 in the present study, and this experience was permeated by positive and negative feelings. Caregivers pointed out some coping strategies as a way to try to reach a balance between providing care to themselves and older people, namely formal and informal support and spirituality.
The feelings experienced by the caregivers analyzed in the studies included in the present synthesis showed that the relationship between caregivers and care receivers is intense and complex. Regardless of the nature of the feelings reported by caregivers, that is, whether the sensation was positive or negative, it was noticed that care activities resulted in emotional discomfort for caregivers. Care-related tasks are physically exhausting and emotionally demanding, and these circumstances may lead to negative psychological effects and higher risks of overload for caregivers (Maree, Moshima, Ngubeni, & Zondi, 2018;McCabe et al., 2016;Moral-Fernández et al., 2018;Vallée & Vallée, 2017;WHO, 2017;Woodford, Farrand, Watkins, & LLewellyn, 2018).
The central theme identified in the present evidence synthesis was life on hold. This theme has also emerged in other qualitative studies that have addressed the experience of caregivers who provided care to patients with terminal illnesses (E. T. Lewis et al., 2019) and cancer (Goldblatt, Granot, & Zarbiv, 2019;Maree et al., 2018).
Formal and informal support stood out among the coping strategies found in the selected publications. This strategy must be considered when improving the process of providing care to older people in the home environment. Thus, it is necessary to elucidate strategies described in the literature to improve the caregiver's routine. In addition to promoting more research that points out which strategies are efficient to ensure the well-being and quality of life of family caregivers.
In this sense, it is indispensable that health professionals understand the family context in which care receivers are inserted and the experiences of caregivers, to promote comprehensive care for older people and all their relatives. It is important to emphasize that family caregivers are important actors in home care, and that it is crucial that health professionals evaluate whether caregivers are overloaded, socially isolated, or showing symptoms of depression and emotional discomfort as a consequence of the act of providing care. Therefore, when assisting the older people, health professionals should also assess the clinical conditions of the caregivers and check if they have experienced negative feelings, such as anger, resentment, grief, sadness, and guilt, and if so, it is recommended to encourage the caregivers to look for psychological counseling to prevent the development of mental disorders. However, a study by McGarry and Arthur (2001, p.187) includes the testimony of a caregiver who reported feeling ignored during the appointments: "If we're both all right then we get through, but we'd like to find someone who was interested in us… to see if we're all right." It can be noticed that the caregiver felt neglected by the health system and professionals, who focused their attention mostly to the older person who received the care. However, it is also imperative to pay attention to caregivers' health, given that their routines can lead to the development of diseases.
Caregivers, in taking up their caregiver role, also say that they put care receivers at the center of attention, which made them put their own lives on hold. This means that they not only stop going out and having fun, but also neglect their selfcare, for example, stopping visits to their doctor or dentist and doing physical exercise (Peacock et al., 2017). Thus, health professionals must accompany caregivers and make sure that all their health conditions are being treated, since it is known that psychological aspects can trigger and/or aggravate the symptoms of some health conditions. The Burden Interview can be used to assist healthcare professionals in assessing caregiver burden. This scale was developed to assess the caregiver burden of older adults with dementia, however it has been used for other types of caregivers, because it includes comprehensive items that address dimensions common to various mental and physical diseases. The 22 scale's items reflect respondent's areas of concern such as: health, social and personal life, financial situation, emotional well being and interpersonal relationships (Scazufca, 2002).
The present review also revealed that caregivers felt insecure regarding the care provided to the older adults, especially when it comes to making decisions, managing adverse conditions and ensuring adequate care. Such findings also emerged in other researches involving caregivers (Lawrence, Murray, Samsi, & Banerjee, 2008;Maree et al., 2018;McCabe et al., 2016). An initiative to minimize this insecurity is to develop the practice of patient-centered care in a way that, in addition to involving the older adults, when they are in clinical conditions to do so, the health professionals also include their caregivers. For this end, a care plan and decision making shared with the older people and caregivers must be adopted, making sure that they are active partners, and, therefore, making caregivers feel safer and more engaged in the care process for the older people (Bombard et al., 2018;Holroyd-Leduc et al., 2016).
