Caregiver Role Strain: Signs, Causes & Prevention

Knowing how to treat caregiver role strain is critical. After all, patients spend the majority of their time outside of a primary care or mental health provider’s clinic and when patients can't take care of themselves it's up to their caregivers to ensure their wellbeing. 

Typically, a caregiver is a professional or unpaid family member who assists a patient suffering from chronic disease, physical disability, or mental illness with daily life and at-home treatment. But when a caregiver is experiencing too much stress, their health and their ability to properly care for a patient becomes compromised.

In this article, we discuss what exactly caregiver role strain is, its causes and symptoms, and methods of prevention and treatment.

What Is Caregiver Role Strain?

Caregiver strain, also known as caregiver burden or burnout, is the physical, emotional, and mental stress that occurs when a caregiver looks after a patient without attending to their own needs. Eventually, this can result in significant physical and mental health problems. 

Unfortunately, caregiver stress is a common issue. As many as 32.9% of unpaid caregivers experience mental or behavioral health problems such as anxiety, depression, or substance abuse. Additionally, 14.5% of caregivers report 14 mentally unhealthy days in a month, and 17.6% have 14 physically unhealthy days in a month.

What Causes Caregiver Stress?

Generally, caregiver role strain occurs due to a combination of financial burdens, increased responsibility, and role changes. 

Caregiving expenses

Up to 78% of caregivers report regular out-of-pocket costs related to caregiving, with one-quarter (26%) of their annual income being spent on providing care. Due to the financial burdens of these expenses, caregivers may opt to spend less on themselves and skip vacations, leading to longer caregiving hours and more stress. 

Overwhelming responsibility

Tasks like taking care of a patient's home, having to provide healthy meals, and administering treatment can quickly become overwhelming, especially for inexperienced or younger caregivers who lack a strong support system. On top of these responsibilities, as many as 61% of caregivers in the United States are also holding down a full-time job, with 60% working 40 hours or more per week. 

Role reversal

When a caregiver is looking after someone who used to take care of them, such as aging parents, this reversal of roles can cause emotional distress. A family member taking on this role can be an example of an informal caregiver—as the person may not have the training or experience required to deliver comprehensive care.

New responsibilities plus the distress of a role reversal can lead to further strain, especially when combined with risk factors such as social isolation, a preexisting mental health condition, or a lack of choice about being a primary caregiver.

What Are the Signs of Caregiver Role Strain?

As the cause of stress is different for each caregiver, the symptoms of role strain come in a wide variety and can be broadly sorted into three categories.

1. Cognitive symptoms of caregiver strain

Excessive stress can hamper a caregiver's ability to clearly think, learn, and remember. Cognitive symptoms can directly affect a patient's health as their caregivers might miss appointments or fail to administer their treatment. Signs include:

• Trouble concentrating

• Increased forgetfulness

• Problems finishing daily tasks

• Difficulty making simple decisions

2. Mental health symptoms of caregiver stress

Frequent stress can affect a caregiver's emotional and mental stability overtime. The longer these symptoms go untreated, the more likely they will interfere with a caregiver's ability to provide care. Look out for symptoms such as:

• Feeling constantly overwhelmed or worried

• Increased irritability 

• Loss of interest in hobbies

• Social withdrawal

• Suicidal ideation

3. Physiological symptoms

Caregiving can involve a lot of physical labor, especially when a caregiver has to take care of a patient's home as well. Repetitive physical strain can result in symptoms like:

• Insomnia or oversleeping

• Chronic tiredness

• Low sex drive

• Gaining or losing weight

• Musculoskeletal pain

How to Assess Caregiver Burden

Caregiver burden tends to be associated with the ability to balance competing needs. Determining what those needs are and how the caregiver's needs can be balanced against a patient's needs is the key to any strategy that reduces the stress of caregiving.

Nursing assessment

Whether a patient's caregiver is new or experienced in providing care, it can be helpful to perform a nursing assessment to understand their skills and needs. Start by assessing their experience with patient care skills, such as bathing, skin care, safety, nutrition, medication, and ambulation. Additionally, the assessment is a chance for caregivers to talk about their own personal needs, elaborate on their relationship with the patient, and identify communication patterns and support systems.

Mental health screenings

It's important to note down any pre-existing conditions a caregiver has, especially because excessive strain can be detrimental to their mental and emotional health. If they aren't sure about the state of their mental health, there are a variety of tests and assessments that can screen for specific conditions. For example, they can take the GAD-7 questionnaire to screen for anxiety, the PHQ-9 questionnaire for depressive symptoms, or the Perceived Stress Scale (PSS) to determine their average stress levels.

Cognitive performance

Evaluating a caregiver's cognitive performance can help determine the kind of support they'll need to successfully fulfill their role, minimizing the chances of fragmented care for the patient. There are a number of clinically approved online tests for cognitive function that can be used to assess caregivers for fatigue, decision making, focus, memory, and attention. One example is the Instrumental Activities of Daily Living (IADL) questionnaire, which can measure a caregiver's cognitive performance for tasks like cooking, shopping, making a phone call, and so on. 

Prevention and Treatment for Caregiver Burnout

Caregiver burnout refers to the late stages of caregiver role strain, where a caregiver has been suffering from the symptoms of excessive stress for a long period of time. Ideally, it's best to prevent burnout from happening in the first place but, if it's already too late, there are ways to help caregivers on their journey to recovery.

