Abstract
Purpose:
This study examined use of personal and social resourcefulness when experiencing anger, anxiety, sadness, decision-making, and financial distress among adult-child and spousal caregivers of persons with dementia.
Methods:
Baseline data on ten Resourcefulness Scale© items measuring personal and social resourcefulness in response to anger, anxiety, sadness, decision-making, and financial distress were obtained from 127 adult-child and 112 spousal caregivers of persons with dementia.
Results:
Adult-child and spousal caregivers similarly used personal resourcefulness for financial distress (62–68%) and both personal and social resourcefulness when angry (67%), sad (87–92%), and making decisions (77–98%). Spousal caregivers used both personal and social resourcefulness when anxious (37%) while adult-children used only personal resourcefulness (46%). The findings were similar across age, race, and gender subgroups.
Conclusions:
Future research should explore effects of other situational factors (e.g., caregiving burden) on resourcefulness. Gerontological health care professionals should assess the caregiver-care recipient relationship when determining and tailoring interventions.
Keywords: dementia, family caregiving, adult-child caregivers, spousal caregivers, resourcefulness, anxiety, depression, financial distress, anger, decision-making
Dementia is a significant public health challenge affecting over 55 million people worldwide (World Health Organization, 2024). Dementia is a clinical syndrome characterized by cognitive decline that impairs independent functioning and daily life, requiring enhanced public health strategies and support systems to address its impact on individuals, their families, and society-at-large (Alzheimer’s Association, 2026). Given that the likelihood of developing dementia increases significantly with age, the projected global prevalence of dementia is expected to reach 78 million by 2030 and 139 million by 2050 (ADI - Dementia Statistics, 2026).
Most persons living with dementia receive care at home from informal caregivers, typically spouses and adult-children (Alzheimer’s Association, 2026). In the United States, an estimated 12 million informal caregivers provide approximately 19.6 billion hours of assistance to a person with dementia, valued at $446 billion (Alzheimer’s Association, 2026). Approximately half of informal caregivers are caring for a parent or parent-in-law with dementia, while more than 15% are supporting a spouse with dementia (Riffin et al., 2017). Due to the unique nature of family relationships, spousal and adult-child caregivers exhibit differences in their caregiving experiences, psychosocial needs, and health outcomes (Dang et al., 2022). Yet little is known about how spousal and adult-child caregivers may differ in how they manage caregiving demands, including their use of self-help and help-seeking skills that constitute personal and social resourcefulness.
Challenges Experienced by Caregivers of Persons with Dementia
Caring for persons with dementia involves complex tasks such as medication administration, assistance with daily activities, behavior management, processing financial transactions, and other activities (Lindeza et al., 2020). Compared to other caregivers, caregivers of persons with dementia provide care that is more time-consuming, physically demanding, and stressful, and often for longer periods of time (Freedman et al., 2022; Kasper et al., 2015). They must also make difficult daily decisions related to treatment and day-to-day activities. Beyond caregiving-related expenses, many informal caregivers of persons with dementia miss work or reduce their work hours and encounter conflicts between their work and caregiving schedules, which also affects their economic stability, resulting in indirect financial distress for the caregiver (Harrison et al., 2025; Thomas et al., 2026)).
Informal caregivers of persons with dementia experience significant stress, depression, anxiety, and burden. The prevalence of anxiety and depression is estimated to be 34% and 44%, respectively (Joling et al., 2015). Emotional distress and mental health problems in caregivers of persons with dementia is related to diverse factors, including financial stress, limited social support and interactions, and the care recipient’s condition (Lindeza et al., 2020; Puga et al., 2023). Caregivers of persons with dementia have more restrictions in their social activities, which is more detrimental to their emotional and mental health, compared to other caregivers (Irani et al., 2024). Psychological and behavioral symptoms of dementia are a well-recognized source of caregiver stress especially given their unpredictable nature and their impact on caregivers’ schedules (Freedman et al., 2022; Mattos et al., 2024).
Comparison of Spousal and Adult-Child Caregivers
Individual caregiver characteristics, such as their relationship with the care recipient, influence caregiving demands and challenges. Spousal caregivers, for example, are usually older than adult-child caregivers and often face their own health problems that may interfere with their caregiving situation (Wawrziczny et al., 2020). Spousal caregivers may offer more support to the care recipient and are usually retired, which may limit their social network and increase social isolation (Li et al., 2021). In comparing social network strength between adult-child and spousal caregivers, Wang and colleagues (2023) found spousal caregivers had weaker social networks. Furthermore, spousal caregivers feel a strong sense of responsibility for the care recipient and believe they alone can provide the best care (Wawrziczny et al., 2020). This heightened sense of responsibility may contribute to better preparation for spouses as caregivers (Dang et al., 2022; Li et al., 2021).
