Caregivers—Who Copes How

INT’L. J. AGING AND HUMAN DEVELOPMENT, Vol. 69(3) 221-244, 2009

CAREGIVERS—WHO COPES HOW?*

NEENA L. CHAPPELL

CARREN DUJELA

University of Victoria, British Columbia

ABSTRACT

Within gerontological caregiving research, there is a major emphasis on

stresses and burdens of this role. Yet there has been little attention directed

toward the coping strategies that caregivers engage in to cope with this role

and the factors that influence their adoption of different coping strategies.

This article examines coping strategies and change in coping strategy over a

1-year period. In particular the differential importance of caregiver capacity

(such as social support, health, and personality) compared with careload

(such as hours of caregiving and need of the care recipient) is examined

within a path model. Data came from a purposive sample of caregivers

experiencing heavy demands. Overall, problem-focused coping is used

more often than emotion-focused coping (either positive or negative) or

seeking social support, but caregivers use all types simultaneously. Caregiver

capacity, specifically neuroticism, is the strongest predictor of problem-

focused coping with those high in neuroticism less likely to use this strategy.

High neuroticism also predicts less use overall and negative emotion-

focused coping strategies. Few significant predictors emerge of change; those

that did were caregiver capacity, not careload variables. The use of all coping

strategies, except seeking social support which remained stable, decreased

over a 1-year period.

*The research reported here was funded by the Social Sciences & Humanities Research Council

of Canada in a grant to Chappell.

221

� 2009, Baywood Publishing Co., Inc.

doi: 10.2190/AG.69.3.d

http://baywood.com

INTRODUCTION

Much emphasis in gerontological research on caregiving has focused on the

stress and burden experienced by these individuals (George, 1987, 1990;

Vitaliano, Young, & Russo, 1991). Despite this focus, data reveal that, at any one

time, the majority of caregivers are not overly burdened (Chappell & Litkenhaus,

1995; Vitaliano & Zhang, 2004). Rather, while experiencing burden, most

caregivers are able to simultaneously meet their demands without becoming

dysfunctional (Schulz & Williamson, 1991) and are able to name satisfactions

derived from this role (Chappell, Reid, & Dow, 2001). Compared with the

overwhelming interest in the stress and burden of caregiving, there is less research

on how most caregivers cope with this role despite the demands placed on them.

The long tradition of research on coping (Folkman & Moskowitz, 2004) tends

to not focus on caregivers. In fact, in the late 1990s Gignac and Gottlieb (1997)

noted that research on coping in the area of chronic stress was almost non-existent.

While the research that examines coping among caregivers has been growing

over the last half dozen years, it is almost entirely on the relationship between

coping and caregiver outcomes such as well-being and is especially targeted to

caregivers of those living with Alzheimer’s disease (Garity, 1997; Kneebone &

Martin, 2003). In contrast, this article examines coping per se, that is, not as a

mediator between the demands of caregiving and caregiver well-being. Rather,

it examines the types of coping strategies caregivers use, the co-existence of

different types of coping, and change in the use of coping strategies over a 1-year

period. It also examines who uses what type of coping, that is, the caregiver

capacities (such as caregiver social support, health, and personality) versus

careload (referring to the demands of caregiving) as predictors of coping strategy.

The data are from a sample of caregivers to care recipients living in the com-

munity (not restricted to only those with dementia).

LITERATURE REVIEW

Coping, the thoughts and behaviors used to manage the internal and external

demands of situations that are appraised as stressful (Folkman & Moskowitz,

2004), has received widespread attention outside of gerontology since the 1970s

and 80s. The most frequently cited types of coping strategies are problem-

focused and emotion-focused (Shaw et al., 1997). While problem-focused coping

has been related to better outcomes and emotional-focused coping to more

distress, results are mixed (Folkman & Moskowitz, 2004). Hooker, Frazier, and

Monahan (1994) name social support as the third commonly identified coping

strategy and conclude after their review of the literature that mixed results

are also evident when relating it to outcomes. Also popular for classifying

coping strategies are distinctions based on topological features rather than

functions. The most popular classification is approach versus avoidance with

the distinction between whether the activity is oriented toward or away from

222 / CHAPPELL AND DUJELA

the stressor (Skinner, Edge, Altman, & Sherwood, 2003). In this instance

approach and avoidance can each include cognitive and emotional activity.

However, problem solving and support seeking are typically considered approach

strategies whereas emotional and escape actions are typically considered

avoidance strategies.

Others such as Stanton, Kirk, Cameron, and Donoff-Burg (2000) note that

emotional coping may be adaptive in the short term. Garity (1997) argues that

problem-focused forms of coping are often used in encounters appraised as

changeable and emotion-focused coping in encounters considered unchangeable.

