Determinants of spouse/partner informal caregiving and its impacts on informal caregivers' physical, psychological health and economic well-being: evidence from the health and retirement study

State policies have recently trended towards encouraging home and community-based services (HCBS) over institutionalized care because of the relative higher costs and lower quality in institutions. Studies suggest, however, that this cost-saving strategy has hidden individual and societal costs that may only surface when the informal caregivers grow older themselves. For example, intense caregiving can negatively impact the caregivers' long-term physical, mental/psychological, and economic well-being. However, the determinants of caregiving duration and their impacts on caregivers' later physical health and psychological health and economic well-being have never been examined holistically. Prior studies touching on these issues have narrowly emphasized the influence of either the elderly recipients' or caregivers' characteristics on informal caregiving and caregivers' outcomes. To address these limitations, this study examined the following questions: Q1) What are the determinants of informal caregivers' time spent on caregiving? Q2) How do caregiving hours impact informal caregivers' later physical health, psychological health, and economic well-being? Furthermore, this study examined the associations between predisposing, enabling, and need factors from the viewpoints of both care recipients and caregivers. It also examines differing lengths of caregiver commitments and how they impact the caregivers' outcomes (physical health, psychological health, and economic well-being) in the future across various caregiver characteristics. Using longitudinal, nationally representative data of the Health and Retirement Study from two waves (2008 and 2010), I looked at 496 dyad units (including care recipients and couples/partners as caregivers) of community-dwelling elderly to evaluate the impact of relative factors on the length of informal caregiving hours and whether providing more caregiving hours cause greater negative impacts on caregivers' later physical health, psychological health, and economic well-being. To answer Q1, I used a hierarchical ordinal logistic regression model to identify predisposing, enabling, and need factors from both care recipients and care recipients' and their impacts on caregiving hours. For Q2, multivariate ordinal logistic regression or ordinal least square (OLS) regression models were separately used to examine the impact of three durations of caregiving hours (providing fewer, medium, and longer caregiving hours) at Time 1 on caregivers' physical, psychological, and economic well-being at Time 2. Findings indicate that recipients with higher functional impairment (activities of daily living (ADL) and instrument activities of daily living (IADL)) and usage of home care service by caregivers have a significant, negative impact on caregivers' length of caregiving hours. In addition, caregivers who are older and employed are more likely to provide a greater number of hours. Furthermore, caregivers who provide more hours are more likely to have a higher level of chronic illness (objective physical health). On the other hand, I found no significant associations between caregiving intensity and self-rated health (subjective physical health), psychological health, or household wealth (including assets and income). The analysis considering predisposing, enabling, and need factors from both care recipients and caregivers to unravel the complicated caregiving phenomena are presented. Implications for research, practice, and policy are drawn based on the results.

methodology

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