Gender issues and Japanese family-centered caregiving for frail elderly parents or parents-in-law in modern Japan: from the sociocultural and historical perspectives

We-Care-Well: exploring the personal recovery of mental health caregivers through Participatory Action Research

Family caregivers play a critical role in supporting the recovery journeys of their loved ones, yet the recovery journeys of family caregivers have not been well-explored. Using a Participatory Action Research approach, we explore the personal recovery journeys of family caregivers for individuals with mental illness. This case study involved piloting and exploring the impact of a novel online workshop series offered to mental health caregivers at Ontario Shores Center for Mental Health Sciences. Recovery courses and workshops conventionally engage patients living with mental health conditions. In the current case, the recovery model is adapted to the needs and experiences of their family caregivers, resulting in a pilot workshop series called "We Care Well". Through participant-led discussions, interactive and take-home activities, and experiential learning, caregivers co-created workshop content and engaged in peer-learning on seven personal recovery-oriented topics. This included: self-care, resilience-building, non-violent communication, storytelling, and mental health advocacy. Throughout the sessions, participants implemented their learnings into their caregiving roles, and shared their experiences with the group to progress through their own recovery journeys. The We Care Well series was found to be an effective intervention to adapt and apply the personal recovery framework to mental health caregivers. PAR, and co-design are viable approaches to engage caregivers in mental health research, and can facilitate knowledge exchange, as well as relationship building with peers and program facilitators.

Experiences of Japanese women simultaneously caring for children and older people: An ethnographic study

Background

Japan has experienced a rapid decline in birth rate and an aging population, coupled with women choosing to delay having children. Family carers are therefore increasingly expected to accept simultaneous responsibilities for both children and parents. This responsibility often falls on women in Japan, but little is known about their views. This study aimed to understand how Japanese women who are simultaneously responsible for caring for children and older people perceive their experiences.

Methods

This was an ethnographic study conducted in central Japan. Over a period of 3 years and 5 months, we observed 19 people active in a peer support group for people with both childcare and caregiving responsibilities. We also carried out individual interviews with 14 Japanese women who were raising children and caring for parents or parents-in-law.

Results

Five key themes emerged. These were "Accepting both childcare and caregiving as my role," "Inability to fulfill the role of mother," "Being supported by children and grandparents," "Unable to talk to anyone about the pressures of caregiving," and "Realizing that caregiving is not the only way to live."

Conclusions

Japanese women who provided care to both children and older people were influenced by traditional Japanese values. However, they had a sense of mission and accepted the role of providing for their families. They felt guilty about not being able to fulfill their role as mothers, and were lonely, with no one to understand or advise them. If the burden of caregiving is concentrated on women, there is an increased risk that their children will become involved in providing some of the care for older people. It may therefore be necessary to develop a support system for female carers, and to increase understanding of the potential harm of placing caregiving responsibility solely on women.

Support nursing researchers' need from academic societies during COVID-19: A cross-sectional survey

The activities of nursing researchers have been constrained by the COVID-19 pandemic. Therefore, this study aimed to investigate the types of support and related factors that nursing researchers hope to receive from academic societies during the pandemic and to obtain suggestions for the role of academic societies in supporting nursing researchers and expanding research. An online survey was conducted with 1532 Japan Academy of Nursing Science members. The survey included 19 items of potential support from the society during the COVID-19 pandemic as well as open-ended questions. Data were analyzed statistically and qualitatively. For 9 of the 19 items, over 50% of respondents reported that they "needed" or "very much needed" support. Multivariate analysis results showed that younger respondents and those with family members requiring care were significantly more likely to report needs for some items. In the open-ended comments, there were several suggestions for activities, including "Lobbying for revision of regulations on research implementation." Nursing researchers expressed needs for support that reflect their demographic characteristics and situations, including collaboration across organizations and securing research-promotion and skill-development opportunities online.

