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Caregiving as a risk factor for mortality: the Caregiver Health Effects Study
Richard Schulz, Scott R. Beach. JAMA, 1999-12-15
Topic: Risk, prevention and care in population studies
Plain-language summary
CONTEXT: There is strong consensus that caring for an elderly individual with disability is burdensome and stressful to many family members and contributes to psychiatric morbidity. Researchers have also suggested that the combination of loss, prolonged distress, the physical demands of caregiving, and biological vulnerabilities of older caregivers may compromise their physiological functioning and increase their risk for physical health problems, leading to increased mortality. OBJECTIVE: To examine the relationship between caregiving demands among older spousal caregivers and 4-year all-cause mortality, controlling for sociodemographic factors, prevalent clinical disease, and subclinical disease at baseline. DESIGN: Prospective population-based cohort study, from 1993 through 1998 with an average of 4.5 years of follow-up. SETTING: Four US communities. PARTICIPANTS: A total of 392 caregivers and 427 noncaregivers aged 66 to 96 years who were living with their spouses. MAIN OUTCOME MEASURE: Four-year mortality, based on level of caregiving: (1) spouse not disabled; (2) spouse disabled and not helping; (3) spouse disabled and helping with no strain reported; or(4) spouse disabled and helping with mental or emotional strain reported. RESULTS: After 4 years of follow-up, 103 participants (12.6%) died. After adjusting for sociodemographic factors, prevalent disease, and subclinical cardiovascular disease, participants who were providing care and experiencing caregiver strain had mortality risks that were 63% higher than noncaregiving controls (relative risk [RR], 1.63; 95% confidence interval [CI], 1.00-2.65). Participants who were providing care but not experiencing strain (RR, 1.08; 95 % CI, 0.61-1.90) and those with a disabled spouse who were not providing care (RR, 1.37; 95% CI, 0.73-2.58) did not have elevated adjusted mortality rates relative to the noncaregiving controls. CONCLUSIONS: Our study suggests that being a caregiver who is experiencing mental or emotional strain is an independent risk factor for mortality among elderly spousal caregivers. Caregivers who report strain associated with caregiving are more likely to die than noncaregiving controls.
What this study adds
Evidence grade: Not rated
Following 392 older spousal caregivers and 427 non-caregivers, this study found that caregivers who reported mental or emotional strain had a 63% higher risk of death over 4 years than non-caregivers. Caregivers who did not report strain did not have elevated adjusted death rates.
Taken from this record’s own fields, not from reading the paper. The grade is assigned from the abstract’s wording; what that means.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Schulz, R., & Beach, S. R. (1999). Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. https://doi.org/10.1001/jama.282.23.2215
Vancouver
Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. 1999. doi:10.1001/jama.282.23.2215. PMID: 10605972.
BibTeX
@article{schulz1999-10605972,
author = {Schulz, Richard and Beach, Scott R.},
title = {{Caregiving as a risk factor for mortality: the Caregiver Health Effects Study}},
journal = {JAMA},
year = {1999},
doi = {10.1001/jama.282.23.2215},
pmid = {10605972},
url = {https://doi.org/10.1001/jama.282.23.2215}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
Why it matters
Following 392 older spousal caregivers and 427 non-caregivers, this study found that caregivers who reported mental or emotional strain had a 63% higher risk of death over 4 years than non-caregivers. Caregivers who did not report strain did not have elevated adjusted death rates.
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How this study scored 55/100
Published in a top-tier journal. Scored zero for study design, sample size, effect reported, studied in people and randomized / blinded because the record does not state it. We have no data on strength of evidence and senior author's track record, so those were left out: it earned 50 of the 91 points we could judge it on, which is 55 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 10 / 10 | Tier 1 — top-tier general journal (JAMA) |
| Journal's citation record | 4 / 4 | JAMA: journal h-index 1,011 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | — / 5 | No evidence rating recorded — left out of this score |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 1999 — older than 20 years, still counted |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 7 / 7 | Cited 3,346 times (OpenAlex, 2026-10-10) |
| Citations per year | 5 / 5 | 115.4 citations a year over 29 year(s) since 1999 |
| Impact for its field and year | 6 / 6 | Cited 124.0× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 4 / 4 | Cited 232 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | OpenAlex's profile for last-listed author Scott R. Beach holds only 3 work(s), too few to judge a track record — left out of this score |
| Institution's track record | 1 / 3 | University of Pittsburgh: institution h-index 1,470 (OpenAlex) |
| Multicenter collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 10605972) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 50 / 91 | Scored on 18 of 20 parts. We have no data for the rest, so they are left out: 50 of the 91 points we could judge it on is 55 out of 100. |
| Total | 55 / 100 | — |
What each of these 20 components measures, and what this score is not →
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