Compared to spousal caregivers, adult-child caregivers are more likely to experience role conflicts due to other obligations, such as work and raising their own families, which can increase their stress (Liu, 2021; Wawrziczny et al., 2020). Yet, given their younger age, on average, adult-child caregivers may face fewer health challenges affecting their ability to provide care (Wawrziczny et al., 2020). Adult-child caregivers provide fewer hours of care on average than spousal caregivers, yet they experience higher perceived care burden (Kunicki et al., 2021). Adult-child caregivers tend to focus on their parents’ abilities instead of their difficulties (Wawrziczny et al., 2020).
Although there has been limited investigation into differences in coping strategies between spousal and adult-child caregivers, differences in caregiving experiences could plausibly create variation in how caregiver manage care stressors. For example, given the greater likelihood of adult-child caregivers juggling multiple social roles and the reduced social networks among spousal caregivers (Liu, 2021; Wang et al., 2023), one might anticipate that adult-child caregivers would be more inclined than spouses to seek out instrumental help from others and therefore be more socially resourceful. Spousal caregivers, in contrast, may avoid engaging help from formal services given their belief that they are best suited to provide care (Dang et al., 2022) and therefore be more personally resourceful. Nevertheless, differences in coping strategies by caregiver relationship remain speculative and require further empirical support to understand how best to support different types of caregivers.
Theoretical Framework
Zauszniewski’s midrange theory of Resourcefulness and Quality of Life© specifies two types of resourcefulness skills for managing challenging situations (Zauszniewski, 2018). While personal resourcefulness involves self-help strategies such as problem-solving, organizational tactics, positive affirmation, cognitive reframing, and intentional behavior change, social resourcefulness skills involve help-seeking behaviors that involve reliance on others, social exchange, and professional guidance (Zauszniewski, 2016, 2018). Notably, individuals may rely on both types of resourcefulness, such as seeking help from another caregiver to achieve cognitive reframing of a situation
Personal and social resourcefulness skills are used by individuals in response to process regulators to prevent adverse effects on health and quality of life (Zauszniewski, 2016, 2018). In the study reported here, process regulators were operationalized by the item stems of the Resourcefulness Scale© that reflect contexts of anger, anxiety, sadness, decision-making, and financial distress. Previous studies indicate that the caregiving situation varies depending on the relationship between the caregiver and the care recipient. Spousal and adult-child caregivers express different needs, feelings, preferences, and attitudes about their role (Dang et al., 2022; Li et al., 2021; Liu, 2021; Statz et al., 2022; Wawrziczny et al., 2020), which may lead to differences in their use of personal and social resourcefulness.
Purpose
Although the use of personal and social resourcefulness has been examined in caregivers of persons with various health conditions, including caregivers of persons with dementia (Zauszniewski et al., 2022), comparisons between adult-child and spousal caregivers of persons with dementia regarding their use of specific personal and social resourcefulness skills have not been made. Understanding similarities or differences in the use of resourcefulness skills can inform the future tailoring of Resourcefulness Training© interventions for adult-child and spousal caregivers.
The purpose of the study was to compare adult-child and spousal caregivers of persons with dementia on their use of personal and social resourcefulness in response to anger, anxiety, sadness, decision-making, and financial distress. The primary research question was: “How do adult-child and spousal caregivers of persons with dementia differ in their proclivity toward using personal and social resourcefulness skills, or both of them, or neither of them in response to anger, anxiety, sadness, decision-making, and financial distress?” Because adult-child and spousal caregivers may differ by age, gender, and race, we also examined whether differences in resourcefulness occurred by demographic subgroups.
Methods
Design and sample.
This descriptive secondary data analysis used the baseline data (i.e., pre-intervention) from 239 caregivers (127 adult-child and 112 spousal) who participated in one of two large clinical trials of family caregivers of persons with dementia. For both parent clinical trials, caregivers were recruited from the community. Potential study participants responded to publicly posted advertisements, flyers, newspaper ads, or social media and contacted the research staff, who screened them by phone to ensure they met the study criteria.
Eligibility criteria for both parent trials were age of 18 years or older and in the role of primary caregiver of a family member with dementia for at least six months. However, the care recipient may have been living within the same household or within a care facility. If living in the same household, the caregiver must have reported performing a minimum of four hours of direct care or supervision per day. If the care recipient resided in a facility, the caregiver must have reported visiting them at least once per week. There were no significant differences in care recipient’s living arrangements (i.e., home versus care facility) between the two parent studies (X2 = .311, p = .281). Caregivers who were other than adult-children or spouses of the person with dementia were excluded from the analysis. For both parent trials, verbal consent was obtained during screening for caregivers who met the study criteria. Signed informed consent was obtained in person prior to data collection.
The adult-child and spousal caregivers who participated in one of the two parent trials were demographically similar. Age ranges were 21–85 years (study #1) and 42–98 years (study #2) (t = 0.44, p = .664). There were 54 women and 7 men in study #1 and 154 women and 24 men in study #2 (X2 = 0.16, p = .827). There were 46 White and 15 Nonwhite in study #1 and 150 White and 28 Nonwhite in study #2 (X2 = 2.42, p = .126). The total scores on the ten resourcefulness items used for this study were also similar across the two parent data sets (t = 0.951, p = .342).
