HEALTHY CAREGIVER SELECTION AMONG DEMENTIA CAREGIVERS: THE ROLE OF SOCIAL SUPPORT

Abstract As of 2019, more than 4 million older adults aged 65+ in the United States are cognitively impaired, including the diagnoses of mild cognitive impairment (MCI) and dementia. Caregivers to these older adults bear significant burden, reflected as high prevalence of chronic stress and mental health problems among the caregiver population. It is thus crucial to understand the wellbeing of the caregiver population to design effective policies. Previous studies have documented survival advantage of dementia caregivers compared to non-caregiving individuals as well as other types of caregivers, namely caregivers to persons with MCI or other types of chronic conditions. However, it remains less clear how the role of social support explains dementia caregiver’s survival advantage. In this paper, we directly compare the level and type of social support between different types of caregivers, and examine to what extent the difference in social support explains the survival and health advantage of dementia caregivers compared to caregivers to persons with MCI, non-cognitive impairment chronic conditions and non-caregiving individuals. We use the 12 waves of the Health and Retirement Study and apply multivariate and survival analysis to calculate difference in age-specific hazard ratios. Our preliminary results show that dementia caregivers tend to secure stronger support from family members than caregivers to persons with MCI. Our results have potential to shed light on the empirical puzzle of healthy caregiver selection effect and have direct implications for designing effective intervention to improve health of the caregiver population.


INFORMAL CAREGIVING BURNOUT AMONG THE SANDWICH GENERATION Erika Fenstermacher, Montgomery Owsiany, and Barry Edelstein, West Virginia University, Morgantown, West Virginia, United States
Twenty-nine percent of U.S. adults care for children. Of those adults, 12% are multigenerational caregivers who also provide unpaid care for one or more adults. Many multigenerational caregivers are considered members of the "sandwich generation," which is a term for multigenerational caregivers who provide care, financial support, and emotional support for both their children and parents. Approximately 71% of this generation is between the ages of 40 and 59, and approximately 10% are 60 or older. The sandwich generation is largely understudied and presents challenges including informal caregiving burnout and depression. Informal caregiving burnout is a syndrome that results from the stress of providing care. Researchers have not yet investigated burnout in the sandwich generation. The present study examined how sandwich generation caregivers differed from caregivers of children and caregivers of parents regarding depression and burnout. Two measures of burnout were used (non-caregiving burnout = degree of physical and psychological fatigue and exhaustion; informal caregiving burnout = degree of physical and psychological fatigue and exhaustion related to caregiving). We found that sandwich generation caregivers and caregivers of parents scored significantly higher than caregivers of children on informal caregiving burnout. Caregiving burnout and non-caregiving burnout were significantly correlated with depression (r = .496, p < .001 and r = .773, p < .001, respectively). Burnout is higher in sandwich generation caregivers and those who care for parents than burnout among those who care only for children. This study is unique in its investigation of informal caregiving burnout among the sandwich generation. Caregiver neglect is common among older persons with dementia and is associated with significant morbidity and mortality. Despite this, little empirical research exists examining factors that contribute or prevent neglect. Our goal was to identify caregiving factors that may be associated with caregiver neglect. Data were drawn from the baseline information of 240 caregivers enrolled in the Caring for the Caregiver Network study who provided care to a family member with dementia. Caregiver depression, burden, social support, perceived mutuality with care-recipients, positive aspects of caregiving, and self-perceived caregiving preparedness, were measured using validated scales. To maximize sensitivity in our measure of caregiver neglect, we operationalized caregiver neglect as consisting of: 1) caregivers' failure to meet care-recipients' needs, using 8-item instrumental activities of daily living (IADL) and 6-item ADL scales, and 2) caregivers not receiving additional formal services (e.g., visiting nurses; home care aides) to address care-recipients' unmet needs. Selection of independent variables into multivariate regression models examining predictors of neglect was based on significance in bivariate analysis (p < .10). Caregiver neglect was found in 29.2% of caregivers. The caregiver being male was significantly associated with greater risk of neglect. In the final adjusted model, only caregiver preparedness was found to be a significant risk factor for neglect (β = -.16 SE=.10, p < .05). This analysis provides the first evidence of the association between caregiver preparedness and risk of caregiver neglect. Future research should examine possible psycho-social mechanism linking preparedness and neglect to inform neglect prevention and intervention programming.

