We prospectively recruited patient-caregiver dyads of community-dwelling older adults and their family caregivers attending the memory clinic, Department of Geriatric Medicine, in Tan Tock Seng Hospital, Singapore, from September 2018 to October 2019. We included patients who were: (a) 65 years and above, (b) diagnosed with dementia or MCI, and (c) living in the community. We defined family caregivers as family members aged 21 years and above who was most involved in the provision of daily care and familiar with the patient’s social and medical status. In the case of MCI patients, caregivers may not be heavily involved in the assistance with activities of daily living, but they still assist with arranging for, accompanying, and/or supervising medical appointments, social activities, and healthy lifestyle-related tasks (such as physical activity and nutrition).
Caregivers who were not family members or were unable to understand English or Mandarin were excluded. Among 204 eligible caregiver-patient dyads, 2 caregivers did not complete the questionnaire, yielding 202 dyads in the final analysis. Ethical approval was obtained from the Institutional Review Board of the National Healthcare Group.
We administered the survey in English or Mandarin. Survey items included socio-demographic characteristics such as age, gender, education level, marital status, work status, presence of domestic helper, living arrangement (living with or apart from the patient), and relationship to the patient.
The 22-item ZBI was used in this study. Each item is rated on a 5-point Likert scale ranging from 0=“never” to 4=“always”. Item scores can be summated to provide a total score ranging from 0 to 88, where higher scores represent higher levels of burden. We previously validated the 4-factor structure of ZBI-22 that accounted for 62.2% of the variance, namely: Factor 1: demands of care and social impact on the caregiver (role strain 1, RS1); Factor 2: confidence or control over the situation (role strain 2, RS2); Factor 3: psychological impact on the caregiver (personal strain, PS); and Factor 4: worry about caregiving performance (WaP).18 (link) The 4-factor structure has been shown to be superior to the 2-factor and 3-factor structures.11
The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression in caregivers.19 (link) This scale has been used in caregivers and the community setting.20 (link) The 14-item scale contains 2 7-item subscale measuring anxiety (HADS-A) and depression (HADS-D). Total scores for each subscale ranged from 0 to 21, with higher scores representing higher levels of anxiety or depression symptoms. A cut-off of ≥8 cut-off was used in both HADS-D and HADS-A to denote significant depressive and anxiety symptoms.20 (link)
Caregivers who were not family members or were unable to understand English or Mandarin were excluded. Among 204 eligible caregiver-patient dyads, 2 caregivers did not complete the questionnaire, yielding 202 dyads in the final analysis. Ethical approval was obtained from the Institutional Review Board of the National Healthcare Group.
We administered the survey in English or Mandarin. Survey items included socio-demographic characteristics such as age, gender, education level, marital status, work status, presence of domestic helper, living arrangement (living with or apart from the patient), and relationship to the patient.
The 22-item ZBI was used in this study. Each item is rated on a 5-point Likert scale ranging from 0=“never” to 4=“always”. Item scores can be summated to provide a total score ranging from 0 to 88, where higher scores represent higher levels of burden. We previously validated the 4-factor structure of ZBI-22 that accounted for 62.2% of the variance, namely: Factor 1: demands of care and social impact on the caregiver (role strain 1, RS1); Factor 2: confidence or control over the situation (role strain 2, RS2); Factor 3: psychological impact on the caregiver (personal strain, PS); and Factor 4: worry about caregiving performance (WaP).18 (link) The 4-factor structure has been shown to be superior to the 2-factor and 3-factor structures.11
The Hospital Anxiety and Depression Scale (HADS) was used to assess symptoms of anxiety and depression in caregivers.19 (link) This scale has been used in caregivers and the community setting.20 (link) The 14-item scale contains 2 7-item subscale measuring anxiety (HADS-A) and depression (HADS-D). Total scores for each subscale ranged from 0 to 21, with higher scores representing higher levels of anxiety or depression symptoms. A cut-off of ≥8 cut-off was used in both HADS-D and HADS-A to denote significant depressive and anxiety symptoms.20 (link)
