Mental and physical health of US rural/urban caregivers of persons with dementia.

Purpose: Increased dependence on caregiving and limited access to healthcare services in rural US communities may contribute to worse mental and physical health in rural caregivers of persons with dementia (PWD) relative to their urban counterparts. We assessed the association between rural/urban residence and mental and physical health among US caregivers of PWD.

Methods: Using 2020-2022 Behavioral Risk Factor Surveillance System data, we identified caregivers of PWD from rural (n = 2311) and urban (n = 15094) areas. Mental health outcome was operationalized as poor mental health days (PMHD); categorized as 0, 1-13, and ≥14 PMHD in previous month. Poor physical health (PPHD) was operationalized in the same manner. Covariates included socio-demographic and caregiving factors. Four sets of unadjusted and adjusted survey-weighted multinomial logistic models (reference: 0 days) were created for PMHD and PPHD.

Results: Approximately, 25.7% of rural and 20.8% of urban caregivers reported ≥14 PMHD while 25% of rural and 10% of urban caregivers reported ≥14 PPHD. Prior to adjustment, rural caregivers had lower odds (0.59, 95% CI: 0.34-1.05) of 1-13 vs. 0 PMHD but higher odds (1.13, 95% CI: 0.55-2.30) of 14 + vs 0 PMHD compared to urban caregivers with neither association being statistically significant. In adjusted models, the association for 1-13 vs 0 PMHD became significant, while rural residence became associated with lower, non-significant odds of 14 + vs. 0 PMHD. For physical health, rural caregivers had lower odds (0.86, 95% CI: 0.53-1.41) of 1-13 vs 0 PPHD but higher odds (2.57, 95% CI: 1.00-6.63) of 14 + vs 0 PPHD in unadjusted models with neither result being significant. After adjustment, the associations for 1-13 vs. 0 PPHD were attenuated and remained non-significant, while rural caregivers had significantly higher odds of 14 + vs 0 PPHD, consistent with unadjusted results.

Conclusions: Rural caregivers of PWD are less likely to experience short-term mental health problems compared to their urban counterparts. However, they face similar levels of experiencing PMHD. Additionally, rural caregivers of PWD are more likely to endure more PPHD than urban caregivers. Considering the extensive day-to-day responsibilities that caregivers of PWD carry and the ongoing need for their support, it is crucial to enhance long-term mental health resources for both rural and urban caregivers. Furthermore, targeted initiatives to support the long-term physical health of rural caregivers are equally essential.