Mortality and hospitalization among older caregivers: Results from the Atherosclerosis Risk in Communities Study

Background Few studies have comprehensively examined health outcomes among older caregivers. We aimed to describe older caregivers and characterize risks for mortality and hospitalization compared to non-caregivers. Methods Caregiving status and characteristics were determined for Atherosclerosis Risk in Communities (ARIC) Study participants via a one-time telephone assessment in 2015. All-cause mortality was identified from active surveillance, state records, and linkage to the National Death Index through December 31, 2021. Hospitalizations were identified from active cohort surveillance. Cox proportional hazard models assessed risks of mortality and hospitalization. Results Among 5,239 ARIC participants [mean age: 75.4 (SD 5.1) years; female: 60.0%; Black: 18.9%], 427 (8.2%) reported caregiving. Caregivers were generally female and younger as compared to non-caregivers. Most caregivers provided care for their spouse (55.0%) and 28.3% reported spending >40 hours/week on caregiving activities. Caregivers had modestly better cognitive scores but were similar to non-caregivers in the number of comorbidities and self-rated health. During a mean 5.4 (SD 1.3) years of follow-up, caregivers had a lower risk of mortality than non-caregivers (18.7% vs. 23.8%), although not statistically significant in fully adjusted time-to-event models (hazard ratio [HR]=0.84; 95%CI:0.67-1.06). Caregivers and non-caregivers had similar risk of hospitalization (63.5% vs. 64.9%; HR = 1.00; 95%CI:0.89-1.14). Conclusions Older caregivers provide substantial care while facing their own health challenges. Despite similar baseline comorbidity burdens as non-caregivers, caregivers had a lower risk of all-cause mortality over the 6 years of follow-up. Future studies should examine the potential protective factors of caregiving in older age to inform caregiver support initiatives for older adults providing care.