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Citation: Hvaliˇc-Touzery, S.; Trkman,
M.; Dolniˇcar, V. Caregiving Situation
as a Predictor of Subjective Caregiver
Burden: Informal Caregivers of Older
Adults during the COVID-19
Pandemic. Int. J. Environ. Res. Public
Health 2022,19, 14496. https://
doi.org/10.3390/ijerph192114496
Academic Editor: Steven A. Cohen
Received: 10 October 2022
Accepted: 3 November 2022
Published: 4 November 2022
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International Journal of
Environmental Research
and Public Health
Article
Caregiving Situation as a Predictor of Subjective Caregiver
Burden: Informal Caregivers of Older Adults
during the COVID-19 Pandemic
Simona Hvaliˇc-Touzery * , Marina Trkman and Vesna Dolniˇcar
Faculty of Social Sciences, University of Ljubljana, Kardeljeva Plošˇcad 5, 1000 Ljubljana, Slovenia
*Correspondence: simona.hvalic-touzery@fdv.uni-lj.si
Abstract:
The COVID-19 pandemic has created and exacerbated emotional, financial, and technical
challenges for informal caregivers of older people. The aim of this study was to explore the caregiving
situation and subjective burden of informal caregivers of older family members during COVID-
19, and to investigate how a caregiving situation’s characteristics predict the subjective burden of
care in times of COVID-19. The study was conducted in April and May 2021 via an online access
panel. The sample (n = 612) was determined using a screening test that enabled us to focus on a
Slovenian population of informal caregivers aged 40+ caring for a person aged 65+ for at least four
hours/week on average. Our findings reveal that the subjective burden of care was high among
informal caregivers during COVID-19. Multiple regression analysis showed that the provision of
activities of daily living, care duration, average hours of care per week, formal care status, and
recipients’ health problems related to dementia or other memory problems significantly predicted
the subjective burden of caregivers. These findings call for better recognition of the role of informal
caregivers. The time and effort devoted to informal care should be supported by legislation and
social security.
Keywords: subjective caregiver burden; COVID-19; informal care; quantitative study; Slovenia
1. Introduction
In the last two and a half years, the COVID-19 pandemic has reached almost every
part of society and affected people in different ways. It has affected people’s physical
and mental health [
1
–
5
], but it is much more than a health crisis; it is a human, economic,
and social crisis that, if not adequately addressed, can lead to an increase in inequality,
exclusion, discrimination, and global unemployment [6].
COVID-19 has impacted healthcare systems [
7
] and the utilization of healthcare ser-
vices [
8
,
9
], demographic trends [
9
,
10
], the way people live and socialize, their well-being,
and their social development [
11
]. The consequences of the pandemic are felt in many seg-
ments of the population and show adverse effects on people’s lives and well-being [
12
,
13
].
The virus has hit the already vulnerable, marginalized, and poorer segments of societies
particularly hard, including people living in poverty situations, older adults, persons with
disabilities, women, youth, and migrants and refugees [
6
,
14
,
15
]. Older adults are the
population with the highest risk of dying from COVID-19, and dependent older adults are
also likely to be less capable of supporting themselves in isolation [
16
]. Studies suggest
that during the pandemic, the need for family care has increased, which has affected more
women than men [17].
One population group that faced particular difficulties during the COVID-19 outbreak
and remained invisible in general discussions of COVID-19 victims was informal caregivers
(ICs) [
18
–
21
], who are broadly defined as “persons of all ages who provide care (usually
unpaid) to family members, other relatives, partners, friends and neighbors with a long-
term illness, disability or other long-lasting health or care need, outside a professional or
Int. J. Environ. Res. Public Health 2022,19, 14496. https://doi.org/10.3390/ijerph192114496 https://www.mdpi.com/journal/ijerph
Int. J. Environ. Res. Public Health 2022,19, 14496 2 of 21
formal employment framework” [
22
]. They form the backbone of long-term care systems in
many European countries [
23
–
26
], but had not been adequately addressed in many of them
even before the pandemic [
27
,
28
]. During the pandemic, most countries did not implement
specific support for ICs [
19
,
21
]. Despite the severe limitations of social and home care
services in Slovenia, ICs received very limited support and had to rely largely on their
own resources to cope with the new challenges of caring for older family members. The
only measure was the one-time solidarity supplement for registered ICs [
29
]. In addition, a
recent study found that almost half of the ICs of older people (48.4%) felt that the Slovenian
government had not taken into account the needs of family members helping older people
when taking measures to mitigate the effects of the coronavirus, and another 37.4% said
that it had barely considered these needs [30].
The EU strategy to support and empower informal carers [
22
], estimates that over 80%
of all long-term care services in Europe are provided by ICs. Furthermore, according to the
recent European care strategy for caregivers and care receivers, “the value of hours of long-
term care provided by informal caregivers is estimated to be around 2.5% of EU GDP higher
than the public expenditure on long-term care” [
31
]. Yet, policy developments relevant to
ICs in EU countries have often been implemented in a fragmented and inconsistent way and
have therefore not always led to real improvements in support for ICs. This is particularly
true in Slovenia, with its fragmented long-term care system that relies heavily on informal
care, and where the needs of ICs are inadequately met [
32
,
33
]. Slovenia is a Central Eastern
European (CEE) country where care for older people depends mainly on the family, a care
model that can be described as “familialistic” [
34
–
36
]. In Slovenia, familialism is not explicit
(i.e., with strong support for family caregivers), but, as in other CEE countries, implicit
familialism can be found [
34
,
37
]. Family care is assumed but not strongly supported by
policy (see, e.g., [
38
]). Policies on work–life balance do not adequately address the issue of
care for older people in terms of inclusive long-term care regulations [
29
,
36
]. Thus, we find
benefit in a contribution from a post-socialist country with a combination of conservative–
corporatist and social-democratic models of care provision [
39
], along with underdeveloped
long-term care systems and strong family elderly care responsibility.
While a comprehensive long-term care system has yet to be implemented, the Slove-
nian Active Ageing Strategy [40] recognizes the importance of better support for ICs. The
recently adopted Slovenian Act on Long-Term Care [
41
] also recognizes the role of family
members; however, it only provides support for a subset of carers, leaving a significant
number of ICs unsupported in their informal care. According to the Slovenian Public
Opinion Survey 2021 [
30
,
42
] conducted during the pandemic, 33.1% of people in Slovenia
aged 40 and over provide at least four hours of unpaid informal care per week to a person
aged 65 or over, with 43.1% covering the most demanding type of care (basic activities of
daily living) [
30
,
42
]. Moreover, in 2013, 75.5% of Slovenian people aged 65 or older who
received any type of home care received only informal care, 6.7% received only formal care,
and 17.8% received a combination of both [
33
]. A proportion of older people in Slovenia
have severe care needs that are unmet [
33
], placing additional pressure on families to
provide care [32].
