United States has found that informal caregivers are more likely to report fair or poor health status and more days of poor physical and mental health than non-caregivers ( ​Cohen, et al, 2021​ ). Research also suggests that caregiver burden may negatively impact caregivers’ ability to engage in healthy behaviors ( Mochari-Greenberger & Mosca, 2012 ) and increase caregiver risk of poor health and chronic diseases ( Miyawaki et al, 2020 ).…”