title: Strain and its correlates among carers of people with dementia in low-income and middle-income countries. A 10/66 Dementia Research Group population-based survey.
abstract: OBJECTIVE
  In a multi-site population-based study in several middle-income countries, we aimed to investigate relative contributions of care arrangements and characteristics of carers and care recipients to strain among carers of people with dementia. Based on previous research, hypotheses focused on carer sex, care inputs, behavioural and psychological symptoms (BPSD) and socioeconomic status, together with potential buffering effects of informal support and employing paid carers.
  
  
  METHODS
  In population-based catchment area surveys in 11 sites in Latin America, India and China, we analysed data collected from people with dementia and care needs, and their carers. Carer strain was assessed with the Zarit Burden Interview.
  
  
  RESULTS
  With 673 care recipient/carer dyads interviewed (99% of those eligible), mean Zarit Burden Interview scores ranged between 17.1 and 27.9 by site. Women carers reported more strain than men. The most substantial correlates of carer strain were primary stressors BPSD, dementia severity, needs for care and time spent caring. Socioeconomic status was not associated with carer strain. Those cutting back on work experienced higher strain. There was tentative evidence for a protective effect of having additional informal or paid support.
  
  
  CONCLUSIONS
  Our findings underline the global impact of caring for a person with dementia and support the need for scaling up carer support, education and training. That giving up work to care was prevalent and associated with substantial increased strain emphasizes the economic impact of caring on the household. Carer benefits, disability benefits for people with dementia and respite care should all be considered.
authors.affiliation: King's College London, (Institute of Psychiatry, Centre for Global Mental Health, Health Service and Population Research Department), London, UK. m.prince@iop.kcl.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.forename: Henry
authors.initials: H
authors.lastname: Brodaty
authors.forename: Richard
authors.initials: R
authors.lastname: Uwakwe
authors.forename: Daisy
authors.initials: D
authors.lastname: Acosta
authors.forename: Cleusa P
authors.initials: CP
authors.lastname: Ferri
authors.forename: Mariella
authors.initials: M
authors.lastname: Guerra
authors.forename: Yueqin
authors.initials: Y
authors.lastname: Huang
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Llibre Rodriguez
authors.forename: Aquiles
authors.initials: A
authors.lastname: Salas
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Sosa
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Williams
authors.forename: A T
authors.initials: AT
authors.lastname: Jotheeswaran
authors.forename: Zhaorui
authors.initials: Z
authors.lastname: Liu
mesh_terms: D000367:Age Factors; D000704:Analysis of Variance; D017028:Caregivers / Q000523:psychology*; D002681:China; D003704:Dementia / Q000451:nursing* / Q000523:psychology; D005260:Female; D006801:Humans; D007182:Income; D007194:India; D007843:Latin America; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000209:etiology*; D011795:Surveys and Questionnaires