Caregiving has become more visible with growing ranks of persons providing care to older adults.  Currently, an estimated 43.5 million people in the United States provide care for an older adult family member.  The majority of caregivers are female and are often employed (National Alliance for Caregiving, 2015).  Diversity in caregiving service delivery structures occurs across cultural groups, with variation in the role of family vs formal (paid) providers, and the specific intra-family role expectations (Gallagher-Thompson et al., 2000; Roth et al., 2003).

Along with social and emotional support, family caregivers assist with instrumental activities of daily living such as managing medications, appointments, transportation, and finances.  As diseases progress, caregivers may perform activities of daily living, such as dressing, bathing, feeding, and assistance with ambulation (O’Malley & Qualls, in press). Concern about the burdens of care on caregivers has spawned research that has documented the negative effects of caregiving on health that can include reduced immune function, increased levels of stress hormones, and increased rates of depression and anxiety (Connell et al., 2001; Joling et al., 2010; Magliano, Fiorillo, De Rosa, Malangone, & Maj, 2005; National Alliance for Caregiving, 2015; Roth et al., 2013; Schulz & Beach, 1999; Vitaliano, Murphy, Young, Echeverria, & Borson, 2011).

Consequently, the caregiving experience has been primarily conceptualized as burden and stress (Carbonneau, Caron & Desrosiers, 2010), with the main focus of research on the negative physical and emotional effects of the caregiving experience (i.e., burden and stress; Connell et al., 2001; Etters, Goodall, & Harrison, 2008; Pearlin et al., 1990).

The recent growth of research and intervention programs has increased our understanding of how multi-faceted the caregiving experience is (Matsumoto et al., 2007; Mosquera et al., 2015; Pearlin, Mullan, Semple, & Skaff, 1990; Zarit, Femia, Kim, & Whitlatch, 2010).  Caregivers can perceive their role positively and experience a sense of growth, competence, and fulfillment.  Some caregivers find their role enjoyable, satisfying, and gratifying (Connell et al., 2001), and many report feelings of self-growth, mastery, increased self-esteem, self-efficacy, and competence (Pearlin, Mullan, Semple, & Skaff, 1990).

A full biopsychosocial assessment can identify challenges and risks of caregiving.  Key components of a multi-disciplinary assessment include the caregiver’s burden, strengths, caregiver understanding and acceptance of the care recipient’s condition (O’Malley & Qualls, in press; O’Malley & Qualls, 2016), and overall health and well-being along with assessment of the family system (O’Malley & Qualls, 2016), the cultural, social, and spiritual meaning of caregiving, and sources of support (both within the family system and in the community).  Some common assessments of the caregiving experience include the Zarit Burden Interview (ZBI; Zarit, Orr, & Zarit; 1985) and the Caregiver Reaction Scale (CRS; O’Malley & Qualls, 2016).  Assessments of behavior problems include the Revised Memory and Behavior Problem Checklist (RMBPC; Teri et al., 1992) and the Behavior Problem Checklist (BPC; O’Malley & Qualls, in press).  For more information on specific assessment tools, see the APA Caregiver Briefcase (www.apa.org/pi/about/publications/caregivers/index.aspx) and the Rosalyn Carter Institute website (www.rosalynncarter.org).

Several interventions are helpful in working with caregivers. Theoretical models for working with caregivers include family systems, person-environment, medical family therapy, stress and coping model, and the illness beliefs model.  Intervention strategies commonly used with caregivers are psychoeducation, support groups, individual therapy, and family intervention. Higher rates of effectiveness are produced by interventions that are tailored to address particular needs (Belle et al., 2006; Collins, Murphy, & Bierman, 2004; Mittleman, Roth, Coon, & Haley, 2004; Zarit, Femia, Kim, & Whitlatch, 2010).  These interventions have been shown to be successful in reducing burden and increasing quality of life (Pinquart & Sörensen, 2006).  Higher rates of effectiveness are produced by interventions that involve multiple contacts over time, use specific intervention protocols, are tailored to specific needs, involve multiple components, include other family members, and are delivered locally and/or in-home including options using technology (Belle et al., 2006; Mittleman et al., 2004; Qualls & Williams, 2013; Zarit, 2009).

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