No significant differences by care recipient living arrangements (i.e., living at home versus living in a care facility) were found on total scores of the ten resourcefulness items used for this analysis (t = 0.439, p = .661). In addition, no significant differences were found between in-home caregivers and those partnering with a care facility on proxy measures of coping (i.e., the total 28-item Resourcefulness Scale© (Zauszniewski et al., 2006; t = 1.026; p = .306) and stress (i.e., caregiver distress scale of the Revised Memory and Behavior Problems Checklist (Teri et al., 1992; t = 0.559; p = .583). Therefore, the in-home caregivers and the care partners with a facility from the two datasets were combined.
However, we examined demographic subgroups defined by age, gender, and race within the adult-child and spousal caregiver categories in the study reported here because significant differences were found between the adult-child and spousal caregivers on demographic characteristics as described in our preliminary analysis of the two parent datasets. The sample size of 239 caregivers (127 adult-children and 112 spouses) was sufficient for the required descriptive exploratory analyses.
Measures
Demographic characteristics.
Age was captured in two categories: less than 65 years and 65 years and older. Gender was self-reported as male or female. Race data were obtained within five categories (i.e., White Caucasian, African American, Asian American, Native American, and other Nonwhite), which were subsequently collapsed into White and Nonwhite.
Caregiving characteristics.
Caregiving situation was captured by years of caregiving and hours of caregiving per week. Dementia symptoms of the care recipient were indicated by frequency and caregiver reaction subscales of the Revised Memory and Behavior Problems Checklist (Teri et al., 1992). Caregiver health was operationalized by the number of health conditions from a list of ten medical conditions and global health using the 10-item PROMIS measure (Hays et al., 2009)..
Resourcefulness.
Data obtained on the Resourcefulness Scale© from the 239 caregivers who took part in one of the parent clinical trials were used. Although the Resourcefulness Scale© (Zauszniewski et al., 2006) consists of 28 items on a 6-point Likert scale, to which respondents indicate the degree to which an item is characteristic of them; this analysis used only the data on ten of its items. The complete 28-item Resourcefulness Scale© measures two forms of resourcefulness: personal (16 items) and social (12 items). The Resourcefulness Scale© has reported reliability and validity with an internal consistency estimate of Cronbach’s alpha =.83 and construct validity indicated by confirmatory factor analysis verifying the presence of two subscales reflecting personal and social resourcefulness, which were moderately correlated (r = .41, p < .001) (Zauszniewski et al., 2006).
The Resourcefulness Scale© items are constructed with an item stem to provide a context that serves as a process regulator (e.g., anger, anxiety, sadness, decision-making, or financial distress) and a response that describes either personal (i.e., self-help) or social (i.e., help-seeking) resourcefulness. For this analysis, five items in which the item stems reflected similar contexts (i.e., anger, anxiety, sadness, decision-making, and financial distress) were selected from each subscale, totaling ten items. For example, two item stems describe feeling anxious. One item suggests independent planning what needs to be done, indicative of personal resourcefulness; another item suggests seeking help, reflecting social resourcefulness. The 10-item scale used for the analysis reported here has been used and applied in previous caregiver research (see Zauszniewski et al., 2022).
To make comparisons across the two relationship categories, the responses to the ten resourcefulness items (i.e., two items per process regulator) were dichotomized into two categories according to whether personal or social resourcefulness was used.. Acceptable reliability of these ten items (Cronbach’s alpha =.70) was reported in a similar analysis of caregivers of persons with varying chronic conditions (Zauszniewski et al., 2022). In the study reported here, the Cronbach’s alpha was also .70 and the 10 items correlated significantly with the total 28-item Resourcefulness Scale (r = .454, p < .001). Next, we created five variables to reflect the five process regulators by combining the personal and social resourcefulness items. These five variables were subsequently coded into four categories to reflect the use of neither personal nor social resourcefulness, only personal resourcefulness, only social resourcefulness, or use of both personal and social resourcefulness for each of the five process regulators.
Ethical considerations
Data used for this analysis consisted of the baseline data from two parent studies focused on testing health self-management interventions and assessing caregiver needs and preferences for the tested interventions (NCT04603482, NCT04247347). Both studies were approved by the University Institutional Review Board following expedited review.
Data collection and management
Data were collected for both parent studies using Research Electronic Data Capture (REDcap), a secure, online, web-based application. The data were exported to SPSS (version 29) and merged to create the datafile used for the study reported here.
Data analysis
Before conducting the secondary analysis to compare the adult-child and spousal caregivers on their use of personal and social resourcefulness skills, we examined group differences in demographic characteristics and caregiving characteristics using chi-square tests and t-tests. The adult-child and spousal caregivers were then compared for consistencies in their use of resourcefulness in relation to the five process regulators (anger, anxiety, sadness, decision-making, and financial distress). Using frequencies and percents generated by IBM SPSS statistics (Version 29), we aimed to establish whether similarities or differences existed in their use of personal resourcefulness, social resourcefulness, both forms of resourcefulness, or neither form of resourcefulness in response to the five process regulators. We were also interested in exploring whether similarities or differences existed by demographics (age, gender, or race) within the adult-child and spousal caregiver categories).
