Year: 2026
Type: article
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.
Authors: L F Donelle, S Adams
Institution: University of South Carolina
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,181
OpenAlex ID: W7223663816