Undue concern for others' opinions deters caregivers of impaired elderly from using public services in rural Japan

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Abstract
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.