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Luo J, Li B, Li J, Ren Z. Examining the impact of Co-residence with a daughter-in-law on older adult health in China: Evidence from a frailty index-based study. SSM Popul Health 2024; 26:101649. [PMID: 38516530 PMCID: PMC10955668 DOI: 10.1016/j.ssmph.2024.101649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/28/2024] [Accepted: 03/01/2024] [Indexed: 03/23/2024] Open
Abstract
Background The increasing geriatric population and variation in the disease spectrum among older adults in China contribute to a growing demand for more aged adult care in Chinese society. Relevant studies have shown that living arrangements with various family members have variable impacts on the older adult's health. This study employs the Frailty Index as a unified measurement standard to assess the overall health levels, integrating the specific "in-law relationships" into the research on living arrangements and the health of older adults. Methods This study used data from the China Longitudinal Aging Social Survey 2016-2018. OLS and Quantile Regression were used to investigate the in-law relationship on older adult health and whether this impact is homogeneous across older individuals with varying infirmity levels. The study used a lag model and propensity score matching to compensate for potential endogeneity concerns. Results The study found that residing with a daughter-in-law (20.22%) had a significant positive correlation with the frailty index (β=0.0088, P<0.001), indicating that the relationship between parents-in-law and daughters-in-law can influence the health of the older adult. This impact is nonlinear and non-homogeneous for older adult people with various levels of frailty, exhibiting an approximately decreasing and then increasing U-shaped distribution, which denotes that older adult people with different health conditions have distinct demands for intergenerational care. In addition, this impact varies among older adult groups of disparate genders, urban and rural areas, and age groups. Conclusion This study investigates the impact of "in-law relationships" within living arrangements on the health of older adults. It shows that co-residing with a daughter-in-law has adverse effects on the health of older adults. Therefore, the study suggests that when the health and economic conditions of the elderly permit, a "live-near-but-not-with" living arrangement with their children can be considered.
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Affiliation(s)
- Juan Luo
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
| | - Ben Li
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
| | - Jiarong Li
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
| | - Zhenpeng Ren
- School of Management, Shanghai University of Engineering Science, 333 Longteng Road, 201620, Shanghai, China
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Hoshino J, Tamakoshi K, Hori Y, Sakakibara H. Association between caregivers' health-related quality of life and care recipients' health outcomes. Int J Nurs Pract 2022; 28:e13044. [PMID: 35246893 DOI: 10.1111/ijn.13044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/12/2021] [Accepted: 02/17/2022] [Indexed: 11/29/2022]
Abstract
AIMS This study aimed to investigate the relationship between family caregivers' health-related quality of life and health outcomes in care recipients. METHODS A total of 160 female caregivers in Japan were initially assessed using self-reported baseline questionnaires to determine physical and mental aspects of their health-related quality of life. Based on these scores, they were divided into three groups: lower, middle, and higher quality of life. We followed up with the 133 participants (after excluding those that did not respond) 6 years later to assess the health of their care recipients; 36 caregivers continued to provide home care, while 97 reported that their care recipient had died or been admitted into institutionalized care. RESULTS Statistically, a higher risk for care recipients' health deterioration was strongly associated with the mental component score in the lower caregivers' quality of life group of than for the middle group, after adjusting for the care recipients' age, health status, and caregivers' age at baseline. There was no significant association between deterioration of health of care recipients and physical component scores of the caregivers. CONCLUSION Caregivers' poor health-related quality of life, particularly poor mental health, may be linked to the deterioration of care recipients' health.
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Affiliation(s)
- Junko Hoshino
- Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Koji Tamakoshi
- Graduate School of Medicine, Nagoya University, Nagoya, Aichi, Japan
| | - Yoko Hori
- General Incorporated Association Happy Net, Nagoya, Aichi, Japan
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Daly M, Perry G. In-Law Relationships in Evolutionary Perspective: The Good, the Bad, and the Ugly. FRONTIERS IN SOCIOLOGY 2021; 6:683501. [PMID: 34150907 PMCID: PMC8211990 DOI: 10.3389/fsoc.2021.683501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/10/2021] [Indexed: 06/13/2023]
Abstract
In-laws (relatives by marriage) are true kin because the descendants that they have in common make them "vehicles" of one another's inclusive fitness. From this shared interest flows cooperation and mutual valuation: the good side of in-law relationships. But there is also a bad side. Recent theoretical models err when they equate the inclusive fitness value of corresponding pairs of genetic and affinal (marital) relatives-brother and brother-in-law, daughter and daughter-in-law-partly because a genetic relative's reproduction always replicates ego's genes whereas reproduction by an affine may not, and partly because of distinct avenues for nepotism. Close genetic relatives compete, often fiercely, over familial property, but the main issues in conflict among marital relatives are different and diverse: fidelity and paternity, divorce and autonomy, and inclinations to invest in distinct natal kindreds. These conflicts can get ugly, even lethal. We present the results of a pilot study conducted in Bangladesh which suggests that heightened mortality arising from mother-in-law/daughter-in-law conflict may be a two-way street, and we urge others to replicate and extend these analyses.
