[Family caregiver's reluctance toward community services: a social psychology perspective].

Health and social care services attempt to meet Alzheimer family caregivers' needs. However, these services are underutilized. To understand this reluctance, we propose to broaden the theoretical perspectives on family care. In the literature, family care has been analyzed considering professional care according to the stress-coping paradigm. It has contributed in discovering caregivers' burden, coping strategies and needs, but at the same time it gives a negative view on family care. Current services have been developed based on the above theory built on analogy with professional care, but they neglect the "caring about" aspect of caring. New perspectives stemming from sociology have taken this aspect into account. First, family care has to be contextualized in family history, disease trajectory as well as in cultural values. Second, the main task of "caring about" consists of maintaining the self-image of the demented subject as long as possible. This fight to maintain the identity of the demented by the caregivers is not addressed in the current literature and in the present support services. In a qualitative study, we interviewed 27 main caregivers, having controlled for socio-demographic characteristics as well as the dementia severity. Results show that underutilization of services is mainly due to the type of services offered, and that reluctance can be global or selective. Caregivers also experience conflict between contradictory needs: instrumental and identity maintenance of the demented. The discussion focuses the role of, among others, gender, family history and cultural norms in the caregivers' reluctance.