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. Author manuscript; available in PMC: 2024 Feb 1.
Published in final edited form as: J Gerontol Soc Work. 2022 Jul 6;66(2):221–238. doi: 10.1080/01634372.2022.2097755

Correlates of Physical and Emotional Strain Among Older Adult Caregivers

Fei Wang 1, Ann W Nguyen 1
PMCID: PMC9816348  NIHMSID: NIHMS1821205  PMID: 35791671

Abstract

Caregiving can be physically challenging and emotionally draining for older caregivers. The existing research on physical and emotional strain mainly focuses on the general caregiver population. Using the Stress Process Model, this study aims to expand on existing caregiving literature by identifying correlates of physical and emotional strain among older caregivers. Hierarchical OLS regressions were performed on data selected from the 2015 Caregiving in the U.S. Survey (N=701). Several risk factors for physical strain and emotional strain were identified: Assistance with ADLs and IADLs, the number of health problems of the care recipient, and the receipt of formal support were positively associated with physical and emotional strain. Moreover, providing care to parents/parents-in-law was associated with higher levels of emotional strain than providing care to non-relatives. The number of care recipients was positively associated with emotional strain. Older African Americans experienced lower levels of physical strain than their white counterparts. The findings uncover the individual differences among older caregivers and provide insights into how these differences uniquely influence caregiving strain. Moreover, the study identifies a risk and protective profile of caregiving strain, which can help practitioners direct services and resources to older caregivers who are particularly at risk for caregiving strain.

Keywords: Caregiving in late adulthood, socio-economic characteristics, physical strain, emotional strain, social support

The older adult population in the United States is projected to nearly double by 2060 (Vespa et al., 2020). With the trend of population aging, the population of older informal caregivers is rapidly expanding. The latest national survey shows that nearly 1 in 5 informal caregivers are 65 years or older (AARP, 2020).

Caregiving is generally depicted as a form of chronic strain that affects the caregiver physically and emotionally. Caregiving physical and emotional strain can be defined as the physical exhaustion and adverse emotional responses, respectively, resulting from caregiving (Vickers, 2021). Older caregivers are especially vulnerable to physical strain due to their competing demands of caregiving and self-care. Specifically, taking on a caregiver role could exacerbate age-related functional limitations and chronic conditions for older caregivers, which in turn, undermine their ability to continue performing caregiving duties (Wang et al., 2022). Moreover, older caregivers may experience emotional strain due to the negative emotions associated with caregiving, such as feeling sad about the loved one’s deteriorating health and worrying about the future (Abramson, 2015). The ongoing pandemic has exacerbated these intertwined challenges that older caregivers face as they are at a heightened risk for COVID-19 (Leggett et al., 2021).

Given the substantial physical and emotional strain that older caregivers experience, this study aims to examine the correlates of physical and emotional strain in a national sample of older caregivers. The findings of the study will add to existing gerontological literature by identifying the factors contributing to different dimensions of caregiving strain among older caregivers. With these findings, social workers can better identify older caregivers who are at risk for physical and/or emotional strain and target services to them accordingly.

Conceptual Framework

The conceptual framework of this study derives from the Stress Process Model (SPM; Pearlin et al., 1990). The SPM is widely used in caregiving research (Nah et al., 2022; Namkung et al., 2017) and has made substantial contributions to identifying the factors that contribute to caregiving strain. According to the SPM, the caregiver’s socio-demographic characteristics and the relational characteristics between the caregiver and the care recipient are important contextual factors that can account for disparities in caregiving strain (Pearlin et al., 1990). Caregiving demands, defined as the amount, duration, or intensity of care required by the care recipient, can significantly affect caregiving strain (Pearlin et al., 1990). The SPM also posits that social support, a coping resource, can mitigate caregiving strain (Pearlin et al., 1990).