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Affiliation(s)
- Martin Daly
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Gretchen Perry
- School of Social Work, University of Canterbury, Christchurch, New Zealand
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Association between primary caregiver type and mortality among Chinese older adults with disability: a prospective cohort study. BMC Geriatr 2021; 21:268. [PMID: 33882871 PMCID: PMC8061058 DOI: 10.1186/s12877-021-02219-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/15/2021] [Indexed: 11/30/2022] Open
Abstract
Background Socio-demographic transitions have dramatically changed the traditional family care settings in China, caused unmet care needs among older adults. However, whether different primary caregiver types have different influences on disabled older adults’ health outcomes remain poorly understood. We aimed to examine the association between the type of primary caregiver (e.g., spouse and children) and death among community-dwelling Chinese older adults disabled in activities of daily living. Methods We used data from Chinese Longitudinal Healthy Longevity Survey. The analytic sample comprised 4278 eligible adults aged ≥ 80 years. We classified primary caregiver type into five categories: spouse, son/daughter-in-law, daughter/son-in-law, grandchildren, and domestic helper. We used Cox regression model to examine the association between primary caregiver type and all-cause mortality. Covariates included age, sex, residence, years of education, co-residence status, financial independence, whether living with children, number of ADL disability, number of chronic conditions, and self-reported health, cognitive impairment, and caregiving quality. Results Married older adults whose primary caregivers were son/daughter-in-law had a 38% higher hazard of death than those who had spouse as the primary caregiver. Married men who received care primarily from son/daughter-in-law or daughter/son-in-law had a 64 and 68% higher hazard of death, respectively, than those whose primary caregiver was spouse. The association between primary caregiver type and mortality among widowed older adults differed between urban and rural areas. Urban residents who had domestic helpers as the primary caregiver had an 16% lower hazard of death, while those living in rural areas had a 50% higher hazard of death, than those having son/daughter-in-law as the primary caregiver. Conclusions The quality of care of the primary caregiver may be a risk factor for mortality of disabled older adults in China. Interventions are necessary for reducing unmet needs and managing care burden.
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Imamura H, Uchiyama E, Akiyama M, Kaneko I, Takebayashi T, Nishiwaki Y. Relationship of living arrangement with the decline in functional capacity in elderly people by gender: a longitudinal observational study. Environ Health Prev Med 2020; 25:15. [PMID: 32434465 PMCID: PMC7240989 DOI: 10.1186/s12199-020-00853-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/01/2020] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Haruhiko Imamura
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan.
