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April 26, 2000

Mortality Among Elderly Caregivers—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;283(16):2105-2106. doi:10.1001/jama.283.16.2101

In Reply: Dr Macleod argues that the conclusions of our study linking caregiver strain to mortality are misleading due to confounding with socioeconomic status, which he suggests was inadequately estimated by duration of education. We chose education as a marker based on recent studies showing it to be a particularly sensitive socioeconomic status indicator among the elderly.1,2 We also included other correlates of social position, such as race and other stressful life events (including financial difficulties). Finally, in additional analyses (not reported in our article), we added income level to the Cox regression models, and this did not change the results for caregiving strain. Although we agree with Macleod's point that caregiving has financial as well as physical and emotional consequences, it does not follow, as he suggests, that our conclusions are "misleading" and are "likely to lead to ineffective interventions." Our findings show that identifying distressed older caregivers and alleviating this distress may prevent morbid consequences including death.