Matina Sostina S, Manderson Lenore, Gómez-Olivé F Xavier, Berkman Lisa, Harling Guy
MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
medRxiv. 2024 Nov 21:2024.10.16.24315588. doi: 10.1101/2024.10.16.24315588.
Informal caregivers play an indispensable role in and are often the sole source of care for older adults in low and middle-income settings worldwide. Intensive informal care predicts mortality and morbidity among caregivers in higher-income settings. However, there is limited evidence from poorer settings, including Africa countries, where caregiving is shared widely, including across generations. We therefore investigated caregivers' health status in rural South Africa.
We conducted quantitative interviews with all household members and all non-household caregivers aged ≥12 (n=1012) of 106 older adults in rural Mpumalanga, South Africa. We used multivariable regression with care-recipient random intercepts to assess the relationships between four caregiving characteristics and both self-reported chronic conditions and self-reported health status, considering how caregiver age moderated each association.
Over half of all caregivers reported at least one chronic health condition, despite half being aged under 40. Caregivers self-reporting the worst health status provided high hours of care. However, caregivers' health status was not significantly associated with weekly care quantity or history of caring. Those aged ≥40 who reported being a main caregiver had 52% increased odds of reporting poorer health compared to other same-aged carers (95% confidence interval: 0.99, 2.35), while having more chronic conditions was associated with being expected to act as a sole caregiver more often among caregivers aged ≤39.
Greater caring responsibilities for older adults were not consistently associated with caregivers' health in a setting where poor health is common, and caregiving is spread widely. Longitudinal data is necessary to unpack possible explanations of these findings, and to determine whether intensive caregiving speeds downward health trajectories for carers.
在全球中低收入环境中，非正式照料者对老年人而言发挥着不可或缺的作用，且往往是其唯一的照料来源。在高收入环境中，高强度的非正式照料可预测照料者的死亡率和发病率。然而，在包括非洲国家在内的较贫困环境中，相关证据有限，在这些地方，照料责任广泛分担，包括代际之间。因此，我们对南非农村地区照料者的健康状况进行了调查。
我们对南非姆普马兰加农村地区106名老年人的所有家庭成员以及所有年龄≥12岁的非家庭照料者（n = 1012）进行了定量访谈。我们使用带有受照料者随机截距的多变量回归，来评估四种照料特征与自我报告的慢性病及自我报告的健康状况之间的关系，同时考虑照料者年龄如何调节每种关联。
尽管一半的照料者年龄在40岁以下，但超过一半的照料者报告至少有一种慢性健康状况。自我报告健康状况最差的照料者提供的照料时间较长。然而，照料者的健康状况与每周照料量或照料史并无显著关联。与其他同龄照料者相比，报告自己是主要照料者的40岁及以上人群报告健康较差的几率增加了52%（95%置信区间：0.99，2.35），而在39岁及以下的照料者中，患有更多慢性病与更常被期望担任唯一照料者相关。
在健康状况普遍较差且照料责任广泛分担的环境中，对老年人承担更大的照料责任与照料者的健康之间并无始终如一的关联。需要纵向数据来剖析这些发现的可能解释，并确定高强度照料是否会加速照料者的健康恶化轨迹。
