This paper views caregiver stress as a consequence of a process comprising a number of interrelated conditions, including the socioeconomic characteristics and resources of caregivers and the primary and secondary stressors to which they are exposed. Primary stressors are hardships and problems anchored directly in caregiving. Secondary stressors fall into two categories: the strains experienced in roles and activities outside of caregiving, and intrapsychic strains, involving the diminishment of self-concepts. Coping and social support can potentially intervene at multiple points along the stress process.

Caregiving and the Stress Process: An Overview of Concepts and Their Measures

Providing care for a frail older adult has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. In this meta-analysis, the authors integrated findings from 84 articles on differences between caregivers and noncaregivers in perceived stress, depression, general subjective well-being, physical health, and self-efficacy. The largest differences were found with regard to depression (g = .58), stress (g = .55), self-efficacy (g = .54), and general subjective well-being (g = -.40). Differences in the levels of physical health in favor of noncaregivers were statistically significant, but small (g = .18). However, larger differences were found between dementia caregivers and noncaregivers than between heterogeneous samples of caregivers and noncaregivers. Differences were also influenced by the quality of the study, relationship of caregiver to the care recipient, gender, and mean age of caregivers.

Differences between caregivers and noncaregivers in psychological health and physical health: a meta-analysis.

In the present meta-analysis, we integrated findings from 228 studies on the association of six caregiving-related stressors and caregiving uplifts with burden and depressed mood. Care recipients' behavior problems showed stronger associations with caregiver outcomes than other stressors did. The size of the relationships varied by sample characteristics: Amount of care provided and care receivers' physical impairments were less strongly related to burden and depression for dementia caregivers than for caregivers of nondemented older adults. For spouse caregivers, physical impairments and care recipients' behavior problems had a stronger relationship to burden than for adult children. Furthermore, we found evidence that the association of caregiver burden with the number of caregiving tasks, perceived uplifts of caregiving, and the level of physical impairment of the care receiver were stronger in probability samples than in convenience samples.

/pdf/associations-of-stressors-and-uplifts-of-caregiving-with-58d3ret9um.pdf

Associations of Stressors and Uplifts of Caregiving With Caregiver Burden and Depressive Mood: A Meta-Analysis

Effects of caregiving on physical health have received less theoretical and empirical attention than effects on psychological health. This meta-analysis integrates results from 176 studies on correlates of caregiver physical health. Caregiver depressive symptoms had stronger associations with physical health than did objective stressors. Higher levels of care recipient behavior problems were more consistently related to poor caregiver health than were care receiver impairment and intensity of caregiving. Higher age, lower socioeconomic status, and lower levels of informal support were related to poorer health. Predictors of physical health are not identical to predictors of psychological health. Associations of caregiving stressors with health were stronger among older samples, dementia caregivers, and men. In sum, negative effects of caregiving on physical health are most likely to be found in psychologically distressed caregivers facing dementia-related stressors.

Correlates of Physical Health of Informal Caregivers: A Meta-Analysis

Assessing social networks among elderly populations.

An examination of data from the 1982 National Long-Term Care Survey reveals that informal caregivers to the disabled elderly are predominantly female and that three-quarters of them live with the care recipient. The data suggest that caregivers as well as care recipients are a vulnerable group since one-third are over age 65, report incomes in the poor to near-poor category and describe t eir health status as fair or poor. Less than 10 percent of the caregivers purchase services. There also is evidence of competing familial and employment demands among a subgroup of caregivers.

/pdf/caregivers-of-the-frail-elderly-a-national-profile-579s8iaqd6.pdf

Caregivers of the Frail Elderly: A National Profile

There is a worsening shortage of competent, committed, paid long-term care workers who are able to meet the needs of older adults. Efforts to address the shortage must be informed by a conceptual framework that acknowledges the unique circumstances affecting these workers. These include nontraditional market forces, low compensation and prestige, limited career opportunities, and inadequate preparation for evolving roles and responsibilities. Applying this framework, we identify strategies that can reverse current trends by expanding worker supply; improving education, training, and developmental activities; and making delivery of long-term care services and supports to older people a more attractive alternative to employment in acute and primary care settings.

Improving The Long-Term Care Workforce Serving Older Adults

The need for a social revolution in residential care

The Feminization of Poverty and Older Women

Better Jobs Better Care was the nation's largest single initiative created to reduce the high vacancy and turnover rates of direct care workers and improve workforce quality through both policy and practice changes. In this article, we describe the important role and key characteristics of direct care workers, what motivated the unique partnership between a provider association and a direct care worker advocacy organization to create this initiative, and how the initiative was designed to respond to the key challenges through applied research and demonstration projects. We conclude by discussing how BJBC has influenced providers, policy makers, and direct care workers to think about these frontline caregivers, who are the crux of the long-term care workforce.

/pdf/the-origins-of-better-jobs-better-care-1jkth9wpeo.pdf

Robyn I. Stone

Papers

Caregivers of the Frail Elderly: A National Profile

Improving The Long-Term Care Workforce Serving Older Adults

The need for a social revolution in residential care

The Feminization of Poverty and Older Women

The Origins of Better Jobs Better Care