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Stigma associated with parental depression or cancer: Impact on spouse and offspring's cortisol levels and socioemotional functioning. Dev Psychopathol 2021; 32:1822-1837. [DOI: 10.1017/s0954579420001431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractStress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.
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Leggett AN, Choi H, Chopik WJ, Liu H, Gonzalez R. Early Cognitive Decline and its Impact on Spouse's Loneliness. RESEARCH IN HUMAN DEVELOPMENT 2020; 17:78-93. [PMID: 33041699 DOI: 10.1080/15427609.2020.1750293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Loneliness is common in dementia caregivers as cognitive impairment (CI) alters marital and social relationships. Unexplored is how an individual's loneliness is affected at earlier, more ambiguous, periods of their spouse's CI. Methods Using the Health and Retirement Study, our study participants included 2,206 coupled individuals with normal cognitive function at the 2006/8 baseline. Loneliness outcomes at baseline, 4-year and 8-year follow-up are assessed by the status of transition to cognitive impairment no dementia (TCIND) (2010/12 & 2014/16) using linear mixed models. Results Individual's loneliness was stable when their spouse's cognition remained normal, but increased with the spouse's TCIND. The increase in loneliness did not vary by gender. Conclusions Loneliness, a key risk factor for reduced life quality and increased depression, increases even at early stages of a partner's CIND. This work suggests the potential impact of early intervention and social support for partners of individuals with CIND.
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Affiliation(s)
| | - HwaJung Choi
- Department of Internal Medicine, University of Michigan, Survey Research Center, Institute for Social Research
| | | | - Hui Liu
- Department of Sociology, Michigan State University
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Abstract
Research on stress and disease has often afforded an important role to emotion, typically conceptualized in broad categories (e.g., negative emotions), viewed as playing a causal role (e.g., anger contributing to pathophysiology of cardiovascular disease), and measured using self-report inventories. In this article, I argue for the value of evaluating specific emotions, considering bidirectional causal influences, and assessing actual emotional responding when considering the role that emotions play in the stress-disease relationship. In terms of specificity, specific emotions (e.g., anger, sadness, and embarrassment) can be linked with particular health outcomes (e.g., cardiovascular disease and musculoskeletal disease). In terms of bidirectionality, the influences of emotions on disease as well as the influences of disease on emotional functioning can be considered. In terms of assessing actual emotional responding, emotions can be studied in vivo under controlled conditions that allow behavioral, physiological, and subjective responses to be measured during different kinds of emotional functioning (e.g., responding to emotional stimuli, interacting with relationship partners, and downregulating emotional responses). With these considerations in mind, I review early theories and empirical studies in psychosomatic medicine that considered the role of specific emotions and emotion-related behaviors. Studies from our laboratory are presented that illustrate a) differences in patterns of autonomic nervous system responding associated with specific emotions, b) relationships between specific emotions and particular health outcomes in the context of social relationships, c) age as a moderator of the relationship between specific emotions and well-being, d) bidirectional influences (emotions influencing disease and disease influencing emotional functioning), and e) impact of changes in emotional functioning in individuals with neurodegenerative diseases on the health of familial caregivers.
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Affiliation(s)
- Robert W Levenson
- From the Department of Psychology, University of California, Berkeley, Berkeley, California
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4
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The Relationship between Burden and Depression in Spouses of Chronic Kidney Disease Patients. DEPRESSION RESEARCH AND TREATMENT 2018; 2018:8694168. [PMID: 29862072 PMCID: PMC5971334 DOI: 10.1155/2018/8694168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 02/04/2018] [Accepted: 03/25/2018] [Indexed: 01/02/2023]
Abstract
The purpose of the present study was to investigate the burden and depression in spouses of patients with chronic kidney disease (CKD). The interrelation between burden and depression in family caregivers has been pointed out by previous researches in several chronic diseases and researchers agree that they clearly go together and one cannot talk about one without considering the other. More particularly, in the present study, the caregiver burden, the depression, anxiety, and also health-related quality of life and demographic factors of spouses of patients with CKD were examined, using self-report questionnaires. Participants were 50 spouses of patients with CKD, 29 of whom were dialysis dependent and 21 were not dialysis dependent. Group differences were examined for participants. Results confirm the interrelation between caregiver burden and depression in spouses. The increased perceived burden related to higher levels of depression. Low levels of caregiver burden, depression, anxiety, and satisfactory quality of life were found in spouses, with no differences between them relevant to whether the patients were dialysis dependent or not. All the above parameters interrelated. Implications for the findings and future research directions are discussed.
