The American Journal of Interdisciplinary Innovations
and Research
51
https://www.theamericanjournals.com/index.php/tajiir
TYPE
Original Research
PAGE NO.
51-59
10.37547/tajiir/Volume07Issue01-06
OPEN ACCESS
SUBMITED
22 October 2024
ACCEPTED
24 December 2024
PUBLISHED
25 January 2025
VOLUME
Vol.07 Issue01 2025
CITATION
Onomuighokpo, O. H., Obohwemu, K. O., Ochei Oboratare, Ejiroghene,
U. C. ., Ogheneruona, O. K. ., Onyeogo , I. D., Omofuoma , D., &
Omokiti, D. (2025). Weak Correlations and Strong Implications: Patient
Age, Functional Status, and Caregiver Burden. The American Journal of
Interdisciplinary Innovations and Research, 7(01), 51
–
59.
https://doi.org/10.37547/tajiir/Volume07Issue01-06
COPYRIGHT
© 2025 Original content from this work may be used under the
terms of the creative commons attributes 4.0 License.
Weak Correlations and
Strong Implications:
Patient Age, Functional
Status, and Caregiver
Burden
Onomuighokpo Hillary Onome, MBBS
Department of Orthopaedics & Trauma Federal Medical Centre,
Asaba, Delta State, Nigeria
Obohwemu Oberhiri Kennedy, PhD
Department of Health, Wellbeing & Social Care, Global Banking
School/Oxford Brookes University, Birmingham, United Kingdom;
and PENKUP Research Institute, Birmingham, United Kingdom
Ochei Oboratare, FWACP
Department of Community Medicine Delta State University Teaching
Hospital (DELSUTH) Oghara, Delta State, Nigeria
Ucho Clitt Ejiroghene, MSC
Department of Community Medicine Delta State University Teaching
Hospital (DELSUTH) Oghara, Delta State, Nigeria
Onodua Kindness Ogheneruona, MBBS
Department of Surgery [Ear, Nose & Throat (ENT)] Federal Medical
Centre, Asaba, Delta State, Nigeria
Onyeogo Deborah Isioma, MBBS
Department of Internal Medicine (Nephrology) Delta State
University Teaching Hospital (DELSUTH) Oghara, Delta State, Nigeria
Omofuoma Daniel, MBBS
Department of Internal Medicine Federal Medical Centre, Owo,
Ondo State, Nigeria
Omokiti Diane, MBBS
Department of Surgery Federal Medical Centre, Asaba, Delta State,
Nigeria
Corresponding Author: Obohwemu Kennedy
Oberhiri, PhD
The American Journal of Interdisciplinary Innovations
and Research
52
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
ABSTRACT:
Background: Family caregivers often face
significant
physical,
emotional,
and
financial
challenges when caring for surgical patients. Caregiver
burden, a critical aspect of healthcare, is influenced by
various patient-related factors, including age,
functional capacity, and illness severity. This study
examines the relationships between caregiver burden,
assessed using the Zarit Burden Index (ZBI), and patient
characteristics among surgical patients in Delta State,
Nigeria, with a focus on practical implications for
caregiving strategies.
Methodology: The study utilized a cross-sectional
design involving caregivers of surgical patients at two
hospitals in Delta State, Nigeria. Data were collected
through interviewer-administered questionnaires.
Caregiver burden was evaluated using the ZBI,
functional status was measured with the Palliative
Performance Scale (PPS), and illness severity was
categorized as mild, moderate, or severe.
Results: Weak correlations were observed between
caregiver burden and patient age (r = 0.218, p = 0.01)
as well as functional status (r = -0.347, p = 0.01).
However, illness severity showed a strong association
with caregiver burden (p < 0.0001), with caregivers of
patients with severe conditions or low functional
capacity experiencing the greatest burden.
Conclusion: Although some correlations are modest,
the findings emphasize the need for targeted
caregiving strategies. Interventions such as caregiver
education, emotional support, and financial assistance
are essential to mitigate the burdens faced by those
caring for elderly or severely ill patients.
