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Reduced Employment in Caregivers of Frail Elders

Impact of Ethnicity, Patient Clinical Characteristics, and Caregiver Characteristics

^a Division of Geriatrics, San Francisco VA Medical Center and the University of California, San Francisco
^b Departments of Psychiatry and Neurology, San Francisco VA Medical Center and the University of California, San Francisco
^c On Lok Senior Health Services, San Francisco, California
^d Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio
^e Division of Geriatrics, University of South Carolina School of Medicine, Columbia
^f Palmetto Health Alliance, Columbia, South Carolina

Kenneth E. Covinsky, San Francisco VA Medical Center (111G), 4150 Clement Street, Bldg. 1, San Francisco, CA 94121 E-mail: covinsky{at}medicine.ucsf.edu.

Decision Editor: John E. Morley, MB, BCh

Background. Without family caregivers, many frail elders who live at home would require nursing home care. However, providing care to frail elders requires a large time commitment that may interfere with the caregiver's ability to work. Our goal was to determine the patient and caregiver characteristics associated with the reduction of employment hours in caregivers of frail elders.

Methods. This was a cross-sectional study of 2806 patients (mean age 78, 73% women, 29% African American, 12% Hispanic, 54% with dementia) with at least one potentially working caregiver (defined as one who is either currently employed or who would have been employed if they had not been providing care) and their 4592 potentially working caregivers. Patients were enrollees at 11 sites of the Program of All-Inclusive Care for the Elderly (PACE). Social workers interviewed patients and caregivers at the time of PACE enrollment. Caregivers were asked if they had reduced the hours they worked or had stopped working to care for the patient. Nurses interviewed patients and caregivers to assess independence in activities of daily living (ADLs) and the presence of behavioral disturbances. Comorbid conditions were assessed by physicians during enrollment examinations.

Results. A total of 604 (22%) of the 2806 patients had at least one caregiver who either reduced the number of hours they worked or quit working to care for the patient. Patient characteristics independently associated with a caregiver reducing hours or quitting work were ethnicity , 95% confidence interval [CI] 1.14–1.78 for African American; , 95% CI 1.43–2.52 for Hispanic), ADL function below the median (, 95% CI 1.44–2.15), a diagnosis of dementia (, 95% –2.17 if associated with a behavioral disturbance; , 95% CI 1.06–1.63 if not associated with a behavioral disturbance), or a history of stroke (OR = 1.42, 95% CI 1.16–1.73). After controlling for these patient characteristics, caregiver characteristics associated with reducing work hours included being the daughter or daughter-in-law of the patient (OR = 1.69, 95% CI 1.37–2.08) and living with the patient (OR = 4.66, 95% CI 3.65–5.95 if no other caregiver lived at home, OR = 2.53, 95% CI 2.03–3.14 if another caregiver lived at home).

Conclusions. Many caregivers reduce the number of hours they work to care for frail elderly relatives. The burden of reduced employment is more likely to be incurred by the families of ethnic minorities and of patients with specific clinical characteristics. Daughters and caregivers who live with the patient are more likely to reduce work hours than other caregivers. Future research should examine the impact of lost caregiver employment on patients' families and the ways in which the societal responsibility of caring for frail elders can be equitably shared.

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