When Press Exceeds Competence: The Interaction Effect of Caregiving Roles and Functional Health on Depressive Symptoms Among Older Adults

Background and Purpose: Individuals aged 50 and older constitute a large and growing share of family caregivers in the United States, many of whom shoulder multiple caregiving roles to their ageing parents, spouse, and grandchildren. In the meantime, as physical functioning declines with age, older family caregivers are increasingly likely to experience limitations in activities of daily living (ADL) and instrumental activities of daily living (IADL), which may complicate their ability to provide care. However, few studies have investigated how multiple family caregiving roles and family caregiver’s own functional disability affect their mental health outcomes. Informed by Lawton and Nahemow’s Press-Competence Model, this study examined the interaction effect of multiple family caregiving roles (as a form of environmental press) and caregiver’s functional health (as a proxy for competence) on caregiver’s mental health, thereby providing a more nuanced understanding of caregiving in later life.

Methods: Data were drawn from the Health and Retirement Study in 2018 and 2020 (n= 12,999). We categorized the five family caregiving roles (parenting grandchildren or great-grandchild(ren), helping a spouse/partner with ADLs, helping a spouse/partner with IADLs, helping parent(s) or parent(s)-in-law with ADLs, helping parent(s) or parent(s)-in-law with IADLs) to no caregiving role, single caregiving role, and multiple caregiving roles. Depressive symptoms were measured using an 8-item version of the Center for Epidemiologic Studies (CES-D) scale. Among caregivers themselves, functional limitations were assessed with any difficulty in ADLs and IADLs. Covariates included informal caregivers’ sociodemographic characteristics, economic, and health conditions. Multivariate regression was used to examine the main and interaction effects of multiple family caregiving roles and caregivers’ functional health on caregivers’ mental health.

Results: About a quarter of the respondents carrying one caregiving role with another 8% carrying two or more caregiving roles. Having any caregiving role was not associated with significantly poorer mental health than not having any caregiving roles. Notably, individuals with multiple caregiving roles and having ADL limitations (β = 0.72; p = .001) reported significantly poorer mental health.

Conclusions and Implications: Our results suggest that when older caregivers do not have any ADL or IADL limitations, having more caregiving roles is not associated with negative mental health outcomes. Only when caregiving roles increased to two or more, older caregivers with ADL limitations had significantly more depressive symptoms. Therefore, early identification of older family caregivers with multiple caregiving roles and ADL needs is imperative to address caregivers’ mental health. Ensuring mental health treatment, targeted functional supports, along with home health aides for caregivers themselves may be effective interventions to improve personal competence, reduce the environmental press, and enhance healthy adaption to the caregiving role in later life. Respite services should also be provided to this high-risk group, allowing them take breaks to prevent burnout.