Title Living Longer but Unhealthier? Spouse Caregivers' Health and Mortality in the US (2004-2014)

This longitudinal population-based study addressed the paradox of poorer health and lower mortality risk among spouse caregivers by proposing and examining the "living- longer- but- unhealthier" hypothesis. Consistent with the stress-buffering effect of caregiving, this hypothesis proposes that the survival advantages of caregiving can be accompanied by a higher prevalence of poorer health. A caregiving mortality advantage might be accompanied by poorer health because caregiving can have a buffering effect by providing prosocial protective effects against stress. The present study sought to better elucidate this paradox by hypothesizing that caregiving intensity may buffer the impact of the positive aspects of spousal caregiving on their mortality such that the mortality advantage does not emerge among spouses with more demanding caregiving duties. This study utilized the Bayesian multistate life table technique to examine the "living- longer- but- unhealthier" hypothesis by estimating total life expectancy (TLE), healthy life expectancy (HLE), and the proportion of remaining life to be spent healthy (PLE) among spouse caregivers with low intense caregiving duties, those with more demanding caregiving duties and noncaregiver peers. This study used six waves of the Health and Retirement Study (HRS) from 2004 to 2014. In general, the analyses revealed partial support for the "living- longer- but- unhealthier" hypothesis for the subset of spouse caregivers who provided relatively less intense caregiving duties (operationalized as less than 14 hours of care per week). That is, spouse caregivers with less intense caregiving duties could expect to live longer and healthier than married noncaregivers. In contrast, spouse caregivers with more intense caregiving responsibilities tended to experience relatively similar total and healthy life expectancy when compared to married noncaregivers. This suggests that low-intensity, but not high-intensity spousal caregiving had protective effects. More time-intensive spousal caregiving may threaten caregivers' health and mortality advantages by increasing caregivers' anxiety, depression and psychological distress through a complex process involving objective, but more importantly, subjective aspects of the caregiving process. Also, more time-intensive spousal caregiving may ebb the potentially positive aspects of caregiving due to its emotionally taxing nature. For example, high-intensity caregivers are more likely to make treatment decisions for the family members for whom they care. The mechanisms and processes whereby the primary stressor of caregiving intensity may erode the potentially positive aspects of caregiving were discussed through concepts suggested in the stress press model (i.e., background and context, job-related stress, religiosity).