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Caregiver Overwhelm Survey

1. I am a friend, son or daughter caregiver
Yes
No
2. I am a spousal caregiver
Yes
No
3. I spend less than 10 hours a week caregiving
Yes
No
4. I spend 10-20 hours a week caregiving
Yes
No
5. I spend more than 20 hours a week caregiving
Yes
No
6. I provide financial support to the person for whom I provide care
Yes
No
7. My loved one has a diagnosis of memory loss
Yes
No
8. My loved one has a terminal illness
Yes
No
9. My loved one lives at home
Yes
No
10. My loved one lives in a care community
Yes
No
11. I am more impatient (than not) with my loved one
Yes
No
12. I have more bad caregiving days than good caregiving days
Yes
No
13. I feel abandoned by other family members/friends who could help me but do not
Yes
No
14. There are occasions when I don't know what to do to solve caregiving issues
Yes
No
15. I feel guilty if I want time for myself away from caregiving
Yes
No
16. My physical health has worsened as a result of caregiving
Yes
No
17. My mental health has worsened as a result of caregiving
Yes
No
18. I am a caregiver who finds it difficult to say no
Yes
No
19. I have lost friends and am unable to attend social activities as a result of caregiving
Yes
No
20. I feel isolated and have no one with whom to discuss my caregiving frustrations
Yes
No