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Refining caregiver vulnerability for clinical practice: determinants of self-rated health in spousal dementia caregivers

Contact Information


Roland von Känel,

Clinical management; Dementia caregivers; Elderly people; Health risk; Psychological stress; Quality of life; Self-rated health.


Caregivers of a family member with a chronic disability or illness such as dementia are at increased risk for chronic disease. There are many factors that contribute to dementia caregiver vulnerability and these factors can be challenging to assess in clinical settings. Self-rated health (SRH) is an independent measure of survival and physical health in the elderly. As an inclusive measure of health, SRH has been proposed as a reliable way to assess a patient’s general health in primary care. Therefore, we sought to identify determinants of poor/fair SRH versus categories of at least good SRH in informal caregivers. Methods In a cross-sectional study, we examined 134 elderly (≥55 years) providing in-home care for a spouse with dementia who rated their own health with a single-item question: “In general, would you say your health is excellent, very good, good, fair or poor?”. In a multivariable model, we compared caregivers with poor/fair SRH to those with good, very good, or excellent SRH on demographics, health characteristics (health behaviors, physical health indicators, psychosocial factors) and caregiving-specific stress (a composite index/total of four caregiving-specific stressors: years of caregiving, dementia severity, care recipient functional impairment and perceived caregiver burden). Results Compared with caregivers who rated their own health as either good (31.3%), very good (38.8%) or excellent (14.2%), caregivers with poor/fair SRH (15.7%) were more likely to have lower physical function and total greater caregiving-specific stress. More years of caregiving, severe dementia and care recipient functional impairment, but not perceived caregiver burden, were also more likely among caregivers with poor/fair SRH. Additionally, high negative affect and low positive affect were more likely in caregivers with poor/fair vs. good or excellent and very good or excellent SRH, respectively. Conclusions Caregivers with poor/fair SRH were characterized by higher levels of medical comorbidity, low physical function, high negative, but low positive affect and longer duration of caregiving, as well as more severe dementia and greater functional impairment of the care recipient. These findings suggest that caregivers need to be more closely evaluated and targeted for preventive interventions in clinical practice.


von Känel, R., Mausbach, B.T., Dimsdale, J.E. et al. Refining caregiver vulnerability for clinical practice: determinants of self-rated health in spousal dementia caregivers. BMC Geriatr 19, 18 (2019).





Conent Area

Roland von Känel

EWB-Related Construct

(2) life satisfaction; (3) positive affect;

Study Design

Species or Study Population

(1) cross-sectional

Sex (%Female)


Age (Mean, SD)

74.1, 8.3

Younger Controls?


Longitudinal Data?


Sample Size




Ethnicity (%white)

not stated (USA)

Inclusion Criteria

To be eligible, caregivers had to be 55 years or older, English-speaking, provide at least 20 h per week of in-home care for a spouse with dementia and endorse at least mild depressive symptoms (i.e., mild level of distress) as per a score of ≥5 on the Patient Health Questionnaire-9 [28] at the time of enrollment.

Exclusion Criteria

Exclusion criteria were current treatment for any malignancies, severe chronic illnesses requiring ongoing medical treatment (e.g., chronic obstructive pulmonary disease, renal failure), severe hypertension (> 200/120 mmHg), major psychiatric illnesses (e.g., schizophrenia, bipolar disorder), prior or ongoing participation in a behavioral caregiver intervention, or treatment with steroids, non-selective beta-blocking, or anticoagulant medications.

EWB Measures

Positive and Negative Affect Scale

Non-EWB Behavioral

health history questionnaire
Clinical Dementia Rating
Activities of Daily Living Questionnaire
Zarit Burden Interview

Physiological Measures


Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details

The datasets generated and analyzed during the current study are not publicly available due them containing information that could compromise research participant privacy/consent, but are available from the corresponding author on reasonable request.

Diagnostic Measures

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