Academic journal article Research and Theory for Nursing Practice

Effort, Workload, and Depressive Symptoms in Family Caregivers of Older Adults: Conceptualizing and Testing a Work-Health Relationship

Academic journal article Research and Theory for Nursing Practice

Effort, Workload, and Depressive Symptoms in Family Caregivers of Older Adults: Conceptualizing and Testing a Work-Health Relationship

Article excerpt

Increasing effort in response to a complex workload is detrimental to workers' health and may explain the negative health consequences experienced by millions of family caregivers who are the primary workforce for older adult care in the United States. This cross-sectional, descriptive correlational study used survey data from 110 family caregivers of community-dwelling older adults to theoretically explain caregiving effort (as perceived exertion) and to examine the relationship between effort and depressive symptoms, a particularly persistent adverse caregiver health outcome. Visual analog scales and exemplar quotes explicated physical, mental, emotional, and time-related effort. Notably, effort was considered too multidimensional by several caregivers to discretely categorize. Among the relationships tested, effort was statistically significantly correlated with workload proxies (time, difficulty, overload), caregiver health and depressive symptoms, and care receiver function. Using regression analysis, effort and workload did not have direct effects on depressive symptoms. Surprisingly, effort was not decreased for caregivers who had formal or informal caregiving help. These findings support an energetical conceptualization in caregiving and highlight the complexity of a caregiving workload assessment. Practice suggestions are offered toward tailored health promotion strategies to benefit the families who constitute this essential, global caregiving workforce.

Keywords: effort; workload; family caregivers; family assessment

When family caregivers describe the effort needed to care for older adults, they describe a fundamental concept within the work-health relationship wherein effort is defined as the energy exerted to perform a workload. As families provide the majority of care to older adults in nations such as the United States (National Alliance for Caregiving & American Association of Retired Persons [NAC/AARP], 2009), it may be meaningful to conceptualize families as a workforce who performs the vital work of caring for older adults (Juratovac, 2009, 2012; Juratovac, Wykle, & Morris, 2006). Because the older population is expanding (Administration on Aging [AoA], 2012), family provided care is likely increasing. Although largely unpaid, family provided care has been valued at more than US$450 billion annually (AARP, 2011) in the United States; yet, this value comes at a cost. A large body of research suggests that family provided care for older adults is associated with increased caregiver morbidity (Amirkhanyan & Wolf, 2003; Pinquart & Sörensen, 2003; Vitaliano, Zhang, & Scanlan, 2003) and mortality (Schulz & Beach, 1999). Importantly, the demands of the caregiving workload co-occur with a disproportionate prevalence of depressive symptoms among caregivers (e.g., Tennstedt, Cafferta, & Sullivan, 1992). However, the prominence of caregiver depression has not reduced appreciably in the decades since (Tsai & Jirovec, 2005; NAC & Evercare, 2006) and is a serious public health concern (Gray, 2003). Upward estimates of 91% of caregivers have depressive symptoms, and the severity of their symptoms seems to be linked to their caregiving workload (NAC & Evercare, 2006). Depressive symptoms likely interfere with daily function and that interference certainly extends to caregivers' role function.

The magnitude of the effort of family caregivers performing this workload had not been documented until recently (Juratovac, 2009). It is hard to imagine a workplace wherein the person who performs the work would be expected to work without some estimation of the impact of the effort and workload on the worker's health. Meanwhile, the potential exists for caregiver morbidity to result from overexerting energy in response to strenuous caregiving work, and family caregivers are expected to care for older adults in their community workplace without an ongoing evaluation of their effort and its relationship to their health. …

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