Shorter Sleep Duration, Smoking More Prominent in Caregivers

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Chronic disease caregivers are more likely to report both risky and health-promoting behaviors than noncaregivers, according to a new study.

Chronic disease caregivers are more likely to engage in both risky and health-promoting behaviors, with longer caregiving hours and providing help with personal care associated with poorer health behaviors. Findings were published recently in the American Journal of Preventive Medicine.

With more than 1 in 5 adults estimated to be caregivers in the United States, the significant time spent caring for a family member/friend with a chronic illness or disability has been associated with emotional and economic hardships.

Moreover, the physical impact of caregiving has been linked with several adverse health behaviors, including lack of regular physical activity, poor dietary habits, and inadequate sleep.

“Overall, studies have yielded mixed associations between caregiving status and health behaviors….the mixed results may reflect differences in measurement, analytic approaches, and sample characteristics, including disease contexts,” noted researchers.

Citing a lack of research on caregivers’ health behaviors by disease context, they conducted a cross-sectional study of pooled 2015-2019 Behavioral Risk Factor Surveillance System data and health behaviors among caregivers of patients with dementia (n = 5525), cancer (n = 4246), chronic obstructive pulmonary disease/emphysema (n = 1959), and diabetes (n = 2853), as well as noncaregivers (n = 203,848).

In the study, caregivers and noncaregivers were compared via regression analyses for caregiving intensity and health behaviors, which included physical activity (aerobic activity and muscle-strengthening), diet (fruit and vegetable consumption), alcohol use, smoking, sleep, and influenza immunization. Caregiving intensity was assessed via 4 measures:

  • Caregiving hours per week (≤ 8 hours, 9-19 hours, 20-39 hours, ≥ 40 hours)
  • Caregiving duration (< 1 month, 1 month to > 6 months, 6 months to < 2 years, 2 years to < 5 years, > 5 years)
  • Providing help with household tasks (yes versus no)
  • Providing personal care (yes versus no)

Secondary aims were to examine the relationships between caregiving intensity and health behaviors and to compare these outcomes between caregivers of patients with dementia and other caregiver groups.

“Caregivers of patients with dementia are hypothesized to report worse health behaviors than other caregiver groups,” said the study authors.

In their findings, all caregiver groups were more likely than noncaregivers to report risky health behaviors, including increased likelihood of smoking (OR, 1.322.20; P < .001) and decreased likelihood of meeting sleep recommendations of 7 hours or more of sleep per night (OR, 0.64-0.74; P < .05).

Adverse health risks were further exacerbated by greater hours of caregiving per week, in regards to reduced likelihood of meeting muscle-strengthening guidelines (OR, 0.90; P < .05) and meeting nightly sleeping recommendations (OR, 0.86; P < .05), as well as greater likelihood of current smoking (OR, 1.10; P < .05).

Providing help with personal care was also associated with a reduced likelihood of meeting sleep recommendations (OR, 0.74; P < .05) and current smoking (OR, 0.72; P < .01). Caregiving duration and providing help with household tasks were not associated with health behaviors.

Conversely, certain caregiver groups were more likely to adhere to health-promoting behaviors, with caregivers of patients with dementia, cancer, and diabetes found to consume more daily servings of vegetables than noncaregivers (relative risk reduction [RRR], 1.05-1.09; P < .05), and caregivers of patients with dementia more likely to meet dietary recommendations (≥ 5 daily servings of fruit and vegetables) than noncaregivers (OR, 1.22; P < .05).

Regarding alcohol use, binge drinking did not differ between caregiver groups and noncaregivers, with caregivers of patients with dementia cited as the sole group to report less likelihood of heavy drinking than noncaregivers (OR, 0.73; P < .05).

In assessing exercise, all caregivers except for those of patients with diabetes were indicated to be more likely to report meeting aerobic activity recommendations than noncaregivers (OR, 1.20-1.30; P < .05) and caregivers of patients with dementia and cancer were more likely to report meeting muscle-strengthening recommendations than noncaregivers (OR, 1.21-1.35; P < .05).

Influenza immunization in the past 12 months did not differ between caregiver groups and noncaregivers.

“Further research is needed to examine the clusters of health behaviors, identify caregivers at higher risk for poor health behaviors and outcomes, and determine how best to intervene with caregivers across illness contexts,” concluded the study authors.


Secinti E, Wu W, Kent EE, Denmark-Wahnefried W, Lewson AB, Mosher CE. Examining health behaviors of chronic disease caregivers in the U.S. Am J Prev Med. Published online September 25, 2021. doi:10.1016/j.amepre.2021.07.004