HA is conducive to improving joint function recovery and reducing complications for patients with femoral neck fracture, and it has been widely applied clinically as a surgical method to treat elderly patients with femoral neck fracture. This study analysed the clinical data of elderly patients with femoral neck fracture and that of their family caregivers. Combined with reported factors that affect the caregiver burden, this study analysed the burden-related factors of caregivers of patients who underwent an operation after femoral neck fracture and primarily revealed the burden borne by caregivers who cared for patients with femoral neck fracture in this area of China. This study showed that most of the family caregivers of patients with femoral neck fracture came under considerable caregiver burden, and the important factors that were obviously correlated with the care burden were the patient’s functional status, Harris score, pain score, GSE score, SSRS score and the ratio of medical expenses to monthly income per capita.
In this study, the sociodemographic characteristics of caregivers indicated that family caregivers were the patients’ spouses, who had a low education level and were advanced in age. However, these demographic characteristics did not aggravate the caregiver burden of caregivers. This is consistent with the results of related parallel studies [10], which may be due to the similar sociodemographic characteristics of caregivers in Western China as well as the consistency in cultural or behavioural factors. This study showed that the patient’s functional status was positively correlated with the caregiver burden. Patients with femoral neck fracture need increased care and personal nursing in their daily lives due to the partial or total loss of self-care ability after the operation, thereby increasing the care burden. This study also showed that the degree of pain that patients experienced was positively correlated with the burden of care. Severe pain affected the quality of life of patients and was injurious to their body and mind. In addition, pain requires continuous analgesic therapy as well as sustained emotional support, which not only increases the caregiver’s expenditure but also contributes to mental health problems in the caregiver and ultimately adds to the burden of care. In this study, most of the family caregivers had a ratio of medical expenses to monthly income per capita of less than 5/1. As a result, these caregivers experienced enormous life pressures, heightening the burden of caregivers. In summary, caregivers had to pay medical expenses and support the family while caring for patients. They were under tremendous pressure physically, psychologically and economically. The persistent stress load affected the health of caregivers, and the health status of caregivers also directly influenced patients’ rehabilitation and quality of life. Therefore, it is necessary for health care institutions and government to introduce specific measures and policies to reduce the care burden for the families of elderly caregivers, such as hospital strengthening care skills training. Additionally, through refining the rehabilitation training guidance and increasing emotional support, the government increases the provision and support for the aged, thus increasing financial support and reducing medical expenses.
Previous studies have demonstrated that caregivers’ social support and self-efficacy are negatively correlated with caregiver burden [17,18]. Caregivers feel that social support affects their anxiety and depression levels, as it can effectively lessen the severity of their stress [19]. However, when the targeted support provided by professionals to caregivers is not satisfactory, the pressure felt by caregivers augments [20]. This study shows that social support can lessen caregiver burden, consistent with the above studies. In China, due to the influence of traditional culture and a lack of available services (for example, in single-child families, offspring cannot take care of elderly parents due to work reasons), caregivers often do not receive substantial support from other members of the family, while social support from the family and professional institutions makes it easier for family caregivers to take care of patients and themselves, cope with stress, and minimize the caregiver burden [21, 22]. Therefore, to reduce the burden of caregivers, professional medical and health institutions can take measures to improve the current situation, provide appropriate social support to help caregivers, and reduce their burden. Self-efficacy is the individual’s confidence or belief in a new organization and its executive capability in a particular field. Individuals with high self-efficacy will carry out the task more proactively, while individuals with low self-efficacy may evade it due to a sense of inability and helplessness [23]. Self-efficacy can bring about more positive emotions and contribute to health [24], thereby reducing the caregiver burden [25]. The results of the questionnaire in this study reveal that self-efficacy is negatively correlated with caregiver burden, consistent with the above results, possibly because family caregivers with high self-efficacy have strong self-regulation abilities, are psychologically healthier, and can better cope with care pressure [26]. Specifically, individuals with a strong ability in emotion regulation can adjust their emotions to fit in with the situation they are in at the moment. Generally, they have more positive emotional experiences, which can in turn promote their mental health and enhance their happiness, make them more flexible in thought and encourage them to come up with solutions to the problem. Given our research findings, more intervention measures should be taken to improve the self-efficacy of family caregivers. Intervention measures can include professional trainings or psychological support, which may help reduce the burden of family caregivers of elderly patients with femoral neck fracture.
This study also has some limitations, as it only involves an orthopaedic centre in Western China. Considering the cross-sectional nature of this study, it is not plausible to establish causality between the results and the survey variables. To better understand the factors influencing the caregiver burden among family caregivers of patients with femoral neck fracture in China, it is also necessary to conduct a longitudinal cohort study to gain deeper insight into the factors involved in the care burden of family caregivers and the impact of these factors on caregivers. In addition, the inclusion of non-randomly selected participants may lead to unpredictable biases. Despite the above limitations, this study has identified factors closely related to the caregiver burden and has proposed improvement strategies and intervening measures, which will eventually contribute to better patient care.