INTRODUCTION:
Family caregivers play a crucial role in supporting
surgical patients, often facing considerable physical,
emotional, and financial challenges. These challenges
are closely linked to various patient-related factors,
such as age, functional status, and the severity of the
illness (Çıtlık et al., 2014; Güner et al., 2021). The role
of family caregivers is indispensable in the healthcare
system, particularly in the context of surgical patients
who require extensive postoperative care. The
multifaceted responsibilities of caregivers encompass
a wide range of activities, including providing
emotional support, assisting with daily living activities,
and managing medical tasks. These responsibilities can
be overwhelming, leading to significant caregiver
burden.
Functional status, evaluated through instruments like
the Palliative Performance Scale (PPS), gauges a
patient's capacity to engage in daily activities and
influences the intensity of caregiving required (Winn,
2023; Mirzaei et al., 2024; Moreno-Alonso et al., 2024).
The PPS is a widely used tool that provides a
comprehensive assessment of a patient's functional
abilities, which is critical in determining the level of
care needed. Studies have shown that patients with
lower functional status require more intensive
caregiving, which can increase the physical and
emotional strain on caregivers (Gallagher et al., 2018;
Andrade et al., 2021; Milton et al., 2022). Additionally,
advanced age and severe health conditions typically
heighten caregiver demands due to the presence of
comorbidities, diminished independence, and the
necessity for intricate care (Gallagher et al., 2018;
Reynolds et al., 2022; Culberson et al., 2023).
The relationship between caregiver burden and
patient-related factors has been extensively studied.
Reinhard et al. (2008) found that caregiver burden is
significantly associated with the patient's functional
status, age, and severity of ill
ness. Similarly, Çıtlık et al.
(2014) reported that caregivers of patients with severe
health conditions experience higher levels of stress
and emotional exhaustion. Güner et al. (2021) further
highlighted the financial challenges faced by
caregivers, noting that the cost of medical care and the
loss of income due to caregiving responsibilities can
exacerbate financial strain.
Although prior research has examined these dynamics,
the often-weak correlations can obscure the practical
implications of the findings. For instance, while some
studies have found significant associations between
caregiver burden and patient-related factors, others
have reported only modest correlations. This
inconsistency in findings suggests that other variables,
such as social support and coping mechanisms, may
also play a crucial role in influencing caregiver burden.
Therefore, it is essential to consider a holistic approach
when examining the factors contributing to caregiver
burden.
This study seeks to investigate the relationships
between caregiver burden, patient age, functional
status, and illness severity, with a particular emphasis
on their significance for caregiving strategies in
Nigeria. Nigeria presents a unique context for this
study due to its diverse cultural and socioeconomic
landscape. The healthcare system in Nigeria faces
numerous challenges, including limited access to
healthcare
services,
inadequate
healthcare
infrastructure, and a high burden of disease (Amedari
& Ejidike, 2021; Abah, 2022; Aregbeshola & Folayan,
2022). These challenges can exacerbate the difficulties
faced by caregivers, making it essential to develop
effective caregiving strategies tailored to the Nigerian
The American Journal of Interdisciplinary Innovations
and Research
53
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
context.
In Nigeria, family caregivers play a vital role in
supporting surgical patients, often facing significant
physical, emotional, and financial challenges. The
relationship between caregiver burden and patient-
related factors, such as age, functional status, and
illness severity, is complex and multifaceted. This study
aims to provide a deeper understanding of these
relationships and their implications for caregiving
strategies in Nigeria. By addressing the unique
challenges faced by caregivers in Nigeria, this research
can contribute to the development of targeted
interventions that alleviate caregiver burden and
improve patient outcomes.
METHODOLOGY
Study Design
This study employed a cross-sectional design to
explore the relationships between caregiver burden
and patient-related factors among surgical patients in
Delta State, Nigeria. The research was conducted in
two prominent hospitals: a tertiary teaching hospital
and a central hospital, both of which serve as major
referral Centres in the region. This design was chosen
for its suitability in identifying associations between
variables at a specific point in time, allowing for a
comprehensive understanding of caregiver burden in
the context of surgical care.
