title: Difficulty assisting with health care tasks among caregivers of multimorbid older adults.
abstract: BACKGROUND
  Family caregivers provide assistance with health care tasks for many older adults with chronic illnesses. The difficulty they experience in providing this assistance, and related implications for their well-being, have not been well described.
  
  
  OBJECTIVE
  The objectives of this study are: (1) to describe caregiver's health care task difficulty (HCTD), (2) determine the characteristics associated with HCTD, and (3) explore the association between HCTD and caregiver well-being.
  
  
  METHODS
  This is a cross-sectional study.
  
  
  METHODS
  Baseline sample of caregivers to older (aged 65+ years) multimorbid adults enrolled in an ongoing cluster-randomized controlled trial (N = 308).
  
  
  METHODS
  The HCTD scale (0-16) is comprised of questions measuring self-reported difficulty in assisting older adults with eight health care tasks, including taking medication, visiting health care providers, and managing medical bills. Caregivers were categorized using this scale into no, low, medium, and high HCTD groups. We used ordinal logistic regression and multivariate linear regression analyses to examine the relationships between HCTD, caregiver self-efficacy, caregiver strain (Caregiver Strain Index), and depression (Center for Epidemiological Studies Depression Scale), controlling for patient and caregiver socio-demographic and health factors.
  
  
  RESULTS
  Caregiver age and number of health care tasks performed were positively associated with increased HCTD. The quality of the caregiver's relationship with the patient, and self-efficacy were inversely associated with increased HCTD. A one-point increase in self-efficacy was associated with a significant lower odds of reporting high HCTD (OR, 0.64; 95% CI, 0.54, 0.77).Adjusted linear regression models indicated that high HCTD was independently associated with significantly greater caregiver strain (B, 2.7; 95% CI, 1.12, 4.29) and depression (B, 3.01; 95% CI, 1.06, 4.96).
  
  
  CONCLUSIONS
  This study demonstrates that greater HCTD is associated with increased strain and depression among caregivers of multimorbid older adults. That caregiver self-efficacy was strongly associated with HCTD suggests health-system-based educational and empowering interventions might improve caregiver well-being.
authors.affiliation: Division of Geriatrics, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA erandgi1@jhmi.edu
authors.forename: Erin R
authors.initials: ER
authors.lastname: Giovannetti
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Wolff
authors.forename: Qian-Li
authors.initials: QL
authors.lastname: Xue
authors.forename: Carlos O
authors.initials: CO
authors.lastname: Weiss
authors.forename: Bruce
authors.initials: B
authors.lastname: Leff
authors.forename: Chad
authors.initials: C
authors.lastname: Boult
authors.forename: Travonia
authors.initials: T
authors.lastname: Hughes
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Boyd
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006701:Home Nursing / Q000379:methods / Q000523:psychology*; D006801:Humans; D008297:Male; D013315:Stress, Psychological / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires