Spousal Caregivers: Who’s the Frailest of Them All?

A number of studies have looked at the negative health consequences associated with spousal caregiving, but little attention has been paid to how the cognitive condition of the individual receiving care might impact health outcomes for the caregiver. Recently, a study in the Gerontologist looked into how care recipients with and without dementia might differently impact the frailty of their spousal caregivers, both close to the death of their spouse and two years later. Prior research has shown that spouses providing care to individuals with dementia are at increased risk for dementia themselves, but little research has investigated the potential impact of such caregiving on a measure of overall physical health like frailty.

This study looked at spousal caregivers who took part in the Health and Retirement Study between 1998 and 2010 whose spouses died between 2000 and 2010. This was a total of 1,246 surviving spouses, with 187 caring for a spouse with some form of dementia. These caregivers’ frailty was assessed by means of the frailty index, which consists of 30 items. This includes eight chronic illnesses, five activities of daily living, seven instrumental activities of daily living, eight depressive symptoms, obesity, and self-reported health.

The frailty of the caregivers was examined within the year that the death of their spouse was reported and then two year later, and their frailty scores from the two time periods were compared. Overall, in the year the death of the spouse was reported, 36.4 percent of dementia caregivers reported increased frailty, compared to 28.1 percent of those caregivers whose spouse did not have dementia. This represents 40.7 percent higher odds of experiencing increased frailty for caregivers whose spouses had dementia. Two years later, this pattern continued to be evident. At that point, 46.5 percent of caregivers with a spouse with dementia had increased frailty compared to before their spouse’s death. For caregivers of spouses without dementia, only 31.6 percent had increased frailty. So two years following the spouses’ deaths, the risk of dementia caregivers being more frail was even greater, with 94.3 percent higher odds of increasing frailty. It seems that no longer having to provide care to a spouse with dementia did not undo the impact of dementia caregiving on frailty. Interestingly, providing care for an individual for longer than one year predicted higher odds of increased frailty the year that the spouse’s death was reported, but the length of care provided no longer remained a significant factor in the risk of frailty two years later.

One potential reason for these differences could be the greater caregiving load placed on those caring for spouses with dementia. The caregivers for spouses without dementia reported their spouses having an average of 2.3 activity of daily living impairments, compared to an average of 4.1 for dementia caregivers. This led to dementia caregivers providing significantly more assistance. However, the potential psychological impact of caring for a spouse with dementia and other potential factors contributing to these findings also need to be assessed in future research. The authors of this study suggest that chronic stress plays a role in these negative health outcomes associated with caregiving, and that the specific chronic stress factors that differ between dementia and non-dementia caregivers should be examined.

Overall, this research suggests the importance of being aware of the different impacts that types of caregiving can have on the caregiver, so that the needs and risks associated with each type can be taken into account and addressed. In 2012, it was estimated that dementia caregivers spent an additional $9.1 billion on their own medical care due to the stress of caregiving. From a health care and policy perspective, it becomes clear that when implementing care plans for individuals with dementia, attention needs to be paid to both the care recipient and the caregiver.


Dassel KB and Carr DC. Does dementia caregiving accelerate frailty? Findings from the Health and Retirement Study. The Gerontologist. (2014). gnu078 DOI:10.1093/geront/gnu078



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