Furthermore, while initially problem-focused and emotion-focused strategies

were viewed as exclusive of one another, subsequent research has established that

different coping strategies often co-occur although one type may predominate

(O’Rourke & Cappeliez, 2002).

Like the research on coping generally, that focused on caregivers is also replete

with different conceptualizations and operationalizations of the different types

of coping (O’Rourke & Cappeliez, 2002; Skinner et al., 2003) and often reports

inconsistent findings. After their review of research on coping by family care-

givers of persons with dementia, Gottlieb and Wolfe (2002) conclude that the

cross-sectional designs, different coping and outcome measures, lack of

specificity and incomparability of target stressors, and the reliance on retro-

spective reports mean that the interpretability of the cumulative body of empirical

findings is questionable. Kneebone and Martin (2003), however, conclude other-

wise. After their review of coping among those caring for persons with dementia

in the community, they conclude that there is a general tendency toward problem

solving and acceptance strategies of coping to be advantageous (for a more

recent study, see Wells, Dywan, & Dumas, 2005).

Irrespective of whether a particular type of coping strategy is ultimately

judged to be positive or negative, it is also important to understand which

caregivers adopt particular types of coping strategies, a topic about which there

is little known. This article seeks to address this gap in knowledge concerning

who uses what coping techniques, that is, the predictors of different coping

strategies by caregivers.

Both the general gerontological caregiving literature and that specifically on

coping strategies suggest the potential importance of caregiver capacities and

careload for differentially distinguishing the type of coping strategy caregivers are

most likely to adopt. Like the conceptualizations of coping style, the predictors

chosen for study tend to vary considerably and findings are mixed. The extent

to which the relative absence of an examination of indirect, as well as direct,

effects of potential influences might account for differential findings is unknown.

Borrowing from the popular stress process model (originally proposed by Pearlin,

Mullan, Semple, & Skaff, 1990) designed to examine caregiver outcomes such

as well-being, background characteristics can be added as another potential

factor preceding primary stressors and current caregiver capacity. If coping

CAREGIVERS—WHO COPES HOW? / 223

strategy is specified as the caregiver outcome, then careload and demands can be

viewed as primary stressors, predicting coping strategy that could have direct

and/or indirect effects on coping style. If indirect, they could act through caregiver

capacity (including personality and social support) to affect coping strategy.

This model is specified in Figure 1.

Demands of the caregiving situation can affect the coping strategy adopted by

the caregiver. For example, Dell’Aquila (2003) find among caregivers to persons

suffering from Parkinson’s disease, that the more time spent as a caregiver the

less the caregiver uses seeking social support coping strategy. While much

research has reported that behavioral problems of care recipients are particularly

difficult for caregivers (see, for example, Chappell & Penning, 1996), the effects

of problem behaviors on the adoption of different coping strategies are unknown.

The illness suffered by the care recipient and/or the stage of that disease could

also affect caregiving coping strategies.

Caregiver capacities include social support caregivers draw on. While there is

much research on social support in old age (Lawrence, Tennestedt, & Assmann,

1998; Vachon, 1999), little examines social support as a predictor of coping.

Dell’Aquila (2003) reports the larger the social network the more likely caregivers

seek social support as a coping strategy but no relationship with emotion-focused

coping. However, some have found that it is the quality and not the quantity of

social support that has the most influence on well-being (Deal, Dunst, & Trivette,

1989), so it could be that those with “better” social relationships are more likely

to seek social support from others. One might speculate that availability of others

and in particular availability of others who are assisting with caregiving might

lead to a greater use of seeking social support. There is also some suggestion

that, depending on the relationship one has with the care recipient, different types

of coping may or may not be effective. Quayhagen and Quayhagen (1988) report

that, among spouses, but not daughters, problem solving, help seeking, and

low self-blame are effective in relation to well-being. Conversely, Knight (1992)


Direct and Indirect Paths to Coping Styles

Context/BackgroundCharacteristics

Primary Stressor/Careload

Mediators/CaregiverCapacity

Outcome Coping/Strategy

– Age– Gender

– Care receiverphysical relatedhealth problems

– Social support– Personality– Caregiver health

– Problem focused– Emotion focused– Negative emotion– Positive emotion– Seeking social

support

Figure 1. Predicting caregiver coping strategy, a modified stressprocess model (Pearlin et al., 1990).

reports no significant differences between spouse caregivers and other types of

caregivers, in terms of help seeking.

Caregiver personality is another potential caregiver resource. Little of the per-

sonality literature examines its importance for determining coping strategies and

even less applies to informal caregivers to seniors. Hooker and colleagues (1994)

though find that neuroticism is significantly related to both problem-focused and

emotion-focused coping but not social support coping among a sample of spouse

caregivers to persons with dementia. Among the non-caregiver research, high

hardy individuals (consisting of a sense of personal control, commitment to people

and activities which one is involved, and perceiving change as a challenge) have

been found to use more approach or problem-focused types of coping strategies

and low hardy individuals to use more avoidance or emotion-focused coping

(Florian, Mikulincer, & Taubman, 1995; Maddi, 1999; Soderstrom, Dolbier,

Leiferman, & Steinhardt, 2000). Among family caregivers of disabled older

adults, Clark (1998) finds those with higher hardiness use more overall transfor-

mational coping (including help-seeking). Sussman (2003) finds caregiver hardi-

ness positively related to problem-focused and support seeking coping strategies

and negatively associated with wishful thinking and avoidant coping strategies

among caregivers to persons with Alzheimer’s disease living in institutions.

Hardiness is sometimes viewed as an aspect of resilience (the ability to

withstand and rebound from crisis and adversity or the ability to transform disaster

into a growth experience and move forward) (Bergeman & Wallace, 1999; Polk,

1997; Walsh, 1996). Resilience is believed to consist of high levels of self-esteem,

personal control, and optimism. Optimism has been associated with use of problem-

focused coping and seeking social support (Scheier, Weintraub, & Carver, 1986).

Braithwaite (1996) reported that caregivers with low personal resiliency had

higher burden, more psychiatric symptoms, and poorer affect but did not examine

the effect of resiliency on the differing use of coping strategies among caregivers.

Different ways of approaching situations and putting forth one’s experience

influence how situations are viewed (McCrae, 1996). The ability to tolerate

change and a willingness to make adjustments to new or different situations

characterizes Openness to Experience. Those individuals who are high in

Openness tend to be more imaginative and creative (McCrae, 1987); they demon-

strate an interest in considering other options and are less fearful of taking risks

(Flynn, 2005). Openness differentiates those who are original, liking variety,

and interested in academic and artistic endeavors from those who are more

conventional, down-to-earth, and preferring routine.

In terms of caregiver health, Dell’Aquila (2003) finds that the more stress

caregivers report, the more likely they are to use seeking social support as a coping

strategy but that global stress or time spent in caregiving is related to neither

problem-solving or emotion-focused coping. Whether caregivers experiencing

worse health seek additional social support is not known but one could speculate

that their own health could affect the coping strategies they use.


Contextual background factors include age and gender. Empirical studies on

the effect of age are extremely limited; those which exist are contradictory.

Stephens and colleagues (1988) find that younger caregivers are more likely

to use escape/avoidance coping. On the other hand, Folkman, Lazarus, Pimley,

and Novacek (1987) report that older people are more likely to use passive

interpersonal emotion-focused forms of coping partially because they appraise

their encounters as less changeable than do younger people. Gender has received

attention in the coping literature with the argument that men are more task-

oriented and therefore more likely to use problem solving whereas women are

more likely to use emotion-focused coping. However, research tends to find

that women are more likely to use emotion-focused coping strategies but no

gender difference in the use of problem solving (Folkman et al., 1987; Kvam &

Lyons, 1991; Soderstrom et al., 2000) although some studies show men use more

approach or problem-focused coping (Holahan, Moos, Holahan, & Brennan,

1995; Ptacek, Smith, & Dodge, 1994).1*

In sum, this article examines different coping strategies used by informal

caregivers to older adults to gain understanding about who among caregivers is

more likely to adopt which type of coping strategy, more specifically, to assess

the differential contributions of caregiver capacities and careload in the choice

of coping strategy. Analyses begin by examining the predominance of different

coping strategies and their co-existence. Multi-variate analyses assess the pre-

dictors of different coping strategies at t1 using path models to assess both

direct and indirect effects. In particular, the article assesses the role of personality

factors (specifically resilience, hardiness, neuroticism, and openness to experi-

ence), social support, and demands on caregivers as potential predictors of coping

styles. Sex and age are introduced as background variables. Change in coping

styles between t1 and 1 year later are then examined.