Correlates of Physical and Emotional Strain

Socio-demographic Characteristics

Prior research shows that females report more caregiving strain than males in the general caregiver population (Biliunaite et al., 2022; Chappell et al., 2015) as well as the older caregiver population (Swinkels et al., 2019; Sutcliffe et al., 2017). Contradictory findings have emerged for age, with some studies showing greater strain among older caregivers (e.g., Anderson & Flatt, 2018), a few finding greater strain among younger caregivers (e.g., Walsh & Murphy, 2020), and some finding no effect for age (e.g., McLaughlin et al., 2019). The inconclusive results could be due to the various age ranges of caregivers sampled and how age was treated analytically (e.g., as a categorical versus continuous variable) in these studies. Another possible explanation could be the heterogeneity of caregiving experience. As the SPM postulates that a wide range of factors could affect caregiving strain (Pearlin et al., 1990), different caregivers may experience the compounding effect of different factors on caregiving strain. Therefore, the experience of caregiving strain may be unique to individuals regardless of age.

Research examining ethno-racial differences generally shows that African Americans experience lower levels of emotional strain than non-Hispanic whites, both in the general caregiver population (Badana et al., 2019) and among older caregivers (Roth et al., 2009). However, this body of research mainly examines Black-white difference in caregiving strain without accounting for other ethno-racial minorities groups, such as Hispanics and Asians. Additionally, being unmarried, employed, having fewer years of education, lower income, and a larger household size, were associated with higher levels of caregiving strain in the general caregiver population (Walke et al., 2018; Connors et al., 2019). However, limited research exists that examines the effects of these characteristics on caregiving strain specifically in the older caregiver population.

Caregiver-Care Recipient Relational Characteristics

Research generally shows that co-residency (i.e., the caregiver living with the care recipient) is associated with higher levels of caregiving strain (Brini et al., 2021; Jansen et al., 2021). However, studies on caregiver-care recipient relationship type show equivocal results, possibly because different studies adopt varying methods to classify relationship types. Some studies indicate that spousal caregivers report higher levels of emotional strain than adult children and other relatives (e.g., Sinha et al., 2017), whereas others demonstrate that spousal caregivers have lower levels of emotional strain than adult children (e.g., Conde-Sala et al., 2010). Given the mixed findings on caregiver-care recipient relationship type and the scarcity of research in the older caregiver population, more investigations are needed to determine the effects of caregiver-care recipient relational characteristics on physical and emotional strain among older caregivers.

Caregiving Demands

Empirical evidence points toward caregiving demands as risk factors for caregiving strain. Caregivers who provide more assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) experience higher levels of caregiving strain (Tsai et al., 2021; Cook et al., 2018). Three other indicators of caregiving demands, namely caregiving hours, the number of care recipients for whom the caregiver provides care, and the number of health problems of the care recipient, are known to be important correlates of health among caregivers (Amer Nordin et al., 2019). Therefore, they may also play a critical role in caregiving strain and thus worth examining.

Caregiving-Specific Social Support

Existing research identifies that social support generally can mitigate mental health problems among older caregivers (Ong et al., 2018). Very few studies have examined support that is specific to caregiving situations in this population, including any form of help with caregiving tasks or resources that address caregiving-related issues. One exception is a study by Townsend et al. (2010), which demonstrates that older caregivers who have others to help with caregiving tasks experience lower levels of emotional strain. However, it is unclear whether the source of help is informal (e.g., family or friends at no cost) or formal (i.e., professionals or paid helpers). Therefore, more research is needed to examine the independent effects of informal and formal caregiving-specific support on caregiving strain among older caregivers.

Study Objectives

Guided by the SPM, this study aims to examine four types of factors (i.e., caregiver socio-demographic characteristics, caregiver-care recipient relational characteristics, caregiving demands, and social support) as potential correlates of physical strain and emotional strain.

