Hostname: page-component-76d6cb85b7-hqrjx Total loading time: 0 Render date: 2026-07-17T02:50:33.583Z Has data issue: false hasContentIssue false
  • English
  • Français

Worry about performance: a unique dimension of caregiver burden

Published online by Cambridge University Press:  02 January 2014

Wee Shiong Lim ,
Wee Kooi Cheah ,
Noorhazlina Ali ,
Huey Charn Han ,
Philomena Vasantha Anthony ,
Mark Chan  and
Mei Sian Chong
Wee Shiong Lim*
Affiliation:
Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
Wee Kooi Cheah
Affiliation:
Department of Medicine, Taiping Hospital, Taiping, Malaysia
Noorhazlina Ali
Affiliation:
Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
Huey Charn Han
Affiliation:
Nursing Service, Tan Tock Seng Hospital, Novena, Singapore
Philomena Vasantha Anthony
Affiliation:
Nursing Service, Tan Tock Seng Hospital, Novena, Singapore
Mark Chan
Affiliation:
Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
Mei Sian Chong
Affiliation:
Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore
*
Correspondence should be addressed to: Dr Wee-Shiong Lim, Department of Geriatric Medicine, Tan Tock Seng Hospital, TTSH Annex, Level 2, 11 Jalan Tan Tock Seng, Novena 308433, Singapore. Phone: +65-6357-7859; Fax: +65-6357-7837. Email: Wee_Shiong_Lim@ttsh.com.sg.
Get access

Abstract

Background:

Recent studies that describe the multidimensionality of the Zarit Burden Interview (ZBI) challenge the traditional dual-factor paradigm of personal and role strains (Whitlatch et al., 1991). These studies consistently reported a distinct dimension of worry about caregiver performance (WaP) comprising items 20 and 21.The present study aims to compare WaP against conventional ZBI domains in a predominantly Chinese multi-ethnic Asian population.

Methods:

We studied 130 consecutive dyads of family caregivers and patients. Factor analysis of the 22-item ZBI revealed four factors of burden. We compared WaP (factor 4) with the other three factors, personal strain, and role strain via: internal consistency; inter-factor correlation; item-to-total ratio across Clinical Dementia Rating (CDR) stages; predictors of burden; and interaction effect on total ZBI score using two-way analysis of variance.

Results:

WaP correlated poorly with the other factors (r = 0.05–0.21). It had the highest internal consistency (Cronbach's α = 0.92) among the factors. Unlike other factors, WaP was highly endorsed in mild cognitive impairment and did not increase linearly with disease severity, peaking at CDR 1. Multiple regression revealed younger caregiver age as the major predictor of WaP, compared with behavioral and functional problems for other factors. There was a significant interaction between WaP and psychological strain (p = 0.025).

Conclusion:

Our results corroborate earlier studies that WaP is a distinct burden dimension not correspondent with traditional ZBI domains. WaP is germane to many Asian societies where obligation values to care for family members are strongly influential. Further studies are needed to better delineate the construct of WaP.

