Declines in caregiver health have been particularly associated with caregivers who perceive themselves as burdened. Caregiver burden and strain have been related to the caregiver’s own poor health status, increased health-risk behaviors (such as smoking), and higher use of prescription drugs.Researchers have reported that caregivers are at risk for fatigue and sleep disturbances, lower immune functioning, altered response to influenza shots, slower wound healing, increased insulin levels and blood pressure, and higher risks for cardiovascular disease. Caregiver burden and depressive symptoms are the most common negative outcomes of providing care for the elderly and chronically ill.