Based on the literature reviewed, we hypothesize that respondents who are women, non-Hispanic white, unemployed, unmarried, have lower levels of education, lower levels of income, or a larger household size will report higher levels of physical and emotional caregiving strain. Additionally, we hypothesize that respondents who provide care for people who reside with them, require assistance with more ADLs and IADLs, have more health problems, or require longer caregiving hours will report higher levels of physical and emotional caregiving strain. Further, we hypothesize that respondents who provide care to more care recipients and receive no informal or formal caregiving-specific support will report higher levels of physical and emotional caregiving strain. Given the mixed findings on age and relationship type, no hypotheses will be provided for these variables.

Methods

Sample

The sample for this analysis was drawn from the 2015 Caregiving in the U.S. survey, which was collected by the American Association of Retired Persons (AARP) and the National Alliance for Caregiving (NAC). Households were chosen by a random selection of telephone numbers and residential addresses. People in selected households were then invited by telephone or mail to participate in the web-based survey via KnowledgePanel® (AARP & NAC, 2015, pp.3–4). KnowledgePanel® is the only probability-based online panel, designed to be representative of the U.S. population (AARP & NAC, 2015). Using a national, probability-based sampling design, this ongoing survey describes the characteristics, roles, and needs of caregivers of adults.

To be included in the survey, participants must be (1) an adult aged 18 or older and (2) providing or used to provide unpaid care to an adult aged 18 or older in the past 12 months. A total of 1248 participants met the criteria and were invited to complete the full online interview. The current analysis was based on a subsample of caregivers aged 59 and older (N = 701). This cut-off age is commonly used in gerontological literature (Vaingankar et al., 2016; Longacre et al., 2017) and by a number of major national and international organizations (Administration for Community Living, 2021; National Center for Injury Prevention and Control, 2020; United Nations, 2019).

Measures

Outcome Variables

Physical strain was measured by the question: “How much of a physical strain would you say that caring for your __ is /was for you?” Response categories ranged from not a strain at all (1) to very much a strain (5). Emotional strain was measured by the question: “How emotionally stressful would you say that caring for your __ is /was for you?” Response categories ranged from not at all stressful (1) to very stressful (5).

Caregiver Socio-demographic Characteristics

Gender was coded as male and female (reference category). Race/ethnicity was categorized as non-Hispanic white (reference category), African American, Asian, and Hispanic. Education was coded as high school/GED or less (reference category), some college or technical school, and college or graduate school. Annual household income was coded as low (less than $30,000; reference category), medium ($30,000-$74,999), and high ($75,000 or more). Employment status (in the last year while caregiving) was dichotomized as not employed (reference category) and employed. Marital status was coded to differentiate respondents who were either widowed/separated/divorced/never married (reference category) or married/cohabiting. Age and household size were assessed continuously. Household size was measured using the question: “How many people, including children, live in your household?”

Caregiver-Care Recipient Relational Characteristics

Co-residency was coded to differentiate respondents who did not live with their care recipients (reference category) and respondents who lived with their care recipients. Relationship type was coded to differentiate between care recipients who were respondents’ parents or parents-in-law (reference category), other relatives, or non-relatives (e.g., friend, neighbor).

Caregiving Demands

Hours of caregiving was assessed continuously; respondents reported the number of hours of care they provided weekly. Assistance with ADLs was assessed using an index of 7 ADLs (i.e., eating, getting in and out of bed, dressing, toilet use, bathing, incontinence care, and medication use). A total score was calculated by adding all items of the ADL index that the respondent endorsed, with higher scores indicating assistance with more ADLs. Assistance with IADLs was measured using an index of 6 IADLs (i.e., managing finances, grocery shopping, housework, preparing meals, transportation, and arranging care services). A total score was derived from summing all items of the IADL index that the respondent endorsed, with higher scores indicating assistance with more IADLs. Number of health problems of the care recipient was a count variable of 6 health problems (i.e., short-term physical condition, long-term physical condition, emotional or mental health problem, memory problem, developmental or intellectual disorder or mental retardation, and behavioral issue). Number of care recipients was measured using the question: “How many adults do you care for/did you provide care for in the past 12 months?”

Caregiving-Specific Social Support

Informal support was assessed by the following question: “Has anyone else provided unpaid help to the care recipient during the last 12 months?” The answer was recorded dichotomously as yes or no. Similarly, respondents were asked to report whether they received formal support from any aides, housekeepers or other people who were paid to help the care recipient. The response was recorded dichotomously (yes/no).

Data Analysis

Data were analyzed using Stata 15.1. Frequencies and descriptive statistics were conducted for all variables. Hierarchical OLS regressions were conducted to examine the correlates of physical and emotional strain. For each outcome variable, the predictors were entered in the following sequence: caregiver socio-demographic characteristics (Model 1), caregiver-care recipient relational characteristics (Model 2), caregiving demands (Model 3), and caregiving-specific social support (Model 4). A hierarchical OLS regression allows an accurate assessment of the independent effect of each set of predictors while controlling for the previous set(s) of predictors. We checked the assumptions of normality, linearity and multicollinearity. All multivariate analyses used survey sampling weights to provide nationally representative estimates.

Results

Table 1 presents the distribution of study variables. The mean age of respondents was 71 years. Over half of respondents were women and 84% of respondents were non-Hispanic white. About two thirds of respondents had at least some college/technical school education. Respondents were predominately unmarried (i.e., widowed, separated, divorced or never married) (70%) and unemployed in the last year while caregiving (85%). The majority of respondents reported medium annual household incomes between $30,000 and $74,999 (44%). On average, respondents lived in a household with one other individual (household size = 2). Care recipients were predominantly relatives of respondents (21% parents or parents-in-law; 61% other relatives). About half of respondents lived outside of their care recipients’ households.

Table 1.

Demographic characteristics of the sample and distribution of study variables

N (%) Mean (S.D.) Min Max
Age 71.10 (7.50) 60 90
Gender
 Female 410 (59.31)
 Male 291 (40.69)
Race/Ethnicity
 Non-Hispanic white 502 (83.68)
 African American 71 (6.34)
 Asian 59 (2.32)
 Hispanic 69 (7.66)
Education
 High school/GED or less 209 (32.54)
 Some college or technical school 179 (28.97)
 College or graduate school 269 (38.49)
Marital Status
 Widowed/Separated/Divorced/ 443 (69.96)
 Never Married
 Married/cohabiting 190 (30.03)
Employment status
 Not employed 474 (84.85)
 Employed 91 (15.15)
Annual household income
 Low (<$30,000) 144 (21.69)
 Medium ($30,000-$74,999) 282 (44.34)
 High (≥ $75,000) 229 (33.97)
Care recipient-caregiver relationship type
 Parents/parents-in-law 182 (21.30)
 Other relatives 358 (60.71)
 Non-relatives 113 (17.98)
Co-residency
 No 351 (52.05)
 Yes 298 (47.95)
Informal support
 No 319 (52.10)
 Yes 330 (47.90)
Formal support
 No 370 (58.58)
 Yes 278 (41.42)
Household size 2.09 (1.02) 1 9
Caregiving hours 30.43 (31.11) 0.5 77
ADL assistance 2.21 (2.15) 0 7
IADL assistance 3.86 (1.74) 0 6
Care recipient’s health problems 1.49 (0.90) 0 6
The number of care recipients 1.51 (0.46) 1 6
Physical strain 2.50 (1.23) 1 5
Emotional strain 2.94 (1.28) 1 5
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Percents and N are presented for categorical variables and Means and Standard Deviations are presented for continuous variables. Percentages are weighted and frequencies are un-weighted.

With regard to caregiving, respondents provided, on average, 30.43 hours of care per week, which is considered high based on the definition of AARP & NAC (high caregiving hours = 21 or above per week). On average, respondents provided care to 1 adult with 1 health issue. The average number of ADLs and IADLs that respondents assisted with were 2.21 and 3.86, respectively. Less than half of respondents used informal and formal support for caregiving. The levels of physical and emotional strain that respondents experienced were moderate, with an average score of 2.50 and 2.94 respectively.

Table 2 presents the results for the hierarchical OLS regressions testing the correlates of physical strain. The final model (Model 4) shows that African Americans reported lower levels of physical strain compared to non-Hispanic whites. Respondents with formal support had higher levels of physical strain than those without formal support. Also, assistance with more ADLs and IADLs and a greater number of care recipient health problems were associated with higher levels of physical strain.

Table 2.

Hierarchical linear regression analysis for the correlates of physical strain among older caregivers

Model 1 Model 2 Model 3 Model 4
B (SE) B (SE) B (SE) B (SE)
Age −.01 (.01) −.01 (.01) .00 (.01) .00 (.01)
Male −.13 (.11) −.12 (.11) −.10 (.10) −.11 (.10)
Race/Ethnicity
 African American −.04 (.19) −.07 (.19) −.25 (.15) −.29 (.14)*
 Asian −.41 (.32) −.36 (.35) −.42 (.36) −.46 (.37)
 Hispanic −.20 (.21) −.18 (.21) −.12 (.20) −.12 (.20)
Education
 Some college or technical school −.08 (.15) −.06 (.14) −.02 (.13) −.05 (.13)
 College or graduate school −.21 (.14) −.19 (.14) −.04 (.13) −.10 (.13)
Married/cohabiting −.24 (.13) −.10 (.14) .09 (.13) .12 (.13)
Employed −.14 (.17) −.07 (.16) .01 (.17) −.03 (.17)
Annual household income
 Medium ($30,000-$74,999) −.30 (.14)* −.27 (.14) −.26 (.14) −.26 (.14)
 High (≥ $75,000) −.20 (.13) −.13 (.16) −.19 (.15) −.17 (.15)
Household size .11 (.07) .03 (.07) .10 (.06) .10 (.06)
Care recipient-caregiver relationship
 Other relatives -- −.13 (.16) .07 (.17) .12 (.16)
 Non-relatives -- −.42 (.17)* −.11 (.17) −.07 (.17)
Co-residency -- .37 (.13)** −.16 (.14) −.11 (.14)
Caregiving hours -- - .00 (.00) .00 (.00)
ADL assistance -- - .21 (.03)*** .20 (.03)***
IADL assistance -- -- .10 (.04)** .09 (.04)*
Care recipient’s health problems -- -- .19 (.05)*** .19 (.06)***
The number of care recipients -- -- −.20 (.09)* −.18 (.09)
Informal support -- -- -- −.03 (.10)
Formal support -- -- -- .26 (.11)*
Intercept 3.30 (.67) 3.44 (.69) 1.84 (.64) 1.82 (.64)
F 2.01 2.59 9.65 9.77
Complex design df 514 507 499 496
N 527 523 520 519
R 2 .04 .08 .26 .27
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B=regression coefficient; SE=standard error

Reference category: Female, Non-Hispanic white, High school/GED or less, Widowed/separated/divorced/never married, Not employed, Low income (<$30,000), Parents/parents-in-law, Living outside of care recipient’s household, No informal support, No formal support.

*

p < .05

**

p< .01

***

p < .001

Table 3 shows the results for the hierarchical OLS regressions testing the correlates of emotional strain. In the final model (Model 4), providing care to parents/parents-in-law was associated with higher levels of emotional strain compared to providing care to non-relatives. Assistance with more ADLs and IADLs, a greater number of care recipient health problems, and respondents receiving formal support were associated with higher levels of emotional strain. In contrast, a greater number of care recipients was associated with lower levels of emotional strain.

Table 3.

Hierarchical linear regression analysis for the correlates of emotional strain among older caregivers

Model 1 Model 2 Model 3 Model 4
B (SE) B (SE) B (SE) B (SE)
Age −.01 (.01) −.01 (.01) .00 (.01) .00 (.01)
Male −.14 (.12) −.12 (.12) −.12 (.11) −.12 (.11)
Race/Ethnicity
 African American −.10 (.22) −.10 (.22) −.23 (.20) −.27 (.20)
 Asian −.31 (.33) −.28 (.33) −.35 (.33) −.41 (.35)
 Hispanic −.07 (.23) .02 (.22) .11 (.20) .11 (.19)
Education
 Some college or technical school .06 (.16) .08 (.15) .14 (.14) .10 (.14)
 College or graduate school −.03 (.17) −.01 (.17) .14 (.15) .08 (.15)
Married/cohabiting −.23 (.15) −.03 (.15) .12 (.14) .16 (.14)
Employed −.32 (.17) −.25 (.16) −.17 (.17) −.18 (.17)
Annual household income
 Medium ($30,000-$74,999) −.08 (.16) −.06 (.16) −.09 (.14) −.09 (.14)
 High (≥ $75,000) .10 (.19) .16 (.19) .05 (.17) .07 (.17)
Household size −.02 (.07) −.10 (.07) −.04 (.06) −.04 (.06)
Care recipient-caregiver relationship
 Other relatives -- −.23 (.17) .00 (.17) .06 (.17)
 Non-relatives -- −.87 (.19)*** −.53 (.19)** −.49 (.19)**
Co-residency -- .28 (.14)* −.29 (.15) −.24 (.15)
Caregiving hours -- -- .00 (.00) .00 (.00)
ADL assistance -- -- .12 (.03)*** .10 (.03)***
IADL assistance -- -- .14 (.04)*** .13 (.04)***
Care recipient’s health problems -- -- .32 (.06)*** .32 (.06)***
The number of care recipients -- -- −.25 (.09)** −.23 (.09)*
Informal support -- -- -- −.05 (.11)
Formal support -- -- -- .31 (.12)**
Intercept 3.96 (.70) 4.00 (.72) 2.39 (.70) 2.38 (.70)
F 1.04 3.31 10.20 10.50
Complex design df 511 505 497 494
N 524 521 518 517
R 2 .02 .09 .24 .26
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B=regression coefficient; SE=standard error

Reference category: Female, Non-Hispanic white, High school/GED or less, Widowed/separated/divorced/never married, Not employed, Low income (<$30,000), Parents/parents-in-law, Living outside of care recipient’s household, No informal support, No formal support.

*

p < .05

**

p< .01

***

p < .001

Discussion

This study focuses on the growing yet understudied population of older adults acting as informal caregivers. Using a nationally representative sample, this study extends our understanding of the experiences of older caregivers by identifying correlates of physical and emotional strain in this population. Consistent with our hypothesis, the study shows that assistance with more ADLs and IADLs and a greater number of health problems of the care recipient were associated with higher levels of physical and emotional strain. According to the SPM (Pearlin et al., 1990), these characteristics represent more demanding caregiving circumstances that can increase older caregivers’ difficulty in performing their duties. Consequently, older caregivers may experience higher levels of physical exhaustion (i.e., physical strain) and more adverse emotions (i.e., emotional strain).

Consistent with our hypothesis, older African American caregivers reported lower levels of physical strain compared to their white counterparts. One possible explanation for this finding is that compared to their white counterparts, older African Americans may have higher levels of resilience that allow them to withstand caregiving adversity and adapt to challenges, which could have attenuated their perceptions of physical strain. Prior research shows that African Americans, especially older cohorts, developed resilience given that they have endured a prolonged history of marginalization (e.g., Jim Crow, segregation, and structural discrimination) (Wang et al., 2021), which is protective against their physical health problems (Cannon & Fawcett, 2018). Given that resilience was not assessed in this study, to confirm this, future research should examine the relationship between resilience and physical strain among older African American caregivers.

Additionally, we conducted two post-hoc chi-square analyses between race/ethnicity (i.e., African American, Hispanic, Asian, and non-Hispanic white) and formal and informal support, respectively (results not shown). We found that African Americans had the highest rates of formal support, x2(3, 648) = 10.44, p < .05, which could help reduce their workload and mitigate their physical strain.