| | - Eiko Uchiyama
- Graduate School of Media and Governance, Keio University, Kanagawa, Japan
| | - Miki Akiyama
- Faculty of Environment and Information Studies, Keio University, Kanagawa, Japan
| | | | - Toru Takebayashi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, Japan
| | - Yuji Nishiwaki
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-Nishi, Ota-ku, Tokyo, 143-8540, Japan
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Jang SN, Kawachi I. Care inequality: care received according to gender, marital status, and socioeconomic status among Korean older adults with disability. Int J Equity Health 2019; 18:105. [PMID: 31269953 PMCID: PMC6610802 DOI: 10.1186/s12939-019-1008-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 06/21/2019] [Indexed: 11/16/2022] Open
Abstract
Background We sought to identify the types of care and care resources available to older Korean adults with disabilities, and document the inequality in care received according to gender, marital status, and socioeconomic status. Method Data were derived from the sixth wave of the Korean Longitudinal Study of Ageing. The sample consisted of 946 men and women who were disabled in ADL and IADL. Generalized linear models and analyses of covariance were used to evaluate group differences in types of care received and care resources. The outcome variables were main primary caregivers, the total number of available caregivers, hours of care received per day, number of days of care, and fees paid to caregivers. Results In total, 41.7% of men with ADL/IADL disabilities reported that they did not receive formal or informal care from any source, compared with 30.7% of women. Almost half (49.2%) of men without a spouse were in a state of care deficit (vs. 30.8% in women without a spouse, P < 0.001). Among care recipients, men reported receiving higher average days of care per month than women (25.6 vs. 21.2 days, P < 0.01). Both men and women received care primarily from their spouse, but adult children were more frequently care providers for older women than men. A combination of care from spouse and paid caregiver was more frequent among women. Dependent older people with high household incomes had a higher likelihood of receiving care There was the clear gradient in rate of paid formal caregivers use by household income (higher income = higher use) among women but not men. Conclusions Care types and resources among disabled older adults appeared to be different by gender, marital status and socioeconomic status under the cultural phenomenon and contextual circumstances in the aging Korean population.
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Affiliation(s)
- Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06709, South Korea. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Muennig P, Jiao B, Singer E. Living with parents or grandparents increases social capital and survival: 2014 General Social Survey-National Death Index. SSM Popul Health 2018; 4:71-75. [PMID: 29349275 PMCID: PMC5769098 DOI: 10.1016/j.ssmph.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION After nearly a century-long trend toward single-family living arrangements, people in wealthy nations are increasingly living in multi-generational households. Multi-generational living arrangements can, in theory, increase psychological, social, and financial capital-factors associated with improvements in health and longevity. METHODS We conducted a survival analysis using the 2014 General Social Survey-National Death Index, a prospective multi-year survey. We explored whether single generational living arrangements were associated with a higher risk of mortality than multi-generational living arrangements. RESULTS We explored this association for different groups (e.g., the foreign-born and those with high self-reported stress in family relationships). Healthy subjects who live in two-generation households were found to have lower premature mortality (hazard ratio 0.9, 95% confidence interval = 0.82, 0.99). Otherwise, we found little evidence that living arrangements matter for the respondents' risk of premature mortality. CONCLUSIONS Healthy people living in two-generation households have longer survival than healthy people living on their own.
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Affiliation(s)
- Peter Muennig
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th Street, New York, NY 10032, USA
- Department of Emergency Medicine, Icahn School of Medicine, Mount Sinai St. Luke’s/ West, 1111 Amsterdam Avenue, New York, NY 10025, USA
| | - Boshen Jiao
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th Street, New York, NY 10032, USA
| | - Elizabeth Singer
- Department of Health Policy and Management, Mailman School of Public Health, Columbia University, 600 West 168th Street, New York, NY 10032, USA
- Department of Emergency Medicine, Icahn School of Medicine, Mount Sinai St. Luke’s/ West, 1111 Amsterdam Avenue, New York, NY 10025, USA
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Tokunaga M, Hashimoto H. The socioeconomic within-gender gap in informal caregiving among middle-aged women: Evidence from a Japanese nationwide survey. Soc Sci Med 2017; 173:48-53. [DOI: 10.1016/j.socscimed.2016.11.037] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/28/2016] [Accepted: 11/26/2016] [Indexed: 11/24/2022]
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Iwata N, Horiguchi K. Differences in caregivers' psychological distress and associated factors by care recipients' gender and kinship. Aging Ment Health 2016; 20:1277-1285. [PMID: 26274388 DOI: 10.1080/13607863.2015.1074161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Noboru Iwata
- a Department of Psychology , Hiroshima International University , Higashi-Hiroshima , Japan
| | - Kazuko Horiguchi
- b Department of Nursing , Hyogo University of Health Sciences , Kobe , Japan
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Kuo YC. Women's Experiences Caring for Their Husbands' Siblings With Developmental Disabilities. Glob Qual Nurs Res 2015; 2:2333393615604169. [PMID: 28462315 PMCID: PMC5342291 DOI: 10.1177/2333393615604169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 08/03/2015] [Accepted: 08/07/2015] [Indexed: 11/28/2022] Open
Abstract
A phenomenological method was used in this study to examine the experiences of women caring for the husband’s sibling with developmental disabilities (DDs) with the aim of establishing how and why they came to care and continued to care for them. Three themes emerged after drawing on stories shared by seven women: for the sake of my husband, powerlessness, and trade-off between cost and rewards. The findings of this study show that Taiwanese women accept the cultural norms, thus accepting the caregiving responsibility. Reciprocity did not help determine whether women started caring for the husband’s sibling with DD. However, when an imbalance in reciprocity is present, women experience negative emotions that often result in tension within the family. Positive factors contributed by the husband and parents-in-law can facilitate the work of caregivers by ameliorating physical pain and psychological distress that can occur during the caregiving process.
