Introduction

For older adults, their functional status is one of many health indicators due to the fact that they are vulnerable and susceptible to experiencing complications that impact negatively on their basic daily activities¹.

In this context, Aranco et al.² describe that in 2020 in Latin America and the Caribbean there were at least 8 million functionally dependent Older Adults (OA), who required support to carry out some basic daily activities. Specifically in Mexico, this study indicates that the prevalence of OA functional dependence was 25.5% between the 2012-2018 time period.

Physical and cognitive changes in old age decrease their personal and functional autonomy, increase their needs, and, at the same time, promote social isolation, which impacts the quality of life of the elderly³.

Generally speaking, the people who help with those needs are relatives, people from the OA social circle or health professionals. Therefore, it is relevant to discuss the importance of informal caregivers and the consequences of their care providing endeavor.

Informal caregivers (IC) are those that provide care without having professional training, do not receive financial compensation, and dedicate long periods of time caring for OA. Usually, they are either close family members or people from the immediate social circle. This is the reason why the relationship between the IC and the OA is emotionally close as it is based on affection, fondness, work, and service towards the other^4-7.

As a consequence of the demands and attention required by OA, the caregiver experiences diverse psychosocial, family, and economic conflicts as well as loss of productivity^5-8.

Those life changes together with the demands involved in their jobs were considered by Bello et al.⁵ to define IC burnout as:

“The state of emotional exhaustion, stress and fatigue that directly affects daily activities, social relationships, freedom, and mental balance. It is the degree to which the person perceives the negative effect of care in different aspects of their lives, such as physical and mental health, social interactions, and their economy”

Zarit et al.⁹ has also characterized burnout as the attitudes and emotional reactions of the caregiver regarding the experience of caring and the degree of disturbances or changes in various facets of their domestic environment and their lives in general. This syndrome is mainly triggered by the following factors:

Since 2019, the world has been facing a health contingency, the COVID-19 pandemic which has greatly affected the OA.

The coronavirus does not affect everyone in the same manner. The OA are the most vulnerable group to suffer the severe disease caused by the SARS-CoV-2 virus, due to multiple reasons including comorbidity, immunosuppression and dementia^10,11.

Social confinement was a measure implemented with the purpose of stopping viral spread and protecting vulnerable groups. Nevertheless, this containment strategy has had adverse consequences due to the alteration of social and family dynamics. In the psychological context, people have experienced a decay in their well-being, high stress levels, and development of anxiety and depression¹².

Urzua et al.¹³ defined quarantine or confinement as the isolation and restriction of the movement of people who either have been or are at risk of being exposed to the virus. Such confinement implies conditions of social distancing, isolation at one’s own home, strict limitations on the freedom of movement, and suspensions of commercial and academic activities, authorizing only essential activities to obtain essential goods such as food and medicine as well to assist health centers for appointments or work¹⁴. Given the specific characteristics of the confinement, or the pandemic in general, these restrictions can be classified as a high psychological stress adversity, which has a greater impact than normative life events¹⁵.

Forlenza et al.¹⁶ described the appearance of mild symptoms in OA such as insomnia, irritability, eating disorders, sadness, and anxiety since the beginning of the pandemic. Likewise, Espin et al.¹⁸ reported that OA can become more anxious, especially if they are isolated or have some cognitive impairment or dementia.

It has been shown that the work load of ICs increased during the pandemic. Indeed, Fajardo¹⁸ indicated that caregivers were in a state of uncertainty that led to fear. Among the main challenges faced by ICs are emotional stress, chronic stress, and a reduction in medical care options because health professionals were taking care of people infected with the new virus¹⁹.

Zorzo et al.²⁰ highlighted that ICs experienced emotional fluctuations during the pandemic due to the amount of information received about COVID-19 and changes in social restrictions, which were modified on a daily basis. Also, personal situations, deaths, loss of work as well as future activities and plans negatively affected ICs, which increase the level of emotional overload. Therefore, the objective of this study was to assess the relationship between the physical dependence experienced by older adults, the work overload of their informal caregiver, and the confinement conditions during the COVID-19-caused sanitary crisis.

Materials and methods

Results

Table 1 shows the correlations between the OA physical dependence and IC burden, finding statistical significance in most of them. The statistical power confirmed these correlations.

The correlations between physical dependence and the three dimensions included in the OA Confinement Conditions instrument are shown in Table 2.

Table 3 show the correlations between IC burden and confinement conditions. As observed, those correlations are weak and the statistical power value (<0.80) is not strong enough to assert that the null hypothesis is truly false. Finally, the correlations between OA confinement conditions and IC burden is shown in Table 4.

Discussion

The general objective of this study was to assess the relationship between the physical dependence of older adults, the burnout of their informal caregivers, and the confinement conditions in the context of the COVID-19 health crisis.

The results indicate that the main basic daily activities where OA experience some degree of dependence are control of urinary incontinence and requiring assistance to go up and down stairs. Similar results were obtained by Esmeraldas et al.³, who reported that at least 1% of the population aged 60 years or over is immobilized, 6% have severe limitations in their daily activities, and up to 10% of that population has moderate disability.

Regarding the relationship between OA physical dependence and IC burnout (total score, dimension “caregiver impact” and “interpersonal relationship”), it was found to be positive, moderate, and statistically significant. This relationship was strengthened by several factors, including new demands and ways to relate that arose during the confinement. The majority of the population, including ICs, adapted to their new work situation from home, were they met the demands that they faced. Besides, ICs had to provide assistance to the OAs, which included new care activities since they were considered the most vulnerable population to this new virus. In addition, ICs went through personal critical situations such as death of loved ones, loss of work, and future plans and activities^20,26.

Since OAs required assistance in some basic daily activities, they also required greater attention from their ICs. Thus, the greater the OA physical dependence, the greater burnout the IC will experience^20,26.

In addition, a moderate, positive, and statistically significant relationship between OA physical dependence and their degree of confinement was identified. In this context, social restrictions have an impact on both the physical and psychological health of OAs. Moreover, these restrictions limit physical activities, which results in a decline of those activities in which OAs had independence. Similarly, Espin et al.¹⁷ describe the loss of interest in carrying out activities that they previously enjoyed doing, excessive and constant anxiety, and frequent loss of memory, which leads to a decrease in functionality.

OA physical dependence was not significantly related to neither healthy habits nor social relationships established during the pandemic. Similarly, the IC burnout was not significantly associated with their healthy habits.

On the other hand, weak, negative and statistically significant associations between burnout and social relationships during the pandemic were identified. Nevertheless, the statistical power values suggest that further research on this field is required. In fact, it seems that social relationships could be a protective factor against burnout. In this regard, Balladares et al.²⁷ state that IC support networks were reduced because of the confinement. Furthermore, it is important to highlight that even before the pandemic, ICs used to limit their social relationships to take care of the OAs, which exacerbated during the confinement. Martinez et al.²⁸ indicate that social support is a protective factor against burnout since it facilitates coping, affects the caregiving activities and guarantees quality of life and emotional well-being of OAs.

Likewise, Monge et al.²⁹ conducted a study aimed at analyzing the relationship between social support, optimism, and vital satisfaction as possible protective factors against caregiver burnout. They describe that social support functions as a protective factor against burnout. Similarly, Cerquera et al.³⁰ have suggested that social support contributes to IC resilience, thereby functioning as a buffer against stress, burden, anxiety, and depression.

Finally, a very interesting result was the statistically significant association between IC burden and the OA confinement degree, not so with the IC’s own confinement, which suggests that confinement of the caregivers is not what generates their burden. Instead, the fact that the OA is confined at home is what causes the burnout state since the pandemic induced a greater demand for care. Therefore, there is a negative consequence of confinement of both IC and OA, which requires further investigation.

Conclusions

Informal caregivers burnout is correlated with the physical dependence of older adults, which implies that the greater this dependency, the care provided will develop more negative emotions associated with the act of caring, a situation that will equally affect both the IC and OA.

As an interesting fact, it seems that the caregiver burnout is more related to the OA confinement conditions than to those of the IC.

In the context of the pandemic, the confinement strategies to reduce infections seem to have negative consequences for the OA, since a high degree of confinement was correlated to greater physical dependence.

In this study, data collection during this health contingency was a challenge because the recruitment of participants was conducted through social networks, which are not regularly used by the target population of this research: Older Adults and their Informal Caregivers. Therefore, it is suggested to continue this research avenue through the analysis of these variables in a post-confinement context.