The data also show that providing care to parents/parents-in-law was associated with higher levels of emotional strain, compared to providing care to non-relatives. This finding adds evidence to the prior research on negative caregiving effect on adult children caregivers (e.g., Suitor et al., 2018). One possible explanation is relational ambivalence. Researchers have long suggested that primary kinship ties (e.g., parents, spouses) are more likely to be appraised as both close and problematic compared to more distal social ties (e.g., friends, acquaintances; Connidis, 2015). Moreover, individuals are more likely to experience ambivalent sentiments toward parents and children than toward other members within their social networks (Connidis, 2015). This is possibly because, compared to some other social relationships, parent-child relationships may involve longer histories and increased sense of obligation—factors that can contribute to both closeness and tensions (Pillemer et al., 2019). Prior research shows that ambivalent caregiving relationship has negative implications for caregiver mental health (Losada et al., 2018). Therefore, in this study, older caregivers caring for parents/parents-in-law may experience greater relational ambivalence than older caregivers caring for non-relatives, which could increase their emotional strain.

Interestingly, formal support was associated with higher levels of physical and emotional strain. This finding, while seemingly counterintuitive, is consistent with the resource mobilization perspective of social support (Wheaton, 1985). That is, in order to cope with stressful events, individuals may actively reach out to members of their network to mobilize support and assistance for dealing with the stressor (Nguyen et al., 2017). Meanwhile, support network members may recognize the visible signs of distress in an individual and mobilize around him/her to provide support for coping with stressful situations (Nguyen et al., 2017). In this study, caregivers who experienced higher levels of physical and emotional strain may be more likely to seek professional services. This finding is consistent with a recent study, which shows that among informal caregivers of family members with an intellectual or mental disability, those who experienced higher levels of anxiety sought help from formal sources more frequently (Sit et al., 2020). For caregivers who have not engaged in social services, their visible signs of strain may be recognized by healthcare professionals during a doctor’s visit with their care recipients. As a result, caregivers may be referred to social services for assistance with caregiving. Altogether, the positive association between formal support and caregiving strain may reflect older caregivers’ efforts to cope with caregiving strain by marshalling professional support.

The positive association between formal support and caregiving strain can also be explained by the care recipient’s needs. We conducted post-hoc Pearson’s correlations between formal support and the caregiving demands variables (i.e., caregiving hours, ADL assistance, IADL assistance, the number of health problems of the care recipient, and the number of care recipients) (analysis not shown). The results show that formal support was positively correlated with ADL assistance (r = .21, p < .001) and IADL assistance (r = .08, p < .05). Given that ADL and IADL are commonly used in the caregiving literature to reflect the level of need of the care recipient, older caregivers with formal support may be more likely to provide care to a loved one with greater care needs than those without formal support, which could increase physical and emotional strain.

Providing care to a greater number of care recipients was associated with lower levels of emotional strain. As caregivers provide care to more people, they accumulate more experience. As a result, caregivers become more confident in performing caregiving tasks and gain greater control over these tasks. Caregiving competence reflects an individual’s self-appraisal of their adequacy and performance as a caregiver; mastery represents an individual’s perceived global sense of control over life situations (Pearlin et al., 1990). Both caregiving competence and mastery can protect against mental health problems, such as depression and anxiety (Chan et al., 2018). In this study, it is possible that caregivers with higher levels of competence and mastery may perceive caregiving duties as less stressful and thus experience lower levels of emotional strain. Moreover, higher levels of competence and mastery elicit goal-directed behaviors in the face of obstacles or setbacks (Bandura, 2001). Therefore, caregivers with higher levels of competence and mastery may actively secure guidance and help when necessary, which helps mitigate their emotional strain. Future studies may consider examining the effects of competence and mastery on emotional strain among older caregivers.

