title: Developing a scale to measure family dynamics related to long-term care, and testing that scale in a multicenter cross-sectional study.
abstract: BACKGROUND
  As Japan's population ages, more frail elderly people are cared for by members of their family. The dynamics within such families are difficult to study, in part because they are difficult to quantify. We developed a scale for assessing family dynamics related to long-term care. Here we report on the development of that scale, and we present the results of reliability testing and validation testing.
  
  
  METHODS
  Two primary-care specialists drafted questions about family dynamics, and discussed them with other primary-care physicians and clinical researchers. The final questionnaire asked about four problems or undesirable situations: disengagement (emotional distance), scapegoating (inappropriate blame), transfer of problems across generations (transfer of unnecessary burden from older to younger generations, trans-generationally displaced revenge), and undesirable behavior (co-dependence). Next, at six general-medicine clinics, doctors evaluated families that had a caregiver and a patient requiring long-term care. The results were analyzed by factor analysis. Cronbach's α was computed, and criterion-related validation tests were done with three types of criteria: relationship before caregiving, ability to do activities of daily living (ADL), and the duration of care.
  
  
  RESULTS
  Results were obtained from 199 families. Among the caregivers, 79% were women and their mean age was 63 years. Among the patients, 71% were women and their mean age was 84 years. The results of factor analysis indicated that the scale was unidimensional. Cronbach's α was 0.73. Not having a good relationship before caregiving was associated with significantly worse family dynamics scores, as was greater dependence regarding ADL.
  
  
  CONCLUSIONS
  We developed a scale that enables physicians to assess the dynamics of families with a patient and a family caregiver. The scale's scores are reliable and the results of validation testing were generally good. This scale holds promise as a tool both for research and for primary-care practice.
authors.forename: Tesshu
authors.initials: T
authors.lastname: Kusaba
authors.forename: Kotaro
authors.initials: K
authors.lastname: Sato
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Matsui
authors.forename: Satoshi
authors.initials: S
authors.lastname: Matsuda
authors.forename: Takashi
authors.initials: T
authors.lastname: Ando
authors.forename: Ken
authors.initials: K
authors.lastname: Sakushima
authors.forename: Takafumi
authors.initials: T
authors.lastname: Wakita
authors.forename: Shingo
authors.initials: S
authors.lastname: Fukuma
authors.affiliation: Institute for Health Outcomes and Process Evaluation Research, Akinonocho, Nakagyo Ward, Kyoto, Japan. fukuhara.shunichi.6m@kyoto-u.ac.jp.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D017028:Caregivers / Q000523:psychology*; D017004:Codependency, Psychological; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005195:Family Relations; D005260:Female; D016330:Frail Elderly; D006801:Humans; D016901:Intergenerational Relations; D007564:Japan; D008134:Long-Term Care / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012539:Scapegoating; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires