Shift to intensive caregiving tied to health declines

(Reuters Health) - Becoming a caregiver for a spouse can be emotionally and physically depleting, and may lead to health declines in the caregiver, according to study from China.

Researchers following more than 1,800 people as they transitioned into spousal caregiving over a four-year period found that caregivers whose spouse was severely dependent were likely to see a decline in their own health over time.

In particular, caregivers who developed health problems around the time of their spouse’s increased need, had a steep decline in their own health over the study period. Surprisingly, caregivers with longstanding health problems seemed more resilient to the increased caregiving burden, the study team reports in Age & Ageing.

“We speculated that caregivers with long-existing multiple chronic conditions before the onset of caregiving may have accumulated experience with their own conditions (so) have a better understanding of their partners’ care needs, or have increased resilience to caregiving difficulties,” said Huiying Liu, co-author of the study and a gerontologist at the University of Hong Kong.

“These accumulated advantages may have protected them from negative health outcomes resulting from the transition into caregiving,” Liu said in an email.

Growing numbers of elderly people have sharply increased the need for informal caregiving, especially in China where formal care is in short supply, the authors write in their report. Over 60 percent of disabled elderly people in China are dependent on informal caregiving and more than half of the time, that care is provided solely by a spouse, the authors note.

For the study, the team followed a sampling of couples enrolled in the China Health and Retirement Longitudinal Study, a nationally representative panel of households. The final analysis focused on 1,866 individuals over age 60 who were not caregivers at the start of the study in 2011.

At the beginning of the study and again in 2013 and 2015, participants were asked to report on their caregiving status and health. By the last follow-up, 413 people had become “low intensity” caregivers of a spouse who needed help with just one activity of daily living. Another 146 people had become high-intensity caregivers of a spouse who needed help with two or more basic activities.

Nearly half of the caregivers started out with no longstanding chronic health conditions of their own or just one, such as arthritis, cancer, or lung, gastric or cardiovascular diseases. Another 45 percent had two or more longstanding conditions and about 15 percent had two or more conditions that were newly diagnosed, or “emerging,” after their spouse began requiring care.

Participants with emerging chronic health problems experienced the biggest declines in health, with rates of hypertension, arthritis and rheumatism, digestive diseases, chronic lung and heart diseases more than doubling.

Being older, female, not receiving a pension, not feeling financially adequate and having depressive symptoms and functional limitations at the start were also associated with worse health among caregivers at the final follow-up.

“It’s one of the biggest studies I’ve seen and it adds weight to the literature showing that caregiving is bad for your health, but this study significantly underestimates the impact of caregiving,” said Janice Kiecolt-Glaser, director of the Institute for Behavioral Medicine Research at Ohio State University in Columbus, who wasn’t involved in the study.

Noting that low-intensity caregivers were included in the analysis, Kiecolt-Glaser said in a phone interview that helping a loved one dress and groom can be difficult, but caregiving for spouses with dementia, or incontinence “is a lot bigger deal.”

“The fact that we see a functional decline in caregivers that is intensified in intense situations supports and indicates that those caregivers need the most preparation and support,” said Erin Kent, a scientific advisor at the U.S. National Cancer Institute in Bethesda, Maryland.

Research in the last two years has suggested that “high-quality relationships may be protective for family caregivers,” said Kent, who wasn’t involved in the current study.

She recommended that families identify as early as possible who will become a primary caregiver and provide them with literature and resources so they have a better idea of what to expect. It’s normal for caregivers to feel overwhelmed and stressed.

“It’s really important to work on friendships and have a good support network because caregivers end up feeling isolated and alone,” Kiecolt-Glaser said.

SOURCE: Age & Ageing, online July 4, 2018.