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Caregiving may be associated with poorer health in certain groups
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CHICAGO—Older white caregivers (those who provide regular care or assistance for a child or a disabled or sick adult) appear to have poorer health outcomes than black female caregivers, according to a report in the October 27 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

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Although past studies have found that caregivers have poorer immune status than non-caregivers, there has not been any consistent evidence stating that caregiving increases disease occurrence or death, according to background information in the article. "These inconsistent results suggest the need to examine factors that may influence the association between caregiving and health decline in older adults, particularly race, sex and overall level of physical activity of caregivers and non-caregivers," the authors write. Since physical activity is associated with lower stress and depressive symptoms, and protects against heart disease, death and mobility disability, including it in studies of caregiving "may provide a more accurate description of how caregiving affects physical health."

Lisa Fredman, Ph.D., of the Boston University School of Public Health, and colleagues assessed the physical activity (including daily routine, exercise and caregiving activity) and health of 3,075 healthy adults (ages 70 to 79) from 1997 to 1998. Of these, 680 (about 22 percent) were caregivers. Demographic information such as race and sex were also noted. Participants were clinically examined or interviewed every year for eight years and short telephone interviews were conducted six months between each annual interview.

"Black women were most likely to be caregivers (28.8 percent) and to spend the most time caregiving," the authors write. "Nineteen percent of black women spent eight or more hours a week performing caregiving activities, whereas white men were least likely to be caregivers (18.2 percent) and less involved in caregiving activities than other race-sex groups."

Approximately 20 percent of caregivers died and 50.9 percent developed mobility limitations (difficulty walking one-quarter mile or climbing 10 steps at two consecutive semiannual follow-ups), while 22 percent of non-caregivers died and 48.9 percent developed mobility limitations. "Associations differed by race and sex. Mortality [death] and mobility limitation rates were 1.5 times higher in white caregivers but not for black female caregivers vs. non-caregivers," the authors write. Caregivers who took care of someone for 24 hours or more per week had higher rates of health decline when physical activity was taken into consideration but lower rates of health decline when physical activity was not considered.

"Given the increasing number of elderly caregivers in the United States, these results underscore the potential toll of caregiving on physical health and the need for services to reduce caregivers' stress and maintain their health and ability to provide optimal care for their family members," the authors conclude.
(Arch Intern Med. 2008;168[19]:2154-2162. Editor's Note: This research was supported in part by the Intramural Research Program of the National Institutes of Health (NIH), National Institute on Aging (NIA), by NIA contracts and by a grant from the NIH, NIA. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail mediarelations{at} .

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