1.1. Aims of the Study
In light of the findings presented in Section 1.2 and 1.3, this study aimed to advance
the available knowledge about the caregiving situation and subjective burden of ICs of
older people in Slovenia during the COVID-19 outbreak. Although ICs’ subjective burden
is well documented in the literature, this is an important topic because it examines how a
caregiving situation’s characteristics predict the subjective burden during the pandemic.
Except for one study that included a small sample of Slovenian ICs [
20
], studies
conducted during the pandemic did not include Slovenian ICs, so their situation during
the pandemic is largely unknown. Furthermore, until the present study, no comprehensive
representative study of the ICs of older adults had been conducted in Slovenia to investigate
the caregiving situation and burden of older people’s ICs. While many studies conducted
Int. J. Environ. Res. Public Health 2022,19, 14496 3 of 21
during the pandemic were based on selective and convenience samples (e.g., [
43
,
44
]), we
conducted a study with a sample from the general population to enable generalization of
the results. Therefore, the first aim of the present study, conducted after the first year of
COVID-19 in Slovenia, was to determine the caregiving situation and burden during the
outbreak. The study targeted a subset of ICs aged 40 to 85 years who provided at least
four hours per week
of unpaid assistance with activities of daily living (ADL), instrumental
activities of daily living (IADL), and/or emotional support to at least one family member
aged
65 years
or older at the time of the study. ADL is a term that collectively describes
activities of functional mobility and personal care, such as bathing, dressing, toileting,
eating, dressing, and getting into or out of a bed or chair [
45
]. IADLs include more
complex and demanding activities, such as meal preparation, laundry, managing finances
and medication, shopping, doing housework, heavy chores, yard work, or maintenance,
transportation, and using the telephone [
46
]. Similar to Zwar et al. [
47
], we focused
on ICs in this age group because most ICs in Europe and the United States are at least
40 years old [37,42,48–52].
Some gaps in the literature related to the caregiving situation as a predictor of the
caregiver’s subjective burden exist. First, many studies have addressed the caregiving
situation in relation to a variety of topics (e.g., engagement in advanced care planning,
gender studies, and the impact on ICs’ physical and mental health) [
47
,
53
–
56
]. How-
ever, the understanding of caregiving situations varies widely among the studies [
57
–
60
],
and they are often vaguely defined [
61
–
65
]. Second, the impact of the pandemic on the
ICs of older people has been investigated in several studies [
43
,
44
,
47
,
66
–
70
], but not the
caregiving situation characteristics and subjective burden during the pandemic phase in
2021. Therefore, the second aim of our study was to clearly and holistically define the
caregiving situation based on the conservation of resources theory [
71
], understanding
the objective burden [
72
,
73
], and the overview presented in Section 1.2, and to investigate
how the caregiving situation’s characteristics predict the subjective burden. As mentioned
by Flyckt et al. [
74
], there are different determinants of subjective and objective burdens.
Bayen et al. [
75
] found both similar and distinct predictors for each type. Reinhard and
Horrowitz [
76
], for example, found several predictors of caregiver burden (i.e., factors that
may affect the experience of a burden): disruptive behaviors and social support, living
arrangements, the relationship between caregiver and care recipient, and demographic
characteristics (ethnicity, cultural factors, income, gender, and age). Within these predictors,
we focused on those related to the caregiving situation during the COVID-19 pandemic.
Our definition of a caregiving situation includes objective burden, defined as the time spent
on caregiving and the caregiving tasks undertaken [
58
,
73
], as some studies have demon-
strated an association between objective and subjective caregiver burdens [
77
–
80
]. The
definition also includes some other characteristics of the caregiving situation mentioned
in the literature: the health status of the care recipient, the duration of care, formal care
resources, and the status of the primary caregiver [57,60,64,65,81].
Two research questions are addressed:
RQ1. What was the caregiving situation and the subjective burden on the ICs of older
family members during the COVID-19 outbreak?
RQ2. Which selected caregiving situation characteristics (i.e., weekly hours of care, duration
of care, provision of IADL and ADL, health status of the care recipient, type of caregiver,
and formal support) significantly predicted ICs’ self-rated subjective burden during the
COVID-19 outbreak?
1.2. Impact of the Pandemic on ICs
Many international studies have shown that the pandemic has worsened the situation
of ICs [
12
,
18
,
20
,
25
,
43
,
44
,
67
–
69
,
82
–
92
]. The pandemic has led to an increase in the intensity of
care, the care activities provided, and the burden on
ICs [18,20,43,67,70,82,84,85,87,87–89,91–94]
.
According to a scoping review [
91
], the pre-existing problems of ICs (e.g., care burden, anx-
iety, sleep disturbances, coping with a disrupted daily routine, and practical and logistical
Int. J. Environ. Res. Public Health 2022,19, 14496 4 of 21
challenges in accessing health care, social support, and medications) have been exacerbated
by the pandemic and restrictive lockdown measures. This has also been confirmed in other
recent studies [12,43,86].
In addition, the pandemic has created additional challenges for ICs, such as anx-
iety and stress related to contracting and spreading the virus, practical concerns re-
lated to delayed and discontinued treatment, and a lack of paid formal support ser-
vices. Most studies report deterioration in the health, quality of life, and psychological
well-being of
ICs [12,18,20,43,44,83–85,87–92]
. The studies also mention a narrowing of
care networks and thus more responsibility for the primary IC [
18
,
92
], an increase in
the needs of care recipients [
20
,
85
], a worsening of the financial situation of ICs during
the
pandemic [20,83,85,88,89,92,95]
, an increase in the hours worked by employed ICs or
changes in their work patterns [
20
,
85
,
93
,
95
], and an increase in concern about the situation
of care recipients [
20
,
85
,
89
]. According to the Global Carer Well-Being Index [
88
], based on
the 12-country global survey, the pandemic has created three pressure points: emotional,
financial, and technological.
Furthermore, since the outbreak of the pandemic, many health and social services
provided by formal providers have been closed, reduced, or restructured, leaving older
adults at home dependent only on their ICs [
18
,
20
,
85
,
89
,
91
]. A study in Europe found that
37.1% of ICs reported experiencing difficulties in accessing and using public or private
health and/or social services for their care recipients during the pandemic outbreak, which
was rated worst among ICs in Portugal and Germany. More than half of ICs (58.5%) felt
that they were not adequately supported by health and social services (with the highest
scores in Estonia at 69.9%, Portugal at 65.3%, and Italy at 62.7%) [20].
Several studies have also shown that the impact of the pandemic varied across different
subgroups of ICs. In particular, the impact was found to be more severe for female ICs
than for their male counterparts in all aspects of the caregiving experience [
20
,
47
,
83
,
85
,
96
].
