title: Impact of caregiver burden on adverse health outcomes in community-dwelling dependent older care recipients.
abstract: OBJECTIVE
  To determine whether caregiver burden is associated with subsequent all-cause mortality or hospitalization among dependent community-dwelling older care recipients.
  
  
  METHODS
  A prospective cohort study of 1,067 pairs of community-dwelling 65-year-old or older care recipients and their informal caregivers was conducted. The 1,067 pairs completed the baseline assessment including caregiver burden assessed by the Zarit Burden Interview and a 3-year follow-up for all-cause mortality and hospitalization.
  
  
  RESULTS
  During the 3-year follow-up, 268 recipients died and 455 were admitted to hospitals. The multivariate Cox proportional hazards model revealed that the recipients with caregivers with a baseline ZBI score in the highest quartile were 1.54 and 1.51 times more likely to show increased risks of all-cause mortality and hospitalization, respectively, in comparison with those with caregivers in the lowest quartile after adjustment for potential confounders. The highest quartile of caregiver burden was associated with all-cause mortality and hospitalization within nonusers of respite services including day-care services, home-help services, and nursing-home respite stay services. No apparent association was observed within the users of these services except for day-care services, for which users showed a statistically significant association between the highest quartile and the risk of hospitalization.
  
  
  CONCLUSIONS
  Heavy caregiver burden is associated with mortality and hospitalization among community-dwelling dependent older adults, even after adjusting for potential confounders. The reduction of caregiver burden and improvement of caregiver well-being may not only prevent the deterioration of caregiver health but also reduce adverse health outcomes for care recipients.
authors.affiliation: Department of Geriatrics, Nagoya University Graduate School of Medicine, Japan. kuzuya@med.nagoya-u.ac.jp
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kuzuya
authors.forename: Hiromi
authors.initials: H
authors.lastname: Enoki
authors.forename: Jun
authors.initials: J
authors.lastname: Hasegawa
authors.forename: Sachiko
authors.initials: S
authors.lastname: Izawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Hirakawa
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimokata
authors.forename: Iguchi
authors.initials: I
authors.lastname: Akihisa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003153:Community Health Services / Q000706:statistics & numerical data*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009026:Mortality; D016016:Proportional Hazards Models