Jump to content

Caregiver burden

From Wikipedia, the free encyclopedia

Caregiver burden, also called caregiver burnout, refers to the sum of physical, emotional, social, and financial difficulties experienced by unpaid caregivers due to providing care for a family member or a friend.[1][2]

Impact

[edit]

Caregiver wellbeing

[edit]

Caring for a loved one can have positive effects on the caregiver, for example, feelings of mutuality, personal growth, and increased family cohesion.[3][4] However, providing long-term, unpaid care can also have wide-ranging negative effects on carers' physical and mental health and on their financial situation.[5][6]

Caregiving responsibilities can limit informal caregivers' ability to engage in social activities, maintain relationships, and pursue personal interests. Many caregivers lack adequate support from family members, friends, healthcare providers, and community resources. Feeling unsupported or misunderstood can compound the challenges of caregiving and increase feelings of burden. Informal, unpaid caregivers frequently experience loneliness, social isolation, alienation, and difficulties reconciling their own needs with their role as caregiver. Many feel overwhelmed by caregiving responsibilities.[7][8]

The financial cost of caring for a family member can be substantial, including expenses for medical care, medications, in-home care services, assisted living facilities, and other related costs. Caregivers are more likely to reduce their work hours or leave their jobs entirely to provide care, leading to loss of income and financial strain. They also face difficulties when trying to re-enter employment later on.[8]

Because the caregiver burden may be felt strongly by one person and not at all by another, regardless of the caregiving situation, it is considered to be subjective and it may be called the "subjective burden". The subjective burden is considered to be one of the most important predictors of negative outcomes from the home care situation.[9][10]

Cultural differences

[edit]

The difficulties caused by caregiving might not always be understood as a burden.[11][12] For example, family caregivers of people with dementia living in low- and middle-income countries might not look at the negative impacts of their care work through the concept of burden.[11]

Caring styles and decisions

[edit]

People who experience caregiver burden can display a wide range of behaviors towards the person in need of care, from loving devotion to abusive behavior (which can manifest as neglect and/or mistreatment). The most common form of abusive behavior is verbal aggression,[13] mainly due to challenging behaviour of the person in need of care. People experiencing caregiver burden are more likely to display abusive behavior and other negative caring styles toward the individuals they care for than those who are not experiencing caregiver burden.[14][15][16]

The caregiver burden often influences the caregiver's decision to eventually institutionalize. Caregiver burden is particularly associated with the care of people with dementia, meaning that the likelihood of institutionalization is especially heightened in those experiencing caregiver burden who care for people suffering from dementia.[17][18]

Risk factors

[edit]

The burden is mainly associated with carer's characteristics and care provision, rather than chronic conditions of care recipients, except for dementia.[19] For people with dementia, their behavioural problems or psychological symptoms are the main contributor to caregiver burden.[20]

Several factors associated with carers contribute to the risk of caregiver burden, including gender, education level, living arrangements, mental health, social support, financial stability, caregiving intensity, and autonomy in assuming the caregiving role. Female caregivers are particularly vulnerable, as they are more likely to take on caregiving responsibilities and experience emotional distress. Lower levels of education may also increase susceptibility, as caregivers with limited knowledge and resources may struggle to navigate complex healthcare needs.

Residing with the care recipient has been identified as a significant risk factor, as it often leads to continuous exposure to the challenges of caregiving without respite. The emotional toll of 24/7 caregiving, especially in cases involving chronic illnesses such as dementia, cancer, or end-of-life care, can be particularly severe. Additionally, care transitions, such as moving a patient from hospital to home, often increase the caregiver's responsibilities and stress levels, further exacerbating caregiver burden.[21]

Measurement

[edit]

There are a variety of methods to measures caregiver well-being, with caregiver burden being one of the most looked-at domains.[22] The instruments includes the Zarit Burden Interview (ZBI),[23] the Caregiver Strain Index[24] and the Cost of Care Index,[25] Burden Scale for Family Caregivers,[26][27] Caregivers' Daily Issues.[28]

ZBI is the most widely used instrument to measure caregiver burden. Initially created as a 29-item self-report questionnaire, it evaluates the challenges faced by informal caregivers, including physical, emotional, social, and financial strain, along with their relationship with the care recipient. It was later refined into a more concise 22-item version.[29] The instrument has been translated and validated in a variety of languages, including Chinese,[30] Italian,[31] and Persian[32]

Support and interventions

[edit]

