Over 40 million Americans are estimated to provide unpaid care to a family member or friend aged 50 years or older in 2020 (1). On average, unpaid caregivers for older adults provide over 22 weekly hours of care, and they assist their care recipients with basic and instrumental activities of daily living and medical tasks, as needed (1). Consistent evidence shows that informal caregivers have reduced social activities over time, which increases caregiver burden and negatively influences caregivers' health and quality of life (2–4). In addition to unpaid or informal caregivers (e.g., family members and friends), paid caregiving services are increasingly needed and more prevalent among care recipients of older ages.

Through social networks and interactions, caregivers can access social support in the form of emotional, informational, and other tangible and intangible resources. Social support can protect caregivers against feeling burdened (5) by providing resources to eliminate or reduce the perceived stress and alleviate the impact of stressors (6, 7). Having a sense of belonging, which is closely associated with perceived social support (8), can act as a buffer against caregiving burden and protect caregivers' mental and social well-being (9–11). Sense of belonging is described as a “component of connecting one's self into the fabric of surrounding people, places, and things” (12). While feelings of belonging have been investigated among various populations (e.g., young adults, older adults, and patients) (9, 13, 14), limited studies have examined the sense of belonging felt by caregivers. Furthermore, paid and unpaid caregivers may have different needs, preferences, and barriers related to connecting with their community and interpersonal groups; however, limited studies have examined or compared feelings of social support or sense of belonging among paid and unpaid caregivers (15).

Communication technologies can be a useful tool to connect caregivers to their social networks and enable them to access resources (16, 17). Specifically, this study focuses on communication technologies (e.g., texting and virtual communication applications), which are considered promising tools to mitigate social isolation among older adults (18, 19). According to Zwingmann et al. (20), family caregivers' perceived social isolation can be alleviated through caregiver support groups established in a more flexible and private setting, such as telephone- and internet-based communications. However, only 7% of informal caregivers of older adults use the communication technology to connect with other caregivers (1). Little is known about use of communication technology among caregivers, especially among paid caregivers, and its association with their social well-being in a natural (i.e., non-experimental) context. Furthermore, the majority of older adults' caregivers are older adults, and despite the increasing communication technology use among the older adult population, it has been suggested that older adults may only be using a few features of communication technologies (21).

This cross-sectional survey study aims to describe communication technology use among paid and unpaid, middle-aged and older caregivers of adults 50 years and older. This study also examines the relationship between communication technology use and perceived social support and sense of belonging to local communities among paid and unpaid caregivers of middle-aged and older adults. Intuitively, we hypothesized communication technology use to be positively associated with social support and sense of belonging to the local community among both paid and unpaid caregivers by facilitating social interactions and increasing their access to social support. Acknowledging the importance of both paid and unpaid caregivers in the system of care for older adults, this study included both caregiver types. This study further explored potential differences in the association between the communication technology use and social support and sense of belonging between paid and unpaid caregivers. Given the subtle differences in their caregiving contexts (e.g., training and work expectations for technology use), paid and unpaid caregivers may use communication technology differently for connecting with their local community or accessing social support.

This study described communication technology use among middle-aged and older, paid and unpaid caregivers of adults 50 years and older in a natural (non-experimental) setting. It also examined the association between their communication technology use, perceived social support, and sense of belonging. In this cross-sectional online survey study, more than 80% caregivers used some form of communication technology (i.e., texting or other communication applications). This study included caregivers who were age 50 and older, and the observed rate of communication technology use is comparable with the rates reported in the 2020 American Association of Retired Persons (AARP) report on older adults' technology use (26). According to the report, about 91% of adults at 50 and older use technology to stay connected with friends and family. About 94% of adults ages 50 and older reported daily use of smartphones, and 83% of those who own a smartphone used instant messaging or email applications. It is important to note that both the current study and AARP report used online surveys, and therefore, the communication technology use rates may be overestimated. Despite the likelihood of over-estimation, this current study result supports high communication technology use rates among middle-aged and older caregivers and suggests that communication technology-based interventions may be useful to promote or maintain social relations and activities among middle-aged and older caregivers of middle-aged and older care recipients.

In the current study, paid caregivers reported a greater sense of belonging to their local community compared to unpaid caregivers. Communication technology use was positively associated with a sense of belonging to their local community among paid caregivers; however, this association was less pronounced among unpaid caregivers. According to Hagerty et al., antecedents of a sense of belonging are an individual's energy for involvement, likelihood, and willingness to be involved, and the likelihood of shared or complementary characteristics (12). In 2020, about 62% of informal caregivers of middle-aged and older adults were employed, and about 60% of them worked full-time (1). Unpaid caregivers, who might have another job, might have lower energy in the caregiving role and/or opportunity to be involved in the local community than paid caregivers. In terms of Hagerty's conceptualization of sense of belonging, paid caregivers may have more energy, and shared complementary characteristics with other paid caregivers in the similar field of occupation. Given the nature of paid caregiving, these caregivers may belong to other networks of employees or professional associations, where posing questions, posting feelings, and offering support on communication technologies may be more commonplace (or even expected). While the use of communication technology can potentially facilitate an individual's involvement in their local community, it may not be solely sufficient to promote involvement in the local community in those who lack the antecedents (i.e., energy, willingness, and shared or complementary characteristics).