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Rückholdt M, Tofler GH, Buckley T. The impact of hospitalisation on a visiting family member: A case study and discussion. Aust Crit Care 2017; 30:182-185. [DOI: 10.1016/j.aucc.2016.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/12/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022] Open
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Connell CM. Impact of spouse caregiving on health behaviors and physical and mental health status. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/153331759400900105] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The impact of caring for a spouse with a progressive dementia on caregiver's health behaviors and health status was examined. Data collected from 44 spouse caregivers indicates that: • Providing full-time care interferes with preventive health behaviors (eating nutritiously, exercising) and contributes to high risk behaviors (overeating, alcohol and substance use); • Health behaviors are frequently used as coping strategies; • Caregivers rated their own health as poorer than their spouse's health; and • Disabling (arthritis, cardiac and back problems) and stress-related health problems (migraines, colitis) are a consequence of and interfere with care provision.
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Affiliation(s)
- Cathleen M Connell
- Department of Health Behavior and Health Education, School of Public Health; Education and Information Transfer Core, Michigan Alzheimer's Disease Research Center University of Michigan, Ann Arbor, Michigan
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7
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Hoshino J, Hori Y, Kondo T, Tamakoshi K, Toyoshima H, Sakakibara H. Characteristics of hypertension-related factors in female home caregivers in Japan-comparison with general community non-caregivers. J Clin Nurs 2012; 22:466-78. [PMID: 22642659 DOI: 10.1111/j.1365-2702.2011.04039.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To examine the characteristics of hypertension-related factors in female family caregivers in Japan who provide care in the home, in comparison with general community non-caregivers. BACKGROUND Hypertension is more frequently encountered in female caregivers than in non-caregivers. Lifestyle factors including sleep and eating habits differ in Japanese female caregivers and the general population. Therefore, hypertension-related factors in caregivers may also differ from those in the general population. DESIGN A cross-sectional study. METHODS The subjects were 150 female caregivers (aged 62·4, SD 12·2 years) who provided home care for persons with physical impairments and/or dementia and 154 female controls (aged 62·7, SD 2·2 years) who did not provide home care. Persons with a history of ischaemic heart disease or cerebral stroke were excluded. Subjects were examined using a self-reporting questionnaire that included a food frequency questionnaire and the tri-axial coping scale. Urine examinations and blood pressure measurements were also done. Logistic regression analysis was conducted for each group with the same variables as explanatory variables. RESULTS Hypertension was present in 46·7% of caregivers and 34·4% of controls (p<0·05). Menopause was a factor related to hypertension in both the caregivers and controls. In the caregiver group, hypertension was associated with the estimated 24-h Na excretion in urine and the carbohydrate-energy ratio for nutriti. BMI was associated with hypertension in the control group, but not in the caregiver group. CONCLUSIONS Hypertension was associated with nutritional factors, such as greater Na excretion in urine and higher carbohydrate energy ratio, in Japanese female caregivers and with obesity in non-caregivers. RELEVANCE TO CLINICAL PRACTICE To prevent hypertension, it is necessary to carefully monitor salt intake and nutritional balance in female caregivers in Japan.
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Affiliation(s)
- Junko Hoshino
- School of Nursing, Sugiyama Jogakuen University, Nagoya, Japan.
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Capistrant BD, Moon JR, Glymour MM. Spousal caregiving and incident hypertension. Am J Hypertens 2012; 25:437-43. [PMID: 22189941 DOI: 10.1038/ajh.2011.232] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Caring for one's spouse has been associated with poor health, including risk of cardiovascular disease (CVD) onset and mortality. However, few studies have assessed the risk of incident hypertension associated with spousal caregiving. This paper investigates this association in a large, nationally representative sample of American older adults. METHODS Married, hypertension-free, Health and Retirement Study (HRS) respondents aged 50+ in 2000, (n = 5,708) were followed up to 8 years (1,708 new self-reported hypertension diagnoses). Current caregiving exposure was defined as assisting a spouse with instrumental or basic activities of daily living (IADLs) 14+ h/week; we define providing ≥14 h/week of care at two consecutive biennial surveys as "long-term caregiving." We used inverse probability weighted discrete-time hazard models with time-updated exposure and covariates to estimate effects of current and long-term caregiving on incident hypertension. We tested for effect modification by race, gender, and recipient memory illness. Sensitivity analyses restricted to respondents whose spouses had care needs. RESULTS After adjusting for demographic, socioeconomic, and health factors, (including risk behaviors, comorbid conditions, and self-rated health), current caregiving significantly predicted hypertension incidence (risk ratio (RR) = 1.36, 95% confidence interval (CI): 1.01, 1.83). For long-term caregivers, there was significant evidence of risk of hypertension onset associated with caregiving (RR = 2.29, 95% CI: 1.17, 4.49). The risk of hypertension onset associated with both current and long-term caregiving did not vary by race, gender, or recipient memory illness diagnosis. Sensitivity analyses supported the primary findings. CONCLUSIONS Providing IADL care to a spouse significantly predicted hypertension onset in a nationally representative sample of US adults.
