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By Victoria R. Marino and William E. Haley, PhD (The School of Aging Studies at the University of South Florida)
Many people have heard that being a family caregiver is extremely stressful and increases the risk for poor health and even higher mortality. But this isn’t the whole story. Recent research suggests that caregiving has stresses, yes, but it has benefits for the caregiver too.
Who are informal caregivers?
Our population is aging, and informal caregivers are the primary source of support and care for older adults with disabilities living in our communities. An informal caregiver is any ordinary person, like you and me, who provides assistance to someone else at no cost. Usually it is family members, spouses, and adult daughters especially, who take on the informal caregiving role.
What do informal caregivers do?
Many older adults living in the community rely on these family caregivers to provide the assistance that they would otherwise receive in an institutional setting. Family caregivers can help with activities of daily living (ADL) like eating, bathing, dressing, and moving around, as well as instrumental activities of daily living (IADL) like shopping, managing medication, and preparing meals. Caregivers can help with many other things as well, such as contributing to treatment planning and advocating on the behalf of the older adult.
Many older adults prefer to continue living in their own homes and communities as they age, and the assistance that caregivers provide helps make this possible by avoiding or delaying nursing home placement. By providing care at no cost, family caregivers save older adults, as well as society, millions of dollars that would otherwise be spent annually on formal care in assisted living facilities, nursing homes, and professional home health care services.
Does caregiving harm your health?
Unfortunately, caregiving has been overwhelmingly portrayed as so detrimental to the physical and emotional health of the caregiver that it can lead to premature death. This is in part because most research has focused on the caregivers psychologists most commonly see, that is, individuals who are already seeking clinical help and are therefore likely to be more distressed than caregivers in general. Many of these studies have found poorer mental and physical health among caregivers than noncaregivers, but studies with more representative samples of caregivers and noncaregivers have found smaller negative effects (Pinquart & Sörensen, 2003). Although one widely cited study did find higher levels of mortality among spouse caregivers who reported caregiving strain compared with spouses of nondisabled partners (Schulz & Beach, 1999), five later studies actually found the opposite effect—caregivers live LONGER than noncaregivers (Roth, Fredman, & Haley, 2015). What explains these very different results? Caregiving can be very stressful, but the greatest stress is most common among caregivers for older adults with particularly burdensome chronic diseases, caregivers with competing work demands, or caregivers who lack support. These stressors do not characterize every caregiving experience.
In fact, one national caregiver survey by the National Opinion Research Center found that 83% of caregivers said that caregiving was a positive experience. Roth and colleagues (2009) found that 33% of caregivers reported “no strain” and only 17% of caregivers reported “a lot of strain.” In other words, many caregivers may not be under as much strain as previously thought, and many caregivers experience both strain and positive aspects of caregiving (Beach et al., 2000).
What are the positive aspects of caregiving?
We know that caregiving can benefit caregivers in a number of ways. Five recent studies showed that caregiving was linked to greater longevity (Roth, Fredman, & Haley, 2015). In another study, among elderly female caregivers of people with osteoporotic fractures, those who provided more assistance with ADLs showed better physical performance and slower rates of physical decline (measured by walking pace, grip strength, and chair-stand speed) than noncaregivers and those who provided less assistance with ADLs (Fredman et al., 2009). This increased physical activity among caregivers providing high levels of assistance may have actually protected them against physical decline. These women may not have experienced the benefits of increased physical activity if not for their caregiving experience. While caregiving can be stressful, it can also keep caregivers active, motivate them to care for their own health, and give them a purpose in life.
Caregiving may also lead to better attitudes towards oneself and one’s life. Several studies have found that over 90% of caregivers reported a greater appreciation for life because of their caregiving experience. These caregivers said they felt needed, appreciated, and important. They also reported that caregiving had helped them strengthen relationships with others, develop a more positive attitude towards life, and learn a new skill.
What makes the caregiving experience positive?
