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Objectives To assess the perceived burden and quality of life (QoL) of family caregivers (FCs) of chronically ill older adults in Abha, Saudi Arabia; explore the relationship between burden and QoL; and identify key sociodemographic, clinical and caregiving-related predictors of both outcomes.Design A cross-sectional study.Setting Primary healthcare centres in Abha city, the capital of the Asir region in southwestern Saudi Arabia.Participants A total of 400 FCs of community-dwelling older adults with chronic diseases, selected using a multistage probability sampling technique. Data were collected using validated Arabic versions of the Zarit Burden Interview-22 and the Adult Carer Quality of Life questionnaire. Descriptive statistics, correlation analysis and multivariate regression models were used to identify factors influencing caregiver burden and QoL.Results Most caregivers were young, female, unemployed and cared for dependent older adults. More than half (59.5%) reported mild burden, 22.8% moderate and 1% severe. Regarding QoL, 47.8% had low and 52.2% moderate levels. Caregiver burden was significantly associated with poorer QoL (χ², p<0.05). Predictors of higher burden included caregiver illness, co-residency, longer caregiving duration, higher recipient dependency and being a first-degree relative. Sufficient income, being single, shorter caregiving duration and access to home care services predicted better QoL. Multivariate analysis indicated that access to home healthcare services reduced burden and improved QoL.Conclusions Caring for chronically ill older adults in Abha imposes a considerable psychosocial and physical burden on FCs, adversely affecting their QoL. The findings underscore the urgent need for integrated caregiver support programmes, including home healthcare services, financial and educational assistance and mental health resources, to promote caregiver well-being and sustain informal elder care within Saudi Arabia’s ageing society.