Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana

**Background:** The population of older adults in sub-Saharan Africa is increasing, leading to a higher prevalence of age-related chronic diseases and a greater demand for informal care. In Ghana, informal caregivers often face significant burdens—emotional, physical, financial, and social—which may negatively impact their own health-related quality of life (HRQoL). While caregiver burden has been studied in specific patient populations (e.g., schizophrenia, stroke), no prior study had examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana. This study aimed to fill that gap, guided by Ashing-Giwa's conceptual model of HRQoL, which posits that socio-ecological (including caregiver burden), cultural, demographic, and healthcare factors influence HRQoL.

**Methods:** Data were drawn from a cross-sectional survey conducted between July and September 2022 in 13 districts (18 rural and 21 urban communities) of the Ashanti Region, Ghana. The analytical sample included 1,853 informal caregivers (≥18 years) of older adults (≥50 years). Caregiver burden was assessed using the 10-item World Health Organization Impact of Caregiving Scale (score range 10–50; higher = greater burden; Cronbach's α = 0.881). HRQoL was measured using the 8-item SF-8 Health Survey (score range 8–42; higher = better HRQoL; Cronbach's α = 0.932). Generalized Linear Models were used to estimate associations, with five sequential models adjusting for socio-economic, cultural, demographic, and healthcare covariates. Beta coefficients (β) and standard errors (SE) were reported; significance was set at p ≤ 0.05.

**Key Results:** The mean age of caregivers was 39.15 years; 72.9% were female; 76.8% earned less than GH¢1000/month; 76.6% had no health insurance; 79.6% lived with the care recipient; and 50.6% had not used healthcare in the past year. The mean age of care recipients was 75.08 years. In the final fully adjusted model (Model 5), caregiver burden was significantly negatively associated with HRQoL (β = −0.286, SE = 0.0123, p = 0.001). Several covariates also showed significant associations: compared to caregivers with tertiary education, those with no formal education (β = −1.204, SE = 0.4085, p = 0.01), primary education (β = −2.390, SE = 0.5099, p = 0.001), or junior high school education (β = −1.113, SE = 0.3903, p = 0.01) had lower HRQoL. Younger caregivers (ages 18–24: β = 2.960, SE = 0.6306, p = 0.001; 25–34: β = 1.728, SE = 0.5794, p = 0.01; 35–44: β = 1.604, SE = 0.5764, p = 0.01) had higher HRQoL compared to those aged 65+. Caregivers who did not use healthcare services in the past year had higher HRQoL than those who used services five or more times (β = 4.786, SE = 0.4610, p = 0.001). Akan ethnicity (β = 0.802, SE = 0.3789, p = 0.05) and Christian (β = 2.572, SE = 0.7234, p = 0.001) or Islamic (β = 2.244, SE = 0.8011, p = 0.01) affiliation were associated with higher HRQoL.

**Clinical Implications:** This is the first study in Ghana to demonstrate a robust negative association between caregiver burden and HRQoL among informal caregivers of older adults, even after controlling for multiple confounders. The findings suggest that interventions to improve caregiver HRQoL should address caregiver burden directly—through self-care education, social support, and periodic health check-ups—and also target modifiable factors such as education and healthcare access. The association between higher healthcare utilization and lower HRQoL may reflect greater health needs among those with poorer health, underscoring the importance of proactive, preventive care for caregivers. Culturally tailored programs that leverage religious and ethnic community networks may enhance social support and mitigate burden. Policy measures should integrate caregiver support into Ghana's healthcare system to prevent a cycle where caregivers themselves become care recipients.