title: Experiences of "endless" caregiving of impaired elderly at home by family caregivers: a qualitative study.
abstract: BACKGROUND
  In Japan, the care burden for elderly requiring care is a serious social issue due to increasing life expectancy and the resulting need for long-term care. We qualitatively described how caregivers dealt with the prolonged caregiving and incorporated caregiving into their lives. We also explained the process of "everlasting caregiving" among primary long-term family caregivers at home.
  
  
  METHODS
  Data were obtained from semi-structured interviews conducted in Japan from 2009 to 2011 about caregiving experience with 23 primary caregivers of care recipients. The grounded theory approach was applied for data analysis.
  
  
  RESULTS
  In this study, caregivers perceived their caregiving as everlasting. In particular, when care recipients stayed alive or when caregivers suffered from diseases, caregivers were not determined to be "unable to perform caregiving." However, when they undertook caregiving, they thought of it in a finite sense. As a result, caregivers feel that they endure caregiving for an endless period. The long-term period of caregiving was divided into two phases, depending on whether caregivers realized the finiteness of caregiving or not. We identified five categories for surviving caregiving in these two phases as follows: Addition of a positive meaning of the use of caregiving services, Management of the use of caregiving services under the initiative of the caregivers, Receiving assistance that can be accomplished without making considerable changes in the lifestyles of family members and relatives, Obtaining available assistances as necessary provided by neighbors and friends, and Re-definition of caregiving needs. This process was named "Handling of the amount and quality of care: surviving strategies for the endless caregiving of impaired elderly at home."
  
  
  CONCLUSIONS
  In this study, caregivers carried out long-term caregiving, but not without struggles. Caregivers could continue their caregiving due to initiative, maintaining the role of primary caregiver. Family members and relatives respected caregivers' individuality and decisions.
authors.affiliation: Konan Women's University, 6-2-23 Morikita-machi, Higashinada-ku, Kobe, Hyogo, 658-0001, Japan. sakakibara@konan-wu.ac.jp.
authors.forename: Kazue
authors.initials: K
authors.lastname: Sakakibara
authors.affiliation: Division of Health Sciences, Department of Health Promotion Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka Suita, Osaka, 565-0871, Japan. kabayama@sahs.med.osaka-u.ac.jp.
authors.forename: Mai
authors.initials: M
authors.lastname: Kabayama
authors.affiliation: Division of Health Sciences, Department of Health Promotion Science, Graduate School of Medicine, Osaka University, 1-7 Yamadaoka Suita, Osaka, 565-0871, Japan. itmkk@sahs.med.osaka-u.ac.jp.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D002908:Chronic Disease / Q000451:nursing*; D005190:Family / Q000523:psychology*; D005260:Female; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research