AS754 - Feasibility of administering a caregiving survey in older women

Investigator Names and Contact Information

Michael J. LaMonte (mlamonte@buffalo.edu) Lorena Garcia (lgarcia@ucdavics.edu) Julie Weitlauf (wjulie1@stanford.edu) Jean Wactawski-Wende (jww@buffalo.edu)

Introduction/Intent

Caregiving is commonly undertaken by older women. Research is mixed, however, about the impact of prolonged caregiving on their health, well-being, and mortality risk. In the Women’s Health Initiative (WHI) participants in both the CT and OS components were asked two basic questions on caregiving (caregiver status: yes/no; caregiving frequency: episodes per week) at study enrollment (1993-1998) and again at main study close out (2004-2005). We recently published results from time-varying analysis of caregiving status (yes (41%) vs. no) over the two assessments in relation to subsequent mortality risk that showed a statistically significant 9% (95% CI: 7%-11%) lower all-cause mortality in caregivers compared to noncaregivers.1 The association was robust to multivariable adjustment for several health indicators and stratification by age, race and ethnicity, depression, optimism, and living alone status that was intended as an attempt to reduce the likelihood of a healthy worker effect as the primary explanation. While our finding adds to a growing literature that suggests caregiving might enhance physical and psychological resiliency in aging, important information on caregiving was not collected in WHI (e.g., information on caregiving type, recipient(s), duration, perceived burden, positive aspects, support resources) and thus could not be evaluated in our analysis. Moreover, there is no established long-term caregiving cohort where repeat longitudinal caregiving assessments have been collected contemporaneous to regular health updates during a wide range of aging among women. WHI offers a unique opportunity to build upon the two basic caregiving assessments (separated by 10 years) already completed by again assessing caregiving status and frequency and additionally collect new information to richly characterize the caregiving experience and its health impact in aging women.

Objectives: This proposed pilot study in currently active WHI women within the northeast region will (1) provide understanding on willingness and ability of older women to complete a brief caregiving survey; (2) allow us to refine the survey instrument and evaluate feasibility of survey administration modalities (conventional mailing; electronic Redcap); and (3) provide data to estimate sample size and statistical power for a subsequent R01 grant in the national WHI.

Results: This pilot study will inform feasibility, and help refine the protocol for implementation, of a caregiving survey as part of a planned larger R01 in the current WHI extension cohort.

The Specific Aims of this Pilot Study are:

1. To obtain preliminary data on willingness of older women to complete a brief survey on caregiving status.
2. To evaluate and refine the survey administration protocol (Redcap, conventional mailing).
3. To obtain preliminary data to estimate statistical power for a larger R01 grant in a subcohort of WHI women who previously responded to the two caregiving questions administered at WHI enrollment and again at close out, and are alive and contactable during the current extension study (2020-2027) that will propose: a. Describe the prevalence of being a current caregiver, the frequency and type of caregiving activities, and the sociocultural aspects of caregiving. b. Evaluate whether caregiving status and frequency are associated with prevalence and incidence of chronic diseases of aging (e.g., CVD, cancer, frailty, others) and mortality when comparing caregivers with noncaregivers. c. Identify factors (demographic, psychosocial, lifestyle, medical, caregiving-related) that mediate or modify an association between caregiving and risk of aging-related chronic diseases (as above).