HEALTHY CAREGIVER SELECTION AMONG DEMENTIA CAREGIVERS: THE ROLE OF SOCIAL SUPPORT
Hantao Jiang, 1 and Xueqing Wang 2 , 1. Columbia University, Princeton, New Jersey, United States, 2. Princeton University, Princeton, New Jersey, United States As of 2019, more than 4 million older adults aged 65+ in the United States are cognitively impaired, including the diagnoses of mild cognitive impairment (MCI) and dementia.
Caregivers to these older adults bear significant burden, reflected as high prevalence of chronic stress and mental health problems among the caregiver population. It is thus crucial to understand the wellbeing of the caregiver population to design effective policies. Previous studies have documented survival advantage of dementia caregivers compared to noncaregiving individuals as well as other types of caregivers, namely caregivers to persons with MCI or other types of chronic conditions. However, it remains less clear how the role of social support explains dementia caregiver's survival advantage. In this paper, we directly compare the level and type of social support between different types of caregivers, and examine to what extent the difference in social support explains the survival and health advantage of dementia caregivers compared to caregivers to persons with MCI, non-cognitive impairment chronic conditions and noncaregiving individuals. We use the 12 waves of the Health and Retirement Study and apply multivariate and survival analysis to calculate difference in age-specific hazard ratios. Our preliminary results show that dementia caregivers tend to secure stronger support from family members than caregivers to persons with MCI. Our results have potential to shed light on the empirical puzzle of healthy caregiver selection effect and have direct implications for designing effective intervention to improve health of the caregiver population. Informal caregivers are integral components in the lives of individuals with health problems. However, little is known if the number of hours of informal care correlates with healthcare literacy levels. Thus, using the Center for Disease Control (CDC) Behavioral Risk Factor Surveillance (BRFSS) 2016 public dataset, the aim of this study examines the association between informal caregivers' hours of care and their health literacy level, by controlling their social/emotional support, type of care they provide, and socioeconomic level. Data was weighted for complex sampling design and logistic regression to examine the data (Nf3,249). The study's results show that being full-time or part-time caregiver has no association to healthcare literacy in verbal (OR=0.99, 95% CI=0.57-1.71) and written (OR=1.21, 95% CI=0.78-1.85) comprehensions. Further, caregiver's type of care does not correlate to healthcare literacy level in verbal (OR=0.87, 95% CI=0.58-1.32; OR=0.93, 95% CI=0.59-1.45) and written (OR=0.91, 95% CI=0.66-1.27; OR=0.81, 95% CI=0.57-1.16) comprehensions. However, caregivers who rarely-to-never receive social/emotional support are four times more likely to have difficulties understanding verbal health information than those who have always-to-usually receive social/emotional support (OR=4.02, 95% CI=2.45-6.61). Caregivers who rarely-to-never receive social/emotional support are two times more likely to have difficulties understanding written health information compared to those that have always-to-usually receive social/emotional support (OR=2.30, 95% CI=1.51-3.51). Caregivers with lower socioeconomic backgrounds are at higher probability of low healthcare literacy level. Our study suggests further longitudinal and qualitative research, to understand healthcare literacy level among informal caregivers, and how social support systems correlates to healthcare literacy level.

FACTORS ASSOCIATED WITH VOLUNTEERING AMONG FAMILY CAREGIVERS OF OLDER ADULTS
Sol Baik, 1 Rachel Coleman, 2 and Jennifer Crittenden 2 , 1. University of Virginia Weldon Cooper Center for Public Service,Charlottesville,Virginia,United States,2. University of Maine,Bangor,Maine,United States Family caregiving has been linked to an increased risk of poor mental health, poor physical health, and higher rates of perceived social isolation among caregivers. Despite the connection between caregiving and negative outcomes, or perhaps because of this connection, caregivers seek out and enjoy other life roles and activities including formal volunteerism. To explore the connection between informal caregiving and volunteering and establish the representative prevalence of formal volunteering among caregivers, descriptive and multivariate logistic regression analyses were carried out with data from 1,745 caregivers in the National Study of Caregiving (NSOC) (2017). Utilizing social capital theory four models were constructed with salient demographic characteristics associated with volunteering (model 1), caregiving context (model 2), caregiver physical and mental health (model 3), along with participation in informal and formal social networks (model 4). About a quarter of the sample participated in volunteering (26%). The average age was 60.5 years (SD = 14.3) and more than half consisted of female caregivers (67.11%). Non-Hispanic Whites (62.9%) were the majority of the sample, followed by non-Hispanic Blacks (28%), Hispanic (6.5%), and caregivers in other racial/ethic groups (2.6%). Gender, educational achievement, caregiving for a spouse, coresiding with care recipient, caregiving for multiple care recipients, quality of relationship with care recipient, caregiver psychological well-being, having emotional/physical support, attending religious services, and group activity participation were all significant indicators for caregiver volunteerism. Findings support the importance of both human and social capital in volunteering among caregivers.

EXERGAME INTERVENTION TO PROMOTE FAMILY CAREGIVERS' SOCIAL SUPPORT, PHYSICAL ACTIVITY, AND WELL-BEING Xin Yao Lin, and Margie Lachman, Brandeis University, Waltham, Massachusetts, United States
Family caregivers often experience high stress, social isolation, poor mental and physical health, and have a sedentary lifestyle. The current study was a randomized trial (Nf76) comparing the effectiveness of Go&Grow (social vs non-social exergame app) to promote well-being through increased social support and physical activity for family caregivers over a 6-week intervention. Both groups received daily reminders to use the app. Findings showed the treatment group increased significantly more than the control group in well-being (management of distress) and social support (satisfaction with contact quality). There was an indirect effect Innovation in Aging, 2022, Vol. 6, No. S1