Social Strain and Conflict Among Older Community-Dwelling Adults Serving as Caregivers: Findings from a National Sample

Introduction

Although many adults develop care needs as they age, some older community-dwelling adults find themselves serving as caregivers for spouses, adult children, and other relatives. Caregiving can bring personal rewards, but it can also have a negative impact on the social well-being of older adults,¹ with recent research suggesting that older caregiving adults experience higher rates of elder mistreatment than those without caregiving responsibilities.² One possible explanation is that caregiving responsibilities may increase strain on relationships that exist outside of the caregiving relationship.³ Although the family caregiver literature has examined aspects of social negativity, family conflict, and other forms of role strain,⁴ it has not focused on how older adults serving in caregiving roles compare directly to others on measures of social strain. We examine experiences of social strain and conflict among older caregivers, compared to older adults without caregiving responsibilities. Our goal is to provide additional insight into the potentially unique social burdens of older caregivers, as an underrecognized component of the informal caregiving workforce in need of more social support resources.

Methods

We used a nationally-representative cohort of older community-dwelling US adults drawn from the 2015–16 National Social Health and Aging Project (NSHAP).⁵ Caregiving was assessed by asking if participants were “currently assisting an adult who needs help with day-to-day activities due to age or disability.” Care-receiving was assessed by asking participants if they were experiencing difficulty with standard activities of daily living (ADLs) or instrumental ADLs (IADLs) and, if so, whether they were receiving help for those ADLs/IADLs.

Social strain was assessed using a previously published scale^3,6–8. Separate questions assessed social strain with participants’ spouse/partner, family members, or friends, including how frequently those persons “criticized” them, “made too many demands” on them, or would “get on [their] nerves,” ranging from “never” to “often.” Participants were considered to have significant strain with a partner, family member, or friend if they reported “often” experiencing any of the above types of strained experiences.³

The prevalence of each type of social strain was examined among adults aged 60 years and older, stratified by self-reported caregiving and care-receiving status. Multivariable logistic regression models examined associations between caregiving and each type of social strain, adjusting for participant demographics (age, ethnicity, gender, marital status, education), overall self-reported mental health, overall self-reported physical health, cognitive function assessed using a survey-adapted version of the Montreal Cognitive Assessment⁹ (MOCA-SA), and any overlapping care-receiving.

Results

Of the 2617 participants aged 60 and older, 54% were women and 46% were men, and 68% were married or living with a partner (Supplementary Table S1). Approximately 18% indicated they were caregivers, and 22% were receiving care/assistance for ADLs or IADLs. Twenty-one percent reported some significant form of social strain or conflict, including 10% reporting strain with family, 3% with friends, and 12% with a partner.

In analyses stratified by caregiving and care-receiving status, social conflict or strain was reported by 34% of older adults who were caregiving, 22% who were receiving but not giving care, and 17% who were neither giving nor receiving care (Figure 1, P < .001). Older adults who were caregiving were more likely to report strain or conflict with family members and with intimate partners, compared to older adults without caregiving responsibilities (Figure 1). In multivariable-adjusted models, caregiving was associated with experiencing at least one type of social strain/conflict (AOR 1.89, 95% CI 1.35–2.64), including strain with a partner (AOR 1.76, 95% CI 1.15–2.70) and strain with a family member (AOR 2.17, 95% CI 1.52–3.10) (Table 1).

Figure 1. Self-Reported Prevalence of Social Strain Among Community-Dwelling Participants Aged 60 Years or Older, by Caregiving and Care-receiving Status.

p <.001 for heterogeneity in the prevalence of any social strain by caregiving/care-receiving status. p <.001 for social strain with partner by caregiving/care-receiving status. p < .001 for social strain with family. p > .05 for social stain with friends.

Table 1.

Adjusted Odds of Social Strain or Conflict Associated with Caregiving Status Among Older Community-Dwelling Adults

	Unadjusted ORa (95% CIb)	Multivariable-Adjustedc OR (95% CI)
Strain/Conflict with Anyone	2.29 (1.70, 3.09)	1.89 (1.35, 2.64)
Strain/Conflict with Partnerd	1.81 (1.22, 2.68)	1.76 (1.15, 2.70)
Strain/Conflict with Family	2.61 (1.88, 3.61)	2.17 (1.52, 3.10)
Strain/Conflict with Friends	1.60 (0.85, 3.01)	1.52 (0.77, 3.00)

^aOR = Odds Ratio

^b95%C I = 95% Confidence Interval

^cAdjusted for age, self-reported ethnicity, gender, educational attainment, marital status, self-reported overall physical health, self-reported overall mental health, cognitive function (assessed by Montreal Cognitive Assessment-Survey Adaptation score), caregiving status, and overlapping care-receiving status

^dAnalyses of strain/conflict with partners were confined to older adults who indicated that they had a spouse or co-habitating partner

Discussion

In this national sample of older community-dwelling adults, one in three older adults who were caregiving reported significant strain or conflict in one of their key social relationships; twice the prevalence of older adults who were neither providing nor receiving care. Caregiving was associated with a nearly two-fold greater odds of reporting strain or conflict with partners, relatives, or friends, independent of demographic background and underlying physical, mental, and cognitive functional status. These findings highlight the potential underrecognized toll of caregiving on surrounding social support systems of older adults.¹⁰ Caregiving may deplete the social reserve of older adults and result in conflict within non-discretionary, core relationships, including partners and family. This strain may raise older adults’ immediate risk of loneliness and psychological distress,¹⁰ as well as precipitate long-term reductions in the quality and number of core relationships leading to social isolation. Consequently, future studies should investigate the role of interdisciplinary clinical teams in identifying social strain among older adult caregivers and how to best provide resources to cope with the social burdens of caregiving.