Caregiver Burden: Looking Beyond the Unidimensional Total Score

Area of Science:

• Gerontology
• Psychology
• Public Health

Background:

• The Zarit Burden Interview (ZBI) is commonly used to assess caregiver burden.
• Recent research suggests a multidimensional (MD) ZBI model may offer more nuanced insights than the traditional unidimensional (UD) approach.
• Understanding the agreement and discrepancies between UD and MD classifications is crucial for accurate burden assessment.

Purpose of the Study:

• To determine the agreement between unidimensional (UD) and multidimensional (MD) classifications of caregiver burden using the Zarit Burden Interview.
• To identify differences in predictors associated with caregiver burden groups defined by UD versus MD models.
• To investigate the characteristics of caregivers whose burden classification differs between the UD and MD approaches.

Main Methods:

• Study included 165 dyads of dementia patients and primary caregivers.
• Caregivers were classified into low, intermediate, and high burden groups using both UD (quartile cutoffs) and MD (exploratory cluster analysis) ZBI scoring.
• Agreement between classifications was assessed using kappa statistics (κ), and predictive factors were analyzed using binary logistic regression.

Main Results:

• A moderate agreement (κ=0.72) was found between the UD and MD ZBI classification models.
• The analysis identified 104 low-burden, 41 high-burden, and 20 intermediate-burden caregivers (defined as UD 'low'/MD 'high').
• Neuropsychiatric symptoms, coresidence, and reduced caregiving hours predicted intermediate burden, while neuropsychiatric symptoms and adult children caregivers predicted high burden.

Conclusions:

• The unidimensional and multidimensional classifications of caregiver burden derived from the Zarit Burden Interview exhibit moderate agreement but also notable discrepancies.
• Specific factors like neuropsychiatric symptoms, living arrangements, and caregiver relationship influence burden differently depending on the classification model used.
• Further research is warranted to understand the clinical significance and unique predictors of the 'intermediate' burden group identified through incongruent classifications.