Family caregiving refers to the efforts of family members to assist an individual with physical health and/or mental health problems and with difficulties in performing everyday activities.
Outcomes in the context of family caregiving have two meanings: (1) outcomes of engagement in the caregiving role and (2) the primary dependent variables in an intervention study, i.e., the major changes that are hypothesized to result from the intervention.
Extensive research over the past 40 years has explored the stress experienced by family caregivers (See “Caregivers’ Stress”). Caregiver outcomes have been characterized in two ways, as the end point of the effects of engagement in the caregiving role and as hypothesized changes expected to result from exposure to a treatment or intervention (See “Interventions for Caregivers of Older Adults”). Whatever the goal of the research, a particular challenge in the selection of outcomes is the heterogeneity of caregiving situations and stressors, and among caregivers themselves, their age, relationship to the care recipient, resources, and so on. Nevertheless, caregivers of persons with different illnesses or disabilities and different amounts of engagement in the role are often grouped together in studies. Even when the focus is on one group of caregivers, such as those providing help to a person with dementia (See “Dementia” and “Behavioral Interventions for Dementia”), there is typically considerable heterogeneity within that group among caregivers’ commitment, characteristics, and experiences.
Despite the heterogeneity among caregivers and care situations, the outcomes in caregiving research have generally been considered within a narrow focus, specifically, the caregiver’s health and emotional well-being. Health has largely been measured with self-report measures of caregivers’ symptoms and diagnosed illness, though recent research has used biomarkers related to the stress process (Lovell and Wetherell 2011). Well-being is usually measured by depressive symptoms, though scales measuring other emotions as well as global distress scales are sometimes included. This focus on health and emotions is derived from stress and coping models (e.g., Aneshensel et al. 1995), which have dominated the field (See “Stress and Coping”). From this perspective, health and well-being are the temporal end-points of a process characterized by stressors and stress mediators or moderators (e.g., stress appraisals, coping, social support), which lead to changes in health and emotional well-being. Stress process models are supported by strong correlational evidence that caregiving stressors (e.g., care tasks, care recipient disability) are associated with poorer health and psychological well-being (Aneshensel et al. 1995; Watson et al. 2018). Both caregiving stressors and their effects on health and well-being outcomes have substantial implications for overall quality of life among caregivers; however, relatively few studies address quality of life or similar measures (e.g., life satisfaction) as a direct outcome of engagement in caregiving or as an explicit target of caregiver interventions.
Although stress process models have been useful in guiding research, there is a growing recognition that health and emotional well-being do not adequately represent the possible range of outcomes that might be relevant to caregivers’ experiences (e.g., Fortinsky et al. 2013; Marino et al. 2017). The argument for a wider range of outcomes is based on both conceptual and empirical grounds. First, although stress models imply a temporal progression (e.g., stressors lead to outcomes), it has always been assumed that these models describe an ongoing dynamic process whereby effects of stressors accumulate and diminish over time. Moreover, “outcomes” such as depression and health problems have reciprocal effects on other elements of the stress process, for example, increasing the likelihood of encountering new stressors and leading to poorer mobilization of resources in responding to a stressor (Aneshensel et al. 1995). Additionally, consistent with cognitive theories of depression, depressive symptoms may lead to overly negative appraisals of caregiving events and caregivers’ own resources, thereby decreasing their ability to manage those events. In other words, factors considered as outcomes, such as depressive and health symptoms, can precipitate new stressors and moderate caregivers’ abilities for managing stressors.
A second consideration is that many caregivers do not experience depressive symptoms or worsening health (e.g., Fortinsky et al. 2013; Marino et al. 2017; Pinquart and Sörensen 2003a). Drawing on multidimensional models of well-being, Marino and colleagues propose that research on caregivers should go beyond hedonic (affective) measures that are often negative in valence and incorporate eudaimonic dimensions of well-being as outcomes, such as feelings of mastery in the care situation and deriving meaning from caregiving. Fortinsky et al. (2013) suggest that a key element in caregiving is resilience, specifically being able to maintain positive affect despite unremitting care demands and to bound back quickly from negative experiences (See “Resilience: Measures and Models”). This multidimensional approach has broad relevance for caregivers and addresses domains that are critical to their adaptation.