There are various forms of support, services, and interventions that may improve the wellbeing of family caregivers and ease their burden.[33][34] Some interventions can also be effective when delivered remotely.[35]

Complementary formal care

[edit]

Using ongoing formal care services to substitute some of the caregiving can ease the burden on family caregivers. These complementary formal services can include home care, day care, personal assistants, and programs like Meals on Wheels. Regularly used services of this kind can have a positive impact on carers' employment, enabling them to continue working alongside caregiving.[33]

Another form of complementary formal care is respite care which is designed to provide short breaks and relief to caregivers through the temporary provision of substitute care. Even though many caregivers value respite care and express their satisfaction with it, the service does not seem to result in long-term improvements in emotional wellbeing. This contradiction might be explained by the respite care providing only occasional and temporary relief, after which carers return to the unchanged demands of long-term caregiving.[33][34]

Training and education

[edit]

Given the complex and wide-ranging needs of people with dementia, their carers require specific knowledge and skills to provide effective care. However, family caregivers often lack knowledge about the disease and its progression, and how to deliver care. Even when information is available, it is typically difficult to understand.[36][37]

Education and training for family caregivers can cover the nature of dementia, caregiving techniques, communication skills, and stress-coping methods. Providing education and training for family caregivers can reduce some of their burden. However, these are more likely to be effective when caregivers are actively participating in the process instead of passively receiving information.[34] Psychoeducation for informal carers is effective in reducing burden and anxiety,[38] and in helping carers process grief.[39]

As informal caregivers living in low- and middle-income countries might not look at dementia care through the concept of burden, providing knowledge about dementia caregiving can raise their awareness about this approach. In turn, this might encourage them to seek help and have positive effects on their mental health.[40]

Psychological therapy and support groups

[edit]

Receiving psychological therapies and attending support groups can also be effective in supporting the mental health of family caregivers.[33] Cognitive behavioural therapy (CBT) can have positive effects on caregiver burden and grief.[34][39] CBT, mindfulness-based cognitive therapy, behavioural activation, and acceptance and commitment therapy can be effective in treating depression in informal carers.[38][39]

Multicomponent interventions

[edit]

The different forms of services and interventions can also be combined into multicomponent interventions which often improve caregiver wellbeing more than their components separately.[34][41]

An example of an effective multicomponent intervention for family caregivers of people with dementia is the START (STrAtegies for RelaTives) programme. START consists of 8 sessions delivered one-to-one by psychologists. The sessions using methods from cognitive behaviour therapy include education about dementia, psychoeducation of stress coping skills, and teaching relaxation. When tested in the United Kingdom, the START programme effectively reduced anxiety and depression in family caregivers.[42][43]

By country

[edit]

United States

[edit]

A nationwide survey showed that 32% and 19% of carers in the United States experience high and medium caregiver burden, respectively, while carers and their feeling are often neglected in clinical settings.[44]

History

[edit]

Modern nursing and caregiving, which emerged in the 18th century, were largely centred on women's self-sacrificing service, with little documentation of the negative aspects of caregiving responsibilities. It was not until the 1950s that researchers began to focus on the hardships and suffering experienced by caregivers. Peter Townsend (1957), after interviewing working-class men and women in East London, England, found that 22% of his study participants experienced "a strain of illness" due to the transition from employment to caregiving.[45]

In the 1960s, Grad and Sainsbury (1963) first defined the burden of caregiving as any cost to the family. This definition was later refined by Hoenig and Hamilton (1966) and Platt and Hirsch (1981) to distinguish between objective burden, which refers to specific activities and events related to negative caring experiences, and subjective burden, which relates to caregivers' personal emotions and experiences. Subjective burden encompasses the emotional strain caregivers endure, while objective burden includes tangible aspects of caregiving that contribute to negative experiences. Various terms to describe caregiver burden were also used, such as caretaker role fatigue, spousal burnout, and role engulfment.[45][2][46]

See also

[edit]

