(1264) Assessment of the Relationship Between Stress and Quality of Life Among Informal Caregivers of Older Adults with Alzheimer’s Disease and Children with Autism Spectrum Disorder

Objectives: This study aimed to understand the appraisal process for quality of life (QOL) among informal caregivers and compare informal caregivers of older adults and children with respect to this process. Informal caregivers provide timely and inexpensive care to those who are disabled or have chronic conditions. Caregiver health outcomes include QOL and this study focuses on an important predictor of QOL, namely stress, and explores how coping strategies may mediate the relationship between these variables. The Transactional Stress Theory attempts to understand perceived stressors, coping mechanisms, and outcomes and was used as the conceptual framework for this study. Given that pharmacy services and pharmacists’ interdisciplinary collaborations could potentially bridge some gaps in caregiver support, understanding the determinants of caregiver QOL and how this appraisal process may differ between caregivers supporting different age groups is important.

Methods: This prospective cross-sectional study utilized a web-based survey to gather data from two distinct groups of informal caregivers: those caring for older adults with Alzheimer’s disease (AD) and those caring for children with autism spectrum disorder (ASD). A national convenience sample of caregivers of patients with AD or ASD was obtained from a market research vendor. Caregivers were eligible to participate in the study if they were adults (≥ 18 years of age) and provided unpaid care either to an older adult (≥65 years) with AD or a child ( < 18 years) with ASD. A total of 1,239 caregivers were invited to respond to the survey. The survey included previously-developed scales as well as several questions about socio-demographic characteristics. For QOL, the World Health Organization Quality of Life – Brief (WHOQOL-BREF) assessment was used (subscales of physical, psychological, environment, and social relationships were used as indicators of a global latent QOL variable). The Perceived Stress Scale (PSS) was used to assess stress. For coping strategies, the Brief Coping Orientation to Problems Experienced scale (Brief COPE) was used, and three subscales were formed: emotion-focused coping, problem-focused coping, and dysfunctional coping. Structural equation modeling was employed to assess the mediating role of coping behaviors in the relationship between perceived stress and QOL. Furthermore, multiple-groups analysis was performed to evaluate differences between the caregiver groups in terms of direct and indirect effects. Socio-demographic characteristics were included as control variables. Model estimates and 95% bootstrap confidence intervals (CIs) are reported.

Results: A total of 574 caregivers responded to the survey; 417 had complete valid responses on all measures. Out of these, 210 (50.4%) were AD patient caregivers and 207 (49.6%) were ASD patient caregivers. Large proportions of caregivers in both groups were female, White, aged 31-45 years, and lived in a suburban area. In model testing, perceived stress was negatively associated with global QOL for both groups (i.e., direct effects) (estimate=-0.201, 95% CI: -0.241 to -0.164 for the ASD caregiver group; estimate=-0.168, 95% CI: -0.201 to -0.137 for the AD caregiver group). The only statistically significant indirect effect was the perceived stress on global QOL through dysfunctional coping for the AD caregiver group (estimate=-0.026, 95% CI: -0.048 to -0.005). None of the differences in indirect and direct effects between the two caregiver groups were found to be statistically significant.

Conclusions: This study underscores the impact of perceived stress on QOL among informal caregivers, irrespective of the condition of the patient cared for, be it AD or ASD. Caregiver coping strategies did not appear to play a significant role in mediating this relationship. Pharmacists can offer patient-centric services, including those aimed at reducing medication burden, to assist with caregivers’ stress. Collaborative relationships with mental health professionals for referrals and other services might also ultimately help enhance patient QOL.