Psychological distress in sons as resident carers of older mothers in Japan

In Japan, care-giving sons are noted for their high rates of abuse of care recipients. This study revealed, for the first time, the difficulties unique to sons caring for their mothers. All sons used long-term care insurance services. However, they provided care that could not be covered by such public services while harbouring psychological distress. In this study, we interviewed 13 sons living with their older mothers as the primary carer and conducted a thematic analysis focusing on their psychological distress. As part of our study findings, we have identified nine themes during analysis: uncomfortable feelings that cannot be mitigated as a son; feeling of futility in being unrecognised as a carer; fear of losing something important; a strong sense of responsibility for one's mother's life; disappointment in being unable to obtain understanding and co-operation from one's siblings in providing care; irritation and anger towards one's wayward mother; guilt about treatment of one's mother; sense of exhaustion due to demanding care; and experiencing hopelessness and despair. Thus, it is important to understand what psychological distress carers experience and to consider possible approaches for their support. The study findings provide suggestions for long-term care support in regions, such as East Asia, where the numbers of son carers are increasing inevitably owing to declining birth rates and ageing population, as in Japan.

Can social capital moderate the impact of widowhood on depressive symptoms? A fixed-effects longitudinal analysis

OBJECTIVES

Widowhood is associated with increased risks of depression in the surviving spouse. We examined whether an increase in individual-level social capital mitigates the adverse impact of widowhood on depressive symptoms.

METHODS

We used data from the 2013/2016 waves of the Japan Gerontological Evaluation Study of functionally independent adults aged 65 years or older (men: n = 20,853; women: n =16,858). Fixed-effects regression was applied to examine the potential buffering effects of changes in social capital on changes in depressive symptoms following widowhood among married people living with their spouse and/or others at baseline.

RESULTS

Widowhood had a deleterious impact on depressive symptoms particularly among men who ended up living alone following their spouse's death. Fixed-effects models revealed that an increase in informal socializing and social participation might buffer the effects of spousal bereavement on depressive symptoms among men who became widowed during the first two years of follow-up and ended up living alone.

DISCUSSION

An increase in structural social capital may mitigate the impact of spousal bereavement on depressive symptoms. However, the associations vary by gender, living arrangement, and time since widowhood. Intensive efforts should be directed toward connecting the vulnerable group, widowed men living alone, to sources of social capital.

Typology of Family Support in Home Care for Iranian Older People: A Qualitative Study

The world population is rapidly aging. In older people, age-related biological decline in most body systems causes functional decline, an increase in dependence, and an increased need for support, especially by their family members. The aim of this study was to explore the main aspects of family support for older parents in home care. This qualitative study was conducted using a deductive qualitative content analysis approach. Participants were 21 older parents living in their own homes, as well as four family members of some participants. Data were collected using semi-structured interviews and then were analyzed using the primary matrix developed based on the existing literature. The main aspects of family support for older parents were grouped into five predetermined categories and one new category: "instrumental support", "financial support", "psycho-emotional support", "healthcare-related support", "informational-technological support", and "social preference support ". Family support for older people in home care is a multi-dimensional phenomenon. Family members can identify the needs of their older parents and provide them with appropriate support in collaboration with healthcare professionals to enhance their quality of life, autonomy, and satisfaction with life.

Relationship of living arrangement with the decline in functional capacity in elderly people by gender: a longitudinal observational study

Background

The living arrangement has been suggested as an important factor affecting health. Recent studies have also suggested that there was a risk among elderly persons who were not alone. This study examined whether the detailed living arrangement was associated with a future decline in functional capacity in the elderly, by gender, in a Japanese suburban city.

Methods

A 3-year longitudinal questionnaire survey (baseline: 2011; follow-up: 2014) for aged 65 years or older was conducted in Kurihara city, Japan. Of the respondents in the baseline survey, we analyzed those who scored 13 points (a perfect score which indicates the highest functional capacity; n = 2627) on the Tokyo Metropolitan Institute of Gerontology Index of Competence at the baseline. The exposure was living arrangement at baseline, divided into five categories: “with spouse only,” “living alone,” “with child and his/her spouse,” “with child without his/her spouse,” and “with other family/person.” The outcome was the decline in functional capacity at the follow-up survey (score decreased to 10 points or less from 13 points).

Results

Of the 2627 analyzed population, 1199 (45.6%) were men. The incidence of the decline was 5.8% in men and 5.9% in women. Multivariable logistic regression analyses adjusted for age, educational attainment, and health behavior and condition revealed that in women, the odds ratio of the decline was higher in living with child and his/her spouse (2.41, 95% confidence interval; 1.10–5.28) referring to living with spouse only. When adjusting activities inside and outside the home such as housework additionally, the association was attenuated to marginal significance (2.25, 0.98–5.18). No statistical significance was observed in men.

Conclusions

These results suggested that living with child and spouse of a child was associated with the future decline in women’s functional capacity.

A comparison of Geriatric Depression Scale scores in older Australian and Japanese women

AIMS

The aim of this study was to compare the prevalence of depressive symptoms in Australian and Japanese populations of community-dwelling older women using the Geriatric Depression Scale (GDS-15). In addition, the relationship between lifestyle and health factors and higher ratings of depressive symptoms was also examined to determine if there were culturally consistent risk factors associated with higher depressive symptom scores.

METHODS

A total of 444 community based women aged between 65 and 77 years completed a depressive symptom measure (GDS-15) and provided information on common lifestyle factors. The Australian sample (n = 222) were drawn from the Women's Healthy Ageing Project and the age-matched, Japanese sample from the Kumamoto Ageing Study of Mental Health (n = 222). The GDS was chosen to; (1) reduce the impact of physical symptoms associated with old age and, (2) reduce the inflation in scores that may result from the Japanese tendency to endorse somatic items more often than Western adults.

RESULTS

Mean GDS total scores were significantly higher for the Japanese population 3.97 ± 3.69 compared with 1.73 ± 2.7 for Australian women. The percentages of women scoring in the normal; mild and moderate ranges for depression were 91, 7 and 2% for Australia and 67, 24 and 9% for Japan. Scores remained significantly higher for the Japanese cohort when controlling for lifestyle and health factors associated with depression. The analysis of lifestyle and health characteristics showed that the greatest difference between cohorts was in the area of living status, with more Australian women living with their partner and more than three times as many Japanese women living with their children. When the data for the countries was considered independently employment status affected the likelihood of higher depression scores in the Australian sample while heart disease and poor sleep impacted the risk for the Japanese population.

CONCLUSIONS

Significantly more Japanese women scored within the mild and moderate ranges on the GDS compared with their Australian peers, even when controlling for possible confounding factors. Of the lifestyle and health factors assessed in this analysis no single variable was a common risk factor for higher depressive scores for both countries. The presence of cultural influences that may impact the risk of experiencing depressive symptoms, and culture specific patterns of item endorsement on depressive symptom measures, needs to be explored in more detail.

Differences in caregivers' psychological distress and associated factors by care recipients' gender and kinship

OBJECTIVES

In this study, we examined the level of psychological distress of Japanese caregivers according to various combinations of the gender of care recipients and the kinship of caregivers (spouse, son, daughter, or daughter-in-law). Furthermore, we explored the associated factors that could exacerbate or alleviate psychological distress.

METHODS

We utilized a cross-sectional descriptive design and implemented a self-administered questionnaire survey with a two-stage stratified sample of community-dwelling caregivers of frail elderly persons throughout Japan. We surveyed 1279 caregiving families, and 1020 questionnaires were completed by primary caregivers (response rate: 79.8%), with 945 respondents providing data on the Japanese version of the Kessler 6 psychological distress scale (K6).

RESULTS

Caregivers' K6 scores varied significantly by care recipients' gender and their relationship with the caregiver. K6 scores were significantly higher among daughters-in-law caring for fathers-in-law than among daughters-in-law caring for mothers-in-law, wives caring for husbands, or daughters or sons caring for mothers. 'Negative influence of caregiving' and 'anxious about continuing caregiving' were factors that commonly exacerbated caregivers' psychological distress. Further analyses involving interactions indicated that the effects of 'anxious about continuing caregiving' and 'personal growth through caregiving' on the psychological distress of daughters-in-law varied by care recipients' gender as did the effects of an alleviating factor, 'keeping their own pace', on daughters.

CONCLUSIONS

Psychological distress levels among family caregivers, as well as exacerbating and alleviating factors, varied depending on the gender and kinship of care recipients.

Depression among family caregivers of community-dwelling older people who used services under the Long Term Care Insurance program: a large-scale population-based study in Japan

OBJECTIVE

To identify predictors for depression among family caregivers of community-dwelling older people under the Long Term Care Insurance (LTCI) program in Japan through a large-scale population-based survey.

METHOD

All 5938 older people with disabilities, using domiciliary services under the LTCI in the city of Toyama, and their family caregivers participated in this study. Caregiver depression was defined as scores of ≥16 on the Center for Epidemiological Studies Depression Scale (CES-D). Other caregiver measures included age, sex, hours spent caregiving, relationship to the care recipient, income adequacy, living arrangement, self-rated health, and work status. Care recipient measures included age, sex, level of functional disability, and severity of dementia. The data from 4128 pairs of the care recipients and their family caregivers were eligible for further analyses. A multiple logistic regression analysis was used to examine the predictors associated with being at risk of clinical depression (CES-D of ≥16).

RESULTS

Overall, 34.2% of caregivers scored ≥16 on the CES-D. The independent predictors for depression by logistic regression analysis were six caregiver characteristics (female, income inadequacy, longer hours spent caregiving, worse subjective health, and co-residence with the care recipient) and one care-recipient characteristic (moderate dementia).

CONCLUSION

This is one of the first population-based examinations of caregivers of older people who are enrolled in a national service system that provides affordable access to services. The results highlighted the importance of monitoring caregivers who manifest the identified predictors to attenuate caregiver depression at the population level under the LTCI.

A gap in formal long-term care use related to characteristics of caregivers and households, under the public universal system in Japan: 2001-2010

We investigated whether the universal provision of long-term care (LTC) under Japan's public system has equalized its use across households with different socio-economic characteristics, with a special focus on the gender and marital status of primary caregivers, and income. We used repeated cross-sectional data from national household surveys (2001, 2004, 2007, and 2010) and conducted multiple logistic regression analyses to obtain odds ratios of caregiver and household characteristics for service use, adjusting for recipients' characteristics. The results showed that the patterns of service use have been consistently determined by caregivers' gender and marital status over the period despite demographic changes among caregivers. The gap in service use first narrowed, then widened again across income levels after the global economic recession. The results indicate that the traditional gender-bound norms and capacity constraints on households' informal care provision remained influential on decisions over service use, even after the universal provision of formal care. To improve equality of service utilization, the universal LTC system needs to meet diversifying needs of caregivers/recipients and their households, by overcoming barriers related to gender norms and economic disparity.

The importance of reciprocity for female caregivers in a super-aged society: a qualitative journalistic approach

As Japan is facing a super-aged society, Japanese women find themselves on the front line as traditional family caregivers. Our aim was to describe the observations and thoughts of one Japanese woman's experience of living with her elderly parents in the suburbs of Tokyo. One open-ended interview was performed and analyzed using content analysis with a methodological departure in qualitative journalistic interviewing. The case was a single woman in her late 40s living with her aged parents. Reciprocity was identified as the glue holding the joy and burdens of the role of caregiving for elderly parents. Moreover, gender was identified as a motivator for reciprocity from a macro to a micro level in a super-aged society.

Caregiver burden mediates between caregiver's mental health condition and elder's behavioral problems among Japanese family caregivers

OBJECTIVES

In Japan, the prevalence of depression has been reported to occur among 1 in 4 family caregivers. The purpose of this study was to investigate the self-rated burden associated with mental health conditions among caregivers.

METHODS

We studied 95 caregivers aged 38-87 years in a cross-sectional study. The General Health Questionnaire (GHQ-12) score of 4 or more was defined as poor mental health.

RESULTS

The proportion of caregivers with poor mental health was 24%. Caregivers with a high GHQ-12 score had the number of caregiver burdens increased by 2.5-fold compared to those with a low GHQ-12 score (p = 0.001). The proportion of caregivers with a high GHQ-12 score was significantly higher with an increasing number of behavioral problems among care recipients (p = 0.003). A mediational model was used to identify the underlying mechanism of the relationship between the number of behavioral problems and poor mental health in caregivers. Consequently, we found that mental health conditions in caregivers were associated with both the number of caregiver burdens and behavioral problems among care recipients.

CONCLUSIONS

It is vital to provide support not only to the caregivers but also to their elderly relatives, paying particular attention to early identification of poor mental health in caregivers so as to administer effective interventions, and to offer useful advice concerning how to deal with behavioral problems.

Informal and formal support among community-dwelling Japanese American elders living alone in Chicagoland: an in-depth qualitative study

A key public health approach to promote independent living and avoid nursing home placement is ensuring that elders can obtain adequate informal support from family and friends, as well as formal support from community services. This study aims to describe the use of informal and formal support among community-dwelling Nikkei elders living alone, and explore perceived barriers hindering their use of such support. We conducted English and Japanese semi-structured, open-ended interviews in Chicagoland with a convenience sample of 34 Nikkei elders age 60+ who were functionally independent and living alone; 9 family/friends; and 10 local service providers. According to participants, for informal support, Nikkei elders relied mainly on: family for homemaking and health management; partners for emotional and emergency support; friends for emotional and transportation support; and neighbors for emergency assistance. Perceived barriers to informal support included elders' attitudinal impediments (feeling burdensome, reciprocating support, self-reliance), family-related interpersonal circumstances (poor communication, distance, intergenerational differences); and friendship/neighbor-related interpersonal situations (difficulty making friends, relocation, health decline/death). For formal support, Nikkei elders primarily used adult day care/cultural programs for socializing and learning and in-home care for personal/homemaking assistance and companionship. Barriers to formal support included attitudinal impediments (stoicism, privacy, frugality); perception of care (incompatibility with services, poor opinions of in-home care quality); and accessibility (geographical distance, lack of transportation). In summary, this study provides important preliminary insights for future community strategies that will target resources and training for support networks of Nikkei elders living alone to maximize their likelihood to age in place independently.

An Uneven Burden

Using data from a large, nationally representative U.S. survey, the authors examine differences in adult caregiving responsibilities, working conditions, and caregiver outcomes by gender, ethnicity, immigration status, and educational attainment. Women, Hispanics, and first-generation immigrant caregivers are more likely to have worse working conditions including an unsupportive culture at work, less schedule flexibility, and less access to paid vacation leave. Women and first-generation immigrant caregivers are more likely to report caregiving contributing to poor job outcomes including quitting work, retiring early, or reducing hours involuntarily. Caregivers with less than a college degree experience both worse working conditions including lack of access to paid sick days and worse job outcomes including having lost wages or a job. Women, second-generation immigrants, and those with a high school diploma or less are more likely to report that their caregiving responsibilities interfere with their quality of life including negative impacts on their ability to spend time with friends. Research and policy implications are discussed.

Purchasing piety? Coresidence of married children with their older parents in Japan

We investigated the conditions under which married children live with their older parents in Japan. We focused on how needs and resources in each generation are associated with whether married couples live with their parents in parent-headed and child-headed households, and we also investigated difference in power relations between older and younger generations and between children and their spouses. We analyzed a nationally representative sample of older parents (n  =  3,853) and their married children (n  =  8,601) from the 1999 Nihon University Japanese Longitudinal Study of Aging (NUJLSOA). Mutinomial regression revealed that married children with relatively affluent parents tended to live with them in parent-headed households and that married children with parents who are in relatively poor health or who are widowed tended to live with them in child-headed households. We also found that less-educated married children tended to live in the households of their higher-income parents, suggesting that parents may be "purchasing" traditional arrangements with less-affluent children. In addition, children with an educational advantage over their spouses were more likely to have parents living with them in child-headed coresident households. We conclude that traditional multigenerational coresidence has become a commodity negotiated within families based on relative resources and needs within and across generations.

