To examine factors associated with the four types of caregiver reactions according to the modified Caregiver Reaction Assessment (mCRA) and assess the differences in the narrative assessment from spouse caregivers between the high-positive and high-negative caregiver reactions.There is a limited understanding of the factors contributing to positive and negative reactions among older spouse caregivers with chronic illnesses. Narrative assessment from spouse caregivers has not been studied before.The study design was a paired sample, mixed method survey design. Data were collected from spouse caregivers (≥55 years old) and care-recipients in one medical institute from February 2017 to December 2017. This manuscript used STROBE checklist to ensure complete reporting.Demographic, socioeconomic, Frailty index, Perceived Stress, and Quality of life data were gathered from caregiver-dyads. mCRA, Relationship, and Life Satisfaction data were collected from caregivers. mCRA identified the four types of caregiver reactions: 1) high-positive, low-negative; 2) high-positive, high-negative; 3) low-positive, high-negative; and 4) low-positive, low-negative. A qualitative interview was conducted to understand the differences in the narrative and choice of words used to describe caregiving experience.Seventy-five caregiver-dyads were recruited. Total perceived stress was found to be negatively associated with high-positive, low-negative caregiver reaction (baseline category: low-positive, high-negative) by multinomial logistic regression. Content analyses showed that low-positive and high-negative caregivers used words that implied a lack of volition. Caregivers with positive experience viewed caregiving as a responsibility; the opposite viewed it as having 'no choice.'Perceived stress is an important indicator of caregiver reactions. Words used when describing caregiving experiences can potentially depict the spouse caregivers' current state of being as a caregiver.Spouse caregiver's narrative of their caregiving experience may provide easy and quick insights if interventions are needed. Early identification of negative reactions will allow for prompt interventions in mitigating caregivers' stress. This article is protected by copyright. All rights reserved.