References

[edit]
  1. ↑ "How To Treat Caregiver Burnout". Cleveland Clinic. Archived from the original on 2025-02-14. Retrieved 2025-03-02.
  2. 1 2 Liu, Zhu; Heffernan, Catrina; Tan, Jie (2020-07-25). "Caregiver burden: A concept analysis". International Journal of Nursing Sciences. 7 (4): 438–445. doi:10.1016/j.ijnss.2020.07.012. PMC 7644552. PMID 33195757.
  3. ↑ Wang, Jun; Li, Xuelian; Liu, Weichu; Yang, Bing; Zhao, Qinghua; Lü, Yang; Xiao, Mingzhao (2022-09-14). "The positive aspects of caregiving in dementia: A scoping review and bibliometric analysis". Frontiers in Public Health. 10 985391. Bibcode:2022FrPH...1085391W. doi:10.3389/fpubh.2022.985391. ISSN 2296-2565. PMC 9515975. PMID 36187613.
  4. ↑ Quinn, Catherine; Toms, Gill; Rippon, Isla; Nelis, Sharon M.; Henderson, Catherine; Morris, Robin G.; Rusted, Jennifer M.; Thom, Jeanette M.; van den Heuvel, Eleanor; Victor, Christina; Clare, Linda (29 June 2022). "Positive experiences in dementia care-giving: findings from the IDEAL programme". Ageing and Society. 44 (5): 1010–1030. doi:10.1017/S0144686X22000526. ISSN 0144-686X.
  5. ↑ Brimblecombe, Nicola; Fernández, José-Luis; Knapp, Martin; Rehill, Amritpal; Wittenberg, Raphael, Wittenberg (2018). "Review of the international evidence on support for unpaid carers". Journal of Long-Term Care: 25–40. doi:10.21953/LSE.FFQ4TXR2NFTF.
  6. ↑ Sabatini, Serena; Martyr, Anthony; Hunt, Anna; Gamble, Laura D.; Matthews, Fiona E.; Thom, Jeanette M.; Jones, Roy W.; Allan, Louise; Knapp, Martin; Quinn, Catherine; Victor, Christina; Pentecost, Claire; Rusted, Jennifer M.; Morris, Robin G.; Clare, Linda (2024-02-19). "Health conditions in spousal caregivers of people with dementia and their relationships with stress, caregiving experiences, and social networks: longitudinal findings from the IDEAL programme". BMC Geriatrics. 24 (1) 171. doi:10.1186/s12877-024-04707-w. ISSN 1471-2318. PMC 10875834. PMID 38373905.
  7. ↑ Koh, Wei Qi; Roes, Martina; de Vugt, Marjolein; Sezgin, Duygu; Gonçalves-Pereira, Manuel; Müller, Nicole; Diaz, Ana; Casey, Dympna; Ingram, Chantal; Walden, Amy Kate; Thyrian, Jochen René; Neal, David; Comas, Adelina; Hopper, Louise (2025-11-02). "What are the unmet needs in people affected by dementia? A scoping review of reviews". Aging & Mental Health. 29 (11): 1943–1966. doi:10.1080/13607863.2025.2534406. hdl:10362/190061. ISSN 1360-7863. PMID 40696903.
  8. 1 2 Brimblecombe, Nicola; Fernández, José-Luis; Knapp, Martin; Rehill, Amritpal; Wittenberg, Raphael, Wittenberg (2018). "Review of the international evidence on support for unpaid carers". Journal of Long-Term Care: 25–40. doi:10.21953/LSE.FFQ4TXR2NFTF.
  9. ↑ Gräßel E, Adabbo R (30 August 2011). "Perceived burden of informal caregivers of a chronically ill older family member". GeroPsych. 24 (3): 143–154. doi:10.1024/1662-9647/a000042.
  10. ↑ Pinquart M, Sörensen S (March 2007). "Correlates of physical health of informal caregivers: a meta-analysis". The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences. 62 (2): P126–P137. doi:10.1093/geronb/62.2.p126. PMID 17379673.
  11. 1 2 Chen, Frank; Hu, Zhiwei; Li, Quan; Zheng, Xuan; Li, Meizhi; Salcher-Konrad, Maximilian; Comas-Herrera, Adelina; Knapp, Martin; Shi, Cheng; The STRiDE consortium (27 February 2025). "Effectiveness of Interventions to Support Carers of People With Dementia in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis". International Journal of Geriatric Psychiatry. 40 (3) e70054. doi:10.1002/gps.70054. ISSN 0885-6230. PMC 11867927. PMID 40015952.
