Regular Research Article
Impact of Caregiver Burden on Adverse Health Outcomes in Community-Dwelling Dependent Older Care Recipients

https://doi.org/10.1097/JGP.0b013e3181e9b98dGet rights and content

Objective

To determine whether caregiver burden is associated with subsequent all-cause mortality or hospitalization among dependent community-dwelling older care recipients.

Methods

A prospective cohort study of 1,067 pairs of community-dwelling 65-year-old or older care recipients and their informal caregivers was conducted. The 1,067 pairs completed the baseline assessment including caregiver burden assessed by the Zarit Burden Interview and a 3-year follow-up for all-cause mortality and hospitalization.

Results

During the 3-year follow-up, 268 recipients died and 455 were admitted to hospitals. The multivariate Cox proportional hazards model revealed that the recipients with caregivers with a baseline ZBI score in the highest quartile were 1.54 and 1.51 times more likely to show increased risks of all-cause mortality and hospitalization, respectively, in comparison with those with caregivers in the lowest quartile after adjustment for potential confounders. The highest quartile of caregiver burden was associated with all-cause mortality and hospitalization within nonusers of respite services including day-care services, home-help services, and nursing-home respite stay services. No apparent association was observed within the users of these services except for day-care services, for which users showed a statistically significant association between the highest quartile and the risk of hospitalization.

Conclusions

Heavy caregiver burden is associated with mortality and hospitalization among community-dwelling dependent older adults, even after adjusting for potential confounders. The reduction of caregiver burden and improvement of caregiver well-being may not only prevent the deterioration of caregiver health but also reduce adverse health outcomes for care recipients.

Section snippets

Study Setting and Cohort Participants

In this study, we employed baseline data on the care recipient and caregiver pairs in the Nagoya Longitudinal Study for Frail Elderly (NLS-FE) and data on the mortality and hospitalization of the care recipients during the 3-year follow-up period. Japan introduced a universal-coverage long-term care insurance (LTCI) program in 2000. Under the LTCI program, each applicant's care levels are determined according to eligibility criteria. Eligibility status is classified into six levels (“needs

RESULTS

The baseline distribution of the sociodemographic characteristics of the care recipients and caregivers according to the quartiles of the ZBI score is shown in Table 1. We used analysis of variance or Pearson χ2 test to evaluate differences among the quartiles of the ZBI score. The bADL score decreased, and the number of community-based services used, the Charlson comorbidity index, and recipient GDS-15 score increased as the level of the ZBI quartile increased. The care recipients whose

DISCUSSION

In the present study, we observed that the recipients with caregivers with a baseline ZBI score in the highest quartile were 1.54 and 1.51 times more likely to show increased risk of all-cause mortality and hospitalization during a 3-year follow-up period, respectively, in comparison with those with caregivers in the lowest. These relationships existed independently of various other risk factors for mortality and hospitalization, including gender, age, number of community-based services used,

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    The authors thank all the patients, caregivers, and the many nurses participating in the study, and the Nagoya City Health Care Service Foundation for Older People for their vigorous cooperation.

    This study was supported by a Grant-in Aid for the Com- prehensive Research on Aging and Health from the Ministry of Health, Labor, and Welfare of Japan and a grant from Mitsui Sumitomo Insurance Welfare Foundation.

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