Decision fatigue and coping responses among primary caregivers of older adults with disabilities: A qualitative study

Primary caregivers of older adults with disabilities often coordinate repeated health-related and daily care decisions in long-term home-based care. Decision fatigue may represent a less visible dimension of caregiver burden, yet it remains poorly understood in this setting. Burden of Treatment Theory may provide a useful lens for understanding decision-making as part of caregivers' ongoing care-related work.

To explore the experiences, manifestations, and coping responses related to decision fatigue among primary caregivers of older adults with disabilities in China.

A descriptive qualitative study informed by a naturalistic paradigm.

Five communities in Xuzhou, China.

Fourteen primary caregivers of older adults with disabilities were purposively recruited.

Semi-structured interviews were conducted between November and December 2025. Data were analyzed using inductive thematic analysis. Burden of Treatment Theory was used as a sensitizing lens during interpretation, not as an a priori coding framework.

Four themes were identified: persistent and cascading care-related decision work; conditions increasing decision workload and constraining caregiver capacity; experiential and relational manifestations of decision fatigue; and coping responses to decision fatigue. Care-related decision work was recurrent, interconnected, and partly organized through experience-informed routines, which still required adjustment as care needs changed. Recurrent trade-offs, uncertainty, resource constraints, and insufficient sustained professional support made this work more difficult to manage. Decision fatigue was reflected in guilt, rumination, self-blame, and relational strain. Caregivers responded by delaying, simplifying, or delegating decisions and by seeking advice from informal and professional sources.

Among primary caregivers of older adults with disabilities, decision fatigue was experienced in the context of recurrent care-related decision demands and constrained caregiver capacity in long-term home-based care. These findings extend understanding of caregiver burden by drawing attention to decision work and may inform structured multidisciplinary decision support aimed at reducing decision workload and strengthening caregiver capacity.