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A transdisciplinary perspective of chronic stress in relation to psychopathology throughout life span development. Dev Psychopathol 2011; 23:725-76. [DOI: 10.1017/s0954579411000289] [Citation(s) in RCA: 170] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AbstractThe allostatic load (AL) model represents an interdisciplinary approach to comprehensively conceptualize and quantify chronic stress in relation to pathologies throughout the life cycle. This article first reviews the AL model, followed by interactions among early adversity, genetics, environmental toxins, as well as distinctions among sex, gender, and sex hormones as integral antecedents of AL. We next explore perspectives on severe mental illness, dementia, and caregiving as unique human models of AL that merit future investigations in the field of developmental psychopathology. A complimenting transdisciplinary perspective is applied throughout, whereby we argue that the AL model goes beyond traditional stress–disease theories toward the advancement of person-centered research and practice that promote not only physical health but also mental health.
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Elliott AF, Burgio LD, DeCoster J. Enhancing caregiver health: findings from the resources for enhancing Alzheimer's caregiver health II intervention. J Am Geriatr Soc 2010; 58:30-7. [PMID: 20122038 PMCID: PMC2819276 DOI: 10.1111/j.1532-5415.2009.02631.x] [Citation(s) in RCA: 140] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the relationships between changes from baseline to post-Resources for Enhancing Alzheimer's Caregiver Health (REACH) intervention in caregiver (CG) self-reported health, burden, and bother. DESIGN Randomized, multisite clinical trial. SETTING CG and care recipient (CR) homes in five U.S. cities. PARTICIPANTS Four hundred ninety-five dementia CG and CR dyads (169 Hispanic, 160 white, and 166 African American) receiving intervention and their controls. INTERVENTION CGs were assigned to the REACH intervention or a no-treatment control group. Intervention subjects received individual risk profiles and the REACH intervention through nine in-home and three telephone sessions over 6 months. Control subjects received two brief "check-in" telephone calls during this 6-month period. MEASUREMENTS The primary outcome was change in CG health status from baseline to after the intervention. Secondary outcomes were CG burden and bother after the intervention. RESULTS After the intervention, CGs reported better self-rated health, sleep quality, physical health, and emotional health, which was related to less burden and bother with their caregiving role than for CGs not receiving the intervention. Changes in depression appeared to mediate these relationships. Several racial and ethnic group differences existed in physical and emotional health, as well as in total frustration with caregiving, emotional burden, and CG-rated bother with CR's activities of daily living and instrumental activities of daily living at baseline and at follow-up, although differences between baseline and posttest did not vary according to race. CONCLUSION A structured, multicomponent skills training intervention that targeted CG self-care behaviors as one of five target areas, improved self-reported health status, and decreased burden and bother in racially and ethnically diverse CGs of people with dementia.
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Affiliation(s)
- Amanda F. Elliott
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, Alabama
| | - Louis D. Burgio
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, Alabama
- School of Social Work and Institute of Gerontology, University of Michigan, Ann Arbor, Michigan
| | - Jamie DeCoster
- Center for Mental Health and Aging, University of Alabama, Tuscaloosa, Alabama
- Institute for Social Science Research, University of Alabama, Tuscaloosa, Alabama
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Abstract
OBJECTIVE To review the literature pertaining to caregiver burden in Alzheimer's disease (AD) and the role of medications and the pharmacist in reducing caregiver burden. DATA SOURCES A MEDLINE search was conducted to identify relevant studies, review articles, case reports, and letters in the English language published from 1985 to September 2003. Additional references were obtained from bibliographies of these articles. STUDY SELECTION All studies evaluating caregiver burden and AD, as well as the role of medications in reducing caregiver burden that were accessible to the authors. DATA SYNTHESIS Caring for the caregiver is a significant part of managing a patient with AD. Many predictors of caregiver burden in AD have been identified. A number of measurement tools have been developed to assess caregiver burden in the research setting. A wide variety of interventions to reduce caregiver burden have been studied. These interventions range from education and support services to drug therapies. Most often these strategies have been studied individually; however, combining drug treatments with nonpharmacologic interventions may be the best approach to improve the quality of life for the caregiver of a patient with dementia and the care recipient. Most of the studies to date of drug therapy and caregiver burden have evaluated cholinesterase inhibitors. Other drug therapies that have been studied include memantine, antipsychotics, antidepressants, and selegiline. PRIMARY CONCLUSIONS AND CLINICAL APPLICATIONS: The pharmacist can play an important part in reducing the caregiver burden associated with AD. It is important to identify caregivers at risk for experiencing significant caregiver burden since the consequences of excess burden to the caregiver-and the care recipient-can be devastating. Among the many tasks of providing such care, caregivers are responsible for administering and managing medications. The difficulties associated with the care recipient's medications can be reduced through effective communication, education, and services available from a pharmacist. Pharmacists are probably the most accessible health care professional for the caregiver. Being able to provide accurate information about AD and its management is an important way to ease the burden of care. Finally, pharmacists can play a significant part in supporting the community in caring for the families of patients with Alzheimer's disease by volunteering with the local chapter of the Alzheimer's Association.
