Longitudinal patterning of caregiving and disturbed sleep among older adults

Informal care by friends and relatives is a central pillar of English social care policy, increasingly necessary to meet the needs of a growing number of older adults (Vlachantoni et al, 2011). Insufficient and disturbed sleep has been linked to a variety of negative health outcomes among older adults including caregivers (Kumari et al, 2010). Poor sleep among caregivers has been associated with reduced quality of life (Cupidi et al, 2012) and cited as a significant reason for cessation of caregiving (Pollak and Perlick, 1991) and is therefore of direct relevance to social care policy. The majority of research on caregiver sleep is cross-sectional, leaving a gap in knowledge about the situations and personal characteristics that may influence sleep outcomes over time. The research conducted as part of my MSc degree was a first step in addressing this research gap. I investigated the association between co-resident caregiving and problematic sleep over a four-year period using data from Understanding Society. A key finding from this research was that co-resident caregivers had a significantly higher risk of suffering problematic sleep than non-caregivers (odds ratio 1.47, 95% confidence interval: 1.06-2.03) (Maun, 2016). This PhD research will significantly extend the work carried out during my MSc, developing the theoretical framework, using advanced quantitative methods, and a wide range of variables to identify confounding and contributory factors to disturbed sleep.

The research questions to be addressed in this research are: How is disturbed sleep patterned among older caregivers by hours of care, duration of care and when entering into and leaving caregiving, in comparison to non-caregivers? What is the longitudinal relationship between caregiving and disturbed sleep and does this relationship hold after accounting for background and context characteristics, primary and secondary stressors and mediating factors?

These research questions will be explored through secondary quantitative analysis of longitudinal data from the English Longitudinal Study of Ageing (ELSA). ELSA is an ongoing, nationally representative sample of 12,000+ individuals aged 50 and over living in private households in England. The sample for the study will include individuals responding to waves 4, 6 and 8, the waves including sleep questions. The research will develop the theoretical framework for the study of caregiver sleep, modifying the caregiver stress framework (Pearlin et al, 1990). Methods to be used include latent variable models such as exploratory and confirmatory factor analysis, and Latent Class Analysis to analyse data from sleep questions and produce a single indicator of disturbed sleep. Panel and multilevel models using fixed and random effects will be used to analyse repeated measurements across waves of data. Structural equation models will test possible mediators of the relationship between caregiving and sleep.

I am developing an advisory group of individuals from the third and public sectors, for instance Carers UK, who can provide advice from a policy perspective as I shape my research, practice-insights into my research findings, and advise me on presenting the research in a policy- and practice-relevant way, increasing the impact of the study beyond the academic sphere.

The research will address how caregiving characteristics relate to sleep, and incorporate a wide range of possible contributory and confounding factors. The findings will contribute to an understanding of changes in caregiver sleep in relation to caregiving, sociodemographic, health and psychological characteristics. Research outcomes will be relevant to social care policy makers and practitioners involved in improving support for carers; and may stimulate interest in piloting and evaluating supportive interventions.