Academic journal article Journal of Marriage and Family

The Long-Term Effects of Caregiving on Women's Health and Mortality

Academic journal article Journal of Marriage and Family

The Long-Term Effects of Caregiving on Women's Health and Mortality

Article excerpt

The U.S. health care system relies heavily on unpaid care to meet the health needs of the ill 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 reaching 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 person providing care? Although caregiving experiencesmayberewarding,thereisalsonoquestion that they can be stressful, and negative physical and mental health consequences of caregiving are well documented (for reviews, see Pinquart & Sörensen, 2003, 2007; Vitaliano, Zhang, & Scanlan, 2003). Still, our knowledge about the relationship between caregiving and health needs elaboration. We address three underexplored issues in this article. First, we know relatively 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 affect the caregiving-health relationship is limited, including information about where caregiving occurs and who is being cared for. Finally, the role of factors that select people into caregiving 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 following 23 years. We also assess how variations in the contexts of caregiving experiences condition their effect on health, including whether care is coresidential and the caregiver's relationship 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 findings 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 specific contexts.

BACKGROUND

As a consequence of the extended life expectancy in the United States, more adults are living with chronic illnesses or disabilities (Centers 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 physical 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). …

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