Caregiver Motivation: Affection or Sense of Duty?

I can’t help but read every report that comes across my virtual desk regarding caregiving. Intellectual pleasure accounts for a lot of this habit, but a sense of professional obligation weighs in heavily too (you are free to call me a nerd now).

That’s why I spent this morning reading Dementia: A Public Health Priority, a report released last week by the World Health Organization and Alzheimer’s Disease International. This 100+ page report is a robust encore to the Alzheimer’s Association’s recently released 2012 Alzheimer’s Disease Facts and Figures Report (see my previous blog post for my reactions to that compilation).

Some interesting facts to ponder:

  • Over 35.6 million people worldwide are living with dementia.
  • Treating and caring for those with dementia across the globe costs over 604 billion U.S. dollars a year, which includes the cost of providing care and the loss of income among persons with dementia and their caregivers.
  • Only 8 countries worldwide have a national dementia plan in place. The United States is not one of them, although we’re in the midst of developing such a plan (thank goodness).

(c) WHO/P. Virot

World Health Organization in Geneva, © WHO/P. Virot

None of these facts is particularly surprising compared to other reports I’ve seen. But this report included a fascinating section on caregivers that reframed some of the notions with which we’ve grown comfortable.

For instance, the report refers to caregiver strain instead of caregiver stress. I found this interesting. It’s more visceral and seems to capture the feeling of caregiver distress pretty accurately, yet it doesn’t seem to acknowledge that caregiver stress can ever be good.

The coolest part of the report was the summary of research on caregiver motivations. To my knowledge, this topic has never before been addressed in a major report on caregiving.

Why do caregivers do what they do? And if we knew that, would we be able to help them more effectively with the right kinds of interventions and programs?

Much of the research found that affection was a key motivator in the choice to be a caregiver. That’s right – the emotional bonds that connect the caregiver and care receiver.

I’ll jump out of the boundaries of scholarly discourse now and call this what it is: love.

Sure, there were also a lot of people who cited a sense of duty or family obligation as key motivators in caregiving. But in one major study – the EUROFAMCARE study – 57% of people listed affection as their primary motivator while only 28% chose a sense of duty or a personal sense of obligation as their principal motivation.

Some studies did show that family obligation is a prominent reason for caregiving in “low- to middle-class income countries.” Across studies, very, very few people said that their primary motivation was that they had no alternative but to be a caregiver.

What are your thoughts on these findings? Depending on the situation, does love often trump duty?

I have three thoughts on this issue.

First, the concept of love versus duty is pervasive in the human experience. I think that often, they coexist. I even wrote at the beginning of this post that I read caregiving reports both because I enjoy it and because I feel obligated to stay current.

Second, when I think about the many caregivers I’ve worked with over the years, the research summarized in the report is a clear fit with what I’ve witnessed. Caregivers are simply inspiring.

And third, if a caregiver feels true love, I don’t know if a sense of duty is even felt on a separate level. It may just melt into the totality of how the caregiver feels about the other person.

And when that happens, perhaps that is when caregiver joy bursts through.


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  • Okay, this is probably way too much information, but here goes. In being a caregiver for my Mom, it was an automatic, visceral response. There was never any question as to what I would do, how I would contribute. It was an honor, humbling, a privilege, and sometimes hard as hell.

    After three or four months of helping my Dad care for my Mom and changing my life circumstances to do that, e.g., shifting career priorities, eiminating extra projects, etc., I found that I was good at it. To my utter surprise. I was in my mid-30s at the time and had put off having a child for several years, thinking I was too selfish to care for another human being.

    Caring for my Mom taught me differently. I was capable of doing it. Within months, I got pregnant with my first child. I credit my Mom with that gift of knowledge. I told her that, but am uncertain if she understood, as a brain tumor had compromised her cognition. Regardless, the gift of caring for her lead me to become a parent without regret and with confidence.

    Hope that makes sense. I am loving your blog. MTM.

  • In reply to Mary Tyler Mom:

    Dear Mary Tyler Mom,

    Thank you so much for sharing your story -- it was not too much information at all. In fact, I think you elucidated a process that others can relate to and appreciate. I know that as a 40+ newlywed who very much hopes to start a family, I truly appreciate your insights on the parallels between caregiving and motherhood.

    Take good care,
    Dr. Chill

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