The narrow focus on affective distress and worsening health has been especially problematic in intervention research with caregivers. Most interventions have used depressive symptoms as an outcome measure. The inclusion criteria for studies, however, have mainly been based on role status (i.e., being a caregiver) and not on whether caregivers have depressive symptoms. In effect, researchers are making the implicit assumption that all caregivers will be experiencing distress and depression. Yet many participants in caregiver intervention trials have had low baseline depressive symptom scores, as well as low scores on other measures of emotional distress, caregiver burden, or health problems that may be used as outcome measures. Consequently, statistical power is decreased, since caregivers with low initial scores cannot show improvement. As a result, most studies report fairly small treatment effect sizes, even when findings are statistically significant (Zarit 2018). The exceptions tend to be studies where depressive symptom scores were relatively high at baseline or where studies have selected caregivers with higher baseline depressive symptoms and who could therefore benefit from treatment (e.g., Perlick et al. 2010).
It can be argued that this broad recruitment strategy might have a preventive effect for caregivers not experiencing depressive symptoms or other types of distress. That is a testable proposition, but some caution is needed. Some evidence suggests that giving treatment for a problem people do not have may result in adverse effects such as evoking negative emotions (Baucom et al. 2006). Furthermore, this approach may detract from resources that could be better used to support caregivers with their current issues and concerns.
A fundamental question that needs to be asked is why caregivers who are experiencing little or no depressive feelings or other distress enroll in interventions. A more precise understanding of what motivates caregivers to seek interventions and what goals they have would lead to a more varied and meaningful set of outcomes. Ultimately, this knowledge will inform targeted and person-centered interventions that address the issues that caregivers are most concerned about. Depression and health should be targets for interventions when risks in these domains are present or when prevention is an explicit goal of a study. In other circumstances, there is a need to identify outcomes that are appropriate for the sample and the intervention goals.
Next, research findings for major caregiver outcomes are discussed. Given the emphasis in the literature, this review focuses on outcomes related to the caregiving stress process, along with positive caregiving outcomes and placement of the care recipient. Other issues pertinent to the selection and application of outcomes are then considered, including sample characteristics and outcomes among both caregivers and care receivers. Finally, recommendations for future research on family caregiving outcomes are described.
Key Research Findings
Depression as an Outcome
Depression is probably the most frequently reported outcome. The term “depression” has two meanings, as an indicator of emotional well-being and as a marker of an affective disorder. Caregiver studies typically use scales that yield a score of total symptoms. Use of measures that yield diagnostic categories is less common. A widely used scale, the Center for Epidemiological Studies Depression Scale (CES-D), produces an overall sum score and also has a validated cutoff point that identifies persons with clinically significant levels of depression (Lewinsohn et al. 1997; See “Center for Epidemiological Studies Depression”). The value of the cutoff is that it identifies people who are more likely to have or be at risk for a depressive disorder and respond to treatment for depression. Some studies use this cutoff, but other research creates categories of low and high depression based on distributions of scores on the CES-D or other measures, often without validating the cutoff.
Most views of depression implicitly assume a continuum from no symptoms to severe symptoms. The difference between a person with a high score and one with a low score on a depression scale is meaningful. The person with a high score is experiencing considerable distress and may meet criteria for a depressive disorder. If that person experiences a large decrease in symptoms during an intervention, that represents a meaningful change that is likely to be reflected in the person’s overall functioning. By contrast, there is less known about the significance of differences among people who report low scores and do not meet diagnostic criteria. Furthermore, it is not known what the value might be, if any, of a person who has a low score initially on a depression scale and shows a drop of one or two points during an intervention. There is little evidence of whether or not that type of change makes a meaningful difference in the person’s life, yet that is often the degree of change reported in caregiver interventions. Likewise, in nonintervention studies, where much of the sample falls in lower ranges on a depression scale, small differences in scores among participants may reflect stable individual characteristics rather than meaningful discrepancies in functioning or quality of life.
Despite these caveats, depression is important to examine as one of the possible outcomes of caregiving. Rates of depression symptoms among caregivers are higher than the noncaregivers, though differences are smaller in population-based samples compared to clinical or self-selected samples (Marino et al. 2017; Pinquart and Sörensen 2003a). Selection effects may account for these findings, as highly stressed caregivers may be more likely to volunteer for clinical studies and less likely to participate in population-based studies.
