Negative/positive home-based caregiving appraisals by informal carers of the elderly in Japan

Abstract

AIM: This study aimed to determine factors associated with negative/positive home-based caregiving appraisals by informal carers of older people in Japan to consider which family carers' community health nurses should focus on. BACKGROUND: Because of the increasing older population in Japan, those needing a high level of care have become more dependent on informal carers. Carers' health is an important aspect of caregiving. Community health nurses play an important role in assessing carers' health, and carer appraisals, that is, how carers perceive their caregiving work, may help them better understand the health state of carers. METHODS: This quantitative study examined 192 primary carers of the elderly (care level >3) who used home-visiting nursing services in both rural and urban Japanese communities. The Japanese version of the Zarit scale (22 items) was used for negative appraisal and a positive caregiving appraisal scale (14 items) for positive appraisal. Participants with above-median scores (care burden, 30.0; positive caregiving appraisal, 39.0) were categorized as having a high care burden and high positive appraisal. To determine factors associated with appraisals, multinomial regression analysis was performed. Negative/positive appraisals were separately set as a dependent variable, and 17 items relating to carer characteristics, care-recipient characteristics, and external variables were set as independent variables. This was followed by stepwise regression and backward elimination. FINDINGS: With respect to care burden, positively associated factors were sekentei or social pressure [odds ratio (OR) 4.25, 95% confidence interval (CI) 1.39-13.04], caregiving obligation (OR 3.11, 95% CI 1.43-6.77), spouse carer (OR 2.58, 95% CI 1.05-6.35), daughter-in-law carer (OR 3.68, 95% CI 1.31-10.34), and depression (OR 50.58, 95% CI 13.85-184.67). With respect to positive appraisal, negatively associated factors were caregiving obligation (OR 0.29, 95% CI 0.15-0.53), male carer (OR 0.44, 95% CI 0.21-0.92), and daughter-in-law carer (OR 0.29, 95% CI 0.12-0.74).