Participants
The study population comprised 469 family caregivers
of surgical patients receiving care at the selected
hospitals. Inclusion criteria required participants to be
primary caregivers, defined as those who provided the
majority of the patient's care, and who had been
actively involved in caregiving for at least one month
prior to data collection. Caregivers were excluded if
they were under 18 years of age, unable to provide
informed consent, or had pre-existing conditions that
could independently contribute to stress or burden.
This sampling strategy ensured a representative cohort
of caregivers directly impacted by the demands of
surgical patient care.
Caregiver burden was assessed using the Zarit Burden
Interview (ZBI), a widely validated 22-item tool
designed to measure the physical, emotional, and
financial strain experienced by caregivers (Zarit et al.,
1980). The ZBI's comprehensive structure, which
employs a Likert scale ranging from 0 (never) to 4
(nearly always), has been extensively utilized in
caregiver research due to its reliability and validity
across diverse settings. Functional status of the
patients was evaluated using the Palliative
Performance Scale (PPS), a tool designed to assess
patient
independence
across
five
domains:
ambulation, activity and evidence of disease, self-care,
intake, and consciousness level (Victoria Hospice
Society, 1996). This scale has proven effective in
clinical and research contexts for categorizing
functional impairment and predicting care needs.
Illness severity was classified as mild, moderate, or
severe based on clinical records, utilizing diagnostic
data, laboratory findings, and physician assessments.
Data Collection and Analysis
Data were collected through interviewer-administered
structured questionnaires, ensuring uniformity in data
acquisition and minimizing potential biases associated
with self-reporting. The questionnaires included items
derived from the ZBI and PPS, alongside demographic
and clinical variables. All data collectors were trained
to standardize the interview process, ensuring
consistency across the two study sites.
Statistical analysis was conducted using Pears
on’s
correlation coefficient to determine the relationships
between caregiver burden, patient age, and functional
status (PPS). The choice of Pearson’s correlation was
guided by its suitability for assessing linear
relationships between continuous variables. To
evaluate the association between illness severity and
caregiver burden, Analysis of Variance (ANOVA) was
performed, as it effectively compares mean
differences across multiple groups. A p-value threshold
of less than 0.05 was established as the criterion for
statistical significance. All statistical analyses were
performed using SPSS software (Version 25), ensuring
robust data handling and interpretation.
This methodology aligns with established practices in
caregiver burden research, offering a rigorous
framework for analyzing the interplay between patient
characteristics and caregiver experiences. By
employing validated instruments and appropriate
statistical tools, the study provides a reliable basis for
understanding the multifaceted challenges faced by
family caregivers in surgical settings.
RESULTS
The analysis of caregiver burden in relation to patient-
specific
factors
revealed
several
noteworthy
correlations, emphasizing the multifaceted nature of
the caregiving experience. The relationships between
patient age, functional status, and illness severity with
caregiver burden were examined using validated tools
and statistical methods, providing insights into the
dynamics of caregiving demands (Table 1).
The American Journal of Interdisciplinary Innovations
and Research
54
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
Table 1: Correlation Between Patient Variables and Zarit Burden Index (ZBI)
Patient Variable
Frequency
(n=469)
Mean ZBI (±SD)
p-value
Gender
0.27
Male
205
25.53 ± 15.41
Female
264
28.75 ± 15.71
Level of Education
0.308
No Formal Education
23
24.09 ± 20.2
Primary
66
24.97 ± 13.8
Secondary
138
28.72 ± 12.8
Tertiary
242
27.51 ± 17.0
Presence of
Comorbidity
<0.0001
Yes
282
30.79 ± 16.2
No
187
25.06 ± 14.9
Severity of Illness
<0.0001
Mild
19
8.42 ± 5.9
Moderate
236
23.20 ± 13.2
Severe
214
33.58 ± 15.8
Type of Surgery
<0.0001
Minor
37
18.00 ± 13.8
Intermediate
260
24.28 ± 14.5
Major
172
33.97 ± 15.3
Regarding patient age, a weak positive correlation was observed between patient age and the burden experienced
by caregivers (r = 0.218, p = 0.01) (Fig. 1). Caregivers tending to younger patients, particularly those under 18
years, reported lower levels of burden compared to those providing care for elderly patients aged 60 years and
above. The higher burden associated with elderly patients is likely attributable to age-related health challenges,
including reduced mobility, increased susceptibility to comorbidities, and the need for greater assistance with
daily living activities. These findings are consistent with previous research, such as Khosravi et al. (2016), which
demonstrated that aging patients often require more comprehensive support, thereby increasing the demands
placed on their caregivers. This relationship underscores the importance of targeted interventions for caregivers
of older adults, who may face unique physical and emotional challenges.
