Abstract
Background
With the increase in the aging population, informal caregivers have become an essential pillar for the long-term care of older individuals. However, providing care can have a negative impact and increase the burden on caregivers, which is a cause for concern.
Objective
This study aimed to comprehensively depict the concept of “informal caregiver burden” through bibliometric and content analyses.
Methods
We searched the Web of Science (WoS) database to obtain bibliometric data and included only papers published between 2013 and 2022. We used content analysis to extract and identify the core concepts within the text systematically.
Results
Altogether, 934 papers were included in the bibliometric analysis, from which we selected 19 highly impactful papers for content analysis. The results indicate that researchers have focused on exploring the factors that impact informal caregiver burden. Meanwhile, there has been a widespread discussion regarding the caregiver burden among those caring for recipients with specific illnesses, such as dementia, Alzheimer’s disease, and cancer, as these illnesses can contribute to varying levels of burden on informal caregivers. In addition, questionnaires and interviews emerged as the predominant methods for data collection in the realm of informal caregiver research. Furthermore, we identified 26 distinct assessment tools specifically tailored for evaluating burden, such as caregiver strain index (CSI).
Conclusion
For future studies, we suggest considering the intersectionality of factors contributing to the burden on informal caregivers. This approach could enhance the well-being of both caregivers and older care recipients.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40520-023-02582-w/MediaObjects/40520_2023_2582_Fig1_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40520-023-02582-w/MediaObjects/40520_2023_2582_Fig2_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs40520-023-02582-w/MediaObjects/40520_2023_2582_Fig3_HTML.png)
Similar content being viewed by others
Data availability
All data generated or analyzed during this study are included in this published paper.
References
Bloom DE et al (2011) Population aging: facts, challenges, and responses. Benefits Compens. Int 41:22
Harper S (2014) Economic and social implications of aging societies. Science 346:587–591
Greenwood N et al (2019) A qualitative study of older informal carers’ experiences and perceptions of their caring role. Maturitas 124:1–7
Carretero S et al (2009) The informal caregiver’s burden of dependent people: theory and empirical review. Arch Gerontol Geriatr 49:74–79
Weinberg DB et al (2007) Coordination between formal providers and informal caregivers. Health Care Manag Rev 32:140–149
Shah, A.J., Wadoo, O. and Latoo, J.J. (2010) Psychological distress in carers of people with mental disorders. Br J Med Pract, 3
Adelman RD et al (2014) Caregiver burden: a clinical review. JAMA 311:1052–1060
Ellegaard O, Wallin JA (2015) The bibliometric analysis of scholarly production: how great is the impact? Scientometrics 105:1809–1831
Akmal A, Greatbanks R, Foote J (2020) Lean thinking in healthcare—Findings from a systematic literature network and bibliometric analysis. Health Policy 124:615–627
Forman J, Damschroder L (2007) Qualitative content analysis. In: Forman J, Damschroder L (eds) Empirical methods for bioethics: a primer. Emerald Group Publishing Limited, Bingley, pp 39–62
Aria M, Cuccurullo C (2017) bibliometrix : an R-tool for comprehensive science mapping analysis. J Informet 11:959–975
Page MJ et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg 88:105906
Rogers G, Szomszor M, Adams J (2020) Sample size in bibliometric analysis. Scientometrics 125:777–794
Garfield E, Paris S, Stock WGJ (2006) HistCiteTM: a software tool for informetric analysis of citation linkage. Inf Wiss Prax 57:391
Duy J, Vaughan L (2006) Can electronic journal usage data replace citation data as a measure of journal use? An empirical examination. J Acad Librariansh 32:512–517
Chien S-C et al (2022) Alerts in clinical decision support systems (CDSS): a bibliometric review and content analysis. Healthcare 10:601. https://doi.org/10.3390/healthcare10040601
Donthu N et al (2021) How to conduct a bibliometric analysis: an overview and guidelines. J Bus Res 133:285–296
Stremersch S, Verniers I, Verhoef PC (2018) The quest for citations: drivers of article impact. J Mark 71:171–193
Linnenluecke MK, Marrone M, Singh AK (2019) Conducting systematic literature reviews and bibliometric analyses. Aust J Manag 45:175–194
Zhang J et al (2016) Comparing keywords plus of WOS and author keywords: a case study of patient adherence research. J Am Soc Inf Sci 67:967–972
Hong QN et al (2018) The mixed methods appraisal tool (MMAT) version 2018 for information professionals and researchers. Educ Inf 34:285–291
Hsieh HF, Shannon SE (2005) Three approaches to qualitative content analysis. Qual Health Res 15:1277–1288
Bank W (2021) Population ages 65 and above (% of total population)–Country Data. https://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS. Accessed 6 Mar 2023
Bastawrous M (2013) Caregiver burden–a critical discussion. Int J Nurs Stud 50:431–441
Hsu T et al (2014) Factors associated with high burden in caregivers of older adults with cancer. Cancer 120:2927–2935
Kang HS et al (2014) Factors associated with caregiver burden in patients with Alzheimer’s disease. Psychiatry Investig 11:152–159
Bleijlevens MH et al (2015) Changes in caregiver burden and health-related quality of life of informal caregivers of older people with Dementia: evidence from the European RightTimePlaceCare prospective cohort study. J Adv Nurs 71:1378–1391
Fauth EB, Gibbons A (2014) Which behavioral and psychological symptoms of dementia are the most problematic? Variability by prevalence, intensity, distress ratings, and associations with caregiver depressive symptoms. Int J Geriatr Psychiatry 29:263–271
Riffin C et al (2019) Multifactorial examination of caregiver burden in a national sample of family and unpaid caregivers. J Am Geriatr Soc 67:277–283
Iavarone A et al (2014) Caregiver burden and coping strategies in caregivers of patients with Alzheimer’s disease. Neuropsychiatr Dis Treat 10:1407–1413
Riffin C et al (2017) Family and other unpaid caregivers and older adults with and without dementia and disability. J Am Geriatr Soc 65:1821–1828
Del-Pino-Casado R et al (2018) Social support and subjective burden in caregivers of adults and older adults: a meta-analysis. PLoS ONE 13:e0189874
Reuben DB et al (2013) The University of California at Los Angeles Alzheimer’s and Dementia Care program for comprehensive, coordinated, patient-centered care: preliminary data. J Am Geriatr Soc 61:2214–2218
Harding R et al (2015) Comparative analysis of informal caregiver burden in advanced cancer, dementia, and acquired brain injury. J Pain Symptom Manag 50:445–452
Jennings LA et al (2015) Unmet needs of caregivers of individuals referred to a dementia care program. J Am Geriatr Soc 63:282–289
Shiba K, Kondo N, Kondo K (2016) Informal and formal social support and caregiver burden: the AGES caregiver survey. J Epidemiol 26:622–628
Dauphinot V et al (2016) Risk factors of caregiver burden evolution, for patients with subjective cognitive decline or neurocognitive disorders: a longitudinal analysis. J Am Med Dir Assoc 17:1037–1043
Denno MS et al (2013) Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Arch Phys Med Rehabil 94:1731–1736
del-Pino-Casado R et al (2014) Cultural correlates of burden in primary caregivers of older relatives: a cross-sectional study. J Nurs Scholarsh 46:176–186
Beach SR, Schulz R (2017) Family caregiver factors associated with unmet needs for care of older adults. J Am Geriatr Soc 65:560–566
Liu S et al (2017) Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer’s disease caregivers in China. J Clin Nurs 26:1291–1300
Orfila F et al (2018) Family caregiver mistreatment of the elderly: prevalence of risk and associated factors. BMC Public Health 18:167
Robinson BC (1983) Validation of a caregiver strain index. J Gerontol 38:344–348
Stull DE (1996) The multidimensional caregiver strain index (MCSI): its measurement and structure. J Clin Geropsychol 2:175–196
Novak M, Guest C (1989) Application of a multidimensional caregiver burden inventory. Gerontologist 29:798–803
Zarit SH, Anthony CR, Boutselis M (1987) Interventions with care givers of dementia patients: comparison of two approaches. Psychol Aging 2:225–232
Regueiro Martinez AA et al (2007) Short Zarit interview on burden of care for caregivers in primary care. Aten Primaria 39:185–188
Bakas T, Burgener SC (2002) Predictors of emotional distress, general health, and caregiving outcomes in family caregivers of stroke survivors. Top Stroke Rehabil 9:34–45
Bakas T et al (2006) Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale. Nurs Res 55:346–355
Matsuda O (1999) Reliability and validity of the subjective burden scale in family caregivers of elderly relatives with dementia. Int Psychogeriatr 11:159–170
Kaufer DI et al (1998) Assessing the impact of neuropsychiatric symptoms in Alzheimer’s disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc 46:210–215
Tarlow BJ et al (2016) Positive aspects of caregiving. Res Aging 26:429–453
Markowitz JS et al (2003) Health-related quality of life for caregivers of patients with Alzheimer disease. Alzheimer Dis Assoc Disord 17:209–214
Spielberger C, Gorsuch R, Lushene R, Vagg P, Jacobs G (1983) Manual for the state-trait anxiety inventory. Consulting Psychologists Press, Palo Alto
Donker T et al (2011) Quick and easy self-rating of Generalized anxiety disorder: validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Res 188:58–64
Garcia-Campayo J et al (2010) Cultural adaptation into Spanish of the generalized anxiety disorder-7 (GAD-7) scale as a screening tool. Health Qual Life Outcomes 8:8
Yesavage JA (1988) Geriatric depression scale. Psychopharmacol Bull 24:709–711
Montón C et al (1993) Anxiety scales and Goldberg’s depression: an efficient interview guide for the detection of psychologic distress. Aten Primaria 12:345–349
Kroenke K, Spitzer RL, Williams JB (2003) The patient health questionnaire-2: validity of a two-item depression screener. Med Care 41:1284–1292
Kroenke K, Spitzer RL (2002) The PHQ-9: a new depression diagnostic and severity measure. Psychiatr Ann 32:509–515
Endler NS, Parker JD (1990) Multidimensional assessment of coping: a critical evaluation. J Pers Soc Psychol 58:844–854
Buysse DJ et al (1989) The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213
Broadhead WE et al (1988) The Duke-UNC functional social support questionnaire. Measurement of social support in family medicine patients. Med Care 26:709–723
Given CW et al (1992) The caregiver reaction assessment (CRA) for caregivers to persons with chronic physical and mental impairments. Res Nurs Health 15:271–283
Reis M, Nahmiash D (2010) Validation of the caregiver abuse screen (CASE). Can J Aging La Revue Can Vieillissement 14:45–60
Bieber A et al (2019) Influences on the access to and use of formal community care by people with dementia and their informal caregivers: a scoping review. BMC Health Serv Res 19:88
Thana K et al (2021) Informal caregiver burden for solid tumour cancer patients: a review and future directions. Psychol Health 36:1514–1535
Chiao CY, Wu HS, Hsiao CY (2015) Caregiver burden for informal caregivers of patients with dementia: a systematic review. Int Nurs Rev 62:340–350
Mosley PE, Moodie R, Dissanayaka N (2017) Caregiver burden in parkinson disease: a critical review of recent literature. J Geriatr Psychiatry Neurol 30:235–252
Kayaalp A, Page KJ, Rospenda KM (2021) Caregiver burden, work-family conflict, family-work conflict, and mental health of caregivers: a mediational longitudinal study. Work Stress 35:217–240
Gibson A et al (2019) Providing care for persons with dementia in rural communities: informal caregivers’ perceptions of supports and services. J Gerontol Soc Work 62:630–648
Gardiner C et al (2020) Equity and the financial costs of informal caregiving in palliative care: a critical debate. BMC Palliat Care 19:71
Haikio K, Cloutier D, Rugkasa J (2020) Is health literacy of family carers associated with carer burden, quality of life, and time spent on informal care for older persons living with dementia? PLoS ONE 15:e0241982
Scheper I et al (2021) Prevention is better than cure: effects of errors on memory performance during spatial learning in healthy aging. Aging Clin Exp Res 33:997–1003
Flanagan D et al (2012) Managing undernutrition in the elderly: prevention is better than cure. Aust Fam Physician 41:695–699
Engel L et al (2022) Providing informal care to a person living with dementia: the experiences of informal carers in Australia. Arch Gerontol Geriatr 102:104742
Ryan GW, Bernard HRJHOQR (2000) Data management and analysis methods. Handbk Qual Res 2:769–802
Burcu AJHUJE (2000) A comparison of two data collecting methods: interviews and questionnaires. Hacettepe Univ J Educ 18:1–10
Krutter S et al (2020) Comparing perspectives of family caregivers and healthcare professionals regarding caregiver burden in dementia care: results of a mixed methods study in a rural setting. Age Ageing 49:199–207
Rodriguez-Gonzalez AM, Rodriguez-Miguez E, Claveria A (2021) Determinants of caregiving burden among informal caregivers of adult care recipients with chronic illness. J Clin Nurs 30:1335–1346
Hengelaar AH et al (2023) Intersectionality in informal care research: a scoping review. Scand J Public Health 51:106–124
Liu R, Chi I, Wu S (2022) Caregiving burden among caregivers of people with dementia through the lens of intersectionality. Gerontologist 62:650–661
Calvo-Perxas L et al (2018) What seems to matter in public policy and the health of informal caregivers? A cross-sectional study in 12 European countries. PLoS ONE 13:e0194232
Tokovska M et al (2021) Informal caregivers and psychosocial support: analysis of European dementia policy documents. J Public Health Res 11:jphr. 2021.2416
Wang M et al (2018) The needs of informal caregivers and barriers of primary care workers toward dementia management in primary care: a qualitative study in Beijing. BMC Fam Pract 19:201
Arku D et al (2022) Program of all-inclusive care for the elderly (PACE) versus other programs: a scoping review of health outcomes. Geriatrics (Basel) 7:31
Travers JL et al (2022) Minority older adults’ access to and use of programs of all-inclusive care for the elderly. J Aging Soc Policy 34:976–1002
Funding
This research was funded by National Health Research Institutes in Taiwan, grant numbers PH-111-GP-07.
Author information
Authors and Affiliations
Contributions
Conceptualization, R-HC, H-YC, C-CH, I-CW, and S-CC; data curation, S-CC and Y-HC; formal analysis, S-CC; funding acquisition, R-HC, H-YC, C-CH, and I-CW; investigation, R-HC, S-CC, and Y-HC; methodology, S-CC, C-MY and DDO; project administration, Y-HC and DDO; resources, S-CC and C-MY; software, S-CC and C-CH; supervision, R-HC; visualization, Y-HC and DDO; writing—original draft, S-CC; writing—review and editing, R-HC, S-CC, Y-HC, C-MY, DDO, I-CW, C-CH, H-YC. All authors have read and agreed to the published version of the manuscript.
Corresponding author
Ethics declarations
Conflict of interest
The authors have no competing interests to declare.
Statement of human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
Not applicable.
Ethical approval
Not applicable.
Consent to participate
Not applicable.
Consent for publication
Not applicable.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Chien, SC., Chang, YH., Yen, CM. et al. Exploring concepts and trends in informal caregiver burden: systematic review using citation network and content analysis. Aging Clin Exp Res 35, 2873–2885 (2023). https://doi.org/10.1007/s40520-023-02582-w
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40520-023-02582-w