Of particular interest were the percents indicating the most frequently used resourcefulness skill (person or social, both, or neither) in response to the five process regulators between the caregiver groups (adult-child and spousal) and subgroups defined by age, gender, and race. Given the exploratory nature of this analysis and our goal to identify consistencies or difference in resourcefulness, we conducted chi-squares between the adult child and spousal caregivers. We considered that both statistically significant and non-significant findings would contribute to understanding these patterns of use of resourcefulness skills. These analyses were expected to provide future direction for comparative and experimental studies of family caregivers of persons with dementia and the tailoring of future Resourcefulness Training© interventions.
Results
Demographic characteristics of the adult-child and spousal caregiver groups
Before conducting the analysis of the use of personal and social resourcefulness by the adult-child and spousal caregivers, we first examined whether the two caregiver groups differed by age, gender, or race. To facilitate these comparisons, the demographic variables were dichotomized. Age was self-reported as less than 65 years (n = 116, 48.5%) or equal to and over 65 years (n = 123, 51.5%); gender was self-reported male (n = 31, 13.0%) or female (n = 208, 87.0%); and race was self-reported as White (n = 196, 82.0%) or Nonwhite (n = 43, 18.0%). Nonwhite participants included 33 African Americans, 1 Asian American, 1 Native American, and 8 who reported being non-white without disclosing race/ethnicity. Results from the chi-square analyses revealed the adult-child and spousal caregiver groups differed by age 65 years and older (X2(1, N = 239) = 115.07, p < 001) and race (X2(1, N = 239) = 11.73, p <.001) but not gender (X2(1, N = 239) = 1.80, p =.180). (See Table 1).
Table 1.
Demographic Characteristics: Age, Gender, and Race by Caregiver Relationship Type
| Demographic | Adult Child (n=127) n (%) |
Spouse (n=112) n (%) |
X 2 | p-value |
|---|---|---|---|---|
| Age | 115.07 | <.001 | ||
| < 65 years | 103 (81.1) | 13 (11.6) | ||
| 65 years and older | 24 (18.9) | 99 (88.4) | ||
| Gender | 1.80 | .180 | ||
| Female | 114 (89.8) | 94 (83.9) | ||
| Male | 13 (10.2) | 18 (16.1) | ||
| Race | 11.73 | <.001 | ||
| White | 94 (74.0) | 102 (91.1) | ||
| Nonwhite | 33 (26.0) | 10 (8.9) | ||
| White Caucasian | 94 (74.0) | 102 (91.1) | 12.88 | .012 |
| African American | 26 (20.5) | 7 (06.2) | ||
| Asian American | 1 (00.8) | 0 | ||
| Native American | 1 (00.8) | 0 | ||
| Other Nonwhite | 5 (03.9) | 3 (02.7) |
Caregivers 65 years and older were more likely to be spousal caregivers (n = 99, 88.4%) as compared to adult-child caregivers (n = 24, 18.9%), while caregivers under 65 years were more likely to be adult-child caregivers (n = 103, 81.1%) as compared to spousal caregivers (n = 13,11.6%). White individuals were more likely to be spousal caregivers (n = 102, 91.1%) as compared to adult-child caregivers (n = 94, 74.0%), while Nonwhite individuals were more likely to be adult-child caregivers (n = 33, 26.0%) as compared to spousal caregivers (n = 10, 8.9%).
Descriptive characteristics of the adult-child and spousal caregiver groups
We also compared the adult-child and spousal caregivers on variables reflecting their caregiving situation (i.e., years of caregiving and hours of caregiving per week), their own health (i.e., number of health conditions and global health), and dementia symptoms of their care recipient (i.e., frequency and caregiver reaction). Table 2 shows that adult-child and spousal caregivers were similar in caregiving years, global health, and their perceptions of the frequency of dementia symptoms and their reactions to them. However, spousal caregivers spent, on average, four more hours per week than the adult-child caregivers (t(1,194.76) = −1.924, p = .056) and reported one more health condition than adult-children caregivers (t(1,237) = −3.981, p < .001).
Table 2.
Descriptive Characteristics: Caregiving Year and Hours per Week, Frequency of Dementia Symptoms and Caregiver Reactions, Number of Caregiver Health Conditions, Caregiver Health.
