Reduced employment in caregivers of frail elders: Impact of ethnicity, patient clinical characteristics, and caregiver characteristics

Background. Without family caregivers, many frail elders who live at home w ould require nursing home care. However, providing care to frail elders req uires a large time commitment that may interfere with the caregiver's abili ty to work. Our goal was to determine the patient and caregiver characteris tics associated with the reduction of employment hours in caregivers of fra il elders. Methods. This was a cross-sectional study of 2806 patients (mean age 78, 73 % women, 29% African American, 12% Hispanic, 54% with dementia) with at lea st one potentially working caregiver (defined as one who is either currentl y employed or who would have been employed if they had not been providing c are) and their 4592 potentially working caregivers. Patients were enrollees at I I sites of the Program of All-Inclusive Care for the Elderly (PACE). Social workers interviewed patients and caregivers at the time of PACE enro llment. Caregivers were asked if they had reduced the hours they worked or had stopped working to care for the patient. Nurses interviewed patients an d caregivers to assess independence in activities of daily living (ADLs) an d the presence of behavioral disturbances. Comorbid conditions were assesse d by physicians during enrollment examinations. Results. A total of 604 (22%) of the 2806 patients had at least one caregiv er who either reduced the number of hours they worked or quit working to ca re for the patient. Patient characteristics independently associated with a caregiver reducing hours or quitting work were ethnicity (odds ratio [OR] = 1.42, 95% confidence interval [CI] 1.14-1.78 for African American; OR = 1 .90, 95% CI 1.43-2.52 for Hispanic), ADL function below the median (OR = 1. 76,95% CI 1.44-2.15), a diagnosis of dementia (OR = 1.68, 95% CI = 1.31-2.1 7 if associated with a behavioral disturbance; OR = 1.31, 95% CI 1.06-1.63 if not associated with a behavioral disturbance), or a history of stroke (O R = 1.42, 95% CI 1.16-1.73). After controlling for these patient characteri stics, caregiver characteristics associated with reducing work hours includ ed being the daughter or daughter-in-law of the patient (OR = 1.69, 95% CI 1.37-2.08) and living with the patient (OR = 4.66, 95% CI 3.65-5.95 if no o ther caregiver lived at home, OR = 2.53, 95% CI 2.03-3.14 if another caregi ver lived at home). Conclusions. Many caregivers reduce the number of hours they work to care f or frail elderly relatives. The burden of reduced employment is more likely to be incurred by the families of ethnic minorities and of patients with s pecific clinical characteristics. Daughters and caregivers who Eve with the patient are more likely to reduce work hours than other caregivers. Future research should examine the impact of lost caregiver employment on patient s' families and the ways in which the societal responsibility of caring for frail elders can be equitably shared.