Millions of people combine work with caring responsibilities – looking after an older relative, a disabled child or a partner, for example. In the UK we rely heavily on family and friends to provide care. Indeed, it’s estimated that carers save the UK economy around £132 billion per year. But caring for someone is likely to be both physically and mentally demanding and the knock-on health effects of that over time are poorly understood. So what are the consequences of caring and are those consequences greater for some than others?
The number of people who care for others without pay is huge and it’s growing. In the United Kingdom there are more than seven million such carers – around one in five adults. About six in 10 of them are women. We also know that becoming a carer can mean having to stop work – but times have changed, and an ageing society, extended working lives and cuts in social care funding can now mean that those doing this unpaid caring are also increasingly often juggling these responsibilities and paid work.
All this is very likely to result in little time for themselves: less time to exercise and to eat healthily for example. Carers may also suffer additional financial burdens leading to measurably higher levels of stress – for example, research has shown that carers have higher levels of cortisol, which can cause the body to lay down fat.
Caring is linked to behaviour which leads to health risks, as well as to poorer health. Carers can suffer from the deterioration of their relationships with those they care for – particularly when the person needing to be cared for has dementia for example.
Causes and consequences
As part of an ESRC-funded research project looking at life course causes and consequences of caring, our research looked at how work and family histories influence caring, and how caring influences people’s health and well-being.
In particular, we were keen to know more about whether particular groups of carers were at increased risk of being obese and also if they were more likely to experience psychological distress than people with no caring responsibilities. We were able to use a major study, Understanding Society, which has followed a representative sample of 40,000 UK households since 2009
Caring and obesity
This enabled us, for the first time, to look at obesity amongst UK carers from the age of 16 onwards: previous studies had only looked at older carers or carers of those with specific conditions such as dementia.
We had information on 9,421 participants who had also been visited by nurses for health checks between 2009 and 2012, of whom 1,282 were carers. We were able to look at factors such as Body Mass Index (BMI) alongside whether participants had an illness or disability, their education, occupation, household income, socioeconomic position, partnership status and whether they were parents.
We looked at whether people were carers and, if so, how many people they cared for and for how many hours in the week. And we also looked at whether they were also doing paid work, and if this was full or part-time. Nurse visits were used to measure participants’ weight, percentage of body fat and BMI.
Roughly in line with national figures, we found women were more likely to be carers and to put in more hours of care each week. Female carers were more likely than their male counterparts to have children at home and also to be working outside the home – this may be because male carers tend to be older.
When we looked at whether men’s caring was linked to obesity, we did find an association – men who were carers had higher BMI and larger waists. However, once we had taken differences in age into account we didn’t find this statistically significant.
But when we looked at women, the story was rather different. In contrast to men, women who were carers were significantly more likely to have larger waists or a higher percentage of body fat. And there was a particularly strong effect when it came to women who combined caring with full-time work: amongst young women aged 16-44 who were in full time work, those who were carers had waists 4cm larger, on average, than those who were not carers. Those who were caring and working beyond the age of 65 were also larger, with higher proportions of body fat and bigger waists.
Caring and mental health
For the second part of our research, looking at whether and how caring for someone might be linked to poorer mental health over time, we used 7 years of data from when the Understanding Society study first collected information in 2009. We made use of information on all those people in the study who were not caregivers in that first year, so we could see any effects of becoming a carer later on. We were able then to track the health of all those people through till 2015.
Once again, we had information on more than 9,000 people for this part of our work. We could also see whether and for what periods of time this group of people were caring for someone sick, disabled or elderly at home or elsewhere. Information given by the participants about how often they experienced lack of sleep, found it hard to concentrate or to make decisions, felt strained or overwhelmed enabled us to see whether our carers were more psychologically distressed than non-carers.
Again we could see that women were more likely to be carers than men, especially when it came to long term caring. And those women who were involved in caring for someone long term had slightly worse mental health scores than women who weren’t caring for someone, or only did so for a short episode.
The mental health of men in the study who cared for someone at some point, no matter how long the period of time, changed very little even at the outset. Women’s mental health took a greater knock, especially at the time when they started caring for someone, but interestingly did not get significantly worse over time.
What this suggests to us is that levels of psychological distress for women are raised when they start to care for someone and that they remain raised, irrespective of all the other background factors we took into account.
Why are women more vulnerable?
Women it appears are particularly vulnerable to the longer-term effects of caring for someone, partly because of how they have to adapt to their changed circumstances and partly because of the longer term ‘wear and tear’ associated with it.
Why is this? Why would women’s health potentially suffer a greater adverse effect than men’s from being a carer? Clearly the fact that women carers do more hours of caring than men is at play here, but in addition to that, it seems the strains on them may be greater – younger women may be working outside the home and may also be caring for children, for instance. They may lose touch with friends who have more freedom to enjoy leisure time. Carers are likely to have less time to spend exercising or to prepare healthy and nutritious meals – and those combining several caring roles with working life are likely to be particularly hard-hit.
This matters, not least because the scale of the issue is so great – and because the UK relies so heavily on family and friends to provide care. What’s clear from our research is that we need to make this largely hidden army of unpaid carers a public health priority not least because of the valuable contribution they make, but also to avoid exacerbating the obesity and mental health crises facing our health services and society more broadly.
Emily Holzhausen OBE from Carers UK, a charity which supports and campaigns for a better deal for carers, agrees our research findings are vital in demonstrating the importance of seeing caring as a public health issue and that it is sound evidence that more needs to be done to tackle physiological stresses of caring, as well as the impact on mental health.
She told us: “There is certainly more work that can be done to look at whether there are particular elements of stress within certain groups of carers and particularly male carers.”
With family and friends taking on ever increasing amounts of care and complexities of tasks, we have to ensure that it does not result in worsening health and wellbeing as a result. Carers UK would like to see every Director of Public Health across the country make the health and wellbeing of carers one of their priorities in the coming year.”
Rebecca Lacey is Senior Research Associate in the Department of Epidemiology & Public Health at UCL. Informal caregiving and markers of adiposity in the UK Household Longitudinal Study and Informal caregiving patterns and trajectories of psychological distress in the UK Household Longitudinal Study are research projects undertaken by Rebecca Lacey, Anne McMunn and Elizabeth Webb of the ESRC International Centre for Lifecourse Studies, University College London.