Context There is strong consensus that caring for an elderly individual with
disability is burdensome and stressful to many family members and contributes
to psychiatric morbidity. Researchers have also suggested that the combination
of loss, prolonged distress, the physical demands of caregiving, and biological
vulnerabilities of older caregivers may compromise their physiological functioning
and increase their risk for physical health problems, leading to increased
Objective To examine the relationship between caregiving demands among older spousal
caregivers and 4-year all-cause mortality, controlling for sociodemographic
factors, prevalent clinical disease, and subclinical disease at baseline.
Design Prospective population-based cohort study, from 1993 through 1998 with
an average of 4.5 years of follow-up.
Setting Four US communities.
Participants 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 disabled and helping with
no strain reported; or (4) spouse disabled and helping with mental or emotional
Results After 4 years of follow-up, 103 participants (12.6%) died. After adjusting
for sociodemographic factors, prevalent disease, and subclinical cardiovascular
disease, participants who were providing care and experiencing caregiver strain
had mortality risks that were 63% higher than noncaregiving 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 providing care (RR, 1.37; 95%
CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to
the noncaregiving controls.
Conclusions Our study suggests that being a caregiver who is experiencing mental
or emotional strain is an independent risk factor for mortality among elderly
spousal caregivers. Caregivers who report strain associated with caregiving
are more likely to die than noncaregiving controls.