Poorer psychological well-being was associated with ICs who provided intensive care
(more than 20 h per week) [
70
,
92
], those who provided personal care more frequently than
before COVID-19 [
14
], those who cared for someone with dementia [
86
,
87
,
97
], parental
caregivers [18,82], and those who were experiencing financial difficulties [85].
Some studies have specifically addressed the situations of ICs of older people during
the pandemic [
25
,
43
,
44
,
47
,
66
–
70
,
82
]. Of these, however, only a few have addressed the
impact of the pandemic on the caregiving burden of ICs of older people [
47
,
70
,
82
,
87
,
94
]. For
example, a German study [
87
] that provided insight into the informal caregiving situation
during the first wave of the pandemic found that older people’s home care situations
deteriorated during the pandemic (e.g., a considerable reduction in the use of support
resources such as day care and family physician visits, as well as other support networks
such as neighborhood help), which placed a heavy burden on their ICs. They became
increasingly concerned about the situation, health, and future of their older relatives and
felt more psychologically burdened. A study conducted among ICs during the second
wave of the COVID-19 pandemic in Germany found a higher caregiver burden in women
than men [
47
]. A smaller American study [
82
] of adult children caring for older parents
found that the burden of care had increased significantly since the onset of the pandemic,
although ICs who had living siblings reported significantly less caregiver burden change
than those without siblings. In a study conducted during the third wave of COVID-19
in Japan [
70
], 41% of ICs complained of an increased caregiver burden. They found that
several factors were associated with an increased caregiver burden during the COVID-19
pandemic, which could be due to increased caregiving intensity. However, the researchers
also suggested that ICs whose burden increased during the pandemic may have already
exhibited risk factors for high caregiver burden prior to its onset. Studies from the Nether-
lands and Serbia [
98
,
99
] found that the declining health of ICs and care recipients during
COVID-19 was related to an increased level of perceived burden of care. While several
studies have examined specific individual characteristics of caregiving situations during
the
pandemic [12,18,20,25,43,44,67–69,82–92]
, only one study comprehensively examined
Int. J. Environ. Res. Public Health 2022,19, 14496 5 of 21
the caregiving situation and care involvement [
66
], and the same study was the only one
that examined the caregiving situation in relation to psychosocial burdens.
As this review of existing research shows, the lives of ICs have been affected by a
number of factors during the pandemic. However, there is still a gap in understanding how
different characteristics of caregiving situation predict the subjective burden of caregiving
during the pandemic. In addition, the above studies have not examined Slovenian ICs, so
their situation remains largely unknown.
1.3. Conceptualization of Caregiver Burden and Caregiving Situation
In the literature, there are various understandings of the concept of caregiver burden,
although its multidimensionality is widely recognized [
76
,
100
–
103
]. Zarit et al. [
104
]
defined caregiver burden as “the extent to which caregivers perceive their emotional or
physical health, social life, and financial status as suffering as a result of caring for their
relative”. The more recent conceptualization by Liu et al. [
105
] defines caregiver burden
as “the level of multifaceted strain perceived by the caregiver from caring for a family
member and/or loved one over time”. The dichotomous conceptualization of burden was
developed by Hoenig and Hamilton [
106
], who separated objective (i.e., events, happenings,
and activities) from subjective (i.e., feelings, attitudes, and emotions) measures of burden.
This concept has since been widely accepted and applied in a variety of settings. Han and
Haley [72] and Montgomery et al. [73] focused on caregiver burden and defined objective
burden (OCB) related to caregiving as time spent caring, caregiving tasks assumed, and
potential financial problems, whereas subjective burden (SCB) refers to the psychological,
social, and emotional effects that caregivers may experience as a result of the objective
burden of caregiving. Thus, OCB refers to the observable and tangible burden, whereas
SCB refers to personal perceptions and evaluations of the burden [
107
,
108
]. We observed
that different definitions of SCB and OCB were used in the studies. For example, OCB has
been defined using caregiver hours [
77
], caregiver hours and years [
79
], expenses and time
spent on caregiving [
74
], and informal care time (hours and days of care) [
75
]. A variety
of measures that vary considerably in length and complexity have been used to measure
SCB (e.g., Zarit Burden Interview [
109
], the CarerQoL VAS [
110
], the Caregiver Strain Index
(CSI) [
111
], the Caregiver Burden Scale [
112
], SF-36 Happiness Subscale [
113
], Modified
Caregiver Strain Index (MCSI) [
114
,
115
], Caregiver Reaction Assessment (CRA) [
116
],
Appraisal of Caregiving Scale (ACS) [
117
], Sense of Competence Questionnaire (SCQ) [
118
],
Self-rated Burden (SRB) [
108
], and Burden Assessment Scale (BAS) [
119
]). Although the
relationship between OCB and SCB has been demonstrated in some studies [
77
–
80
], caution
is required because of the different definitions of OCB and SCB. For the purpose of this
study, a reliable, accurate, and simple measure of subjective burden—the single-item SRB
scale—was used to indicate the degree of subjective caregiver burden.
The caregiving situation has been considered in many studies, but a conceptual
definition is lacking, and the understanding of the caregiving situation is less clear. Some
studies assess the caregiving situation without providing a rationale for their appraisal
of it [
61
–
65
,
108
], and some base their understanding of the caregiving situation on the
instrument used to measure it [
57
,
58
,
60
]. We found only one study [
81
] in which the
appraisal of the caregiving situation was based on the conservation of resources theory [
71
].
In this theory, caregiving conditions refer to objective caregiving situations, such as the
older adult’s health (e.g., functional limitations and cognitive impairments) or the time
required to provide care. This definition excludes resources (e.g., financial resources,
coping, social support, family harmony, and use of services) from the concept of the
caregiving situation. Lyons et al. [
57
] discussed the caregiving situation based on 12 care-
related difficulties (e.g., family tension, insufficient financial resources to meet care needs,
excessive demands, and seeking community services), in which resources are included in
the concept of the caregiving situation. Kraijo et al. [
64
] examined the caregiving situation
from the perspective of objective burden (e.g., duration and intensity of informal care) and
the consequences experienced by ICs in providing informal care. Schultz et al. [
60
] used
Int. J. Environ. Res. Public Health 2022,19, 14496 6 of 21
some items from another study to examine the caregiving situation (e.g., relationship to
the care recipient, primary care recipient’s health problem, hours per week providing care,
duration of caregiving, and co-residence of caregiver and care recipient).
