Yumiko Arai

Factors related to feelings of burden among caregivers looking after impaired elderly in Japan under the Long‐Term Care insurance system

Abstract  Since the 1970s, the burden of caregiving has been the subject of rather intense study, a trend that will continue with the rapid graying of populations worldwide. Since the Long‐Term Care insurance system began in 2000, few cross‐sectional studies have attempted to identify factors related to the feelings of burden among caregivers looking after the impaired elderly in Japan. In the present report, among 46 pairs of caregivers and impaired elderly, the elderly receiving regular nurses’ visits in Kyoto Prefecture, Japan were assessed for problems with activities of daily living, the severity of dementia, the presence of behavioral disturbance, and cognitive impairment. The caregivers were asked to complete questionnaires in relation to their feelings of burden and caregiving situation. The results indicated that caregivers of impaired elderly with behavioral disturbances were more likely to feel a ‘heavier burden.’ Those temporarily relieved of caregiving three or more hours a day were less likely to experience ‘heavier’ caregiver burden than those who were not. Moreover, caregivers who found it ‘inconvenient’ to use care services tended to be more likely to feel a ‘heavier’ caregiver burden than those who did not. Recourse to respite services, which are ideally positioned to help, proved inconvenient because of their advance reservation system. More ready access to respite services in emergencies could do much to reduce caregiver burden.

Validation of ‘personal strain’ and ‘role strain’: Subscales of the short version of the Japanese version of the Zarit Burden Interview (J-ZBI_8)

Abstract  The eight‐item short version of the Japanese version of the Zarit Burden Interview (J‐ZBI_8) has been confirmed for reliability and validity, and its two subscales (personal strain and role strain) are based on the factor structure of the ZBI. It has been demonstrated that these subscales have good reliability. The aim of the present study was to confirm their construct validity. A total of 51 impaired elderly who had been receiving regular nurses’ visits in Kyoto Prefecture, Japan and their family primary caregivers, participated in the present study. Each caregiver was asked to complete a questionnaire which included the J‐ZBI_8, the hours spent in caregiving, and the physical and cognitive disability of the impaired elderly. A principal component analysis identified the following two principal components of these variables: ‘Activities of Daily Living deficits’ and ‘behavioral disturbances’. Consequently, Barthel Index (BI) and Troublesome Behavior Scale (TBS) were selected as the representative variable, respectively, for each component. We subsequently calculated the Spearmans rank correlations among the subscales of J‐ZBI_8, BI and TBS. Personal strain was found to be correlated with TBS (rho = 0.48, P < 0.01), while role strain was correlated with the BI (rho = −0.29, P = 0.04). The correlation between personal strain and BI was not significant, nor was the correlation between role strain and TBS. These findings indicate that the personal strain and role strain measured by J‐ZBI_8 correspond to the personal strain and role strain of the ZBI originally described by Whitlatch et al. Therefore, the construct validity of the J‐ZBI_8 subscales is confirmed.

Feelings of burden and health-related quality of life among family caregivers looking after the impaired elderly

Abstract  The aim of the present study was to examine the relationship between feelings of burden and health‐related quality of life (HRQOL) among family caregivers looking after the impaired elderly residing in a community located in southern Japan. Subjects were 85 pairs comprising elderly individuals requiring care and their respective family caregivers. Questionnaire items for the family caregivers related to demographic variables, caregivers’ burden, HRQOL, use of public services, hours spent caregiving, duration of caregiving, and satisfaction with verbal communication with family. Questionnaire items for the elderly recipients of care concerned demographic variables, activities of daily living, and cognitive status. According to bivariate analysis, caregivers’ burden was significantly related to cognitive status, hours spent caregiving, and each HRQOL subscore except physical function. From multiple regression analysis, subscore of HRQOL with respect to mental health and satisfaction with verbal communication were extracted as influential factors. Final regression coefficient was 0.72 (P < 0.01) and coefficient of determination was 0.53. These results suggest that satisfactory mental health status plays an important role in limiting family caregivers’ burden.