| Variable | Adult Child (n=127) Mean (SD) |
Spouse (n=112) Mean (SD) |
t-value | p-value |
|---|---|---|---|---|
| Caregiving Years | 5.02 (4.80) | 4.32 (3.32) | 1.304 | .193 |
| Caregiving Hours per Week | 22.70 (11.21) | 26.20 (16.11) | −1.924 | .056 |
| Frequency of Dementia Symptoms | 2.15 (0.86) | 2.02 (0.86) | 1.136 | .257 |
| Reaction to Dementia Symptoms | 2.15 (0.86) | 2.02 (0.86) | 1.136 | .257 |
| Number Health Conditions (of 10) | 1.46 (1.46) | 2.22 (1.51) | −3.981 | <.001 |
| Global Health | 26.13 (4.92) | 27.16 (4.99) | −1.597 | .112 |
Caregivers’ use of personal and social resourcefulness skills
Table 3 displays the percents of adult-child and spousal caregivers who reported the use of both personal and social resourcefulness, either personal or social resourcefulness, or neither personal nor social resourcefulness in response to anger, anxiety, sadness, decision-making, and financial distress. The findings, including chi-square analyses between the adult-child and spousal caregivers, are reported for each of the five process regulators (Table 3). However, the findings for demographic subgroups (age, gender, and race) within the adult-child and spousal caregiver categories are reported in Table 4.
Table 3.
Use of Personal and Social Resourcefulness Skills by Adult Child and Spousal Caregivers
| Caregiver Experiences | Adult Child | Spouse | Chi square | Significance |
|---|---|---|---|---|
| N=127 | N=112 | |||
| Anger | ||||
| None | 6% | 10% | X2 = 2.127 | p = .546 |
| Social | 10% | 11% | ||
| Personal | 17% | 20% | ||
| Both | 67% | 60% | ||
| Anxiety | ||||
| None | 25% | 27% | X2 = 1.729 | p = .630 |
| Social | 12% | 11% | ||
| Personal | 36% | 30% | ||
| Both | 27% | 33% | ||
| Sadness | ||||
| None | 4% | 5% | X2 = 3.056 | p = .383 |
| Social | 14% | 7% | ||
| Personal | 9% | 11% | ||
| Both | 72% | 78% | ||
| Decision-making | ||||
| None | 2% | 2% | X2 = 2.620 | p = .454 |
| Social | 6% | 8% | ||
| Personal | 15% | 21% | ||
| Both | 77% | 69% | ||
| Financial distress | ||||
| None | 19% | 21% | X2 = 0.686 | p = .877 |
| Social | 8% | 6% | ||
| Personal | 54% | 55% | ||
| Both | 20% | 17% | ||
Table 4.
Percent of Use of Personal and Social Resourcefulness Skills by Adult Child and Spousal Caregivers of Persons with Dementia by Gender, Race, and Age
| Caregiver Relationship | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Caregiver Experiences | Adult Child (N=127) | Spouse (N=112) | |||||||||||
| Male N=13 |
Female N=114 |
White N=94 |
Nonwhite N=33 |
< 65 yrs N=103 |
> 65 yrs N=24 | Male N=18 |
Female N=94 |
White N=102 |
Nonwhite N=10 |
< 65 yrs N=13 |
> 65 yrs N=99 | ||
| Anger | |||||||||||||
| None | 15% | 4% | 4% | 9% | 4% | 12% | 22% | 7% | 11% | 0 | 8% | 10% | |
| Social | 0 | 11% | 10% | 12% | 8% | 21% | 5% | 12% | 12% | 0 | 23% | 9% | |
| Personal | 23% | 17% | 16% | 21% | 18% | 12% | 28% | 18% | 19% | 20% | 8% | 21%) | |
| Both | 62% | 68% | 70% | 58% | 70% | 54% | 45% | 63% | 58% | 80% | 61% | 60% | |
| Anxiety | |||||||||||||
| None | 31% | 25% | 24% | 27% | 24% | 29% | 28% | 26% | 28% | 20% | 15% | 28% | |
| Social | 23% | 10% | 13% | 9% | 13% | 8% | 0 | 13% | 11% | 10% | 8% | 11% | |
| Personal | 31% | 37% | 34% | 43% | 36% | 38% | 34% | 29% | 30% | 20% | 31% | 29% | |
| Both | 15% | 28% | 29% | 21% | 27% | 25% | 38% | 32% | 31% | 50% | 46% | 31% | |
| Sadness | |||||||||||||
| None | 0 | 4% | 4% | 3% | 3% | 8% | 5% | 4% | 5% | 0 | 15% | 3% | |
| Social | 31% | 12% | 15% | 12% | 14% | 12% | 11% | 6% | 7% | 10% | 8% | 7% | |
| Personal | 7% | 10% | 7% | 15% | 9% | 12% | 22% | 9% | 10%) | 20% | 15% | 10% | |
| Both | 62% | 74% | 74% | 70% | 74% | 67% | 62% | 81% | 78% | 70% | 61% | 80% | |
| Decision-making | |||||||||||||
| None | 7% | 0 | 2% | 3% | 3% | 0 | 5% | 1% | 2% | 0 | 0 | 2% | |
| Social | 0 | 8% | 6% | 3% | 4% | 12% | 5% | 9% | 8% | 10% | 15% | 7% | |
| Personal | 23% | 14% | 12% | 24% | 16% | 8% | 34% | 19% | 22% | 10% | 23% | 21% | |
| Both | 70% | 78% | 80% | 70% | 77% | 79% | 56% | 71% | 68% | 80% | 61% | 70% | |
| Financial distress | |||||||||||||
| None | 31% | 18% | 19% | 18% | 18% | 21% | 11% | 23% | 21% | 20% | 31% | 20% | |
| Social | 0 | 9% | 9% | 6% | 8% | 8% | 5% | 6% | 6% | 10% | 8% | 6% | |
| Personal | 46% | 54% | 51% | 61% | 52% | 62% | 56% | 56% | 55% | 60% | 46% | 57% | |
| Both | 23% | 19% | 21% | 15% | 22% | 8% | 28% | 15% | 18% | 10% | 15% | 17% | |
Responses to anger by caregiver relationship.