METHODS

Data were collected in face-to-face interviews, lasting on average 2 hours

4 minutes, with caregivers to persons age 65 or over living in the community

from April 2003 to January 2004, in greater Victoria, British Columbia, Canada

and communities “up island” from greater Victoria to 1½ hours drive. The

sample was purposive, obtained through referrals from a variety of health service

agencies, such as the Family Caregivers’ Network, the Alzheimer’s Society, and

the Geriatric Outreach program within the local area. Agencies were asked to

refer those who, in their opinion, were providing heavy caregiving. Once referred,

individuals were screened to assess whether they were providing care for a

minimum of 4 hours/3 days/week. This criterion was created by an expert steering

committee that included caregivers and health care service providers who worked


1*See “Endnotes” and end of chapter for all footnotes.

with seniors, to target those providing heavy caregiving. It exceeds the cutoff

of over 3 hours/week that Keefe and Rosenthal (2000) found differentiated

employed caregivers to elderly relatives from those providing no help, on both

cultural and structural dimensions. In total, 92 caregivers were included; 52

(56.5%) were interviewed in greater Victoria and 40 (43.5%) “up island.”

Caregivers were re-interviewed 1 year later. At t2 N = 80 or 87% of the

original sample. Over the year, caregivers increased the numbers of hours per

week of care on average by 2, bringing the sample 0 to 88; those living with

the care recipient decreased, down from 63% to 48.8%. At t2 21% of care

receivers were in an institution and 14% were deceased; 65% were living in

the community, of whom 75% were living with the caregiver. Data were collected

from informal caregivers, irrespective of the illness of the care recipient because

our interest was in the use of coping strategies in the general population of

informal caregivers to counter the general focus in the literature on caregivers

only to those with dementia.

The primary variable of interest was coping. The brief Ways of Coping Scale

(WOC) which correlates highly with the long version (Folkman et al., 1987)

was used. First, respondents were asked to describe a time when they found it

difficult to cope with supporting the care recipient and the circumstances. Then

they were asked to respond to 31 items using a 4-point Likert scale for each item

ranging from 0 (not used) to 3 (used a great deal). The three most commonly

referenced strategies of coping were computed. Problem-solving coping consisted

of summing the items for the confrontive coping and planful coping (alpha = .69).

An emotion-focused scale combined distancing coping, control, accepting respon-

sibility, escape, and reappraisal (alpha = .72). Because emotion-focused coping

includes both negative-focused and positive-focused emotions, separate scales

measured each: negative emotion-focused coping included distancing coping,

control, and escape (alpha = .64). Positive emotion-focused coping included

accepting responsibility and reappraisal (alpha = .64). Seeking social support

consisted of the original five items comprising this scale in the WOC scale

(alpha = .75).

Change in coping strategy was computed using the Reliability Change Index

(RCI) consisting of t2-t1/SE meas. This classical approach is suitable when there

is no known intervening variable between t1 and t2, does not require uniform

distribution of the data and rules out high probability of measurement error. It

provides a means of assessing true change (Maassen, 2004; Wu & Hart, 2002).

Social support was measured with several items. A single item asked whether

they received unpaid assistance from anyone and was coded as 0, 1, 2, or 3+.

They were asked whether they received emotional support from family (0 = no;

1 = yes), their living arrangement (number of people in household) and their

marital status (married or not). They were asked about whether their relationship

with their care recipient had changed since they had begun caregiving and if

so, how (primarily negative – 1, no change – 2, primarily positive – 3). No one said


it had not changed. The relationship of the caregiver to the care receiver was

also recorded (husband, wife, daughter, son, other).

The personality factors of resilience, hardiness, neuroticism, and openness to

experience were measured using five separate scales (alphas = .92; .85; .84, and

.60 respectively). The Resilience Scale (Wagnild & Young, 1990, 1993) is a

25-item measure of the positive emotional stamina people use to manage diffi-

cult life events. It uses a 7-point scale, from 1 (disagree) to 7 (agree) with a

higher score indicating more resilience. The Family Hardiness Index (McCubbin,

McCubbin, & Thompson, 1986) is a 20-item scale with four subscales (commit-

ment, confidence, challenge, and control) but the overall score has been shown

to be the best indicator of hardiness. It uses a 4-point scale from 0 (false) to

3 (totally true). The Big Five Test (Costa & McCrae, 1987) measured personality

traits. The BFT is a 25-item scale that uses 5 points from 1 (not at all true of

me) to 5 (very true of me); the neuroticism and openness to experience scales

were used here. Neuroticism is calculated by summing the reverse scored items

of tense, anxious, nervous, worrying, and self-pitying. Openness to experience

is calculated by summing the scores of imaginative, original, warm, outgoing,

and clever.

