1. Caregiver Stress & Rural America
Flo Weierbach, RN MPH PhD
Rural Health Association of Tennessee
Annual Conference
November 17, 2011

2. Purpose
Identify the impact family caregiving has on the family caregiver
Identify rural community resources that act as a facilitator or barrier for the family caregiver
Discuss the health status of the family caregiver and how it may affect the elderly care recipient
Discuss preliminary findings from Determinants of Health for Rural Caregivers Research Study

3. Family Caregivers Backbone of community providers Number of caregivers
Provide 80% community based long term care
Number of caregivers
>18 yrs 43.5 million (care recipient >50 yrs)
Who they are
Daughters
Cost to society
57% Employed (46% FT, 11% PT)
6 in 10 Caregivers work

4. Rural Elderly Who are they & What do they do? What do they need
US 12.9%,
Rural Elder: 28% (2.75 in 10)
Veterans, farmers, truck drivers, still working, retirees (transplants)
What do they need
Access to services
Caregiver impact & rural workplace
Financial
Percent of elderly:
National: 2009=28%, 1990=14.74%
Tennessee: 2009: > 65=13.1%, >85yrs=1.7% (15.7% adults > 65)

5. Rural Communities Elder Friendly Community Social & Civic Engagement
Basic Needs
Elder Friendly Community
Independence for Frail & Disabled
Physical & Mental Health
Elder-Friendly Community
Study focus: rural elder’s identified needs and their stories concerning how community resources met their identified needs.What is the communities contribution to health.
Model based on practice-Feldman and Oberlink (2003) using focus groups identify four components necessary for an elder-friendly community. The model see Figure, identifies components that elderly have identified as necessary for them to live and thrive in a community.
Urban, suburban, and rural elder groups identified variables in the four areas: address basic needs, promote social and civic engagement, optimize physical and mental health and well being, and maximize independence for frail and disabled.
The variables under the four categories include: financial security, health and health care, social connections, housing and community based supportive services, such as assistance with housekeeping, yard work and other chore type activities, and transportation and safety identified under the four components can be characterized as formal and informal community resources.
The elder-friendly model provides a structure to identify relationships between the four identified community components, community resources and the elder with ADL/IADL needs.
(Elder-Friendly Community Model; Feldman & Oberlink, 2003)

6. Community Resources Basic Needs Social & Civic Engagement
Housing (affordable, modifications)
Safety
Food acquisition
Knowledge of community resources
Social & Civic Engagement
Connections to the community (Senior Centers, Ruritans)
Church
Neighbors
Physical & Mental Health
Comprehensive Health Care
Independence for Frail & Disabled
Age in Place
Assistance with ADLs/IADLs
Supportive services for Caregivers
Transportation

7. Rural Resources Family: Kin Networks Churches: Social Networks
Neighbors
Civic Organizations: Ruritans
Longevity & Connections

8. Caregiver Burden Objective Burden Stress Burden Relationship Burden
Interferes with life
Stress Burden
Stress & anxiety
Relationship Burden
Strain in relationship
Assistance with ADLS
Problem Behaviors
Intent to Institutionalize
Self Rated Health

9. Elder Friendly Community
Caregiver Stress
What does stress look like for Rural Caregivers? Is stress the same for the Insider and Outsider?
Community
Elder Friendly Community
Basic Needs
Physical &
Mental Health
Independence for
Frail & Disabled
Social & Civic
Engagement

10. Caregiver Stress

11. Caregiver Health Model
Beyond Stress:
Caregiver Health Model
CG Needs CG
Health
Beliefs & Attitudes of CG
Tasks
Environment
CG Health Promotion Behaviors

12. Caregiver Stress Beliefs & Attitudes Tasks Health Needs
Health Promotion

13. Demographics N=13 Time providing care Caregiver gender
2/15.4% Male
9/69.2% Female
2/15.4% No response
Time providing care
6/46.2% <1 year – 2 years
1/7.7% 6 years
1/7.7% 9 years
5/28.5% No response

14. ADLs/IADLs
ADLs
IADLs

15. CG Health Health: PROMIS: Global Health Domain19
Developed by NIH to provide a standardized clinical instrument to measure physical, mental & social health.
Global health domain currently in phase 2 (clinical) testing: predictor of health care utilization & mortality

16. CG
Health
Promis Instrument

17. Beliefs & Attitudes of CG
Attitudes and Beliefs:
Kosloski’s Measure of Caregivers Beliefs & Attitudes 20
-Measures caregiver’s attitudes & beliefs about caregiving
-Subscales include: family relationships, obligation to care, family values and religion.
-Reliabilities ranged from
-Four factors were supported by a factor analysis providing preliminary validity evidence

18. CG Tasks Activities: Oberst’s Caregiving Burden Scale57
-Measures caregiving burden
-Two subscales (caregiving difficulty with tasks and caregiving demands)
-Coefficient alpha reliabilities ranged from
-Factor analysis supported two factors, demand and difficulty.

19. CG Tasks Activities: Oberst’s Caregiving Burden Scale57
-Measures caregiving burden
-Two subscales (caregiving difficulty with tasks and caregiving demands)
-Coefficient alpha reliabilities ranged from
-Factor analysis supported two factors, demand and difficulty.

20. Psychological Needs CG Needs Importance M / SD Satisfaction
Deal with unpredictable future
6.33 / 1.16
3.83 / 1.64
Dealing with my fears
5.73 / 1.90
4.73 / 2.24
Be more patient and tolerant
6.25 / 1.77
3.67 / 2.43
Importance and Satisfaction scales range from 1 – 7.
Higher score means more important/satisfied.
Needs:
Hileman’s Home Caregiver Need Survey22
-Measures the importance of caregiver’s needs
-Six subscales: information, household, patient care, personal, spiritual and psychological
-Cronbach ‘s alpha reliabilities ranged from
-Factor analysis supported the 6 factor structure and provides validity evidence of the measure.

21. Needs Involving Information
CG Needs
Needs Involving Information
Importance
M / SD
Satisfaction
Type and extent of illness
6.08 / 1.89
6.15 / 1.21
Cope with role changes
6.08 / 1.66
5.38 / 1.66
Importance and Satisfaction scales range from 1 – 7.
Higher score means more important/satisfied.
Needs:
Hileman’s Home Caregiver Need Survey22
-Measures the importance of caregiver’s needs
-Six subscales: information, household, patient care, personal, spiritual and psychological
-Cronbach ‘s alpha reliabilities ranged from
-Factor analysis supported the 6 factor structure and provides validity evidence of the measure.

22. Personal Needs CG Needs Importance M / SD Satisfaction Time to rest
5.69 / 1.97
4.46 / 2.60
Maintain own health
5.92 / 1.80
4.46 / 2.03
Importance and Satisfaction scales range from 1 – 7.
Higher score means more important/satisfied.
Needs:
Hileman’s Home Caregiver Need Survey22
-Measures the importance of caregiver’s needs
-Six subscales: information, household, patient care, personal, spiritual and psychological
-Cronbach ‘s alpha reliabilities ranged from
-Factor analysis supported the 6 factor structure and provides validity evidence of the measure.

23. CG Health Promotion Behaviors
Walker’s Health Promoting Lifestyle Profile II HPLPII21
-Measures health promoting activities
-Six subscales (health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations and stress management).
-Cronbach’s alpha for the total scale is 0.922

24. Acknowledgements Caregiver Participants
American Nurses Foundation (ANF)
East Tennessee State University
Research Development Committee
Center for Nursing Research

25. weierbach@etsu.edu (423) 439-4588
???Questions???
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