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Affiliation(s)
- Patricia W Slattum
- Department of of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA
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Kim JH, Knight BG. Effects of Caregiver Status, Coping Styles, and Social Support on the Physical Health of Korean American Caregivers. THE GERONTOLOGIST 2008; 48:287-99. [DOI: 10.1093/geront/48.3.287] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Knight BG, Longmire CVF, Dave J, Kim JH, David S. Mental health and physical health of family caregivers for persons with dementia: a comparison of African American and white caregivers. Aging Ment Health 2007; 11:538-46. [PMID: 17882592 DOI: 10.1080/13607860601086561] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
This investigation analyzed the differences between African American and white caregivers in the effects of family caregiving for a person with dementia on mental health and physical health variables (including subjective health, reported diseases and cardiovascular measures). A population-based sample of 102 caregivers is compared with 102 non-caregivers matched on ethnicity, gender and age. There were no significant group differences for mental health effects. Most significant physical health effects were attributable to main effects of ethnicity rather than caregiving status. However, African American caregivers had higher diastolic blood pressure than all other groups, a finding consistent with group-specific risk for circulatory system disorders.
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Affiliation(s)
- B G Knight
- University of Southern California, Los Angeles, CA 90089-0191, USA.
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Pinquart M, Sörensen S. Correlates of physical health of informal caregivers: a meta-analysis. J Gerontol B Psychol Sci Soc Sci 2007; 62:P126-37. [PMID: 17379673 DOI: 10.1093/geronb/62.2.p126] [Citation(s) in RCA: 641] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Effects of caregiving on physical health have received less theoretical and empirical attention than effects on psychological health. This meta-analysis integrates results from 176 studies on correlates of caregiver physical health. Caregiver depressive symptoms had stronger associations with physical health than did objective stressors. Higher levels of care recipient behavior problems were more consistently related to poor caregiver health than were care receiver impairment and intensity of caregiving. Higher age, lower socioeconomic status, and lower levels of informal support were related to poorer health. Predictors of physical health are not identical to predictors of psychological health. Associations of caregiving stressors with health were stronger among older samples, dementia caregivers, and men. In sum, negative effects of caregiving on physical health are most likely to be found in psychologically distressed caregivers facing dementia-related stressors.
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Affiliation(s)
- Martin Pinquart
- Department of Developmental Psychology, Friedrich Schiller University, Am Steiger 3 Haus 1, D-07743 Jena, Germany.
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Skarupski KA, de Leon CFM, McCann JJ, Bienias JL, Wilson RS, Evans DA. Is lower cognitive function in one spouse associated with depressive symptoms in the other spouse? Aging Ment Health 2006; 10:621-30. [PMID: 17050091 DOI: 10.1080/13607860600844184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study examines whether lower cognitive function in one spouse is associated with depressive symptoms in the other spouse. The subjects were 528 community-dwelling spouse pairs aged 65+ who participated in the Chicago Health and Aging Project (CHAP), an ongoing longitudinal, bi-racial, population-based study of risk factors for incident Alzheimer's disease and other age-related chronic conditions. CHAP participants were assessed at 3-year intervals over a period of nearly ten years. The results show a cross-sectional association of wives' lower cognitive function at baseline with depressive symptoms in husbands; however, husbands' cognitive function was not associated with wives' depressive symptoms. There was no longitudinal association of cognitive function at baseline with increased depressive symptoms over time. Furthermore, change in cognitive function over time had no effect on depressive symptoms in either spouse. The relationship between cognitive function and depressive symptoms in spouse pairs is complex. Our findings suggest that husbands may be particularly psychologically vulnerable to the negative effects of their wives' cognitive impairment. This vulnerability may have a range of long-term health and caregiving implications.