Measurement of the health of the caregiver included the number of chronic

conditions: “For each problem that I read, please tell me if this health issue is

something that you are currently managing or facing in your life”; conditions

included: high blood pressure or hypertension (with or without medication);

coronary heart disease, stroke, or effects of stroke; paralyses or paraplegia;

Parkinson’s disease; other neurological problems; eye trouble not relieved by

glasses; ear trouble including hearing loss, etc. The number of chronic conditions

was summed. Perceived health was measured: “For your age, would you say,

in general, your health is excellent, good for your age, fair for your age, poor for

your age, or bad for your age.” Because poor and bad response categories had

so few responses, they were combined.

Demands of caregiving were measured in terms of the health of the care receiver

and other characteristics of the caregiving role. Functional disability was asked

in terms of the level of assistance required with daily activities, coded as requires

no assistance or requires assistance for each of a list of 14 areas such as: bathing;

toileting; using the telephone; transportation; and financial responsibilities

(alpha = .78). Chronic conditions of the care receiver were asked using the same

question as above in relation to the caregiver but in reference to the care recipient.

Behavioral problems of the care receiver were also asked: “Do you have to

deal with behavioral problems?” Categories were: verbal agitation, physically

non-aggressive, and physically aggressive behavior. The mental health of the

care receiver was solicited: “Are there any mental health issues facing the care

receiver?” In addition, caregivers were asked how many years they had been

providing care (coded in years) and hours/week of caregiving (coded in hours).

Sex (male, female) and age (left continuous) were used as control variables.


Analyses began with an examination of the existence of the different coping

strategies (raw score means divided by number of items to allow comparison

between the different types of coping), and their co-existence using Pearson’s r.

Multiple regression analyses were performed in a path model with each of the

variables in the categories in Figure 1 as a dependent variable (DV), with each

of the five different coping strategies as final DVs. Because of the small sample

size relative to the number of IV and control variables, each group was entered

in a separate regression (a separate regression for each: personality factors,

social support factors, caregiver health, demands of caregiving, and control

variables). Only those variables that revealed a statistical significance of p < .10

were entered into a final regression for that coping strategy. In the final regres-

sions, only variables with a p < .05 were considered significant. The final

regressions are shown here. Data were examined for colinearity, linearity,

homescedasticity, and normality.

RESULTS

Sample characteristics are shown in Table 1. Females, not surprisingly, con-

stitute the majority of the sample (68.5%) with male caregivers under a third.

Caregivers are primarily married (83.3%); half are caring for a spouse (50%).

These caregivers are relatively highly educated with 28.3% having a bachelor

degree or more and 23.9% having a college diploma or associate degree. The

average age of the caregivers is 60.7; the average age of the care recipient is

80.1 years. Caregivers have been providing care on average for 8 years and on

average provide 86 hours of care per week. Almost two-thirds (63.0%) live

with the person they are providing care to. The sample, while not representative,

successfully included caregivers who are under heavy demands, as intended.

The occurrences of the different strategies of coping appear in Table 2. Overall,

problem-focused coping is used more than any other type of coping with seeking

social support a close second (1.53 and 1.50 respectively). Negative emotion is

used less than the other types. That is, caregivers engage in problem-focused

coping and seeking social support more than emotion-focused coping. Turning

to the correlations of the coping strategies with one another, Table 3 shows that

they are related to one another. Problem-focused coping is significantly and

positively related to all other forms of coping, with the highest correlations with

positive emotion coping (r = .45; p < .001) and the overall emotion coping scale

(r = .41; p < .001). In other words, those engaged in problem solving are likely

to also be engaged in emotion-focused coping and for that emotion-focused

coping to be positively oriented. Seeking social support is also correlated with

problem-focused coping (r = .40; p < .001). Not surprisingly, the highest cor-

relations are between the overall emotion-focused scale and the two sub-scales

of which it consists, namely, negative-emotion coping (r = .89; p < .001) and

positive-emotion coping (r = .76; p < .001). Seeking social support is least likely


to co-occur with overall or negative emotion-focused coping. While these

different strategies co-exist, by no means are they synonymous, at most there

is a 20% overlap.

The predictors of different strategies of coping appear in Path Models 1-5.

Table 4 summarizes the significant direct predictors and the DVs for which

they were significant. The model was most successful in explaining variance in

problem-focused coping (44%). While significant predictors emerged for the

other strategies of coping, they explain less of the variance (17% for negative

emotion-focused coping; 21% for positive-emotion focused coping; 19% for


Table 1. Selected Sample Characteristics t1 (N = 92)

A) Sex %

Male

Female

31.5

68.5

B) Marital Status %

Married

Divorced/Separated

Other

83.3

6.7

9.8

C) Relation to Care Recipient (Caregiver is _______) %

Wife

Husband

Daughter

Son

Other

38.0

12.0

35.9

10.9

3.0

D) Education %

� High School

Trade diploma/some university

College diploma/assoc. degree

� Bachelor degree

26.1

18.5

23.9

28.3

E) Caregiver Lives with Care Recipient %

Yes

No

63.0

37.0

overall emotion-focused coping; 19% for seeking social support). Gender is

unrelated to type of coping strategy used. Men and women are equally likely to

engage in problem-focused, emotion-focused coping, and seeking social support.

