Caregiver Burden as Impacted by COVID-19: Translation of a Rapid Review to Clinical Recommendations

Abstract

<h3>Introduction</h3> The research on caregiver burden among caregivers of individuals with neurodegenerative diseases has been growing throughout the past few decades, allowing health professionals to gain an understanding of the challenges faced by caregivers and provide important recommendations and interventions to reduce caregiver burden. Currently, a new set of challenges has arisen as the US faces the novel Coronavirus disease (COVID-19) pandemic, which disproportionally impacts older adults. Given that the risk of COVID-19 illness severity increases with age, older adults have been advised to self-quarantine and follow stay-at-home orders put in place by government officials. This physical isolation is purported to lead to decreased social interaction and physical activity among older adults and their caregivers, removing protective factors for overall well-being, aging, and quality of life, and subsequently increasing caregiver burden. Despite the assumed impact of the COVID-19 pandemic on caregivers of individuals with neurodegenerative diseases, a rapid review of the current body of literature is critical to provide a summary of work being conducted in this emerging area. As such, the current presentation aims to disseminate the findings of a rapid literature review and lessons learned from translating the findings into clinical recommendations. <h3>Methods</h3> Source documents for this literature review were identified through a computerized search using the <i>APA PsychInfo Database</i> and <i>Google Scholar</i> covering the year 2019 to 2020. The following keywords, and combinations of these were utilized: <i>"Caregiver," "Caregiver Burden," "Family Caregiver," "Burden," "Dementia," "Alzheimer's Disease,"</i> and <i>"COVID-19."</i> All English-Language journal articles that appeared to be relevant for this literature were read. After applying exclusion criteria (i.e. articles unrelated to the COVID-19 Pandemic or those that did not assess caregiver burden associated with older adults), 21 peer-reviewed articles warranted inclusion. <h3>Results</h3> After rapid review of the available literature to date, a total of 12 articles in our review assessed for the impact of COVID-19 on caregiver burden. Six articles indicated that the worsening of patients' behavioral and psychological symptoms, an increase in patients' functional impairment, being the sole caregiver, and increased daily hours of care have all been associated with increased caregiver burden and depression. Additional factors such as social support, coping strategies, mindfulness, reduction of social isolation, reinforcement of positive activities, and acceptance of role change and loss, among others, have been identified to protect against caregiver burden, as assessed by 3 articles included in our review. <h3>Conclusions</h3> As the Centers for Disease Control and Prevention (CDC) and government officials continue to urge the public to practice social distancing by staying home and keeping interaction with people outside of the household to a minimum, increased experiences of social isolation and continued reduction of readily available outside resources due to the global pandemic is expected to greatly impact caregivers and related caregiver burden. Within the past year, researchers have answered the call to better understand the impact of the COVID-19 pandemic through substantial and timely contributions giving unique insights to help guide practice and future research. Within the research to date, the long-term effects of COVID-19 on caregivers and caregiver burden remain unknown. Gaining an understanding of the impact of COVID-19 on caregivers will serve to inform caregivers and health professionals about treatment and interventions, as well as raise awareness of the lasting impact COVID-19 will continue to have over the coming years. In order to summarize and disseminate timely findings, the current review highlights the dimensions of caregiving that affect the caregiver and the person being cared for; it will also address how those dimensions have been impacted by the COVID-19 pandemic. As seen in our clinical practice, older adults are now faced with additional obstacles when it comes to aging successfully. The burden of adapting and facilitating successful aging within the pandemic complicates the burden already felt by the caregiver, compromising the caregiver's self-care and quality of life. Implications of this review will serve to call attention to the impact COVID-19 has had and continues to have on caregivers and patients with neurodegenerative diseases, touch on the experiences and consequences of caregiver burden, and will further provide concrete translational clinical recommendations of these findings to improve patient care and outcomes. <h3>Funding</h3> N/A.