Providing personal informal care to older European adults: Should we care about the caregivers' health?
Introduction
The population in Europe is ageing. In the European Union, the proportion of people aged 65 years and older has grown from approximately 14.1% in 1992 to 16.0% in 2002 and 17.8% in 2012. This proportion is likely to further increase during the coming decades (Eurostat, 2013). When the proportion of elderly people in the population increases, the demand for health care is expected to do so as well. To meet the growing health care demands, governments rely increasingly on the provision of informal care by family, neighbours and friends. In 2008, around 35% of the adult population of the Netherlands provided informal care of which 23% provided care for more than three months (CBS, 2013, Oudijk et al., 2010). In 2009, about 4 million of the 65 million people in France provided informal care compared to 4.3 million people providing formal care, and in Italy around two-thirds of the care needed by older people is provided by their relatives (Triantafillou et al., 2010).
Informal care is defined as “care given to dependent persons, such as the sick and elderly, outside the framework of organized, paid, professional work”(Oxford Dictionary of Sociology, 2009), and can involve several types of help, such as personal care, practical or instrumental care, or supervision. Providing personal care is often more physically and mentally demanding for the caregiver than other types of informal care, and might even have a negative influence on the caregivers' health (Broe et al., 1999). So far, most studies investigating the provision of informal personal care in relation to the carer's health have been conducted in specific care situations, such as caring for partners with dementia (Beaudreau et al., 2008, McCurry et al., 2007) or for patients with schizophrenia (Ukpong, 2012). These studies indicate that providing informal personal care may lead to sleep inefficiency (Beaudreau et al., 2008, McCurry et al., 2007), emotional distress (Beaudreau et al., 2008, McCurry et al., 2007, Ukpong, 2012) and depression (Beaudreau et al., 2008, McCurry et al., 2007). Additionally, stress derived from caregiving could be a risk factor for mortality through the development of coronary heart disease (Vitaliano et al., 2002). Providing personal care to one's spouse for over 14h per week has been indicated as a significant predictor of hypertension (Capistrant et al., 2012b) and may increase the risk of cardiovascular diseases with 35% (Capistrant et al., 2012a). Furthermore, when spending a considerable amount of time to caring, caregivers have less time to exercise and will therefore benefit not as much from the favourable influences of physical exercise on both physical and mental health (Bauman, 2004, Burton et al., 1997, U.S. Department of Health and Human Services, 1996, Schulz et al., 1997, Warburton et al., 2006).
Because of the potential negative influence of providing informal care on the caregiver's health and the potential increase in informal health care demand, it is important to have more insight in the relationship between caregiving and health from the caregiver's perspective. Therefore, this study investigated the longitudinal association between the provision of informal personal care and the caregiver's self-rated, mental and physical health in an older adult population. In addition, potential moderators of this association were studied in order to gain insight into potential mechanisms and vulnerable groups.
Section snippets
Study design
A prospective study was conducted with data of the longitudinal cohort of the Survey of Health, Ageing and Retirement in Europe (SHARE) (Börsch-Supan et al., 2005, Börsch-Supan et al., 2013). In SHARE, information of non-institutionalised adults aged 50 years and older and their spouses were collected using computer-assisted personal interviews. The first wave included 31,115 participants across twelve countries, with a total household response of 61.6% (SHARE-Project, 2012). In this study, only
Results
At baseline, gender was almost evenly distributed (Table 1). Most participants were between 50 and 69 years of age, were married or living together in a household and were mostly low educated and retired. About 12.7% stated to give personal care, which increased to 15.3% in the second wave. Poor self-rated health was reported by 23.5%, while EURO-D scores indicating depression were reported by 21.7% and approximately one-third (33.6%) reported poor physical health (Table 2). There were moderate,
Discussion
This study showed that providing informal personal care was significantly associated with poor mental health and poor physical health over a follow-up period of eight years, even after taking into account the respondents' health status at the previous waves and adjusting for socio-demographic variables such as age, gender, educational level, country of residence, and mutual adjustments for other health outcomes. Self-rated health was only significantly associated with the provision of personal
Conclusion
This study shows that providing informal personal care could have a detrimental influence on the caregivers' health. Although policy makers may be tempted or forced to rely increasingly on informal care because of increasing health care demands, caution is warranted. This study indicates that relying on informal personal care provision may not only relieve the burden on the health care system but that it may even contribute to the growth of care demand. Instead, it might be valuable that health
Funding
This paper uses data from SHARE wave 4 release 1.1.1, as of March 28th 2013 or SHARE wave 1 and 2 release 2.5.0, as of May 24th 2011 or SHARELIFE release 1, as of November 24th 2010. The SHARE data collection has been primarily funded by the European Commission through the 5th Framework Programme (project QLK6-CT-2001-00360 in the thematic programme Quality of Life), through the 6th Framework Programme (projects SHARE-I3, RII-CT-2006-062193, COMPARE, CIT5-CT-2005-028857, and SHARELIFE,
Contributorship
LH carried out the data-analyses and drafted the manuscript. SC and MAB developed the research questions, supervised the data-analysis and critically commented on draft versions of the manuscript. SJWR developed the research questions and critically commented on draft versions of the manuscript. CRM and AB provided critical comments on the analysis and the manuscript. All authors read and approved the final manuscript.
Conflict of interest statement
The authors declare that there is no conflict of interest.
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