Age, however, is significantly and directly related to all types of emotion-focused

coping, overall, positive and negative. Specifically, those who are younger tend

to engage in each of these types of emotion-focused coping compared with

those who are older. While age is not directly related to the use of problem-

focused coping or seeking social support it is related indirectly through careload

demands, specifically hours/week caregiving which in turn is negatively related

to social support (specifically those providing more hours/week of care tend to

have less unpaid assistance) which is related to problem-focused coping. Age

is similarly indirectly related to seeking social support, through hours/week

of caregiving.

Demands of caregiving are related to coping style. Care receiver functional

disability, specifically with using the telephone, is related to overall and negative


Table 2. Ways of Coping, Raw Scores/

Number of Items

Problem-focused

Emotion-focused

Negative emotion

Positive emotion

Seek social support

1.53

1.37

1.18

1.23

1.50

Table 3. Coping Strategies—Correlation Matrix

Problem-

focused

Emotion-

focused

Emotion-

negative

Emotion-

positive

Seeking

social

support

Problem-focused

Emotion-focused

Emotion-negative

Emotion-positive

Seeking social support

1

.41***

.26**

.45***

.40***

1

.89***

.76***

ns

1

.39***

ns

1

.23* 1

*p < .05; **p < .01; ***p < .001.


Path

Mo

del1:

Pro

ble

m-f

ocu

sed

co

pin

g.


Path

Mo

del2:

Em

otio

n-f

ocu

sed

co

pin

g.


Path

Mo

del3:

Po

sitiv

e-e

mo

tio

nfo

cu

sed

co

pin

g.


Path

Mo

del4:

Neg

ative

-em

otio

nfo

cu

sed

co

pin

g.


Path

Mo

del5:

Seekin

gso

cia

lsu

pp

ort

co

pin

g.

emotion-focused coping. Those caring for individuals with greater disability

are more likely to use overall and negative emotion-focused coping. It is the

strongest predictor of negative emotion-focused coping, explaining 5% of

the variance. The sum of functional disability has an indirect effect on

problem-focused coping, through openness to experience (those caring for

persons with more disability tend lower on openness to experience). Another

careload demand, sum of care receiver’s chronic conditions, has an indirect

effect through neuroticism (those caring for persons with greater disability

are more likely to be high on neuroticism) also directly effecting the use

of negative emotion-focused coping. A similar indirect effect is found for

emotion-focused coping, and negative-emotion focused coping, and problem-

focused coping. Hours of care provided per week is the only significant predictor

of seeking social support, where those providing fewer hours of care are more

likely to seek social support, perhaps because they have the time to do so.

However, it is indirectly related to both problem-focused coping and positive

emotion-focused coping through unpaid assistance (in both instances the more

hours of care is related to less unpaid assistance) which is directly related to

both styles of coping.

In terms of social support, caregivers who have more unpaid assistance from

others are more likely to use problem-focused and positive emotion-focused

coping strategies. Those for whom their relationship with the care recipient has

changed for the worse, those in smaller households, and those with more income

are also more likely to problem solve, irrespective of age.


Table 4. Summary of Direct Predictors of Coping

Problem-

focused

Emotion-

focused

Negative

emotion

Positive

emotion

Seeking

social

support

Age

Relation changed

IADL – telephone

Unpaid assistance

Household size

Household income

Openness to Experience

Neuroticism

Hours of caregiving

–

+

–

+

+

–

–

+

–

–

+

–

–

+

– –

In terms of personality factors, neuroticism is related to three of the four

strategies, specifically those who are high on neuroticism are less likely to use

problem-focused coping, overall or negative emotion-focused coping strategies.

Personality factors are unrelated to the use of positive emotion-focused coping.

Neuroticism, furthermore, is the strongest predictor of problem-focused coping,

explaining 8% of the variance. Openness to experience is also a significant

predictor of problem-focused coping with those more open to experience more

likely to problem solve.

Of the five coping strategies, all showed significant change over the 1-year

period except seeking social support. Change for all other strategies of coping is

negative; in all instances caregivers decrease their use of the coping strategy (other

than seeking social support which remains stable) over the course of 1 year.