Caregiver depression scores are higher among women than men, and are most strongly associated with the care receiver’s behavioral and psychological problems (Pinquart and Sörensen 2003b; Watson et al. 2018; See “Behavioral and Psychological Symptoms of Dementia”). Other factors associated with depressive symptoms include amount of care receivers’ cognitive and physical impairment, low caregiver self-efficacy and mastery, inadequate income, and unmet caregiver needs and high activity restriction (Fortinsky et al. 2013; Pinquart and Sörensen 2003a; Watson et al. 2018).
Most studies are cross-sectional. Caregiving, however, often extends over a multiyear period, and so longitudinal research provides a different and valuable perspective on risk of depression. Studies that have followed caregivers over several years report that between 40% and 69% have consistently low levels of depression, around 20% have continually high depression, and the remaining caregivers have fluctuating periods of high and low depression (e.g., Joling et al. 2015). It will be important for future work to proactively address the needs of caregivers who are at risk for sustained high levels or increasing depression, such as those in highly stressful care situations with minimal resources.
Other Dimensions of Distress
Other dimensions of emotional distress, particularly anxiety and anger, have received some attention in the caregiving literature (Watson et al. 2018). Like depression, anxiety has a dual meaning, referring to symptoms and to disorders where anxiety is a prominent feature. Cooper et al. (2007) conducted a systematic review that identified 33 studies that used measures of anxiety. They found that anxiety affected a quarter of caregivers of persons with dementia and that scores were higher than among matched controls who were not caregivers. Using a structured diagnostic instrument that was administered to spouse caregivers every 3 months, Joling et al. (2015) reported that 54% of the sample met criteria for an anxiety disorder at one or more points during the observation period. There was, however, considerable overlap of depressive and anxiety disorders, with 32% of the sample receiving both diagnoses.
Anger is a powerful emotion that has been found to occur frequently among caregivers of persons with dementia (Coon et al. 2003). Using psychoeducational interventions that focused on either anger or depression, Coon et al. (2003) found that both interventions had positive effects on both emotions. Anger was also found to decrease among caregivers of persons with dementia with use of adult day care (Zarit et al. 1998; See “Adult Day Services,” “Effectiveness of Respite Care for Caregivers,” and “Respite Care”). In a subsequent study (Zarit et al. 2014), anger and depression were found to be lower on days the person with dementia used adult day care compared to days they provided all the care. Additionally, both anger and depressive symptoms were associated with daily cortisol responses.
Subjective Stress and Burden
Measures of burden and subjective stress are role-specific ways for assessing impact on caregivers’ lives. Caregiving leads to changes in the relationship of caregiver and care receiver, which may upend the pattern of exchanges of support and affection. Caregiving may also come to dominate a caregiver’s time, diminishing valued activities with family and friends or at work that provide enjoyment and meaning. Feelings of subjective stress and burden result from these changes and represent a fundamental outcome of the caregiver’s involvement. That’s not to suggest that all caregivers experience these feelings, but rather there is the potential for all caregiving situations to generate subjective stress or burden.
Although general stress measures are sometimes used in caregiving research, role-specific stress measures tap into specific experiences in a caregiving context. Role overload (i.e., the perceived time and energy costs of caregiving) and role captivity (i.e., feeling trapped in the care role) are two widely used measures that have been responsive to the effects of interventions (Gaugler et al. 2018; Zarit et al. 1998).
Burden has been studied extensively in the caregiving literature (Pinquart and Sörensen 2003b). Although definitions of burden vary, most measures examine how caregivers perceive the effects of assisting a relative on their personal life and on social and family relationships and activities. Financial burden is also sometimes included. Burden shares some conceptual overlap with more global aspects of subjective well-being such as quality of life; however, it is distinct in that it centers on how different life areas are directly impacted by caregiving. Burden measures show strong associations with care stressors, particularly care receiver behavioral and psychological symptoms (Pinquart and Sörensen 2003b). They also show a moderate inverse association with social support (del-Pino-Casado et al. 2018).
Burden and other role-specific measures have been frequently used as an outcome measure in intervention research (Pinquart and Sörensen 2003b). They may be particularly useful as outcomes because they assess the specific effects of stressors that are intrinsic to the caregiving role.
