Role Overload and Sleep Outcomes Among Caregivers of Older Adults with Alzheimer's Disease and Related Dementias: Examining the Mediating Role of Secondary Stressor

Background and Purpose

Seventy percent of people with Alzheimer’s disease and related dementias (ADRD) in the United States live in community settings, supported by 16.3 million family caregivers who collectively dedicate 18.6 billion hours of unpaid care each year. Family caregiving is critical for people with ADRD as it delays the need for institutional care and facilitates “aging-in-place”. However, ADRD caregivers often experience a high level of role overload (i.e., feeling overwhelmed by caregiving demands that exceed available resources), which can significantly affect their sleep. Approximately 67% of ADRD caregivers encounter sleep issues. Moreover, ADRD caregiving can indirectly affect caregivers’ health by introducing stressors across various aspects of their lives, known as secondary stressors. This study aims to examine the mediating effects of secondary stressors on the relationship between role overload and sleep in ADRD caregivers.

Methods

This study used a cross-sectional research design. Data were drawn from the 2021 National Study of Caregiving IV, which included people caring for Medicare enrollee age 65 and older in the United States. The current analysis included a subsample of caregivers who provided care to an older adult who has been diagnosed as having ADRD (N = 2431). Role overload was assessed using three self-report items from the Role Overload Scale. Secondary stressors refer to several challenges that caregivers experienced in their lives due to ADRD caregiving, namely negative caregiver-care recipient relationships, family disagreement over care, and social participation restriction. Sleep outcomes included both sleep disturbance and sleep interruption. Caregiver socio-demographics (i.e., age, gender, race, and education) and self-rated physical health served as covariates. Path analysis was used to examine the study aim.

Results

The positive association between role overload and sleep interruption was mediated by negative caregiver-care recipient relationships (indirect effect = .03, p < .001) and social participation restriction (indirect effect = .03, p < .05). Specifically, caregivers with higher levels of role overload had more negative relationships with care recipients (B = .38, p < .001), which in turn, exacerbated their sleep interruption (B = .07, p < .001). Also, higher levels of role overload were associated with more restrictions in social participation (B = .16, p < .001), which increased sleep interruption (B = .18, p < .01).

Conclusions and Implications

Findings of this study suggest that negative caregiver-care recipient relationships and social participation restriction are modifiable factors associated with sleep problems among ADRD caregivers. These findings help inform interventions tailored to enhance caregivers’ relationships with older adults with ADRD and increase their social participation, thus improving their quality of sleep. The study can also inform policies that promote ADRD-friendly communities. Such a community may facilitate effective communications between caregivers and older adults with ADRD, encourage social participation, and promote sleep wellness for ADRD caregivers. Future research should examine stressors and sleep across types of caregivers (e.g., spouses, adult children). Longitudinal studies are crucial for understanding the long-term health effects of ADRD caregiving and caregivers’ sleep patterns and trajectories over time.