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Affiliation(s)
- Kimberly A Skarupski
- Rush Institute for Healthy Aging, Rush University Medical Center, 1645 W. Jackson, Suite 675, Chicago, IL 60612-3227, USA.
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Tiegs TJ, Heesacker M, Ketterson TU, Pekich DG, Rittman MR, Rosenbek JC, Stidham BS, Gonzalez-Rothi LJ. Coping by stroke caregivers: sex similarities and differences. Top Stroke Rehabil 2006; 13:52-62. [PMID: 16581630 DOI: 10.1310/cjvw-wcpk-2fcv-369p] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Informal care provision presents many challenges. As the population ages, more people are forced to enter the role of informal caretaker. Despite the increase in the need for caregivers and the importance of providing care, there is little empirical research examining how men and women approach and cope with providing care. The current study examined stroke patients and their care providers to assess possible gender differences in the impact of caretaking on caretakers and care recipients. Results indicate no significant difference in patient well-being based on the gender of the caregiver. Some measures indicated that men have advantages as caregivers. Results are discussed with regard to the accuracy and utility of sex-role stereotypes about caregivers. In addition, these data provide potential insight about how to decrease caregiver burden, delay long-term hospitalization of the patient, and increase the quality of life for caretakers and patients.
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Perlick DA, Hohenstein JM, Clarkin JF, Kaczynski R, Rosenheck RA. Use of mental health and primary care services by caregivers of patients with bipolar disorder: a preliminary study. Bipolar Disord 2005; 7:126-35. [PMID: 15762853 DOI: 10.1111/j.1399-5618.2004.00172.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Caring for a relative with schizophrenia or dementia has been associated with reports of caregiver burden, symptoms of anxiety, depression, poor self-rated health, and elevated health service use; however, comparable data for caregivers of relatives with bipolar disorder are lacking. This study reports preliminary data on the health, psychological distress and health service use of caregivers of patients with bipolar disorder. It additionally evaluates the relationship of the level of burden caregivers report experiencing to their use of health services, controlling for level of psychological distress and health status. METHODS Subjects were primary caregivers of 264 patients with Research Diagnostic Criteria-diagnosed bipolar disorder and their bipolar relatives. Caregiver mental health and primary care service use were assessed retrospectively for the 7-month period prior to inpatient or outpatient admission of the bipolar patient. Caregiver depression, anxiety, medical conditions and patient symptomatology were assessed as well. RESULTS Hierarchical logistic regression analysis demonstrated that caregiver burden significantly increased the likelihood of mental health service use (OR = 13.53, p < 0.001) even after controlling for caregiver psychological distress and medical conditions, while anxiety and depression level, but not burden, significantly increased the likelihood of primary care service use, controlling for other variables (OR = 1.72, p = 0.02). CONCLUSIONS Burdens experienced by family caregivers appear to increase use of health services, and presumably cost, and may be reduced by psychosocial intervention.
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Affiliation(s)
- Deborah A Perlick
- Northeast Program Evaluation Center, West Haven VAMC and the Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06516, USA.
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Abstract
Increasing numbers of women provide care to their ill spouses; however, no studies have examined possible effects of caregiving stress on cognitive function. We administered 6 tests of cognitive function to 13740 Nurses' Health Study participants aged 70-79 years. We collected information on caregiving and numerous potential confounding variables via biennial mailed questionnaires. After adjustment for potential confounders (age, education, mental health index, vitality index, use of antidepressants, and history of high blood pressure, diabetes, and heart disease), we found modest but significantly increased risks of low cognitive function on three of the cognitive tests among women who provided care to a disabled or ill spouse compared with women who did not provide any care. For example, on the TICS, a test of general cognition, the risk of a low score was 31% higher in women who provided care compared with women who did not (RR = 1.31, 95% CI 1.10, 1.56). We found a moderately increased risk of poor performance on several cognitive tests among women who provided care to their disabled or ill husbands.
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Affiliation(s)
- Sunmin Lee
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02115, USA
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Lee S, Colditz G, Berkman L, Kawachi I. Caregiving to children and grandchildren and risk of coronary heart disease in women. Am J Public Health 2003; 93:1939-44. [PMID: 14600070 PMCID: PMC1448080 DOI: 10.2105/ajph.93.11.1939] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2003] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relationship between burden of providing care to non-ill children and grandchildren and incidence of coronary heart disease (CHD) among women. METHODS A prospective cohort study was conducted as part of the Nurses' Health Study among 54,412 women aged 46 to 71 years who were registered nurses. Women answered questions about their child care responsibilities. RESULTS We documented 321 incident cases of CHD during 4 years of follow-up. Multivariate analyses showed that caring for non-ill children 21 hours or more per week and caring for non-ill grandchildren 9 hours or more per week (vs no caregiving) were associated with an increased risk of CHD (relative risks were 1.59 and 1.55, respectively). CONCLUSIONS High levels of care provision to grandchildren (and possibly children) may increase the risk of CHD among women.
