Academic journal article Scholarly Inquiry for Nursing Practice

Response to "Testing a Model of Family Caregivers' Perceptions of Elder Behavior Two Weeks Posthospitalization on Caregiver Response and Health"

Academic journal article Scholarly Inquiry for Nursing Practice

Response to "Testing a Model of Family Caregivers' Perceptions of Elder Behavior Two Weeks Posthospitalization on Caregiver Response and Health"

Article excerpt

Care for chronically ill or dependent elders provided by informal caregivers in the community has become an increasing focus of concern because of the growth in the numbers of older adults. Yet, in spite of proliferation of research in this area, Pillemer (1996), in his critique of three recent books emphasizing issues in family care and possible interventions, notes that we still know very little about aging families, and answers the question of whether we know what to do for and about family caregivers with a resounding 'No.' In fact, a recent study supports the lack of an impact of home health care for caregivers to impaired older adults on strain, depressive symptomatology, and positive appraisals (Schwarz & Blixen, 1997).

It is from within this context-expanding but deficient knowledge regarding family care and how to intervene-that I wish to respond to the article by Bull and her colleagues on caregivers of recently hospitalized, chronically ill elders. For while the focus of their study is on a less commonly studied population, caregivers of noncognitively impaired elders who have experienced an acute exacerbation of a chronic condition, it raises a number of interrelated issues that need to be critically considered in order to provide the necessary knowledge base for practice. I will focus on two specific points : (1) burden-how it is defined and measured and whether caregivers are truly burdened and in need of services; and (2) transitions as an opportunity for intervention.


An assumption underpinning most of the caregiving literature is that family caregiving is burdensome, difficult or distressful, and that interventions are needed to allow caregivers to continue in their role and to promote their own well-being. Without attempting to critique this assumption, it raises two issues that have been recurrent themes in caregiving research: how should we define and measure 'burden;' and are caregivers really 'burdened'? These are important issues, for in order to intervene appropriately we need to know the dimensions of the problem.

Definitional Issues

Dr. Bull and her colleagues define burden from within a stress and coping framework, which is not an uncommon approach in the caregiving literature. Burden, however, is defined in two ways, and the measurement of burden appears to tap into both definitions. This makes it difficult to clearly identify precursors to burden, mediators and where they may influence the stress and coping process, and points of intervention.

On page 0 of the article, it is noted that "The extent to which caregivers perceive that their social life, physical health, emotional health or finances is impaired as a result of caregiving has been referred to as burden." This is congruent with the appraisal process in the stress and coping paradigm which focuses on the unique experience of each person, or as Lazarus (1993) notes, the personal meaning. Thus, a stressful appraisal would see harm or loss in one's health or emotional well-being. This definition is also congruent with the importance of caregivers' subjective perceptions and personal characteristics in predicting alterations in well-being (Gwyther & George, 1986), and ending caregiving (Kasper, Steinbach, & Andrews, 1994; Zarit, Todd, & Zarit, 1986), as well as with the perceptions of the caregiving situation component of the ABCX Model applied to care giving (Biegel, Sales, & Schulz, 1991), and the subjective burden as defined by Zarit and his colleagues (1986). Two components of the caregiver response instrument used to assess this variable appear directly related to this definition (p. 00): the caregivers' assessment of the extent to which care giving interferes with their daily activities and the extent to which caregiving has placed a financial strain on the family.

There is a shift in focus, however, on page 0 of the article. In the description of Lazarus and Folkman's Transactional Stress Theory, burden becomes the last step in the model-the outcome of the complex pattern of effects on the mind and body produced by the stressor. …

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