CONCLUSIONS

Despite the preoccupations within gerontological research with stressors and

burdens of caregiving, there is surprisingly little on coping strategies caregivers

use in order to deal with the demands made on them. If one asks the question,

who are the caregivers who adopt different coping strategies, the literature cannot

provide an answer. The intent of this article was to begin filling this gap by

examining the types of coping strategies used by caregivers under heavy demands

to a senior living in the community. It was a deliberate decision to seek a sample

of caregivers that was not restricted to one disease group. However, the relatively

small sample size precludes an analysis of differences by disease type. It is

important to pursue further research, asking whether the predictors of coping

strategy are similar or different across disease and disability groups and if so,

how. In order to recruit a sample of caregivers who were under heavy demands

from this role, a purposive sample was drawn so the results cannot be generalized.

Nevertheless, among this group of caregivers, these data support the co-existence

of different coping strategies. Caregivers do not choose either emotion-focused or

problem-focused but tend to engage in different types of coping simultaneously.

These findings add to previous work that has noted the co-existence of coping

strategies (O’Rourke & Cappeliez, 2002).

Furthermore, these data reveal problem- and emotion-focused coping strategies

change over time; their use decreases, lending support to Folkman and Lazarus’

(1985) contention that they are fluid. Seeking social support though remains

stable. A gender difference is not supported; men are no more likely to adopt

problem-focused coping than are women and women are no more likely to adopt

emotion-focused coping than are men. Age, though, emerges as an important

factor effecting all styles of coping either directly or indirectly through care

demands, specifically hours/week of care provided. Those who are younger are

more likely to engage in emotion-focused coping contrary to the finding reported

by Folkman et al. (1987). The reasons for this are unknown although it might be


speculated that younger caregivers have yet to come to terms with the aging

process and its declines in health, finding the experience more emotionally

charged. Kramer (1993) suggests that those with a shorter duration of caregiving

use more emotional strategies because they have not adjusted to the onset and

progression of disease.

Given that these caregivers are providing, on average, more hours per week

than a full-time job, the effects of the actual demands of that job warrant comment.

The number of years providing care is unrelated to coping strategy as are health

of the caregiver, supporting notions that caregivers tend to their loved ones and

not to themselves. Increased functional disability of the care recipient results

in more negative emotion-focused coping. More hours of caregiving per week is

related to seeking social support. Both factors reveal additional indirect effects:

functioning is indirectly related to problem-focused and negative emotion-focused

coping through personality. Hours per week caregiving is indirectly related to

problem-focused and positive emotion-focused coping through unpaid assistance

and to negative emotion-focused coping through personality. Interestingly, func-

tioning is more related to emotional coping, and directly so; chronic conditions

are more related to problem-focused as well as emotion-focused coping but tends

to operate indirectly through personality.

Social support, particularly unpaid assistance, emerges as related to both

problem-focused and emotion-focused coping with other measures of social

support, such as household size and change in relationship, also related to problem-

focused coping. That is, social support appears to be particularly important for

individuals who engage in problem-focused coping. More specifically, those

who are in a relationship with a care recipient whom they perceive to have

worsened, who are in a smaller household, with unpaid assistance and with

more income engage in problem-focused coping. This suggests that although

their situation is perceived as having deteriorated, with the help of others and

with some economic resources, they turn to problem solving perhaps because

they feel they have the means to do so both in terms of drawing on others and

in terms of income.

A comment is also warranted on the fact that the amount of unpaid assistance

and therefore in some senses the availability of others from which one might

seek social support does not correlate with seeking social support as a coping

strategy. Whether they receive emotional support from their family, the number

of people living in the household, their marital status, whether their relationship

with the care recipient has changed, their relationship with the care recipient

that is, spouse or child, none of these are correlated with seeking social support.

If the social networks within which one is embedded do not affect whether

one seeks social support, it might be speculated that it is personality factors, but

at least among this group of caregivers, none of the personality factors correlate

with seeking social support. Whether this particular group is providing so much

care and is under such heavy demands that they do not have the time to seek out


others is not known and would require comparative data to answer. It is however,

an important question to address in future research.

The personality factor of neuroticism is the strongest correlate of problem-

focused coping and emerges as a correlate of both problem-focused and emotion-

focused coping with less neuroticism related to a greater likelihood of using

each coping style. This supports earlier research for example by Hooker and

colleagues (1994). The findings reported here are also consistent with earlier

research in that neuroticism is unrelated to seeking social support. Interestingly,

neither hardiness nor resilience are related to any of the strategies of coping

examined. Perhaps this is because the constructs of hardiness and resilience

suggest “better” coping whereas the coping strategies examined here could be

either advantageous or disadvantageous to the caregivers. This research did

not examine whether the coping strategies were beneficial to the caregivers

involved. The fact that neuroticism is related to coping strategies indicates that

high neuroticism interferes with coping whether that coping strategy is ultimately

beneficial or not.

