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OBJECTIVES: Ambivalent feelings in dementia family caregivers have been found to be related to caregivers´ stress associated with the behavioral and psychological symptoms of dementia (BPSD-related stress), and depressive symptoms. Ambivalent feelings may also affect caregivers´ perceived quality of the relationship with the person living with dementia (PLwD), but this variable has been scarcely studied. This study analyzes the role of ambivalent feelings in the association between caregivers' BPSD-related stress, perceived quality of the relationship with the PLwD, and depressive symptomatology. METHODS: A theoretical model was developed and tested in a sample of 390 family caregivers. RESULTS: The obtained tested model had an excellent fit to the data, explaining 24% of the variance of depressive symptomatology. A significant association was found between caregivers' BPSD-related stress, ambivalent feelings, and depressive symptomatology. Also, an indirect effect in the association between ambivalent feelings and depressive symptomatology was found through the perceived quality of the relationship. CONCLUSIONS: Ambivalent feelings in dementia family caregivers are associated with caregivers' BPSD-related stress, perception of a lower relationship quality, and higher depressive symptomatology. CLINICAL IMPLICATIONS: Targeting caregivers' ambivalent feelings and the quality of the relationship in interventions for dementia family caregivers may decrease their distress.
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OBJECTIVES: This study aims to analyze the role that family obligations and social desirability have for understanding guilt and depressive symptoms in family caregivers. A theoretical model is proposed to analyze this significance based on the kinship with the person cared for. METHODS: Participants are 284 family caregivers of people with dementia divided into four kinship groups (husbands, wives, daughters and sons). Face-to-face interviews were conducted assessing sociodemographic variables, familism (family obligations), dysfunctional thoughts, social desirability, frequency and discomfort associated with problematic behaviors, guilt and depressive symptoms. Path analyses are performed to analyze the fit of the proposed model and multigroup analysis to study potential differences between kinship groups. RESULTS: The proposed model fits the data well and explains significant percentages of variance of guilt feelings and depressive symptomatology for each group. The multigroup analysis suggests that, for daughters, higher family obligations were associated with depressive symptomatology through a report of higher dysfunctional thoughts. For daughters and wives, an indirect association between social desirability and guilt was observed through reaction to problematic behaviors. CONCLUSION: The results support the need to consider the significance of sociocultural aspects such as family obligations and the desirability bias in the design and implementation of interventions for caregivers, especially for daughters. Considering that the variables that contribute to explaining caregivers' distress vary depending on the relationship with the person cared for, individualized interventions may be warranted depending on the kinship group.
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Cuidadores , Demência , Humanos , Depressão , Estresse Psicológico/diagnóstico , CulpaRESUMO
The study assessed gender differences in the associations between familism dimensions, dysfunctional thoughts, and resource and outcome variables in 190 Spanish dementia family caregivers. A theoretical model was tested through path analysis, obtaining an excellent fit of the model to the data. Higher scores in the familial obligations dimension were associated with lower self-efficacy for self-care and obtaining respite and leisure frequency, and higher anxious and depressive feelings, in female caregivers only. Significant between-gender differences were obtained, suggesting that female caregivers holding strong familistic values are more vulnerable to the negative consequences of caregiving compared to male caregivers.
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Cuidadores , Demência , Humanos , Masculino , Feminino , Fatores Sexuais , Adaptação Psicológica , Ansiedade , Estresse PsicológicoRESUMO
Caring for a relative with dementia has been linked to negative consequences for caregivers' psychological health, such as anxiety or guilt. Cognitive theories of psychopathology propose that attentional bias towards negative stimuli contribute to the development and maintenance of emotional disorders and clinical symptomatology. However, attentional bias has scarcely been explored in dementia family caregivers. The aim of this study was to examine the relationship between attentional bias and anxiety symptomatology, guilt feelings, and experiential avoidance in a sample of dementia family caregivers. Participants were 226 dementia family caregivers. Attentional bias was measured using a novel priming adaptation of the dot-probe task. The sample was divided into high and low anxiety symptomatology, guilt feelings, and experiential avoidance groups. The results revealed two opposite patterns of emotional information processing in dementia family caregivers. While anxiety was found to be associated with an attentional preference for negative information, experiential avoidance was related to attentional avoidance of this information. Although guilt was also related to an attentional preference for negative information, this relationship was no longer significant when controlling for anxiety levels. These inflexible attentional patterns may have negative clinical consequences, given that in both cases relevant information necessary for adaptive coping with the stressful situation of caregiving may be unattended to or omitted.