  12. ↑ Nguyen, Huong; Nguyen, Trang; Tran, Duyen; Hinton, Ladson (2021-11-29). ""It's extremely hard but it's not a burden": A qualitative study of family caregiving for people living with dementia in Vietnam". PLOS ONE. 16 (11) e0259788. Bibcode:2021PLoSO..1659788N. doi:10.1371/journal.pone.0259788. ISSN 1932-6203. PMC 8629297. PMID 34843513.
  13. ↑ Cooney C, Howard R, Lawlor B (June 2006). "Abuse of vulnerable people with dementia by their carers: can we identify those most at risk?". International Journal of Geriatric Psychiatry. 21 (6): 564–571. doi:10.1002/gps.1525. PMID 16783768. S2CID 5974629.
  14. ↑ Hansberry MR, Chen E, Gorbien MJ (May 2005). "Dementia and elder abuse". Clinics in Geriatric Medicine. 21 (2): 315–332. doi:10.1016/j.cger.2004.11.002. PMID 15804553.
  15. ↑ Grafström M, Nordberg A, Winblad B (December 1993). "Abuse is in the eye of the beholder. Report by family members about abuse of demented persons in home care. A total population-based study". Scandinavian Journal of Social Medicine. 21 (4): 247–255. doi:10.1177/140349489302100404. PMID 8310277. S2CID 21355712.
  16. ↑ Karrasch RM, Reichert M (2008). "Subjektive Beurteilungen und Wahrnehmungen von Pflegenden und Gepflegten in der Partnerpflege" [Subjective evaluation and perception of caregivers and cared persons in the spouse care setting.]. Zeitschrift für Gerontopsychologie und -psychiatrie (in German). 21 (4): 259–265. doi:10.1024/1011-6877.21.4.259. Retrieved 2020-05-03.{{cite journal}}: CS1 maint: deprecated archival service (link)
  17. ↑ Kurasawa S, Yoshimasu K, Washio M, Fukumoto J, Takemura S, Yokoi K, et al. (November 2012). "Factors influencing caregivers' burden among family caregivers and institutionalization of in-home elderly people cared for by family caregivers". Environmental Health and Preventive Medicine. 17 (6): 474–483. Bibcode:2012EHPM...17..474K. doi:10.1007/s12199-012-0276-8. PMC 3493627. PMID 22454030.
  18. ↑ Eska K, Graessel E, Donath C, Schwarzkopf L, Lauterberg J, Holle R (2013). "Predictors of institutionalization of dementia patients in mild and moderate stages: a 4-year prospective analysis". Dementia and Geriatric Cognitive Disorders Extra. 3 (1): 426–445. doi:10.1159/000355079. PMC 3843910. PMID 24348504.
  19. ↑ Riffin, Catherine; Van Ness, Peter H.; Wolff, Jennifer L.; Fried, Terri (2019). "Multifactorial Examination of Caregiver Burden in a National Sample of Family and Unpaid Caregivers". Journal of the American Geriatrics Society. 67 (2): 277–283. doi:10.1111/jgs.15664. ISSN 1532-5415. PMC 6367031. PMID 30452088.
  20. ↑ Chiao, C.-Y.; Wu, H.-S.; Hsiao, C.-Y. (2015). "Caregiver burden for informal caregivers of patients with dementia: A systematic review". International Nursing Review. 62 (3): 340–350. doi:10.1111/inr.12194. ISSN 1466-7657. PMID 26058542.
  21. ↑ Adelman, Ronald D.; Tmanova, Lyubov L.; Delgado, Diana; Dion, Sarah; Lachs, Mark S. (2014-03-12). "Caregiver Burden: A Clinical Review". JAMA. 311 (10): 1052–1060. doi:10.1001/jama.2014.304. ISSN 0098-7484. PMID 24618967.
  22. ↑ Mosquera, Isabel; Vergara, Itziar; Larrañaga, Isabel; Machón, Mónica; del Río, María; Calderón, Carlos (2016-05-01). "Measuring the impact of informal elderly caregiving: a systematic review of tools". Quality of Life Research. 25 (5): 1059–1092. doi:10.1007/s11136-015-1159-4. ISSN 1573-2649. PMID 26475138.
  23. ↑ Zarit SH, Reever KE, Bach-Peterson J (December 1980). "Relatives of the impaired elderly: correlates of feelings of burden". The Gerontologist. 20 (6): 649–655. doi:10.1093/geront/20.6.649. PMID 7203086.
