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Patterns and Health Effects of Caring for People With Dementia

The Impact of Changing Cognitive and Residential Status¹

Correspondence: Ian McDowell, Department of Epidemiology & Community Medicine, University of Ottawa, 451 Smyth Rd., Ottawa, Ontario K1H 8M5, Canada. E-mail: mcdowell{at}uottawa.ca.

Decision Editor: Laurence G. Branch, PhD

Purpose: To link changes over 5 years in the health, vital and residential status of very elderly people to changes in their family caregivers' health. Design and Methods:Canadian population-based, longitudinal study including community and institutional residents. From interviews and clinical examinations, 948 people (mean age = 86 years) were classified as demented, frail, or healthy at two points in time. Caregivers reported on the care they provided and their health outcomes. Results: Diagnostic and residential groups of care recipients differed significantly in their level of activity of daily living/instrumental activity of daily living disability (range = 0.2 problems for the healthy group, 10–12 in the dementia groups) and in the amount of assistance received; caregiver burden scores were higher for people with dementia in the community than for those in institutions (p < .001). However, these differences did not translate directly into contrasts in caregiver health. Caregivers of healthy elders reported fewer health problems than did caregivers for people with dementia or frailty, but the latter groups did not differ significantly. Death of the care recipient and admission to institutional care did not have a consistent impact on caregiver health. Implications: The relationship between caregiver load and health outcomes is complex and dynamic; treatments that slow the progression of dementia will not necessarily relieve caregiver strain.

Key Words: Alzheimer's disease • Caregiver • Home care • Epidemiology • Canada

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