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Affiliation(s)
- Yeh-Chen Kuo
- National Taipei University of Education, Taipei City, Taiwan, R.O.C
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Goodwin R, Takahashi M, Sun S, Ben-Ezra M. Psychological distress among tsunami refugees from the Great East Japan earthquake. BJPsych Open 2015; 1:92-97. [PMID: 27703729 PMCID: PMC4995552 DOI: 10.1192/bjpo.bp.115.000422] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 06/30/2015] [Accepted: 08/06/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The 2011 Great Japan tsunami and nuclear leaks displaced 300 000 people, but there are no large studies of psychological distress suffered by these refugees. AIMS To provide a first assessment of major factors associated with distress and dysfunctional behaviour following the disasters. METHOD All refugee families living in Miyagi were sent a questionnaire 10-12 months after the disasters. 21 981 participants (73%) returned questionnaires. Questions assessed psychological distress (Kessler Psychological Distress Scale, K6), dysfunctional behaviours, demographics, event exposure, change in physical activity, household visitors and emotional support. RESULTS Nine percent scored 13+ on the K6 indicating risk of severe mental illness. Psychological distress was greater among Fukushima refugees. Demographic variables, family loss, illness history and change in physical activity were associated with psychological distress and dysfunctional behaviours. Associations between psychological distress and dysfunction and visitors/supporters depended on relation to supporter. CONCLUSIONS Practitioners need to recognise existing disease burden, community histories and family roles when intervening following disasters. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2015. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Robin Goodwin
- , PhD, Department of Psychology, University of Warwick, Coventry, UK
| | | | - Shaojing Sun
- , PhD, School of Journalism, Fudan University, Shanghai, China
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Tokunaga M, Hashimoto H, Tamiya N. A gap in formal long-term care use related to characteristics of caregivers and households, under the public universal system in Japan: 2001-2010. Health Policy 2014; 119:840-9. [PMID: 25467791 DOI: 10.1016/j.healthpol.2014.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 10/21/2014] [Accepted: 10/24/2014] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Mutsumi Tokunaga
- Department of Health and Social Behavior, The University of Tokyo, School of Public Health, 7-3-1 Hongo, Bunkyo-ku Tokyo 113-0033, Japan.
| | - Hideki Hashimoto
- Department of Health and Social Behavior, The University of Tokyo, School of Public Health, 7-3-1 Hongo, Bunkyo-ku Tokyo 113-0033, Japan
| | - Nanako Tamiya
- Department of Health Service Research, Graduate School of Human Care Services, Tsukuba University, Japan
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The association between involvement in family caregiving and mental health among middle-aged adults in Japan. Soc Sci Med 2014; 115:121-9. [DOI: 10.1016/j.socscimed.2014.06.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 05/25/2014] [Accepted: 06/12/2014] [Indexed: 12/14/2022]
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Kurata S, Ojima T. Knowledge, perceptions, and experiences of family caregivers and home care providers of physical restraint use with home-dwelling elders: a cross-sectional study in Japan. BMC Geriatr 2014; 14:39. [PMID: 24674081 PMCID: PMC3986818 DOI: 10.1186/1471-2318-14-39] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 03/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of physical restraints by family caregivers with home-dwelling elders has not been extensively studied but it might be widespread. Furthermore, it is also not clear how home care providers who support family caregivers perceive the use of physical restraint in elders' homes. This study assessed family caregivers' and home care providers' knowledge and perceptions of physical restraint used with elders living at home in Japan, a country with the highest proportion of elders in the world and where family caregiving is common. METHODS We undertook a cross-sectional study of 494 family caregivers, 201 home helpers, 78 visiting nurses, 131 visiting physicians, and 158 care managers of home-dwelling frail elders needing some care and medical support in Japan, using questionnaires on knowledge of 11 physical restraint procedures prohibited in institutions and 10 harmful effects of physical restraints, perceptions of 17 reasons for requiring physical restraints, and experiences involving physical restraint use. RESULTS Family caregivers were aware of significantly fewer recognized prohibited physical restraint procedures and recognized harmful effects of physical restraint than home care providers, and differences among home care providers were significant. The average importance rating from 1 (least) to 5 (most) of the 17 reasons for requiring physical restraints was significantly higher among family caregivers than home care providers, and significantly different among the home care providers. Moreover, these differences depended in part on participation in physical restraint education classes. While 20.1% of family caregivers had wavered over using physical restraints, 40.5% of home care providers had seen physical restraints used in elders' homes and 16.7% had advised physical restraint use or used physical restraints themselves. CONCLUSIONS Knowledge and perceptions of physical restraints differed between family caregivers and home care providers and were also diverse among home care providers. Because both groups might be involved in physical restraint use with home-dwelling elders, home care providers should acquire standardized and appropriate knowledge and perceptions of physical restraints to help family caregivers minimize abusive physical restraint use.
