Type of caregiver and its association with mortality among adults aged 65 years and older who require assistance with activities of daily living in China: a longitudinal study

A large proportion of older adults (age 65 years and older) in China need assistance with activities of daily living. The quality of care for this population has attracted growing attention. However, little is known about the patterns of their caregiver type or its association with mortality rates. We examined the pattern of primary caregiver type among community-dwelling older adults in China, and the association between caregiver type and mortality. Data were from the China Longitudinal Health and Longevity Study (an ongoing survey conducted in 22 provinces) from 2005, 2008, and 2011. We described the relative frequency of caregiver type among married and widowed adults aged 65 years and older. Cox models were used to examine the association of primary caregiver type with mortality. The research ethics committees of Peking University and Duke University granted approval for the protection of human subjects for the China Longitudinal Health and Longevity Study. All study participants gave informed written consent. We included 437 married and 3971 widowed participants. The average age was 96·7 (SD 6·9) years and 73·7% (3332 of 4408) were female. For married people, the primary caregiver was the spouse (55·1%, 241 of 437), son and daughter-in-law (25·2%, 110 of 437), daughter and son-in-law (12·1%, 53 of 437), grandchild (2·3%, 10 of 437), or housekeeper (3·9%, 17 of 437). For widowed people, the primary caregiver was the son and daughter-in-law (60·2%, 2462 of 3971), daughter and son-in-law (21·1%, 864 of 3971), grandchild (9·9%, 403 of 3971), or housekeeper (5·9%, 242 of 3971). A multivariable adjusted model (a regression model with one outcome and adjusting for multiple variables) showed that among married adults aged 65 years and older, hazard of death was higher when the primary caregiver was a son and daughter-in-law (41% [95% CI 6–87]) or daughter and son-in-law (67% [10–154]) than when the spouse was the primary caregiver. For widowed people, hazard of death was lower when the primary caregiver was a daughter and son-in-law (12% [3–20]) or a grandchild (14% [2–24]) than when a son and daughter-in-law was the primary caregiver. The majority of adults aged 65 years and older who need assistance with activities of daily living in China relied on their spouse and children to care for them. The type of primary caregiver was associated with mortality rate in both married and widowed people. More resources should be allocated to such older Chinese adults w