The American Journal of Interdisciplinary Innovations
and Research
55
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
Figure 1: Correlation Between Patient Age and Zarit Burden Index (ZBI)
The scatter plot shows the weak positive correlation between patient age and ZBI (r = 0.218, p = 0.01).
The functional status of patients, as measured by the Palliative Performance Scale (PPS), was inversely related to
caregiver burden, with a weak negative correlation identified (r = -0.347, p = 0.01) (Fig. 2). Lower PPS scores,
indicative of diminished independence in areas such as mobility, self-care, and cognitive function, were associated
with increased caregiver burden (Table 2). This finding aligns with previous studies, such as those by Glajchen
(2012) and Xiao et al. (2020), which highlighted the significant physical and emotional toll exerted on caregivers
by patients with reduced functional capabilities. The increased demands in caregiving for patients with lower
functional status often involve complex medical care, assistance with basic daily activities, and heightened
vigilance, all of which contribute to elevated levels of burden. These results underscore the critical need for
support systems that address the practical and emotional needs of caregivers managing patients with impaired
functional status.
Figure 2: Correlation Between Palliative Performance Scale (PPS) and Caregiver Burden (ZBI)
The scatter plot illustrates the weak negative correlation (r = -0.347, p = 0.01).
Table 2: Palliative Performance Score (PPS) of Patients
Score (%)
Frequency (n=200)
Percent (%)
10
2
0.4
20
6
1.3
30
15
3.2
40
20
4.3
50
35
7.5
60
85
18.1
70
111
23.7
80
91
19.4
90
99
21.1
100
5
1.1
Illness severity emerged as the most significant factor influencing caregiver burden. A strong association was
observed between the severity of the patient's condition and caregiver burden (p < 0.0001). Caregivers of patients
classified as having severe illnesses reported the highest mean Zarit Burden Index (ZBI) scores (33.58 ± 15.8),
followed by caregivers of patients with moderate (23.20 ± 13.2) and mild illnesses (8.42 ± 5.9) (Fig. 3). These
findings are in alignment with Mercer et al. (2012), who noted that severe illnesses often necessitate intensive
medical and personal care, leading to considerable physical, emotional, and financial strain on caregivers. The
escalating burden associated with increased illness severity underscores the pressing need for targeted
The American Journal of Interdisciplinary Innovations
and Research
56
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
interventions, including specialized training for caregivers, financial assistance programs, and access to respite
care, to mitigate the stressors inherent in such caregiving scenarios.
Figure 3: Distribution of ZBI Scores Across Illness Severity
The bar chart shows the highest burden for caregivers
of severely ill patients.
These results thus highlight the complex interplay
between patient characteristics and caregiver burden.
The findings emphasize the necessity of tailoring
interventions to address the specific needs of
caregivers, particularly those managing elderly
patients, individuals with significant functional
impairments, or those with severe illnesses. By
identifying the primary drivers of caregiver burden,
healthcare systems can better allocate resources and
design support mechanisms to improve the well-being
of both caregivers and patients.
DISCUSSION
The findings of this study contribute to the growing
div of literature examining the complex dynamics of
caregiver burden in the context of surgical patients.
Although the correlations between patient-specific
factors and caregiver burden were statistically modest,
the results offer critical insights into the experiences of
caregivers and highlight the need for targeted
interventions to address the challenges they face.