Problems family caregivers encounter in home care of patients with frontotemporal lobar degeneration

Aim:  Frontotemporal dementia (FTD) is a degenerative dementia in which primary degeneration of the frontal region of the brain occurs. Because of the behavioral symptoms, the care of FTD patients has numerous problems. However, little has been clarified with regard to the actual care situation, especially in a family care setting. The aim of the present study was to elucidate the caregiver burden and problems associated with the care of FTD patients in home care settings.

Factors related to institutionalization among the frail elderly with home-visiting nursing service in Japan.

A dramatic increase in the number of elderly people in Japan has led to a concurrent increase in the number of frail elderly in need of care. It is estimated that the number of frail elderly will reach 3.9 million by the year 2010. Family members are often both physically and mentally burdened with caring for the frail elderly. The present study was conducted to identify the risk factors for institutionalization among the frail elderly receiving in-home care in Japan.

Depression among caregivers of the frail elderly in urban Japan

Abstract A cross‐sectional study was conducted in order to investigate the various factors related to the depression in caregivers of the elderly in need of care in urban Japan. The caregivers answered a self‐administered questionnaire about various factors that may affect their depression, and also completed a Center for Epidemiologic Studies Depression Scale evaluation (CES‐D). Compared with non‐depressed caregivers, depressed caregivers attended the elderly longer, while time spent for physical caregiving did not differ between the two groups. Even after controlling confounding factors, time of attending the elderly was an independent factor related to caregivers depression.

Family caregiver burden and quality of home care in the context of the Long-Term Care insurance scheme: an overview

This review outlines the findings of 22 studies conducted between 1997 and 2005 by Arai and 19 collaborators regarding caregiver burden and assessment of quality of home care for the elderly. The published research covers the following: cross‐sectional studies on caregiver burden; changes in caregiver burden; appropriateness of the Long‐Term Care insurance assessment scheme; attitudes towards caregiving among caregivers; the development of the short Japanese version of the Zarit Caregiver Burden Interview (J‐ZBI_8); and the effectiveness of service use in reducing caregiver burden and development of a Home Care Quality Assessment Index (HCQAI).

Network for improving the dementia care system

First, there has been tremendous social pressure on the family, particularly on female members, to provide care. This is partly due to Confucianism, where the virtue of filial piety has been strongly stressed, if not enshrined. Second, a caregiving role used to be a legal obligation for the eldest son of the family. Before World War II, Japanese civil law stipulated that the eldest son would inherit the assets of the family; in turn, the entire responsibility of caring for the parents fell to the wife of the eldest son, the daughter-in-law. The government made good use of this Confucianinfluenced norm, which has continued to be influential in Japanese society even after World War II. Indeed, the prime minister of Japan in 1979 strongly reiterated the importance of ‘Japanese-style welfare’, in which self-help, tolerance, and the solidarity of the family are the priorities. The government even stressed that the ‘European-style welfare state’ might discourage the prevailing notion of caregiving as a family duty. Under these circumstances, it was not surprising that the government was reluctant to provide social services. The development of domiciliary care in Japan has thus lagged far behind that in the UK or Scandinavian countries. Social services that were available had to have municipal approval after means testing. An increase in the number of impaired elderly people and a concomitant decrease in the capacity of informal care (partly due to the increasing prevalence of the ‘nuclear family’ and career-oriented women) have now made ‘caregivers’ burden’ a social issue. 2–4

Assessment of family caregiver burden in the context of the LTC insurance system: J‐ZBI

This paper covers our recent work regarding cross‐sectional studies on caregiver burden, changes in caregiver burden, appropriateness of the LTC insurance assessment scheme, attitude towards caregiving among caregivers, and the development of the short version of the Japanese version of the Zarit Caregiver Burden Interview (J‐ZBI_8).