The new public long-term care insurance system and feeling of burden among caregivers of the frail elderly in rural Japan.

The present study was conducted to investigate the factors related to the feelings of burden (i.e., stress) among caregivers of the frail elderly in rural Japan after the introduction of the new public long-term care insurance system in 2000. Forty-one out of 42 caregivers answered a self-administered questionnaire (i.e., the Japanese version of the Zarit Caregiver Burden Interview (ZBI)) regarding their caregiving situation. Compared with lightly burdened caregivers (n = 20; ZBI > or = 41), those heavily burdened (n = 21; ZBI < or = 40) attended the frail elderly with greater numbers of behavioral disturbances (2.2 +/- 2.6 vs. 0.6 +/- 1.0, p = 0.02) and those with dementia (60.9% vs. 39.1%, p = 0.08). Heavily burdened caregivers spent a longer time with the elderly (17.9 +/- 6.1 hours vs. 11.8 +/- 8.4 hours, p = 0.01) as well as in providing for their physically care (14.0 +/- 7.9 hours vs. 8.6 +/- 8.2 hours, p = 0.04), thus having less time to go out unaccompanied by their patients (1.1 +/- 1.6 hours vs. 2.4 +/- 2.3 hours, p = 0.04). Such caregivers tended to be depressed (70.0% vs. 42.9%, p = 0.08), although they used more social services (5.2 +/- 2.0 vs. 3.7 +/- 2.1, p = 0.03) than the lightly burdened caregivers. In addition, more than half of caregivers (56.1%) in the present study were depressed. This rate was higher than the rates in our studies before the introduction of the new public long-term care insurance system (a rural town: 53.3%, an urban town 46.6%). Furthermore, the number of social services used by caregivers did not seem to increase after the introduction of this insurance system (before: 4.1 +/- 2.0, after: 4.4 +/- 2.1). These findings suggest that the quantity and quality of social services for the frail elderly and their caregivers may not suffice even after the introduction of the new public long-term care insurance system.