Relationship between family caregiver burden and physical frailty in older adults without dementia: a systematic review

Abstract

BackgroundPhysical frailty is a prevalent syndrome in older adults that increases vulnerability for a range of adverse outcomes including increased dependency and death. Caregivers of older adults experience significant physical, emotional, and financial burden, which is associated with poor physical and mental health. While it is known that care recipients’ dementia is associated with burden, the literature regarding the impact of physical frailty on burden has yet to be synthesized. We conducted a systematic review to assess the state of the evidence regarding the relationship between these two prominent concepts in the geriatric literature.MethodWe used a structured search of databases to identify original English-language articles. Two researchers screened the titles and abstracts of all 1202 retrieved studies and then full-text versions of 265 retained studies. Screening was based on a priori inclusion criteria, which included discussion of physical frailty, caregiver burden, and a population of community-dwelling older adults without dementia. Nine included papers underwent data abstraction and critical appraisal using the Cochrane Risk of Bias Tool or the Newcastle-Ottawa Scale (for randomized controlled trials or cross-sectional studies, respectively). Heterogeneity of the included studies precluded meta-analysis.ResultsFive publications had the same author and drew from the same population; these were treated as a single study. Three of our studies were of limited value since they did not include a validated measure of frailty. While caregivers of frail older adults experience burden, the scarce available evidence and lack of studies comparing this population with normative values does not allow conclusions to be drawn about the strength or nature of the relationship. Judging from excluded studies, the term “frailty” is often used without reference to a clear definition or is treated as synonymous with functional impairment or advanced age.ConclusionsOur review suggests that caregivers of frail older adults experience burden and that the degree of burden may differ from that of other caregiver populations. The limited evidence does not allow conclusions to be drawn or to inform clinical practice. Further research is needed, given the salience of physical frailty and burden.Systematic review registrationPROSPERO CRD42015019198Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0447-1) contains supplementary material, which is available to authorized users.

Prevalence and Potential Predictors of Frailty among Community-Dwelling Older Persons in Northern Thailand: A Cross-Sectional Study

“…Lack of caregiving support often leads to poor nutritional status and physical activity disengagement [33]. This in turn leads to physical frailty [34]. Across the three models, age, education, and having no spouse persisted as factors associated with pre-frailty and frailty.…”

Burden, profile and care: caregivers of socially vulnerable elderly persons

“…Caregiver burden is an indicator of negative impact that can affect the physical, psychological, emotional and financial state and cause mental health outcomes 30,31 . Caregivers are often not ready to assume all the responsibilities thrust upon them without support.…”

Caring responsibility from the perspectives of older persons whose adult children are their caregivers

“…Motivations of family care have been described in terms of solidarity and norms of filial obligation (Bengtson & Roberts, 1991), as ambivalence (Lendon, 2017;Luescher & Pillemer, 1998), and as altruism and reciprocity (Klimaviciute, Perelman, Pestieau, & Schoenmaeckers, 2017;Silverstein et al, 2012). In line with the theory of ambivalence, informal caregiving is often associated with caregiver burden (Adelman, Tmanova, Delgado, Dion, & Lachs, 2014;Bastawrous, 2013;Ringer et al, 2017) This is further supported by Dale et al (2011), who found that the majority of home-living persons 75+ years receiving home nursing and family care were not bothered about receiving family care, especially those who had a partner and were co-residing. However, these older persons were less confident that their family could extend the care in case of increasing needs in the future.…”