Brain Structural Markers and Caregiving Characteristics as Interacting Correlates of Caregiving Strain.
OBJECTIVE
To evaluate the association between brain structural markers and caregiving strain among older informal caregivers.


METHODS
A secondary data analysis combining data from the Caregiver Health Effects Study (1993-1994) and the Cardiovascular Health Study MRI examination (1992-1994).


METHODS
Four United States communities.


METHODS
Co-residing spousal caregivers (N = 237; mean age: 76.2 years, SD: 2.2 years).


METHODS
Visually rated ventricular and white matter (WM) grades from magnetic resonance imaging, caregiving strain defined as "emotional or physical strain associated with providing care" for any of 12 activities of daily living (ADLs) and instrumental activities of daily living (IADLs), plus measures of caregiving characteristics and caregiver's health.


RESULTS
Overall, 56% of caregivers reported strain. We detected an interaction where strain was very common (>82%) among caregivers who helped with four or more IADLs, regardless of WM grades, and among caregivers with the worst WM grades (WM grades ≥4), regardless of the number of IADLs they helped with. Among caregivers helping with fewer than four IADLs, having WM grade 4 or greater was associated with a 55% higher prevalence ratio for reporting strain. This association remained statistically significant but was most markedly attenuated by adjustments for: care recipient's memory and behavioral problems, caregiver's depression symptoms, and caregiver's ADL impairment.


CONCLUSIONS
Caregiving strain is very common among older informal caregivers who provide help with many IADLs, and among caregivers who help with fewer IADLs, but have manifest signs of white matter pathology. Modern quantitative-neuroimaging studies are needed to evaluate whether more subtle variability in brain structure confers caregiving strain and the related health consequences.
Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA. Electronic address: sfs26@pitt.edu.
Stephen F
SF
Smagula
University Center for Social and Urban Research, Graduate School of Public Health, University of Pittsburgh, PA.
Scott
S
Beach
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
Andrea L
AL
Rosso
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
Anne B
AB
Newman
Department of Psychiatry, Western Psychiatric Institute and Clinic of University of Pittsburgh Medical Center, Pittsburgh, PA.
Richard
R
Schulz
D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D002552:Cerebral Ventricles / Q000473:pathology; D005260:Female; D006304:Health Status; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D015995:Prevalence; D013315:Stress, Psychological / Q000453:epidemiology* / Q000473:pathology*; D014481:United States / Q000453:epidemiology; D066127:White Matter / Q000473:pathology*
Informal caregivers; brain structure; caregiving strain; white matter