Commentary

Caregiving has long been associated with psychological and physical morbidity, but the study by Schulz and Beach is the first to identify a link between caregiving and mortality. The authors studied older adults living with their spouses, and the definition of caregiving hinged on the disability of the spouse rather than on the provision of help by the participant.

In an accompanying editorial, Kiecolt-Glaser and Glaser point out the potential for underestimation of mortality risk because of the broad definition used for caregiving and because caregiving status was identified only at baseline.¹ They also highlight the complex interplay between physical health and depression and the particular disadvantages faced by caregiving spouses who have to cope simultaneously with an ill person in the house, the loss of a partner's support, and a reduction in opportunity to seek support elsewhere.

No details are given of spouses' illnesses, and participants' perception of who cares for whom seems based on comparison of their own and their spouses' illness to determine who is “less ill” or “more able.” We may assume that caregivers with cardiovascular disease who rate themselves as “helping” are likely to have spouses with profound disabilities or terminal illness.

The need to focus care planning on the couple is emphasised in both the article and the editorial. To do this, the interaction between both partners must be considered rather than the simple summation of individual needs. Health and social care providers may need to instigate changes in conceptual frameworks used for assessment and intervention. For example, they may need to consider interpersonal or systemic models and changes in organisational procedures, such as cross referencing of records, before couple focused planning can be successful.