Correlations between caregiver competence, burden and health-related quality of life among Chinese family caregivers of elderly adults with disabilities: a cross-sectional study using structural equations analysis

OBJECTIVE: To examine the relationship between caregiver competence and health-related quality of life (HRQoL) among family caregivers of disabled elderly adults, and to evaluate the role of caregiver burden as a potential mediator of that relationship. DESIGN: Cross-sectional study. SETTING: Two general hospitals in Shanghai, China. PARTICIPANTS: Study participants were 135 family caregivers of disabled elderly adults listed on a roster for outpatient and emergency services utilisation from January to March 2022. DATA ANALYSIS AND OUTCOME MEASURES: We used stratified linear regression and structural equation model analysis. HRQoL was the main outcome, measured using the Medical Outcomes Study 36-Item Short form Health Survey. Caregiver competence was assessed using the Family Caregiver Task Inventory, and caregiver burden was assessed with the Zarit Burden Interview. RESULTS: Caregivers of moderately and severely disabled elderly adults showed poorer scores in Physical Component Summary (F=20.463, p<0.05) and Mental Component Summary (F=17.062, p<0.05) compared with caregivers of older adults with mild disabilities. At the same time, those caregivers showed higher scores on the caregiving burden (F=19.533, p<0.05) and caregiving difficulties (F=16.079, p<0.05). A structural equation model was performed and successfully adjusted (χ(2)/df=1.175, p=0.261, NFI=0.970, RFI=0.949, IFI=0.995, CFI=0.995, GFI=0.963, TLI=0.992, AGFI=0.920, RMSEA=0.036). The total effect of Family Caregiver Task Inventory scores on HRQoL scores was −0.980, with a direct effect of −0.645. The mediating effect on HRQoL scores through the intermediate variable of caregiver burden scores was −0.335. CONCLUSIONS: Family caregivers’ HRQoL is closely related to caregiver difficulties and burdens. Early identification and targeted measures are needed to reduce the burden and problems in caregiving.