The understanding of the caregiving situation in the National Alliance for Caregiving
& AARP [
65
] report is very broad and includes demographic information about caregivers
and care recipients, the relationship between care recipients and caregivers, the number
of people being cared for, and the duration of care. However, the health status of the care
recipient, the living situation of the care recipient (e.g., distance from the caregiver), care
activities (e.g., provision of ADLs and/or IADLs), intensity of care (e.g., overall duration of
care, average hours of care per week), and resources (e.g., formal help, help from family and
friends, and status of primary caregiver) are not considered. Common to all of the studies
discussed is that their definition of the caregiving situation includes time spent caring
(e.g., hours of care per week and/or duration of care) and, in some cases, caregiving tasks
undertaken, which overlaps with the definition of objective caregiving burden. However,
the caregiving situation goes beyond the definition of the OCB and as can be seen in these
examples, sometimes includes the health status of the care recipient. This is discussed by
various researchers as important in understanding the caregiving situation [
57
], as well as
formal support for care and possible financial problems. In addition, individual studies
add some other variables to the concept of the caregiving situation. Based on this review,
we will consider weekly hours of care, duration of care, provision of ADLs and IADLs,
health status of the care recipient, status of the primary caregiver, and formal support for
care when assessing the caregiving situation.
2. Methodology
2.1. Study Design, Data Collection, and Sample Description
This study was based on an online survey in which data were obtained through the
voluntary participation of respondents. The sample was selected by Valicon from the
pool of panel members using quota sampling by statistical region (NUTS-3), gender, and
age group. The data were weighted by age, gender, type of settlement, and statistical
region according to the population data provided by the Statistical Office of the Republic of
Slovenia and the Slovenian Public Opinion Survey.
The data were collected during the COVID-19 pandemic in April and May 2021 via an
online access panel. A total of 3284 individuals were invited to participate. Acknowledging
the AAPOR standard, we filtered out cases with insufficient data. There were 637 respon-
dents (19.4%) who qualified. The data were then weighted by gender, age, and region to fit
the Slovenian population of ICs aged 40 years and over caring for a person who is at least
65 years old for at least four hours/week on average. We obtained 612 eligible respondents.
Finally, due to missing values in the variables, we analyzed 549 cases (weighted n= 544)
using multiple linear regression.
The majority of ICs (68.4%) were between 40 and 64 years old, and 31.6% were
65 years
or older. There were slightly more women (51.0%) than men in the sample. A
large percentage of ICs were proximate caregivers who lived in the same building or up
to half an hour away from the care recipients, while 10.7% of ICs were distant caregivers,
living half an hour or more away from their care recipients. The average age of the care
recipients was 78.7 years. Of them, 65.5 fell in the last five years (Table 1).
2.2. Measures
A structured questionnaire was used. To establish the subjective burden of care, the
SRB [
108
] was used, which expresses burden on a scale ranging from “not at all straining”
(0) to “much too straining” (10). We defined ICs’ caregiving situations with care-specific
independent variables, such as provision of ADL and IADL, type of carer, overall care
duration, average hours of care per week, formal care use, and care recipient’s health
problem. Data on caregiving situations were obtained by adapting individual question sets
from the Eurofamcare study [120] and the COVID-19 study [20].
Int. J. Environ. Res. Public Health 2022,19, 14496 7 of 21
Table 1. Characteristics of informal caregivers and their care recipients.
Categories Total
Informal caregivers’ characteristics (n= 544)
Gender (% female) 51.0
Age (mean [standard deviation]) 57.63 [10.85]
Education 1,2
Primary school (ISCED Levels 0–2, %) 2.6
Secondary school (ISCED Level 3, %) 51.4
Higher education (ISCED Levels 5–8, %) 46.0
Employment status
Employed (%) 54.3
Retired (%) 36.9
Unemployed (%) 8.8
Married or has a partner (% yes) 80.0
Time distance between IC and care recipient
Live in in the same building (%) 54.8
Live up to 30 Min away (%) 34.4
Live 30 Min or more away (%) 10.8
Care recipients’ characteristics
Age (mean [standard deviation]) 78.68 [8.50]
Poor or very poor health (% yes) 327.7
Fall experience in the last 5 years (% yes) 65.5
Note:
1
We mapped Slovenia’s educational levels with ISCED’s levels with help from the following governmental
document [
121
];
2
The share of missing values per variable was 0.4%;
3
The share of missing values per variable
was 0.1%.
2.3. Analysis
Descriptive analyses were conducted to examine the characteristics of the participants,
their caregiving situations, and their SRB scores. Independent-samples t-tests (variables with
two categories), and ANOVAs (variables with three or more categories) were performed when
analyzing caregiving situation characteristics in relation to SRB total score (RQ1).
Multiple regression analysis was used to examine whether the demographic charac-
teristics of ICs and caregiving situation variables predicted ICs’ SRB scores (RQ2). Forced
entry was used as a method of variable entry, so we made no decisions about the order in
which a set of independent variables was added to the model. We assessed the model’s fit
in several ways. We assessed the R-square and checked whether it indicated a significantly
better fit with the model using the predictors than with the model without them by using
the F-statistic. We also checked for any multicollinearity among the predictors. All the
analyses were conducted using IBM SPSS 22.0.
3. Results
3.1. Caregiving Situation and SRB during COVID-19
To answer our first research question, we examined informal caregiving situations.
Given the different understandings of caregiving situations discussed in Section 1, we
describe several indicators of caregiving situations, although not all of them were included
in our model. Two-thirds (67.9%) of ICs cared for one older person, 26.7% cared for two
persons, and 5.4% cared for more than two older persons. The highest percentage of ICs
cared for a parent (53%), 16.6% for their partner, 14.5% for their in-laws, and 15.9% for
another family member. A large percentage of ICs (60%) considered themselves to be the
primary persons providing assistance to their older relatives. More than half (55.4%) of
the ICs provided support with ADLs, while IADLs were provided by the majority of ICs
(97.1%) (Table 2). In addition, 70.4% of ICs offered care daily or almost daily, and 27.7%
offered care at least once a week. A negligible number offered help less frequently (1.9%).
The median amount of informal care provided was 7.1 h per week. A total of 41.4% of ICs
offered 11 or more hours of care per week, and 23.3% offered more than 20 h per week. The
Int. J. Environ. Res. Public Health 2022,19, 14496 8 of 21
majority of ICs (73.6%) provided care to an older person for between one and five years,
and 15% for up to one year. Several variables measured the health status of the older adults
being cared for: 69.1% of them suffered from a chronic disease, 17.4% from dementia, and
7.3% from another mental disorder. A total of 17.8% of care recipients had some form of
disability, more than one-third (26.6%) suffered from a temporary disease, and 4.9% had
a terminal disease (Table 2). Of the care recipients, 17.6% needed help with most ADLs,
one-third (35.1%) needed little help, and slightly less than half (47.3%) got by without help
with ADLs. In addition, more than half of the care recipients (52.6%) needed help with
most IADLs, 40.7% needed little help, and 6.7% completed IADLs on their own. However,
only one-fifth of care recipients (21.1%) received formal help from social or health services
in the six months prior (e.g., health care, home help, help with basic care, transportation
services, and meal delivery) (Table 2).
Table 2. Caregiving situation and self-rated care burden.
Caregiving Situation’s Variables N = 544 (Weighted) SRB
(Mean (Standard Deviation))
t-Test or
F-Statistics 4
Provision of ADLs 1
1 = Providing (%) 55.4 5.59 (2.98)
−7.757 ***
0 = Not providing (%) 44.6 3.77 (2.51)
Provision of IADLs 2
1 = Providing (%) 97.1 4.79 (2.92)
−0.676 ns
0 = Not providing (%) 2.9 4.28 (3.11)
Type of carer
1 = Primary (%) 60.0 4.94 (2.92)
1.599 ns
2 = Secondary (%) 12.8 4.66 (3.02)
3 = Carers sharing care responsibility
equally (%) 27.2 4.44 (2.85)
Duration of care (months; mean (standard
deviation)) 69.68 (92.62)
Average hours of care per week (mean
(standard deviation)) 18.29 (23.24)
Formal care status
1 = Uses formal support 3and does not
need more of it (%) 8.3 5.21 (3.14)
61.551 ***
2 = Uses formal support and would like
more of it (%) 12.9 7.27 (2.43)
3 = Does not use formal support nor wants
any (%) 53.3 3.47 (2.37)
4 = Does not use formal support but would
like it (%) 25.5 6.09 (2.68)
Care recipient’s health problem
1 = Has temporary disease (%) 26.6 4.12 (2.80) 3.179 **
0 = Does not have temporary disease (%) 73.4 5.01 (2.93)
1 = Has chronic disease (%) 69.1 4.73 (2.85) 0.564 ns
0 = Does not have chronic disease (%) 30.9 4.88 (3.08)
1 = Has dementia 4(%) 17.4 6.71 (2.53) −7.985 ***
0 = Does not have dementia 4(%) 82.6 4.37 (2.84)
1 = Has mental disorder (%) 7.3 5.40 (3.13) −1.405 ns
0 = Does not have mental disorder (%) 92.7 4.73 (2.90)
1 = Has disability (%) 17.8 5.63 (3.19) −3.212 ns
Int. J. Environ. Res. Public Health 2022,19, 14496 9 of 21
Table 2. Cont.
Caregiving Situation’s Variables N = 544 (Weighted) SRB
(Mean (Standard Deviation))
t-Test or
F-Statistics 4
0 = Does not have disability (%) 82.2 4.59 (2.83)
1 = Has terminal disease (%) 4.9 6.91 (2.59) −3.926 ***
0 = Does not have terminal disease (%) 95.1 4.66 (2.90)
Note:
1
Activities of daily living;
2
Instrumental activities of daily living;
3
Care recipient has received formal
services, defined as social and home health care provided by qualified personnel (e.g., health professionals, social
workers, and social care attendants) in the past six months; These services include nurse visits, social home help,
home-delivered meals, and personal care assistance;
4
This refers to people with dementia, senility, or other
serious memory problems; For variables with two categories, we ran independent samples t-tests, while for
variables with three or more categories, we ran an analysis of variance and reported F-statistics; *** p< 0.000;
** p< 0.01; p< 0.05; ns = non-significant.
SRB scores were measured on a scale ranging from 0 (not at all straining) to 10 (much
too straining). The ICs’ average SRB score was 4.78 (SD = 2.92), and 41.2% of ICs scored
between 5 and 10. The average SRB score was higher for women than for men (5.06 vs. 4.44),
and there were no differences in SRB related to travel time between ICs and care recipients
or employment status. Moreover, we examined SRB in the context of informal caregiving
situations (Table 2). SRB was higher among ICs who provided ADLs than among those
who did not. SRB was higher in primary ICs than in other types of ICs, as well as in ICs
whose care recipients had dementia, senility, or other severe memory loss, and in ICs whose
care recipients had a terminal illness. The highest burden across all IC subgroups was
found in ICs who reported insufficient formal support for their care recipients (Table 2).
Correlational analyses in Table 3show significant associations between SRB and the
following variables: provision of ADLs, average hours of care per week, temporary disease,
disability, terminal disease, formal care status indicating that the care recipient receives
formal care and does not need any additional help, and formal care status indicating that
the care recipient does not receive formal care but would like some.
The results of independent samples t-tests and ANOVAs are presented in Table 2.The
average SRB scores were significantly different for groups defined by the following vari-
ables: formal care status (F = 61.551, p< 0.001), provision of ADLs (t =
−
7.857, p< 0.001),
duration of care (t =
−
3.154, p< 0.01), and care recipient’s health problems, such as demen-
tia (t =
−
7.985, p< 0.001), terminal disease (t =
−
3.926, p< 0.001) and temporary disease
(t = 3.179, p< 0.01).
3.2. Caregiving Situation’s Variables as Predictors of SRB
To answer our second research question (RQ2), we performed a multiple regression
analysis. In Table 4, we present the results of the multiple regression model. Control
variables gender of IC (0 = male, 1 = female), travel distance between IC and care recip-
ient (0 = less than 30 min apart, 1 = more than 30 min apart), and employment of IC
(
0 = unemployed
, 1 = employed) are binary variables, while age of IC is a scale variable
with values from 40 to 88.
Int. J. Environ. Res. Public Health 2022,19, 14496 10 of 21
Table 3. Pearson correlations among caregiving situation characteristics’ variables.
Caregiving Situation’s Variable 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
1. ADLs 1
2. IADLs −0.022 1
3. Care duration −0.097 * −0.024 1
4. Average hours of care per week 0.179 * 0.040 0.059 1
5. Formal care status:
reference category vs. care recipient receives
formal care and would like to get
additional care 2
0.087 * −0.043 −0.041 −0.012 1
6. Formal care status:
reference category vs. care recipient receives
formal care and does not need any
additional help 2
0.215 * −0.082 * 0.029 0.068 −0.115 * 1
7. Formal care status:
reference category 1vs. care recipient does
not receive formal care but would like to
get some 2
0.120 * 0.025 −0.049 0.084 * −0.175 * −0.226 * 1
8. Type of carer:
primary vs. secondary 1−0.049 −0.044 0.000 −0.148 * 0.097 * 0.064 0.000 1
9. Type of carer:
primary vs. sharing equal responsibility 1−0.085 * −0.031 −0.089 * −0.105 * 0.018 −0.053 0.043 −0.234 * 1
10. Care recipient has temporary disease −0.091 * 0.010 −0.076 * −0.071 * 0.005 −0.179 * −0.107 * −0.071 * 0.045 1
11. Care recipient has chronic disease −0.073 * 0.028 0.028 −0.010 −0.053 −0.034 0.074 * −0.069 −0.003 −0.330 * 1
12. Care recipient has dementia 0.063 * 0.021 −0.106 * 0.75 * 0.033 0.113 * 0.192 * 0.040 −0.003 −0.148 * −0.217 * 1
13. Care recipient has mental disorder 0.043 0.048 0.010 −0.004 −0.008 0.074 * 0.093 * −0.083 * −0.013 0.062 −0.011 0.081 * 1
14. Care recipient has disability 0.262 * 0.063 0.105 * 0.187 * 0.033 0.221 * 0.057 −0.034 −0.014 −0.0138 * −0.053 0.062 0.011 1
15. Care recipient has terminal disease 0.145 * −0.100 * −0.080 * 0.125 * 0.063 0.138 * 0.051 0.094 * −0.020 −0.112 * −0.142 * 0.000 −0.064 −0.058 1
16. Self-reported burden of care (SRB) 0.311 * 0.029 −0.134 0.244 * 0.045 0.329 * 0.265 * −0.015 −0.070 −0.135 * −0.024 0.303 * 0.060 0.137 * 0.166 * 1
1Primary = 0; 2Reference category = care recipient does not use formal support nor wants any = 0; * p< 0.05.
