Context There is strong consensus that caring for an elderly individual wit
h disability is burdensome and stressful to many family members and contrib
utes to psychiatric morbidity. Researchers have also suggested that the com
bination of loss, prolonged distress, the physical demands of caregiving, a
nd biological vulnerabilities of older caregivers may compromise their phys
iological functioning and increase their risk for physical health problems,
leading to increased mortality.
Objective To examine the relationship between caregiving demands among olde
r spousal caregivers and 4-year all-cause mortality, controlling for sociod
emographic factors, prevalent clinical disease, and subclinical disease at
baseline.
Design Prospective population-based cohort study, from 1993 through 1998 wi
th an average of 4.5 years of follow-up. Setting Four US communities. Parti
cipants A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years
who were living with their spouses.
Main Outcome Measure Four-year mortality, based on level of caregiving: (1)
spouse not disabled; (2) spouse disabled and not helping; (3) spouse disab
led and helping with no strain reported; or(4) spouse disabled and helping
with mental or emotional strain reported.
Results After 4 years of follow-up, 103 participants (12.6%) died. After ad
justing for sociodemographic factors, prevalent disease, and subclinical ca
rdiovascular disease, participants who were providing care and experiencing
caregiver strain had mortality risks that were 63% higher than noncaregivi
ng controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2
.65). Participants who were providing care but not experiencing strain (RR,
1.08; 95% CI, 0.61-1.90) and those with a disabled spouse who were not pro
viding care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mo
rtality rates relative to the noncaregiving controls.
Conclusions Our study suggests that being a caregiver who is experiencing m
ental or emotional strain is an independent risk factor for mortality among
elderly spousal caregivers. Caregivers who report strain associated with c
aregiving are more likely to die than noncaregiving controls.