Work, Leisure Time Activities, and Mental Health among Family Caregivers of the Elder People in Japan.

In Japan, there is a high incidence of family members caring for their elderly. To facilitate this, caregivers often quit their jobs, work reduced hours, and forfeit leisure activities. This study examined the relationship between the mental health of the caregivers and the sacrifices and adjustments they make to care for the elderly. A cross-sectional survey was conducted with responses from 171 caregivers. Referencing Pearlin's stress process model, the relationship among five types of work change, four types of leisure activity quitting, caregivers' subjective care burden, and depression were analyzed using t-test and multiple regression analysis. Caregivers who quit their work or other home activities had significantly more daily living care responsibilities than those who did not. Moreover, caregivers who gave up leisure activities had a greater sense of subjective care burden than those who did not. The experience of giving up peer activities and taking leave of absence from work was significantly associated with increased depressive symptoms. Being a part-timer or financially prosperous was associated with good mental health. To support family caregivers, it is essential to reduce the burden of long-term care and provide financial help and an environment where they interact with their peers, and their moods can be enhanced.

[Gender differences in caregiving experience changes over 2-years and effects on psychological well-being of spousal caregivers in a longitudinal study].

PURPOSE: We examined spousal gender differences in change of caregiving experience over 2-years, focusing on care-recipient's physical and mental conditions, living arrangements, financial status, utilization of long-term care insurance (LTCI), availability of secondary caregivers, caregiver's coping strategies and psychological well-being. We also investigated causal associations between caregiving experiences and psychological well-being of the spousal caregivers. METHOD: We conducted a 2-wave survey, in Oct. 2003 and 2005. The subjects were a stratified random sample of 5,000 users of LTCI in Higashi-osaka city in Japan. Data were collected through mailed, anonymous self-report questionnaires. Totals of 212 wives and 356 husbands were longitudinally analyzed. A cross-lagged effect model by simultaneous analysis of multiple populations was made to analyze a causal association between caregiving experiences and caregivers' psychological well-being. RESULTS: There were no significant changes in care-recipient's physical and mental conditions. Over the 2 years, husbands increased the amount of ADL assistance and availability as secondary caregivers, and wives increased utilization of LTCI services. We also found gender differences in the priority of coping strategies. Husbands' preferred coping strategy over 2 years was more on 'willing commitment caregiver's role 'while for wives' it was 'instrumental support seeking'. Wives demonstrated a significantly reduced positive appraisal of caregiving. Though the amount of ADL assistance and 'instrumental support seeking' reduced husband's depression, husband's positive appraisal of caregiving significantly increased strategies of 'emotional support seeking' and 'willing commitment of care role'. Wives & depression decreased with 'valuing own leisure and refreshing' strategies. Furthermore, wives' positive caregiving appraisal increased both strategies of 'keeping own pace of caregiving' and willing acceptance of care role'. CONCLUSION: The husband's results support an interpretation of adaptation to the caregiving role over two years. Therefore husbands who do not experience increase in ADL assistance might be at risk of caregiver's depression. We should monitor their situation of caregiving continually. Though wives increased utilization of LTCI services, this service use did not improve their psychological wellbeing, and they exhibited decreased positive appraisal of caregiving.

Fatigue in Japanese people with multiple sclerosis.

The aim of this study was to obtain descriptions of the experiences of fatigue of people with multiple sclerosis, including experiences related to their interpersonal relations and social life. We used a qualitative, exploratory, and descriptive design and conducted semistructured interviews with nine participants. Seven concepts emerged from the data analysis: "fatigue as an individualized and novel sensation", "self-analysis of the factors that are associated with fatigue", "effects of fatigue on living and the self", "unique measures for handling fatigue", "insufficient coping", "living with fatigue", and "the assumption of a lack of common understanding of fatigue." Based on these findings, fatigue was found to affect the lifestyle of people with MS and their ability to be true to themself. As a result, the participants devised their own way of coping with fatigue. However, the coping measures also created other dilemmas, which led to isolation. Nevertheless, the participants made efforts to live with fatigue on their own terms.

Gender differences in spousal caregiving in Japan.

