Caregiver Burden and Associated Factors Among Family Caregivers of People With Dementia in Rural and Remote Areas: A Systematic Review and Meta-Analysis

Background Evidence on family caregivers of people with dementia in rural and remote areas remains limited, and burden levels and associated factors lack systematic quantitative synthesis. Objective To synthesize burden and associated factors. Methods Nine databases were searched through November 2025 following PRISMA. Quality was appraised with the Joanna Briggs Institute checklist. Comparable data were meta-analyzed; others were narratively synthesized. Results Twelve studies involving 1,416 caregivers were included. Pooled mean scores were 45.19 for the 22-item Zarit Burden Interview (95% CI 29.49–60.89) and 19.90 for the 12-item version (95% CI 12.98–26.82). Burden was associated with behavioral and psychological symptoms of dementia ( r = 0.44, 95% CI 0.16–0.65), poorer caregiver mental health ( r = 0.48, 95% CI 0.38–0.56), and longer dementia or caregiving duration ( r = 0.29, 95% CI 0.13–0.43). Narrative synthesis implicated functional impairment, greater caregiving demands, lower self-efficacy, and economic disadvantage. Despite low-to-very-low certainty, findings indicate substantial, multifactorial burden and prioritize caregiver support. PROSPERO CRD420261277658.