Like depression, health has received considerable attention in the literature. Measures have included subjective ratings of health, objective indicators such as illness incidence and prevalence, and biomarkers of health risk such as blood pressure or cortisol. In an early, comprehensive review, Pinquart and Sörensen (2003a) reported differences between caregivers and noncaregivers in both subjective and objective measures of health, though differences were smaller than those found for depression, stress, and burden. The effects were also greater in studies that included only dementia caregivers, compared to mixed or nondementia samples
More recent work has called into question whether caregivers’ health is universally at risk. In a landmark paper, Roth et al. (2015) observed that several recent population-based studies show reduced mortality and health risk among caregivers. They suggest that these findings indicate selection into the role may be associated with better health, and that there are possible health benefits of caregiving activities under some circumstances. In addition, caregivers experiencing health problems may be less likely to enroll or continue to participate in population-based studies than in convenience or clinical samples.
Although Roth et al. (2015) provide a valuable corrective to the excessive emphasis on negative effects of caregiving, it is imperative to acknowledge the extensive literature that documents a pathway from stressors to physiological markers to illness (Lovell and Wetherell 2011). A growing body of research reports associations of caregiving stressors and physiological changes. Biomarkers have included measures of the hypothalamic-pituitary-adrenal axis such as cortisol, indicators of cardiovascular risk such as C-reactive protein and high blood pressure, and measures of inflammation such as Interleukin-6. Studies have demonstrated improvement in caregivers’ biomarker levels with intervention (e.g., Klein et al. 2016; Moore et al. 2013). Recent work has also found associations of care stressors and biomarkers with decline in functional health (Liu et al. 2017). Thus, while many caregivers appear to be resilient to health declines, those with greater care-related stress may be more susceptible to maladaptive biological responses that increase risk of chronic illness and disability.
Positive Caregiving Outcomes
Positive outcomes among caregivers such as psychological resources are an important direction for broadening the scope of caregiving outcomes (See “Benefits of Caregiving”). Using a caregiving subsample drawn from the Midlife in the United States (MIDUS) study, Litzelman et al. (2017) evaluated change in psychological resources and links to caregiver well-being over a 10-year period. Caregivers with increasing or high-stable personal mastery reported better affect, more positive social relationships, and higher levels of self-acceptance, autonomy, personal growth, and environmental mastery than those with low-stable scores. Increased persistence in goal striving (primary control) was linked to greater personal growth and environmental mastery, whereas increasing or high-stable positive reappraisals (secondary control) were associated with better affect. This study illustrates the pivotal influence of psychological resources in maintaining multiple dimensions of caregiver well-being.
With regard to care-related positive outcomes, caregiving gains (i.e., perceived rewards or uplifts from caregiving) have been found to mitigate caregiving stress. Finding meaning in the care role, for instance, partially mediates the association between caregiver burden and mental health among spouses caring for a partner with dementia (McLennon et al. 2011). Likewise, among family caregivers of older adults with Alzheimer’s disease (See “Alzheimer’s Disease”), positive aspects of caregiving mediate how care recipient depression is linked to caregiver reports of burden, anxiety, and depression (Wang et al. 2018). These findings highlight the importance of targeting caregiving gains in interventions to prevent or reduce care-related stress.
Relatively few interventions target positive aspects of caregiving, yet this may be a key strategy to promote caregiver resilience (Fortinsky et al. 2013; Marino et al. 2017). Cheng et al. (2017), for example, developed a benefit-finding intervention to restructure negative appraisals and identify caregiving gains among people caring for an individual with Alzheimer’s disease. In a double-blind home-based randomized controlled trial, caregivers who received the benefit-finding intervention showed gains including significant reductions in depressive symptoms relative to caregivers receiving standard or simplified (lectures only) psychoeducation. These gains were primarily the result of increased self-efficacy in controlling upsetting thoughts. Inclusion criteria for these trials required at least mild depressive symptoms (scoring ≥3 on the Hamilton Depression Rating Scale; See “Hamilton Rating Scale for Depression”) to ensure that improvements in caregiver distress were possible.
Placement of the Care Recipient as an Outcome
Placement of the care recipient is sometimes used as an outcome in caregiving studies in order to identify factors associated with placement and to examine whether interventions can delay placement. Supporting caregivers to help keep disabled older persons at home is of considerable importance (See “Aging in Place: Maintaining Quality of Life for Older Persons at Home” and “Home and Community-Based Services (HCBS)”). Most people prefer to live in their own home. Furthermore, the cost of nursing home care places considerable strain on families and society (See “Aged-Care Homes”). Interventions with caregivers to delay placement have generally been ineffective (e.g., Fox et al. 2000). One reason is that many of these interventions have not presented delay of placement as a goal, and so it may be that at least some caregivers in those studies did not share that goal. Bolstering this point, there is evidence that some caregivers use services as a way of transitioning care from home to institution (Zarit et al. 1999).