  24. ↑ Robinson BC (May 1983). "Validation of a Caregiver Strain Index". Journal of Gerontology. 38 (3): 344–348. doi:10.1093/geronj/38.3.344. PMID 6841931.
  25. ↑ Kosberg JI, Cairl RE, Keller DM (April 1990). "Components of burden: interventive implications". The Gerontologist. 30 (2): 236–242. doi:10.1093/geront/30.2.236. PMID 2347506.
  26. ↑ Graessel E, Berth H, Lichte T, Grau H (February 2014). "Subjective caregiver burden: validity of the 10-item short version of the Burden Scale for Family Caregivers BSFC-s". BMC Geriatrics. 14 23. doi:10.1186/1471-2318-14-23. PMC 3942019. PMID 24555474.
  27. ↑ Grau H, Graessel E, Berth H (2015). "The subjective burden of informal caregivers of persons with dementia: extended validation of the German language version of the Burden Scale for Family Caregivers (BSFC)". Aging & Mental Health. 19 (2): 159–168. doi:10.1080/13607863.2014.920296. PMID 24914762. S2CID 3212251.
  28. ↑ Bachmann, Pavel (2020-06-19). "Caregivers' Experience of Caring for a Family Member with Alzheimer's Disease: A Content Analysis of Longitudinal Social Media Communication". International Journal of Environmental Research and Public Health. 17 (12): 4412. doi:10.3390/ijerph17124412. ISSN 1660-4601. PMC 7345212. PMID 32575455.
  29. ↑ Loo, Yu Xian; Yan, Shi; Low, Lian Leng (2021-04-16). "Caregiver burden and its prevalence, measurement scales, predictive factors and impact: a review with an Asian perspective". Singapore Medical Journal. 63 (10): 593–603. doi:10.11622/smedj.2021033. PMC 9728322. PMID 33866708.
  30. ↑ Lu, Lu; Wang, Lie; Yang, Xiaoshi; Feng, Qiaolian (December 2009). "Zarit Caregiver Burden Interview: Development, reliability and validity of the Chinese version". Psychiatry and Clinical Neurosciences. 63 (6): 730–734. doi:10.1111/j.1440-1819.2009.02019.x. ISSN 1323-1316. PMID 19781014.
  31. ↑ Chattat, Rabih; Cortesi, Valeria; Izzicupo, Fabio; Re, Maria Letizia Del; Sgarbi, Cinzia; Fabbo, Andrea; Bergonzini, Elisa (June 2011). "The Italian version of the Zarit Burden Interview: a validation study". International Psychogeriatrics. 23 (5): 797–805. doi:10.1017/S1041610210002218. ISSN 1741-203X. PMID 21205379.
  32. ↑ Rajabi-Mashhadi, Mohammad T; Mashhadinejad, Hosein; Ebrahimzadeh, Mohammad H; Golhasani-Keshtan, Farideh; Ebrahimi, Hanieh; Zarei, Zahra (2015-01-15). "The Zarit Caregiver Burden Interview Short Form (ZBI-12) in spouses of Veterans with Chronic Spinal Cord Injury, Validity and Reliability of the Persian Version". Archives of Bone and Joint Surgery. 3 (1): 56–63. PMC 4322127. PMID 25692171.
  33. 1 2 3 4 Brimblecombe, Nicola; Fernández, José-Luis; Knapp, Martin; Rehill, Amritpal; Wittenberg, Raphael, Wittenberg (2018). "Review of the international evidence on support for unpaid carers". Journal of Long-Term Care: 25–40. doi:10.21953/LSE.FFQ4TXR2NFTF.
  34. 1 2 3 4 5 Walter, Erik; Pinquart, Martin (2020-11-23). Heyn, Patricia C (ed.). "How Effective Are Dementia Caregiver Interventions? An Updated Comprehensive Meta-Analysis". The Gerontologist. 60 (8): e609–e619. doi:10.1093/geront/gnz118. ISSN 0016-9013. PMID 33226434.
  35. ↑ González-Fraile E, Ballesteros J, Rueda JR, Santos-Zorrozúa B, Solà I, McCleery J (January 2021). "Remotely delivered information, training and support for informal caregivers of people with dementia". The Cochrane Database of Systematic Reviews. 1 (1) CD006440. doi:10.1002/14651858.cd006440.pub3. PMC 8094510. PMID 33417236.
