Horizontal and vertical targeting: a population-based comparison of public eldercare services in urban and rural areas of Sweden.
BACKGROUND The government recommends home care for self-care-dependent older people in order to suppress care expenditure. Family relationships between primary caregivers and self-care-dependent older people might be one of the factors influencing the institutionalized rate. METHOD We investigated family relationships between primary caregivers and self-care-dependent older people at home in the rural town of Oodate, Akita Prefecture, and the urban district of Katsushika, Tokyo, in 2003. One thousand and thirty-six primary caregivers completed the questionnaire and entered the present study. Two years later, we prospectively followed how the family relationship between them influenced the institutionalized rate in 2005. Finally, 556 primary caregivers completed the questionnaire in 2005. RESULTS The institutionalized rate of subjects with poor family relationships (31%) was significantly higher than that of subjects with good family relationships (12%). CONCLUSION Good or poor family relationships were significantly related to psychological strains and might determine the institutionalized rate in nursing homes.