One exception is the New York University Caregiver intervention (NYUCI), which reported a significant delay in institutional placement among spousal caregivers in the treatment condition by over a year compared to a control group (Mittelman et al. 2006). An adaptation of the NYUCI that served offspring of the person with dementia had similar effects (Gaugler et al. 2013). In another study of placement, wives using adult day care placed their husbands sooner than a control group not using adult day care, but daughters who used adult day care kept parents at home longer than daughters in the control group (Cho et al. 2009).
Examples of Application
Depression and Health of Caregivers
In contrast to the vast majority of caregiver interventions that assume all caregivers are vulnerable to depression or health risks, interventions could instead focus on caregivers who are experiencing or at risk for these problems. Indicated prevention approaches for caregivers with some symptoms but no disease or disorder may be especially beneficial. In a study of 725 caregivers of a person with dementia across an 18-month period, for instance, higher initial depressive symptoms and worse self-rated health were the strongest risk factors for depression (Joling et al. 2012). Pinpointing characteristics of the caregiver and care situation that confer heightened susceptibility to mental and physical health conditions will help allocate limited resources toward caregivers in greatest need.
Furthermore, studies that focus on at-risk caregivers can consider mediating and moderating processes that explain long-term changes in outcomes of interest. In a study of caregivers of older adults with Alzheimer’s disease, self-efficacy for controlling upsetting thoughts was found to partially mediate the association between caregiver burden and depression over the course of a year (Grano et al. 2017). This finding suggests that training caregivers in the successful management of negative appraisals may protect them from harmful mental health consequences. Potential mediators of treatment effects elucidate the pathways through which interventions may be effective, allowing researchers to identify key components. Likewise, moderation analyses may identify individuals who respond best to a given intervention.
It is also important to consider that caregivers who are not experiencing depressive symptoms, burden, or poor health have frequently sought out interventions. Studies are needed that examine what these caregivers are seeking and to develop approaches that address their concerns. One such concern is being prepared for the problems that they will face in the future. The outcomes of this type of preventive approach could be learning skills, finding a balance of caregiving and other activities, and gaining a sense of efficacy in managing daily challenges. Over the long run, this type of approach could lead to lower occurrence of emotional distress or health problems, but the primary outcome would be gaining the skills and confidence for handling problematic situations.
Outcomes for Both Caregivers and Care Receivers
Caregiving involves a dyadic relationship in which the caregiver and care receiver shape one another’s emotions and behaviors (Moon and Adams 2013). Hence, caregiving interventions should ideally evaluate outcomes among both caregivers and care recipients. Illustrating this point, Perlick et al. (2010) found that family-focused treatment for caregivers of patients with bipolar disorder benefitted both members of the care dyad. Caregivers were instructed in self-care strategies and ways to help the patient manage his or her illness. Relative to standard health education, caregiver randomization to family-focused treatment was linked to greater decreases in depressive symptoms for caregivers and patients at post-treatment. Of note, reductions in patients’ depressive symptoms were mediated by concurrent reductions in caregivers’ depressive symptoms. These findings underscore the interdependence within caregiving dyads and demonstrate the value of considering each care partner’s outcomes.
Other interventions aim to treat caregivers and care recipients together as a unit. Dyadic interventions for medical or psychiatric conditions have generally been effective in improving the psychological well-being, coping skills, and perceived relationship quality of one or both care dyad members (e.g., Baucom et al. 2014; Moon and Adams 2013). Whitlatch et al. (2017) developed and evaluated a six-session dyadic intervention for persons with early stage dementia and their family caregivers. Caregiver-care recipient dyads were randomly assigned either to the treatment condition (called SHARE) or to a control condition. The intervention focused on discussions of future care that led to creation of a care plan that reflected the values and preferences of each care partner (See “The Role of Caregivers in Older Adults’ Future Care Plans”). Dyads in the control group participated in educational sessions about dementia. Findings indicated that nearly all dyads enrolled in SHARE were able to create a care plan. Caregivers in SHARE reported implementing portions of the plan, using more services for themselves and the care recipient (e.g., respite, support groups) compared to the control group. Furthermore, caregivers in the treatment condition reported decreases in emotional disruption behaviors when interacting with the care recipient (e.g., withholding emotions to keep him or her from worrying), whereas control group reported increases in these behaviors. Caregivers in SHARE also had higher treatment satisfaction than did control group participants. This study reveals that brief dyadic interventions show strong potential for enhancing outcomes among caregivers and care recipients in the early stages of illness.
