Three hypotheses were tested:
In a non-random survey a 53 item questionnaire was distributed to 565 individuals, social institutions, senior centers, health agencies and churches. A total of 174 caregivers completed usable instruments for a return rate of 31%. Of the caregivers, 92 were Caucasian, 34 were African-American, 19 were Asian-american and 25 were Hispanic. Four individuals either did not identify their race or chose an "other" category.
For the 3 hypotheses noted above, the central dependent variable was a 22 item caregiver burden scale. The possible range is from 0 - 88, with a higher score indicating more perceived burden by the caregiver. The range in the present sample of 174 caregivers was 2 - 75 with a mean of 32.53 and standard deviation of 17.47.
Prior to testing the 3 stated hypotheses, an analysis of variance (ANOVA) was performed with race as the independent variable. The purpose was to determine if the perception of burden varied as a function of race. The results were statistically significant, F = 3.5, p < .01, df = 3, 166). For each of the 4 racial groups the mean burden scores were as follows: African-Americans = 26.71; Hispanics = 29.24; Asians = 31.37; and Whites = 36.72.
Once statistical significance is found through an ANOVA,it is necessary to conduct a post-hoc test to determine specifically among which combinations of groups the significance occurred. The post-hoc test revealed a significant difference between the burden scores of the white group, mean = 36.72, and the African-American group, mean = 26.71.
Hypothesis 1
Hypothesis one asks whether the perception of burden experienced by the caregiver is affected by the quality of the previous relationship between the caregiver and the care receiver. One hundred fifty seven caregivers responded to the questions regarding their previous relationship. Sixty one caregivers responded it was "always positive," 43 responded that it was "mostly positive," 47 responded that it was about equally "positive and negative," and 6 caregivers responded that it was either "mostly negative" or "always negative."
A Pearson Product-Moment correlation (r) was performed between the variables of "caregiver burden" and "previous relationship" and a statistically significant relationship was found (r = .23, p < .005). This finding supports hypothesis one. The quality of the caregiver-care receiver's previous relationship directly affects the present perception of burden by the caregiver. Those caregivers who feel their previous relationship was positive perceive less burden in their present caregiving responsibilities.
A follow up ANOVA was performed between "caregiver burden" and "previous relationship" and was found to be statistically significant (F = 3.5, p < .05, df = 3, 153). The mean burden scores for the four groups were as follows: for the group who defined their previous relationship as "always positive" (group 1) mean = 28.5; "mostly positive" (group 2) mean = 35.49; "positive and negative" (group 3) mean = 37.66; "mostly negative" combined with "always negative" (group 4) mean = 37.33.
The post-hoc test revealed the significant differences between groups to be between groups 1 and 2 and groups 1 and 3. Groups 1 and 4 were not seen as significant due to the small number in group 4 (n = 6), despite the high mean score for group 4.
Hypothesis 2
Hypothesis 2 concerns the relationship between the caregiver's perception of burden and the social support network available to them. the hypothesis specifically states that burden will be less as a direct function of available social support.
The variable "social support" consists of a 10 item scale with a possible range of 10 - 40. The higher score indicates more social support. In the present sample the range was 10 - 38 with a mean of 27.98 and standard deviation of 6.14. One hundred seventy one caregivers responded to this variable.
To test the hypothesis, a Pearson Product-Moment Correlation was performed between the burden and social support variables and found to be not statistically significant: r = -.09, p = .22.
Hypothesis 3
The third hypothesis concerns the health status of the care receiver; specifically their level of cognitive impairment, and its impact on the caregiver's perception of burden. It states that burden will be higher if the care receiver is cognitively impaired.
In the present sample 122 caregivers indicated the person for whom they care is cognitively impaired and 42 indicate the care receiver is not cognitively impaired. Ten individuals did not respond to this question.
While the burden scores for the caregivers with a cognitively impaired care receiver was higher (mean = 34.1) than for those whose care receiver was not cognitively impaired (mean = 29.6) no statistically significant differences were found.
To further test the relationship 4 separate ANOVA's were conducted for the 4 racial groups with cognitive impairment as the individual variable and burden as the dependent variable. In all cases no statistically significant results were found. Accordingly, no support for hypothesis 3 was found.
Additional analysis
Two additional variables were examined in an attempt to reveal other possible factors associated with the perception of caregiver burden. The first was a 15 item activity scale which asked the extent to which the care receiver was able to perform various activities such as using the telephone, shopping for groceries, preparing meals, dressing and a variety of other activities of daily living. The possible range of this scale is 0 - 30 with the higher score representing less ability to care for one's self and the need for more help. the range in the current sample was 0 - 30, mean = 18.31 and standard deviation = 8.68.
The results of a Pearson Product Moment Correlation revealed a statistically significant relationship between burden and the activity scale; r = .29, p < .001. As the care receiver's need for help in performing basic activities increased, the caregiver's perceptions of burden also increased.
A variable assessing "behavioral concerns" was also correlated with the burden variable. This variable was composed of a 9 item scale measuring the extent to which the care receiver was mentally confused and disoriented, unpleasant and uncooperative, depressed and/or tearful, withdrawn or lethargic, suspicious and other behavioral concerns. The possible range of the scale is 0 - 18 with the higher score indicating more behavioral problems.
In the current sample the range was 0 - 16 with a mean of 5.78 and standard deviation of 4.08. The correlation between burden and the behavioral variable was statistically significant; r = .41, p < .001, indicating a direct relationship between the two variables with burden increasing as behavioral concerns increased.
In summary, burden scores were seen to vary as a function of race, with African-American caregivers indicating the lowest level of perceived burden and white caregivers indicating the highest level of perceived burden.
Caregiver burden was also affected by the quality of the previous relationship between the caregiver and the care receiver. When caregivers note that the relationship prior to becoming the caregiver was more positive, their current perceptions of burden are less.
The present sample of caregivers appear to have a moderately high level of social support. No relationship was found between this variable when related to caregiver burden.
The cognitive status of the care receiver was not statistically associated with caregiver burden. Although a higher burden score was detected for those caregivers providing care to persons with a cognitive impairment compared to providing care to persons with no cognitive impairment, the relationship was not significant.
Finally, the level of caregiver burden was strongly associated with the degree to which the care receiver was able to perform basic activities of daily living and the care receiver's level of behavioral functioning.
For further information and copies of the questionnaire, contact, Dr Ronald Marks, Tulane School of Social Work, (504-862-3485) or by email to rmarks@mailhost.tcs.tulane.edu