Copyright CU Aging Center 2/2007 CG Reaction Scale(V1)
Name of Person
Completing Form
Date Form was
completed
Name of Patient
CAREGIVER REACTION SCALE
The following questions are designed to help us understand the types of difficulties you and your
family faces as caregivers.
Each item is rated on a 1 to 4 scale.
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
Please respond to all items by checking () the appropriate box
(A) Here are some thoughts and feelings that people sometimes have about themselves
as caregivers. How much does each statement describe your thoughts about caregiving.
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
Wish you were free to
lead a life of your own.
Feel trapped by your
relative's illness.
Wish you could just
run away
Feel stressed by your
relative's illness and
needs
(B) How much does each statement describe you:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
You are exhausted
when you go to bed at
night
You have more to do
than you can handle
You don't have time
just for yourself
You work hard as a
caregiver but never
seem to make any
progress
(C) Caregivers sometimes feel that they lose important things in life because of their
relative's illness. To what extent have your personally lost the following:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
Being able to confide
in your relative
The person whom you
used to know
Having someone who
really knew you well
A chance to do some
of the things you
planned
Contact with other
people
A sense of who you
are
Lost an important part
of yourself
(D) People can often learn things about themselves from taking care of a relative.
How much do you:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
Believe you've
learned how to deal
with this very difficult
situation
Feel that, all in all,
you're a good
caregiver
In general, feel
competent as a
caregiver
Feel self-confident as
a caregiver
(E) Since becoming a caregiver, how much have you:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
Become more aware
of your inner strengths
Become more self-
confident
Grown as a person
Learned to do things
you didn't do before
(F) There are many different ways of coping with the stress caregiving. How often do you:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
Try to accept your
relative as he/she is,
not how you wish he/
she could be
Try to think about the
present rather than
the future
Try to keep your
sense of humor
Spend time alone
Eat
Smoke
Get some exercise
Watch TV
Read
Take some medication
to calm you down
Drink some alcohol
(G) Family members don't always see eye-to-eye when it comes to dealing with a relative
who is ill. How much disagreement have you had with anyone in your family about the
following issues:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
The seriousness of
your relative's memory
problems
The need to watch out
for your relative's
safety
What things your
relative is able to do
for him/herself
Whether your relative
should be placed in
nursing home or
assisted living
(H) How much disagreement have you had with people in your family because they:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
Don't spend enough
time with your relative
Don't do their share in
caring for your relative
Don't show enough
respect for your
relative
Lack patience with
your relative
Don't visit or
telephone you enough
Don't give you enough
help
Don't show enough
appreciation for your
work as a caregiver
Give you unwanted
advice
(I) How much do you agree with the following statements about your present work
situation
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
You have less energy
for your work
You have missed too
many days
You have been
dissatisfied with the
quality of your work
You worry about your
relative while you're at
work
Phone calls about or
from your relative
interrupt your work
(J) These questions ask about your household expenses and your standard of living.
Compared with just before you began to take care of your relative how much you would
agree, with the following statements:
1 (not at all) 2 (somewhat) 3 (quite a bit) 4 (completely)
1 2 3 4
Total household
income has decreased
Total monthly
expenses have
increased
In general, family
finances work out at
the end of the month
Adapted from Pearlin, et al. (1990)
CU Aging Center 2/2007
