WHY: Family caregivers provide the majority of long-term care for chronically disabled older adults. Caregiver strain is the perception of persistent problems and a feeling of decreased well-being that results from providing prolonged care. Caregiver strain is associated with burnout of caregivers and premature institutionalization of care-recipients along with unmet care-recipient needs. Caregivers may be prone to depression, grief, fatigue, financial hardship, and changes in social relationships. They may also experience physical health problems (Thornton & Travis, 2003). Screening tools are useful to identify families who would benefit from a more comprehensive assessment of the caregiving experience.

BEST TOOL: The Modified Caregiver Strain Index (MCSI) is an easy-to-use tool that can quickly screen for caregiver strain in long-term caregivers. The tool has 13 questions that measure strain related to care provision. There is at least one item for each of the following major domains: Financial, Physical, Psychological, Social, and Personal. This instrument can be used to assess individuals of any age who have assumed the caregiving role for an older adult. The Modified Caregiver Strain Index (MCSI) is a more recent version of the Caregiver Strain Index (CSI) developed in 1983. The MCSI was modified and developed in 2003 with a sample of 158 family caregivers providing assistance to older adults living in a community-based setting. Scoring is 2 points for each 'yes', 1 point for each 'sometimes', and 0 for each ‘no’ response. Scoring ranges from 26 to 0; a higher score indicates a higher level of caregiver strain (Travis et al., 2003; Thornton & Travis, 2003).

VALIDITY AND RELIABILITY: The internal reliability coefficient is slightly higher (=.90) than the coefficient originally reported for the CSI in 1983 (=.86). Two-week retest data for one-third of the caregiving sample (n=53) was available and resulted in a test-retest reliability coefficient of .88 (Thornton & Travis, 2003). The MCSI has been translated into Chinese and has been shown to be valid and reliable in Chinese caregivers (n=223) (=.91) (Chan, Chan, & Suen, 2013).

STRENGTHS AND LIMITATIONS: The MCSI is a brief, convenient, self-administered instrument that is easy to score. Long-term family caregivers were not comfortable with the dichotomous choice on the CSI; the modified instrument provides the ability to choose a middle category response best suited to some situations (Travis et al., 2003). The MCSI clarifies and updates many of the items on the original instrument.  Increased understanding of the strain experienced by caregivers with differing ethnicities, health, and amount of support may lead to targeted interventions for those caregivers. Additionally, identifying the effects of care-recipients’ level of illness and disability may provide insight into more individualized strategies for reducing caregiver strain. Caregiver strain scores are not categorized as low, moderate, or high, so professional judgment is needed to evaluate the level of caregiver strain by total score. The tool effectively identifies families who may benefit from more in-depth assessment and follow-up. 

FOLLOW-UP: The higher the score on the MCSI, the greater the need for more in-depth assessment to facilitate appropriate intervention. Additional items and further efforts to develop and test a set of subscales could enhance the applicability of the instrument for research and practice. The older adult care-recipient’s cognitive status and problematic behaviors should be assessed as well as the caregiver's perception of role overload or deprivation in key relationships, goals, and activities. Family conflict, work role-caregiving conflict, financial strain, and caregiver social support are also important variables in the overall caregiving experience. Additional work with highly strained long-term caregivers who are receiving little or no formal services is indicated.

MORE ON THE TOPIC:

Ain, Q.U., Dar, N.Z., Ahmad, A., Munzar, S., & Yousafzai, A.W. (2014). Caregiver stress in stroke survivor: data from a tertiary care hospital -a cross sectional survey, BMC Psychology, 2(1), 1-7.doi: 10.1186/s40359-014-0049-9

Chan, W.C., Chan, C.L., & Suen, M. (2013). Validation of the Chinese version of the Modified Caregivers Strain Index among Hong Kong caregivers: An initiative of medical social workers. Health and Social Work, 38(4), 214-221.

Cooper, D.L, Powe, B.D, & Smith, T. (2013). Social support provided by and strain experienced by African-American cancer caregivers. Support Care Cancer, 21(10), 2719–2725. doi: 10.1007/s00520-013-1849-9

Jennings, L.A., Reuben, D.B., Evertson, L.C., Serrano, K.S., Chodosh, J., Tan, Z., Wenger, N.S., Ercoli, L., & Grill, J. (2015). Unmet needs of caregivers of individuals referred to a dementia care program. JAGS, 63(2), 282-289. doi: 10.1111/jgs.13251

Kelly, D.H., McGinley, J.L., Huxham, F.E., Menz, H.B., Watts, J.J., Iansek, R., Murphy, A.T., Danoudis, M., Adair, B., & Morris, M.E. (2012). Health-related quality of life and strain in caregivers of Australians with Parkinson's disease: An observational study BMC Neurology, 12(1), 57-63. doi: 10.1186/1471-2377-12-57

Ogunlana, M.O., Dada, O.O., Oyewo, O.S., Odole, A.C., & Ogunsan, M.O. (2014). Quality of life and burden of informal caregivers of stroke survivors. Hong Kong Physiotherapy Journal, 32(1), 6-12. doi: 10.1016/j.hkpj.2013.11.003

Robinson, B.C. (1983). Validation of a Caregiver Strain Index. Journal of Gerontology, 38(3), 344-348.

Thornton, M., & Travis, S.S. (2003). Analysis of the reliability of the Modified Caregiver Strain Index. The Journals of Gerontology, 58B(2), S127-S132.

Travis, S.S., Bernard, M.A., McAuley, W.J., Thornton, M., & Kole, T. (2003). Development of the Family Caregiver Medication Administration Hassles Scale. The Gerontologist, 43(3), 360-368.

Wolff, J.L., Giovannetti, E.R., Boyd, C.M., Reider, L., Scharfstein, D., Marsteller, J. Wegener, S.T., Frey, K., Leff, B., Frick, K.D., Boult, C., & Palmer, S. (2010). Effects of guided care on family caregivers. Gerontologist, 50(4), 459-470. doi:10.1093/geront/gnp124