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Affiliation(s)
- Sunmin Lee
- Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, MA 02115, USA
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Eisdorfer C, Czaja SJ, Loewenstein DA, Rubert MP, Argüelles S, Mitrani VB, Szapocznik J. The effect of a family therapy and technology-based intervention on caregiver depression. THE GERONTOLOGIST 2003; 43:521-31. [PMID: 12937331 PMCID: PMC2413057 DOI: 10.1093/geront/43.4.521] [Citation(s) in RCA: 166] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The majority of persons with Alzheimer's disease (AD) are cared for at home by a family member such as a spouse or daughter. Caregiving places enormous demands on these caregivers, and the negative consequences associated with caregiving are well documented. This paper reports results from the Miami site of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) program that examined the efficacy of a family therapy and technology-based intervention in reducing depressive symptoms (according to the Center for Epidemiological Studies Depression scale) among family caregivers of AD patients at 6 months and 18 months follow-up. DESIGN AND METHODS There were 225 White American and Cuban American caregivers that were randomized into a structural ecosystems therapy, structural ecosystems therapy + computer-telephone integrated system, or minimal support control condition. RESULTS Caregivers in the combined family therapy and technology intervention experienced a significant reduction in depressive symptoms at 6 months. The 18-month follow-up data indicated that the intervention was particularly beneficial for Cuban American husband and daughter caregivers. IMPLICATIONS The results indicate that information technology has a promising role in alleviating distress and depression among groups of AD caregivers. The data also demonstrate that interventions have differential impacts according to ethnic group and the caregiver-patient relationship.
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Affiliation(s)
- Carl Eisdorfer
- Department of Psychiatry and Behavioral Sciences, University of Miami School of Medicine, 1695 N.W. 9th Avenue, Suite 3204, Miami, FL 33136, USA.
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Shaw WS, Patterson TL, Semple SJ, Dimsdale JE, Ziegler MG, Grant I. Emotional expressiveness, hostility and blood pressure in a longitudinal cohort of Alzheimer caregivers. J Psychosom Res 2003; 54:293-302. [PMID: 12670605 DOI: 10.1016/s0022-3999(02)00412-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the interactive effect of chronic stress and emotional expressiveness (EE) on blood pressure (BP) in older adults. METHOD Among spousal caregivers (n=111) of Alzheimer's disease (AD) patients, BP was assessed at home by a visiting nurse every 6 months for 7 years. Caregiving demands, EE, social desirability and hostility were also assessed. RESULTS State hostility was more prevalent among newer caregivers and those encountering more dementia problem behaviors and ADL limitations but unrelated to BP or BP change (P>.05). In a cross-sectional analysis, higher diastolic BP was associated with more spousal problem behaviors and being less emotionally expressive (P<.05). Longitudinal (growth curve analysis) increases in diastolic BP were predicted by providing more spousal ADL assistance (P<.05) but not by EE. CONCLUSION Both caregiving stress and low EE may contribute independently to hypertension risk in the elderly.
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Affiliation(s)
- William S Shaw
- Liberty Mutual Center for Disability Research, Hopkinton, MA, USA
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22
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Lee S, Colditz GA, Berkman LF, Kawachi I. Caregiving and risk of coronary heart disease in U.S. women: a prospective study. Am J Prev Med 2003; 24:113-9. [PMID: 12568816 DOI: 10.1016/s0749-3797(02)00582-2] [Citation(s) in RCA: 351] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND A growing number of women provide care to disabled or ill relatives. Many studies have linked caregiving to psychiatric morbidity, lower perceived health status, elevated blood pressure, and poorer immune function. However, no studies have examined the association between caregiving and cardiovascular disease incidence. METHODS We conducted the study in 54,412 women from the Nurses' Health Study, a prospective cohort of female registered nurses residing in 11 U.S. states. These women were aged 46 to 71 years and did not have diagnosed coronary heart disease (CHD), stroke, or cancer at baseline (1992). We collected information on caregiving responsibilities in 1992 and coronary heart disease between baseline (June 1, 1992) and return of the 1996 questionnaire. RESULTS During 4 years of follow-up, we documented 321 incident cases of CHD (231 nonfatal cases of myocardial infarction and 90 CHD deaths). In multivariate analyses controlling for age, smoking, exercise, alcohol intake, body mass index, history of hypertension, diabetes mellitus, and other covariates, caregiving for disabled or ill spouse for > or =9 hours per week was associated with increased risk of CHD (RR, 1.82; 95% confidence interval, 1.08-3.05). However, caregiving for disabled or ill parents or disabled or ill others was not significantly associated with increased risks of CHD. CONCLUSION These data indicate that high levels of caregiving burden for ill spouses may increase the risk of CHD among women.
