The Modified Caregiver Strain Index (CSI)

Best Practices in Nursing Care to Older Adults from The Hartford Institute for Geriatric Nursing New York University, College of Nursing

Issue Number 14, Revised 2007
Series Editor: Marie Boltz, PhD, APRN, BC, GNP
Managing Editor: Sherry A. Greenberg, MSN, APRN, BC, GNP
New York University College of Nursing
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WHY: Informal supporters provide the majority of long-term care to chronically disabled older adults. Caregiving has been recognized as an activity with perceived benefits and burdens. Caregivers may be prone to depression, grief, fatigue, and changes in social relationships. They may also experience physical health problems. Perceived caregiver burden has been associated with premature institutionalization and patient reports of unmet needs. Screening tools are useful to identify families who would benefit from a more comprehensive assessment of the caregiving experience.

BEST TOOL: The Modified Caregiver Strain Index (CSI) is a tool that can be used to quickly screen for caregiver strain with long-term family caregivers. It is a 13-question tool that measures strain related to care provision. There is at least one item for each of the following major domains: Employment, Financial, Physical, Social, and Time. This instrument can be used to assess individuals of any age who have assumed the role of caregiver for an older adult. The Modified Caregiver Strain Index is a version of the Caregiver Strain Index developed in 1983. The tool was modified and developed in 2003 with a sample of 158 family caregivers providing assistance to adults aged 53 and older living in a community-based setting (Travis, et al, 2002; Thornton & Travis, 2003). Scoring is 2 points for each ‘yes’, and 1 point for each ‘sometimes’ response. The higher the score, the higher the level of caregiver strain.

VALIDITY AND RELIABILITY: Internal reliability coefficient is slightly higher (=.90) than the coefficient originally reported for the CSI in 1983 (=.86). Two-week retest data for one-third of the caregiving sample (n=53) were available and resulted in a test-retest reliability coefficient of .88.

STRENGTHS AND LIMITATIONS: The Modified CSI is a brief, easily administered, self-administered instrument. Long-term family caregivers were not comfortable with the dichotomous choice on the CSI and the modified instrument provides the ability to choose a middle category response best suited to some situations. The Modified CSI clarifies and updates some of the items on the original instrument. The tool is limited by lack of a corresponding subjective rating of caregiving impact. There is no breakdown of score regarding low, moderate or high caregiver strain, so professional judgment is needed to evaluate by total score the level of caregiver strain. The tool effectively identifies families who may benefit from more in-depth assessment and follow-up.

FOLLOW-UP: The higher the score on the Modified CSI, the greater the need for more in-depth assessment to facilitate appropriate intervention. Additional items and further efforts to develop and test a set of subscales could enhance the applicability of the instrument for research and practice. The patient’s cognitive status and problematic behaviors should be assessed, as well as the caregiver’s perception of role overload or deprivation in key relationships, goals or activities. Family conflict, work role-caregiving conflict, and caregiver social support are also important variables in the overall caregiving experience. Additional work with highly strained long-term caregivers who are receiving little or no formal services is indicated.

MORE ON THE TOPIC:

Best practice information on care of older adults: www.ConsultGeriRN.org. Gerritsen, P., & Van Der Ende, P. (1994). The development of a care-giving burden scale. Age and Ageing, 23(6), 483-491.

Novak, M., & Guest, C. (1989). Application of a multidimensional caregiver burden inventory. The Gerontologist, 29(6), 798-803.

Parks, S.,M.D., & Novielli, K., M.D. (2000). A practical guide for caring for caregivers. American Family Physician, 62, 2613-20, 2621-2.

Pearlin, L., Mullan, J., Semple, S. & Skaff, M. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30(5), 583-594.

Robinson, B. (1983). Validation of a Caregiver Strain Index. Journal of Gerontology, 38(3), 344-348.

Thornton, M., & Travis, S.S. (2003). Analysis of the reliability of the Modified Caregiver Strain Index. The Journal of Gerontology, Series B, Psychological Sciences and Social Sciences, 58B(2), S127-132.

Travis, S., Bernard, M., McAuley, W., Thornton, M., Kole, T. (2002). Development of the family caregiver medication administration hassles scale. The Gerontologist, 43(3), 360-368.

Tsai, P., & Jirovec, M.M. (2005). The relationships between depression and other outcomes of chronic illness caregiving. BioMed Central Nursing, 4(1), 3.

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