Mortality Associated with Caregiving, General Stress, and Caregiving‐Related Stress in Elderly Women: Results of Caregiver‐Study of Osteoporotic Fractures

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Abstract
OBJECTIVES: To investigate the separate and combined effects of caregiver status and high stress on mortality risk over 8 years in elderly women. DESIGN: Prospective cohort study conducted in four U.S. communities followed from 1999/01 (baseline) to December 31, 2007. SETTING: Home‐based interviews. PARTICIPANTS: Three hundred seventy‐five caregiver and 694 noncaregiver participants from the Caregiver‐Study of Osteoporotic Fractures (Caregiver‐SOF) who participated in the baseline Caregiver‐SOF interview. MEASUREMENTS: Caregiver status was based on SOF respondents' self‐report of performing one or more instrumental or basic activities of daily living for a relative or friend with impairments. Two measures of stress were used: Perceived Stress Scale and stress related to caregiving tasks. All‐cause mortality was the outcome. RESULTS: Caregivers were more stressed than noncaregivers; 19.7% of caregivers and 27.4% of noncaregivers died. Mortality was lower in caregivers than noncaregivers (adjusted hazard ratio, (AHR)=0.74, 95% confidence interval (CI)=0.56–0.89). High‐stress respondents had greater mortality risk than low‐stress respondents over the first 3 years of follow‐up (AHR=1.81, 95% CI=1.16–2.82) but not in later years. Likewise, high‐stress caregivers and noncaregivers had higher mortality risk than low‐stress noncaregivers, although low‐stress caregivers had significantly lower mortality than did noncaregivers, whether perceived stress or caregiving‐related stress was measured (AHR=0.67 and 0.57). Similar results were observed in analyses comparing spouse caregivers with married noncaregivers. CONCLUSION: Short‐term effects of stress, not caregiving per se, may increase the risk of health decline in older caregivers.

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