Zarit Caregiver Burden Assessment
We are interested in learning the benefits of the Respite Care program. We ask that you complete the 12-item survey below. Your responses will not be reported individually. Responses will be combined with the responses provided by other care partners in an attempt to evaluate the overall effectiveness of the program.
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The following is a list of statements that reflect how people sometimes feel when taking care of your Person with Parkinson's (PwP). After reading each statement, indicate how often you experience the feelings listed by selecting the number that best corresponds to the frequency of these feelings.
Caregiver Name: *
1) Do you feel that because of your PwP that you don't have enough time for yourself?
 *
NEVER
NEARLY ALWAYS
2) Do you feel stressed between caring for your PwP and trying to meet other responsibilities?
 *
NEVER
NEARLY ALWAYS
3) Do you feel angry when you are around your PwP?
 *
NEVER
NEARLY ALWAYS
4) Do you feel your PwP affects your relationship with others in a negative  way?  *
NEVER
NEARLY ALWAYS
5) Do you feel strained when you are around your PwP? 
 *
NEVER
NEARLY ALWAYS
6) Do you feel your health has suffered because of your involvement with your PwP?
 *
NEVER
NEARLY ALWAYS
7) Do you feel you don’t have as much privacy as you would like, because of your PwP?   
 *
NEVER
NEARLY ALWAYS
8) Do you feel your social life has suffered because you are caring for your PwP? *
NEVER
NEARLY ALWAYS
9) Do you feel you have lost control of your life since your PwP's illness? *
NEVER
NEARLY ALWAYS
10) Do you feel uncertain about what to do about your PwP?
 *
NEVER
NEARLY ALWAYS
11) Do you feel you should be doing more for your PwP?
 *
NEVER
NEARLY ALWAYS
12) Do you feel you could do a better job in caring for your PwP?
*
NEVER
NEARLY ALWAYS
Please click on the Submit button below.
Michel Bédard, PhD,1,2 D. William Molloy, MB,3 Larry Squire, MA,1 Sacha Dubois, BA,3 Judith A. Lever,MSc(A),4 and Martin O’Donnell, MRCP(I)3 The Gerontological Society of America Vol. 41, No. 5, 652–657 The Gerontologist. The Zarit Burden Interview: A New Short Version and Screening Version

A courtesy of L’Orech Yomim/Center for Healthy Living, Inc. 2011
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