Impact of informal caregiving on older adults' physical and mental health in low-income and middle-income countries: a cross-sectional, secondary analysis based on the WHO's Study on global AGEing and adult health (SAGE)

Sylvie D Lambert, Steven J Bowe, Patricia M Livingston, Leila Heckel, Selina Cook, Paul Kowal, Liliana Orellana, Sylvie D Lambert, Steven J Bowe, Patricia M Livingston, Leila Heckel, Selina Cook, Paul Kowal, Liliana Orellana

Abstract

Objectives: A high proportion of care stemming from chronic disease or disability in low-income and middle-income countries is provided by informal caregivers. The goal of this study was to determine the level of burden experienced by these caregivers, explore associated factors and assess whether caregivers' and non-caregivers' health differed.

Design and setting: This cross-sectional study was a secondary analysis of data on caregivers' burden, health and health risk factors in Ghana, India and the Russian Federation collected as part of the WHO's Study on global AGEing and adult health (SAGE) Wave 1.

Participants: Caregivers in Ghana (n=143), India (n=490) and Russia (n=270) completed the measures.

Outcome measures: Factors associated (ie, demographics and caregiving profile variables) with burden were explored among caregivers. Then, quality of life (QOL), perceived stress, depression, self-rated health (SRH) and health risk factors were compared between caregivers and matched non-caregivers (1:2).

Results: The largest caregiving subgroups were spouses and adult children. Caregivers mostly cared for one person and provided financial, social/emotional and/or physical support, but received little support themselves. Burden level ranged from 17.37 to 20.03. Variables associated with burden were mostly country-specific; however, some commonality for wealth, type of care and caregiving duration was noted. Caregivers with a moderate or high level of burden reported lower QOL and higher perceived stress than those experiencing low burden. Caregivers reported lower QOL and SRH than non-caregivers.

Conclusion: Given the lack of support received and consequences of the burden endured by caregivers, policy and programme initiatives are needed to ensure that caregivers in low- and middle-income countries can fulfil their role without compromising their own health.

Keywords: ageing; caregiver; chronic disease; international health; psychosocial factors.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Comparison of health-related outcomes between caregivers and non-caregivers (matched controls) by country, SAGE Wave 1 (2007/10). ES, effect size; SAGE, Study on global AGEing and adult health.
Figure 2
Figure 2
Comparison of health risk factors between caregivers and non-caregivers (matched controls) by country, SAGE Wave 1 (2007/10). ES, effect size; SAGE, Study on global AGEing and adult health.

