The Indirect Effect of the Frailty of Dependent Elderly People Needing Hospitalization on Their Informal Caregivers' Anxiety

Background A high prevalence of anxiety symptoms has been identified among the caregivers of disabled older people. The aim of the study was to explore the relationships between objective burden (intensity of care and burdensome characteristics of the care recipient, like frailty status), caregiver characteristics, subjective burden, and anxiety in a sample of informal caregivers caring for hospitalized elderly patients. Methods In this cross-sectional study, patients' and their informal caregivers' characteristics were recorded for 311 patient-caregiver dyads. Subjective caregiver burden and caregivers' anxiety were assessed by using the Zarit Burden Interview and the Hospital Anxiety and Depression Scale (HADS), respectively. Correlation coefficients and path analysis were used to examine the relationship between variables. Caregivers' anxiety was considered as the outcome variable. Caregivers' subjective burden was entered as a mediator between caregiver characteristics-objective burden and anxiety. An objective burden was measured based on the care needs of the dependent elderly (frailty status, cognitive impairment, comorbidity, independence in activities of daily living, behavioral problems, hours spent on caregiving, and duration of caregiving). Results Abnormal anxiety symptoms (HADS score 11-21) were reported by 92 caregivers (29.6%). Borderline cases (HADS score 8-10) were 66 caregivers (21.2%). A mild, moderate, or severe subjective burden was recorded for 113 (36.3%), 100 (32.2%), and 26 (8.4%) caregivers, respectively. The female gender of the caregiver, the spousal relationship with the patient, and the subjective burden were directly related to higher levels of caregivers' anxiety. A subjective burden was found to be a significant mediator in the relationship between duration of caregiving, patients' frailty status, caregiver gender, patients' comorbidity, and caregivers' anxiety. Conclusion Among the risk factors for caregivers' anxiety, the frailty status of the patient is probably the only modifiable factor via interventions targeting frailty reversion or reduction.