Primary and Secondary Stressors Affecting Family Caregiver Burden for Disabled Older Adults: A Systematic Review

Background: With the rapidly aging global population, family caregivers face increased burdens when caring for disabled older adults; however, comprehensive understanding of the determinants remains limited.

Objective: To systematically analyze the factors affecting caregiver burden among family caregivers of disabled older adults within the stress process model framework.

Methods: In accordance with PRISMA guidelines, six electronic databases were searched up to September 2024. The methodological quality was assessed via the JBI critical appraisal tool. Twenty-eight studies meeting the inclusion criteria were analyzed.

Results: Analysis of 28 studies revealed that caregiver burden results from a complex stress process involving distinct patterns of stressors and moderators. Primary stressors included care recipients’ functional limitations in activities of daily living (ADLs), behavioral problems, and cognitive impairments, with functional dependency and behavioral problems showing consistent positive correlations with burden. The secondary stressors included caregivers’ psychological factors (depression and anxiety) and socioeconomic circumstances, with caregiving time, depressive symptoms, and financial difficulties demonstrating strong positive associations with burden. Conversely, caregiver health status and cohabitation were negatively correlated with burden. Moderating factors—particularly social support, service utilization, and psychological resources such as resilience and coping strategies—consistently demonstrated significant protective effects against caregiver burden.

Conclusion: The stress process model effectively frames the multifaceted nature of caregiver burden, highlighting the interaction between primary and secondary stressors. Future interventions should adopt a dual-focus approach, addressing both primary care-related stressors and secondary psychosocial factors while strengthening moderating resources to enhance caregivers’ quality of life.