摘要：Objectives. We sought to identify predictors of beginning and ending caregiving. Methods. At baseline and 3-year follow-up, we interviewed 4245 community residents (61.4% Black, 38.4% White, 0.20% other) aged 65 years or older. We used logistic regression to test predictors of beginning caregiving among baseline noncaregivers and of continuing caregiving among baseline caregivers. Results. After control for demographic variables, physically healthier individuals were significantly more likely to become caregivers and to continue caregiving. Mental health had little influence on beginning caregiving, but declining mental heath was associated with continuing caregiving. Conclusions. Maintenance of physical health and function is essential to the ability of older adults to begin and to continue caregiving. Studies that compare the health of current caregivers with that of noncaregivers may substantially underestimate the impact of caregiving on health. Caring for an ill or a disabled family member or friend is an increasingly common experience 1 that may have substantial public health implications. As the US population ages and the burden of chronic disease grows, 2 factors that affect the supply of caregivers are of increasing importance, especially among older adults, who represent a considerable proportion of all caregivers. 3– 8 This is also the age group that is most likely to require care and most vulnerable to the health effects of caregiving. However, few studies have examined whether demographic and health factors influence the process of becoming a caregiver or relinquishing the caregiver role. Longitudinal studies of predominantly older caregivers have found that those who reported more psychological and physical care–related strain experienced greater morbidity 9– 12 and mortality 13 over time. However, most longitudinal studies enrolled people who had already been providing care and therefore these studies cannot distinguish between health status before starting caregiving and changes in health during caregiving. Studies that begin with current caregivers have 2 limitations that may be more pronounced among older adults. First, studies that follow only caregivers cannot provide information on whether health changes occur at rates similar to rates in noncaregivers of the same age. Second, studies that compare current caregivers with noncaregivers may have difficulty identifying an appropriate comparison group if health effects of caregiving have already occurred and may severely underestimate or overestimate the health effects of caregiving. As Baumgarten et al. 9 noted, caregivers with rapidly deteriorating health are more likely than caregivers without health problems to stop caregiving and may be underrepresented in research studies that do not begin observation before the start of care. Three small studies examined changes in caregivers’ mental and physical health before and after caregiving began. 14– 16 Two of the studies found no differential effect of entry into caregiving on mental and physical health over 1 year 15 or on depression over 3 years, 16 and 1 study 14 found increased depression and decreased happiness over 5 years. A large study 17 found that nurses who began caring for a spouse during a 4-year interval (1992–1996) were twice as likely as noncaregivers to experience an increase in depressive and anxious symptoms; the odds of experiencing these symptoms increased with an increasing number of weekly hours of care. These studies provide preliminary data on changes in health after entry into caregiving but do not consider whether caregivers’ physical or mental health is associated with beginning or ending caregiving. To our knowledge, only 1 study 12 has provided data on whether caregivers’ health differs from that of others their age before these caregivers begin to provide care. That study found no difference in baseline measures of depression or self-assessed health between spouses who remained noncaregivers and those who began caregiving. Our study followed a large community population of older adults (61.4% Black, 38.4% White, 0.20% other) and measured health and caregiver status at baseline and 3 years later. This design allowed us to measure demographic and health variables of participants and to determine which non-caregivers subsequently became caregivers. We also followed people who were caregiving at baseline to see if specific demographic and health characteristics contributed to continuation or end of care. Obtaining such information about caregivers before they begin providing care has several potential benefits. The information may provide a more complete understanding of the relationship between caregiving and health; it can inform the choice of appropriate comparison groups for future studies of the health effects of caregiving; and it may provide data to more accurately identify the future pool of older caregivers. In addition, knowledge of factors associated with ending caregiving may permit earlier and more suitable targeting of resources to informal caregivers.
