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

Authors

  • Lisa Fredman PhD,

    1. From the *Epidemiology Department and Biostatistics Department, School of Public Health, Boston University, Boston, Massachusetts; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Medicine and Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and §Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota.
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  • Jane A. Cauley Dr. PH,

    1. From the *Epidemiology Department and Biostatistics Department, School of Public Health, Boston University, Boston, Massachusetts; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Medicine and Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and §Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota.
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  • Marc Hochberg MD, MPH,

    1. From the *Epidemiology Department and Biostatistics Department, School of Public Health, Boston University, Boston, Massachusetts; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Medicine and Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and §Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota.
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  • Kristine E. Ensrud MD, MPH,

    1. From the *Epidemiology Department and Biostatistics Department, School of Public Health, Boston University, Boston, Massachusetts; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Medicine and Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and §Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota.
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  • Gheorghe Doros PhD,

    1. From the *Epidemiology Department and Biostatistics Department, School of Public Health, Boston University, Boston, Massachusetts; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Medicine and Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and §Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota.
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  • for the Study of Osteoporotic Fractures

    1. From the *Epidemiology Department and Biostatistics Department, School of Public Health, Boston University, Boston, Massachusetts; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Medicine and Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore, Maryland; and §Department of Epidemiology, University of Minnesota, Minneapolis, Minnesota.
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Address correspondence to Lisa Fredman, Epidemiology Department, Boston University School of Public Health, 715 Albany Street, Boston, MA 02118. E-mail: lfredman@bu.edu

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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