DOI: 10.1002/alz.082857 ISSN: 1552-5260

Burden of caregiving to people living with dementia in low‐and middle‐income countries in Asia: a systematic review

Anh Tuan Tran
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Home‐based care is the primary type of care given to people with dementia in Asian countries due to cultural perceptions and the limited formal dementia care support. Long‐term caregiving can lead to a high caregiver burden, further strained by limited access to caregiver support in less developed countries. It is essential to assess the level of caregiver burden and its factors in such settings to understand the impact on caregivers’ well‐being and quality of life. Aim: To synthesize the evidence on the level of caregiving burden and its factors among caregivers of people with dementia (PWDs) in LMICs in Asia.


Systematic review was conducted based on the PRISMA protocol. 71 eligible studies were identified from MEDLINE (Ovid), EMBASE (Ovid), PsyINFO (Ovid), CINAHL Plus (EBSCOhost), Cochrane Collaboration, Web‐of‐Science, and Scopus and from 2000 to 19 August 2022. Each article’s methodological quality was assessed with an appraisal checklist developed by the JBI.


A total of 71 studies (12,424 caregivers) were identified from 09 LMICs (China, India, Iran, Malaysia, Pakistan, Philippines, Thailand, Turkey, and Vietnam). The caregiver burden was assessed using 10 tools, the commonest being Zarit Burden Interview (ZBI, n = 41) and Caregiver Burden Interview (CBI, n = 17). The prevalence of caregiver burden using ZBI ranged from 9.47% in Thailand to 64.57% in India. The prevalence of the burden of caregiving ranged from 25.00% in Thailand and 68.66% in China, as assessed by CBI. There were various patient characteristics (including severity and duration of dementia, Mini‐mental State Examination (MMSE) score, BPSD severity etc.) and characteristics caregiver characteristics (age, gender, education level, employment status, income, religion) associated with the burden of caregiving. Social support, positive aspects of caregiving (PAC), resilience, and intrapersonal resources were some of the moderating factors associated with caregiver burden. A meta‐analysis is still being attempted based on the homogeneity of the results.


Caregivers of people living with dementia in LMICs in the Asian region have a high burden of caregiving. There should be targeted interventions to alleviate the caregiver burden and to improve the quality of life of carers of people living with dementia in such countries

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