Informal supporters provide the majority of long-term care to chronically disabled older adults. Caregiving has been recognized as an activity with perceived benefits and burdens. Caregivers may be prone to depression, grief, fatigue, and changes in social relationships. They may also experience physical health problems and fatigue. Perceived caregiver burden has been associated with premature ìnstitutionalization and patient reports of unmet needs. Screening tools are useful to identify families who would benefit from a more comprehensive assessment of the caregíving experience.
The Caregiver Strain Index (CSI) is a tool that can be used to quickly identify families with potential caregiving concerns. It is a 13-question tool that measures strain related to care provision. There is at least one item for each of the following major domains: Employment, Financial, Physical, Social, and Time. Positive responses to seven or more items on the index indicate a greater level of strain. This instrument can be used to assess individuals of any age who have assumed the role of caregiver for an older adult. It was developed with a sample of 132 caregivers providing assistance to recently hospitalized older adults and is appropriate for caregivers of any age.
VALIDITY AND RELIABILITY
Internal consistency reliability is high (alpha = 0.86) and construct validity is supported by correlations with the physical and emotional health of the caregiver and with subjective views of the caregiving situation.
STRENGTHS AND LIMITATIONS
The CSI is a brief, easily administered instrument. The tool is limited by lack of a corresponding subjective rating of caregiving impact. The tool effectively identifies families who may benefit from more in-depth assessment and follow-up.
A positive screen (7 or more items positive) on the CSI indicates a need for more in-depth assessment to facilitate appropriate intervention. Pearlin et al. (1990) have identified various domains that should be addressed in a comprehensive assessment of the caregíving process. The patient's cognitive status and problematic behaviors should be assessed, as well as the caregiver's perception of role overload or deprivation in key relationships, goals, or activities. Family conflict, work role-caregiving conflict, and caregiver social support are also important variables in the overall caregiving experience.
THE CARECIVER STRAIN INDEX
- Pearlin, L., Mullan, J., Semple, S., & Skaff, M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist 30, 583-594.
- Robinson, B. (1983). Validation of a Caregiver Strain Index. Journal of Gerontology, 38, 344-348.
- MORE ON THE TOPIC
- Gerritsen, P., & Van Der Ende, P. (1994). The development of a care-giving burden scale. Age and Ageing 23, 483-491.
- Novak, M., & Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist 29, 798-803.
- Ravazzin Center for Social Work Research in Aging, Fordham University Graduate School of Social Service. (1997). Family Elder Caregiving: The Grotta Report on philanthropic trends and best practice models. New Jersey: The Grotta Foundation.
THE CARECIVER STRAIN INDEX