1. Involve other family members

When the full burden of care is placed on a single person their chances of experiencing caregiver strain increase due to social isolation, increased responsibility, and the stress of not having a support team. To ease the pressure, encourage caregivers to reach out to their family for assistance. 

There are two main forms of family support, either financial assistance or a sharing of caregiving responsibilities—reducing the overall burden by distributing it across family members. Support from their family not only helps them manage caregiver role strain, but can enhance the quality of life for the patient, too.

2. Support group recommendations and self-care

In some cases, a caregiver's family members may not be able to provide them with the support they need. This is when they should contact a caregiver support group instead. Support groups tend to offer both online and in-person interactions, such as the Family Caregiver Alliance, in order to meet a caregiver's demanding schedule. There are also support groups that bring together caregivers who are caring for patients with certain kinds of conditions or diseases, like the Alzheimer's Association support group. 

Outside of organizations, self-care resources can also help prevent burnout for caregivers with limited support systems. A study on self-care needs and practices for caregivers defines self-care as their ability to prioritize and maintain their own health, and can involve a broad range of activities that promote physical and mental well being.

3. Connect with emotional support resources

Burnout occurs due to high levels of stress and emotional exhaustion, and as many as 72% of caregivers experience emotional stress specifically. To reduce their stress levels, a caregiver can try connecting with emotional support resources—such as a therapist, counselor, or social worker. By helping a caregiver find an avenue to discuss their feelings, problems, and concerns, clinicians can give them a way to reduce feelings of exhaustion and find emotional stability. 

4. Provide education on caregiving responsibilities

While a caregiver may know how to execute the practicalities of their role, they may not be mentally prepared for the amount of time and responsibility that it demands. The less they understand about the reality of their role, the more likely they will suffer from caregiver role strain as they become overwhelmed. 

The good news is that a caregiver's stress levels can be reduced through enhancing their role preparedness via education. Caregiver education can involve teaching them about the reality of how much time their new responsibilities will take, allowing them to fit these tasks into their schedule without being suddenly overwhelmed. For example, a caregiver who is prepared and educated about their role can take time off for vacation or personal commitments by using respite care resources to cover their responsibilities. 

5. Provide alternatives to medication such as a healthy lifestyle

When a caregiver is suffering from stress it may seem like medication is the simplest solution. However, medication is not always an appropriate approach to symptom management and it can complicate the level of medical oversight that's needed in both caregiver and patient care. Instead, try to provide the caregiver with safe and effective alternatives. 

Work with the caregiver to help them find time for exercise routines, a nutritional diet, getting enough sleep, and ways to socialize—all of which can result in healthy outcomes without the potential for risk. And if the caregiver is an older adult, living a healthy, balanced lifestyle will not only reduce their stress levels, but also has the added benefit of helping to prevent chronic diseases like dementia.

6. Monitor medication use

If medication is the appropriate course of action for a caregiver, then introducing the treatment in limited doses would be ideal. Keep track of the amount of medication prescribed and how often they request for more or stronger medication. Overall, any medication should be a temporary measure to help the caregiver reduce their stress levels while they seek alternative solutions. 

If there's concern that a caregiver is abusing their medication, healthcare providers may want to recommend a drug abuse screening test such as the DAST-10, which can be taken online in as little as two-minutes. The results of the screening will help determine if a different course of action needs to be taken before the devastating consequences of drug abuse start to affect both the caregiver and the patient.

7. Provide regular re-assessment 

Once a healthcare professional has done all they can to treat or prevent caregiver role strain, it can be helpful to take a step back and reassess the situation. Depending on the caregiver's symptoms, this might mean a mental health screening, tracking signs of physiological distress, or discussing their cognitive health. 

But asking the caregiver to make an appointment regularly can be difficult, and may even contribute to further stress. That's where online assessments and screening tests have the advantage. It's much easier to schedule a quick virtual questionnaire than to have the caregiver come to the clinic, adding stress for them and the patient.

8. Establish a care plan

One way to schedule consistent cognitive assessments and mental health screening tests is via a cognitive care plan. The right cognitive care plan will allow clinicians to gather a large amount of longitudinal data. When data is collected over a long period of time, it tends to be more accurate, allowing them to make informed decisions. With computerized assessments and a care plan designed for their needs, they'll be able to more accurately monitor the caregiver's stress levels and contribute to the prevention and treatment of caregiver burnout without adding too much to their already busy schedule.

Recommended Resources

For more ways a patient's caregiver can find support and improve their skills, ask them to take a look at the following resources:

• Medication Management: A Family Caregiver’s Guide

Learn how to understand medicine labels, side-effects, and problems of common medication.

• Home and car safety guides

Ways to prevent driving and home accidents, and what to do during an emergency.

• Adapting homes for age-related changes

Adapt and adjust a patient's home to make it more accessible for their needs.

• Family Caregiver Alliance

Find resources and support channels that caregivers can use to their advantage when providing long-term, at-home care.

• AARP Resources for Caregiving

Discover resources like national organizations and programs, as well as financial and legal help, respite care, and more.

Final Thoughts

When a caregiver experiences excessive stress, their quality of life and their capacity to care declines. This not only leads to potentially poorer health outcomes for the patient, but also puts a caregiver's own health at risk.

Providing caregiver assistance and resources to find support is the first half of the solution to caregiver role strain. The second half involves routine assessments that can be taken online at their convenience, allowing clinicians to track their progress towards a healthier physical and mental state and intervene in symptom management when issues arise.

By preventing or treating caregiver burnout, healthcare professionals can actively improve a patient's experience by ensuring that their at-home care is the best it can be.