Burden and Positive Aspects of Caregiving: A Cluster Analysis of Dementia Caregiving Experiences

Elizabeth Cousins-Whitus, Kent State University, Kent, United States
Karlee Patrick, Kent State University, Kent, United States
John Martin, Kent State University, Kent, United States
Jennifer Drost, Summa Health System, Akron, United States
Christopher Was, Kent State University, Kent, United States
Mary Beth Spitznagel, Kent State University, Kent, United States


Although burden commonly occurs in the context of dementia caregiving, the caregiving role is linked to beneficial outcomes as well. Individuals who report many positive aspects of caregiving tend to exhibit lower burden relative to those reporting few; positive aspects of caregiving and burden are thus often viewed as opposing constructs. The goal of this study was to demonstrate whether and how constructs of burden and positive aspects of caregiving coexist within the individual caregiver, and to explore potential contributors to caregiver profiles created based upon these constructs.

Participants and Methods:

Cluster analysis was conducted on 225 care recipient-caregiver dyads consecutively enrolled at an outpatient geriatric clinic and meeting inclusion criteria including diagnosis on the dementia spectrum and completed assessments from an informal caregiver. Measures included the Zarit Burden Interview (ZBI), Positive Aspects of Caregiving (PAC), Cohen Mansfield Agitation Inventory (CMAI), activities of daily living (I/ADLs), and global cognition (i.e., Mini Mental State Examination or Montreal Cognitive Assessment). Exploratory agglomerative hierarchical cluster analysis was conducted with ZBI and PAC using squared Euclidean distance and Ward’s linkage. Demographic factors and clinical characteristics were explored as potential predictors of cluster membership using multinomial logistic regression.


Results suggested a three-cluster solution: a High Burden group (high ZBI, low PAC), a High Positive Experiences group (high PAC, low ZBI), and a Low-Moderate Experiences group (low ZBI, moderate PAC). ANOVA of the three-cluster solution revealed a statistically significant difference in mean scores of PAC (F(2, 222)=[160.747], p<.001) and ZBI

(F(2, 222)=[137.658], p<.001) with large effect sizes of PAC (η2=.592) and ZBI (η2=.554). Each cluster differed significantly from the others on either the PAC or ZBI. Greater neuropsychiatric symptoms on the CMAI predicted belonging to the High Burden cluster (β=.089, 95% confidence interval: .051, .159, p <.001). Greater care recipient dependence in I/ADLs predicted belonging to the High Positive Experiences cluster, while greater independence predicted the Low-Moderate Experiences cluster (β=.089, 95% confidence interval: -.185, -.003, p=.039).


Findings suggest that burden and positive aspects of caregiving do not simultaneously present in caregivers at high levels. Supportive caregiver interventions might be tailored to profiles demonstrated here. Future research should investigate other potential contributors to experiences of burden and positive aspects of caregiving.

Category: Dementia (Alzheimer's Disease)

Keyword 1: caregiver burden
Keyword 2: activities of daily living
Keyword 3: dementia - Alzheimer's disease