Factors Influencing Quality of Life Among Family Caregivers Supporting Heart Failure Home Care in Rural Appalachia.

Rural caregivers of older adults with heart failure experience substantial caregiving burden and reduced quality of life. This cross-sectional study examined how caregiver characteristics, demographics, psychological variables (anxiety, depression, loneliness, spiritual well-being), and palliative care concerns predict quality of life among rural family caregivers. Conducted in rural Appalachia, the study included 68 informal caregivers providing in-home care to adults aged 50 or older with advanced heart failure. Quality of life was measured using the World Health Organization Quality of Life-BREF, assessing physical, psychological, social, and environmental domains. Backward stepwise regression analyses were conducted for each domain. Caregivers were primarily older (mean age 60), female, White, and spouses or partners. All models were statistically significant. Lower depressive symptoms consistently predicted better quality of life across multiple domains. Greater spiritual well-being was associated with improved psychological and social relationship, while fewer palliative care-related communication and practical concerns were linked to better psychological and environmental quality of life. Lower loneliness predicted better social relationship, and higher income and older age were associated with improved environmental quality of life. Findings highlight the importance of interdisciplinary support, including social work and healthcare services, to enhance rural caregiver well-being through tailored, home-based, and palliative care interventions.