Through the Burden: A Model of Self-Transcendence in in Family Caregivers of NH Residents
Dalit Zaguri-Greener, Ruth Lopez, Anna Zisberg
Innovation in Aging December 1, 2025 DOI: 10.1093/geroni/igaf122.4240 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Cross-sectional survey Peer reviewed |
|---|---|
| Sample size | 232 |
| Population | Family caregivers of nursing home residents with advanced dementia |
| Key findings | Perceptions of family-centered care from nursing home staff predicted lower caregiver burden (β = –.611), and lower burden predicted higher self-transcendence (β = –.52). The direct path from family-centered care to self-transcendence was nonsignificant, but the indirect effect through burden was significant, indicating full mediation. The authors argue that caregiving in this setting can be a transformative process and that nursing home policies should support communication, family engagement, and shared decision-making. |
Abstract
Abstract Background Family caregivers of nursing home (NH) residents with advanced dementia often experience high emotional and logistical burden. While most models emphasize stress and coping, fewer address meaning-making and personal growth. This study applies Reed’s Self-Transcendence (ST) Theory to explore how caregiving may foster adaptation and meaning after placement.
Objective: To examine whether perceptions of family-centered care predict caregiver burden and ST.
Methods: Using a cross-sectional survey of 232 family caregivers of NH residents with advanced dementia, we examined the relationships between “Perception of Family-Centered Care” (basic care, symptom management, communication, trust, shared decision-making, and recognition of personhood), in NH staff, burden, and ST.
Results: Structural equation modeling revealed that Perception of Family-Centered Care significantly predicted lower caregiver burden (β = –.611, p < .001). In turn, lower burden was associated with higher ST (β = –.52, p = .002). The direct path from Perception of Family-Centered Care to ST was nonsignificant (β = –.154, p = .218). However, the indirect effect from Perception of Family-Centered Care to ST through caregiver burden was significant (β = .67, 95% CI [.214 – 2.253], p = .000), indicating full mediation.
Conclusions: Findings highlight the transformative nature of family caregiving in the NH setting. Recognizing family caregiving as a dynamic, transformative process can guide interventions that help family caregivers move through the burden-transcend toward meaning and connection. NH policies should consider integrating structured communication, family engagement, and decision-making support to reduce burden while fostering resilience, meaning-making, and role adaptation.