Current status and individual differences in the sense of benefit for family caregivers of older adults with disabilities
The 218 family caregivers of disabled older adults included in this study had a sense of benefit score of 57.00 (47.00, 67.25), and the overall score was lower than that of Wang Ruting[21] and Zhu Xiaojia[34] among primary caregivers of patients with ischemic stroke and caregivers of patients with dementia, suggesting that family caregivers of disabled older adults perceive benefits but at a low level when coping with caregiving tasks. Potential profile analysis yielded three potential categories of family caregivers of disabled older adults that could be categorized into a low level of perceived benefit group, a medium level of perceived benefit group, and a high level of perceived benefit group, suggesting heterogeneity in the perception of benefit among family caregivers. Among them, 12.84% of the family caregivers of the disabled elderly belonged to the high-level sense of benefit group, with total caregiver sense of benefit scores ranging from 75 to 108, and the highest scores on the personal growth dimension. The reason may be that most of the family caregivers of the disabled elderly under 40 years old in this category have strong self-regulation ability, and they can adjust their mindset in time and rationalize their time in the face of the caregiving experience, so that they can better deal with the stress and problems. 43.58% of the family caregivers of the disabled elderly belonged to the intermediate level of benefit group, with the total score of the caregiver's sense of benefit ranging from 47 to 77 and the scores of the dimensions in the middle position, indicating that this category of the disabled elderly belongs to the high level of benefit group. This indicates that family caregivers of older adults with disabilities in this category received relatively balanced benefits across all dimensions.43.58% of family caregivers of older adults with disabilities were in the low level of benefit group, with caregiver perception of benefit scores ranging from 31 to 63, and the lowest scores on the health behaviors dimension. This may be related to the low level of literacy among family caregivers of disabled older adults in this category. Previous studies have found that literacy is a protective factor for health literacy in the population, and family caregivers of disabled older adults with a high level of literacy are able to use multiple channels to acquire health knowledge, cope with the challenges of caregiving, and guide their own health behaviors as well as the health behaviors of their disabled older adults[35]. In addition the three categories also scored at a low level on the social relationship dimension, which may be due to the fact that caring for the disabled elderly is a long and tedious task, and that caregivers mostly live with the elderly, which prevents them from interacting with their relatives and friends, and reduces their utilization of external social support. The results of this study suggest that family caregivers of the disabled elderly are a special group that deserves the attention of society. Healthcare professionals and community workers should take reasonable and effective interventions to meet the needs of different types of family caregivers of the disabled elderly in combination with the relevant influencing factors, to enhance their positive feelings during the caregiving process, and to improve the quality of life and satisfaction of both caregivers and the disabled elderly.
Factors Influencing Potential Categories of Sense of Benefit for Family Caregivers of Disabled Older Adults
Years of care and work status
The results of this study showed that care duration < 1 year was a risk factor (OR = 0.349, P = 0.026) and 1 year ≤ care duration < 3 years was a protective factor(OR = 2.751, p = 0.043) for the perception of benefit for family caregivers of disabled older adults.This finding was not found in the Wang's study [36]. The reason for this may be that family caregivers of disabled older adults with < 1 year of caregiving have not yet fully adapted to the sudden role change physically and psychologically, and have a lower level of mastery of caregiving skills and relatively poor caregiving ability, which diminishes their perception of the positive aspects of caregiving tasks[37].The family caregivers' perception of the positive aspects of the caregiving task is weakened. For 1 year ≤ care duration < 3 years caregivers, their psychological adaptability improved over time, and they had a more positive understanding and appreciation of their caregiving role, making it easier for them to obtain the benefits of family caregiving[12]. This suggests that clinical staff and community workers should encourage family caregivers of disabled older adults with 1 year ≤ caregiving < 3 years to share their caregiving experiences to enhance the sense of belonging to them among other caregiver groups. Meanwhile, comprehensive health education and training programs should be conducted for family caregivers of disabled older adults with < 1 year of caregiving to enhance their caregiving abilities and help them better explore the positive effects of caregiving. This study also found that working family caregivers of the disabled elderly had a lower level of perceived benefit than retired and separated family caregivers of the disabled elderly (OR = 0.360, p = 0.027), whereas in the Mei et al.[38] 's study did not find this effect of work status on caregivers' sense of benefit. This may be due to the fact that the average age of the working family caregivers of disabled older adults included in this study was (47.91 ± 10.77) years old and the cause of the caregiver's disability was predominantly illness, requiring long-term medication or hospitalization. Caregivers are not only responsible for the daily care of the disabled elderly, but also have to pay high costs to maintain home care, which makes them prone to adverse emotions and difficult to experience the positive aspects of the caregiving process. Furthermore, the results of a meta-analysis showed that mental health education can benefit caregivers by alleviating negative emotions and caregiving burdens[39]. Therefore, society and families should also pay attention to working family caregivers of the disabled elderly, providing one-on-one or peer-led psychological counseling activities and positive motivation when appropriate according to their psychological conditions. They should be assisted in organizing their caregiving time, and respite services should be provided when necessary to reduce the burden of caregiving and enhance the caregivers' sense of benefit.