Caregiver capacity emerges as a more important predictor of coping strategy

than does workload, except for negative emotion-focused coping where functional

disability is the most significant predictor. Otherwise, caregiver resources and

especially the personality characteristic of neuroticism are particularly important.

The decomposition of overall emotion-focused coping into negative emotion-

focused coping and positive emotion-focused coping suggests that each has

somewhat different correlates. This may be a fruitful avenue for future research.

Finally, there are, in addition, many areas to be probed in future research

that were not incorporated here. We asked about coping during a difficult time.

It is equally important to ask about coping during daily hassles and compare how

this differs from coping with major events. Our primary interest centred on the

caregiver but it is also important to know more about the care recipient, such as

the number of children they have and other aspects of their support network.

Data on both caregiver and care receiver perceptions of the caregiving experience

is equally interesting.

ENDNOTE

1We know almost nothing about predictors of change in coping strategies used

by caregivers over time even though coping is viewed as situation specific, that is,

as a dynamic process (Folkman & Lazarus, 1985). Powers, Gallagher-Thompson, and

Kraemer (2002) report stability in cognitive, behavioral, and avoidant coping over 2

years, measured at 6 month intervals, among non-depressed caregivers to those with

dementia. They did not examine predictors of change but speculate that changes in

coping may occur only when major events such as institutionalization of the loved one.

Regression analyses were conducted to assess the predictors of change. The same strategy

as noted in the text was followed except t2 was the DV and t1 of that variable was forced

in first. Variance explained after the effect of t1 is removed refers to the predictors of


change. Then t2 IVs were added as a block after those significant at t1 were entered. The t2IVs included: care receiver status at t2 (remains in the community, now institutionalized,

or deceased) and change in: care receiver’s behavioral problems, care receiver’s ADLs,

and chronic conditions, caregivers’ chronic conditions, resilience, neuroticism, and hardi-

ness. All other variables showed no significant change.

Few significant predictors emerge and they are most often dissimilar from the predictors

of engaging in that coping strategy at t1. The predictors are t1 variables. For example,

it is not change in the health of the care recipient or the caregiver that predicts coping

strategy at t2 but rather it is their health at t1. Similarly with other predictors. Less of the

variance is explained in change than at t1 for all coping strategies except negative-focused

coping (the large amounts of variance are explained by the DV at t1, not by the explanatory

factors entered into the model).

Gender is significant, for problem-focused coping with caregivers to female recipients

less likely to use this coping strategy at t2 and those caring for male recipients more likely

to use it at t2, explaining 4% of the t2 variance. Age is a predictor of emotion-focused

coping; those who are younger use this type of coping more than those who are older,

explaining 7% of the t2 variance. Self-rated health is also a significant predictor, explaining

4% of the t2 variance. Those who rate their health as better, tend to use this strategy less at

t2. Self-rated health also predicts the use of negative emotion-focused coping at t2, in the

same direction and explaining 6% of the t2 variance. Perceived change in the relationship

at t1 (when asked about change since beginning caregiving) also predicts the use of negative

emotion-focused coping; those who perceive the relationship to have changed for the

better were more likely to use this strategy at t2 (explaining 4% of the variance). No

significant predictors emerged for positive emotion-focused coping. It is to be noted that

all of the significant variables refer to caregiver capacity, none to careload. It is also

noteworthy that care recipient status, whether they are still in the community, in a facility,

or deceased at t2 is unrelated to change in coping strategy. This suggests that Powers,

Gallagher-Thompson, and Kraemer’s (2002) speculation that changes in coping occur

only when major events such as institutionalization occur is, at least at times, inaccurate.

While few predictors of change emerge, those that do, all refer to caregiver capacity.

None refer to careload. This suggests that there are ways for caregivers to cope, despite

heavy care demands. It is also notable that the predictors of change are not the same as

the predictors of coping strategy at a given point in time. The forces that lead us to change

our coping strategies differ from those that influence us to adopt a particular strategy

at one point in time. This is important for those who examine how to influence coping

strategies. Typically, we examine the correlates of coping strategies rather than the factors

that lead us to change the particular techniques that we have been engaged in.

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Direct reprint requests to:

Neena L. Chappell

Canada Research Chair in Social Gerontology

Professor, Centre on Aging and Department of Sociology

University of Victoria

Sedgewick Building, Rm A136

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Victoria, BC V8W 2Y2

e-mail: [email protected]


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Caregivers—Who Copes How