The burden produced by caring for relatives with dementia is an increasing problem in the United States and Taiwan, necessitating a better understanding of the interrelationships of the factors that influence burden.
To test a theoretical model specifying how the demands of care, filial obligation, caregiving self-efficacy, coping strategies, and caregiving involvement affect caregiver burden.
A descriptive cross-sectional design with a convenience sample (n = 150) from outpatient clinics of three hospitals in Taiwan was used. The Caregiver Burden Inventory and the Cost of Care Index assessed caregiver burden. The antecedents of burden were assessed by the Physical Self-Maintenance Scale, Instrumental Activities of Daily Living, the Mini-Mental State Examination, the Revised Memory and Behavior Problem Checklist, the Montgomery obligation subscale, Cicirelli's obligation scale, the Caregiving Self-efficacy Scale, the Caregiving Involvement Scale, and the Ways of Coping Questionnaire.
The original model did not fit the data well but minor respecifications produced a good model as evidenced by a X2/df ratio of 2.1, a goodness-of-fit index of .89, and a comparative fit index of .93. Demands of care on the caregiver and filial obligation had direct positive effects on caregiving involvement. Caregiving involvement and emotion-focused coping had direct positive effects on caregiving burden. Filial obligation, caregiving self-efficacy, and problem-focused coping had direct negative effects on caregiving burden. Six of the seven original hypothesized structural relationships were confirmed in the final model.
The Burden Model tested in this study corroborates findings from other burden studies and extends our knowledge of caregiver burden. Filial obligation, self-efficacy, demands of care, involvement in care, and coping were shown to predict burden in this sample of Taiwanese caregivers. Future study is needed to evaluate interventions designed for family caregivers of persons with dementia. Especially needed is research in the area of counselling and mental health services to assist caregivers in dealing with manifestations of burden.
Kuei-Ru Chou is an Associate Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan.
Lynda L. LaMontagne is an Associate Professor, School of Nursing, Vanderbilt University, Nashville, TN.
Joseph T. Hepworth is a Research Associate Professor, School of Nursing, Vanderbilt University, Nashville, TN.
Accepted for publication September 3, 1998.
This study was supported by the National Defense Medical Center, Taipei, Taiwan, ROC; and partially funded by the Vanderbilt University Graduate School Dissertation Enhancement Award and the Joint Center for Nursing Research, School of Nursing Vanderbilt University, to the first author. The authors wish to acknowledge the following for their support of this study: Bonnie Holaday, RN, DNS, Kenneth Wallston, PhD, and Linda Lindsey-Davis, PhD.
Address reprint requests to Lynda L. LaMontagne, RN, DNSc, Associate Professor, School of Nursing, Vanderbilt University, 412 Godchaux Hall, 21st Avenue South, Nashville, TN 37240-0008.