Caregiving Burden Among Migrant Domestic Workers Caring for Older Adults with Dementia in Hong Kong

Background and Purpose: Migrant domestic workers (MDWs) are a growing yet under-researched formal caregivers, particularly in regions experiencing rapid population aging. In Hong Kong, approximately 400,000 MDWs provide continuous, in-home care for older adults with dementia, often under complex and demanding work conditions. Despite their significant involvement in daily caregiving, limited research has explored the multidimensional factors contributing to their caregiving burden. Guided by the Caregiving Stress Process Model and the Sociocultural Stress and Coping Model, this study examines how sociodemographic factors, care recipient needs, job-related pressures, coping resources, and cultural adaptation influence caregiver burden among MDWs.

Methods: Using cross-sectional data collected from MDWs (N = 121) caring for older adults with dementia across Hong Kong, this study examined significant socio-demographic and job-related covariates of MDWs' caregiving burden. Participants were recruited through convenience sampling in collaboration with local non-governmental organizations. The majority were born in Indonesia (73.6%), with a mean age of 43.6 years and an average of 8.79 years of work experience in Hong Kong. Nearly 85.1% had a high school education or below, 70.3% were married, and 63.6% earned a monthly salary below 5,000 HKD (≈645 USD). A hierarchical regression model was used: (1) Sociodemographic factors: age, education, and self-reported health status; (2) Primary stressors: care recipients' neuropsychiatric symptoms and activities of daily living (ADL) dependency; (3) Secondary stressors: job stress; (4) Coping resources: social support and resilience; (5) Cultural factors: acculturation and Cantonese proficiency.

Results: Job stress showed the strongest statistical association with caregiver burden after adjusting for all covariates. Higher levels of job stress were related to greater reported burden among MDWs. Higher Cantonese proficiency was also significantly associated with greater caregiver burden, indicating that increased language ability may coincide with increased expectations or responsibilities in the caregiving role. The self-reported health status of MDWs emerged as a significant sociodemographic factor, indicating that those who rated their health more poorly tended to report higher levels of caregiver burden.

Conclusions and Implications: The findings underscore that for MDWs, work-related pressures and sociocultural factors are more influential than care demands in shaping caregiver burden. Interventions should extend beyond dementia care training to comprehensively address the occupational, health, and cultural dimensions of MDWs' caregiving experience. Policies that enhance job protections, rest time, and access to health and language services could mitigate stress and improve care outcomes. The integration of stress and sociocultural models in this study offers a comprehensive lens for future research and intervention design, emphasizing the need to address the intersection of labor, health, and migration in dementia caregiving contexts.