Psychological Factors, Health Behaviors, and CVD Risk in Caregivers of Thai Older Adults with Dementia

Aims: Family caregivers of persons with dementia are at increased risk for cardiovascular disease (CVD), yet associated factors remain underexplored, particularly in Thailand’s rapidly aging society. This study examined direct effects of psychological factors (resilience, caregiver burden, and perceived social support) and health behaviors (physical activity and sleep quality) on cardiovascular disease (CVD) risk among family caregivers of Thai older adults with dementia, and assessed indirect effect of resilience on CVD risk, guided by the conceptual framework of Kubzansky and colleagues (2018). Methods: We conducted a cross-sectional study using purposive sampling, enrolling 180 primary family caregivers at two hospitals in northern Thailand between June and October 2024. CVD risk was assessed using QRISK3, a 10-year CVD risk prediction algorithm incorporating demographic and health-related indicators. To gather the indicators, objective measures of body weight, height, blood pressure, and cholesterol levels were obtained following standardized protocols. Psychological and behavioral variables were assessed using validated Thai versions of the Connor-Davidson Resilience Scale, Zarit Burden Interview, Multidimensional Scale of Perceived Social Support, International Physical Activity Questionnaire, and Pittsburgh Sleep Quality Index. Generalized structural equation modeling (GSEM) was employed to investigate both direct and indirect effects. Results: Approximately 60% of participants had a low 10-year CVD risk (<10%), while 40% were classified as having moderate to high risk. About 62% reported high perceived social support (scores 61–84/84), and nearly half experienced no to mild caregiver burden (scores 0–20/88). About 47% engaged in moderate levels of physical activity (600–2,999 MET-minutes/week). Regarding resilience, 57% demonstrated borderline low levels (scores ≤30/40), and nearly 70% reported poor sleep quality (score ≥5/21). GSEM revealed that caregiver burden was positively associated with CVD risk (β = 0.179, p = 0.018), while resilience, social support, physical activity, and sleep quality had no significant direct effects. However, resilience was indirectly associated with reduced CVD risk through decreased caregiver burden (β = –0.145, p = 0.040), accounting for 86% of the total significant indirect effect (β = –0.168, p = 0.027). Conclusions: Caregiver burden directly increases CVD risk, while resilience helps reduce caregiver burden and may indirectly lower CVD risk. Nurses should assess caregiver burden and CVD risk regularly and apply integrated interventions addressing psychological and behavioral factors to reduce CVD risk in dementia caregivers. This study addresses the underexplored CVD risk in Thai dementia caregivers, identifying resilience as a key protective factor and promoting a paradigm shift toward resilience-focused health interventions.