Validation of the Chinese version of the Zarit Burden Interview.

Abstract Objective: To validate the Chinese version of the Zarit Burden Interview as an instrument for assessing the stress experienced by carers of elderly patients with dementia. Patients and Methods: The Zarit Burden Interview was first translated into Chinese and then back-translated into English for comparison. Forty Chinese patients with mild to moderate dementia were recruited from 2 psychiatric clinics in Hong Kong. The Zarit Burden Interview, General Health Questionnaire, and Caregiver Activity Survey were completed by the patients' carers. Two raters rated another 16 carers separately for assessment of inter-rater reliability. Results: The intraclass correlation coefficient was 0.99 and the split half correlation coefficient was 0.81, suggesting a high inter-rater reliability and internal consistency. The correlation between the Zarit Burden Interview and the General Health Questionnaire was 0.59 (p Conclusion: The Chinese version of the Zarit Burden Interview is a valid and reliable tool to evaluate the stress experienced by carers of elderly people with dementia in Hong Kong. Key words: Dementia, Dependency, Stress, psychological Introduction Identification of carer stress is as an important issue in caring for patients with dementia. It is becoming increasingly evident that carers have a role in the overall treatment outcome. Most elderly people with dementia live in the community and rely heavily on their relatives for support. Early institutionalisation is undesirable, as this generally imposes a negative effect on disease progression. Patients with dementia show greater impairment in unfamiliar settings, while familiar cues at home can often trigger well-established habits. However, the burden of taking care of an elderly relative with dementia at home can be great. Apart from the demands of physical care, patients with dementia often have psychiatric and behavioural problems that are difficult to deal with in the absence of adequate support. Having limited knowledge and skills, carers often experience stress when caring for relatives with dementia. The burden of care is affected by different factors. The illness severity and level of disability could affect the burden for patients and their carers. (1-3) Behavioural problems and dependency of patients contribute to, and may be a major cause of, stress. (4-9) However, the strengths and coping mechanisms of carers, as well as social support and community resources, could affect the perceived burden. (3,10-12) The amount of time carers spend with their relative each day also affects the perceived burden.9,13 Poor physical and psychiatric health of carers can also affect the perceived level of stress. (3,8,14,15) Excessive stress could lead to increased psychiatric morbidity for carers. (16,17) Gilleard et al found that the prevalence of psychological disturbance was high among carers, as shown by an increased score for the General Health Questionnaire (GHQ). (18) Excessive stress for the carer could also lead to an increased chance of institutionalisation for the patient. (19,20) There is also evidence to show that carers' stress and maladaptive coping strategies may result in increased behavioural problems of patients with dementia. (21) These factors would lead to an increase in economic burden. (22,23) To better address the stress of carers of patients with dementia, it is desirable to have an instrument to measure their burden in direct relationship to the demand for care. This approach will help clinicians to investigate the factors affecting the level of stress and design appropriate intervention strategies. The Zarit Burden Interview (ZBI) has been specifically designed for the assessment of subjective burden of carers, defined as the extent to which carers perceived their emotional or physical health, social life, and financial status to have changed as a result of caring for their relative with dementia. …