Work-family balance among caregivers of elderly people: a systematic review

Medeiros, Thaís Juliana; Barbosa, Gustavo Carrijo; Alves, Ludmyla Caroline de Souza; Gratão, Aline Cristina Martins

doi:10.1590/2526-8910.ctoAR241831542

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Review Article • Cad. Bras. Ter. Ocup. 30 • 2022 • https://doi.org/10.1590/2526-8910.ctoAR241831542 copy

Work-family balance among caregivers of elderly people: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Active workers may experience role conflict when trying to reconcile work and caregiving activities with elderly family members.

Objective

To carry out a systematic review of empirical research on work-family balance among caregivers of the elderly.

Method

Scopus, PubMed, Scielo, BVS, Web of Science and PsycInfo databases were consulted to identify research published from 2015 to 2020.

Results

20 articles were identified and categorized as follows: 1. Caregivers of elderly people with dementia and cancer; 2. Gender; 3. Sandwich Generation and Baby Boomers; and 4. Individual and collective coping strategies. It was highlighted that there are specificities in the work-family balance that can favor both positive and negative spillovers; therefore, they must be considered in the planning of individual and collective strategies.

Conclusion

In order to favor work-family balance, the choices between work and family responsibilities should be studied, as well as expanding this narrow framework through the analysis of aspects involving gender, biography, cultural norms, social values, economic aspects and political solutions available to these workers.

