Understanding “Good Days” and “Bad Days”: Emotional and Physical Reactivity Among Caregivers for Elder Relatives*

Abstract: Using a daily diary design, we examined fluctuations in caregiver well-being; how day-to-day variations in stressors related to the caregiving experience are linked to fluctuations in well-being; and whether caregivers who are women, or high on certain personality traits (e.g., neuroticism) are more susceptible to emotional/physical health fluctuations in the face of daily stressors. Sixty-three caregivers reported on eight consecutive days. Multilevel analyses (Hierarchical Linear Modeling) indicated significant within-person reactivity. On days when caregivers faced more tasks than usual, more care recipient behavior problems, or more family disagreements regarding care, they experienced more depressive symptoms, feelings of burden, and physical symptoms. Some within-person patterns of reactivity were moderated by gender and personality. Implications for community interventions for caregivers are discussed. Key Words: caregiving, daily diary, family, gender, multilevel analysis, personality, well-being. (ProQuest Information and Learning: ... denotes formulae omitted.) Despite the fact that numerous studies have confirmed the link between caregiving for dependent elders and family caregivers' experience of mental and physical health problems (see reviews by Pinquart & Sorensen, 2003, 2005; Vitaliano, Zhang, & Scanlan, 2003), we know little about the day-today variations in the caregiving experience and how they might link to fluctuations in the well-being of individual caregivers. Such information is important, however, because as noted stress scholar Pearlin (1994) has suggested, "[caregiving] stressors do not simply exist at some static level; instead, they develop and change as the conditions and circumstances of caregiving itself develop and change" (p. 12); moreover, "outcomes [for caregivers] are best thought of not as end-states but as patterns of continuity and change that parallel continuities and changes in the conditions of caregiving" (p. 18). Although Pearlin's (1994) model refers to development and change from a long-term perspective, most individuals in a caregiving role likely experience a range of both "good days" and "bad days"-that is, they experience day-to-day fluctuations in caregiving stressors and personal well-being. Yet, existing studies typically only tap caregiver experiences and well-being in a general, summarized, and retrospective fashion (e.g., over the past month) and, therefore, only provide information on between-person or mean-level differences (e.g., wellbeing of caregivers vs. noncaregivers). As such, these studies serve to tell us which groups of people, on average, suffer from more or less mental and physical health problems. However, we have little understanding of within-person variation (i.e., how and why caregivers vary around their own mean in terms of psychological and physical well-being). In response to this critical gap in the literature, the purpose of the present study was to (a) document within-person variability or daily fluctuation in caregivers' experiences and well-being, (b) determine whether caregivers report more signs of negative well-being on days when they report higher than usual care demands or care-related stressors, and (c) identify which caregivers are particularly susceptible or reactive to fluctuations in daily care demands and care-related stressors. Conceptual Framework: Day-to-Day Stressors and Caregiver Well-Being At the heart of Pearlin's (1994) caregiver well-being model are stressors defined as "conditions, experiences, and activities that are problematic for people" (Pearlin, Mullan, Semple, & Skaff, 1990, p. 586) and have the capacity to impair mental and physical health (Pearlin, 1994). Stressors are categorized as either primary or secondary. Primary stressors stem directly from the needs of the care recipient and the nature and extent of caregiving demanded by those needs. …