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Viés de Atenção , Demência , Ansiedade , Cuidadores , Emoções , Culpa , HumanosRESUMO
Objectives: Family caregivers of people with dementia often report feelings of guilt. However, the number of studies analyzing guilt and the factors associated with its appearance are scarce. The aim of this study is to explore the subjective experience of guilt in the family care of people with dementia.Methods: A qualitative analysis of the narratives of 13 family caregivers of people with dementia about their feelings of guilt was done.Results: Seven categories for understanding guilt in caregiving were obtained: guilt derived from actions themselves; guilt derived from one's limitations; guilt for feeling negative emotions; guilt associated with the change in the relationship with the person cared for; guilt for neglecting other areas; guilt induced by the person cared for, and guilt induced by others. The results showed the existence of cases in which guilt is absent by distress-avoiding processes.Conclusions: Guilt is a relevant variable in understanding caregiver distress, and its analysis is necessary for therapeutic work in the field of care.Clinical implications: Psychological interventions aimed at family caregivers should include specific techniques in order to address guilt feelings.
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Cuidadores , Demência , Cuidadores/psicologia , Demência/psicologia , Emoções , Culpa , HumanosRESUMO
OBJECTIVES: A pilot randomized controlled trial study was conducted for testing the efficacy of a novel Guilt Focused Intervention (GFI), that was compared with a Cognitive Behavioral Intervention (CBI) for caregivers of people with dementia with high levels of guilt and distress. METHODS: Participants were 42 caregivers who were randomized assigned to the intervention conditions. RESULTS: Participants in the GFI showed significant reductions in depression, anxiety, and guilt at posttreatment and follow-up. Participants in the CBI presented reductions in anxiety and guilt at posttreatment and follow-up. Clinically significant change for guilt was found in 62.5% in the GFI and 9.09% in the CBI group at posttreatment. At follow-up, 58.33% in GFI and 12.5% in the CBI group were recovered. CONCLUSIONS: The preliminary results of this pilot study suggest that caregivers with significant levels of guilt and distress might benefit from an intervention specifically designed to target guilt feelings. CLINICAL IMPLICATIONS: A novel and initial intervention approach specifically designed for targeting caregivers' feelings of guilt might have the potential to reduce caregiver's emotional distress.
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Cuidadores , Demência , Ansiedade/psicologia , Ansiedade/terapia , Cuidadores/psicologia , Demência/psicologia , Culpa , Humanos , Projetos PilotoRESUMO
OBJECTIVES: To analyze caregivers' perceived impact of the pandemic in their mental health and the well-being of the care-recipients. METHODS: Caregivers (N = 88) were asked if they had COVID-19 and about their perceptions of change of care-recipients' health conditions as well as whether their own mental health, conflicts with care-recipients and other relatives, thoughts of giving up caregiving, and feelings of coping well with the situation. RESULTS: A large percentage of caregivers perceived a worsening of care-recipients' symptoms and of their own negative emotions, an increase in the number of conflicts and thoughts of needing to give up caregiving. Having had COVID-19 and reporting higher levels of distress as well as giving up caregiving were related to perceived worsening in care-recipients well-being. Perceived increases were mainly reported by younger caregivers, those who perceived to have not coped well, and those reporting an increase in conflicts. Some caregivers perceived an increase in positive emotions. CONCLUSIONS: The pandemic has a negative impact on caregivers' perceptions about the course of their own emotions and care-recipients' well-being. CLINICAL IMPLICATIONS: Interventions are needed to train caregivers in strategies to cope with the sources of stress caused by the pandemic and to promote social support.
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COVID-19 , Demência , Adaptação Psicológica , Cuidadores , Humanos , SARS-CoV-2RESUMO
The objective was to develop the Interpersonal Triggers of Guilt in Dementia Caregiving Questionnaire (ITGDCQ). An emotion frequently experienced by caregivers is guilt. However, the studies analyzing potential factors that generate guilt are scarce. Guilt may be generated through interpersonal interactions. A total of 201 dementia caregivers were evaluated for frequency of leisure, guilt, anxiety, depression, and a pool of items measuring the frequency, and guilt was derived from different behaviors performed by the care recipient (ITGDCQ-CR) and other relatives (ITGDCQ-OR). Exploratory factor analysis of the ITGDCQ-CR showed a two-factor solution, explaining 56.24% of the variance. The ITGDCQ-OR subscale also showed two factors, explaining 63.24% of the variance. All the factors had acceptable to good reliability indexes. Positive associations were found between both subscales and depression, anxiety, guilt, and stress associated with CR's behavioral problems. ITGDCQ-CR was negatively correlated with frequency of leisure. The interpersonal dynamics assessed with the ITGDCQ generated other emotions such as anger or sadness. Through structural equation modeling, 28% of the variance of caregivers' distress was explained by the assessed variables, including a significant contribution of the interpersonal dynamics assessed with the ITGDCQ. The results provide preliminary support for the use of the ITGDCQ as a valid and reliable measure of care recipients' or other relatives' factors that trigger or facilitate the experience of guilt in the caregivers. The association between these factors and caregiver distress suggests potential clinical implications for the findings.
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Demência , Relações Familiares , Cuidadores , Culpa , Humanos , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
BACKGROUND: One of the main health-related worries for older adults is becoming dependent. Even healthy older adults may worry about becoming dependent, generating guilt feelings due to the anticipation of future needs that others must solve. The guilt associated with self-perception as a burden has not been studied in older adults, and there is no instrument available to measure these feelings. AIMS: To adapt the Self-Perceived Burden Scale (SPBS; Cousineau et al., 2003) for the assessment of feelings of guilt for perceiving oneself as a burden for the family in older adults without explicit functional or cognitive impairment. METHOD: Participants were 298 older adults living independently in the community. Participants completed the assessment protocol, which included measures of guilt associated with self-perception as a burden, depressive and anxious symptomatology, self-perceived burden, and sociodemographic information. RESULTS: Results from exploratory, parallel and confirmatory factor analyses suggest that the scale, named Guilt associated with Self-Perception as a Burden Scale (G-SPBS), has a unidimensional structure, explaining 57.04% of the variance of guilt. Good reliability was found (Cronbach's alpha = .94). The results revealed significant (p < .01) positive associations with depressive and anxious symptomatology. DISCUSSION: These findings suggest that the G-SPBS shows good psychometric properties which endorse its use with healthy community older adults. Also, guilt associated with perceiving oneself as a burden seems to be a relevant variable that can contribute to improving our understanding of psychological distress in older adults.
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Culpa , Autoimagem , Idoso , Análise Fatorial , Humanos , Psicometria , Reprodutibilidade dos Testes , Inquéritos e QuestionáriosRESUMO
Objectives: Familism is a cultural value that has been shown to be important for understanding the dementia caregiving process. The aim of this study is to analyze the psychometric properties of the Revised Familism Scale (RFS).Method: Face-to-face assessments were done with 199 dementia family caregivers. Exploratory factor analysis, discriminant validity, and reliability analyses of the RFS were carried out.Results: The results suggest that the RFS has good psychometric properties and is composed of three factors: "Familial interconnectedness", "Familial obligations", and "Extended family support".Conclusion: The RFS seems to be a reliable measure of familism, a multidimensional construct measuring a relevant cultural value for dementia family caregivers.
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Cuidadores , Demência , Família , Humanos , Psicometria , Reprodutibilidade dos TestesRESUMO
Objective: Dementia caregiving has been described as a chronically stressful situation with adverse cardiovascular effects. Psychological resources such as mindfulness may reduce the impact of stress on caregivers' cardiovascular health. The objective of this study was to analyze the moderating effect of trait mindfulness on the relationship between frequency of disruptive behaviors of the care recipient and blood pressure (BP) in dementia caregivers. Method: Participants were 110 dementia family caregivers. Two hierarchical regressions (for systolic and diastolic BP) were conducted to analyze whether mindfulness moderates the relationship between disruptive behaviors and BP after controlling for known predictors of cardiovascular outcomes. Results: A significant moderator effect of mindfulness was found between the frequency of disruptive behaviors and diastolic BP (ß = -.195, p < .05). Among those caregivers reporting low levels of mindfulness, the relationship between frequency of disruptive behaviors and diastolic BP was relatively stronger than among those reporting high mindfulness levels. Conclusions: The results suggest that a high level of trait mindfulness may have protective effect on BP when caregivers face high levels of stress. Clinical Implications: Mindfulness seems to be an important variable with potential for buffering the effects of caregiving stressors on caregivers' blood pressure.
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Cuidadores/psicologia , Demência/psicologia , Hipertensão/terapia , Atenção Plena/métodos , Estresse Psicológico/terapia , Adaptação Psicológica , Idoso , Índice de Massa Corporal , Demência/epidemiologia , Feminino , Humanos , Hipertensão/etiologia , Hipertensão/psicologia , Masculino , Pessoa de Meia-Idade , Comportamento Problema/psicologia , Fatores de Risco , Estresse Psicológico/etiologia , Estresse Psicológico/psicologiaRESUMO
Providing care for a relative with dementia is considered to be a chronic stressor that has been linked to negative mental health consequences for caregivers. A theoretical model was developed and tested to assess the degree to which ambivalence and guilt feelings contribute to caregivers' depressive symptomatology. Participants included 212 dementia family caregivers. In addition to ambivalence and guilt feelings, sociodemographic characteristics, behavioural and psychological symptoms of dementia, and depressive symptomatology were assessed. Hypotheses derived from the stress and coping model were tested using path analysis. The analysed model showed an excellent fit to the data. In total, 35% of the variance in depressive symptomatology was explained by the assessed variables. Although significant correlations were obtained between frequency and appraisal of behavioural and psychological symptoms of dementia and depression, the obtained model suggests that this effect was mediated through ambivalence. In addition, ambivalence had an indirect effect on depression. The association of ambivalence with depression was explained through feelings of guilt; that is, respondents who reported ambivalent feelings were more likely to experience guilt, leading in turn to greater depressive symptomatology. The findings suggest that dementia caregivers' ambivalence and guilt feelings are relevant for understanding their depressive symptomatology. These factors should be addressed in psychological interventions with caregivers.
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Atitude Frente a Saúde , Cuidadores/psicologia , Demência/psicologia , Transtorno Depressivo/psicologia , Culpa , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Espanha , Estresse Psicológico/psicologia , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: Although research shows that nursing home staff experience significant levels of stress and burnout, studies analyzing the relationship of psychosocial variables on their feelings of anxiety are scarce. This study aims to analyze the relationship between psychosocial variables and levels of anxiety among staff. METHOD: Participants were 101 nursing home professionals. In addition to anxiety, socio-demographic variables, depersonalization, burden, relationship with families of the residents, and guilt about the care offered to the residents were assessed. A hierarchical regression analysis was carried out to analyze the contribution of the assessed variables to staff anxiety levels. RESULTS: The obtained model explained 57% of the variance in anxious symptomatology. Guilt about the care offered and poor quality of the relationship with residents' family were associated with anxiety. Further, working at nursing homes where the staff report higher levels of anxiety symptoms, the presence of depersonalization and burden were also associated with anxiety. CONCLUSION: The findings suggest that in addition to work-related variables (burden and burnout), problems with family members and guilt about the care offered are relevant variables for understanding staff's anxious symptomatology. CLINICAL IMPLICATIONS: Interventions that address issues of guilt about the quality of care, and problematic relationships with family members of residents, may have potential to reduce staff anxiety and promote their well-being.
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Ansiedade/psicologia , Esgotamento Profissional/psicologia , Casas de Saúde/estatística & dados numéricos , Recursos Humanos de Enfermagem/psicologia , Idoso , Ansiedade/epidemiologia , Esgotamento Profissional/epidemiologia , Despersonalização/psicologia , Feminino , Culpa , Humanos , Masculino , Relações Profissional-Família , Psicologia , Espanha/epidemiologiaRESUMO
BACKGROUND: Caregivers' commitment to personal values is linked to caregivers' well-being, although the effects of personal values on caregivers' guilt have not been explored to date. The goal of this study is to analyze the relationship between caregivers´ commitment to personal values and guilt feelings. METHOD: Participants were 179 dementia family caregivers. Face-to-face interviews were carried out to describe sociodemographic variables and assess stressors, caregivers' commitment to personal values and guilt feelings. Commitment to values was conceptualized as two factors (commitment to own values and commitment to family values) and 12 specific individual values (e.g. education, family or caregiving role). Hierarchical regressions were performed controlling for sociodemographic variables and stressors, and introducing the two commitment factors (in a first regression) or the commitment to individual/specific values (in a second regression) as predictors of guilt. RESULTS: In terms of the commitment to values factors, the analyzed regression model explained 21% of the variance of guilt feelings. Only the factor commitment to family values contributed significantly to the model, explaining 7% of variance. With regard to the regression analyzing the contribution of specific values to caregivers' guilt, commitment to the caregiving role and with leisure contributed negatively and significantly to the explanation of caregivers' guilt. Commitment to work contributed positively to guilt feelings. The full model explained 30% of guilt feelings variance. The specific values explained 16% of the variance. CONCLUSION: Our findings suggest that commitment to personal values is a relevant variable to understand guilt feelings in caregivers.
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Cuidadores/psicologia , Demência/enfermagem , Culpa , Valores Sociais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Análise de Regressão , Espanha , Estresse Psicológico , Inquéritos e Questionários , Adulto JovemRESUMO
The present study aims to analyze the existence of different profiles in family caregivers of people with dementia according to psychosocial and resource variables. In addition, it aims to study whether there is a greater representation of each kinship group in each of the profiles and if there are differences in emotional distress among such profiles considering the kinship with the care-recipient. Participants were 288 family dementia caregivers, divided into four kinship groups (wives, husbands, sons and daughters). Psychosocial (familism, dysfunctional thoughts and experiential avoidance), resource (leisure activities and social support) and outcomes (depressive, anxious and guilt symptomatology) variables were collected. A hierarchical cluster analysis using Ward's method, an exploratory factor analysis of two fixed factors and contingency tables were performed. Five clusters were obtained: Low psychosocial vulnerability-High resources, Low psychosocial vulnerability-Low resources, Mixed, High psychosocial vulnerability-High resources, and High psychosocial vulnerability-Low resources. Results suggested that clusters associated with lower distress were the Low psychosocial vulnerability-High resources and the High psychosocial vulnerability-High resources. Clusters associated with higher distress were the Low psychosocial vulnerability-Low resources and Mixed. High levels of dysfunctional thoughts, familism and experiential avoidance do not always have a maladaptive function. This could depend on sociocultural and resource variables such as the kinship with the caregiver or perceived social support. The identification of profiles of family caregivers potentially needing protection and vulnerable to psychological distress could help to increase the effectiveness of interventions aimed at this population.
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Cuidadores , Demência , Família , Apoio Social , Humanos , Cuidadores/psicologia , Masculino , Feminino , Demência/enfermagem , Idoso , Pessoa de Meia-Idade , Família/psicologia , Adulto , Angústia Psicológica , Idoso de 80 Anos ou mais , Estresse Psicológico/psicologia , Depressão/psicologiaRESUMO
BACKGROUND: The world prevalence of people with dementia is increasing. Most of the care received by people with dementia is provided by family caregivers, and this prolonged activity has a significant impact on caregivers' levels of depression. Stressors and frequency of leisure are known predictors of caregivers' depressive levels. The longitudinal impact of caregivers' ambivalent and guilt feelings is unknown. METHODS: Participants were 177 family caregivers of relatives with dementia who were assessed three times during a 2-year period. In addition to demographic variables, psychological symptoms of the dementias, and frequency of leisure activities, caregivers' ambivalent feelings, guilt, and depressive symptoms were measured. The longitudinal association of changes in these variables with changes in caregivers' depressive symptoms over time was assessed using mixed linear models. RESULTS: Changes over time in the assessed variables predicted 48.05% of variance of changes over time in depressive symptoms. Even when variables strongly associated with increased depressive symptoms were controlled (lower caregivers' age and educational level, higher reaction to BPSD, and lower leisure activities), increases in ambivalence and guilt contributed to an increase of 9.22% of the variance of changes depressive symptoms over a 2-year period. The effects of ambivalent feelings on depression are indirect, mediated by guilt feelings. Cessation of caregiving do not seem to alter these findings. CONCLUSIONS: Caregivers' ambivalent and guilt feelings are significant predictors of caregivers' mental health. Caregivers may significantly benefit from early detection of ambivalent and guilt feelings and preventive strategies targeting triggers associated with ambivalent and guilt symptoms.
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Cuidadores , Demência , Depressão , Culpa , Humanos , Cuidadores/psicologia , Masculino , Feminino , Depressão/psicologia , Depressão/epidemiologia , Demência/psicologia , Idoso , Pessoa de Meia-Idade , Estudos Longitudinais , Idoso de 80 Anos ou mais , Adulto , Atividades de Lazer/psicologiaRESUMO
INTRODUCTION: Taking care of a relative with dementia may be linked to negative consequences for the caregiver. One of the processes that can be experienced is anticipatory grief, that is defined as the feelings of pain and loss that appear in the caregiver before the death of the person cared for. OBJECTIVES: The review aimed to conceptualize anticipatory grief in this population, to study the related psychosocial variables, and to know the repercussions for the health of the caregiver. METHOD: A systematic search was made under the directives of PRISMA statement in the ProQuest, PubMed, Web of Science (WOS), and Scopus databases, including studies published in the last 10 years (2013-2023). RESULTS: A total of 160 articles were obtained, 15 being finally selected. It is observed that anticipatory grief is defined as an ambiguous process since it appeared before the death of the sick family member. Being a female caregiver, spouse of a family member with dementia, having a closer relationship with him and/or having an important responsibility in care, are associated with a greater chance of experiencing anticipatory grief. In relation to the person cared for, if he or she is in a severe phase of the disease, is younger, and/or presents problematic behaviours, there is also greater anticipatory grief in the family caregiver. Anticipatory grief has a significant impact on caregivers' physical, psychological, and social health, being associated with greater burden, depressive symptomatology, and social isolation. CONCLUSIONS: Anticipatory grief turns out to be a relevant concept in the context of dementia, being necessary to include it in intervention programs for this population.
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Cuidadores , Demência , Humanos , Masculino , Feminino , Cuidadores/psicologia , Pesar , Dor , Isolamento Social , Demência/psicologiaRESUMO
Compassion has been suggested as a relevant variable for understanding dementia caregivers' psychological distress. The objectives were to analyse the psychometric properties of the Caregiving Compassion Scale (CCS) and to explore the association between caregivers' compassion and their emotional health. Two hundred and thirty-six dementia caregivers were evaluated for compassion, depressive symptoms, guilt, ambivalence, care-recipient's functional and cognitive status, frequency of behavioural problems and desire to institutionalise the care-recipient. Exploratory factor analyses, correlations and regression analyses were done. Two factors were obtained. The factor labelled "Distress from witnessing the care recipient suffering" was associated with higher stress linked to witness depressive problems in the care-recipient and with caregivers' ambivalence and guilt levels. The factor labelled "Motivation/disposition for helping" was associated with less desire for institutionalisation, and it showed a negative association with ambivalence and guilt feelings. The CCS seems to be a valid and reliable scale for assessing compassion in dementia caregivers.
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Cuidadores , Demência , Cuidadores/psicologia , Empatia , Humanos , Psicometria , Estresse Psicológico/psicologiaRESUMO
AIMS: To analyze the relationship between guilt for perceiving oneself as a burden and negative self-perceptions of aging, perceived control and anxious and depressive symptomatology in older people without cognitive or functional limitations. METHODS: Participants were 351 community-dwelling people over 60 years without explicit cognitive or functional limitation. Indirect effet analysis were conducted that examined the indirect effect of negative self-perceptions of aging through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology in guilt for perceiving oneself as a burden. RESULTS: Both models showed an indirect relationship between negative self-perceptions of aging and guilt for perceiving oneself as a burden through 1) perceived control and anxious symptomatology and 2) perceived control and depressive symptomatology, explaining 26.37% of anxious symptomatology, 48.51% of depressive symptomatology and 13.73% and 14.44% of guilt for perceiving oneself as a burden, respectively. DISCUSSION: The results obtained suggest that higher negative self-perceptions of aging is associated with a lower perception of control and greater psychological distress (anxiety and depression), and this process increases the feeling of guilt for perceiving oneself as burden to family members in older people without functional or cognitive limitations.