Burden of care impacting family caregivers of dependent community-dwelling older adults in rural and urban settings of Southern Turkey

Population ageing is taking place at an unprecedented rate in Turkey and expected to continue through 2050. This study represents an important first initiative aimed at understanding dimensions of informal family caregiver burden in Turkey. The future implications for primary family caregivers of community-dwelling dependent older adults will be significant as fertility rates and the ratio of potential caregivers to care dependent older adults will decrease, leading to a reduction in the availability of informal carers of community-dwelling dependent older adults in Turkey’s foreseeable future. The study sample comprised 332 informal caregiver/care-recipient dyads that involved direct access to an informal family caregiver and a community-dwelling dependent older adult. Data was drawn from the Antalya Home Care Survey (AHCS) conducted over the period April 2009 through to March 2010. The age range for informal family caregivers was 20 to 89 years of age with the average age being 50.1 years. In the case of the community-dwelling dependent older adults, the age range was 44 to 100, with the average age being 78.5 years. The informal family caregivers were predominantly female representing 87.8% of the informal caregiver group. Females again were overrepresented in the dependent community-dwelling older adult sample with 62.0% being female compared to 38.0% older males. The aim of the study was primarily concerned with determining the nature and extent of informal caregiver burden in urban, quasi-rural and rural environments in the Province of Antalya, Turkey. Independent variables related to caregiver characteristics, a comparison of past and present dyadic relationships, and a framework of caregiver components of care were tested for statistical correlation to three factor-analysis-derived-components of care-related burden, namely, psycho-spiritual, social, and physical burden. The three components combined explained 53.8% of the variance in caregiver burden. Results suggest that the psycho-spiritual component, explaining 31.2% of variance, represented the most significant consequence of caregiver burden. Hypotheses tests revealed only living arrangements to be significantly related to all three burden components while support for Activities of Daily Living support, self-rated health, present and past-present comparison of quality of relationship, and physical environment were found to be significantly related to two of the three burden components. Additionally, six of eleven variables namely, economic burden, caregiver income, kin relationship, anxiety of future, self-rated health, and past-present comparison of dyadic quality of relationships were found to be significantly related to the selected environmental contexts comprising urban, quasi-rural, and rural. Supportive interventions at the provincial and central government levels need to be informed by further research that further investigates the growing elder care needs of families, particularly those related to the health and well-being of informal primary caregivers. An array of emerging issues that warrant future attention included a) concerns relating to caregiver fatigue, b) absence of regular respite with potential consequences for unintended neglect and/or abuse of community-dwelling older adults in receipt of caregiving, and c) the need to address the differential support needs of urban as well as rural-based informal family caregivers of dependent older adults. A range of recommendations placed in four sub-categories provides useful insights and challenges for further research and policy formulation