Study of Caregiver Stress and Beneficial Practices
Thank you for agreeing to take part in this important survey studying the effects of various services and actions on caregiver stress levels. This survey should take between 10-20 minutes to complete. All answers will be kept confidential, with no identifying information recorded. If you choose to leave your email address to receive results after the study is complete, it will not be recorded in connection to your answers.
Please fill out the following questions regarding your role as the primary caregiver for a person with Alzheimer’s Disease.
Which of the following services do you regularly access to help care for this person? (Select multiple options if applicable) *
Required
Optional: Describe the services used (or explain the lack of)
Your answer
How long have you been providing care for this person? *
How many hours do you spend caring for this person in an average week? *
What actions do you take to help yourself in daily life (self-care measures)? (select multiple options if applicable) *
Required
Optional: Describe what you do now to take care of yourself, or explain how it has recently changed
Your answer
Modified Caregiver Strain Index
Here is a list of things that other caregivers have found to be difficult. Please select the options that apply to you. We have included some examples that are common caregiver experiences to help you think about each item. Your situation may be slightly different, but the item could still apply.
My Sleep is Disturbed (For example: the person I care for is in and out of bed or wanders around at night) *
Caregiving is inconvenient (For example: helping takes so much time or it's a long drive over to help) *
Caregiving is a physical strain (For example: lifting in or out of a chair; effort or concentration is required) *
Caregiving is confining (For example: helping restricts free time or I cannot go visiting) *
There have been family adjustments (For example: helping has disrupted my routine; there is no privacy) *
There have been changes in personal plans (For example: I had to turn down a job; I could not go on vacation) *
There have been other demands on my time (For example: other family members need me) *
There have been emotional adjustments (For example: severe arguments about caregiving) *
Some behavior is upsetting (For example: incontinence; the person cared for has trouble remembering things; or the person I care for accuses people of taking things) *
It is upsetting to find the person I care for has changed so much from his/her former self (For example: he/she is a different person than he/she used to be) *
There have been work adjustments (For example: I have to take time off for caregiving duties) *
Caregiving is a financial strain *
I feel completely overwhelmed (For example: I worry about the person I care for; I have concerns about how I will manage) *
Demographics
What is your gender?
What is your race/ethnicity?
If you would like to receive the results of this study once responses have been evaluated, please enter your email address here (your contact information will not be connected to your responses):
Your answer
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