Keywords

Zarit Burden Interviewcaregiversdementiadimensionsfactor analysis

Information

Type
Research Article
Information
International Psychogeriatrics , Volume 26 , Issue 4 , April 2014 , pp. 677 - 686
Copyright
Copyright © International Psychogeriatric Association 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Ankri, J., Andrieu, S., Beaufils, B., Grand, A., and Henrard, J. C. (2005). Beyond the global score of the Zarit Burden Interview: useful dimensions for clinicians. International Journal of Geriatric Psychiatry, 20, 254–260.Google Scholar
Ballesteros, J., Santos, B., González-Fraile, E., Muñoz-Hermoso, P., Domínguez-Panchón, A. I. and Martín-Carrasco, M. (2012). Unidimensional 12-item Zarit Caregiver Burden Interview for the assessment of dementia caregivers’ burden obtained by item response theory. Value Health, 15, 1141–1147.CrossRefGoogle ScholarPubMed
Bedard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A. and O'Donnell, M. (2001). The Zarit Burden Interview: a new short version and screening version. Gerontologist, 41, 652–657.Google Scholar
Chan, T. S. F., Lam, L. C. W. and Chiu, H. F. K. (2005). Validation of the Chinese version of the Zarit Burden Interview. Hong Kong Journal of Psychiatry, 15, 9–13.Google Scholar
Chan, M., Tay, L. and Chong, M. S. (2011). Amnestic mild cognitive impairment and early Alzheimer's disease in an Asian memory clinic – evidence for a clinical spectrum. Dementia and Geriatric Cognitive Disorders Extra, 1, 113–123.Google Scholar
Chattat, R. et al. (2011). The Italian version of the Zarit Burden Interview: a validation study. International Psychogeriatrics, 23, 797–805.Google Scholar
Cheah, W. K., Han, H. C., Chong, M. S., Anthony, P. V. and Lim, W. S. (2012). Multidimensionality of the Zarit Burden Interview across the severity spectrum of cognitive impairment: an Asian perspective. International Psychogeriatrics, 24, 1846–1854.Google Scholar
Cheng, S. T., Lam, L. C. W., Kwok, T., Ng, N. S. and Fung, A. W. (2013). Self-efficacy is associated with less burden and more gains from behavioral problems of Alzheimer's disease in Hong Kong Chinese caregivers. Gerontologist, 53, 71–80.CrossRefGoogle ScholarPubMed
Choo, W. Y., Low, W. Y., Karina, R., Poi, P. J. H., Ebenezer, E. and Prince, M. J. (2003). Social support and burden among caregivers of patients with dementia in Malaysia. Asia-Pacific Journal of Public Health, 15, 23–29.CrossRefGoogle ScholarPubMed
Collin, C., Wade, D. T., Davies, S. and Horne, V. (1988). The Barthel ADL index: a reliability study. International Disability Studies, 10, 61–63.CrossRefGoogle ScholarPubMed
Garand, L., Dew, M. A., Eazor, L. R., DeKosky, S. T. and Reynolds, C. F. (2005). Caregiving burden and psychiatric morbidity in spouses of persons with mild cognitive impairment. International Journal of Geriatric Psychiatry, 20, 512–522.CrossRefGoogle ScholarPubMed
Kaufer, D. I. et al. (2000). Validation of the NPI-Q, a brief clinical form of the neuropsychiatric inventory. Journal of Neuropsychiatry and Clinical Neurosciences, 12, 233–239.Google Scholar
Knight, B. G., Fox, L. S. and Chou, C. P. (2000). Factor structure of the Burden Interview. Journal of Clinical Geropsychology, 6, 249–258.CrossRefGoogle Scholar
Ko, K. T., Yip, P. K., Liu, S. I. and Huang, C. R. (2008). Chinese version of the Zarit Caregiver Burden Interview: a validation study. American Journal of Geriatric Psychiatry, 16, 513–518.Google Scholar
Lai, D. W. L. (2007). Validation of the Zarit Burden Interview for Chinese Canadian caregivers. Social Work Research, 31, 45–53.CrossRefGoogle Scholar
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179–186.Google Scholar
Lawton, M. P., Kleban, M. H., Moss, M., Rovine, M. and Glicksman, A. (1989). Measuring caregiver appraisal. Journals of Gerontology, 44, 61–71.CrossRefGoogle Scholar
Leggett, A. N., Zarit, S., Taylor, A. and Galvin, J. E. (2011). Stress and burden among caregivers of patients with Lewy body dementia. Gerontologist, 51, 76–85.CrossRefGoogle ScholarPubMed
Lim, W. S., Chin, J. J., Lam, C. K., Lim, P. P. and Sahadevan, S. (2005). Clinical dementia rating: experience of a multi-racial Asian population. Alzheimer Disease and Associated Disorders, 19, 135–142.Google Scholar
Losada, A., Márquez-González, M., Peñacoba, C. and Romero-Moreno, R. (2010). Development and validation of the Caregiver Guilt Questionnaire. International Psychogeriatrics, 22, 650–660.Google Scholar
Lu, L., Wang, L., Yang, X. and Feng, Q. (2009). Zarit Caregiver Burden Interview: development, reliability and validity of the Chinese version. Psychiatry and Clinical Neurosciences, 63, 730–734.CrossRefGoogle ScholarPubMed
Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43, 2412–2414.CrossRefGoogle ScholarPubMed
Rankin, E. D., Haut, M. W., Keefover, R. W. and Franzen, M. D. (1994). The establishment of clinical cutoffs in measuring caregiver burden in dementia. Gerontologist, 34, 828–832.CrossRefGoogle ScholarPubMed
Sahadevan, S., Lim, J. P., Tan, N. J. and Chan, S. P. (2000). Diagnostic performance of two mental status tests in older Chinese: influence of education and age on cut-off values. International Journal of Geriatric Psychiatry, 15, 234–241.Google Scholar
Sorensen, S., Duberstein, P., Gill, D. and Pinquart, M. (2006). Dementia care: mental health effects, intervention strategies and clinical applications. Lancet Neurology, 5, 961–973.CrossRefGoogle Scholar
Sun, F., Ong, R. and Burnette, D. (2012). The influence of ethnicity and culture on dementia caregiving: a review of empirical studies on Chinese Americans. American Journal of Alzheimer's Disease and Other Dementias, 27, 13–22.Google Scholar
Tabachnick, B. G. and Fidell, L. S. (2007). Using Multivariate Statistics, 5th edn. Boston, MA: Pearson Education.Google Scholar
Turró-Garriga, O., Soler-Cors, O., Garre-Olmo, J., López-Pousa, S., Vilalta-Franch, J. and Monserrat-Vila, S. (2008). Distribucion factorial de la carga en cuidadores de pacientes con enfermedad de Alzheimer. Revista De Neurologia, 46, 582–588.Google Scholar
Whitlatch, C. J., Zarit, S. H. and von Eye, A. (1991). Efficacy of interventions with caregivers: a reanalysis. Gerontologist, 31, 9–14.CrossRefGoogle ScholarPubMed
Zarit, S. H., Reever, K. E. and Bach-Perterson, J. (1980). Relatives of the impaired elderly, correlates of feelings of burden. Gerontologist, 20, 649–655.Google Scholar