  36. ↑ Koh, Wei Qi; Roes, Martina; de Vugt, Marjolein; Sezgin, Duygu; Gonçalves-Pereira, Manuel; Müller, Nicole; Diaz, Ana; Casey, Dympna; Ingram, Chantal; Walden, Amy Kate; Thyrian, Jochen René; Neal, David; Comas, Adelina; Hopper, Louise (2025-11-02). "What are the unmet needs in people affected by dementia? A scoping review of reviews". Aging & Mental Health. 29 (11): 1943–1966. doi:10.1080/13607863.2025.2534406. hdl:10362/190061. ISSN 1360-7863. PMID 40696903.
  37. ↑ De Poli, Chiara (2025-04-03). "Explaining the unmet information needs of family carers of people with dementia: a theoretical model of information behaviour". BMC Geriatrics. 25 (1) 219. doi:10.1186/s12877-024-05626-6. ISSN 1471-2318. PMC 11967026. PMID 40181254.
  38. 1 2 Sun, Yue; Ji, Mengmeng; Leng, Minmin; Li, Xinrui; Zhang, Xueer; Wang, Zhiwen (12 February 2022). "Comparative efficacy of 11 non-pharmacological interventions on depression, anxiety, quality of life, and caregiver burden for informal caregivers of people with dementia: A systematic review and network meta-analysis". International Journal of Nursing Studies. 129 104204. doi:10.1016/j.ijnurstu.2022.104204. PMID 35247788.
  39. 1 2 3 Sánchez-Alcón, Miriam; Sánchez-Ramos, José Luis; Garrido-Fernández, Almudena; Sosa-Cordobés, Elena; Ortega-Galán, Ángela María; Ramos-Pichardo, Juan Diego (October 2023). "Effectiveness of interventions aimed at improving grief and depression in caregivers of people with dementia: A systematic review and meta-analysis". International Journal of Mental Health Nursing. 32 (5): 1211–1224. doi:10.1111/inm.13142. hdl:10272/22148. ISSN 1445-8330. PMID 36971150.
  40. ↑ Chen, Frank; Hu, Zhiwei; Li, Quan; Zheng, Xuan; Li, Meizhi; Salcher-Konrad, Maximilian; Comas-Herrera, Adelina; Knapp, Martin; Shi, Cheng; The STRiDE consortium (27 February 2025). "Effectiveness of Interventions to Support Carers of People With Dementia in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis". International Journal of Geriatric Psychiatry. 40 (3) e70054. doi:10.1002/gps.70054. ISSN 0885-6230. PMC 11867927. PMID 40015952.
  41. ↑ Cheng, Sheung-Tak; Li, Kin-Kit; Losada, Andrés; Zhang, Fan; Au, Alma; Thompson, Larry W.; Gallagher-Thompson, Dolores (February 2020). "The effectiveness of nonpharmacological interventions for informal dementia caregivers: An updated systematic review and meta-analysis". Psychology and Aging. 35 (1): 55–77. doi:10.1037/pag0000401. ISSN 1939-1498. PMID 31985249.
  42. ↑ "Low-cost therapy supports dementia carers' mental health". National Institute for Health and Care Research (NIHR). 23 June 2025. Retrieved 1 May 2026.
  43. ↑ Knapp, Martin; Lorenz-Dant, Klara; Walbaum, Magdalena; Comas-Herrera, Adelina; Cyhlarova, Eva; Livingston, Gill; Wittenberg, Raphael (27 January 2024). "Scaling-up an evidence-based intervention for family carers of people with dementia: Current and future costs and outcomes". International Journal of Geriatric Psychiatry. 39 (2) e6059. doi:10.1002/gps.6059. ISSN 0885-6230. PMID 38279805.
  44. ↑ Adelman, Ronald D.; Tmanova, Lyubov L.; Delgado, Diana; Dion, Sarah; Lachs, Mark S. (2014-03-12). "Caregiver Burden: A Clinical Review". JAMA. 311 (10): 1052–1060. doi:10.1001/jama.2014.304. ISSN 0098-7484. PMID 24618967.
  45. 1 2 Hoffmann, Rosemary L.; Mitchell, Ann M. (1998). "Caregiver Burden: Historical Development". Nursing Forum. 33 (4): 5–12. doi:10.1111/j.1744-6198.1998.tb00223.x. ISSN 0029-6473. PMID 10205484.
  46. ↑ Hoenig, J.; Hamilton, Marian W. (1966-06-01). "The Schizophrenic Patient in the Community and His Effect On the Household". International Journal of Social Psychiatry. 12 (3): 165–176. doi:10.1177/002076406601200301. ISSN 0020-7640. PMID 5964677.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Caregiver_burden&oldid=1357714242"