Journal of Clinical Surgery and Anesthesia

The Impact of Caregiving on the Health and Quality of Life: A Comparative Population Based Study of Caregivers of Elderly Persons in the USA, UK, Canada and Australia

Ookubo Odion Patrick^2* and Ogbu JC²

¹Veritas University, Abuja, Nigeria
²Department of Microbiology, University of Abuja, Abuja, Nigeria

*Corresponding author
Ookubo Odion Patrick, Veritas University, Abuja, Nigeria.

ABSTRACT
Caregiving is an important public health issue that affects the health and quality of life of millions of people living in the United States, United Kingdom, Canada, Australia, and the world at large. The caregiver’s responsibilities may increase and change as the recipient’s needs increase, which can cause additional stress on the caregiver. Therefore, this study examines the impact of caregiving on the health and quality of life of caregivers of older adults in the United States, United Kingdom, Australia, and Canada.

The caregiving data presented in this study were collected from studies from the United States of America, United Kingdom, Canada, and Australia. 

Carers in all 4 countries reported high levels of stress, low levels of health, depression, reduced incomes, difficulty making ends meet, social isolation, loneliness, and absenteeism from work. Caregivers sometimes had to leave the workforce altogether and this led to lower government revenue from income taxes. It is an established fact that a reduction in the workforce of a country often leads to a reduction in government revenue from income taxes. 

Based on the findings, it was recommended among others that there should be an increase in messaging or information that emphasizes both the important role of caregivers and the importance of maintaining their health and wellbeing.

Introduction
Caregiving is an important public health issue that affects the health and quality of life of millions of people. Caregivers assist with the social and health needs of others. Caregiving may include assistance with one or more important activities of daily living, such as bathing and dressing, paying bills, shopping and transportation. It also includes emotional support and helping people cope with chronic illness or disability. Caregiving responsibilities may increase or change as the beneficiary’s needs increase, which may place additional burden on caregivers.

Purpose of Study
This comparative population-based study seeks to find out the impact of caregiving on the health and quality of life of caregivers for elderly persons in the United States of America, the United Kingdom, Australia and Canada. 

Methodology
The caregiving data presented in this study were collected from comparative studies from the United States of America, United Kingdom, Canada, and Australia. Caregivers in the various cities and states were interviewed and their responses were recorded. It is a comparative population-based study of caregivers of elderly persons. 

Study Areas
States and cities in the USA, UK, Canada, and Australia

Result And Discussion of Findings
The United States of America
The National Alliance of Caregiving (2021)
The National Alliance for Caring reported that 40% to 70% of caregivers demonstrated clinically significant symptoms of depression. Nearly 25% of caregivers met the diagnostic criteria for major depression and 20% of employed female caregivers over 50 years old reported symptoms of depression, compared to 8% of their non-caregiving peers. According to the National Alliance of Caregiving, caregiving stress can be so severe that it can cause premature aging and take as much as 10 years off of a family caregiver’s life. The alliance reported that the mental toll of caregiving can also lead to a negative physical impact. Specifically, stress from dementia caregiving can take such a toll on a caregiver’s immune system that up to three years after their caregiving duties end, they are more likely to develop a chronic illness themselves. More than 10% of family caregivers reported that caregiving has caused their physical health to deteriorate and 23% of family caregivers who had been caring for a loved one for five years or more reported that their health is fair or poor. In addition to skipping routine medical care, 63% of caregivers said they have poor eating habits and 58% say their physical exercise had decreased since beginning their caregiving responsibilities.

47% of working caregivers reported that an increase in caregiving expenses have resulted in them dipping into all or most of their savings. More than 40% of family caregivers reported negative financial impacts due to their caregiving responsibilities they leave work, stop saving for retirement, and go into debt.”

Caregiving needs have also led to job losses, particularly since three-fifths of family caregivers are active in the U.S. workforce. In 2021, the need for caregiving led to the loss of more than 650,000 jobs, which had an economic effect of roughly $44 billion, according to Blue Cross Blue Shield [1]. An additional 800,000 caregivers suffered from absenteeism issues in the workplace because their caregiving roles are so time-consuming.

The United Kingdom
Carers UK (2022)
The organization presented a study on the Impact of caregiving on finances. It reported that the current cost of living crisis caused unprecedented pressure on the finances of caregivers: A quarter of carers (25%) were cutting back on essentials like food and 63% were extremely worried about managing their monthly costs. 

Carers UK also reported that Black, Asian and ethnic minority carers are more likely to be struggling financially. It stated that at the beginning of the pandemic, over half (58%) of unpaid carers from Black, Asian and minority ethnic groups said they were worried about their finances, compared to 37% of White carers. 

According to Carers UK, an average of 600 people a day leave work to care - with over 500,000 people leaving work to provide unpaid care pre-pandemic. Between 2010 and 2020, more than 1.9 million people in paid employment became unpaid carers every year Petrillo and Bennett, 2022. 