Int. J. Environ. Res. Public Health 2022,19, 14496 11 of 21
Table 4. Multiple regression analyses predicting ICs’ subjective burden during COVID-19.
Model 1
(Partial Model)
Model 2
(Partial Model)
Model 3
(Partial Model)
Model 4
(Full Model)
B Beta B Beta B Beta B Beta
Control
variables
Gender 0.579 * 0.099 0.486 * 0.083 0.266 0.046 0.243 0.042
Travel distance between IC and care recipient 0.026 0.003 0.265 0.028 0.060 0.006 0.109 0.012
Employment 0.125 0.021 0.574 0.098 0.532 0.091 0.475 0.081
Age 0.004 0.014 0.006 0.022 0.005 0.018 0.004 0.014
Informal caregiving situation’s variables
Provision of ADLs 1.568 *** 0.267 0.777 ** 0.132 0.694 ** 0.118
Provision of IADLs 0.449 0.026 0.816 0.047 0.855 0.049
Care duration −0.004 ** −0.116 −0.004 ** −0.119 −0.003 ** −0.098
Average hours of care per week 0.028 *** 0.220 0.022 *** 0.177 0.020 *** 0.163
Type of carer:
primary vs. secondary −0.422 −0.048 −0.519 −0.059
Type of carer:
primary vs. sharing equal responsibility −0.374 −0.057 −0.387 −0.059
Formal care status:
reference category 1vs. care recipient receives formal care
and would like more 1.484 *** 0.140 1.333** 0.126
Formal care status:
reference category 1vs. care recipient receives formal care
and does not need additional help 3.400 *** 0.391 3.157*** 0.363
Formal care status:
reference category1vs. care recipient does not receive
formal care but would like some 2.253 *** 0.337 1.992*** 0.298
Care recipient has temporary disease 0.027 0.004
Care recipient has chronic disease 0.172 0.027
Care recipient has dementia 1.269 *** 0.165
Care recipient has mental disorder −0.184 −0.016
Care recipient has disability −0.092 −0.012
Care recipient has terminal disease 0.808 0.060
F-statistic 1.372 12.966 20.610 15.592
Sig. of F-statistic 0.242 0.000 0.000 0.000
R-square 0.010 0.162 0.336 0.361
Adjusted R-square 0.003 0.150 0.319 0.338
Note: N = 544. B = unstandardized coefficients; beta = standardized coefficients;
1
ICs whose care recipients do not receive formal care and do not need any; * p< 0.05; ** p< 0.01;
*** p< 0.001; Source: author’s analysis based on original data.
Int. J. Environ. Res. Public Health 2022,19, 14496 12 of 21
A model containing only the control variables (Model 1 in Table 4) did not significantly
improve our ability to predict SRB scores compared to using no predictors, F (4, 539) = 1.372,
p= 0.242. The control variables of ICs hold weak explanatory power since by themselves
they explain just 0.3% of the variance in SRB. Model 2 (Model 1 with additional predictors,
namely, provision of ADLs and IADLs, duration of care, and average hours of care per
week) explains 15% of the variability in SRB. Model 3 evaluated the effects of all previous
variables plus type of carer and formal care status and explained 31.9% of the variability
in SRB. Model 4, with all control and caregiving situation variables, explains 33.8% of the
variability of SRB. There is a significant improvement in the model’s fit when all variables
are included in the model, F (4, 524) = 15.592, p< 0.001.
In Model 4, the caregiving situation variables with statistical differences in the means
of SRB are: provision of ADL (1 = IC provides at least one ADL, 0 = not providing), care
duration (measured in months), average hours of care per week, formal care status (see
four categories in Table 2), and recipient’s health problem related to dementia, senility, or
other serious memory problem (1 = dementia, 0 = no dementia).
The difference in means between those who provided ADLs and those who did not
was B = 0.694 (p= 0.002), with those who provided ADLs scoring higher on the SRB scale
than those who did not. The variable care duration was recorded as a scale variable with
values indicating the number of months from 0 to 576. B =
−
0.003 (p= 0.007) indicates that
for every additional month of care, a decrease of 0.003 in the burden score is predicted. Next,
the number of average hours of care per week was recorded as a scale variable, with values
ranging from 4 to 168. B = 0.020 (p< 0.001) indicates that for every additional average hour,
the SRB score is significantly higher by 0.020. The caregiving situation variable dementia,
senility, or other serious memory problem B = 1.269 (p< 0.001) indicates that as we change
our perspective from a group of care recipients with dementia to a group of care recipients
without it, an increase of 1.269 on the SRB is predicted. Finally, for the caregiving situation
variable formal care status, we created categories that combine information about whether
the IC’s care receiver receives formal support and whether they require more of it. The
reference category for this variable is the third category in Table 2, because it is the most
populated category of the four (n= 290). We created three dummy variables from the
rest of the three categories. The results show that the SRB score was significantly higher
in all three comparisons: first, as we change our perspective from the reference category
to a category of ICs whose care recipients receive formal care and need additional care
(
B = 1.333
;
p= 0.001
); second, as we change our perspective from the reference category to
a category of ICs whose care recipients receive formal care but do not need additional care
(B = 3.157; p< 0.001); and third, as we change our perspective from the reference category
to a category of ICs whose care recipients do not receive formal care but would like some
in the future (B = 1.992; p< 0.001).