Family function
Logistic regression results showed that the level of BFS among family caregivers of disabled older adults was higher the better the family functioning (OR = 1.146, p = 0.019), which is consistent with the findings of Mei[38]. In the process of caring for the disabled elderly, caregivers often face the dual challenges of caregiving tasks and psychological pressure, and a sound family structure and close family relationships can provide them with continuous spiritual motivation to overcome difficulties, and give material help to family caregivers of the disabled elderly at the right time, which is conducive to the family caregivers of the disabled elderly to better achieve a balance between the caregiving tasks and their personal lives, to reduce the negative impact of caregiving, and to reduce their perception of the benefits of the caregiving work. A before-and-after controlled study in Broekema found that interventions based on improving family functioning helped to alleviate caregiver burden.[40] This suggests that family members should work together to fulfill the role of family cohesion. This suggests that family members should work together as a cohesive family to care for the family caregiver who is the primary caregiver for the older person with disabilities, and to improve communication with the family caregiver in order to assist them in their daily caregiving tasks. Community workers should also pay attention to the establishment of a community support system. For family caregivers of the disabled elderly with family dysfunction, they should be mobilized to actively participate in community activities, carry out one-on-one or peer-led psychological counselling activities, increase the number of ways to talk about their worries, and recognize the efforts of family caregivers of the disabled elderly, so as to make them feel cared for outside of the family, and to enhance their sense of benefit.
Coping tendency
Logistic regression results showed that the level of perceived benefit for family caregivers of disabled older adults with a positive coping tendency was higher than that of caregivers with a negative coping tendency (OR = 2.054, p < 0.001), which was consistent with the results of the study conducted by Zhang[41]findings conducted with caregivers of hospitalized lung cancer patients, respectively. Coping style is an individual's tendency to take cognitive and behavioral measures when facing a stressful event, which determines the individual's subsequent attitudes and behaviors[42]. When family caregivers of disabled older adults face caregiving burdens, positive coping styles can reduce caregiver burdens[43]. It helps caregivers to adjust their emotions in a timely manner, increase their satisfaction with their caregiving work, better integrate family and social resources, gain more affirmation from the disabled older adults and their families, and more easily perceive the positive impact of the caregiving process. At the same time, family caregivers of disabled older adults with positive coping tendencies are mostly able to face the difficulties in the process of caregiving, which is to some extent conducive to the enhancement of caregiving ability, enabling them to perceive benefits in terms of mindfulness and knowledge and skills[44]. Therefore, clinical staff and community workers should guide family caregivers of older adults with disabilities to adopt positive coping styles. At the same time, they should pay attention to the influence of psychological state on the sense of benefit, and adopt self-expression and positive stress reduction to help family caregivers of the disabled elderly to express negative emotions, to understand the role of caregiving with a more positive perspective, and to improve the quality of caregiving.
There are a number of limitations to this study. First, this study is only a cross-sectional survey that does not consider the possibility of changes in family caregivers' sense of benefit over time and context of caregiving for older adults with disability, and lacks a long-term follow-up survey. A longitudinal study is recommended for further in-depth research. In addition, this study based on and literature review only analyzed three variables: family function, sense of coherence, and coping tendency, and did not include other relevant psychosocial factors in the analysis. In the follow-up study, we can try to include more relevant factors so that the analysis of the factors influencing BFS from caregiving can be more comprehensive and in-depth.