Should Caregiving Be Considered a Social Determinant of Health?
The Centers for Disease Control and Prevention defines social determinants of health as the "conditions in the places where people live, learn, work, and play" that affect a wide range of health risks and outcomes. Some of the most commonly cited social determinants of health are income disparities which can limit access to healthy food, the safety of one's neighborhood, stable housing, or one's education level.
Whether or not a person is a caregiver for an older family member seems to be an often overlooked social determinant of health, especially among women. The Family Caregiver Alliance's National Center on Caregiving estimates that there are nearly 44 million unpaid caregivers in the United States and over three quarters are women.
The health effects of caregiving can't be ignored. Researchers have found that:
Women caregivers are almost six times as likely to experience depressive symptoms and anxiety than non-caregivers.
Caregivers report chronic conditions like heart attack and heart disease, cancer, diabetes, and arthritis at nearly twice the rate of non-caregivers.
Caregivers with high levels of emotional and mental strain have more than a 60% higher risk of death than non-caregivers.
The economic impact of caregiving on women can also create a downward spiral with negative effects. A joint report in 2011 by MetLife and the National Alliance for Caregiving found that on average women lose close to $325,000 in compensation due to caregiving. Imagine that a woman in her prime earning years devotes time and energy to family caregiving. The loss in income may limit her ability to live in a safe neighborhood with access health food. Even if lost income doesn’t have immediate negative effects, it may reduce the amount of money that the woman is able to save for both retirement and her own long-term health expenses.
What Can the Healthcare Community Do for Caregivers?
The encouraging news is that the health effects of caregiving may be easier to address than some other social determinants of health. I say this because there are two possible sources of assistance:
The family member's physician. Maria Carney, the Chief of Geriatric and Palliative Medicine at Northwell Health, suggests that the physicians caring for older patients should prioritize the caregiver's needs along with the patient's needs. When I was caring for my Dad, I found that his cardiologist did just that. Typically, patients were asked to come to the office for two separate appointments – one to see the cardiologist and a separate appointment to see the nurse for periodic pacemaker checks. The cardiologist knew that I had to take time off work for these appointments, so he asked the scheduling team to book them back-to-back on the same day, so I could limit my time away from my job.
The caregiver's own physician. With more and more adults taking on caregiving roles, it would be beneficial if primary care physicians proactively asked patients whether they are caregivers and then kept an eye on health conditions correlated with caregiving. Many primary care doctors have information in electronic health records which indicates whether a patient's parents are still alive and perhaps even how old they are. This data could be used to create a flag for doctors to inquire about caregiving during office visits.
Even if the healthcare community doesn't ask caregivers how they are doing, caregivers can advocate for themselves by discussing how this responsibility may be affecting their physical and mental health with both their own doctors and their family members' physicians. Recognizing the potential health impacts of caregiving is first step toward positive action.