title: Combined effect of factors associated with burdens on primary caregiver.
abstract: BACKGROUND
  It is argued that a multidimensional approach is necessary for burden assessment. Reducing caregiver burden is a social problem in the ageing Japan society. We examined the combined effect of factors affecting the care burden among community-dwelling handicapped people and their caregivers.
  
  
  METHODS
  The participants were 49 handicapped people (aged 53-104 years) who received home-visit rehabilitation, and their 49 caregivers (age 42-85 years). Caregivers were provided questionnaires consisting of questions on social support, subjective well-being, self-efficacy with regard to care continuation, the Motor Fitness Scale and caregiver burden. Care recipients were assessed using the Bedside Mobility Scale and the Barthel Index.
  
  
  RESULTS
  We prepared the hypothesis model using structural equation modeling with the bootstrap method within outcome measures. The hypothesis model did not fit the data well. The impact of the Motor Fitness Scale was shifted from the caregiver burden to care self-efficacy and well-being, having a cooperator for care and variable of spouse caregiver or others associated with caregiver well-being in the revised model. The fit of the revised model was acceptable (goodness of fit index, 0.903; comparative fit index, 0.998; root mean square error of approximation, 0.017). In the revised model, the care recipients' disabled state was associated with caregiver burden. In addition, higher burden and poor motor fitness of caregivers might lead to lower care self-efficacy in providing continuous care and lower caregiver well-being.
  
  
  CONCLUSIONS
  These findings suggested that the program to reduce caregiver burden should focus on aspects of the care recipients' disabled state, the caregivers' well-being, fitness, and care self-efficacy.
authors.affiliation: School of Health Sciences, Sapporo Medical University, Chu-ou-ku, Sapporo, Japan. makizako@sapmed.ac.jp
authors.forename: Hyuma
authors.initials: H
authors.lastname: Makizako
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Abe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shimada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ohnuma
authors.forename: Taketo
authors.initials: T
authors.lastname: Furuna
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nakamura
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation; D005190:Family; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D020377:Self Efficacy; D012944:Social Support; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires