Sunday, June 12, 2011

Assessing Alzheimer's Caregiver Stress -- The Modified Caregiver Strain Index


Caregiving has been recognized as an activity with perceived benefits and burdens. Caregivers may be prone to depression, grief, fatigue, and changes in social relationships. They may also experience physical health problems.

Alzheimer's Reading Room

The combination of stress and burden can and does effect an Alzheimer's (dementia) caregivers' overall health.

Physical health, family finances, social interactions, time demands, and employment are all issues that can affect caregiver health.

By identifying the sources and degree of strain/stress a caregiver can learn to deal with the issues or learn that they need to seek help.

The Modified Caregiver Strain Index helps to determine the level of strain a caregiver is experiencing. The test can help identify problem areas and help in the selection of interventions that can be used to alleviate caregivers' strain and improve the lives of caregivers and care recipients.


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The video below is one of the the Try This Assessment Tool Series videos offered to nurses to assist them in caring for their older patients.

For me, the video below was enlightening. So even though this is an assessment tool designed for nurses, I found that is it very helpful as a personal assessment tool. It really made me look at myself.

I suggest that all Caregivers, family, and friends of caregivers take the time to watch the video and learn more about these issues.

Often overlooked, caregivers can, and often do, suffer from depression. 40 percent of dementia caregivers suffer from depression. This "job" tends to wear you down over time.


The Modified Caregiver Strain Index (CSI) from Hartford Institute - NYU.




The Modified Caregiver Strain Index (CSI)

By M. Terry Sullivan, RN, MSW, MSN, CMC, Connecticut Community Care, Inc.

WHY: Informal supporters (caregivers) provide the majority of long-term care to chronically disabled older adults. Caregiving has been recognized as an activity with perceived benefits and burdens. Caregivers may be prone to depression, grief, fatigue, and changes in social relationships.

They may also experience physical health problems.

Perceived caregiver burden has been associated with premature institutionalization and patient reports of unmet needs. Screening tools are useful to identify families who would benefit from a more comprehensive assessment of the caregiving experience.

BEST TOOL: The Modified Caregiver Strain Index (CSI) is a tool that can be used to quickly screen for caregiver strain with longterm family caregivers.

It is a 13-question tool that measures strain related to care provision. There is at least one item for each of the following major domains: Employment, Financial, Physical, Social, and Time.

This instrument can be used to assess individuals of any age who have assumed the role of caregiver for an older adult. The Modified Caregiver Strain Index is a version of the Caregiver Strain Index developed in 1983. The tool was modified and developed in 2003 with a sample of 158 family caregivers providing assistance to adults aged 53 and older living in a community-based setting (Travis, et al, 2002; Thornton & Travis, 2003).

Scoring is 2 points for each ‘yes’, and 1 point for each ‘sometimes’ response. The higher the score, the higher the level of caregiver strain.

VALIDITY AND RELIABILITY: Internal reliability coefficient is slightly higher (=.90) than the coefficient originally reported for the CSI in 1983 (=.86). Two-week retest data for one-third of the caregiving sample (n=53) were available and resulted in a test-retest reliability coefficient of .88.

STRENGTHS AND LIMITATIONS: The Modified CSI is a brief, easily administered, self-administered instrument.

Long-term family caregivers were not comfortable with the dichotomous choice on the CSI and the modified instrument provides the ability to choose a middle category response best suited to some situations. The Modified CSI clarifies and updates some of the items on the original instrument. The tool is limited by lack of a corresponding subjective rating of caregiving impact. There is no breakdown of score regarding low, moderate or high caregiver strain, so professional judgment is needed to evaluate by total score the level of caregiver strain. The tool effectively identifies families who may benefit from more in-depth assessment and follow-up.

FOLLOW-UP: The higher the score on the Modified CSI, the greater the need for more in-depth assessment to facilitate appropriate intervention.

Additional items and further efforts to develop and test a set of subscales could enhance the applicability of the instrument for research and practice. The patient’s cognitive status and problematic behaviors should be assessed, as well as the caregiver’s perception of role overload or deprivation in key relationships, goals or activities. Family conflict, work role-caregiving conflict, and caregiver social support are also important variables in the overall caregiving experience.

Additional work with highly strained long-term caregivers who are receiving little or no formal services is indicated.

Go here for the paper copy of the test and a lot more information.

More Insight and Advice for Caregivers


Original content Bob DeMarco, the Alzheimer's Reading Room