Stressors, Coping Resources, and Psychological Health: Comparing Caregivers of Older Adults with and without Dementia

Background and Purpose:

The adverse psychological effects of dementia caregiving are well-documented in research. Compared to the broader population of caregivers, caregivers of older persons living with dementia experience higher levels of psychological distress and poorer psychological well-being. Research indicates that caregiver role overload (i.e., the sense of feeling overwhelmed by caregiving demands that exceed available resources) is a significant stressor that can increase psychological distress, whereas coping resources such as caregiver perceived gain and resilience can improve psychological well-being. The purpose of this study is to examine how stressors and coping resources influence psychological health for caregivers of older adults with and without dementia, and if the identified associations are different for the two caregiver groups.

Methods:

This study used a cross-sectional research design. Data were drawn from the 2017 National Study of Caregiving, which included caregivers of Medicare enrollees aged 65 and older in the United States. Caregivers of older adults with (N=894) and without (N=1,348) dementia were included in the analysis. Psychological distress was measured using the Patient Health Questionnaire (PHQ)-4. Psychological well-being was assessed using the Ryff Scales of Psychological Well-Being. Caregiver role overload was measured using the Role Overload Scale. The Connor-Davidson Resilience Scale was used to assess resilience. Perceived gain was measured using an index of 4 items that described the benefits of caregiving. Linear regression models were estimated separately for the two caregiver groups, adjusting for caregivers’ age, gender, race, imputed annual income, and self-rated health. For the significant effects of caregiver stressors and coping resources on psychological health, a series of Wald test was conducted to identify whether any of these effects was significantly different between the two caregiver groups.

Results:

Role overload was found to be positively associated with psychological distress but negatively associated with psychological well-being in both caregiver groups. Resilience was negatively associated with psychological distress but positively associated with psychological well-being in both groups of caregivers. Moreover, perceived gain was positively associated with psychological well-being but not associated with psychological distress. Further, this positive association was significantly different between the two caregiver groups—perceived gain had a stronger effect on psychological well-being for caregivers of older adults with dementia, compared to caregivers of older adults without dementia.

Conclusion and Implications:

This study identified caregiver stressors and coping resources as modifiable factors contributing to psychological health. The findings inform several strategies that can be incorporated into individual counseling and caregiver support groups as a means to decrease psychological distress and enhance psychological-welling in caregivers. These strategies include alleviating the sense of role overload, promoting resilience, and fostering a sense of purpose and meaning in caregiving activities. The study also revealed the nuances in the experiences of caregivers of older adults with dementia and highlighted the crucial, positive role of perceived gain in enhancing their psychological well-being. Interventions and policies should prioritize efforts to empower caregivers to recognize and value the positive aspects of dementia caregiving.