Caregiving situation variables with no statistical differences in the means of SRB scores
were provision of IADLs (B = 0.855, p= 0.173), whether the care recipient had a temporary
disease (B = 0.027, p= 0.919), chronic disease (B = 0.172, p= 0.499), mental disorder
(
B = −0.184
,p= 0.649), terminal disease (B = 0.808, p= 0.115), or disability (
B = −0.092
,
p= 0.756), and type of carer. For the categorical variable type of carer (1 = primary,
2 = secondary
, 3 = shared), we chose the reference category as number 1 (n= 326) and
created two dummy variables for categories 2 and 3. Our results show that secondary
ICs (B =
−
0.519, p= 0.127) and shared care (B =
−
0.387, p= 0.115) had non-significant
differences in average SRB scores when compared to primary ICs. In line with expectations,
all four control variables—gender of IC (B = 0.243, p= 0.246), travel distance between IC
and care recipient (B = 0.109, p= 0.748), employment status of IC (B = 0.475, p= 0.086), and
age of IC (B = 0.004, p= 0.769)—had differences in group means that were not statistically
significant. We checked for multicollinearity issues by examining the values of the variance
inflation factor (VIF). VIF indicates whether a predictor has a strong linear relationship with
the other predictors. The values were between 1.051 and 1.826, which is acceptable [122].
Int. J. Environ. Res. Public Health 2022,19, 14496 13 of 21
4. Discussion
The current analysis provides new insights into the characteristics of the caregiving
situation of ICs of older people during the COVID-19 pandemic. Characteristics of the
caregiving situation of ICs were studied also as predictors of subjective care burden, as
measured on the SRB scale. While there is a lack of data linking specific contexts, care
recipients’ characteristics, and the burden of ICs [
123
], this study attempts to fill this
research gap. Two important findings emerged from this analysis regarding ICs’ SRB and
can be related to the research questions: (RQ1) better understanding of caregiving situation
and SRB during the COVID-19 in Slovenia; and (RQ2) the variables of the caregiving
situation in our model (provision of ADLs, duration of care, average hours of care per
week, caring for persons with dementia, and formal care status) explained 36.1% of the
variability in SRB scores.
Our study showed a complex picture of caregiving situation in Slovenia during the
pandemic, with more than half of ICs providing ADLs, a third of ICs providing care to
more than one older person, a high percentage (70%) of ICs providing care daily or almost
daily, and three quarters of ICs providing care for more than one year. As shown in another
Slovenian study [
34
] conducted a few years before the COVID-19 pandemic, formal care was
used by a small proportion of informal care recipients, resulting in a substantial care burden
for ICs years before the pandemic. As shown in a scoping study by Muldrew et al. [
91
], the
pandemic exacerbated existing issues related to informal caregiving and caused additional
issues. In our study, the ICs of older people who provided more demanding and intensive
care experienced a higher subjective burden of care. These findings are consistent with the
results of several other studies [
18
,
43
,
66
,
70
,
91
,
99
,
124
,
125
] that found a high and increased
caregiver burden during the COVID-19 pandemic. A German study of 1000 ICs [
66
] found
that 25.5% to 39.7% of ICs reported that their caregiving situations somewhat or greatly
worsened during the COVID-19 pandemic, especially among those caring for a person with
dementia or who normally relied on professional help. Our study also confirmed a higher
subjective burden among the ICs of people with dementia.
Multiple regression analysis showed that two variables, the formal care status of
the care recipient, and caring for a person with dementia or other severe memory loss,
are the two strongest predictors of SRB. Provision of ADLs, longer duration of care, and
higher average hours of care per week also predicted SRB, but to a lesser extent. These
results are consistent with the findings of a Japanese study on ICs [
70
]. The authors of the
Japanese study found that factors associated with increased caregiver burden during the
COVID-19 pandemic were ICs with depressive symptoms, care receivers with dementia,
care receivers with low scores for ADL performance, care days and times, and the use
of home care and visiting care services. Furthermore, a German study by Bergmann
and Wagner [
18
] found that ICs who cared for their parents during the first phase of the
pandemic in spring/summer 2020, and who increased the frequency of personal care,
reported significantly more psychological distress (e.g., sadness, depression, anxiety, and
nervousness). According to Rajovic et al. [
99
], caregiver burden is a mediating factor
between determinants of the caregiving process (ADL, duration of care, level of care
complexity, social support, financial support, and physical health) and indirect effects on
depressive symptomatology. A cross-sectional study on ICs in 41 Serbian municipalities
during the first phase of the pandemic found that more than two-thirds (71.9%) of ICs in
Serbia experienced a mild to severe burden, and more than one-quarter (27.1%) had mild
to severe depression symptomatology. They found that functioning capacity in ADL was
one of the most important predictors of IC burden. Other predictors of IC burden were
the duration of daily care, the level of care complexity, insufficient financial support, and
ICs’ self-perceived physical health. A study of 2468 ICs in several European countries [
20
]
and a Lithuanian study of ICs [
124
] found that women caregivers were significantly more
burdened than men. This was in contrast to our study and a German study of ICs of older
adults in the second wave of COVID-19 [
47
], which found no difference in caregiver burden
between genders. However, they did find higher levels of anxiety and lower quality of
Int. J. Environ. Res. Public Health 2022,19, 14496 14 of 21
life among female ICs than among male ICs. Cohen et al. [
125
] found that increases in
the burden of care in the early months of the pandemic were associated with increased
intensity of care. They also found that changes in care intensity and care burden were
complex and varied by gender. Interestingly, they found that men with higher initial care
intensity were more likely to have an increase in care burden due to the pandemic, but the
association was not significant for women.
According to the OECD working paper [
19
], ICs “are the first line of support for older
people in many countries and COVID-19 and responses have exacerbated challenges for
caregivers, as many of them had to provide care in a context of limited availability of
long-term care services”, which was also noted in our study. Therefore, they should be
identified as a priority group within the long-term care sector and receive direct support
for their informal care [
19
,
91
]. In addition, they should be legally recognized and, as
such, have access to a range of rights (e.g., social protection, financial support, pension,
respite care, information, training for better care, flexible work arrangements, and care
allowances) [
19
,
22
,
91
]. Public authorities need to promote a policy framework for the
creation of ICT-based solutions for ICs and beyond, as European policy has recognized the
role of these technologies in supporting aging in place [
126
–
128
] and ICs [
129
,
130
]. Several
studies [
130
–
134
] have identified a high potential for ICT-enabled solutions to improve the
well-being of ICs and reduce their care burdens, and these should be made available to ICs
and older people.
As mentioned, Slovenia has a familialistic model of care, where the family is not only
normatively but also legally obliged to help its older family members. At the same time, ICs
receive minimal support. The weakness of this system became even more apparent during
the COVID-19 pandemic, when limited access to home care and health services forced
families to take on even more responsibility for care. As expected, the results showed a
high level of caregiving intensity and self-rated burden among family members during
the pandemic. The results also showed that the formal care status of the care recipient
(whether or not they receive sufficient formal support), caring for a person with dementia
or other severe memory loss, and high care intensity (longer duration of care and higher
average hours of care per week) were relatively strong predictors of self-rated burden.
