1. Introduction
Chronic Renal Failure (CRF) is one of the most common chronic diseases in the elderly [8]. At present, hemodialysis is the most common treatment for this disease in Iran and worldwide [12]. Iran is also facing a growing trend of dialysis patients [8]. Caring for these patients is associated with many problems such as burnout, anxiety, and depression for caregivers [15]. Therefore, the quality of life of the caregivers who care for these patients is more affected than other caregivers, and they gradually lose their energy and become depleted [11]. Due to the increase in the number of dialysis patients in the world and Iran and the caregiving burden that caregivers of these patients face in life, the present study was conducted to determine the predictors of the caregiving burden among caregivers of hemodialysis patients.
2. Methods
This descriptive cross-sectional study was performed in 2020 on 252 elderly caregivers undergoing dialysis in Qazvin province. Samples were selected by census method from the main caregivers of patients referred to hemodialysis centers in the province. Inclusion criteria for caregivers were willing to participate in the study, age 18 and older, and primary responsibility for caring for the elderly on dialysis for at least one month. Exclusion criteria for caregivers were inability to communicate, simultaneous care of another patient, and receipt of care costs. Inclusion criteria for the elderly, age 60 and older, underwent dialysis, and had a home caregiver. Demographic characteristics checklist, Barthel scale, perceived social support questionnaires (Multidimensional Scale of Perceived Social Support (MSPSS)), Schwarzer’s and Jerusalem general Self-efficacy questionnaires, and the Pargament’s Religious Coping Scale (RCOPE) were used to collect data. Health status of the caregiver with a question “How do you assess your health status?” It was evaluated with a 5-point Likert from poor to excellent [46]. 
Then written consent was obtained, and then the questionnaires were answered by the caregivers. Data were analyzed in SPSS software v. 23 using the multivariate linear regression model. The normality of the data was confirmed by Smirnov Kolmograph, histogram curve, skewness, and kurtosis. The significance level of all tests was considered less than or equal to 0.05.
3. Results
The Mean±SD age of caregivers was 44.9±13.16 years, and elderly patients were 69.4±7.7 years. Most elderly patients participating in the study were married (69%), living with a spouse or children (65.5%). The duration of dialysis in most of the studied elderly was less than 3 years (58.3%). Most female caregivers were married with a high school diploma or higher and lived with a spouse or children.
According to the results, the Mean±SD caregiving burden was 32.539 ±15.053. Most caregivers reported mild to moderate (44.4%) to moderate (50%), and only 5.6% of caregivers were under severe care stress. The Mean±SD social support was 60.250±16.815, which was higher than the average, and the highest mean of social support was related to family support, with a mean of 21.441. The Mean±SD dependence of elderly patients was above average (70.89±22.54), and Self-efficacy (25.46±7.06) and religious coping (17.63±5.94) of caregivers was moderate according to the results. According to the present study, caregivers’ caregiving burden decreased with increasing social support (β=-0.146) caregivers’ health status (β=-0.131). The caregiving burden increased significantly in the caregivers of patients with severe dependence compared to those with moderate dependence (β=0.218). Also, caregivers with excellent economic status were under less caregiving burden than caregivers with moderate economic status (β=0.173) (Table 1). Finally, the estimated model predicted 28.4% (R2=0.284) of caregiver caregiving burden in elderly dialysis patients.



4. Discussion
The results of the present study, in line with the results of the study of Abbasi et al. (2011) [17] and Mollaqloo et al. (2013) [18], showed that the health status of the caregiver was inversely related to the caregiving burden. Because caregivers have to meet the needs of themselves and their patients simultaneously, the presence of chronic diseases and health problems disrupts the delivery of care roles and imposes a high burden of care [17]. 
The results showed that social support was a predictor of caregivers’ caregiving burden. As social support increased, caregivers’ caregiving burden decreased. The results of this study are in line with the results of most previous studies [39, 59]. Caregivers who receive social support are likely to have more time and resources for better and more effective care. They also have more energy to focus on care and can easily deal with the new conditions of life with the patient [36]. Therefore, more attention should be paid to the health status of caregivers as potential patients. By taking measures to develop social support for caregivers, an effective step was taken to reduce the caregiving burden among caregivers of hemodialysis patients.
Ethical Considerations
Compliance with ethical guidelines
The study was approved by the Ethics Committee of Qazvin University of Medical Sciences, Qazvin, Iran (IR.QUMS.REC.1398.329). The written consent form was obtained from all caregivers before participation in the study. 
Funding
This research part of the Mahdieh Taherkhani Master of Nursing in the Faculty of Nursing and Midwifery, Qazvin University of Medical Sciences.
Authors' contributions
Conceptualization, methodology, research, drafting, editing and finalization of writing, Sources: All authors; Financing: Mahdieh Taherkhani; Project Management: Seyedeh Ameneh Motalebi.
Conflicts of interest
The authors declared no conflict interest.
Acknowledgments
The authors would like to thank the Vice-Chancellor for Research of Qazvin University of Medical Sciences and all the caregivers of older patients for their support and cooperation.

 

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