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Affiliation(s)
- Sunmin Lee
- Department of Health and Social Behavior, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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23
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24
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Yee JL, Schulz R. Gender differences in psychiatric morbidity among family caregivers: a review and analysis. THE GERONTOLOGIST 2000; 40:147-64. [PMID: 10820918 DOI: 10.1093/geront/40.2.147] [Citation(s) in RCA: 359] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The major goal of this article was to review and synthesize the empirical research on caregiver gender and psychiatric morbidity, with the aim of answering three questions: (a) Is there greater psychiatric morbidity among female than male caregivers, (b) is the excess psychiatric morbidity among female caregivers attributable to caregiving, and (c) what factors in the caregiving situation contribute to the excess psychiatric morbidity among female caregivers? In almost all studies reviewed, women caregivers reported more psychiatric symptoms than men caregivers. Comparisons with noncaregiving community samples suggest that female caregivers experience excess psychiatric morbidity attributable to caregiving. Using a stress process model as an organizing framework, the study demonstrated that at all stages of the stress process, women are at greater risk for psychiatric morbidity than men. Directions for future research and implications for interventions and public policy are discussed.
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Affiliation(s)
- J L Yee
- Center for Mental Health Services Research, School of Social Work, University of Pittsburgh, PA 15260, USA. jlyee+@pitt.edu
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25
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Shaw WS, Patterson TL, Ziegler MG, Dimsdale JE, Semple SJ, Grant I. Accelerated risk of hypertensive blood pressure recordings among Alzheimer caregivers. J Psychosom Res 1999; 46:215-27. [PMID: 10193912 DOI: 10.1016/s0022-3999(98)00084-1] [Citation(s) in RCA: 176] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to determine whether the stress of caregiving for the Alzheimer's disease (AD) patient accelerates the likelihood of exceeding hypertensive blood pressure (BP) criteria in periodic longitudinal home assessments. In this cohort study, participants consisted of spousal caregivers of AD patients (n = 144) and demographically equivalent non-caregiving controls (n = 47). Thirty percent of caregivers and 33% of controls were receiving antihypertensive treatment at study entry. Supine systolic and diastolic blood pressure (SBP and DBP) was assessed by semi-automated recordings taken in the home every 6 months for 2 to 6 years. Survival analyses (Cox proportional hazards models) were used to determine whether the hazard for developing hypertension (DBP>140, SBP>90) was greater in caregivers than in controls, and whether increased hazards were related to background characteristics or the extent of caregiving demands. Based on periodic 6-month assessments of BP over 6 years, the hazards of meeting criteria for borderline hypertension were greater for caregivers than for controls (Cox Proportional Hazards, chi2 [1, N = 174] = 4.86, p = 0.03). This difference remained statistically significant (p<0.05) after controlling for age, gender, education, socioeconomic status, body mass index, and use of antihypertensive medications. Increased risk of hypertension was not related to the extent of daily living assistance provided, patient problem behaviors, or caregiver distress. The chronic stress of caring for an AD spouse may have adverse effects on blood pressure; however, the mechanism for this relationship remains unclear.
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Affiliation(s)
- W S Shaw
- San Diego State University--University of California, San Diego Joint Doctoral Program in Clinical Psychology, USA
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26
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Vitaliano PP, Schulz R, Kiecolt-Glaser J, Grant I. Research on physiological and physical concomitants of caregiving: where do we go from here? Ann Behav Med 1998; 19:117-23. [PMID: 9603686 DOI: 10.1007/bf02883328] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
This article discusses the current state of research on the physiological and physical concomitants of caregiving. We offer recommendations about theoretical, empirical, and treatment issues that researchers should consider in future investigations. Important theoretical issues include specifying acute and chronic stress in caregiving research. Empirical issues include sample selection, home versus clinic assessments, the use of experimental probes, moderating and mediating variables, and measurement issues (problems with self-report of health, medical records, physical exams, and lab assessments). Finally, we note that investigators should use this newfound knowledge to target interventions to specific subsets of vulnerable caregivers. In this way, basic research into caregiving, as a model of chronic human stress, can provide more focused approaches to benefit both caregivers and patients.
