The Long‐Term Effects of Caregiving on Women's Health and Mortality
| Author | Melissa A. Hardy,Eliza K. Pavalko,Jennifer Caputo |
| Published date | 01 October 2016 |
| DOI | http://doi.org/10.1111/jomf.12332 |
| Date | 01 October 2016 |
J C E K. P Indiana University
M A. H Pennsylvania State University∗
The Long-Term Effects of Caregiving on Women’s
Health and Mortality
Caregivers experience numerous mental and
physical health effects from the stress of provid-
ing care, but we know little about whether these
problems persist in the long term and whether
long-term effects differ across caregiving con-
texts. Using the National Longitudinal Survey
of Mature Women, we examined the relationship
between caregiving and long-term patterns of
depressive symptoms, functional limitations, and
mortality. We also explored the health effects of
caregiving in-home versus out-of-home and by
caregiver/care-recipient relationship. Analyses
show that in-home spousal and parental care-
giving predict increased depressive symptoms
and functional limitations in the long term
but are unassociated with mortality, whereas
caregiving outside the home is unassociated
with later depression and functional limitations
but predicts a lower risk of mortality. This study
highlights the usefulness of approaching stress-
ful experiences such as caregiving from the life
course perspective, viewing them as processes
that unfold over time within specic contexts that
may carry delayed or cumulative consequences.
The U.S. health care system relies heavily on
unpaid care to meet the health needs of the ill
Department of Sociology, Ballantine Hall 744, 1020 E.
Kirkwood Avenue,Bloomington, IN 47405
(caputoj@indiana.edu).
∗Department of Sociology and Criminology, 502 Oswald
Tower,University Park, PA 16802.
Key Words: aging, caregiving, depression,health.
and disabled. In 2009, the value of that care was
estimated at $450 billion, a value far greater than
the $361 billion spent on Medicare that year
(Feinberg & Choula, 2012). Most adults provide
care at some point in their lives and many do so
multiple times, but women are especially likely
to provide unpaid care. National estimates are
that about 60% of unpaid caregivers are women
(National Alliance for Caregiving & American
Association for Retired Persons [NAC], 2015).
Women are more likely to help with personal
care, devote more hours of care each week,
spend more years providing care, and perform
more care tasks than men (Pinquart & Sörensen,
2006). As the population ages, life expectancy
increases, U.S. family sizes decline after reach-
ing a mid-20th century peak, and the demand for
unpaid caregivers of both genders is expected
to grow.
How does this unpaid work affect the per-
son providing care? Although caregiving experi-
ences may be rewarding, there is also no question
that they can be stressful, and negative physi-
cal and mental health consequences of caregiv-
ing are well documented (for reviews, see Pin-
quart & Sörensen, 2003, 2007; Vitaliano, Zhang,
& Scanlan, 2003). Still, our knowledge about
the relationship between caregiving and health
needs elaboration. We address three underex-
plored issues in this article. First, we know rel-
atively little about how caregiving experiences
are related to long-term health trajectories as
caregivers themselves enter old age. Second,
our understanding of how caregiving contexts
1382 Journal of Marriage and Family 78 (October 2016): 1382–1398
DOI:10.1111/jomf.12332
The Long-Term Health Effects of Caregiving 1383
affect the caregiving–health relationship is lim-
ited, including information about where caregiv-
ing occurs and who is being cared for. Finally,
the role of factors that select people into caregiv-
ing as well as those that may explain the negative
health effects of caregiving after it occurs, such
as bereavement, have been underexplored.
In this article, we integrate insights from the
life course perspective with theory about the
stress process to address these gaps. We use
data from the National Longitudinal Survey
of Mature Women (NLS-MW) merged with
mortality data from the National Death Index
and Social Security Death Index to study the
long-term health consequences of providing
care. After assessing the range of women’s
caregiving experiences during a 5-year period in
midlife, we examine the relationships between
these experiences and depressive symptoms
and functional limitations during the following
14 years and all-cause mortality during the fol-
lowing 23 years. We also assess how variations
in the contexts of caregiving experiences con-
dition their effect on health, including whether
care is coresidential and the caregiver’s rela-
tionship to the care recipient. Because our data
cover such a long period of time, we are able to
account for health and other factors that select
women into caregiving as well as to explore
the effects of bereavement when parents or a
spouse dies—both of which also are likely to
shape late-life health trajectories. Our ndings
highlight the utility of integrating stress process
and life course frameworks in research related to
families and health, showing that the effects of
stressful role experiences should be considered
over the long term and within their specic
contexts.
B
As a consequence of the extended life
expectancy in the United States, more adults are
living with chronic illnesses or disabilities (Cen-
ters for Disease Control and Prevention, 2014),
and much of the responsibility for caring for
this population has fallen to informal caregivers.
Recent national research estimates that 18.2%
of U.S. adults are caregivers, most of whom
provide care to a relative with a long-term phys-
ical health problem (NAC, 2015). Caregivers
supply an average of more than 24 hours of
help a week on a broad range of tasks, including
assistance with transportation and household
tasks, basic activities of daily living such as
bathing or dressing, and, increasingly, even
nursing tasks such as administering injections or
catheter maintenance (NAC, 2015). Considering
the comprehensive scope of these potential
demands, it may come as little surprise that 38%
of caregivers perceive their caregiving activities
as stressful (NAC, 2015). Often conceptualized
as a chronic stressor, caregiving has direct
stressful effects as well as negative effects on
other areas of caregivers’ lives (Pearlin, Mul-
lan, Semple, & Skaff, 1990). The well-being of
those who provide this important social resource
has thus often been framed as a public health
concern (e.g., Schulz & Sherwood, 2008).
Approaching caregiving as a stressful role
experience, several decades of research have
documented its negative mental and physical
health effects (for reviews, see Pinquart &
Sörensen, 2003, 2007; Vitaliano et al., 2003).
Although these ndings are compelling, a num-
ber of areas where our understanding of the
caregiving–health relationship needs elabora-
tion persist. The life course paradigm, which
views life experiences as dynamic processes that
unfold over time within personal and historical
contexts (Elder, Johnson, & Crosnoe, 2003),
can be used to supplement our knowledge about
caregiver health in three specic ways that are
addressed in our article.
First, viewing stressful role experiences
such as caregiving through the lens of the
life course perspective compels us to consider
how these experiences impact health not only
in the short term but also as caregivers age
and develop care needs of their own. When
compared with research on short-term health
effects, we know little about the long-term
health trajectories associated with providing
care (Schulz & Sherwood, 2008). The few
studies that have investigated longer term health
effects have found that some physical health
problems, such as cardiovascular disease and
mobility limitations, continue to be more preva-
lent among older caregivers up to 8 years after
caregiving, but that caregivers may begin to
experience reductions in their levels of stress
and negative affect by 3 years postcaregiving
(Capistrant, Moon, Berkman, & Glymour, 2011;
Fredman et al., 2008; Robinson-Whelen, Tada,
MacCallum, McGuire, & Kiecolt-Glaser, 2001).
Although they offer an important glimpse at
how persistent the health effects of caregiving
may be, most of these studies focus on older
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