Population ageing and wellbeing: lessons from Japan's long-term care insurance policy

Japan's population is ageing rapidly because of long life expectancy and a low birth rate, while traditional supports for elderly people are eroding. In response, the Japanese Government initiated mandatory public long-term care insurance (LTCI) in 2000, to help older people to lead more independent lives and to relieve the burdens of family carers. LTCI operates on social insurance principles, with benefits provided irrespective of income or family situation; it is unusually generous in terms of both coverage and benefits. Only services are provided, not cash allowances, and recipients can choose their services and providers. Analysis of national survey data before and after the programme started shows increased use of formal care at lower cost to households, with mixed results for the wellbeing of carers. Challenges to the success of the system include dissatisfaction with home-based care, provision of necessary support for family carers, and fiscal sustainability. Japan's strategy for long-term care could offer lessons for other nations.

Aging in rural Japan--limitations in the current social care policy

Owing to equal and increased opportunities for education and employment, today's trend in Japanese marriages is characterized by late and less frequent marriage. This paper discusses unavoidable diversity in rural families to point out the anticipated consequences of aging in rural areas and to discuss limitations in current public social care policies. Specifically, the averaged proportion of never-married and single persons at ages 45 to 49 and 50 to 54 in legally recognized depopulated cities, towns, and villages in Japan is calculated to illustrate the expected diversity in families in rural depopulated areas. It also illustrates the need for future studies to develop better social care policies for increasing numbers of single caregivers and single elders.

Mothers and daughters-in-law: a prospective study of informal care-giving arrangements and survival in Japan

Background

Daughters-in-law have played an important role in informal care-giving arrangements within East Asian traditional norms. The aim of this study was to measure the impact of daughter-in-law care-giving on the survival of care recipients. We prospectively examined the associations between different types of kinship relationship between the main family caregiver and the care recipient in relation to survival among care recipients.

Methods

A questionnaire was administered to Japanese community-dwelling seniors who were eligible to receive national long-term care insurance (LTCI) community-based services. Among 191 individuals whose informal care-giving arrangement was definitively determined, we observed 58 care recipients receiving care from spouses, 58 from daughters-in-law, 27 from biological daughters, 25 from other relatives, and 23 care recipients living alone.

Results

During 51 months of follow-up from December 2001, 68 care recipients died, 117 survived, and 6 moved. Hazard ratios of each care-giving arrangement were estimated by Cox proportional hazard models adjusted for care recipients' demographic factors, their care needs level based on their physical and cognitive functioning and their service use, caregivers' demographic factors, and household size. The highest risk of mortality was found for female elders receiving care from daughters-in-law (HR 4.15, 95% CI 1.02-16.90) followed by those receiving care from biological daughters (HR 1.64, 95% CI 0.37-7.21), compared to women receiving spousal care. By contrast, male elders receiving care from daughters-in-law tended to live longer than those receiving care from their spouses.

Conclusions

Our finding suggests that there may be a survival "penalty" for older Japanese women who are cared for by their daughters-in-law.

Releasing from the oppression: caregiving for the elderly parents of Japanese working women

Caregiving in Japan is defined as predominately a woman's responsibility. However, caregiving has been largely understudied as a lived experience or within a cultural frame of reference. In an estimated 50% of Japanese households, women are currently caregivers of one or more family members. However, the relative absence of information on their experiences has held back the development of programs and services to support their caregiving. In this article, I present results of a grounded-theory study that explored the experiences of Japanese working women caregivers as they cared for the elderly family member in their home. I interviewed 11 women caregivers including 6 daughters and 5 daughters-in-law. I generated a substantive grounded theory, resulting in the identification of the core concept of "releasing self," which included three dimensions: laughing away, self-belief, and losing enthusiasm for the elderly and elderly care.

Caring for Older Adults

Confucianism is one of the frequently mentioned social factors in the research of care for the older adults in East Asian countries such as China, Taiwan, Japan, and Korea. Although Confucian philosophy functions as a powerful source of reference for care, the context of care in Confucian texts is not yet largely studied in nursing. This column focuses on the meaning of care in two key Confucian texts, the Analects and Mencius. The context of care in Confucian texts should provide a sound foundation and substantial understanding for researchers studying care in East Asian society.