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Affiliation(s)
- P P Vitaliano
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195, USA
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27
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Schulz R, Newsom J, Mittelmark M, Burton L, Hirsch C, Jackson S. Health effects of caregiving: the caregiver health effects study: an ancillary study of the Cardiovascular Health Study. Ann Behav Med 1998; 19:110-6. [PMID: 9603685 DOI: 10.1007/bf02883327] [Citation(s) in RCA: 280] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
We propose that two related sources of variability in studies of caregiving health effects contribute to an inconsistent pattern of findings: the sampling strategy used and the definition of what constitutes caregiving. Samples are often recruited through self-referral and are typically comprised of caregivers experiencing considerable distress. In this study, we examine the health effects of caregiving in large population-based samples of spousal caregivers and controls using a wide array of objective and self-report physical and mental health outcome measures. By applying different definitions of caregiving, we show that the magnitude of health effects attributable to caregiving can vary substantially, with the largest negative health effects observed among caregivers who characterize themselves as being strained. From an epidemiological perspective, our data show that approximately 80% of persons living with a spouse with a disability provide care to their spouse, but only half of care providers report mental or physical strain associated with caregiving.
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Affiliation(s)
- R Schulz
- Department of Psychiatry, University of Pittsburgh, PA 15260, USA
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28
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Whitlatch CJ, Feinberg LF, Sebesta DS. Depression and health in family caregivers: adaptation over time. J Aging Health 1997; 9:222-43. [PMID: 10182405 DOI: 10.1177/089826439700900205] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study examined the predictors of caregiver depression and "adaptation" over time in a sample of 202 family caregivers of cognitively impaired adults. By examining caregiver adaptation (i.e., a caregiver's ability to adjust psychologically to the demands of providing long-term in-home care), we were able to account for initial levels of depression, regression to the mean, and floor and ceiling effects. Results indicated that the strongest predictors of caregiver depression 1 year after baseline were initial levels of depression, worsening of caregiver subjective physical health status and burden, and short-term use of in-home respite assistance. These findings suggest that caregivers who experience deterioration in levels of physical health and burden and who use in-home respite on a short-term or sporadic basis may be especially vulnerable to the chronic stress of providing long-term in-home care.
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Gallagher SK, Mechanic D. Living with the mentally ill: effects on the health and functioning of other household members. Soc Sci Med 1996; 42:1691-701. [PMID: 8783431 DOI: 10.1016/0277-9536(95)00296-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Based on data from the National Health Interview Survey Mental Health Supplement, 1989 (NCHS, 1991), this article compares health outcomes for respondents living with someone who is mentally ill (N = 776) with a randomly selected subsample of respondents not living with someone identified as mentally ill (N = 716). When other predictors of health are controlled, sharing a household with a mentally ill person is associated with poorer self-reported physical health, increased risk of reporting some activity limitation, and increased service utilization-both greater risk of hospitalization or visiting a physician, and a greater number of days hospitalized and number of physician visits among those utilizing these services. The severity and duration of mental illness have little effect across health outcome measures. Impaired health and increased utilization of medical care among persons living with someone who is mentally ill suggest hidden costs to individuals, to families of the mentally ill, and to the service system.
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Affiliation(s)
- S K Gallagher
- Department of Sociology, Oregon State University, Corvallis 97331-3703, USA
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30
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Abstract
This national interview study examined the health impact of caring for frail elders in a sample of 437 spouse caregivers. The principal findings were that (a) caregiver emotional strain was the strongest common predictor of both poor perceived health and functional limitations, (b) wife caregivers' poor health was associated with care recipients' perceived unmet needs and increased depression, (c) husband caregivers' poor health status was predicted by longer caregiving duration, and (d) non-White wife caregivers reported poorer perceived health than did their White counterparts.
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Jutras S, Lavoie JP. Living with an impaired elderly person: the informal caregiver's physical and mental health. J Aging Health 1995; 7:46-73. [PMID: 10165961 DOI: 10.1177/089826439500700103] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although it is acknowledged that providing an elderly relative with informal assistance can be stressful and burdensome, previous research does not provide clear evidence of the impact of informal caregiving on the physical and mental health of caregivers. The objective of this research was to compare health indicators of coresidents of elderly people who have physical or cognitive impairments with those of two comparison groups: individuals living with a nonimpaired person aged 55 or over and individuals who were not living with a person of that age. Samples were drawn from the Qu/ebec Health Survey database. Although very few differences in physical health were observed between coresidents (n = 292) and individuals in the comparison groups, coresidents systematically presented poorer psychological health indicators. This result supports previous findings related to the low level of psychological well-being of informal caregivers. This suggests that informal caregivers should be regarded as a target population for which health and social services should be carefully planned.
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