Co-resident care-giving and problematic sleep among older people: evidence from the UK Household Longitudinal Study

Abstract

In light of current pressures within formal social care services, informal carers assume an important role in meeting the care needs of a growing number of older people. Research suggests relationships between care-giving and health are complex and not yet fully understood. Recently, wide-ranging associations between sleep and health have been identified, however, our understanding of the links between care-giving and sleep is limited at present. This study assesses longitudinal patterns in co-resident care-giving and problematic sleep among older people in the United Kingdom. Our sample included 2,470 adults aged 65 years and older from the UK Household Longitudinal Study. Problematic sleep was defined as two or more problems in going to sleep, staying asleep or sleep quality. Using logistic regression models, we assessed how co-resident care-giving status, intensity and transitions influence the likelihood of problematic sleep in the following year, adjusting for potential confounding factors. Adjusted analyses found co-resident care-givers were 1.49 (95% confidence interval = 1.06–2.08) times more likely to report problematic sleep in the following year, relative to those not providing care. Care-giving over 20 hours per week and continuous co-resident care-giving also significantly increased the odds of problematic sleep. This suggests older co-resident care-givers may be at greater risk of incurring sleep problems than non-care-givers. Further longitudinal research is needed to investigate care-giver-specific consequences of poor sleep.

Factors associated with the sleep of carers: A survey of New Zealanders supporting a family member with cognitive impairment or dementia

“…Notably, only 30% rated themselves as satisfied or very satisfied with their sleep. The prevalence of sleep disturbances was higher than in the general adult population (Paine et al., 2004; Sadeghniiat-Haghighi et al., 2014) and comparable to other studies including older people or carers (Gibson et al., 2015; Gibson, Gander, Paine, et al., 2016; Maun et al., 2018; Peng & Chang, 2013). Dementia-related carers have been identified as particularly vulnerable to sleep disturbances due to the heightened responsibilities associated with supporting their family member across day and night (e.g.…”

“…All these items were significantly related to ISI scores at the univariate level, but only self-reported health status remained independently associated with sleep status in the multiple linear and logistic regression models (Tables 3 and 4). These findings provide support for the theory of sleep as a secondary stressor resulting from the caregiving role (Maun et al., 2018; Simpson & Carter, 2013b) and the tendency of carers to relegate their own health issues to the background, given the often encompassing nature of the caregiving role (Cheng, 2017; Pearlin et al., 1990). However, the present survey did not include detailed scales evaluating carers’ mood and stress in relation to carer burden, which might be of value for future studies.…”

“…Sleep problems are among the most disruptive behavioural symptoms of dementia and have been associated with the neurophysiological pathology of the disease, exacerbated primary sleep disorders, a reduction in exposure to time cues, changes to psychosocial context as well as the impact of comorbidities and medications. Dementia-related sleep problems have been identified as exacerbating the waking symptoms of dementia (Bliwise, 2004; McCurry & Ancoli-Israel, 2003), as well as contributing to poorer sleep, reduced vitality and quality of life among family carers (Gehrman et al., 2018; Gibson, Gander, Alpass, & Stephens, 2015; Hope et al., 1998; Maun et al., 2018; McCurry et al., 2015). In a psychosocial model, sleep disturbances have been identified as a secondary stressor to those primarily related to caregiving.…”

“My quiet times”: Themes of sleep health among people caring for a family member with dementia

“…Such themes are akin to those described by young parents and shift workers (Gander et al, 2019;Gay et al, 2004). However, an important difference for this population is that they are typically of older age and have responsibilities on a 24/7 basis yet are unpaid and under supported (Jorgensen et al, 2010;Maun et al, 2018;Pearlin et al, 1990). Sacrificing sleep was implied as an expected part of the carer role.…”

“…Sleep disturbances are common among people with dementia, with symptoms commonly including dysregulated sleep timing, increased symptoms of insomnia, night time agitation or confused behaviours, nightmares and daytime sleepiness (Bliwise, 2004;McCurry & Ancoli-Israel, 2003). Informal carers often have sleep disturbances secondary to the care recipient's sleep as well in response to the often 24/7 nature of caregiving and stress related to the situation (Gibson & Gander, 2020;Gibson et al, 2014;Jay et al, 2019;Maun et al, 2018;McCurry et al, 2015).…”