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. Combination of cognitive impairment, frailty, perceived stress, and excessive burden poses a risk to the health of caregivers.  Objectives: This study aimed to investigate the influence of the combination of these conditions on the occurrence of hospitalizations and deaths among older caregivers in a 4-year follow-up period.  Methods: This is a longitudinal study in the communities with 351 older caregivers who underwent gerontological and geriatric evaluations in 2014 and completed cognitive (Mini-Mental State Examination), physical frailty (Cardiovascular Health Study criteria), perceived stress (Perceived Stress Scale), and care burden (Zarit Burden Interview) assessments. In 2018, data on hospitalization and mortality were collected.  Results: As a result, 32 (12.6%) caregivers had deceased. Among the 228 survived caregivers who were reevaluated, 24% reported using hospital services in the previous year. Mean length of hospital stay was 3 days (range: 1–22 days). Hospitalization was associated with cognitive impairment co-occurring with frailty (p=0.05), stress (p=0.03), burden (p=0.01), and frailty co-occurring with stress (p=0.04). Considering singular effects, the mortality rate (33.3%) was higher among frail caregivers, followed by those with cognitive impairment (23.1%) and a high level of perceived stress (20.4%). Considering accumulative conditions, mortality rate (43.8%) was higher among frail older caregivers with cognitive impairment, followed by those with a high level of perceived stress and cognitive impairment (32.4%).  Conclusions: The investigation of accumulated effects is important to the identification of potentially vulnerable older caregivers as well as the management and monitoring of the care, health, and independence of those who provide care for other older adults.

Accumulated cognitive impairment, frailty, burden, and perceived stress and the risk of hospitalization and mortality in older caregivers