Although caregiving is a demanding role, caregivers can take care of their own well-being by using the psychological and social resources available to them. Vitaliano and his colleagues (2003) suggested that distress is determined by exposure to stressors and vulnerability, in proportion to the psychological and social resources of the individual. Psychological resources can be any internal resource that you rely on in stressful situations, such as being able to see benefits, your problem solving skills, and spirituality. Social resources include support from family and friends, caregiver support groups, and communities such as churches. The more socially engaged we are, the more resilient we may be. We laugh more, we experience more positive feelings and emotions. In the past some have seen this as a form of denial, but more recently we have begun to see these strategies as positive ways to reduce stress, even after particularly aversive events such as the death of a spouse (Bonanno, 2004). Reframing the caregiving experience by finding meaning and benefits in the role can help caregivers see caregiving as a more positive experience. Armed with these internal and external resources, and with the knowledge that they are stronger than they realized, caregivers can better cope with the stressors of the caregiving experience.
Why does this matter?
For a while we have seen the caregiving experience as almost entirely a time of chronic stress and strain, but this is not the whole picture. There are positive benefits too, such as the physical benefits that come from increased physical activity and the psychological benefits from giving care to a loved one. Seeing the benefits, relying on psychological and social resources, and reappraising the caregiving experience are all ways to make the caregiving experience more positive. We need to rethink how we portray the caregiving role – yes, it can be stressful, but assuming the role of a caregiver does not guarantee physical or emotional harm. Promoting the positive aspects of caregiving can help ensure that people are not deterred from what could be a highly rewarding and beneficial experience and that we continue to meet the care needs of the aging population.
To learn more about caregiving and available resources see the APA Family Caregivers Briefcase.
References
Beach, S. R., Schulz, R., Yee, J. L., & Jackson, S. (2000). Negative and positive health effects of caring for a disabled spouse: Longitudinal findings from the caregiver health effects study. Psychology and Aging, 15, 259–271.
Bonanno, G. (2004). Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? American Psychologist, 59(1), 20-28.
Fredman, L., Doros, G., Ensrud, K. E., Hochberg, M. C., & Cauley, J. A. (2009) Caregiving intensity and change in physical functioning over a 2-year period: Results of the caregiver-study of osteoporotic fractures. American Journal of Epidemiology, 170(2), 203-210.
National Opinion Research Center. (2014, May). Long term care in America: Expectations and realities. Retrieved from http://www. longtermcarepoll.org/PDFs/LTC%202014/AP-NORC-Long- Term%20Care%20in%20America_FINAL%20WEB.pdf
Pinquart, M., & Sörensen, S. (2003). Differences between caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18(2), 250-267.
Roth, D. L., Perkins, M., Wadley, V. G., Temple, E. M., & Haley, W. E. (2009). Family caregiving and emotional strain: Associations with quality of life in a large national sample of middle-aged and older adults. Quality of Life Research, 18(6), 679–688.
Roth, D. L., Fredman, L., & Haley, W. E. (2015). Informal caregiving and its impact on health: A reappraisal from population-based studies. The Gerontologist, 55, 309-319.
Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: The Caregiver Health Effects Study. Journal of the American Medical Association, 282, 2215–2219.
Vitaliano, P. P., Zhang, J., & Scanlon, J. M. (2003). Is caregiving hazardous to one’s health? A meta-analysis. Psychological Bulletin, 129(6), 946-972.
Biographies
Victoria R. Marino is an undergraduate student at the University of South Florida expecting to graduate in May 2016 with a BA in Gerontology and a minor in Behavioral Healthcare. She has received the Wiley P. Mangum Scholarship for her academic performance in Gerontology as well as the Mom’s Project Scholarship for her undergraduate research in positive aging, and aims to pursue a PhD in Aging Studies.
William E. Haley, PhD is a clinical psychologist and Professor in the School of Aging Studies at the University of South Florida. He has studied family caregiving for over 30 years, and has served as President of APA Division 20 (Adult Development and Aging) and the APA Society of Clinical Geropsychology (Division 12, Section II).
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