Do informal care recipients internalise carer burden? Examining the impact of informal care receipt on health behaviours

Background: Providing informal care has a negative effect on the caregiver’s health and wellbeing, but little is known about how individuals respond to receiving informal care. Care recipients may improve their health behaviours to minimise the onerousness of caregiving and the stress faced by their carer from seeing a loved one in ill-health.
Objective: We aim to examine whether informal care recipients internalise the potential for carer spillovers through changes in health behaviours.
Methods: We used data from 3,250 older adults with care needs who took part in the UK Household Longitudinal Study between 2017 and 2019. We examined the response to informal care receipt in terms of the probability of engaging in four health behaviours: healthy diet, physical activity, smoking, and alcohol consumption. We estimated average treatment effects using regression adjustment with inverse probability treatment weights, comparing individuals that received informal care to those receiving either formal or no care.
Results: We found that informal care receipt increased the probability of refraining from negative health behaviours (smoking and alcohol consumption) but reduced the probability of engaging in positive health behaviours (eating fruits and/or vegetables and physical activity).
Conclusions: The asymmetric effects detected suggest that the underlying mechanisms are different, and care recipients may be engaging in risk and effort compensation between negative and positive health behaviours. Failure to account for the behavioural responses from informal care recipients may lead to under- or over-estimation of the extent of caregiving burden and the effectiveness of interventions impacting informal carers.