Understanding Women in the Role of Caregivers for Older Adults in Japan

This article provides an overview of Japanese women in the role of caregivers of older family members. Cultural influence on women's identity, significance of the caregiver 's role, and the struggles and rewards of being caregivers are discussed. Finally, ideas are provided for the use of arts in counseling and implications of their use are discussed. ********** Challenges that Japanese women experience in being caregivers to older individuals (age 65 and over) are ever present in today's Japanese society. The number of older adults in Japan is increasing rapidly and is becoming one of the primary concerns for this society (Yamamoto-Mitani, Tamura, Deguchi, Ito, & Sugishita, 2000). According to the Ministry of Health, Labor, and Welfare, cited in the Statistical Handbook of Japan (Ministry of International Affairs and Communications, 2004), the Japanese population 65 years of age or older continues to show a significant increase. In 1970, 7.1% of the total population consisted of older adults, and this number had more than doubled (to 14.5%) in 1995. In 2003, the number reached 19% of the total population, and it is predicted to exceed 30% in 2040. A review of the literature suggests that the majority of participants in existing studies of caregivers were female adults who were in their 50s (Abe, Kashiwagi, & Tsuneto, 2003; Arai, Zarit, Sugiura, & Washio, 2002; Hosaka & Sugiyama, 2003; Yamamoto-Mitani et al., 2003; Yamamoto-Mitani et al., 2000). This phenomenon may not be exclusive to Japanese society because the role of caregiver seems to be assigned to women across cultures. In addition, women are more emotionally invested in family relationships and, thus, tend to be more susceptible to stressors related to changes in the family life cycle (McGoldrick, 2005). Meeting the obligations for aging parents is a commonly shared value in many Asian cultures, including the Japanese culture (Baruth & Manning, 2003). The concept of filial piety describes how the caregiver roles are ascribed to family members of a younger generation, and such a role is considered a cultural norm (McLaughlin & Braun, 1998). Although family structures have changed over the years (e.g., increase of dual-career couples, late marriage, fewer children), many Japanese women still assume the responsibility as caregivers for their older family members. The traditional cultural view on women's roles continues to have tremendous influence on Japanese women's identity development, including self-worth and perspective on life as a woman, throughout the life span. There are numerous studies (Abe et al., 2003; Arai et al., 2002; Hosaka & Sugiyama, 2003; Yamamoto-Mitani et al., 2003; Yamamoto-Mitani et al., 2000) related to older citizens in Japan, and these studies have raised concerns about family caregivers (e.g., their health and psychological well-being). However, little research has been conducted that examined the attitudes of caregivers toward older adults (Yamamoto-Mitani et al., 2000) or relationships between caregivers' coping strategies and their mental health (Abe et al., 2003). In addition, there is a void in these studies regarding incorporating counseling as a means of support to caregivers. The purpose of this article is to understand the significance of the responsibility of taking care of older family members that is passed on to women in Japan and the impact of caregiver roles on women's well-being. Using a case study, we attempt to explain traditional Japanese family values, women's roles within a family, and the concept of caring for older adults, as well as review the literature addressing these issues. In addition, we discuss culturally appropriate counseling approaches in working with female caregivers. CONCEPTS OF CAREGIVING FROM JAPANESE CULTURAL PERSPECTIVES With the implementation of home-care insurance in existing Japanese health care systems, more families are encouraged to provide home-based care to their older members instead of seeking longer term hospital care (Hosaka & Sugiyama, 2003). …