Perceived Gratitude, Role Overload, and Mental Health among Spousal Caregivers of Older Adults

Impact of caregiving on mental, self-rated, and physical health: evidence from the China health and retirement longitudinal study

OBJECTIVES

Given the escalating demand for care services, understanding the impact of informal caregiving, providing unpaid care for family members, on own health is essential. This study longitudinally analyzed the association of caregiving (and different caregiver types) with mental, physical, and self-rated health. Urban-rural, gender, and employment heterogeneity were further investigated.

METHOD

Based on three-wave data (2011, 2013, and 2018) from the China Health and Retirement Longitudinal Study, we used growth curve models to assess the impact of informal caregiving (providing care to family members) and caregiver types (caregivers to grandchildren, parents, spouses, or multiple family members) on three health outcomes (depressive symptoms, self-rated health, and activities of daily living limitations).

RESULTS

Our study included 13,377 individuals. Results showed a negative correlation of caregiving with mental, physical, and self-rated health. Compared to noncaregivers, spousal caregivers and multiple caregivers were both associated with worsening mental, self-rated, and physical health. In contrast, adult child caregivers were only negatively associated with mental health, and grandparent caregiving did not significantly affect any health outcomes. Further heterogeneity analysis showed that gender did not moderate the relationship between caregiving and health, whereas the negative association between caregiving and health was more pronounced among the rural population and those employed in agriculture.

DISCUSSION

Findings from the present study suggest that caregiving is detrimental to health, and recommend considering caregiver type when examining caregiving and health. These findings have vital implications for policymakers in addressing the challenges of structuring and implementing a sustainable informal care system.

Correlates of felt age in caregivers of people with dementia: findings from the IDEAL study

Objective

Family relationships influence how people appraise their own aging and how their appraisals impact their health. We analyzed felt age (FA) among family caregivers of people with dementia.

Methods and measures

We used a stratified sample of 1,020 spousal and 202 adult-child caregivers from the IDEAL study. We estimated cross-sectional associations and bidirectional influences between caregivers' FA and their health and wellbeing (depression, number of health conditions, stress, positive aspects of caregiving) over 2 years.

Results

Among spousal caregivers, 25% had a younger FA and 36% had an older FA. Among adult-child caregivers, 21.8% had a younger FA and 36.1% had an older FA. In spousal and adult-child caregivers an older FA was cross-sectionally associated with higher depression, number of health conditions, and stress, and fewer positive aspects of caregiving. In spousal caregivers, hours of care per day moderated the association between FA and depression, and FA was associated with stress 1 year later.

Conclusion

Caregiving may impact FA and its relationship with health. We urge continued research on the connections between caregiving and FA, and how interventions might support caregivers' positive views on their own aging, which will translate views on aging scholarship to meaningfully improve caregivers' lives.

It Was Not the Best Option: Family-Role Overload and Regret about Sacrificing Work for the Family

We aimed to analyze whether women with higher family-role overload regret sacrificing their professional work to fulfill family responsibilities better after analyzing the costs of making the work sacrifice. In Study 1, participants (n = 218 women and men) self-reported their family-role overload, rated the costs of sacrificing their work for their family, and rated the extent to which they experienced regret about this sacrifice. In Study 2, participants (n = 285 women) reported their gender role ideology and responded to the same measures as in Study 1. In Study 3, participants (n = 180 women) reported their ideology and their partner's perceived gender role ideology and completed the same procedure as in Study 1. The main findings showed that women (but not men) with higher family-role overload perceived more costs of sacrificing their work for the family, which were associated with greater regret about making the sacrifice. Additionally, women who perceived a traditional ideology in their partner reported more family-role overload, which was associated with greater costs of making the work sacrifice, which in turn was related to greater experienced regret. These findings indicate that although women make these sacrifices based on societal expectations in accordance with their gender role, they could not have obtained the results they could have expected and consequently could regret risking their professional progress for the family. In addition, they suggest that partner involvement is also necessary to overcome this invisible gender inequality.

