Burden/Stress/Strain Assessments

The terms burden, stress and strain are quite often used interchangeably in the literature (Thornton & Travis, 2003) and, arguably, theye are some of the most extensive concepts researched within the caregiving literature (Bedard et al., 2001; Dumont et al., 2008 ; Gupta, 2004; Pearlin, et al., 1990).  Caregiver burden has been around since the early 1980s when Zarit (1980) introduced the Zarit Burden Inventory. Since this time, the Zarit Burden Inventory has undergone revisions, including a Short Form Zarit Burden Interview (Bedard et al., 2001) and a number of other caregiver burden instruments and related stress and strain instrument have been developed.  Furthermore, to reflect variations in burden across different diseases, some burden instruments that have been developed are disease-specific.

Caregiver Burden Inventory

  • To measure caregiver burden as it relates to time, developmental comparison with peers, physical health, social relationships, and emotional health.
  • 5 items for each: a) time-dependence burden; b) developmental burden; c) physical burden; d) social burden (5-point scale)
  • 4 items for emotional burden (5-point scale)
  • http://www.fullcirclecare.org/caregiverissues/health/burden.html
  • Novak, M., & Guest, C. (1989). Application of a multidimensional Caregiver Burden Inventory. The Gerontologist, 29, 798-803.

Caregiver Burden Scale

  • Measures caregiver burden at the end of life.
  • 18 items (4-point scale)
  • Dumont, S., Fillion, L., Gagnon, P., & Bernier, N. (2008). A new tool to assess family caregiver burden during end-of-life care. Journal of Palliative Care, 24(3), 151-161.

Caregiver Distress Activities

  • Measures the effort made by the caregiver to decrease the symptoms of stress that result from caregiving.
  • 8 items (4-point scale)
  • Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583-594.

Caregiver Strain Index

Caregiver Stress Effects

  • Measures aspects of family life that are negatively affected by caregiving role, as well as restrictions in caregiver activities as a result of the caregiving role.
  • 8 items for negative changes in elder, caregiver and family relationships
  • 5 items for restrictions in caregivers’ activities
  • Deimling, G. T., & Bass, D. M. (1986). The strengths and resources of families caring for impaired elders: Report to tThe Retirement Research Foundation: The Benjamin Rose Institute.
  • Deimling, G. T., & Bass, D. M. (1986). Symptoms of mental impairment among elderly adults and their effects on family caregivers. Journal of Gerontology, 41, 778-784.

Caregivers’ Stress Scale

  • Measures 15 domains: cognitive status, problematic behaviour, overload, relational deprivation, family conflict, job-caregiving conflict, economic strains, role captivity, loss of self, caregiving competence, personal gain, management of situation, management of meaning, management of distress, and expressive support.
  • Series of 15 scales (3-point, 4-point, 5-point scales)
  • Pearlin, L. I., Mullan, J. T., Semple, S. J., & Skaff, M. M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583-594.

Care-related Strain

  • Measures the stress felt by a caregiver as a result of having a relative in a nursing home.
  • 7 items (4-point scale)
  • Whitlatch, C. J., Schur, D., Noelker, L. S., Ejaz, F. K., & Looman, W. J. (2001). The stress process of family caregiving in institutional settings. The Gerontologist, 41, 462-473.

Cost of Care Index

  • Measures different aspects of burden including personal and social restrictions, emotional health, worthiness of caregiving, relationship with care recipient, and economic costs.
  • 4 items for each: a) personal and social restrictions; b) physical and emotional health; c) value investment in caregiving; d) perception of the care recipient as a provocateur; e) economic costs (4-point scales)
  • Kosberg, J. I., & Cairl, R. E. (1986). The cost of care index: A case management tool for screening informal care providers. The Gerontologist, 26, 273-278.

Family Strain Scale

  • Measures subjective burden related to emotional/psychological affect, changes in living in living patterns, and changes in relationships/health.
  • 5 items
  • Morycz, R. K. (1985). Caregiving strain and the desire to institutionalize family members with Alzheimer’s disease: Possible predictors and model development. Research on Aging, 7, 329-361.

