Caregivers play a vital role in supporting individuals who might otherwise require placement in long-term care facilities. They are the unsung heroes who provide daily assistance to family members or friends with chronic health conditions or disabilities. In the U.S., approximately one in five adults takes on this significant responsibility.¹ Recognizing the importance of caregiver well-being, the 2022 National Strategy to Support Family Caregivers underscores the need to prioritize this large segment of our population.² Despite the critical nature of their role, caregiving often comes with considerable emotional, physical, and economic challenges.

Methods

The Behavioral Risk Factor Surveillance System (BRFSS) is a comprehensive annual survey that gathers data on health behaviors and conditions from a representative sample of U.S. adults (aged 18 and older). For this analysis, data from the 2015–2016 and 2021–2022 surveys were examined, focusing on the responses from 92,461 caregivers and 353,242 non-caregivers. The study assessed 19 health indicators, including smoking rates, mental distress, and chronic diseases, to compare changes over time between caregivers and non-caregivers.

Trends in Caregiving and Health Indicators

Caregiving Prevalence and Demographics: The proportion of adults providing care remained stable between 2015–2016 and 2021–2022, around 20%. However, there was a notable increase in caregivers aged 60 and older, rising from 28.0% to 35.4%, compared to a smaller increase among non-caregivers.

Improvements in Health Indicators: Caregivers saw improvements in several areas:

• Decreased prevalence of current smoking
• Reduced physical inactivity
• Fewer instances of lacking health coverage
• Fewer reports of not being able to see a doctor due to cost

Worsening Health Indicators: Despite these improvements, six health indicators worsened for caregivers:

• Increased rates of frequent mental distress
• Higher prevalence of depression
• Rising levels of obesity and asthma
• More instances of having any chronic physical condition or multiple conditions

Comparative Analysis: While smoking rates declined among both caregivers and non-caregivers, caregivers continued to smoke at higher rates (16.6% vs. 11.7%). Additionally, both groups saw increased lifetime depression, but caregivers remained more affected (25.6% vs. 18.6%).

Discussion

The findings underscore the dual-edged nature of caregiving. On one hand, caregivers experienced some positive health changes, such as reduced smoking and improved physical activity. On the other hand, they faced worsening mental health and chronic physical conditions. This reflects the complex interplay between the rewards of caregiving and its demands.

The increase in lifetime depression and frequent mental distress across both groups aligns with broader trends observed during the COVID-19 pandemic, which has exacerbated mental health issues across the population.³ The expansion of Medicaid and other health reforms during the study period might have contributed to some improvements, such as reduced instances of lacking health coverage.

Implications for Public Health Practice

To address these challenges, it is crucial to integrate strategies that support caregivers into existing public health programs. Community organizations offer valuable resources, including:

• Respite care services to relieve caregiving duties
• Skills training and support groups to help manage caregiving stress
• Care coordination to streamline support

Healthcare providers should also proactively identify caregivers and offer resources to support their mental and physical health. Initiatives such as enhanced paid family leave and anti-discrimination laws can further alleviate some of the pressures faced by caregivers (2).

Conclusion

The health of caregivers is a critical area for public health focus. As caregiving responsibilities continue to grow, understanding and addressing the associated health challenges is essential. By leveraging community resources and integrating caregiver support into broader health strategies, we can improve the well-being of these essential individuals who play such a crucial role in our society.

References

1. AARP and National Alliance for Caregiving. Caregiving in the United States 2020. Washington, DC: AARP; 2020. https://www.aarp.org/pri/topics/ltss/family-caregiving/caregiving-in-the-united-states/
2. The Recognize, Assist, Include, Support, and Engage (RAISE) Act Family Caregiving Advisory Council; The Advisory Council to Support Grandparents Raising Grandchildren. 2022 National Strategy to Support Family Caregivers. Washington, DC: Administration for Community Living; 2022. https://acl.gov/sites/default/files/RAISE_SGRG/NatlStrategyToSupportFamilyCaregivers-2.pdf
3. Kraut RE, Li H, Zhu H. Mental health during the COVID-19 pandemic: Impacts of disease, social isolation, and financial stressors. PloS one. 2022 Nov 23;17(11):e0277562.