The tendency to use both personal and social resourcefulness was found for both adult-child and spousal caregivers of persons with dementia. This finding was consistent for the total groups and demographic subgroups (age, gender, and race) within each of the caregiver categories. The percents of usage for both personal and social resourcefulness were 67% and 60% for the adult-child and spousal caregivers, respectively. Chi-square analysis indicated the two groups of caregivers were similar (X2 = 2.127, df = 3, p = .546). Among the demographic subgroups (age, gender, and race), the responses for use of both personal and social resourcefulness ranged from 45% (male spousal caregivers) to 80% (nonwhite spousal caregivers).
Responses to anxiety by caregiver relationship.
Adult-child caregivers differed from spousal caregivers in their response to anxiety. While the adult-child caregivers reported a tendency to use personal resourcefulness (36%), spousal caregivers most frequently reported using both personal and social resourcefulness (33%). It is noteworthy that these percents are lower than percents found for using resourcefulness with other process regulators, indicating that both groups of caregivers varied more in the type of resourcefulness used. However, the finding that adult-child caregivers tended to use personal resourcefulness while the spousal caregivers tended to use both personal and social resourcefulness in response to anxiety. However, these findings were not statistically significant (X2 = 1.729, df = 3, p = .630). The findings were similar across the demographic subgroups (age, gender, and race) within the caregiver categories. Among the adult-child caregiver subgroups, responses for use of personal resourcefulness ranged between 31% (male caregivers) and 43% (Nonwhite caregivers). However, another 31% of male adult-child caregivers reported not using either personal or social resourcefulness in response to anxiety. Among the spousal caregiver subgroups, responses for use of both personal and social resourcefulness ranged from 31% (White caregivers and those over age 65 years) to 50% (Nonwhite caregivers).
Responses to sadness by caregiver relationship.
Similar to the findings for anger, the tendency to use both personal and social resourcefulness in response to sadness was found for both the adult-child and spousal caregivers of persons with dementia. This finding was consistent across the total groups and demographic subgroups (age, gender, and race) of caregivers. The percents of usage for both personal and social resourcefulness were 72% and 78% for the adult-child and spousal caregivers, respectively. Chi-square analysis indicated the two groups of caregivers were similar (X2 = 3.056, df = 3, p = .383).. Among the demographic subgroups (age, gender, and race), responses for both personal and social resourcefulness ranged from 61% (spousal caregivers younger than 65 years) to 81% (female spousal caregivers).
Responses to decision-making by caregiver relationship.
In response decision-making, the findings for both the adult-child and the spousal caregivers showed a tendency to use both personal and social resourcefulness. This finding was consistent across the total groups and the demographic subgroups (age, gender, and race) of caregivers. The percents for using both personal and social resourcefulness were 77% and 69% for adult-child and spousal caregivers, respectively. Chi-square analysis indicated the two groups of caregivers were similar (X2 = 2.620, df = 3, p = .454). Among the demographic subgroups (age, gender, and race), responses for using both personal and social resourcefulness ranged from 56% (male spousal caregivers) to 80% (White adult-child caregivers and Nonwhite spousal caregivers).
Responses to financial distress by caregiver relationship.
Interestingly, both the adult-child and the spousal caregivers of persons with dementia reported using only personal resourcefulness when faced with financial distress. This finding was consistent across the total groups and the demographic subgroups (age, gender, and race) of caregivers. The percents of using personal resourcefulness were 54% and 55% for the adult-child and spousal caregivers, respectively. Chi-square analysis indicated the two caregiver groups were similar (X2 = 2.127, df = 3, p = .546).. Across the demographic subgroups (age, gender, and race), the responses for using both personal and social resourcefulness ranged between 46% (male adult-child caregivers and spousal caregivers under 65 years) and 62% (adult-child caregivers over age 65 years).
Discussion
This study examined similarities and consistencies in the use of resourcefulness by adult-child and spousal caregivers of persons with dementia. Within the midrange theory of Resourcefulness and Quality of Life© (Zauszniewski, 2018), the study examined caregivers’ use of personal and social resourcefulness in response to five process regulators (anger, anxiety, sadness, decision-making, and financial distress). The findings indicated similarities between the adult-child and spousal caregivers in response to anger, sadness, and decision-making. Both caregiver groups reported a tendency to use both personal and social resourcefulness in response to those three process regulators. These findings are similar to a study of caregivers of persons with various medical conditions, including dementia (Zauszniewski et al., 2022) in which family caregivers reported using both personal and social resourcefulness to manage anger, sadness, and decision-making, however their relationships with their care recipients were not examined.
