Perceived role overload and physical symptom experience among caregivers of older adults: The moderating effect of social support

Study Aim/Purpose:  This study examined associations between perceived role overload and negative physical symptoms among caregivers who provide health-related assistance to older persons. It also examined the potential moderating effects of informal and formal support resources on these associations.

Summary of Methods:  The researchers analyzed data from surveys of 1,471 primary caregivers from the 2017 National Study of Caregiving (NSOC). NSOC is a supplement to the National Health and Aging Trends Study that surveys a nationally representative sample of Medicare beneficiaries aged 65 and older. Caregivers’ perception of the burden of their caregiving role was assessed using Pearlin’s Role Overload scale, using a composite score based on four questions, each with response options on a three-point scale (“not so much,” “somewhat,” or “very much”). Physical symptom experience was assessed based on questions regarding experience of symptoms of pain, limited leg strength or movement, and lower energy or exhaustion. Those who reported each symptom also answered questions on how often the symptom limited their activities in the last month. Informal support from friends or family was assessed using three questions, and formal support was assessed with one question asking whether they had used a support group, respite service, or received training to help them provide care. The survey data on caregiver characteristics (demographics, health conditions, and characteristics of their care giving role) were used as covariates in the analysis. Chi-squared tests and independent t-tests were conducted to examine relationships between perceived overload and each physical symptom. Binomial logistic regression analysis was used to estimate the odds ratios of having each type of physical symptom in relation to level of perceived role overload, controlling for covariates. For those reporting each symptom, ordinal logistic regression analysis was used to calculate the odds ratio for the frequency of experiencing symptom-related limitations in activities. To examine the association  between formal and informal support and experience of physical symptoms related to role overload, interaction effects were analyzed and these were adjusted to account for the effects of caregiver characteristics.

Summary of Results: Reporting of physical symptoms was associated with caregivers’ older age, non-Hispanic white race, and unemployed status. Caregivers’ number of medical  conditions, higher levels of psychological distress, and care for spouses or partners were also associated with reporting physical symptoms, while caregiving duration, hours, and tasks were not significantly associated with reporting physical symptoms.

The main study analyses found that caregivers who perceived higher role overload were more likely to experience physical symptoms (i.e., pain, limited leg strength, and low energy) and frequent activity limitations due to the symptoms. These associations remained significant after adjusting for caregiver demographics, medical conditions and levels of depression and anxiety, their caregiving characteristics, as well as whether social support was received or used. The association between role overload with pain and low energy were weaker among caregivers with high informal support that those with low or no informal support. In contrast, among those who used formal supports, perceived role overload had a greater association with pain than for those who did not use formal supports.

Study Limitations (as cited by authors):  The authors recognize that their use of cross-sectional data does not allow for defining causal relationship, despite the strong statistical associations identified. For example, they note that there is likely a bidirectional relationship between perceived role overload and physical symptoms. Additionally, caregivers who have pain symptoms may be more likely to rely on formal supports. The authors also highlight the fact that the survey did not assess the intensity or duration of the physical symptoms or collect information about other factors, such as caregivers’ health behaviors, which may mediate the relationship between perceived role overload and physical symptoms.

Authors’ Discussion/Conclusions:  The authors identified the need for longitudinal research to: 1) assess the impacts of caregiving and supports on caregivers’ physical symptoms, 2) provide more detailed data collection on the intensity and duration of physical symptoms experienced by caregivers, and 3) examine the quality of and satisfaction with the social support used or available. They also recommend research to identify additional factors that may moderate or mediate the relationship between perceived role overload and caregivers’ physical symptoms.

The authors also discuss implications of the study findings for clinical practice. To help mitigate the health consequences of caregiving, they recommend that health care providers recognize and address  the relationship their research identified between perceived role overload and caregiver health and well-being. Specifically, they propose that providers conduct periodic assessments of caregivers’ physical symptoms, communicate with them about their needs and concerns, assess their informal support systems, and provide them with information on available support resources.