According to AARP, the annual cost of unpaid elder caregiving—a responsibility that falls primarily to family members—totals about $450 billion.

Until Case Western Reserve University nurse researchers began their study, however, the mental, physical and emotional expenditure of such caregiving had never been measured.

“Without knowing the impact of effort, we have two vulnerable people at risk for health issues—the caregiver and the care receiver,” said Evanne Juratovac, assistant professor at the Frances Payne Bolton School of Nursing and the study’s lead investigator.

Juratovac was part of a research group that analyzed the effort of 110 family members in the study, “Effort, Workload, and Depression Symptoms in Family Caregivers of Older Adults: Conceptualizing and Testing a Work-Health Relationship,” published in the international journal, Research and Theory for Nursing Practice (Vol. 26, No. 2, 2012).

The study analyzed caregivers whose responsibilities ranged from simply ordering medicine to full-time care. The study’s caregivers had a median age of 58.5 years (with 44 percent over age 60) and were mostly women (64 percent). Also, more than half of the caregivers were still employed while caring for one of their parents. The average age of the person receiving care was about 82.

The study is among the first to specifically examine the energy used to meet the demands and responsibilities of caregiving. Participants were surveyed about their daily activities and how they applied to mental, physical, emotional or time-related effort.

While it had been previously established that caregivers can develop depression, this study found that “higher effort by the caregiver correlated with higher depressive symptoms,” Juratovac said.

One participant, for example, said the effort “felt like pushing an elephant up a mountain.” Another participant reported being constantly physically exhausted from the mental work. Yet another, who had to travel to provide parent care in the home, was taxed by the time and energy of having to juggle and rearrange schedules.

Researchers were surprised to learn, however, that a caregiver’s effort was not eased when other family members or outside professionals stepped in to help.

Knowing what kinds of effort are expended, therefore, would help in the development of interventions to ease this workload, yet maintain quality care for the recipient, Juratovac said.

Contributing to the study were Diana Morris, Florence Cellar Associate Professor of Gerontological Nursing; Jaclene Zauszniewski, Kate Hanna Harvey Professor in Community Health Nursing; May Wykle, Marvin E. and Ruth Durr Denekas Professor from the Frances Payne Bolton School of Nursing; and Aloen L. Townsend, professor from the Mandel School of Applied Social Sciences.