Caregiving, Mortality, and Mobility DeclineThe Health, Aging, and Body Composition (Health ABC) Study

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Abstract
Most studies1 of informal caregiving and health outcomes have been guided by psychosocial stress theories, but this framework may not sufficiently explain the association between caregiving and health decline in older adults. Although studies2,3 have found poorer immune status in caregivers compared with noncaregivers, evidence that caregiving increases disease incidence or mortality has been inconsistent.4 Three studies found that caregivers to an ill or disabled spouse had elevated rates of all-cause mortality5,6 and fatal and nonfatal coronary heart disease (CHD).7 These associations, however, were limited to spousal caregivers who were stressed by caregiving activities6 and women who performed caregiving tasks for 9 or more hours per week.7 In contrast, among women caregivers, stress did not increase the rate of CHD, and caregivers to a friend or nonspouse relative had lower rates of CHD than noncaregivers.7 These inconsistent results suggest the need to examine factors that may influence the association between caregiving and health decline in older adults, particularly race, sex, and the overall level of physical activity of caregivers and noncaregivers.