Developing and Examining a Model of Stressors, Caregiver Strain and Multidimensional Outcomes for Older Spousal Caregivers

Background and Purpose: With a global trend of population aging, the issues with elder care have become more prevalent across the world. As a fast-aging economy that ranked number one for life expectancy in the world, Hong Kong is facing an increasing demand of elder care. Family has been the most consistent source of elder care in Hong Kong. Fueled by years of late marriages and low fertility rates, families in Hong Kong are shrinking in size, leaving older spouses to take the primary responsibility as caregivers. Older spousal caregivers may experience substantial strain resulting from the intersection of aging and family caregiving. However, few studies have examined caregiver strain in this population. Moreover, the extant studies mainly focused on the factors contributing to caregiver strain or a single dimension caregiving outcome. In view of the scarce and discontinued investigations, this study established a new model to examine the mediation effect of caregiver strain on the associations between caregiver stressors and multidimensional outcomes.

Methods: This study employed a cross-sectional survey design. Data were drawn from the survey “Profile and Service Needs of Hong Kong Elderly Carers”. The survey consisted of a convenience sample of 1115 family caregivers of older adults. The current analysis was based on a subsample of spousal caregivers aged 65 or older, who were not employed at the time of the survey (N = 645). Caregiver stressors included caregiver age, retirement status, perceived income adequacy, care recipient’s activities of daily living (ADL) and instrumental activities of daily living (IADL). Caregiver strain was measured using the Chinese version of Caregiver Burden Inventory (C-CBI). Four adverse outcomes were measured: financial burden (the Financial Burden Scale), poor physical health (the Global Health Scale), depressive symptoms (the Patient Health Questionnaire-2), and negative family functioning (the negative subscale of General Functioning Scale). Structural equation modeling was used to examine the mediating effect of caregiver strain on the relationship between stressors and caregiving outcomes.

Results: Four mediational pathways were identified. Caregiver strain partially mediated the effects of perceived income adequacy on (1) financial burden and (2) poor physical health. The effects of ADL assistance on (3) financial burden and (4) depressive symptoms were also partially mediated by caregiver strain. Moreover, several stressors were associated with greater caregiver strain, including being younger, low income adequacy, and more ADL and IADL assistance. Perceived income adequacy and ADL assistance were also found to be directly associated with financial burden, poor physical health, and depressive symptoms. Additionally, caregiver strain was associated with all four adverse outcomes.

Conclusions and Implications: this study makes innovative contributions to caregiving research by establishing a conceptual framework for older spousal caregivers and identifying the mediating role of caregiver strain in the relationship between stressors and multidimensional caregiving outcomes. Social work interventions focusing on reducing caregiver strain is needed. Moreover, the findings revealed the risk factors for caregiver strain (i.e., ADL and IADL assistance, low income adequacy). Social services, such as in-home respite care and financial assistance, should be provided to older spouses.