Caregiving intensity and health impacts: Magnification of effects by income and employment status

In 2009, there were over 60 million unpaid, informal caregivers providing invaluable care to older adults in the US. It is well-known that informal caregiving by family members to older adults has profound benefits to both the health care system and to society. However, informal caregiving has numerous negative impacts on the health of the caregiver, especially in caregivers who provide more extensive care, often precipitated by employment and family-related stress. Building on recent research, the purpose of this study is to determine, among informal caregivers, how caregiving intensity, as measured by hours caregiving per week and an index of specific functions involved in caregiving, is associated with health outcomes, including general health, preventive health behaviors, and nutrition in a large, nationally representative sample of adults. This study then examines how these associations are modified by income and employment. We abstracted over 7,000 caregiver records from the 2009 and 2010 Behavioral Risk Factor Surveillance System who were administered the Caregiver Module. Using generalized linear models to model three representative outcomes, overall health status, exercise status, fruit and vegetable consumption, we found general associations between caregiving intensity and each of the outcomes, and stronger associations between outcomes and caregiving intensity in lower income individuals and for those employed full-time. We observed what could be described as a threshold effect of income, unique to each outcome. The findings of this study could be used to target high-risk informal caregivers for programs and services to mitigate the harmful health effects of informal caregiving.