Caregiving needs increase as older adults approach the end of life
Dying adults in the United States have 2.5 people assisting them, on average, according to a new study. Yet those caring for adults at the end-of-life, especially spouses, are likely to report that they have no one assisting them and no time for themselves. Researchers at Icahn School of Medicine at Mount Sinai have found that dying adults received almost twice as many hours of help per week compared to those not at the end of life, and that end-of-life caregivers were significantly more likely to report physical difficulty related to giving care. Their analysis was published today in the July issue of Health Affairs.
Katherine Ornstein, PhD, Assistant Professor of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and coauthors used the National Health and Aging Trends study and its linked National Study of Caregivers to profile end-of-life caregiving in the United States. They found that older adults at the end of life had an average of 2.5 caregivers assisting them and received 61.3 hours of help per week versus 35.5 hours for older adults not at the end of life. 35 percent of end-of-life caregivers reported physical difficulty related to giving care versus 21 percent in other caregivers, and 51 percent reported having no time for themselves versus 40 percent in other caregivers. For end-of-life caregivers who were spouses, nearly two-thirds reported that they receive no support from family or friends. This is the first study to prospectively examine all the paid and unpaid caregiver support individuals receive at the end of life using a nationally representative sample.
“This study reveals the huge reliance our society places on family and other unpaid caregivers throughout the course of serious illness and especially at the end of life,” said Dr. Ornstein. “Although receipt of paid caregiving increases toward the end of life, the vast majority of older adults do not receive any paid help. They are relying on families for their care, which is often quite complex and challenging. We must recognize and support the vital role of family in end of life care.”
Previous studies are often limited to the experience of one primary caregiver or are limited to individuals with one specific disease. Furthermore, prior studies of end-of-life caregiving often ask about these experiences after a loved one died and are subject to recall bias.
Compared to other caregivers, end-of-life caregivers reported higher rates of financial difficulty caring for those with cancer. End of life care caregivers who were spouses reported the most care-related challenges, including increased depression and physical difficulty.
“The challenging job of a caregiver is not usually restricted to a few months before an individual dies and we must do more to support them throughout the often long course of serious illness. Palliative care, which provides an added layer of support for patients and families in the setting of serious illness, is one critical tool to support caregiving families. State and federal legislation, as well as workplace policies, are also essential to providing the needed support to seriously ill people and their families,” added Dr. Ornstein.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.