Caregiver Strain Index (CSI)

M. Terry Sullivan, RN, MSW, MSN, CMC


Dermatology Nursing. 2004;16(4) 


Why: Informal supporters provide the majority of long-term care to chronically disabled elders. 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 and fatigue. 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 Caregiver Strain Index (CSI) is a tool that can be used to quickly identify families with potential caregiving concerns. 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. Positive responses to seven or more items on the index indicate a greater level of strain. This instrument can be used to assess individuals of any age who have assumed the role of caregiver for an older adult. It was developed with a sample of 132 caregivers providing assistance to recently hospitalized older adults and is appropriate for caregivers of any age.

Validity and Reliability: Internal consistency reliability is high (alpha = 0.86) and construct validity is supported by correlations with the physical and emotional health of the caregiver and with subjective views of the caregiving situation.

Strengths and Limitations: The CSI is a brief, easily administered instrument. The tool is limited by lack of a corresponding subjective rating of caregiving impact. The tool effectively identifies families who may benefit from more in-depth assessment and follow-up.

Followup: A positive screen (7 or more items positive) on the CSI indicates a need for more in-depth assessment to facilitate appropriate intervention. Pearlin and colleagues (1990) have identified various domains that should be addressed in a comprehensive assessment of the caregiving process. 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.

More on the Topic:

Gerritsen, P., & Van Der Ende, P. (1994). The development of a care-giving burden scale. Age and Ageing 23: 483-491.

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

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

Ravazzin Center for Social Work Research in Aging, Fordham University Graduate School of Social Service. (1997). The Grotta Report on philanthropic trends and best practice models. Family Elder Caregiving.

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

The Caregiver Strain Index: I am going to read a list of things that other people have found to be difficult. Would you tell me if any of these apply to you?(Give examples)

  Yes=1 No=0
Sleep is disturbed (e.g., because _____is in and out of bed or wanders around at night)    
It is inconvenient (e.g., because helping takes so much time or it s a long drive over to help)    
It is a physical strain (e.g., because of lifting in and out of a chair; effort or concentration is required)    
It is confining (e.g., helping restricts free time or cannot go visiting)    
There have been family adjustments (e.g., because helping has disrupted routine; there has been no privacy)    
There have been changes in personal plans (e.g., had to turn down a job; could not go on vacation)    
There have been other demands on my time (e.g., from other family members)    
There have been emotional adjustments (e.g., because of severe arguments)    
Some behavior is upsetting (e.g., because of incontinence; _____has trouble remembering things; or _____accuses people of taking things)    
It is upsetting to find_____ has changed so much from his/her former self (e.g., he/she is a different person than he/she used to be )    
There have been work adjustments (e.g., because of having to take time off)    
It is a financial strain    
Feeling completely overwhelmed (e.g., because of worry about _____; concerns about how you will manage)    
TOTAL SCORE (Count yes responses. Any positive answer may indicate a need for intervention in that area. A score of 7 or higher indicates a high level of stress.)    

Robinson, B. (1983). Validation of a Caregiver Strain Index. Journal of Gerontology. 38:344-348. Copyright (c)
The Gerontological Society of America. Reproduced by permission of the publisher.

Dermatology Nursing is pleased to publish this regular feature, "Try This: Best Practices in Nursing Care to Older Adults," developed by the Hartford Institute for Geriatric Nursing.

This article was reprinted with permission from "Try This: Best Practices in Nursing Care to Older Adults" series from the John A. Hartford Foundation Institute for Geriatric Nursing. Mathy Mezey, EdD, RN, FAAN, is Director of the Institute and Terry Fulmer, PhD, RN, FAAN is Co-Director. Series Editor is Sheila Molony, MS, RN,C

Permission is hereby granted to reproduce this material for not-for-profit educational purposes only, provided The Hartford Institute for Geriatric Nursing, Division of Nursing, New York University is cited as the source. Available on the internet at E-mail notification of usage to:


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