The study reported here found that spousal caregivers differed from the adult-child caregivers in their use of personal and social resourcefulness when feeling anxious. Adult-child caregivers most frequently reported a tendency to use personal resourcefulness in response to anxiety, while spousal caregivers most frequently reported using both personal and social resourcefulness. The findings related to the adult-child caregivers were consistent with a previous study of the use of personal and social resourcefulness by family caregivers of persons with various medical conditions, including dementia (Zauszniewski et al., 2022). It was unexpected to find that spousal caregivers reported using both personal and social resourcefulness skills to manage anxiety, since the prior study showed most caregivers tended to use only personal resourcefulness in the face of anxiety (Zauszniewski et al., 2022).
This finding was also unexpected since spousal caregivers are less likely to have external support (Wang et al., 2023) and may therefore be expected to rely more on personal coping resources, while adult-child caregivers might have more access to external support networks, including siblings and other family members. A study comparing the caregiving experience of spousal and adult-child caregivers of persons with dementia with Lewy Bodies found that adult-child caregivers reported greater social support than spousal caregivers (Rigby et al., 2019). However, while social support focuses on the availability and quality of support from others, social resourcefulness emphasizes the individual’s ability to actively seek help from others. Thus, despite the greater likelihood of adult-child caregivers having access to external support, they may not necessarily have the skills needed to leverage it to manage certain care challenges.
The use of different resourcefulness skills in response to anxiety in the two caregiver groups may reflect potential differences in how adult-child caregivers and spousal caregivers manage anxiety-producing situations. It is possible that more recent generations, including current adult-child caregivers experience parasocial relationships through social media, which they may not perceive as social resourcefulness (i.e., actively seeking help from others). “Lurking” on forums may provide caregivers with ideas on managing anxiety-producing situations, potentially reducing their intentional use of social resourcefulness skills. Ni and colleagues (2023) analyzed posts from the online community managed by the Alzheimer’s Association. They found that while more adult-child caregivers were registered as members, spousal caregivers published more posts and were more active participants. It remains unclear whether these parasocial relationships constitute personal or social resourcefulness.
We also found there was consistent use of personal resourcefulness for both the adult-child and spousal caregivers in response to financial distress. This consistent reliance on personal resourcefulness skills in response to financial distress lends itself to several interpretations. In the North American cultural context in which this study was conducted, experiencing financial distress is often stigmatized, such that financially distressed caregivers may not ask others for help to avoid anticipated negative attitudes (Inglis et al., 2022; Moorhouse et al., 2023). Spousal caregivers may be particularly reluctant to ask for financial help from adult children, for example, if they hold beliefs that financial support should flow down to the younger generations, rather than vice-versa. Alternatively, caregivers may be discouraged from relying on social resourcefulness if these have proven unsuccessful in the past for managing financial distress. In a qualitative study of Latino caregivers of persons living with dementia, for example, caregivers reported discontinuing attempts to access financial support from other family members after previous disappointment or because they recognized these family members could not afford to assist them financially (Mage et al., 2024).
Interestingly, although there were substantial differences between the adult-child and spousal caregivers on age, race, number of health conditions, and caregiving hours per week, which would be considered as contextual factors in the context of Resourcefulness Theory©, the two groups reported using personal and social resourcefulness similarly in relation to most of the process regulators (i.e., anger, sadness, decision-making, and financial distress) examined in this study. To date, caregiver research on resourcefulness has had a limited focus on the potential influence of contextual factors on the use of personal and social resourcefulness skills. Further examination of the effects of context factors on the use of resourcefulness skills may provide direction for future tailoring of resourcefulness interventions.
There is also a methodological consideration: the phrasing of the item used to assess social resourcefulness in the face of financial distress refers to seeking help with paying bills. Caregivers may assume this item suggests asking friends and family for money, without considering other options that may be more discrete, such as asking about hardship programs from creditors (e.g., lowering interest). Such alternative options for managing financial distress may be more appealing than obtaining assistance from those with whom caregivers share an interpersonal connection.
Limitations
The study has several limitations. Although this study drew upon two datasets to generate the largest possible sample to study resourcefulness in caregivers of persons with dementia, reliance on existing data limited by sample size and its sample characteristics. Small sample sizes within the demographic subgroups precluded our ability to conduct tests of significance. However, in our sample, spousal caregivers were older than adult-child caregivers, and most Non-White caregivers were adult-children, which is consistent with other large-scale studies (e.g., Pinquart & Sorensen, 2005; Rigby et al., 2019; Roth et al., 2007). In addition, we were unable to examine differences in resourcefulness among spousal and adult-child caregivers according to caregiver culture. Yet we acknowledge that that culture may have an important impact on the context in which caregiving occurs according to kin relationships, such as motivations to provide care and cultural expectations shaping caregiving provided by adult-children (Zarzycki et al., 2022).