In addition, health professionals must ensure that the care offered by informal caregivers is properly executed. To do that, when necessary, health professionals must train caregivers in developing their activities, ensuring that older people are well cared for. It is necessary to emphasize that the training sessions bring clarity to the caregivers about what their duties and responsibilities are in relation to care, and it also contributes to mediate a key barrier identified: providers' skepticism towards engaging patients and caregivers and empowering them. Therefore, these training sessions help to create a level playing field and support staff in their efforts to be partners (Bombard et al., 2018).
The present review reveals that caregivers reported the need for formal and informal support, as coping strategies.
However, which services they considered sufficient to guarantee such support have not been so well elucidated. Given this, the reflection goes through whether the caregivers are clear about what could be done to improve their condition as caregivers.
Corroborating this reflection, a qualitative study described that it is unclear whether caregivers do not discuss their specific needs because they do not know how to express themselves or because they regard looking after care receivers as their natural duty and therefore do not perceive their own needs (Furlong & Wuest, 2008). This should be further elucidated in other qualitative studies.
Even though care providers did not point out specific measures that could be provided in order to support them, it is indispensable to promote public policies such as the provision of home care, daycare centers, support groups, and other strategies. Mbanaso, Shavelson and Ukawuilulu (2006) emphasized that, in addition to these strategies, actions that decrease caregivers' level of isolation by means of local support and remote assistance must be promoted.
In this review, one unique finding that is not deeply explored elsewhere is care receivers themselves hindered this support by not being willing to accept care from anyone except the main caregivers. Therefore, for the coping strategies to be successful, it is essential that the care receivers are made aware of the importance of the caregiver sharing care with other family members, as well as with formal care services such as daycare and home care.
In this sense, a substantive grounded theory was developed to describe the process of deciding to use home healthcare services (HHCS). This process consisted of three stages: first, including initial resistance, especially by older adults; then caregivers' trying to do too much without help; and finally, families' giving HHCS a try; accommodating the use of HHCS, especially if the older adults developed a personal relationship with the HHCS worker (Crist, García-Smith, & Phillips, 2006).
In order to enhance acceptability of HHCS, it is recommended that at the individual level, health professionals taking the time to establish trust by giving personal attention, this is essential. At the system level, the HHCS agency needs to try to assign the same nurse and other staff to make consistent visits. Because, the opportunity to see the same nurse more than once facilitates relationship building (Crist & Speaks, 2011).
It is believed that the findings of the present qualitative synthesis can provide resources for discussions about the experience of family caregivers. These findings can also contribute to the creation of public policies that allow caregivers to provide care to their relatives and themselves, including the emotional support necessary for their mental health not to be compromised by care routines, resulting in improvements in their quality of life.

Strengths and limitations
Although the search strategy was comprehensive, only articles published in English, Spanish, and Portuguese were selected for full-text reading. Some included studies provided limited information, derived from superficial and descriptive data. Another problem was that some publications did not indicate the age, degree of kinship with the care receiver, or gender of caregivers. These issues hindered a more comprehensive analysis of the influence of these factors on the findings of the present synthesis.
However, even with these limitations, the present study has high scientific pertinence because, to the best of the authors' knowledge, a synthesis of evidence has not yet been published that analyzed the experience lived by family caregivers of the older person in a holistic way, with the potential to reveal the experience lived by the caregivers, regardless of the clinical condition of the care receiver and thus emerge the possible demands that these caregivers present.
Additionally, the present synthesis was conducted according to the ENTREQ reporting guidelines. This checklist stands out because of its methodology for adopting sound strategies for data collection, analysis, and extraction. The article search and selection followed the PRISMA prerequisites, which emphasize the importance of describing the search strategy and the eligibility criteria, which allows for reproducibility of the study. The CASP checklist was used to evaluate which articles had higher and lower methodological quality. It is worth stressing that these steps were carried out by two researchers, who performed the assessment simultaneously and with blinding, and that the discrepancies were