The relationship between patient age and caregiver
burden, although weak, revealed that caregivers of
older patients reported higher scores on the Zarit
Burden Interview (ZBI). This trend aligns with existing
literature, which has consistently shown that elderly
patients, often dealing with multiple comorbidities and
significant mobility limitations, place substantial
physical, emotional, and financial demands on their
caregivers (Khosravi et al., 2016; Gallagher et al., 2018;
Reinhard et al., 2008). These findings underscore the
necessity of providing tailored support to caregivers of
older patients. Interventions such as respite care,
which offers temporary relief from caregiving
responsibilities, and training in physical assistance
techniques can reduce the physical strain and injury
risks associated with caregiving (Glajchen, 2012;
Mercer et al., 2012; Kaminishi et al., 2024).
Additionally, counselling services can help caregivers
manage stress and anxiety, enhancing their overall
well-being and ability to continue providing care
(Khosravi et al., 2016; Gallagher et al., 2018; Bayly et
al., 2021).
The weak negative correlation between the Palliative
Performance Scale (PPS) and caregiver burden reflects
the increased strain experienced by caregivers when
patients have significant functional impairments.
Patients with low PPS scores frequently require
extensive assistance with daily living activities, such as
bathing, feeding, and mobility, which can lead to
physical exhaustion and emotional burnout among
caregivers (Reinhard et al., 2008; Glajchen, 2012; Reis
& Jesus, 2022). The findings suggest a need for
strategically designed interventions to ease the
caregiving burden. Assistive technologies, such as
wheelchairs and lifting devices, can facilitate
caregiving tasks, reducing the physical effort required
(Mercer et al., 2012; Gallagher et al., 2018; Choi,
Patterson & Chinho, 2024). Educational programs
tailored for caregivers of dependent patients can
improve caregiving skills and promote confidence in
managing complex care needs (Glajchen, 2012; Cui et
The American Journal of Interdisciplinary Innovations
and Research
57
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
al., 2014; Gemito et al., 2024). Furthermore, the
integration of professional home care services can
distribute caregiving responsibilities more evenly,
thereby mitigating caregiver burnout (Reinhard et al.,
2008; Gallagher et al., 2018; Pérez et al., 2022).
Illness severity emerged as the most significant factor
associated with caregiver burden, with caregivers of
patients with severe illnesses reporting the highest ZBI
scores. This finding corroborates previous studies
indicating that the management of complex medical
conditions requires not only technical expertise but
also significant emotional resilience (Mercer et al.,
2012; Gallagher et al., 2018; Reinhard et al., 2008). The
heightened demands placed on caregivers in such
scenarios necessitate robust support systems.
Specialized training programs focused on managing
advanced care needs, financial assistance to address
income loss and caregiving expenses, and access to
mental health resources are critical components of an
effective support framework for caregivers of severely
ill patients (Mercer et al., 2012; Gallagher et al., 2018;
Cui et al., 2014).
Although the statistical correlations observed in this
study were modest, they reveal important trends with
practical implications. Weak correlations do not
negate the tangible challenges faced by caregivers,
particularly those managing the care of elderly,
functionally impaired, or critically ill patients (Cui et al.,
2014; Gallagher et al., 2018; Reinhard et al., 2008).
These findings highlight the imperative for healthcare
systems to develop and implement comprehensive
strategies aimed at supporting caregivers. Such
strategies should include caregiver education, the
provision of financial assistance, and the establishment
of accessible mental health resources to improve
caregiving outcomes and enhance the quality of life for
both caregivers and patients (Glajchen, 2012; Mercer
et al., 2012; Cui et al., 2014). By addressing these
critical needs, healthcare systems can foster resilience
and sustainability within caregiving relationships,
ultimately benefiting all stakeholders involved
(Gallagher et al., 2018; Reinhard et al., 2008).
CONCLUSION
This investigation elucidates the complex dynamics
between caregiver burden and patient-related factors.
Despite the modest nature of the correlations, the
implications for caregiving strategies are considerable.
Customized interventions, such as caregiver education,
financial aid, and mental health support, have the
potential to reduce caregiver burden and enhance
outcomes. Future studies should concentrate on
assessing these interventions to optimize their
effectiveness.
The findings underscore the necessity for a
multifaceted
approach
to
caregiver
support,
recognizing that caregiver burden is influenced by a
constellation of factors including patient age,
functional status, and illness severity. Tailored
educational programs can equip caregivers with the
necessary skills and knowledge to manage complex
care needs, thereby reducing physical and emotional
strain. Financial aid programs can alleviate the
economic pressures associated with caregiving,
enabling caregivers to focus more on providing quality
care without the added stress of financial instability.