In line with the study hypothesis, this study indicates a positive correlation between communication technology use and social support. This finding confirms prior work and strengthens the evidence that communication technology is a promising tool to enhance perceived social support among middle-aged and older caregivers (27, 28). In that there was no statistically significant difference in this relationship between paid and unpaid caregivers, communication technology-based interventions targeting social support can be effective for paid and unpaid caregivers.

This study has some limitations. First, this study used an online panel survey, and the study sample may not be representative of the middle-aged and older caregiver population in the US. Despite our efforts to resemble the middle-aged and older caregiver population, the nature of data collection (i.e., via online) excluded those without access to internet (22). According to the 2020 AARP report on family caregivers of adults 50 years and older, the majority of caregivers of adults 50 years and older were 50 years and older (56%) and non-Hispanic White (61%), and about 31% had high school graduate or less education (NAC and AARP). Using the data from the Integrated Public Use Microdata Series (IPUMS), the Paraprofessional healthcare Institute (PHI) reported that about 66% of the home care workers were younger than 55 years old; about 37% were non-Hispanic White; and about 53% had high school graduate or less education (29). While the reports do not specifically describe the sociodemographic characteristics of the caregivers 50 years and older, the observed sociodemographic comparison between paid and unpaid caregivers in this was comparable to the national reports. In this study, compared to paid caregivers, unpaid caregivers were older, were more likely to be a non-Hispanic White individual, and were less likely to have lower educational attainment (i.e., high school graduate or less education). To complement these findings, future efforts should utilize diverse sampling and data collection methods to advance what is known about communication technology use among paid and unpaid caregivers. Second, while the study sample included paid caregivers, the number was small (n = 86, 17%) and may not be representative of all paid caregivers based on their specialty or employer type. Furthermore, caregivers' paid status was loosely defined based on self-reported data (i.e., “what type of caregiver are you?” and “For this person, the oldest person for whom you provide caregiving, are you a paid caregiver?”). Third, this study examined only specific categories of communication technology (i.e., texting and other instant messaging and audio and video calls). While text message is the most frequently used technologies by middle-aged and older adults to stay connected with their social networks (92% in both 2019 and 2020), the online survey excluded the use of email and social media, which are also communication technology used to connect older adults to their networks (21, 26). Further, measurement of communication technology use did not distinguish between specific uses for professional or personal reasons among paid caregivers. Future studies should incorporate additional items about the types and purposes of communication technology used among paid and unpaid caregivers. Fourth, the phrase “local community” was not defined for the survey respondents, which may have introduced subjectivity and bias in its interpretation across populations.

Despite these study limitations, the study provides new insights about the use of communication technology among paid and unpaid, middle-aged and older caregivers of adults 50 years and older. Sense of belonging (12, 30) and social support are important constructs related to health, and this study suggests positive relationships between these two constructs and communication technology use among these caregivers. Findings provide evidence supporting the potential of communication technology-based interventions to promote a sense of belonging and social support among middle-aged and older caregivers. Furthermore, this study also shows that communication technology may play different roles in connecting middle-aged and older caregivers to their local communities, which may also differ for paid and unpaid caregivers. Given the observed differences between these caregiver groups, a diverse set of interventions are likely needed to enhance sense of belonging and social support across paid and unpaid caregiver populations. For paid caregivers, such interventions may be dictated by the caregivers' training, issued technology, and industry standards. Interventions for paid caregivers may be more easily assessed in terms of the intervention reach, implementation, and effectiveness, relative to unpaid caregivers. Regardless of the paid or unpaid caregiver audience, interventions including communication technology should take into consideration aspects of the caregivers' social network and their access to, comfort with, and preference for communication technology. Because paid and unpaid caregivers are essential resources supporting an aging society, it is critical to understand their respective needs and the types of interventions that would be feasible and effective to improve their feelings of belonging and support.

The datasets presented in this article are not readily available because of the language in the original informed consent. The data may be available on request from the co-author, MO, upon IRB approval. Requests to access the datasets should be directed to MO, mory@tamu.edu.

This study involves human participants and was reviewed and approved by Texas A&M University IRB. The participants provided their electronic informed consent to participate in this study.

SL led the data analyses and development of the initial manuscript draft. MO contributed to the data analyses and development of the initial manuscript draft. All authors contributed to the study conceptualization, data collection, and revision of the manuscript.

The caregiver survey was funded by contributions from the Texas A&M Center for Population Health and Aging, DVD Associates, LLC, and Clairvoyant Networks Incorporated.

The study was partially supported by Mr. Steve Popovich, the president and CEO of Clairvoyant Network. Clairvoyant Network is a company developing products related to caregiving solutions. Mr. Popovich was not involved in the conceptualization, methodology, analyses, and development of this manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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