The Linked Health of Diverse Caregivers: Insights from the National Social Life, Health, and Aging Project

Background and Purpose: The growing reliance on family in elder care, especially for those from diverse ethnoracial groups, calls for a comprehensive exploration of caregiver health. This study aims to enhance our comprehension in three critical areas: 1) examining caregiver health across five key dimensions—physical, mental, cognitive, social, and sexual—using the "linked health" concept, which posits that changes in one health aspect can affect others, thereby influencing overall well-being; 2) investigating how caregivers' ethnoracial and linguistic backgrounds correlate with their overall health profiles; and 3) evaluating the impact of social networks on caregiver health.

Methods: We analyzed data from the National Social Life, Health, and Aging Project (NSHAP), which surveys a nationally representative group of older adults, including their spouses and partners, across the U.S. (N=1,309). To address the limited representation of caregivers from diverse backgrounds in the dataset, we examined data from caregivers in the first three rounds of NSHAP, focusing on their initial caregiving experiences. We assessed multiple indicators within each health domain: physical and mental health were evaluated through self-perceptions and clinical measures; cognitive health was gauged using adapted survey instruments; social health was analyzed via eight social network variables; and sexual health was assessed through questions about sexual frequency and relationship satisfaction. Our objective was to identify patterns and associations between caregiving and varied health aspects using regression analysis.

Results: Black and Hispanic caregivers reported worse self-rated health than White caregivers, yet these differences did not correspond to disparities in functional health, indicating comparable daily functioning levels across groups. In cognitive health, both Black and Hispanic caregivers scored lower than their White peers. Despite using an unbiased assessment tool, cognitive differences remained pronounced for Black caregivers, suggesting the need to explore the impact of long-standing discrimination and the buffering effects of social networks. Larger social networks were linked to better cognitive outcomes, pointing to the protective influence of social connections against cognitive decline. However, social health assessments revealed that Black caregivers experienced greater social strain and received less support than White caregivers, highlighting a connection between cognitive and social health. Hispanic caregivers exhibited unique social and sexual health patterns based on language, with Spanish-speaking individuals reporting less social strain than English speakers. Although English-speaking Hispanic caregivers faced poorer social health, their Spanish-speaking counterparts had better social health, which translated into less mental health symptoms despite lower self-rated mental health.

Conclusions and Implications: This study provides deeper insights into the complex health dynamics affecting caregivers and underscores the necessity of integrating social and sexual health assessments with traditional cognitive, mental, and physical evaluations in caregiver research. By highlighting significant disparities among minority caregivers, particularly in underexplored social and sexual health areas, our findings calls for detailed evaluations and targeted interventions. Adopting this comprehensive approach can guide healthcare providers and social workers towards effective preventive strategies, enhancing caregivers' overall health outcomes. By broadening health considerations, support for caregivers from diverse backgrounds could be strengthened by addressing their varied immediate and long-term health needs.