Informal and formal care for elderly persons: how adult children's characteristics affect the use of formal care in Japan

Informal care by adult children remains the most common source of caregiving for elderly parents in Japan, even after the introduction of long-term care insurance in 2000. We estimate how the potential supply of child caregivers affects the use of formal care of elderly parents, focusing on the differences across children. We find that the effects of children's presence vary substantially with gender, marital status, and opportunity costs of children. The potential supply of daughters-in-law, as the traditional source of informal care, is less important in providing care than that of unmarried children. The opportunity costs of children make a difference in the use of formal long-term care.

Health expectancies in Japan: gender differences and policy implications for women

Based on prospective observation of elderly people in the community in Japan, we compared the time-course of development and progression of physical disability between women and men. Men experienced disability at a younger age and at a faster rate than did women. The duration of time spent with disability in women was twice as long as in men. Consequently, women consume about two-thirds of the total resources of formal caregiving services in Japan. Women in Japan are increasingly educated, postponing marriage to higher ages, and less likely to care for parents in the home. Given these changes in family structure and social norms, the capacity for informal family caregiving has decreased dramatically. A recently enacted national long-term care insurance system may further change the picture of caregiving.

Evolving values in community-based long-term care services for Japanese Americans

This study used grounded theory to explore how long-term care services are perceived and what factors influence family caregiving and long-term care service utilization choices among Japanese Americans. Family and generational perspectives elucidated a dialectic between forces of integration into the broader culture, and reconnection with the culture of origin within the context of powerful ethnically based historical and generational experiences. This study describes the evolution of the values underlying service delivery and family expectations and demonstrates the dynamic relationships among cultural expectations, historical context, and service evolution for a group of members involved in the caregiving experience.

Attitudes toward community-based services among Japanese American families

PURPOSE

This descriptive study explored attitudes toward community-based long-term care services and factors influencing service utilization among Japanese American families.

DESIGN AND METHODS

Using grounded theory methodology, the Japanese American sample included 26 family caregivers, 4 persons receiving care, and 14 professional providers (n = 44).

RESULTS

Attitudes toward services were identified along six dimensions: ability to meet care needs, autonomy in daily life, quality of care and staff, cost, emotional connotations, and social and physical environment. Participants used formal services in a dynamic manner, meeting both episodic and chronic needs. Families played an active role in sustaining and augmenting the caregiving situation, regardless of living arrangement.

IMPLICATIONS

This research highlights the range of criteria included in attitude formation about services and the dynamic nature of the interplay between families and formal services.

Daughters-in-law in Korean caregiving families

AIM

The aim of this study was to examine the emotional and physical health and experiences of daughter-in-law (DIL) caregivers compared with daughter caregivers who care for cognitively and/or functionally impaired older people in Korea.

BACKGROUND

In Korea, DILs are the predominant caregivers of impaired older people, but little is known about DIL caregivers. A study which explores the emotional and physical health outcomes of DIL caregivers who care for impaired parents-in-law in the sociocultural context of Korea is necessary.

METHOD

A cross-sectional descriptive correlational study was conducted to examine the emotional and physical health of 93 DIL caregivers compared with 27 daughter caregivers who care for the cognitively and/or functionally impaired older people in Korea. This study hypothesized that DIL caregivers would have poorer emotional and physical health than daughter caregivers and that the type of relationship with the care-recipient is an important predictor of caregivers' health outcomes. t-tests, chi-square and hierarchical regression analyses were used for hypotheses testing.

RESULTS

Contrary to expectations, this study found that caregivers' health outcomes were very similar for DILs and daughters in Korean families. The type of relationship was not an important predictor of caregivers' health outcomes, and neither was the quality of intergenerational relationship. However, Korean DIL and daughter caregivers reported relatively poor emotional and physical health compared to those of Western caregivers in previous studies.

CONCLUSIONS

Daughter-in-laws caregivers were not at greater risk group of negative health outcomes than daughter caregivers. However, DIL and daughter caregivers in Korea were a vulnerable group regardless of their relationship with the care-recipient. The cultural norms and social expectations regarding family-centred caregiving in Korea may cause negative health outcomes for Korean caregivers. Further family caregiving studies in the Korean context are recommended.