Keywords:
Work-life balance; Caregivers; Aged

Author	Delimitation	Objective	Instruments	Conclusions
Honda et al. (2015)Honda, A., Abe, Y., Date, Y., & Honda, S. (2015). The impact of multiple roles on psychological distress among japanese workers. Safety and Health at Work, 6(2), 114-119. http://dx.doi.org/10.1016/j.shaw.2014.12.004. http://dx.doi.org/10.1016/j.shaw.2014.12...	Cross-sectional quantitative study.	To examine the differential impact of various roles associated with psychological distress among Japanese workers.	Kessler Psychological Distress Scale (K10).	Participants who had only one job function had an increased risk of psychological distress.
Hansen & Slagsvold (2015)Hansen, T., & Slagsvold, B. (2015). Feeling the squeeze? the effects of combining work and informal caregiving on psychological well-being. European Journal of Ageing, 12(1), 51-60. http://dx.doi.org/10.1007/s10433-014-0315-y. http://dx.doi.org/10.1007/s10433-014-031...	Cross-sectional quantitative study.	To assess how work and informal care interact, affecting the psychological well-being of employees according to the working day.	Sociodemographic Questionnaire, Satisfaction with Life Scale, Positive and Negative Affect Schedule, Center for Epidemiological Studies Depression Scale, Loneliness Scale, Short Form Health Survey.	Caring at home is related to lower psychological well-being, but only among women who do not work full-time.
Lee & Tang (2015)Lee, Y., & Tang, F. (2015). More caregiving, less working: caregiving roles and gender difference.Journal of Applied Gerontology, 34(4), 465-483.	Cross-sectional quantitative study.	To examine the relationship between caregiving roles and workforce participation.	Sociodemographic and current employment status questionnaire.	Women caregivers of parents and/or grandchildren were less likely to be in the workforce than non-caregivers.
Lee et al. (2015)Lee, Y., Tang, F., Kim, K. H., & Albert, S. M. (2015). The vicious cycle of parental caregiving and financial well-being: a longitudinal study of women. The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, 70(3), 425-431. http://dx.doi.org/10.1093/geronb/gbu001. http://dx.doi.org/10.1093/geronb/gbu001...	Longitudinal quantitative study.	To assess the relationship between caring for elderly parents and the financial well-being of caregivers.	Sociodemographic questionnaire, total family income.	Women tend to have negative economic outcomes as a result of caring for elderly parents.
Jolanki (2015)Jolanki, O. (2015). To work or to care? Working women’s decision-making. Community Work & Family, 18(3), 268-283. http://dx.doi.org/10.1080/13668803.2014.997194. http://dx.doi.org/10.1080/13668803.2014....	Cross-sectional qualitative study.	To analyze how working women help their parents or in-laws.	Semi-structured interviews, adapted to the narratives of the interviewees.	While working-women can take on caring responsibilities, most of them reject the idea of leaving work to care.
Lkhoyaali et al. (2015)Lkhoyaali, S., El Haj, M. A., El Omrani, F., Layachi, M., Ismaili, N., Mrabti, H., & Errihani, H. (2015). The burden among family caregivers of elderly cancer patients: prospective study in a Moroccan population. BMC Research Notes, 8(347), 1-4. http://dx.doi.org/10.1186/s13104-015-1307-5. http://dx.doi.org/10.1186/s13104-015-130...	Longitudinal quantitative study.	To assess the social, psychological, behavioral and economic impact on family caregivers of elderly cancer patients.	Sociodemographic and economic questionnaire and the Diagnostic and Statistical Manual of Mental Disorders IV.	Even with a great impact on the family members of the elderly with cancer, the benefits of care were observed in 80% of the participants.
Sakka et al. (2016)Sakka, M., Sato, I., Ikeda, M., Hashizume, H., Uemori, M., & Kamibeppu, K. (2016). Family-to-work spillover and appraisals of caregiving by employed women caring for their elderly parents in Japan. Industrial Health, 54(3), 272-281. http://dx.doi.org/10.2486/indhealth.2015-0029. http://dx.doi.org/10.2486/indhealth.2015...	Cross-sectional quantitative study.	To examine the differences in family repercussions for work between employed and non-employed women who had care responsibilities for elderly parents.	Sociodemographic Questionnaire, Survey Work-Home Interaction-Nijmegen, Cognitive Caregiving Appraisal Scale and Family Adaptation Partnership Growth Affection.	Being a middle-aged woman, employed and caring for her elderly parents were significant predictors of negative family repercussions for work.
Hwang et al. (2017)Hwang, A. S., Rosenberg, L., Kontos, P., Cameron, J. I., Mihailidis, A., & Nygård, L. (2017). Sustaining care for a parent with dementia: an indefinite and intertwined process. International Journal of Qualitative Studies on Health and Well-being, 12(1), 1-15. http://dx.doi.org/10.1080/17482631.2017.1389578. http://dx.doi.org/10.1080/17482631.2017....	Cross-sectional qualitative study.	To understand how adult offspring of people with dementia support care in their family and formal care contexts in Canada.	Sociodemographic questionnaire, focus groups (separated by gender).	Family values and relationships, distrust of institutional and home care systems and lack of knowledge about how to provide care had an influence on the care offered to family members.
Häusler et al. (2017)Häusler, N., Bopp, M., & Hämmig, O. (2017). Informal caregiving, work-privacy conflict and burnout among health professionals in Switzerland - A cross-sectional study. Swiss Medical Weekly, 147, 1-8. http://dx.doi.org/10.4414/smw.2017.14552. http://dx.doi.org/10.4414/smw.2017.14552...	Cross-sectional quantitative study.	To assess the impact of informal care on the risk of burnout among health professionals.	Copenhagen Burnout Inventory; Copenhagen Psychosocial Questionnaire.	Triple-duty caregivers were found to have a significantly higher risk of burnout compared to formal-only caregivers.
Alpass et al. (2017)Alpass, F., Keeling, S., Allen, J., Stevenson, B., & Stephens, C. (2017). Reconciling work and caregiving responsibilities among older workers in New Zealand. Journal of Cross-Cultural Gerontology, 32(3), 323-337. http://dx.doi.org/10.1007/s10823-017-9327-3. http://dx.doi.org/10.1007/s10823-017-932...	Longitudinal quantitative study.	To explore the challenges presented to older New Zealanders who combine paid work with caring responsibilities.	Economic Living Standards Index; Short Form Health Survey; Center for Epidemiological Studies Depression Scale.	Attempts to reconcile work and care responsibilities for older workers can impact mental health and living standards.
Mehta & Leng (2017)Mehta, K. K., & Leng, T. L. (2017). Experiences of formal and informal caregivers of older persons in Singapore. Journal of Cross-Cultural Gerontology, 32(3), 373-385. http://dx.doi.org/10.1007/s10823-017-9329-1. http://dx.doi.org/10.1007/s10823-017-932...	Cross-sectional qualitative study.	To focus on the dynamics of family care for the elderly based on the perspective of working life in Singapore.	Recorded interview.	The findings point to the need for improvements in policies, training and support for caregivers.
