Fredman Lisa, Cauley Jane A, Satterfield Suzanne, Simonsick Eleanor, Spencer S Melinda, Ayonayon Hilsa N, Harris Tamara B
Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
Arch Intern Med. 2008 Oct 27;168(19):2154-62. doi: 10.1001/archinte.168.19.2154.
Although caregivers report more stress than noncaregivers, few studies have found greater health decline in older caregivers. We hypothesized that caregivers may be more physically active than noncaregivers, which may protect them from health decline.
The sample included 3075 healthy adults from the Health, Aging, and Body Composition (Health ABC) Study. They were aged 70 to 79 years in April 1997 to June 1998 and resided in Memphis, Tennessee, or Pittsburgh, Pennsylvania. Caregivers (680 [22.1%]) were participants who provided regular care or assistance for a child or a disabled or sick adult. Outcomes included all-cause mortality and incident mobility limitation (defined as difficulty walking one-quarter mile or climbing 10 steps on 2 consecutive semiannual contacts) during 8 years. Total physical activity included daily routine, exercise, and caregiving activity.
Overall, 20.6% of caregivers died and 50.9% developed mobility limitations vs 22.0% and 48.9% of noncaregivers, respectively. Associations differed by race and sex. Mortality and mobility limitation rates were 1.5 times higher in white caregivers (eg, among white female caregivers, adjusted hazard ratio for mortality, 1.6; 95% confidence interval, 1.0-2.5) but not for black female caregivers vs noncaregivers (adjusted hazard ratio for mortality, 0.9; 95% confidence interval, 0.5-1.4). Physical activity mediated these associations in most race-sex groups. High-intensity caregivers (ie, caregiving > or =24 hours per week) had elevated rates of decline when adjusted for physical activity but lower rates when not adjusted for activity.
Older white caregivers have poorer health outcomes than black female caregivers. Physical activity appears to mask the adverse effects of high-intensity caregiving in most race-sex groups.
尽管照料者报告的压力比非照料者更大，但很少有研究发现老年照料者的健康状况下降得更严重。我们推测照料者可能比非照料者身体活动更多，这可能使他们免受健康状况下降的影响。
样本包括来自健康、衰老和身体成分（Health ABC）研究的3075名健康成年人。他们在1997年4月至1998年6月期间年龄在70至79岁，居住在田纳西州孟菲斯或宾夕法尼亚州匹兹堡。照料者（680人[22.1%]）是为儿童或残疾或患病成年人提供定期照料或帮助的参与者。结局包括8年间的全因死亡率和新发活动能力受限（定义为在连续两次半年随访中行走四分之一英里困难或爬10级台阶困难）。总身体活动包括日常活动、锻炼和照料活动。
总体而言，20.6%的照料者死亡，50.9%出现活动能力受限，而非照料者的这两个比例分别为22.0%和48.9%。关联因种族和性别而异。白人照料者的死亡率和活动能力受限率是非照料者的1.5倍（例如，在白人女性照料者中，调整后的死亡风险比为1.6；95%置信区间为1.0 - 2.5），但黑人女性照料者与非照料者相比则不然（调整后的死亡风险比为0.9；95%置信区间为0.5 - 1.4）。身体活动在大多数种族 - 性别组中调节了这些关联。高强度照料者（即每周照料≥24小时）在调整身体活动后下降率升高，但未调整活动时下降率较低。
老年白人照料者的健康结局比黑人女性照料者更差。在大多数种族 - 性别组中，身体活动似乎掩盖了高强度照料的不利影响。
