Online Program

Informal caregiving to older adults in the "sandwich generation": Modification by race, ethnicity, income, and household size

Tuesday, November 5, 2013

Elizabeth Do, MPH, Virginia Institute of Psychiatric and Behavioral Genetics, Richmond, VA
Monique J. Brown, MPH, Department of Family Medicine and Population Health, Division of Epidemiology, Virginia Commonwealth University School of Medicine, Richmond, VA
Steven A. Cohen, DrPH, MPH, Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, VA
Background Nearly 50 million Americans provide informal care to an older relative or friend. Many are members of the “sandwich generation”, providing care for elderly parents and children simultaneously. Although evidence suggests that the negative health consequences of caregiving are more severe for sandwiched caregivers, little is known about how these associations vary by sociodemographic factors.

Methods We abstracted data from the Behavioral Risk Factor Surveillance System to determine how the association between caregiving and health varies by sociodemographic factors, using ordinal logistic regression with interaction terms and stratification by number of children, income, and race/ethnicity.

Results The association between informal caregiving and health varied by membership in the “sandwich generation,” income, and race/ethnicity. This association was significant among subjects with one (OR = 1.13, 95% CI [1.04, 1.24]) and two or more children (OR = 1.17, 95% CI = 1.09, 1.26]), but not in those without children (OR = 1.01, 95% CI [0.97, 1.05]). Associations were strongest in those earning $50,000-$75,000 annually, but these income-dependent associations varied by race/ethnicity. In Whites with two or more children, the strongest associations between caregiving and health occurred in lower income individuals. These trends were not observed for Whites without children.

Discussion Our findings suggest that the added burden of caregiving for both children and elderly relatives may be impacted both by income and race/ethnicity. These differences should be taken into account when developing culturally appropriate interventions to improve caregiver health and maintain this vital component of the US health care system.

Learning Areas:

Diversity and culture
Occupational health and safety
Planning of health education strategies, interventions, and programs
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
Analyze the role of effect modification of race, ethnicity, income, and number of children in the associations between caregiving and health. Compare informal caregivers of the "Sandwich Generation", who have dual roles as caregivers to older relatives and children, to informal caregivers of older adults alone. Compare and contrast the beneficial and detrimental consequences of informal caregiving by sociodemographic characteristics. Identify socioeconomic groups for targeted interventions to reduce caregiver burden.

Keyword(s): Caregivers, Health Disparities

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an assistant professor at Virginia Commonwealth University and have studied population aging and its implications for seven years. I have downloaded and analyzed the data for this study, as well as co-written the abstract, methods, and results of the analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.