The global population of older adults is growing as a result of improved healthcare quality, increased public health, medical science advances, improved nutritional status, and increased life expectancy (1). The World Health Organization (WHO) projects that the number of elderly people aged over 60 will rise by 10% between 2015 and 2050 and reach 923 million by 2050 (1, 2). The population of older adults in Iran is predicted to rise to 10.5% in 2025 and to 21.7% in 2050 (3). The increased population of older adults has raised the prevalence of chronic diseases because older adults are susceptible to various chronic diseases due to changes in their physiological, cognitive, and emotional status (4). Chronic diseases affect the performance of older adults and prolong their treatment periods, preventing them from doing daily activities properly (5). Chronic diseases in older adults are associated with declining functional status and quality of life, social isolation, and increased reliance on caregivers (5–7).
Individuals who provide care for patients with chronic and debilitating diseases are known as caregivers (8). There are two types of caregivers: formal caregivers, who have received professional training, and informal caregivers, or family caregivers, who have not received training and frequently include a patient's spouse, children, relatives, and neighbors (9, 10). The need for family caregivers has increased as a result of the growing number of older adults, the prevalence of their chronic diseases, and rising healthcare costs (11). Family caregivers experience higher levels of stress, financial strain, and emotional exhaustion than formal caregivers due to the long hours of caregiving (12–15). Furthermore, the ongoing psychological and physical stress associated with providing long-term care for elderly patients with chronic diseases can impose a great care burden on caregivers (16). Care burden refers to a negative response to how caregiving affects a caregiver's social, professional, and personal roles (17). Zarit et al. defined care burden as the perceived adverse effects of caregiving on one's emotional, social, financial, and physical functioning (18). As viewed by Beach et al., the increased care burden on caregivers can cause family caregivers to experience adverse outcomes such as anxiety and depression, burnout, exhaustion, occupational issues, a lack of personal time, disruptions to social interactions and leisure activities, and family problems (19). Therefore, it will negatively affect their efficiency (20). Among family caregivers, spouses may bear a greater level of care burden than other family members (21). Reportedly, the Asian caregivers of elderly patients with chronic diseases bear a low to moderate care burden (22). Studies indicate that care burden is influenced by two groups of factors: the older adult’s characteristics and the caregiver's characteristics. The older adult’s characteristics include functional dependence, affliction with multiple diseases, and memory and sleep disorders However, the caregiver's characteristics include old age, female gender, elderly spouse, low educational attainment, affliction with depression, social isolation, low income, long duration of caregiving, and no support from others (22–24). It has also been reported that the type of disease can determine the severity of care burden (25), with caregivers for patients with brain injuries from accidents experiencing a higher level of care burden than caregivers for cancer patients (26). Another study showed an inverse correlation between care burden and the health status of caregivers (27). Spirituality and its dimensions, e.g., spiritual intelligence, are recognized as important factors influencing mental health (28). Spiritual intelligence develops a person's ability to apply spirituality in practice (29, 30). Although a potential relationship seems to exist between spiritual intelligence and care burden, a few studies have addressed such a relationship.
Spiritual intelligence refers to a set of spiritual resources, capacities, and abilities that can improve one’s mental health and flexibility (31). Spiritual intelligence can help caregivers manage their conditions and improve their clinical competency (32). Spirituality can serve as a powerful shield and coping mechanism to deal with the complexities of care burden. In other words, spirituality provides a framework that enables caregivers to derive valuable meaning from their experiences. Such understanding helps them manage unpleasant emotions such as sadness, guilt, anger, and loneliness, as well as stress and anxiety, while also encouraging peace, acceptance, and self-reflection. Furthermore, spirituality fosters empathy and compassion for oneself and others, allowing caregivers to better perceive the views of those they care for (33). Kaur et al. developed a model of caring behaviors for nurses and showed that spiritual intelligence positively affected the emotional intelligence and caring behaviors of nurses. Their findings also indicated that caregivers with higher levels of spiritual intelligence perceived higher self-efficacy in caring for patients (34).
The long-term care of older adults with chronic diseases can impose a high level of care burden on family caregivers. Since higher-quality care requires maintaining the health status and enhancing the quality of life of family caregivers, we must identify the factors affecting care burden. Moreover, spiritual intelligence, as a component of mental health and adaptation, and car burden seem to be correlated. Considering the paucity of relevant studies, this study aimed to assess the relationship between spiritual intelligence and care burden in family caregivers of the elderly with chronic diseases in Tehran within 2022–2023.