Moreover, access to mental health resources is crucial
in addressing the psychological toll of caregiving,
offering caregivers the support needed to maintain
their own well-being.
Future research should prioritize the evaluation of
these interventions through rigorous, longitudinal
studies to determine their long-term efficacy and
sustainability. Such studies should also explore the
potential for integrating technology-based solutions,
such as telehealth services and digital health
platforms, to provide continuous support and
resources for caregivers. Additionally, examining the
role of community-based support networks and their
impact on caregiver resilience could offer valuable
insights into creating more robust support systems.
Advancing our understanding of the interplay between
caregiver burden and patient-related factors, and
rigorously testing targeted interventions, can help
develop more effective strategies to support
caregivers. This approach will not only enhance the
quality of life for caregivers but also improve patient
outcomes, fostering a more resilient and sustainable
caregiving environment.
CONFLICTS OF INTEREST
The authors declare no conflicts of interest.
FUNDING
This research did not receive any specific grant from
funding agencies in the public, commercial, or not-for-
profit sectors.
ACKNOWLEDGEMNT
The authors would like to acknowledge the
management and technical staff of PENKUP Research
Institute, Birmingham, United Kingdom for their
excellent assistance and for providing manuscript
writing/editorial support in accordance with Good
Publication Practice (GPP3) guidelines.
REFERENCES
Abah, V.O., (2022). Poor health care access in Nigeria:
A function of fundamental misconceptions and
misconstruction of the health system. In Healthcare
The American Journal of Interdisciplinary Innovations
and Research
58
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
Access-New Threats, New Approaches. IntechOpen.
Amedari, M.I. and Ejidike, I.C., (2021). Improving
access, quality and efficiency in health care delivery in
Nigeria: a perspective. PAMJ-One Health, 5(3).
Andrade, J.J.D.C., Silva, A.C.O., Frazão, I.D.S., Perrelli,
J.G.A., Silva, T.T.D.M. and Cavalcanti, A.M.T.S., (2021).
Family functionality and burden of family caregivers of
users with mental disorders. Revista Brasileira de
Enfermagem, 74(05), p.e20201061.
Aregbeshola, B.S. and Folayan, M.O., (2022). Nigeria's
financing of health care during the COVID‐19
pandemic: Challenges and recommendations. World
Medical & Health Policy, 14(1), pp.195-204.
Bayly, M., Morgan, D., Elliot, V., Kosteniuk, J., Froehlich
Chow, A., Peacock, S. and O'Connell, M.E., (2021). Does
early-stage intervention improve caregiver well-being
or their ability to provide care to persons with mild
dementia or mild cognitive impairment? A systematic
review and meta-analysis. Psychology and Aging,
36(7), p.834.
Choi, U.Y., Patterson, P. and Chinho, N., (2024).
Reducing the Burdens of Paid Caregivers of Older
Adults by Using Assistive Technology: A Scoping
Review. Western Journal of Nursing Research, 46(4),
pp.315-326.
Cui, J., Fang, F., Shen, F., Song, L., Zhou, L., & Ma, X.
(2014). Caregiver burden and its influencing factors for
the disabled elderly in China. Archives of Gerontology
and Geriatrics, 58(1), 37-42.
Culberson, J.W., Kopel, J., Sehar, U. and Reddy, P.H.,
(2023). aaUrgent Needs of Caregiving in Ageing
Populations with Alzheimer’s Disease and Other
Chronic Conditions: Support Our Loved Ones. Ageing
Research Reviews, p.102001.
Gallagher, R., Luttik, M. L., & Jaarsma, T. (2018). Social
support and self-care in heart failure. Journal of
Cardiovascular Nursing, 33(2), 123-129.
Gemito, L., Alves, E., Moreira, J., Marques, M.F.,
Caldeira, E., Ferreira, R., Bico, I., Pinho, L., Fonseca, C.,
Sousa, L. and Lopes, M., (2024). Programmes
Addressed to Informal Caregivers’ Needs: A Syste
matic
Literature Review. Geriatrics, 9(3), p.71.