References

    1. United Nations Department of Economic and Social Affairs - Population Division. World population ageing 2015. ST/ESA/SER.A/390.
    1. Prince MJ, Wu F, Guo Y, et al. . The burden of disease in older people and implications for health policy and practice. Lancet 2015;385:549–62. 10.1016/S0140-6736(14)61347-7
    1. Knickman JR, Snell EK. The 2030 problem: caring for aging baby boomers. Health Serv Res 2002;37:849–84. 10.1034/j.1600-0560.2002.56.x
    1. Institute of Medicine (IOM). Retooling for an Aging America: Building the Health Care Workforce, 2008.
    1. Caregiver assessment: principles, guidelines and strategies for change Report from a national consensus development conference. San Francisco, CA: Family Caregiver Alliance, 2006.
    1. Trujillo AJ, Mroz TA, Piras C, et al. . Caregiving and elderly health in Mexico. Int J Health Serv 2012;42:667–94. 10.2190/HS.42.4.f
    1. Lambert SD, Girgis A, Levesque J. The impact of cancer and chronic conditions on caregivers and family members : Koczwara B, Cancer and chronic conditions: addressing the problem of multimorbidity in cancer patients and survivors. springer Science+Business Media, 2016.
    1. Kim Y, Schulz R. Family caregivers' strains: comparative analysis of cancer caregiving with dementia, diabetes, and frail elderly caregiving. J Aging Health 2008;20:483–503. 10.1177/0898264308317533
    1. Wolff JL. Family matters in health care delivery. JAMA 2012;308:1529–30. 10.1001/jama.2012.13366
    1. Cepoiu-Martin M, Tam-Tham H, Patten S, et al. . Predictors of long-term care placement in persons with dementia: a systematic review and meta-analysis. Int J Geriatr Psychiatry 2016;31:1151–71. 10.1002/gps.4449
    1. Stenberg U, Ruland CM, Miaskowski C. Review of the literature on the effects of caring for a patient with cancer. Psychooncology 2010;19:1013–25. 10.1002/pon.1670
    1. Beesley VL, Price MA, Webb PM. Australian Ovarian Cancer Study Group, Australian Ovarian Cancer Study—Quality of Life Study Investigators. Loss of lifestyle: health behaviour and weight changes after becoming a caregiver of a family member diagnosed with ovarian cancer. Support Care Cancer 2011;19:1949–56. 10.1007/s00520-010-1035-2
    1. Aldrich N. CDC seeks to protect health of family caregivers. National Association of Chronic Disease (CDC), 2011.
    1. Canadian Institutes of Health Research (CIHR). Pan-Canadian vision and strategy for health services and policy research 2014-2019, 2015.
    1. Thrush A, Hyder AA, Hyder A. The neglected burden of caregiving in low- and middle-income countries. Disabil Health J 2014;7:262–72. 10.1016/j.dhjo.2014.01.003
    1. World health Organization. World report on disability, 2011.
    1. Marten R, McIntyre D, Travassos C, et al. . An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). The Lancet 2014;384:2164–71. 10.1016/S0140-6736(14)60075-1
    1. World Health Organization. Secondary Ghana 2017. Ghana:
    1. Canadian Institute for Health Information. National health expenditure trends, 1975 to 2016. Ottawa: ON, 2016.
    1. National Center for Health Statistics. Health, United States, 2015: with special feature on racial and ethnic health disparities, 2016.
    1. Ke X, Saksena P, Holly A. The determinants of health expenditure: a country-level panel data analysis. Geneva: World Health Organization, 2011.
    1. Yip W, Mahal A. The health care systems of China and India: performance and future challenges. Health Aff 2008;27:921–32. 10.1377/hlthaff.27.4.921
    1. Beaglehole R, Epping-Jordan J, Patel V, et al. . Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care. Lancet 2008;372:940–9. 10.1016/S0140-6736(08)61404-X
    1. McIntyre D, Thiede M, Dahlgren G, et al. . What are the economic consequences for households of illness and of paying for health care in low- and middle-income country contexts? Soc Sci Med 2006;62:858–65. 10.1016/j.socscimed.2005.07.001
    1. Kowal P, Chatterji S, Naidoo N, et al. . Data resource profile: the World Health Organization Study on global AGEing and adult health (SAGE). Int J Epidemiol 2012;41:1639–49. 10.1093/ije/dys210
    1. Naidoo N. SAGE Working Paper No. 5. WHO Study on global AGEing and adult health (SAGE) Waves 0 and 1 – Sampling information for China, Ghana, India, Mexico, Russia and South Africa. Geneva: WHO, 2012.
    1. United Nations Educational SaCOU. International Standard Classification of Education (ISCE) 1997, 2006.
    1. Howe LD, Galobardes B, Matijasevich A, et al. . Measuring socio-economic position for epidemiological studies in low- and middle-income countries: a methods of measurement in epidemiology paper. Int J Epidemiol 2012;41:871–86. 10.1093/ije/dys037
    1. Sanuade OA, Boatemaa S. Caregiver profiles and determinants of caregiving burden in Ghana. Public Health 2015;129:941–7. 10.1016/j.puhe.2015.05.016
    1. Schmidt S, Mühlan H, Power M. The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study. Eur J Public Health 2006;16:420–8. 10.1093/eurpub/cki155
    1. da Rocha NS, Power MJ, Bushnell DM, et al. . The EUROHIS-QOL 8-item index: comparative psychometric properties to its parent WHOQOL-BREF. Value Health 2012;15:449–57. 10.1016/j.jval.2011.11.035
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385–96. 10.2307/2136404
    1. Kessler RC, Ustün TB. The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 2004;13:93–121. 10.1002/mpr.168
    1. World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research (DCR-10). Geneva, Switzerland: World Health Organization, 1993.
    1. Kulkarni RS, Shinde RL. Depression and Its Associated Factors in Older Indians: A Study Based on Study of Global Aging and Adult Health (SAGE)-2007. J Aging Health 2015;27:622–49. 10.1177/0898264314556617
    1. Hirve S, Juvekar S, Sambhudas S, et al. . Does self-rated health predict death in adults aged 50 years and above in India? Evidence from a rural population under health and demographic surveillance. Int J Epidemiol 2012;41:1719–27. 10.1093/ije/dys163
    1. World Health Organization. Body mass index - BMI. 2016.
    1. Bull FC, Maslin TS, Armstrong T. Global physical activity questionnaire (GPAQ): nine country reliability and validity study. J Phys Act Health 2009;6:790–804. 10.1123/jpah.6.6.790
    1. American Heart Association. Fruits and Vegetables. 2016.
    1. Health Canada. Canada’s food guide - how much food you need every day. 2007.
    1. Anand A, Roy N. Prevalence and determinants of co-use of alcohol and tobacco among men in working age group (18-59 years) in India. Epidemiol Biostat Public Health 2016;13:e11642.
    1. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–88. 10.1016/0197-2456(86)90046-2
    1. Mwinituo PP, Mill JE. Stigma associated with Ghanaian caregivers of AIDS patients. West J Nurs Res 2006;28:369–82. discussion 83-91 10.1177/0193945906286602
    1. Pharr JR, Dodge Francis C, Terry C, et al. . Culture, caregiving, and health: exploring the influence of culture on family caregiver experiences. ISRN Public Health 2014;2014:1–8. 10.1155/2014/689826
    1. Thara R, Kamath S, Kumar S. Women with schizophrenia and broken marriages–doubly disadvantaged? Part II: family perspective. Int J Soc Psychiatry 2003;49:233–40. 10.1177/00207640030493009
    1. Shibre T, Kebede D, Alem A, et al. . Schizophrenia: illness impact on family members in a traditional society–rural Ethiopia. Soc Psychiatry Psychiatr Epidemiol 2003;38:27–34. 10.1007/s00127-003-0594-7
    1. Pinto RA, Holanda MA, Medeiros MM, et al. . Assessment of the burden of caregiving for patients with chronic obstructive pulmonary disease. Respir Med 2007;101:2402–8. 10.1016/j.rmed.2007.06.001
    1. Yusuf AJ, Nuhu FT. Factors associated with emotional distress among caregivers of patients with schizophrenia in Katsina, Nigeria. Soc Psychiatry Psychiatr Epidemiol 2011;46:11–16. 10.1007/s00127-009-0166-6
    1. Organization WH. Impact of AIDS on older people in Africa: Zimbabwe case study. Geneva, Switzerland: Non-communicable Disease Prevention and Health Promotion, 2002.
    1. Schulz R, Sherwood PR. Physical and mental health effects of family caregiving. Am J Nurs 2008;108(9 Suppl):23–7. 10.1097/01.NAJ.0000336406.45248.4c

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren