A Life-Stage Comparative Study of the Psychosocial Care Burdens and Needs of Middle-Aged and Older Family Carers in Home Care
Round 1
Reviewer 1 Report
Comments and Suggestions for AuthorsThis is a complex issue in which multiple variables are involved. Consequently, and taking into account the data collected in the study, a revision of certain elements is proposed:
- Reference is made to physical, psychological and social burdens (Zarit et al., 1980) and caregiver stress (Pearlin et al., 1990). There are more recent studies related to caregiving (some of them with a specific focus) that could provide a more up-to-date set of references:
Mboungou Y, Semino L, Coronados Y, Ruiz D. Emotional states and burden of the primary caregiver of patients disabled by stroke. Rev Cub Med Fis Rehabil. 2018;10(3):1–11. [Links]
Salazar-Maya A, Cardozo-García Y, Escobar-Ciro C. Care burden of family caregivers and level of dependence of their relative. Investig Enferm Imagen Desarro. 2020;22. Available at: https://revistas.javeriana.edu.co/index.php/imagenydesarrollo/article/view/28369 [Links]
Ghazawy ER, Mohammed ES, Mahfouz EM, Abdelrehim MG. Determinants of caregiver burden of persons with disabilities in a rural district in Egypt. BMC Public Health. 2020;20:1156. doi:10.1186/s12889-020-09266-4 [Links]
Morelli N, BS, MM, GG. Supporting family caregiver engagement in the care of older persons living in hard-to-reach communities: a scoping review. Health Soc Care Community. 2019;27(6):1363–1374. doi:10.1111/hsc.12826 [Links]
Niu S, DSWSMJSY. Correlations between caregiver competence, burden and health-related quality of life among Chinese family caregivers of older adults with disabilities: a cross-sectional study using structural equation analysis. BMJ Open. 2023;13(2):e067296. doi:10.1136/bmjopen-2022-067296 [Links] - In the section:
3.2. Demographic Characteristics of Care Recipients (p. 4)
“Support levels 1 and 2 indicate relatively light care needs, whereas care levels 1–5 represent progressively higher care requirement levels.”
This statement contains an error and should be corrected. Levels 3 to 5 correspond to higher care needs. - It is stated that the results were refined through consultations with researchers and public health professionals in the field of Geriatrics. Which professionals were involved, how many were consulted, and what did these contributions consist of?
- Gender analysis is identified as a limitation. The sample is predominantly composed of women. Nevertheless, it would be of interest to include some reference to the presence or absence of gender-based differences in any aspect, as well as to pre-established cultural patterns related to caregiving and the capacity for choice.
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Comments.pdf
Author Response
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Reviewer 2 Report
Comments and Suggestions for AuthorsThis manuscript addresses an important and timely issue in aging societies, namely how psychosocial caregiving burdens and support needs may differ between middle-aged and older family carers. The topic is policy relevant and the data are potentially informative. Here are some of my comments on the paper:
1. The current paper repeatedly invokes “life stage” as a core explanatory construct, yet this concept is operationalized almost exclusively through an age-based grouping (30–64 vs ≥65). Life stage typically implies role configurations (e.g., employment status, parenting responsibilities, financial obligations), none of which are directly measured. As written, the framing overstates what the data can support.
2. Claims about the lack of comparative research would benefit from greater precision. There is a substantial literature comparing adult-child and spousal caregivers. I think what appears novel here is the specific sampling context and needs framework rather than the comparison per se.
3. The introduction would be strengthened by providing more concrete epidemiological context on caregiver burden, particularly from a global perspective. At present, the background relies heavily on Japan-specific statistics and policy documents, which makes it difficult to situate the study within the broader international literature on informal caregiving. I would encourage the authors to include up-to-date worldwide or cross-national statistics on the prevalence of family caregiving and caregiver burden. This would help to underscore the magnitude and universality of the problem. Example of caregiver burden prevalence that the author can use: Soh et al. (2025). Prevalence of depression, anxiety, burden, burnout, and stress in informal caregivers: An umbrella review of meta-analyses. Archives of Gerontology and Geriatrics Plus, 100197.
4. It seems that the reported ethics approval date postdates data collection. It will be useful to clarify this
5. The checklist approach used for “causes of burden” and “life challenges” lacks clear psychometric grounding. It is also unclear whether these items function as antecedents, correlates, or components of burden.
6. The demographic results show extremely large differences between groups in caregiver–care recipient relationship (Cramer’s V > .70). This suggests that the comparison might be effectively between adult-child caregivers and spousal caregivers, rather than between life stages per se.
7. The central conclusion that psychosocial burdens and needs differ more by life stage and social roles than by age is not empirically demonstrated, as social roles were not directly measured. This claim should be substantially softened
8. Several passages imply causal interpretations (e.g., work demands leading to greater burden), which are not warranted given the cross-sectional design.
Author Response
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Author Response File: Author Response.pdf
Reviewer 3 Report
Comments and Suggestions for AuthorsLine 37, I would expect specific numbers or percentages. Overall, the background section could include more specific demographics about the aging population.
Clearly stated tables with interesting information supported by the background. For example, the OFC group experienced greater physical strain, and spouses, primarily female, in the OFC group felt less burdened but had greater concerns about the future.
I thought the lower percentage of care recipients over 85 receiving care due to mental conditions was interesting due to issues of Alzheimer's in that age range.
Figure 3 provides an excellent comparison between the two groups.
Good policy recommendations. Could benefit from specific recommendations for future research.
Overall, an interesting and well-written article.
Author Response
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Author Response File: Author Response.pdf
Round 2
Reviewer 2 Report
Comments and Suggestions for AuthorsOverall, the authors have responded appropriately and thoughtfully to my comments, and I find the revised manuscript to be meaningfully improved.