Conditions for successful implementation of couple-based collaborative management model of diabetes among community-dwelling older Chinese: a qualitative comparative analysis

BACKGROUND

Diabetes mellitus is a prevalent and potentially devastating chronic illness affecting many older adults. Given spousal involvement in many aspects of diabetes management, coping with their partners is increasingly seen as a potential solution to make up for limited resources. This study aimed to identify the key conditions for optimal implementation of couple-based collaborative management model (CCMM) among Chinese older couples with type 2 diabetes mellitus.

METHODS

Older couples and community healthcare practitioners were selected according to couples' joint intervention attendance rate and community's average attendance rate. This mixed methods research consisted of a qualitative phase and a quantitative phase. In the qualitative phase, in-depth interviews were conducted among 12 pairs of couples in the intervention group and 4 corresponding practitioners, in the follow-up period of the multicentered RCT from January to April 2022. Qualitative comparative analysis (QCA) in the quantitative phase to identify conditions influencing CCMM's implementation and to explore necessary and sufficient combinations of conditions (i.e., solutions) for improving patients' glycated hemoglobin (HbA1c) control (outcome).

RESULTS

Key conditions included implementation process, couple's role in diabetes management, their belief and perception of CCMM, as well as objective obstacles and subjective initiative for behavior change. Accordingly, major barriers in CCMM's implementation were patients' strong autonomy (particularly among husbands), misbelief and misperception about diabetes management as a result of low literacy, and mistrust of the practitioners. QCA further revealed that no single condition was necessary for effective HbA1c control, while three types of their combinations would be sufficient. Solution 1 and 2 both comprised the presence of spousal willingness to help, plus correct belief and perception of diabetes management, well embodying the utility of couple collaborative management in supporting patients' HbA1c control. On the other hand, solution 3 indicated that high-quality implementation even without spousal support, can promote the patient's subjective initiative to overcome objective obstacles, suggesting enhanced self-management for HbA1c control.

CONCLUSIONS

Tailored CCMM should be implemented in reference to older couple's preferences and literacy levels, to ensure intervention fidelity, and establish correct understanding of collaborative management among them.

The Mediating Effect of Caregiving Relationship Quality on the Association Between Caregiving Stressors and Mental Health Problems Among Older Spousal Caregivers

Providing care to a spouse can be especially challenging for older adults given their compounding stressors resulting from aging and caregiving. This cross-sectional study examines the relationships between caregiving stressors and caregiver mental health problems and the potential mediator (i.e., caregiving relationship quality) of these associations. A total of 431 Americans (≥65 years) were selected from the National Study of Caregiving. Path analysis shows that care assistance was positively associated with caregiver mental health problems, and this association was mediated by negative relationship quality (Indirect effect  =  .14, p  =  .016). Moreover, role overload was positively associated with caregiver mental health problems, which was mediated by negative relationship quality (indirect effect  =  .13, p  =  .002). Findings suggest that caregiving stressors can adversely affect mental health by exacerbating negative relationship quality. Interventions that limit negative exchanges and increase compassionate communications between older spousal caregivers and their care-receiving partners are needed.

Impact of Caregiving on Cognitive Functioning: Evidence From the China Health and Retirement Longitudinal Study

OBJECTIVES

Few studies have examined the association between caregiving and the cognitive functioning of caregivers. This study explored the association between caring for family members and cognition and how the link differs by caregiving intensity and caregiving types. Furthermore, rural-urban and gender heterogeneity were investigated.

METHODS

This study analyzed Waves 2011, 2013, and 2018 of the China Health and Retirement Longitudinal Study, with cognitive functioning assessed in 3 dimensions: memory, executive function, and orientation function. The cognition trajectories between caregivers and noncaregivers were compared with the growth curve model.

