The Invisible Risk: Evidence from a National Health Survey on Caregivers’ Risk of Dementia
Abstract
Objectives: An estimated 63 million unpaid US caregivers constitute a substantial yet often invisible healthcare workforce. This study examined population-level risk for cognitive decline among U.S. adults and compared dementia risk profiles between unpaid caregivers and non-caregivers to inform public health prevention strategies.
Methods: A secondary analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative health surveillance dataset, was conducted. Twelve of the 14 evidence-informed modifiable dementia risk factors identified by the 2024 Lancet Commission were operationalized using BRFSS variables. Respondents were categorized as unpaid caregivers or non-caregivers. Weighted descriptive and comparative analyses assessed the prevalence and distribution of dementia risk factors across caregiving status and demographic characteristics.
Results: The sample included 17,055 caregivers and 58,630 non-caregivers; 22% of respondents identified as unpaid caregivers. Caregivers were predominantly women caring for a parent, spouse/partner, or child, with over half reporting caregiving durations of 2 or more years. Compared to non-caregivers, unpaid caregivers demonstrated significantly higher prevalence of 9 of 12 modifiable dementia risk factors. These findings indicate a disproportionate burden of preventable risk factors among caregivers.
Conclusions: Unpaid caregivers represent a high-risk population for cognitive decline within a public health context. The concentration of modifiable dementia risk factors underscores the need for targeted prevention and surveillance strategies that incorporate caregiver status as a key determinant of cognitive health and to advance the ‘patient as family’ model of care. Integrating caregiver risk into dementia prevention frameworks advances population health approaches and informs health promotion and aging policy.
Key messages: • Unpaid caregivers are a large, essential workforce but face higher dementia risk due to more preventable risk factors, highlighting a gap in current public health strategies.
• Dementia policies should prioritize caregivers through risk screening and targeted supports, recognizing them as both care providers and at-risk individuals.
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BibTeX
@article{donelle2026invisible,
title = {{The Invisible Risk: Evidence from a National Health Survey on Caregivers’ Risk of Dementia}},
author = {L F Donelle and S Adams},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1015},
url = {https://doi.org/10.1093/eurpub/ckag169.1015},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - The Invisible Risk: Evidence from a National Health Survey on Caregivers’ Risk of Dementia
AU - L F Donelle
AU - S Adams
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1015
UR - https://doi.org/10.1093/eurpub/ckag169.1015
AB - Objectives: An estimated 63 million unpaid US caregivers constitute a substantial yet often invisible healthcare workforce. This study examined population-level risk for cognitive decline among U.S. adults and compared dementia risk profiles between unpaid caregivers and non-caregivers to inform public health prevention strategies. Methods: A secondary analysis of the 2023 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative health surveillance dataset, was conducted. Twelve of the 14 evidence-informed modifiable dementia risk factors identified by the 2024 Lancet Commission were operationalized using BRFSS variables. Respondents were categorized as unpaid caregivers or non-caregivers. Weighted descriptive and comparative analyses assessed the prevalence and distribution of dementia risk factors across caregiving status and demographic characteristics. Results: The sample included 17,055 caregivers and 58,630 non-caregivers; 22% of respondents identified as unpaid caregivers. Caregivers were predominantly women caring for a parent, spouse/partner, or child, with over half reporting caregiving durations of 2 or more years. Compared to non-caregivers, unpaid caregivers demonstrated significantly higher prevalence of 9 of 12 modifiable dementia risk factors. These findings indicate a disproportionate burden of preventable risk factors among caregivers. Conclusions: Unpaid caregivers represent a high-risk population for cognitive decline within a public health context. The concentration of modifiable dementia risk factors underscores the need for targeted prevention and surveillance strategies that incorporate caregiver status as a key determinant of cognitive health and to advance the ‘patient as family’ model of care. Integrating caregiver risk into dementia prevention frameworks advances population health approaches and informs health promotion and aging policy. Key messages: • Unpaid caregivers are a large, essential workforce but face higher dementia risk due to more preventable risk factors, highlighting a gap in current public health strategies. • Dementia policies should prioritize caregivers through risk screening and targeted supports, recognizing them as both care providers and at-risk individuals.
SN - 1101-1262
SN - 1464-360X
ER -