Kim et al. (2018a)Kim, H., Lee, S., Cheon, J., Hong, S., & Chang, M. (2018a). A comparative study to identify factors of caregiver burden between baby boomers and post baby boomers: a secondary analysis of a US online caregiver survey. BMC Public Health, 18(1), 1-9. http://dx.doi.org/10.1186/s12889-018-5488-4. http://dx.doi.org/10.1186/s12889-018-548...	Cross-sectional quantitative study.	To compare sociodemographic characteristics that are related to caring for two generations and to identify which factors contribute to the burden of such caregivers.	Sociodemographic and care-related questionnaire; Self-reported overload.	Vulnerable subgroups should be prioritized for policy benefits, such as those with no choice and younger working caregivers.
DePasquale et al. (2018)DePasquale, N., Polenick, C. A., Davis, K. D., & Berkman, L. F. (2018). A bright side to the work-family interface: husbands’ support as a resource in double-and-triple-duty caregiving wives’ work lives. The Gerontologist, 58(4), 674-685. http://dx.doi.org/10.1093/geront/gnx016. http://dx.doi.org/10.1093/geront/gnx016...	Cross-sectional quantitative study.	To examine how women who combine long-term caregiving employment with informal caregiving roles differed from their caregiver peers in terms of performance and job retention.	The Maslach Burnout Inventory; Michigan Organizational Assessment Questionnaire; 2 items reflecting intentions to leave the job role.	Dual and triple-duty caregivers did not differ from workplace-only caregivers in terms of job retention and performance factors.
Eguchi & Wada (2018)Eguchi, H., & Wada, K. (2018). Mental health of working-age populations in japan who provide nursing care for a person at home: a cross-sectional analysis. Journal of Occupational Health, 60(6), 458-466. http://dx.doi.org/10.1539/joh.2017-0295-OA. http://dx.doi.org/10.1539/joh.2017-0295-...	Cross-sectional quantitative study.	To investigate associations between having a person in need of nursing care at home and psychological distress.	Kessler Psychological Distress Scale (K6).	Having a person who needs nursing care at home appears to be positively correlated with worsening mental health.
Kolodziej et al. (2018)Kolodziej, I. W. K., Reichert, A. R., & Schmitz, H. (2018). New evidence on employment effects of informal care provision in Europe. Health Services Research, 53(4), 2027-2046. http://dx.doi.org/10.1111/1475-6773.12840. http://dx.doi.org/10.1111/1475-6773.1284...	Longitudinal quantitative study.	To estimate how labor force participation is affected when adult children provide informal care to parents.	Questionnaire with information about the individual’s health aspects of care and interpersonal relationships.	The results reveal negative causal effect, indicating that providing care reduces labor force participation by 14%.
Evans et al. (2019)Evans, K. L., Millsteed, J., Richmond, J. E., Falkmer, M., Falkmer, T., & Girdler, S. J. (2019). The impact of within and between role experiences on role balance outcomes for working Sandwich Generation Women. Scandinavian Journal of Occupational Therapy, 26(3), 184-193. http://dx.doi.org/10.1080/11038128.2018.1449888. http://dx.doi.org/10.1080/11038128.2018....	Cross-sectional quantitative study.	To explore how role characteristics and interactions are related to role balance for women working and caring for children and aging parents.	Sociodemographic and labor aspects questionnaire; Role Balance Scale; The Role Checklist.	Participants tended to role imbalance. Some characteristics intrinsic to the role of mother and family member were related to role balance.
Sakka et al. (2018)Sakka, M., Goto, J., Kita, S., Sato, I., Soejima, T., & Kamibeppu, K. (2018). Associations among behavioral and psychological symptoms of dementia, care burden, and family-to-work conflict of employed family caregivers. Geriatrics & Gerontology International, 19(1), 51-55. http://dx.doi.org/10.1111/ggi.13556. http://dx.doi.org/10.1111/ggi.13556...	Cross-sectional quantitative study.	To assess the associations between behavioral and psychological symptoms of people with dementia, care burden and family-work conflict of employed family caregivers.	Sociodemographic questionnaire, Zarit Burden Scale-Short Version, Survey Work-Home Interaction-Nijmegen and Dementia Behavior Disturbance Scale.	It is important for employed family caregivers to reduce family work conflicts and maintain their work-life balance.
Fernandes et al. (2018)Fernandes, C. S., Margareth, Â., & Martins, M. M. (2018). Cuidadores familiares de idosos dependentes: mesmas necessidades, diferentes contextos uma análise de grupo focal. Geriatric, Gerontology and Aging, 12(1), 31-37.	Qualitative phenomenological and cross-cultural study	To identify the demands of family caregivers of dependent elderly people.	Two focus groups (one in Portugal and one in Brazil).	Despite the different social and political contexts, caregivers’ needs are similar and converge on the same problems and challenges.
Kim et al. (2018b)Kim, J., De Bellis, A. M., & Xiao, L. D. (2018b). The experience of paid family-care workers of people with dementia in South Korea. Asian Nursing Research, 12(1), 34-41. http://dx.doi.org/10.1016/j.anr.2018.01.002. http://dx.doi.org/10.1016/j.anr.2018.01....	Cross-sectional qualitative study.	To comprehend the experience of paid family care workers for people with dementia in South Korea.	Sociodemographic questionnaire.	The results help to identify the educational needs and the level of support these workers need to improve the treatment of dementia in the home care environment.
Crespo et al. (2019)Crespo, M., Guillén, A. I., & Piccini, A. T. (2019). Work experience and emotional state in felderly relatives. The Spanish Journal of Psychology, 22(E34), 1-11. http://dx.doi.org/10.1017/sjp.2019.34. http://dx.doi.org/10.1017/sjp.2019.34...	Cross-sectional quantitative study.	To investigate the influence of work experience variables on the emotional state of caregivers.	Sociodemographic questionnaire, Center for Epidemiologic Studies Depression Scale, Positive and Negative Affect Schedule, Worry and Strain Scale, Impact of care at work, Caregiver Burden Interview, Role Overload and Captivity Scale and Work-Caregiving Role Conflict.	The effect of perceived work experiences on caregivers’ emotional state is more relevant than work conflicts.

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[1] Author’s Contributions

Thaís Juliana Medeiros: Literature search, analysis, data interpretation and writing of the text. Gustavo Carrijo Barbosa and Ludmyla Caroline de Souza Alves: Literature search, analysis and writing of the text. Aline Cristina Martins Gratão: Data interpretation, writing and review of the text. All authors approved the final version of the text.