Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, New York, USA.
Master of Public Health Program, School of Health Professions, Eastern Virginia Medical School, Norfolk, Virginia, USA.
J Am Geriatr Soc. 2024 Jan;72(1):24-36. doi: 10.1111/jgs.18620. Epub 2023 Nov 8.
Caregiving is commonly undertaken by older women. Research is mixed, however, about the impact of prolonged caregiving on their health, well-being, and mortality risk. Using a prospective study design, we examined the association of caregiving with mortality in a cohort of older women.
Participants were 158,987 postmenopausal women aged 50-79 years at enrollment into the Women's Health Initiative (WHI) who provided information on current caregiving status and caregiving frequency at baseline (1993-1998) and follow-up (2004-2005). Mortality was ascertained from baseline through March of 2019. Cox regression with caregiving status defined as a time-varying exposure was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for mortality, adjusting for sociodemographic factors, smoking, and history of diabetes, hypertension, cardiovascular disease (CVD), and cancer. Stratified analyses explored whether age, race-ethnicity, depressive symptoms, frequency of caregiving, optimism, and living status modified the association between caregiver status and mortality.
At baseline, 40.7% of women (mean age 63.3 years) self-identified as caregivers. During a mean 17.5-year follow-up, all-cause mortality (50,526 deaths) was 9% lower (multivariable-adjusted HR = 0.91, 95% CI: 0.89-0.93) in caregivers compared to non-caregivers. The inverse association between caregiving and all-cause mortality did not differ according to caregiving frequency or when stratified by age, race-ethnicity, depressive symptoms, optimism, or living status (interaction p > 0.05, all). Caregiving was inversely associated with CVD and cancer mortality.
Among postmenopausal women residing across the United States, caregiving was associated with lower mortality. Studies detailing the type and amount of caregiving are needed to further determine its impact on older women.
照顾者通常是老年女性。然而，关于长期照顾对她们的健康、幸福和死亡风险的影响，研究结果不一。本研究采用前瞻性研究设计，考察了照顾者与队列中老年女性死亡的相关性。
参与者为 158987 名 50-79 岁的绝经后女性，她们在参加妇女健康倡议（WHI）时报告了当前的照顾者状况和基线（1993-1998 年）及随访（2004-2005 年）时的照顾频率。通过基线至 2019 年 3 月确定死亡情况。使用定义为随时间变化的暴露因素的 Cox 回归估计死亡率的风险比（HR）和 95%置信区间（CI），调整了社会人口因素、吸烟和糖尿病、高血压、心血管疾病（CVD）和癌症的病史。分层分析探讨了年龄、种族、抑郁症状、照顾频率、乐观程度和生活状况是否改变了照顾者状况与死亡率之间的关系。
基线时，40.7%的女性（平均年龄 63.3 岁）自认为是照顾者。在平均 17.5 年的随访期间，全因死亡率（50526 例死亡）在照顾者中降低 9%（多变量调整 HR=0.91，95%CI：0.89-0.93），与非照顾者相比。照顾与全因死亡率之间的反比关系不因照顾频率而不同，也不因年龄、种族、抑郁症状、乐观程度或生活状况而分层（交互作用 p>0.05，均）。照顾与 CVD 和癌症死亡率呈反比关系。
在美国各地居住的绝经后妇女中，照顾者的死亡率较低。需要进一步研究详细说明照顾的类型和数量，以进一步确定其对老年妇女的影响。