RESULTS

Results demonstrated a positive association between caregiving and cognitive functioning (β = 0.249, p < .001). Considering caregiving intensity, the positive association was only found in low (β = 0.335, p < .001) and moderate-intensity caregivers (β = 0.250, p < .05) but not in high-intensity caregivers. Moreover, grandparents, adult children, and multiple caregivers had a higher average cognition level at age 60 than noncaregivers (all β > 0, all p < .05), and adult child caregivers exhibited a significantly slower rate of decline in cognition across age (β = 0.040, p < .01). However, spousal caregivers showed no significant disparities with noncaregivers. Moreover, the impact of caregiving on memory function is more apparent among urban adults.

DISCUSSION

Results indicate that caregiving can benefit cognitive function. This study proposes considering caregiving intensity and caregiving types when exploring caregiving and cognition. Based on these findings, policy-makers may overcome the challenges involved in establishing and developing a supportive informal care system in China.

Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia

OBJECTIVES

We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups.

METHODS

Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers' age, gender, race, education, relationship to care recipient, and self-rated health.

RESULTS

Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia.

DISCUSSION

Findings highlight the need for tailored interventions based on caregivers' perceptions of meaningful social activities and dementia-friendly communities to promote social participation.

Empowerment and quality of life: the mediating role of self-efficacy and health literacy among spousal caregivers in China

The aim of this study was to explore the chain mediation model of self-efficacy and health literacy between empowerment and quality of life among spousal caregivers of disabled elderly based on 'Marriage Binding'. From December 2020 to June 2022, the cross-sectional study was conducted in hospitals and communities, in Guangdong, Fujian, Sichuan, Hunan, Jiangxi, Guangxi and Yunnan provinces, China. Descriptive statistics were used to describe the demographic data and four main variables, including empowerment, self-efficacy, health literacy and quality of life. Spearman correlation analysis was used to analyze the correlation between the four main research variables. Multiple Linear Regression and bootstrap analysis were used to analyze the direct and indirect effects among them. Any two variables of spousal caregivers were correlated among empowerment, self-efficacy, health literacy and quality of life. Self-efficacy and health literacy can separately and sequentially mediate the relationship between empowerment and quality of life. To improve the quality of life of spousal caregivers of disabled elderly, the mediating role of self-efficacy, the mediating role of health literacy and the chain mediating role of self-efficacy and health literacy should take effect. In the future, some intervention studies should be taken to enhance the effects of those variables that may be beneficial for improving quality of life of spousal caregivers of disabled elderly.

Heterogeneity in the mental health cost of caring for others

Drawing on the stress process, gender theory, and social roles theories, this study examines whether the associations between caregiving and mental health reflect the heterogeneity in caregiving experiences. It explores whether differences in care circumstances (location and intensity of care) and caregiver characteristics (gender and relation to care recipient) impact caregivers' health. While previous research has looked at these factors individually, this study uses longitudinal estimation methods to examine their combined associations with mental health. Using British data from the nationally representative panel survey Understanding Society (N = 366,907), fixed-effect models are used to assess the associations between the location and intensity of care, the caregiver's gender, and the relation to the care recipient and mental health. I report differences in mental health between non-caregivers and caregivers, as well as among caregivers across different care circumstances. While the results highlight the somewhat unique nature of each care circumstance and its relation to mental health, they uncover some general patterns. First, caregiving is a stressful social role. Second, care intensity is a crucial dimension of variation in the relationship between caregiving and mental health. Third, the location of care interacts with care relations only for less intensive caregivers. Fourth, there is a gradation in the negative association between caregiving activities and mental health by care relations. Finally, female caregivers are more susceptible to role overload and role captivity. When the care act is more expected and normative, such as when caring for a spouse, there is no difference by gender in mental health. Yet, differences by gender are evidenced when the intensive care act is less normative. This study unveils nuanced patterns in the joint and unique relations between care circumstances, caregiver characteristics, and mental health, and underscores the importance of effective care support especially for spousal and female parental caregivers.