BACKGROUND: Gender differences in spousal caregivers and their relationship to care experiences, social demographics, and caregivers' depression were examined. METHODS: A stratified random sample of 2,020 users of public long-term care insurance in a city of Osaka prefecture, Japan, participated in this study. Responses from 308 spouses (56.2% wives, 43.8% husbands) were analyzed. Variables relating to care experiences, social demographics, and caregivers' depression were compared by conducting simultaneous analyses of multiple populations. RESULTS: Wives caring for husbands had higher depression scores than husbands caring for wives. Wives tended to adopt "emotional support seeking" and "willing commitment" as coping strategies for their caregiving experience. Husband caregivers used more home-care services; however, increased service use had no effect on husbands' depression. The availability of secondary caregivers reduced depression for caregivers, regardless of gender. CONCLUSIONS: The effects on depression differed related to the caregiver's gender. Husbands relied more on family or home-care services when caring for their wives, whereas wives provided higher levels of care, positively accepted their role, and did not seek to share caregiving, but sought emotional support.

Management of behavioral and psychological symptoms of dementia in long-term care facilities in Japan.

BACKGROUND: An increasing number of old people, and their medical requirements, cannot be managed by their families in their homes, which has been the traditional and prevalent practice in Japan. The number of people with dementia is increasing and behavioral and psychological symptoms of dementia (BPSD) make care difficult. In the present study, we investigated management techniques for BPSD in long-term care facilities in Japan by using the data mining method, which looks at the reported behaviors of care providers. METHODS: First, interviews were conducted with 15 care providers to develop items for a questionnaire. These data were analyzed qualitatively and synthesized with criteria from the professional literature. The resulting self-report questionnaire on techniques used to manage different symptoms of dementia was completed by 275 care providers. We applied the association rule as a data mining method examining 15 management techniques related to 13 BPSD. RESULTS: Analysis identified four types of management techniques: (i) emotional and behavior-concordance techniques; (ii) acceptance and supportive techniques; (iii) restraining techniques; and (iv) avoidance techniques. Different management techniques, and combinations of techniques, were found to vary in use and effectiveness with different BPSD. CONCLUSIONS: Good management techniques for many BPSD have been developed and are being implemented by care providers. The present study has the potential to inform researchers and care providers in Japan about the types of management techniques in current use, as well as areas of potential need for staff training.

[Evaluation of demographic factors for autonomy of the elderly and their families in selecting long-term care insurance services].

PURPOSE: This study was conducted to characterize (1) the autonomy of service users, both frail elderly and of their family caregivers, in selecting Long-term care insurance services, and to evaluate (2) influencing demographic factors. The aim was to propose new directions for the care providing system. METHODS: The subjects were 1,760 users of public Long-term Care Insurance who were randomly stratified and sampled in Higashi-osaka city, Osaka prefecture. Data were collected through a mailed anonymous self-report questionnaire in October, 2001. The number returned was 1,178 (66.9%). In this study, 723 eligible cases were analyzed in separate models: 146 cases for the elderly model, and 577 for the family model. Multiple regression analysis and two-way analysis of variance were performed to identify factors which have direct and interactive effects, respectively, on the autonomy. RESULTS: 1) The degree of autonomy of the elderly (3.1 +/- 0.8 (range 1-4)) was high in comparison with the family (2.8 +/- 0.8). 2) In the elderly model, the ability to collect service information and the level of knowledge about the service contents had a direct effect on the autonomy. In the family model, ability to collect service information and the level of knowledge about the service contents, the degree of informing the provider of own care needs, and good relations among family members had direct effects. 3) In the elderly model significant two-way interactive effects on the autonomy were observed between the level of knowledge about the service contents and the age; attitudes of the service providers and the age or gender of the recipient; the degree of informing the provider of own care needs and the gender. In the family model, significant interactions were noted between the attitudes of the service providers and the age of the family caregiver; the level of congitive disorders of the elderly and the length of service usage. CONCLUSIONS: It was clarified that the score for autonomy of the family was low in comparison with that for elderly, and the essential requisites of service providers for enhancing the autonomy of elderly people and families may vary depending on the basic characteristics or the situation of the user. It was suggested that support to enhance users autonomy should be provided by taking the demographic factors of the user into consideration.