Factors associated with the positive impact of caring for elderly and dependent relatives

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Abstract

Until recent years, the research on caregivers of dependent dwelling elder subjects has dealt with the negative aspects of caregiving (e.g. depression, anxiety, anger). Recently, however, the positive aspects of caregiving have received considerable attention, although it is difficult to define these characteristics. The aim of this study is to determine some factors which can be seen as predictors of the positive aspects experienced by caregivers. We have carried out a cross-sectional study on 111 informal caregivers of dependent elderly patients who were assessed by a semi-structured interview and by standardised questionnaires. The Caregiving Satisfaction Scale was used as the main outcome measure. Caregivers experienced high levels of caregiving satisfaction (mean ± S.D. = 22.38 ± 5.39). In most cases, caring for elderly and dependent relatives had a positive impact on caregivers. Multiple regression analyses revealed that satisfaction was associated with better previous affectionate relationships between the caregivers and the dependents, with being caregiver by own initiative, with maintaining leisure time, with less use of venting emotions, and with caregiver not working out of home. These findings suggest that the positive aspects of caregiving are mainly related to specific characteristics of the caregivers. Furthermore, caregiving satisfaction was not related to aspects of the stressors.

Introduction

Most of the dependent elderly population dwell at their own or at a family home. The relatives, known as informal caregivers, are those who provide most of the assistance for the necessary activities of daily living (ADL), such as: feeding, bathing, dressing, toileting, etc. Only a small proportion of the dependent elderly are in nursing homes or are attended by professional formal caregivers (Aneshensel et al., 1995).

Research on informal caregivers has been focused on the negative and traumatic aspects of providing care. Overwhelmingly, research shows how caregiving for dependent elderly subjects generates emotional and physical distress on relatives. Thus, it shows that caregivers get ill more often than those who are not caregivers (Kiecolt-Glaser et al., 1991); their immune response is reduced (Kiecolt-Glaser and Glaser, 1994); and they feel, on many occasions, overcome by the burden of the care (Dura et al., 1990), as well as by anxiety (Russo et al., 1995), anger (Anthony-Bergstone et al., 1988) or depression (Ory et al., 2000).

Recently, however, more importance has been given to the positive aspects of informal caregiving. It seems that caregivers have not only adverse experiences, but also positive feelings related to their caregiver role (Kramer, 1997a).

It is difficult to define the positive aspects of caregiving, known as caregiving satisfaction, since there is no clear definition of this construct. The positive aspects found by the caregivers in their role of caregiving are more than the absence of pathology. We can say that caregiving satisfaction represents the perceived subjective gains and rewards, and the experience of personal growth that occurs as a result of providing care (Kramer, 1997a, López, 2001).

Little is known about predictors of positive aspects felt by informal caregivers. Some studies suggest that predictors of negative aspects of caregiving, such as burden, anxiety, depression, etc. differ from predictors of positive aspects (Rapp and Chao, 2000).

There are gender differences with regard to caregiving satisfaction. For women caregivers, a greater satisfaction in caregiving correlates with lower levels of anxiety and depression (Yee and Schulz, 2000) and with maintenance of the same close relationship with the cared husband that they had before the start of dependence (Motenko, 1989). On the other hand, male caregivers find more positive aspects related to caregiving when they are less educated, healthier, have better social networks, or report greater use of problem focused coping (Kramer, 1997b).

There are also differences in caregiving satisfaction related to kinship between the caregiver and the care recipient (Lawton et al., 1991). For spouses, caregiving satisfaction does not correlate with care recipient symptomatology, the amount of time spent in caregiving, and caregiver health; however, it is associated with greater emotional well-being. Among children, a greater satisfaction is associated with more time spent providing care, but not with the caregiver's emotional well-being.

Psychogeriatric literature from the United States is increasingly interested in analyzing the impact of caring for dependent elderly individuals on caregivers with different sociocultural backgrounds (i.e. Caucasian, African–American, Hispanic) (Dilworth-Anderson et al., 2002). Thus, traditional caregiving ideology (e.g. sense of reciprocity, setting an example for one's children, fulfilling personal values and familiar traditions) are predictors of caregiving satisfaction in Caucasians but not in African–Americans (Lawton et al., 1992). Since there are differences between caregivers of diverse well-defined sociocultural groups in the United States, it is reasonable to consider possible differences among Spanish subjects and other groups of caregivers.

The aim of this study is to determine predictors of the positive aspects reported by informal caregivers of dependent elderly individuals in Spain.

Section snippets

Sample

The sample was made up of 111 caregivers of older and dependent persons. Caregivers were recruited from different family associations, gerontology services, and health centers. Other caregivers responded to an advertisement published in the media.

To be eligible for the study, caregivers had to meet the following criteria: (a) the caregiver was providing care for a community-dwelling dependent older patient (aged over 60); (b) the caregiver identified him- or herself as the family member who was

Results

As shown in Table 1, the sample was composed of caregivers whose age ranged between 27 and 90 years, with a mean age of 57.9 years. Most were married (73.9%), adult children of the patients (66.7%), and female (82%). Though there were great differences in the education level of the caregivers, most had finished primary studies. However, a substantial percentage of caregivers had little educational attainment, and 28.8% had not reached a medium level of education. Most caregivers (57.6%) did not

Discussion

Surprisingly, a higher objective burden for the caregiver (e.g. longer period of time as the caregiver, caring longer hours per day, having less external support, etc.) does not correlate with satisfaction. However, working outside the home is associated with less caregiving satisfaction. A possible explanation is that working in two different places (at home and at work) yields a clash of roles, as neither of the roles can be ideally performed, and therefore the subjects have difficulty in

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