Research and Practice Implications

The present study has important implications for research on aging and family caregiving. It bridges the knowledge gap by examining social support that is specific to the context of caregiving. Further investigations are needed to differentiate the effects of caregiving-specific social support and general social support on caregiving strain. This study also informs a possible approach to systematically examine the types of social support (i.e., caregiving-specific, general, formal, and informal) among older caregivers. Moreover, the positive associations between race/ethnicity and the number of care recipients and caregiving strain suggest that some internal mechanisms, such as resilience, competence and mastery, may play important roles in mitigating caregiving strain among older caregivers. Future research can examine the effects of these factors on caregiving strain.

This study also carries several practice implications. The findings of our study uncover the differences among older caregivers, which could inform a better understanding of how individual differences uniquely influence caregiving strain for social workers working with older caregivers. Moreover, our findings can inform a novel clinical assessment framework for social workers in the healthcare or mental health setting to identify risk and protective factors for caregiving strain.

Social workers, especially gerontological social workers, have considerable expertise in providing direct services to older adults. Based on our findings, resources and services should be directed to older caregivers who are particularly vulnerable to caregiving strain (i.e., individuals with higher levels of caregiving demands or caring for parents/parents-in-law). Gerontological social workers can provide psychoeducation, support groups, and caregiver training to at-risk older caregivers. Older caregivers who utilize these resources may better equip themselves with caregiving skills and obtain support from other older caregivers, which could help mitigate their caregiving strain (Hendrix et al., 2020; Sabo & Chin, 2021). Also, gerontological social workers can connect these at-risk groups with in-home respite care service. Through providing direct assistance to older caregivers with various tasks, in-home respite care service can relieve them from heavy duties and reduce their feelings of strain while allowing them to keep their loved one’s company. Moreover, given the various needs of care recipients, at-risk older caregivers may be supported by multiple service systems (e.g., healthcare, disability, elderly social service). Therefore, case management is essential to mitigate caregiving strain by helping older caregivers navigate different service systems and coordinate caregiving duties between themselves and service providers. Additionally, social workers at community or family service centers can organize psychoeducation sessions for the families of the at-risk older caregivers and initiate discussions within the family about sharing caregiving duties with the older caregiver.

Limitations and Strengths

The study’s findings must be considered in light of several limitations. First, the cross-sectional nature of the data does not allow conclusions to be made about causality. Second, study variables were assessed via self-report, which is susceptible to recall and social desirability biases. Third, the sample was predominantly white. Future research should use more racially and ethnically diverse samples. Fourth, no data were available to explore the quality of social support and older caregivers’ satisfaction with the support received. Therefore, qualitative measures can be included to assess older caregivers’ perception of the quality and helpfulness of the support, and the challenges in utilizing the support.

Despite these limitations, the present study contributes to the existing literature on older caregivers by developing a risk and protective profile of caregiving strain for this population. Moreover, the bulk of caregiving research to date has mainly focused on general social support without accounting for caregiving-specific support. Our study addresses this knowledge gap by examining the effects of informal and formal caregiving-specific support on caregiving strain. Additionally, this study is strengthened by its use of a national probability sample, which allows for population-level inferences.

The COVID-19 pandemic has posted unprecedented challenges to caregivers that can exacerbate their caregiving strain, such as difficulty in scheduling doctor’s appointments and getting in-home and community care services (e.g., meals-on-wheels, transportation, adult day care) for their loved ones. Moreover, some caregivers face the problems with visiting their elderly family members residing in long-term care facilities. Even though most care services may have reopened by now, older caregivers may still not use them for fear that they and their loved ones could be exposed to and contract the coronavirus (Phillips et al., 2020). While this study did not directly measure physical and emotional strain as a result of the pandemic, it helps us anticipate the risk and protective factors for physical and emotional strain among older caregivers amid the pandemic and necessitate an immediate focus on prevention of and intervention for physical and emotional strain.

Acknowledgment

This work was supported by the National Heart, Lung, and Blood Institute to AWN under Grant [number 5R25HL105444-11] to AWN.

Footnotes

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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