Glajchen, M. (2012). Physical well-being of oncology
caregivers: An important quality-of-life domain.
Seminars in Oncology Nursing, 28(4), 226-235.
Kaminishi, K.S., Morris, S., Garcia, R., Safavi, R. and
Hirsch, C.H., (2024). Caregiver Interventions in
Geriatric Psychiatry. In Geriatric Psychiatry: A Case-
Based Textbook (pp. 801-821). Cham: Springer
International Publishing.
Khosravi, B., Ghazanfari, Z., & Parsa, P. (2016). The
relationship between caregiver burden and quality of
life in caregivers of hemodialysis patients. Journal of
Nursing and Midwifery Sciences, 3(4), 44-50.
Mercer, S. W., Zhou, Y., Humphris, G. M.,
McConnachie, A., & Bikker, A. P. (2012).
Multimorbidity and the inverse care law in primary
care. BMJ, 344, e4152.
Milton, A., Schandl, A., Larsson, I.M., Wallin, E.,
Savilampi, J., Meijers, K., Joelsson‐Alm, E., Bottai, M.
and Sackey, P., (2022). Caregiver burden and
emotional wellbeing in informal caregivers to ICU
survivors
—
A
prospective
cohort
study.
Acta
Anaesthesiologica Scandinavica, 66(1), pp.94-102.
Mirzaei, M., Ahmadi, N., Bagheri Fahraji, B., Ardekani,
A.M., Rahimdel, A., Soltani, M.H., Ardekani, S.M.Y.,
Bidaki, R., Kasnavie, F.H., Dastjerdi, G. and Aboutorabi,
M., (2024). A randomized clinical trial evaluating
Hydralazine’s efficacy in early
-
stage Alzheimer’s
disease: The EHSAN Study. Scientific Reports, 14(1),
p.28837.
Moreno-Alonso, D., Julià-Torras, J., Majó Llopart, J.,
Serrano-Bermúdez, G., Duran Adán, A., Pergolizzi, D.,
Llorens-Torromé, S. and Trelis-Navarro, J., (2024). The
Catalan Institute of Oncology (ICO) Presents the ICO
Toolkit-2: An Updated, Spanish National Assessment
Kit for Patients with Malignant Neoplasm in Palliative
Care. Journal of Palliative Medicine.
Pérez, V., Menéndez-Crispín, E.J., Sarabia-Cobo, C., de
Lorena, P., Fernández-Rodríguez, A. and González-
Vaca, J., (2022). Mindfulness-based intervention for
the reduction of compassion fatigue and burnout in
nurse caregivers of institutionalized older persons with
dementia: a randomized controlled trial. International
Journal of Environmental Research and Public Health,
19(18), p.11441.
Reinhard, S. C., Given, B., Petlick, N. H., & Bemis, A.
(2008). Supporting family caregivers in providing care.
In R. G. Hughes (Ed.), Patient Safety and Quality: An
Evidence-Based Handbook for Nurses (pp. 341-404).
Agency for Healthcare Research and Quality (US).
Reis, K.M.C.D. and Jesus, C.A.C.D., (2021). Impaired
comfort at the end of life: An association with nursing
diagnosis and clinical variables. Texto & Contexto-
Enfermagem, 30, p.e20200105.
Reynolds 3rd, C.F., Jeste, D.V., Sachdev, P.S. and Blazer,
D.G., (2022). Mental health care for older adults:
recent advances and new directions in clinical practice
and research. World Psychiatry, 21(3), pp.336-363.
Winn, P., (2023). Integrating Palliative Care into Long-
Term Care. In Post-Acute and Long-Term Care
Medicine: A Guide for Practitioners (pp. 197-228).
Cham: Springer International Publishing.
The American Journal of Interdisciplinary Innovations
and Research
59
https://www.theamericanjournals.com/index.php/tajiir
The American Journal of Interdisciplinary Innovations and Research
Zarit, S. H., Reever, K. E., & Bach-Peterson, J. (1980).
Relatives of the impaired elderly: Correlates of feelings
of burden. The Gerontologist, 20(6), 649
–
655.
