Many older adults find themselves serving as unpaid or informal caregivers to spouses or family members, and a growing body of research has shown how stress associated with caregiving can lead to negative health outcomes for these caregivers. A recent article on caregiving and stress in older adults examines caregivers’ levels of stress compared to noncaregivers, compares the stress levels of high- and low-intensity caregivers, and examines how transitions in caregiving status may affect stress levels.
This study followed the stress levels of 992 women with an average age of 82 at the start of the study. Researchers classified participants into three groups: noncaregivers, low-intensity caregivers, and high-intensity caregivers. Low-intensity caregivers were those who performed assistance with fewer than two ADL (activities of daily living) tasks and fewer than six IADL (instrumental activities of daily living) tasks. High-intensity caregivers were those who assisted with either two or more ADL tasks or six or more IADL tasks. As they followed these women over a nine-year period, the researchers also looked at how transitions from one category of caregiving to another impacted their stress levels.
Not surprisingly, those individuals who maintained the highest caregiving load from the start to the end of the study reported having the highest levels of stress, with an average score of 18.97 on the stress scale used in the study. Those caregivers providing a lower level of caregiving had a score of 16.47; this compares to an average stress score of 15.73 for noncaregivers.
When the researchers examined the impact of transitions in caregiving status, they found that those individuals who transitioned from being a lower-intensity caregiver into a high level of caregiving had the highest average stress score reported in the study of 19.41. This was higher than the 17.13 average stress score seen in those individuals who went from being a noncaregiver to a high-intensity caregiver. This comparison suggests that the stress of providing high intensity care may increase over time.
When caregivers transitioned to becoming noncaregivers, their stress levels decreased to scores similar to those who had been noncaregivers throughout the study; this latter group had the lowest average reported stress scores at 14.64, followed by those who transitioned from being a high-intensity caregiver to a noncaregiver, with an average score of 14.85. Those who transitioned from low-intensity caregiving to being a noncaregiver had an average score of 15.77. Interestingly, when a high-intensity caregiver transitioned to the reduced role of being a low-intensity caregiver, their levels of stress did not return to the average level for a low-intensity caregiver, instead only coming down to an average score of 17.50.
The study also examined how caring for individuals with different medical conditions impacted the likelihood of transitioning from low-intensity to high-intensity caregiving. Those caregivers who provided care to someone with a history of stroke, someone with memory problems, or who lived with the care recipient had significantly higher odds of becoming high-intensity caregivers.
These findings support previous recommendations that greater attention needs to be paid to the needs of caregivers, so that the negative health effects of stress can be reduced or avoided. The authors of this study conclude that “Considering the adverse health outcomes of chronic stress, our results emphasize the importance of directing stress reduction interventions to high-intensity caregivers.” Moreover, this study also suggests that the types of caregiving transitions being made need to be taken into account when estimating caregiver stress. In particular, it should not be assumed that those high-intensity caregivers who remain caregivers but with a reduced caregiving load will return to a stress level associated with other low-intensity caregivers, and there should be follow-up with lower-intensity caregivers so that they can be provided with the additional psychological support needed if they transition to providing a higher level of care.
Lyons JG, Cauley JA, and Fredman L. The effect of transitions in caregiving status and intensity on perceived stress among 992 female caregivers and noncaregivers. Journals of Gerontology Series A: Biological Sciences (2015); 70(8): 1018–1023.