An estimated 1,250,000 older persons have a severe mental illness (SMI). This number is expected to double by 2030. While many research studies have examined the characteristics and needs of caregivers of demented elders and of younger persons with SMI, very little is known about caregivers of elders with SMI (ESMI). The purpose of this study was to examine the objective and subjective burden experienced by ESMI caregivers. A telephone survey was used to obtain information from a sample of 60 familiar caregivers of persons age 55 and over with a diagnosis of schizophrenia, bipolar disorder, or major recurrent depression. A modified version of Tessler, Fisher, & Gamaches' family caregiver scales (1992) was used to determine respondents' objective and subjective burden. Objective burden was operationalized as the amount of help provided to the care recipient with daily activities while subjective burden was defined as the amount of stress experienced as a result of help provided. Almost 40% of the subjects were adult children while 26% were siblings. 85% had at least weekly contact with their afflicted family member. One-third lived with their ESMI relative. Findings revealed that all caregivers provided help with daily activities to their SMI relative. Caregivers indicated that their older SMI relatives exhibited a substantial number of mental health symptoms (M = 11.5, SD = 5.5), the most frequently occurring being depression, lethargy, being worried, and having difficulty thinking. The level of subjective burden reported by the caregivers ranged from none at all to a moderate amount (M = 6.5, SD=3.5). The activity which the caregivers perceived as most burdensome was providing assistance with grooming, bathing, and dressing. Hierarchical linear regression analysis revealed that those caregivers who had more contact with their ill family member, whose care recipient's symptoms included guilt and lethargy, and who had contact with a mental health provider experienced increased objective burden, F (4,58) = 10.8, p < .001; R² = .41. Factors predictive of subjective burden included increased client symptoms, higher levels of help provided to the client, increased income, and knowing the care recipient's diagnosis, F (4,46) = 13.8, p < .001;, R² = .51. Family members provide valuable assistance and resources to older persons with SMI. As seen in the current study, some experience substantial burden as a consequence of the caregiving activities. Few services currently exist for these caregivers. Routine evaluation of ESMI caregivers' needs is called for to ensure that family members receive the supports needed to effectively engage in their caregiving role. Further, interventions are needed that enhance ESMI caregiver ability to handle the practical and emotional demands of their caregiving role.

Tessler, R. & Gamache, G. (2000). Family experiences with mental illness. Westport, CT: Greenwood Press.