Better care for family caregivers

People who help sick, aging loved ones are at risk for physical illness themselves. There may be ways to improve their resilience

By Lydia Denworth edited by Josh Fischman

https://www.scientificamerican.com/

This article was made possible by the support of Yakult and produced independently by Scientific American’s board of editors.

My mother lived with Alzheimer’s disease for 12 years. Even with a lot of help, caregiving took a toll on me. It was physically hard to transfer her from bed to wheelchair, hard on my time when Mom couldn’t be left alone, and emotionally devastating as her decline took away the person I had known and loved. She passed away in 2024.

Roughly one in five American adults is now where I was: responsible for the care of a chronically ill or disabled loved one. About half of them are doing this work for elderly relatives. It is well known that family caregivers are at higher risk than noncaregivers for depression. But such helpers also have more than their share of diabetes, asthma, obesity and a variety of pain conditions. And they tend to die earlier. In a study by the U.S. Centers for Disease Control and Prevention released in 2024, caregivers scored worse than noncaregivers on 13 of 19 health indicators. The root cause, research shows, is chronic stress. It leads not only to mental distress but also, by hampering the immune system, to physical ailments.

Caregivers are finally getting some care, however. Scientists are using what they’ve learned about how stress affects mental and physical function to develop approaches that could strengthen resilience. “It’s important to understand that the caregiving itself, though a strain, does not determine worse mental and physical health,” says psychologist Elissa Epel, who directs the Aging, Metabolism and Emotions Center at the University of California, San Francisco. “There are a lot of resilience factors that can make a difference.”

Innovative programs providing support and resources are slowly being replicated around the country. And in 2024 the Centers for Medicaid and Medicare Services adopted policies that will help physicians train people to provide direct care to relatives and will support both doctors and families as they do so.

Combined with depression, the strain of caregiving increases inflammation that contributes to age-related bodily damage, an effect called inflammaging.

The connections among chronic stress, impaired immunity and physical problems came to light in the 1980s and 1990s in pioneering work by psychoneuroimmunologist Janice Kiecolt-Glaser of the Ohio State University. Among other things, she found that spouses caring for ill partners recovered more slowly from puncture wounds on their arms than those who weren’t providing care.

Caregivers also appear biologically older than people without a caregiving burden. “We know caregiving accelerates many domains of aging,” says social psychologist Kathi Heffner, associate chief of research in the geriatrics and aging division of the University of Rochester Medical Center. Combined with depression, the strain of caregiving increases inflammation that contributes to age-related bodily damage, an effect called inflammaging. Studies of caregivers show decreases in the enzyme activity that protects telomeres, caps on the ends of chromosomes that get shorter as people get older. Those telomeres shrink faster in people who are under stress, and that includes caregivers.

As we age, our bodies also produce fewer naive T cells—immune cells the body holds in reserve until it is faced with a novel attacker, such as SARS-CoV-2, the virus that causes COVID. A person’s T cell profile, the ratio of naive to mature cells, can indicate the health of their immune system. Epel and her colleagues showed in 2018 that parents caring for disabled children have T cell profiles that skew toward fewer naive ones, and this observation is consistent with accelerated immunological aging.

One obvious way to help caregivers is to lower their burden. In a program called Caring for Caregivers at Rush University Medical Center in Chicago, one of the goals is to raise awareness of the effects of caregiving and change the culture among health-care providers. “We want primary-care doctors to start asking, ‘Are you providing care for someone?’” says Diane Mariani, a social worker and program manager of Caring for Caregivers. “Then it should go further: ‘How do you feel it might be affecting your health?’” And go further still, with the doctor offering possible remedies.

Unfortunately, a caregiver’s burden often grows over time, especially when they are caring for someone with cancer or dementia. “The stressors aren’t going to go away,” Heffner says. “In fact, the challenges are going to increase as the disease progresses.” That’s why Heffner, Epel, and others are looking to strengthen resilience. They have noticed that not all caregivers are affected in the same way. “People can find more meaning and purpose in being a caregiver,” Epel says. Those with social support seem to do better.

In a 2025 randomized trial, Heffner tested cognitive training (such as brain games) as a strategy to build resilience. Previous studies found such training and games can produce faster neural processing in people, and that speed correlates with higher adaptability to stress. Ninety-six people caring for loved ones with dementia played games designed to improve their speed of processing and attention for eight weeks; another 96 watched educational videos. The game players showed significantly improved processing speed and attention six months later. “A year later they reported being less bothered by the memory and behavioral challenges of the person they were caring for,” Heffner says. She is now examining blood work from the study participants to look for any improvements in immune responses and to see whether the cognitive training slowed aging in T cell profiles.

“If we can increase the capacity for stress adaptation in these caregivers, that’s going to lead to better outcomes and to better quality of life for the caregivers,” Heffner says. That’s a result we should all care about.

Lydia Denworth is an award-winning science journalist and contributing editor for Scientific American. She is author of Friendship: The Evolution, Biology, and Extraordinary Power of Life's Fundamental Bond (W. W. Norton, 2020) and several other books of popular science.