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Reducing stress burden and objective burden in spousal caregivers through implementation of Powerful Tools for Caregivers
  1. Linda A Gerdner
  1. Stanford Geriatric Education Center, Center for Education in Family and Community Medicine, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to: Linda A Gerdner
    Stanford Geriatric Education Center, Center for Education in Family and Community Medicine, Stanford University School of Medicine, Stanford, CA, USA; lgerdner{at}

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Implications for practice and research

  • Powerful Tools for Caregivers (PTC) is a psychoeducational programme grounded in the model of self-efficacy. PTC is designed for caregivers of persons with chronic illness for the purpose of teaching management of emotions, effective communication and decision-making skills. The programme is conducted by two trained PTC class leaders using a scripted curriculum in English, Spanish or Korean language. A companion book, The Caregiver Helpbook (2nd edition), is available in English or Spanish (Leslie Congleton, PTC Program Coordinator, Caregiver Services; personal communication, 9 June 2011).

  • Nurses, or other interested persons, may become a PTC class leader by successfully completing a 2-day training programme conducted by a certified master trainer. Classes are offered at specified times and locations across the nation.

  • It is important to critique studies that evaluate the effects of PTC and to determine sectors of the care giving population that are most likely to benefit. Findings of the study conducted by Savundranayagam and colleagues indicated PTC is effective in reducing stress burden and objective burden in spousal caregivers.


There are an estimated 44.4 million non-paid caregivers for persons aged 18 years or older in the USA. Approximately 6% or 2.7 million of these caregivers are spouses.1 Research indicates that caring for a spouse with chronic illness can negatively impact the caregiver's physical and psychological health. Pinquart and Sörensen2 conducted a meta-analysis of 168 studies published between 1980 and 2010 that met specific criteria. The purpose was to compare differences between caregiving spouses, adult children and children-in-law. Overall, spouses used less informal support, provided more care, perceived their physical health to be worse and experienced more depressive symptoms.

Savundranayagam and colleagues studied the effects of PTC on the burden of caring for a spouse with chronic illness. Care recipients had a variety of chronic illnesses such as: heart disease, stroke and Parkinson's disease. More than 80% of care recipients were reported to have cognitive impairment, with over 50% actually having a diagnosis of probable Alzheimer's disease or related dementia (ADRD). In the USA, nearly 15 million non-paid caregivers are caring for someone with ADRD.3 On 4 January 2011, President Obama signed into law the National Alzheimer's Project Act (Public Law 111–375). The scope of this law includes, but is not limited to, the need to address the escalating burden of care for someone with Alzheimer's disease.


Savundranayagam and colleagues used a pretest–post-test quasi-experimental design to evaluate the effects of PTC on three dimensions of burden in spouse caregivers. The investigators hypothesised that mean scores for stress burden, relationship burden and objective burden would be significantly lower in PTC participants than those in the comparison group.

The comparison group consisted of 95 spouse caregivers from the League of Experienced Family Caregivers (LEFC). Data for participants in the comparison group were drawn from questionnaires completed upon enrollment in LEFC with a follow-up questionnaire administered 6 weeks later.

Participants in the experimental groups were recruited from PTC classes offered in eight states. Of the 115 spouses enrolled, 22% withdrew from the study, excluding them from data analysis. PTC consisted of six weekly sessions with each session being 2.5 hours in length. The dependent variable was measured via the burden measure developed by Montgomery and colleagues.4

Selection bias was increased by a lack of random group assignment. Therefore, data collection included pertinent covariates for caregivers and care recipients. Analysis procedures controlled for differences in these experimental and comparison groups. Structural equation modelling was used to analyse the impact of PTC on outcome variables.


Participants in the PTC group reported significant lower levels of stress burden (anxiety and depression) and objective burden (degree that caregiver demands infringed on caregiver's personal time) than those in the comparison group. No group differences were found in relationship burden (extent to which care recipient is perceived as being manipulative or over-demanding).


Savundranayagam and colleagues made a unique contribution to the growing body of research on PTC by using a quasi-experimental design with outcome measures to differentiate types of caregiver burden. The importance of this study is underscored by Pinquart and Sörensen2 who, following a meta-analysis of caregiver research, concluded the need for future research to address dimensions of caregiver burden.


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  • Competing interests None.

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