Lastly, Carers UK reported that over a quarter of carers (29%) feel lonely often or always and LGBT carers are more likely to feel lonely. 48% of bisexual carers and 45% of lesbian and gay carers often or always feel lonely, compared with 33% of heterosexual carers

The Joseph Rowntree Foundation (2022)
The Joseph Rowntree Foundation reported that Caring comes with additional costs that can have a significant impact on carers’ finances and many carers suffer financial hardship. According to the foundation, 44% of working-age adults who are caring for 35 hours or more a week are in poverty.

Canada
The University of Alberta Survey (2021)
For many families, caregiving presents a spectrum of stress, concern and uncertainty, and many are struggling. The University of Alberta survey identified high rates of loneliness (87 per cent), anxiety (73 per cent) and deteriorating mental health (69 per cent) among family caregivers. The survey also reported that six million Canadians juggle these care responsibilities with work, many balancing the needs of their own aging parents or family members with high or complex medical needs against the need to make a living.  Such high physical and emotional stress often causes absenteeism from work, and a low level of physical health. They may eventually be forced to reduce their hours of work or leave the workforce altogether. This leads to reduced family incomes, difficulty making ends meet, lower government revenue from income taxes, and an estimated $1.3 billion in lost productivity across the economy.

Australia
NSW National Carer Survey (2020)
Caregivers who responded to the 2020 National Carer Survey reported an average score of 57% level of health, compared with 75% for the general population [2]. Providing care for a loved one can impact carers’ mental health [3,4]. Nearly half of the carers who responded to the 2020 National Carer Survey reported high or very high levels of psychological distress [2]. According to the survey, carers often did not have the time or energy to prioritize their own health. Nearly 2 in 3 carers had a chronic health condition, compared to 1 in 3 Australians overall [5]. 

The National Carer Survey confirmed that Caring can reduce the time available to carers to spend quality time with friends, family members and the person they care for, and that Carers often miss out on the social opportunities associated with work, recreation and leisure activities as a result of their caring responsibilities [6,7]. More than half of the carers who responded to the 2020 National Carer Survey indicated that they were socially isolated or highly socially isolated [2]. Nearly 2 in 3 carers who responded to the 2020 National Carer Survey reported having less than 10 hours per week to themselves [2].

Carers often had to deal with strong emotions, like anger, guilt, grief and distress that affected their relationships with others [8,9]. Carers responding to the 2020 National Carer Survey reported very low satisfaction with their relationships compared to the Australian population, especially when they did not feel recognized in their caring role [10]. 

1 in 4 carers who responded to the 2020 National Carer Survey had left a paid job at some point in order to care, and 1 in 3 had reduced their working hours [2].

Twice as many carers of working age (aged 15-64 years) lived in a low-income household, and 1 in 4 relied on a Centrelink payment, compared to only 1 in 10 non-carers.

Half of the carers who responded to the 2020 National Carer Survey had experienced some form of financial stress in the past 12 months. Nearly 2 in 3 carers who responded to the 2020 National Carer Survey had to pay extra for medicines, 1 in 2 for transport, and 1 in 3 for disability aids and health services [2].

Conclusion
From this study, it was discovered that caregiving can affect the caregiver’s life in a myriad of ways including his/her ability to work, engage in social interactions and relationships, and maintain good physical and mental health. It was also discovered that caregiving can affect a caregiver’s monthly and annual income, and government revenue from income taxes.

Recommendation 

1. There is a need for an increase in messaging that emphasizes both the important role of caregivers and the importance of maintaining caregivers’ health and wellbeing
2. Education on the importance of caregiving should be provided to the public and individuals interested in caregiving before they begin. Caregivers should also be aware of the resources and support available to them.
3. Healthcare providers should be aware of the health risks for caregivers. Healthcare providers must encourage caregivers’ use of available information and tools, and make referrals to supportive programs and services.
4. Caregiver training and support programs should be evaluated to determine program accessibility, effectiveness, and impact.
5. There should be an Increase in awareness of and access to evidence-based programs and services, as caregivers and care recipients are usually not aware of the existence of evidence-based programmers and services.
6. Caregivers should be encouraged to get regular check-ups, use preventive services and engage in self-care to maintain health.
7. Caregivers with a disability and/or chronic diseases should have access to self-management programs to maintain their health.

References

1. The National Alliance of Caregiving. 2021.
2. NSW National Carer Survey. 2020.
3. Talley R, Crews J. Caring for the Most Vulnerable: Framing the Public Health of Caregiving. Am J Public Health. 2007.
4. Hoffman D, Zucker HA. Call to Preventive Action by Health Care Providers and Policy Makers to Support Caregivers. 2016.
5. Behavioral Risk Factor Surveillance System, Centers of Disease Control and Prevention 2015 – 2017.
6. Seeking That Elusive Good Night Sleep. 2018.
7. Prevo L, Kashan H, Evelyne Linssen, Steff Kremers, Rik Crutzen et.al. Population Characteristics and Needs of Informal Caregivers Associated with the Risk of Perceiving a High Burden: A Cross- Sectional Study. The Journal of Health Care Organization, Provision, and financing.2018.
8. Carers UK. 2022.
9. The Joseph Rowntree Foundation. 2022.
10. The University of Alberta Survey. 2021.