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Caregiver Burnout Assessment

Please indicate how much each of the following statements applies to you (choose one per row):

(1 = Not at all, 2 = A little, 3 = Somewhat, 4 = A lot)

I have missed work or daily activities due to caregiving responsibilities
1
2
3
4
I feel physically tired from caregiving
1
2
3
4
I have less time for leisure and relaxation
1
2
3
4
I feel guilty when I cannot attend to the elderly person properly
1
2
3
4
Caregiving has affected my health
1
2
3
4
I feel emotionally stressed by caregiving
1
2
3
4
I have made changes to my personal plans because of caregiving
1
2
3
4
I feel that caregiving has limited my social life
1
2
3
4
I worry about the future of the elderly person
1
2
3
4
I have had financial difficulties due to caregiving
1
2
3
4

Caregiver Reaction and Satisfaction

Please indicate how much you agree with each statement:

(1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree)

I feel privileged to care for my elderly family member
1
2
3
4
5
Caring for them makes me feel good
1
2
3
4
5
I feel my efforts are appreciated
1
2
3
4
5
I want to continue caring for them
1
2
3
4
5
I feel close and emotionally bonded due to caregiving
1
2
3
4
5
I have to alter my daily routine for caregiving
1
2
3
4
5
I find it hard to relax due to caregiving duties
1
2
3
4
5
I have to cancel or avoid social engagements
1
2
3
4
5
My health has worsened since I started caregiving
1
2
3
4
5
I feel tired most of the time
1
2
3
4
5
Caregiving has put financial pressure on my family
1
2
3
4
5
It is hard to pay for the elderly person's health needs
1
2
3
4
5
My family shares caregiving responsibilities
1
2
3
4
5
I feel others in my family have left me to manage alone
1
2
3
4
5
I feel physically tired from caregiving
1
2
3
4
5
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