Dementia Caregiving and Sleep Health Disparities

Background and Purpose

Caregivers consistently report poorer sleep quality than non-caregivers, which is associated with an increased risk of poor health and well-being. The demands of dementia caregiving, in particular, may uniquely contribute to sleep disturbance. While racial and ethnic disparities in caregiving prevalence, intensity, and health have been established, it remains unclear whether there sleep disparities by race and ethnicity differ across dementia care status. Therefore, guided by Pearlin’s stress process model and utilizing national data on Medicare beneficiaries and their caregivers, the current study aims to investigate the linkages among race and ethnicity, caregiving demands, and changes in sleep disturbances among individuals caring for those with probable dementia, possible dementia, or no dementia..

Method

The current study used Round 5 of National Health and Aging Trends Study (NHATS) and two Rounds of and the National Study of Caregiving (NSOC, 2015 and 2017) (N=1063, 307 Black caregivers, 626 Non-Hispanic White caregivers, and 64 Hispanic caregivers). We conduced separate OLS regression by dementia care status (probable dementia, possible dementia, or no dementia) to investigate the association between providing care, depression, physical health, and sleep disturbance (interrupted sleep, trouble in falling back asleep) controlling for background factors.

Results

Most caregivers were adult children (75%) and female (70%), and over 60% of caregivers were younger than 65 years old (M=61 SD=14, range 18-94). Across all waves, between 70% and 80% of participants reported experiencing interrupted sleep or difficulties in falling back asleep. Hispanic caregivers, in comparison to White caregivers, were more likely to report increased interrupted sleep over the span of 2 years. Additionally, older caregivers and those providing more assistance with Activities of Daily Living (ADL) were more likely to report difficulties in falling back asleep over the same period. In the possible dementia group, Black caregivers, compared to White caregivers, reported higher levels of interrupted sleep. Among non-dementia caregivers, worse perceived health at baseline was associated with more interrupted sleep two years later. Older non-dementia caregivers were more likely to experience difficulties in falling back asleep. Across three groups, baseline depression was not associated with changes in sleep disturbance.

Conclusion and Implications

The study reveals significant racial disparities and variations by dementia care status. These findings underscore the importance of tailored support interventions addressing the unique needs of diverse caregiver populations by dementia care status. Moreover, the lack of association between depression and changes in sleep disturbance suggests the need for further exploration of other factors contributing to sleep disruptions among caregivers. Future research should also utilize community-based participatory research and provide suggestions for culturally responsive and accessible intervention strategies to meet caregivers needs by dementia care status. These findings highlight the importance of tailored support programs for caregivers based on the dementia stage, race and ethnicity, and caregiver characteristics.