A longitudinal study of coping and burnout among Japanese family caregivers of frail elders.

OBJECTIVES: The purpose of this study is to clarify causal relations between coping strategies and burnout in family caregivers of frail elders in Japan. METHODS: Baseline and 1-year follow-up interviews were conducted with 546 caregivers living in suburban Tokyo. Using newly refined measures, five coping strategies of caregivers (Keeping Their Own Pace, Positive Acceptance of Caregiving Role, Diversion, Informal Support Seeking, and Formal Support Seeking), and caregiver burnout were measured, as well as several confounding factors. RESULTS: After controlling for these confounding factors, results of cross-lagged effects modelling showed that adoption of a Diversion coping strategy decreased caregiver burnout, while increases in burnout decreased caregiver Positive Acceptance of Caregiving Role. CONCLUSIONS: The beneficial effect of an Adaptive Avoidance Coping strategy, Diversion, on caregiver mental health was confirmed in this two-wave longitudinal study. The mechanism by which Diversion appears to work is by containing caregiving stressors from completely spilling over into caregivers' personal lives. In addition, we also show that preventing a decline in caregiver mental health (i.e. an increase in burnout) allowed caregivers to more easily embrace the caregiving role and, as a result, elder care-recipients were better positioned to receive high quality care.

Longitudinal changes in the well-being of Japanese caregivers: variations across kin relationships.

This study examined how the psychological well-being of Japanese caregivers changed over time; it also examined the variation across kin relationships with care recipients. Three interviews over the course of 30 months were conducted with a representative sample of community-dwelling caregivers of frail elderly persons living in a Tokyo suburb. Latent growth modeling demonstrated that mean levels of both depression and emotional exhaustion worsened over time. Change in emotional exhaustion over time showed significant individual variability, whereas change in depression showed little individual variability. Although wife caregivers tended to experience the worst trajectory of emotional exhaustion, daughters-in-law also showed a similar negative trend. The difference in individuals' well-being trajectories by kinship may be explained partly by differences in care recipients' disabilities.

[Stress-buffering effects of coping strategies among caregivers for impaired Japanese elderly].

This study examines stress-buffering effects of coping strategies among caregivers for Japanese impaired elderly. Eight hundred thirty-two valid responses obtained from primary caregivers of impaired persons aged 65 years old and over living in the community were analyzed. A path model was constructed with physical disability and cognitive impairment of the elderly as the primary stressor, caregiving captivity as the secondary stressor, followed by burnout. Main and interaction effects of five coping strategies were examined by regression analysis with interaction terms between the primary stressor, the secondary stressor, and five coping strategies. Four main effects of coping strategies were found: "Diversion" decreased caregiving captivity; "Keeping their own pace," "Positive acceptance of caregiving role," and "Diversion" decreased burnout. Two buffering effects were found: "Diversion" decreased caregiving captivity only at low level of Activities of Daily Living (ADL) impairment; "Keeping their own pace" buffered the detrimental effects of caregiving captivity for burnout.

[Factors related to under-utilization of in-home services under the long-term insurance system].

PURPOSES: This study was conducted to examine factors associated with under-utilization of in-home services covered by the long-term care insurance. Under-utilization was measured in terms of the discrepancy rate between benefits limits and service costs for individuals. Based on the behavioral model, possible predictors were chosen; the level of nursing care as the need factor, living arrangements and income as enabling factors, and family caregiving consciousness as a predisposing factor. Both direct and interaction effects of those factors were examined. METHODS: 1,500 people were randomly selected from all people certified as needing long-term care in one ward, Tokyo to be interviewed. People categorized as "requires assistance" or "requires nursing care level 1" were interviewed directly. With people categorized as "level 2" to "level 5", their primary caregivers were interviewed. Information about in-home service utilization was collected from the insurer. RESULTS: People who were categorized as requiring a lower level of nursing care, lived with others, had a low income, or had high family caregiving consciousness demonstrated significantly greater under-utilization rate as compared with others. An interaction between living arrangements and the level of nursing was observed in this regard. While people who lived alone exhibited low a level of under-utilization rate without regard of the level of nursing care, the rate changed by those who lived with other. CONCLUSIONS: Under the new system, informal support might have a significant impact on under-utilization of in-home services. The responsibility for paying 10% of total care costs might be related to under-utilization by people with low income, though reduction of individual co-payments has been introduced for individuals in difficult financial conditions.