Implications for Gerontological Health Care
The findings from this study highlight the significant implications for gerontological health professionals. Caregivers of persons with dementia are a central focus of gerontological health practice, particularly in the community and long-term care settings, where family caregivers are routinely assessed and supported. Gerontological health care professionals are often the primary contact for these caregivers and must transition from generalized support to interventions informed by the caregiver’s relationship and typical coping profile. For example, the finding that adult-child caregivers rely on personal resourcefulness for anxiety, while spousal caregivers use both personal and social skills, provides critical information. Gerontological health professionals can thus explore whether the adult-child caregiver is internalizing anxiety and neglecting accessible support. Similarly, the consistent reliance on personal resourcefulness for financial distress by both groups underscores the role of gerontological health professionals in connecting caregivers to community resources that may include financial counseling. Gerontological health care workers are ideally positioned to integrate these findings into their clinical practice.
Recommendations for Future Research
A strength of the present study is the evaluation of overlapping caregiver demographics (age, gender, and race) with caregiver relationship to the care recipient in the evaluation of their resourcefulness. Future research can build off of these findings by purposively recruiting a diverse group of spousal and adult-child caregivers that ensures a balance in gender, race/ethnicity and age. The influence of additional contextual variables such as living arrangements, hours of caregiving, and length of time in the caregiving role should be explored. These approaches would allow for evaluating subgroup differences in resourcefulness, as well as specification of differences attributable to demographic characteristics that often overlap with being a spousal or adult-child caregiver, including living arrangements with the care recipient.
The finding that approximately one fourth of caregivers in both groups indicated not using any resourcefulness skills in response to anxiety, which was a higher percentage than for any of the other process regulators, suggests the need to explore other possible strategies that caregivers of persons with dementia use to manage anxiety. Additional recommendations for future research include the examination of other variables that may affect the choice of skills, including the length of time in the caregiving role, the stage of dementia of the care recipient, living arrangements, and socioeconomic status.
Finally, the measures of personal and social resourcefulness comprised two separate items related to each of the five process regulators. Thus, the caregivers were not forced to choose between personal and social resourcefulness: they responded separately to one item reflecting personal resourcefulness and a second item describing social resourcefulness, thus allowing for the analysis of simultaneous use of the two skills. Forcing caregivers to choose between the two skills is contrary to Resourcefulness Theory©, which specifies that complementarity of using both personal and social resourcefulness (Zauszniewski, 2016).
Conclusion
This was the first study to compare adult-child and spousal family caregivers of persons with dementia on their use of personal and social resourcefulness in managing anger, anxiety, sadness, decision-making, and financial distress. Accordingly, the findings are foundational for future research with family caregivers of persons with dementia. In particular, the proclivity toward the use of social resourcefulness by spousal caregivers to manage anxiety and the reluctance in using social resourcefulness skills when facing financial distress by both the adult-child and spousal caregivers are intriguing and warrant further investigation.
Acknowledgements
The authors acknowledge the contributions of ideas to earlier versions of this manuscript by Alexandra Jeanblanc (project manager) and Dr. Evanne Juratovac (intervention specialist).
Funding statement:
Data for this analysis were obtained from two studies funded by the National Institutes of Health/National Institute of Nursing Research (NINR), Grant No. R01-NR016817 and Grant No. R01-NR018476, both awarded to Dr. Jaclene A. Zauszniewski (principal investigator).
Footnotes
Ethical Considerations: Data used for this analysis consisted of the baseline data from two parent studies focused on testing health self-management interventions and assessing caregiver needs and preferences for the tested interventions (NCT04603482, NCT04247347). Both studies were approved by the Case Western Reserve University Institutional Review Board following expedited review (#20191787 and #20241509).
Consent to Participate: For both parent studies, the requirement for written informed consent from the study participants was waived. After study participants were screened for meeting the eligibility criteria, they entered the REDcap survey where they were informed about the study requirements, its purpose, duration, and procedures, its potential risks and benefits, and the elements of voluntary participation, including the rights to skip questions and withdraw from the study. The consent also included a statement regarding the future dissemination of findings from the research. If they agreed to participate, they clicked “yes” to enter the survey. If they clicked “no,” they were thanked for considering and exited the survey.
Declaration of conflicting interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Contributor Information
Jaclene A. Zauszniewski, Catherine Seibyl Professor of Nursing, Research, and Caregiving, Case Western Reserve University, Cleveland, Ohio, USA.
Christopher J. Burant, Case Western Reserve University, Cleveland, Ohio, USA; Louis Stokes Northeast Ohio VA Medical Center, Cleveland, OH, USA.
Rayhanah R. Almutairi, Community and Psychiatric Mental Health Nursing Department, College of Nursing, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia..
Kylie Meyer, Case Western Reserve University, Cleveland, Ohio, USA.
Elliane Irani, Case Western Reserve University, Cleveland, Ohio, USA.
Data availability:
The dataset generated during and/or analyzed during the current study are available from the corresponding author on request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The dataset generated during and/or analyzed during the current study are available from the corresponding author on request.