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Affiliation(s)
- Sadami Kurata
- Gerontological Nursing, Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan.
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Yiengprugsawan V, Harley D, Seubsman SA, Sleigh AC. Physical and mental health among caregivers: findings from a cross-sectional study of Open University students in Thailand. BMC Public Health 2012; 12:1111. [PMID: 23267664 PMCID: PMC3543164 DOI: 10.1186/1471-2458-12-1111] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 12/22/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregivers constitute an important informal workforce, often undervalued, facing challenges to maintain their caring role, health and wellbeing. Little is known about caregivers in middle-income countries like Thailand. This study investigates the physical and mental health of Thai adult caregivers. METHODS This report derives from distance-learning students working and residing throughout Thailand and recruited for a health-risk transition study in 2005 (N=87,134) from Sukhothai Thammathirat Open University. The cohort follow-up questionnaire in 2009 (N = 60,569) includes questions on caregiver status which were not available in 2005; accordingly, this study is confined to analysis of the 2009 data. We report cross-sectional associations between caregiver status and health. RESULTS Among the study participants in 2009, 27.5% reported being part-time caregivers and 6.6% reported being full-time caregivers. Compared to male non-caregivers, being a part-time or full-time male caregiver was associated with lower back pain (covariate-Adjusted Odds Ratios, AOR 1.36 and 1.67), with poor psychological health (AOR 1.16 and 1.68), but not with poor self-assessed health. Compared to female non-caregivers, being a part- or full-time female caregiver was associated with lower back pain (AOR 1.47 and 1.84), psychological distress (AOR 1.32 and 1.52), and poor self-assessed health (AOR 1.21 and 1.34). CONCLUSIONS Adult caregivers in Thailand experienced a consistent adverse physical and mental health burden. A dose-response effect was evident, with odds ratios higher for full-time caregivers than for part-time, and non-caregivers. Our findings should raise awareness of caregivers, their unmet needs, and support required in Thailand and other similar middle-income countries.
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Affiliation(s)
- Vasoontara Yiengprugsawan
- National Centre for Epidemiology and Population Health, The Australian National University, Building 62, Mills Rd, Acton 2601, Canberra, ACT, Australia
| | - David Harley
- National Centre for Epidemiology and Population Health, The Australian National University, Building 62, Mills Rd, Acton 2601, Canberra, ACT, Australia
| | - Sam-ang Seubsman
- School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, Thailand
| | - Adrian C Sleigh
- National Centre for Epidemiology and Population Health, The Australian National University, Building 62, Mills Rd, Acton 2601, Canberra, ACT, Australia
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Tamiya N, Noguchi H, Nishi A, Reich MR, Ikegami N, Hashimoto H, Shibuya K, Kawachi I, Campbell JC. Population ageing and wellbeing: lessons from Japan's long-term care insurance policy. Lancet 2011; 378:1183-92. [PMID: 21885099 DOI: 10.1016/s0140-6736(11)61176-8] [Citation(s) in RCA: 350] [Impact Index Per Article: 26.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
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.
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Affiliation(s)
- Nanako Tamiya
- Department of Health Services Research, Graduate School of Human Care Sciences, University of Tsukuba, Ibaraki, Japan
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