Validation of a Measure of Role Overload and Gains for End-of-Life Dementia Caregivers

OBJECTIVES

Caregiving stress process models suggest that heterogeneous contexts differentially contribute to caregivers' experiences of role overload and gains. End-of-life (EOL) caregivers, especially EOL dementia caregivers, facing unique challenges and care tasks, may experience role overload and gains in different ways than other caregivers. This study evaluates measurement invariance of role overload and gains between EOL caregivers and non-EOL caregivers and between EOL dementia and EOL non-dementia caregivers.

METHODS

We utilized role gains and overload data from 1,859 family caregivers who participated in Round 7 of the National Study of Caregiving. We ran confirmatory factor analyses to investigate the factorial structure across all caregivers and then examined the structure's configural, metric, and scalar invariance between (a) EOL caregivers and non-EOL caregivers and (b) EOL dementia and EOL non-dementia caregivers.

RESULTS

Across the entire sample, the two-factor overload and gains model had good fit (χ 2(19) = 121.37, p < .0001; RMSEA = .053, 90% CI = [.044, .062]; CFI = .954; TLI = .932). Tests of invariance comparing EOL caregivers to non-EOL caregivers and EOL dementia caregivers to EOL non-dementia caregivers maintained configural, metric, and partial scalar invariance. Latent mean comparisons revealed that EOL caregivers had higher role overload (p = .0002), but no different role gains (p = .45), than non-EOL caregivers. Likewise, EOL dementia caregivers had higher role overload (p = .05), but no different role gains (p = .42), than EOL non-dementia caregivers.

DISCUSSION

Results offer both a deeper theoretical understanding of end-of-life dementia caregivers' experiences of role overload and gains, and a practical tool to measure those experiences.

Correlates of Physical and Emotional Strain Among Older Adult Caregivers

Caregiving can be physically challenging and emotionally draining for older caregivers. The existing research on physical and emotional strain mainly focuses on the general caregiver population. Using the Stress Process Model, this study aims to expand on existing caregiving literature by identifying correlates of physical and emotional strain among older caregivers. Hierarchical OLS regressions were performed on data selected from the 2015 Caregiving in the U.S. Survey (N = 701). Several risk factors for physical strain and emotional strain were identified: Assistance with ADLs and IADLs, the number of health problems of the care recipient, and the receipt of formal support were positively associated with physical and emotional strain. Moreover, providing care to parents/parents-in-law was associated with higher levels of emotional strain than providing care to non-relatives. The number of care recipients was positively associated with emotional strain. Older African Americans experienced lower levels of physical strain than their white counterparts. The findings uncover the individual differences among older caregivers and provide insights into how these differences uniquely influence caregiving strain. Moreover, the study identifies a risk and protective profile of caregiving strain, which can help practitioners direct services and resources to older caregivers who are particularly at risk for caregiving strain.

Collaborative medication management for older adults after hospital discharge: a qualitative descriptive study

BACKGROUND

Safe medication management for older adults after hospital discharge requires a well-coordinated, interprofessional, patient-centered approach. This study aimed to describe the perceived needs for collaborative medication management for older adults taking several different medications at home after hospital discharge.

METHODS

A qualitative descriptive study was conducted using semi-structured interviews with older adults (n = 28), informal (n = 17), and professional caregivers (n = 13).

RESULTS

Findings revealed four main needs: older adults and informal caregivers' perceived needs for greater involvement in discharge planning; older adults' perceived needs to be informed, listened to, and to be actively involved in decision-making; informal caregivers' perceived needs for help in supporting and coordinating medication management; and older adults' and informal and professional caregivers' perceived needs for better communication and coordination between professional caregivers.

CONCLUSION

This study revealed two underutilized pathways towards improving collaborative medication management: medication follow-up involving a community healthcare professional taking an overarching responsibility and empowering older adults and their informal caregivers in medication management after hospital discharge.