Eunika Simons

Date of Award

Summer 2022

Document Type

Open Access Dissertation


Health Services and Policy Management

First Advisor

Janice C. Probst


Purpose. The United States is experiencing unprecedented demographic shifts as the population continues to age. More than 53 million Americans are caregivers and that number is continuing to grow. Caregiving has become a significant societal and public health issue to be addressed. This study provided a population-based national perspective regarding informal caregivers to identify differences between caregivers reporting cognitive decline and those caregivers reporting no cognitive decline. The analysis explored the relationships between the type and characteristics of informal caregivers, the nature of the caregiving relationship, caregiver unmet needs, and the general, physical, and mental health-related outcomes of the caregivers.

Methods. The study used the Behavioral Risk Factor Surveillance System (BRFSS) years 2015-2018 pooled to gather information about caregivers and caregivers reporting subjective cognitive decline. Chi-square and logistic regression were used to analyze data from the BRFSS to examine the associations of caregivers and subjective cognitive decline to determine health outcomes, socio-demographic information, and the functional and social impacts of cognitive impairment.

Results. More than half of caregivers reported memory loss/confusion has interfered with daily activities: work, volunteer, or social activities, and their daily lives were affected by subjective cognitive decline. The study suggests significant differences in demographic characteristics, the nature of the caregiving, and caregiver unmet needs. The findings conclude there is an association between caregivers with subjective cognitive decline and reported poorer health outcomes. The strongest associations with subjective decline were sex—males, employment status—unemployed and unable to work, which may indicate the current status of the caregiver

Conclusion. These findings support the need for further exploration of informal caregivers and in this instance, subjective cognitive decline. The health care system must include caregiver health in the care plans of those care recipients, especially with chronic, long-term health concerns including Alzheimer’s and dementia. Those care recipients require more complex care over a longer period of time and more formal care options might not be available due to cost and geographical location.


© 2022, Eunika Simons

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