Novel Caregiver Burden

  • Measures strain, isolation, disappointment, and emotional involvement.
  • 20 items (4-point scale)
  • Elmstahl, S., Malmberg, B., & Annerstedt, L. (1996). Caregiver’s burden of patients 3 years after stroke assessed by a Novel Caregiver Burden Scale. Archives of Physical Medicine and Rehabilitation, 77, 177-182.

Measures of Strain

  • Measures 3 domains: difficulty of caregiving (threat to family well-being), negative consequences of caregiving, and perceptions of negative consequences of caregiving on the family.
  • 3 items for appraised difficulty of caregiving (4-point scale)
  • 3 items for negative consequences of caregiving (2-point scale)
  • 2 items for perceptions of negative consequences of caregiving on the family (2-point scale)
  • Bass, D. M., & Bowman, K. (1990). The transition from caregiving to bereavement: The relationship of care-related strain and adjustment to death. The Gerontologist, 31, 32-42.

Montgomery Burden Interview

  • Two scales are used to assess both objective and subjective burden.  The objective scale focuses on privacy, time, personal freedom, amount of money available, amount of energy, amount of vacation activities, recreational activities, relationships with other family members, and health.  The subjective scale focuses on attitudes and emotional reactions toward caregiving.
  • 9 items for objective scale (5-point scale)
  • 13 items for subjective scale (‘rarely or never’ to ‘most of the time’)
  • Montgomery, R., Gonyea, J. G., & Hooyman, N. R. (1985). Caregiving and the experience of subjective and objective burden. Family Relations, 34, 19-26.
  • Montgomery, R., Stull, D. E., & Borgatta, E. F. (1985). Measurement and the analysis of burden. Research on Aging, 7, 329-361.

Perceived Caregiver Burden Scale

  • Measures caregiver burden in terms of perceptions and feelings about caregivers’ physical and emotional health, family relationships, social life, work, and finances.
  • 31 items (4-point scale)
  • Stommel, M., Given, C. W., & Given, B. (1990). Depression as an overriding variable explaining caregiver burdens. Journal of Aging and Health, 2, 81-102.

Perceived Caregiver Burden Scale, Revised

  • Measures caregiver burden in terms of perceptions and feelings about caregivers’ physical and emotional health, family relationships, social life, work, and finances.
  • 13 items (4-point scale)
  • Gupta, R. (1999). The revised caregiver burden scale: A preliminary evaluation. Research on Social Work Practice, 4, 508-520.

Perceived Burden Scale

  • Measures extent to which caregivers believe that changes have occurred because of problems or concerns with caregiving.
  • 22 items (5-point scale)
  • Poulshock, S. W., & Deimling, G. T. (1984). Families caring for elders in residence: Issues in the measurement of burden. Journal of Gerontology, 39, 230-239.

Perceived Stress Scale

Relatives’ Stress Scale

  • Measures the reaction to caregiving of relative carers of elderly patients with senile dementia living in the community.  Focuses on 3 domains: personal distress in relation to the care recipient, life upset as a result of caregiving, and negative feelings toward the care recipient.
  • items (5-point scale)
  • Greene, J. G., Smith, R., Geardiner, M., & Timbury, C. C. (1982). Measuring behavioral disturbance of elderly demented patients and its effects on relatives: A factor analytic study. Age and Ageing, 11, 121-126.

Screen for Caregiver Burden

  • Measures objective and subjective burden relating to occurrence of care demands and distress associated with them.
  • 25 items (5-point scale)
  • Vitaliano, P. P., Scanlan, J. M., Krenz, C., Schwartz, R. S., & Marcovina, S. M. (1996). Psychological distress, caregiving, and metabolic variables. The Journals of Gerontology, 51B(5), P290.

Zarit Burden Interview

Short Form Zarit Burden Interview

  • Shorter version of the Zarit Burden Interview designed to measure impact of caregiving.
  • 12 items (5-point scale)
  • Bedard, M., Molloy, D. W., Squire, L., Dubois, S., Lever, J. A., & O’Donnell, M. (2001). The Zarit Burden Interview: A new short version and screening version. The Gerontologist, 41, 652-657.