As mentioned, a high care burden and lack of support for ICs can have very negative
consequences for ICs and, in the long run, for the long-term care system. These results call
for urgent changes in Slovenian long-term care policy and demonstrate the need to support
ICs. We can say that the important lesson from the pandemic, also highlighted in this study,
is the need to better recognize and value informal care in Slovenia. The results of this
study, as well as a recently presented European care strategy that provides a framework
for improving the situation for both those in need of care and the people who care for
them professionally or informally and that also emphasizes the importance of supporting
ICs [31], will hopefully bring some improvements for ICs in Slovenia.
Limitations and Future Research Directions
Our results should be considered in the context of the study’s limitations. First, caution
should be exercised in interpreting the results, as they are applicable only to this sample
of ICs in Slovenia. Slovenian ICs may have a caregiving situation that is so specific to
the country of data collection that the results cannot be easily generalized to ICs in other
countries (e.g., a strong reliance on family for social support and a large proportion of ICs
living in multigenerational households) [
35
]. Second, this was a cross-sectional study, and
it is not known whether the caregiving situation and SCB are similar over time, especially
before and after the pandemic. It is also not possible to determine temporal relationships
to estimate SCB. Because most research in the area of informal care outcomes is based
on cross-sectional analyses [
135
], future longitudinal studies should examine caregiving
outcomes over time.
Third, our model was tested on a general population of ICs aged 40 to 85 years who
provided at least four hours per week of unpaid assistance with ADLs, IADLs, and/or
Int. J. Environ. Res. Public Health 2022,19, 14496 15 of 21
emotional support to at least one family member aged 65 years or older. Although gender,
employment, age, and travel distance between IC and the care recipient were included
as control variables in the regression model, the analysis could be improved if the model
were tested on different subgroups of the heterogeneous group of ICs. Indeed, there could
be significant differences in caregiving situations and SCB between different subgroups
of ICs defined by different sociodemographic characteristics. In particular, the oldest age
groups of ICs should be studied, as ICs aged 75+ are likely to become one of the fastest
growing segments of the caregiving population in coming years [
25
]. Future studies could
therefore “oversample older age groups, in order to have crucial information about this—
for long-term care services very important—target group” [
25
]. Further qualitative studies
could also examine specific subgroups of ICs, so that profound nuances of the caregiving
situation and SCB can be explored.
Fourth, only a limited number of predictors of SCB were examined in this study.
Although we included important characteristics of the caregiving situation, we could also
add, for example, characteristics of the relationship between IC and the care receiver,
support received for caring activities from the ICs’ social network, number of people
cared for, ICs’ financial resources, caregiver–care recipient co-residence, and frequency of
caregiving activities. In this way, the model could explain an even higher percentage of
the variance in the dependent variables. However, in deciding which predictors to include
in the exploratory regression model, a balance must be struck between being too narrow
and too broad. We have attempted to include a wide range of predictors identified in
various studies to gain a basic understanding of how they could significantly predict the
SCB of ICs.
Finally, future analysis could be enriched by performing a path analysis with additional
dependent variables, such as physical health (e.g., spinal disorders and pain conditions)
and mental health (e.g., depressive symptoms, anxiety, and stress), difficulties in social life,
labor market participation and social inclusion, and quality of life in general. In addition,
the SCB of ICs could be conceptualized and measured differently, taking into account
physical, social, and financial burdens.
Considering the above limitations and possible future research directions, it would
be worthwhile to conduct a longitudinal study and/or a cross-national comparative study
in the future. A comparison group with non-caregivers from population-based samples
could also be introduced in future studies to further investigate predictors of health-related
quality of life.
5. Conclusions
Many studies related to the outcomes of informal caregiving included care receivers
with a specific condition (e.g., dementia, cancer, or mental or physical disorders) and from
caregiving arrangements or situations. Many have also recruited only specific subgroups
of caregivers (e.g., female or spousal). Most studies do not assess an individual appraisal
of the ICs regarding their caregiving situations, or their motivations and outcomes [
135
].
As a response to this, our study is based on data that fit the Slovenian population of ICs
aged 40 years and over. It is also focused on care receivers aged 65 and older with different
conditions, characteristics, and situations. While many studies are based on selective and
convenience samples, we conducted a study with a sample from the general population to
be able to generalize the results. This is also one of the few national studies focusing on
caregiving situation characteristics and SCB during the pandemic phase in 2021. An original
feature of this study is that it is the only empirical study examining the caregiving situation
characteristics as predictors of SCB during the pandemic. Empirical analysis showed a high
caregiver burden during the COVID-19 pandemic. The caregiving situation variables that
significantly predicted SRB are: provision of ADL, care duration (measured in months),
average hours of care per week, formal care status, and recipients’ health problems related
to dementia, senility, or other serious memory problems. Further conceptual and empirical
research is needed to uncover the underlying mechanisms of the interplay between the
Int. J. Environ. Res. Public Health 2022,19, 14496 16 of 21
characteristics of the caregiving situation (which includes OCB) and SCB, as well as the
relationship between OCB and SCB.
Author Contributions:
Conceptualization, V.D. and S.H.-T.; methodology, S.H.-T., V.D. and M.T.;
validation, S.H.-T., V.D. and M.T.; formal analysis, M.T.; investigation, S.H.-T. and V.D., resources,
V.D.; data curation, S.H.-T. and V.D.; writing—original draft preparation, S.H.-T., V.D. and M.T.;
writing—review and editing, S.H.-T., V.D. and M.T.; visualization, S.H.-T., V.D. and M.T.; supervision,
V.D.; project administration, V.D. and S.H.-T.; funding acquisition, V.D. and S.H.-T. All authors have
read and agreed to the published version of the manuscript.
Funding:
The authors acknowledge that this study was financially supported by the Slovenian
Research Agency (Factors impacting intention to use smart technology enabled care services among
family carers of older people in the context of long-distance care, ID J5-1785; Digital transformation
of health and social care: Welfare technology acceptance and knowledge among current and future
healthcare and social care professionals ID J5-4578; Programme internet research, P5-0399).
Institutional Review Board Statement:
The study was conducted in accordance with Slovenian and
international codes of medical ethics, declarations, and conventions and the General Data Protection
Regulation (GDPR), and approved by the Committee for Ethics in Research at the Faculty of Social
Sciences University of Ljubljana (CER FSS) on 12 March 2021 (801-2021-020/JG).
Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.
Data Availability Statement:
The dataset is available in the PsychArchives repository (https://www.
psycharchives.org/); http://dx.doi.org/10.23668/psycharchives.8240 accessed on 1 November 2022.
Acknowledgments:
The authors would like to recognize and thank Nejc Berzelak for his valuable
assistance and advice in the survey data collection process.
Conflicts of Interest:
The authors declare no conflict of interest. The funders had no role in the design
of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or
in the decision to publish the results.
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