Ikspite a rapid iricre'rse in disabled cldcrly in Jcip.in, the burden of the c~regivci-h'is u o t hccn properly lack of objective ~iie~r~tireiiiciits. Our stiidy w a s 'iiiiied at ad

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.

This longitudinal study investigates the caregiving experiences among Japanese caregivers who provided informal care at home for disabled elderly between 1998 and 1999. Forty-seven caregivers of the impaired elderly continued caregiving at home in Matsuyama Town, a rural area of northern Japan, while 18 caregivers discontinued it. The mean score of the Center for Epidemiologic Studies Depression Scale in 1998 among those who gave up caregiving was significantly higher than that of those who continued caregiving, indicating that depression predicts early discontinuation of care in the home. This is one of the few studies in Japan to suggest that initial caregiver depression is a factor in the decision to terminate care for the disabled elderly at home.

Objective To determine whether opinions of others may discourage the use of public services for the elderly. Design Users and non‐users were compared regarding several variables including caregivers' concerns about opinions of others. Setting Matsuyama Town, located in a rural area of northern Japan. Subjects Seventy pairs of (1) elderly persons in need of care assessed by the procedure employed by the Ministry of Health and Welfare, and (2) their respective family caregivers. Measures Cognitive function (Hasegawa Dementia Rating Scale), diagnosis of dementia, activities of daily living (ADL: Barthel Index), caregivers' burden (Zarit Caregiver Burden Interview), behavioral disturbances (Dementia Behavioural Disturbance Scale), caregiver interviews. Results A logistic regression analysis revealed that those who looked after the elderly with severe dependency in ADL were three times more likely to use public services (OR = 3.33, 95% CI = 1.02 – 10.88, p = 0.04). Those concerned about what others think or say were less likely to use public services (OR = 0.22, 95% CI = 0.06 – 0.78, p = 0.01) than those who did not. Conclusions Caregivers' undue concern for the opinions of others apparently deterred them from using public services. The overriding notion of care for the elderly as a family duty is still prevalent in rural Japan. It would be useful for the government to launch a public awareness programme to help caregivers understand the benefits of services available for the elderly. Copyright © 2000 John Wiley & Sons, Ltd.