A recent literature review suggests that the effects on caregiving on informal, unpaid caregivers need to be reappraised. Much of the literature on caregiving emphasizes physical and psychological distress to caregivers, which has come to be viewed as an inevitable outcome of caregiving. This negative assessment of caregiving extends from peer-reviewed academic articles to agency reports, fact sheets, policy recommendation, and even advice columns. The authors of the review conclude that an overall negative evaluation of the effects on caregivers is mostly unjustified, and suggest an alternative appraisal. This review indicates that caregiving—in particular the act of providing care—can yield beneficial health and well-being outcomes, including reduced mortality, and the authors argue that a more balanced view of caregiving should be adopted, which has implications for caregiver assessment, intervention, and policy.
The article highlights some methodological limitations of caregiving studies, and also draws on mounting empirical data. Reviewing existing research on caregiving, the authors suggest that the act of providing care is typically confounded with a number of other variables, which include conditions preceding caregiving that differentiate caregivers and noncaregivers. One study which examined caregiving over time shows that there are important differences between caregivers and noncaregivers at baseline, which may impact later observed differences. There are also factors that co-occur with providing care, but which are not an intrinsic part of providing care, which may also be confounded with the impact of caregiving, such as shared exposure to stressors, financial hardship, family conflict, and increased workload. The authors note that these and similar factors by themselves or in combination with others have been shown to be risk factors for physical and/or psychological stress, independent of caregiving. This suggests that previously reported caregiver distress may not be uniquely due to the effects of caregiving. They also give the example of a study showing that noncaregivers with disabled spouses had no different mortality rates than caregivers with disabled spouses. Compared with noncaregivers without disabled spouses, the caregivers of disabled spouses did show greater mortality; however, the lack of differences between noncaregivers with disabled spouses and caregivers with disabled spouses suggests that factors related to having a disabled spouse, not factors directly related to caregiving, are at play.
The authors also note that while proportionately more caregivers (17 percent) than noncaregivers (13 percent) report being in fair-to-poor health, the majority of caregivers (83 percent) still report being in better than fair-to-poor health. Additionally, when caregivers are asked how caregiving has impacted their health, 74 percent report that it has had no impact, and 8 percent report that it has made their health better. In a study comparing caregivers for individuals with Alzheimer’s or dementia with caregivers for individuals without these conditions, the caregivers for Alzheimer’s or dementia did report that providing care created or aggravated health problems or stress. But across all caregivers in the study, a majority of both groups reported that they were in excellent, very good, or good health (greater than 83 percent) and that they were satisfied or very satisfied with their lives (greater than 93 percent). Lastly, it is suggested that positive aspects of caregiving are often ignored or not assessed.
Turning to positive aspects of caregiving, the authors begin by suggesting that caregiving impulses have naturally evolved in humans and other mammals, making humans “natural caregivers.” To support this, they point to hormones in the brain that play a role in forming social bonds; some of these hormones have been associated with decreasing stress and anxiety. Researchers have characterized these hormones as “at the core of the caregiving behavioral system.” While this connection remains speculative, it does suggest that the social bonds that an informal caregiver may have with a care recipient could potentially have positive neurological consequences. More direct evidence about potential positive aspects of caregiving does exist in the literature on giving and psychological well-being. Studies of giving more generally have shown improvements in mood, relationship satisfaction, and subjective well-being that are associated with providing assistance to another. Similarly, giving to others has also been associated with a decrease in negative emotional states, and depressive symptoms associated with a spousal loss. Some studies on informal caregiving report similar findings. Spousal caregivers have reported reductions in anxiety and depression related to helping others, as well as increases in well-being. In a large-scale survey of informal caregivers providing more than 40 hours of care per week in an end-of-life care situation, 69 percent reported that giving assistance enables them to appreciate life more, 70 percent reported it making them feel better about themselves, and 76 percent reported that it made them feel helpful and useful. By comparison, only 29 percent said that the caregiving caused emotional stress, just 18 percent said it caused physical strain and only 14 percent said it caused “financial hardship.” Looking at caregiving and mortality, this review also describes a finding that more caregiving hours (more than 14 hours a week) were associated with longer survival of caregivers over a seven-year period, which was not related to care recipient characteristics or caregiver demographic and health factors. Other studies have found similar patterns of greater longevity being associated with caregiving.
Although this review emphasizes the often-overlooked positive aspects of informal caregiving, and notes limitations in studies that suggest that the act of caregiving leads to negative psychological and physical outcomes, negative aspects of the caregiving experience or circumstances surrounding the caregiving experience are not denied. In an attempt to account for both positive and negative findings associated with informal caregiving, the authors propose a model of informal caregiving that looks at both positive and negative reactions to caregiving as adaptive, depending on caregivers’ circumstances. Certain aspects of the caregiving context or perceptions of that context can act as cues for certain types of emotional responses to caregiving. A number of different motivational conflicts and tradeoffs must be resolved by a caregiver, and depending on circumstances, resources, or personality factors, a caregiver’s motivations could be either self-directed or other-directed. The authors here suggest that it is other-directed motivations in caregivers that may lead to positive caregiver outcomes, while self-directed motivation may lead to possible negative caregiver outcomes.
This review concludes by discussing implications for caregiver assessment and interventions, as well as policy implications. For both, they argue that positive aspects of caregiving be taken into account and measured. Doing so may clarify which caregivers are most in need of assistance, and can help better match interventions with specific caregiver needs. Furthermore, efforts can be made to attempt to design interventions that can bring about other-centered motivations, which they theorize will then bring about positive caregiver outcomes. In terms of policy, this review suggests that a lack of resources may be an important contributor to caregivers having self-directed motivations, which could be addressed by programs aimed at providing needed resources to caregivers. They also emphasize that policy statements and other depictions of caregivers should be revised to reflect both the positive and negative sides of caregiving.