Future Directions for Research
Shaping caregiver research and outcomes toward individualized goals and away from a “one size fits all” view may have enduring advantages. Given the diversity among caregivers and care situations, it is important to determine more about what individuals need and want from care-related services and interventions. Individualized goals should be considered within the backdrop of unique stressors and resources involving caregivers, care receivers, and the wider system of relatives and nonrelatives who do or do not provide care. Identifying individual goals along with personal and situational factors that support or hinder their realization would inform personalized treatment that potentially offers a lasting positive impact on caregiving experiences.
Another critical area for future work is the design of interventions to support family caregivers who perform medical care tasks. Medical/nursing tasks such as keeping track of medications, giving injections, managing peripheral intravenous lines, and caring for wounds or bed sores are common but require specialized skills in which many caregivers lack training (Mollica et al. 2017). These tasks can be stressful, time consuming, and long term, potentially leading to caregiver distress. Notably, a national survey sponsored by the United Hospital Fund and American Association of Retired Persons (AARP) revealed that almost one-third (32%) of family caregivers engaged in medical/nursing care believe they need to constantly monitor for complications, and their worries increase with a higher number of these care tasks (Reinhard et al. 2012).
Despite the potential challenges of medical/nursing tasks, caregivers providing this care have been found to report higher caregiving gains which include enhanced closeness with the care recipient and learning new skills (Polenick et al. 2017). Training in the safe and proper delivery of medical/nursing care may help to alleviate stress and maximize positive caregiving outcomes. In a study of 641 informal cancer caregivers, those who did not receive training in the provision of medical/nursing tasks reported greater burden, and this association was partially mediated by lower confidence in caring for the care recipient’s physical needs (Mollica et al. 2017). This study demonstrates the value of targeting both positive and negative outcomes to improve the well-being of caregivers who provide complex medical caregiving.
Lastly, developing strategies to promote self-care among caregivers is a promising direction for research. Caregivers often report difficulty in caring for their own health needs. Self-care encompasses a range of behaviors that sustain health, psychological well-being, and the ability to provide quality care. This includes maintaining healthy habits (e.g., physical activity), minimizing health risks (e.g., alcohol use), effectively managing one’s own chronic conditions (e.g., medication adherence), and participating in noncare activities that are enjoyable and personally meaningful (e.g., spending time on hobbies).
Prior work indicates that targeting aspects of caregiver self-care may be broadly beneficial (Perlick et al. 2010). A descriptive systematic review of 14 studies evaluating caregiver physical activity interventions showed, for instance, that these strategies reduced distress and improved outcomes including physical activity levels, psychological well-being, sleep quality, and self-efficacy related to caregiving and exercise (Lambert et al. 2016). Similarly, Moore et al. (2013) evaluated a 6-week behavioral activation intervention designed to lower depressive symptoms and cardiovascular disease risk factors among dementia family caregivers by increasing engagement in enjoyable leisure activities. Compared with caregivers in an Information-Support control condition, those randomized to the intervention had greater reductions in negative affect, depressive symptoms, and interleukin-6. There were no group differences from baseline to 1-year follow-up, however, suggesting that booster sessions may be needed to maintain treatment effects. It will also be important to identify caregivers who are most likely to benefit from behavior change strategies.
Caregiving research has generally focused on a limited range of outcomes. Studies in the future should target outcomes that capture a fuller spectrum of positive and negative experiences that are central to caregivers’ daily lives. Gaining knowledge of caregivers, care recipients, and situational factors to inform tailored interventions would facilitate person-centered care that accounts for individual goals, strengths, and vulnerabilities. With rapid population aging, family caregivers will play an increasingly vital part in the long-term care of older adults with chronic conditions and functional disability. A more nuanced understanding of how and under what circumstances interventions are effective in managing care-related concerns and promoting gains among caregivers is needed to preserve their optimal health, well-being, and quality of life.
Courtney A. Polenick was supported by grant K01AG059829 from the National Institute on Aging.
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