A systematic review of family carers' experience of compassion when caring for older adults

BACKGROUND: Although caring can be a rewarding experience, family carers of older adults frequently report isolation, stress, anxiety, and burden, which may hinder their ability to cultivate compassion for self and others. Cultivating compassion is associated with better psychological health and wellbeing and may therefore act as a protective factor against the adverse emotional impacts of caregiving. OBJECTIVES: This review aims to: (1) understand carers' experiences, including the barriers and facilitators to cultivating and maintaining compassion when caring for older adults; (2) identify the tools that have been used to assess the experience of compassion in carers and to determine if they have been developed with this population; (3) explore if compassion as experienced by carers is related to other health and wellbeing outcomes. METHODS: We conducted a search across five electronic databases from inception to December 2025. Eligible peer-reviewed studies reported qualitative and/or quantitative data on experiences of compassion among family carers of older adults (aged > 65 years), or people living with dementia. Study quality was appraised using the Hawker tool. We used a narrative approach to synthesise the qualitative and quantitative data. RESULTS: Twenty-nine papers reporting 28 studies were included. Qualitative synthesis identified compassion as primarily other-directed, relational, and grounded in love, moral obligation, and identity. Compassion was facilitated by attachment, meaning, and alignment with carers' values, but undermined by emotional over-identification, chronic responsibility, fatigue, guilt, and limited support. Quantitative studies used a wide range of compassion-related constructs and measures, none of which were developed with carers. Quantitative evidence showed consistent associations between higher self-compassion and better psychological wellbeing, adaptive coping, and lower burden. Findings for compassion directed toward others were mixed, with emotionally over-engaged forms associated with distress, while motivational or value-based compassion was linked to more positive caregiving appraisals. CONCLUSIONS: Compassion in caregiving is a complex and relational phenomenon that can be both sustaining and burdensome. While self-compassion and receiving compassion from others appear protective, unbuffered compassion for others may increase vulnerability to distress. Future research should prioritise longitudinal designs, carer-specific measures of compassion, and interventions that support sustainable, relationally grounded compassion. TRIAL REGISTRATION: PROSPERO CRD42019134233, registered 22 May 2019.