Abstract
Background and Objectives:
The number of people with dementia and the burden on families to care for them are increasing. As a result, families are affected in their use of time to carry out daily activities. This study compared family caregivers of dementia patients (dementia family) and non-family caregivers of dementia patients (non-dementia family), reflecting their characteristics on weekdays and weekends.
Methods:
There were 92 participants each in the groups dementia family and non-dementia family. Each group was divided into 121 people on weekdays and 71 people on weekends. Time usage was measured by occupational area. The variables assessed were “lack of time,” “tiredness,” “life satisfaction,” and “leisure satisfaction.” Variables including “house chores sharing” and “role division” were also assessed. The time usage of the Korea National Statistical Office’s 2019 “time use survey” was reclassified based on the occupational areas of the Occupational Therapy Practice Framework-Fourth Edition, and time usage and satisfaction were analyzed. Frequency analysis and independent t-test were used for statistical processing.
Results:
On weekdays, the dementia family showed less time usage in the “leisure” area for men and “social participation” area for women than the non-dementia family. On weekends, dementia family showed less time usage in the “activities of daily living” (ADLs) area than the non-dementia family and women in dementia family showed less time usage in “ADLs” area compared to women in the non-dementia family. Satisfaction was found to be higher in terms of “lack of time” and “tiredness” on weekdays and “tiredness” on weekends in dementia family than in the non-dementia family.
Conclusions:
Time usage and satisfaction of dementia family and non-dementia family showed differences during weekdays and weekends. These results suggest that for family caregivers of dementia patients, it is necessary to improve the efficient use of time and satisfaction during weekdays and holidays.
Keywords: Dementia family, occupational area, time usage, weekdays, weekends
Introduction
Dementia is a comprehensive term for a number of diseases that are mostly progressive and greatly interfere with memory, other cognitive abilities, and behavioral abilities.[1] It is a syndrome caused by more than 80 different diseases.[2] In 2022, the number of dementia patients in Korea reached 13.13 million, and it is expected to reach 22.36 million in 2050.[3] Furthermore, the number of dementia patients worldwide was 57.4 million as of 2019 and is estimated to increase to 152.8 million in 2050.[4]
Neuropsychologic symptoms in patients with dementia are heterogeneous and mostly unpredictable, including disturbances in emotional experience, delusions and abnormal thought content, perceptual disturbances, disturbances in motor function, changes in sleep patterns, and effects on appetite and eating habits.[5] In addition, problems in the cognitive and intellectual abilities of patients with dementia cause problems in activities of daily living (ADLs).[6] These problems not only place a significant burden on the family caregivers of dementia patients (dementia family),[7] but also result in patients remaining with their families until the end of their lives.[8]
In this study, the family caregivers of dementia patients (hereafter referred to as dementia family) include all family members caring for the elderly with dementia[9] and all families without family members with dementia are defined as non-family caregivers of dementia patients (hereafter referred to as non-dementia family). Dementia puts stress and burden on the dementia family[10] and affects their performance and time allocation for all daily tasks to care for patients with dementia.[11] In particular, dementia family requires more time to care for dementia patients than non-dementia family.[12] Accordingly, the burden level increases as the dementia family spends more time,[13] and the restriction of the dementia family’s time leads to a reduction in social relationships and economic problems.[14] In the end, these negative problems lead to weakening of the dementia family’s health, and as the caregiving time increases, psychologic pain such as depression also accumulates.[10,15] In this way, time is an important factor for the dementia family, and the health of the dementia family can be improved by identifying and improving care matters, including time.[12]
However, time is an important concept that allows us to check how smoothly ADLs are performed.[16] Information about time can tell what kind of action a person performs and for how long, and the behavioral characteristics of the subject can also be analyzed.[17] However, since time has limited characteristics, people who perform various roles experience difficulties in time usage.[18] In particular, the difference in time use between work-related weekdays and rest-related weekends varies according to family characteristics and gender.[19] In addition, time use is related to occupation, which refers to daily activities for purpose and meaning in life.[20,21] Examining the time use of different groups and people according to occupation allows us to know how it contributes to their happiness, health, and quality of life.[21]
Accordingly, several studies have been conducted on the care time of dementia family.[22,23,24,25] First, in one study, the main caregiver spent 4.97–6.91 h of care and 160–223 euros per day, and when family members other than the main caregiver took care of them, they spent 0.70–1.06 h of care and 23–34 euros.[22] Another study found that the dementia family used an average of 25.0 caring hours per week and 3.82 million yen per year.[23] In the following study, the time for formal care received from a professional caregiver and the time for informal care received from a dementia family were compared,[24,25] and over a period of 4 weeks, 35 h of formal care and 299 h of informal care had been reported.[24] Subsequently, it was reported that the dementia family used an average of 1.2 h of formal care and 2.3 h of informal care per day, and that the informal care time increased as the symptoms of dementia worsened.[25] However, most of the studies show the disadvantage of comparing only the total care time and cost without considering the occupational area.
However, studies investigating the time usage of dementia family based on occupational area have also been conducted.[26,27] These studies were analyzed using Occupational Therapy Practice Framework-Third Edition (OTPF-3) classification and subareas of occupational therapy.[26,27] First, a study utilized “ADLs” and “instrumental ADLs (IADLs)” and the difference in care time after treatment was compared.[27] During the day, it was reported that caregiving time decreased from 2.78 to 2.43 h in the “ADLs” area and from 5.71 to 5.22 h in the “IADLs” area.[26] In addition, the care time of those participating in informal care during the day was 1.5 h in the “ADLs” area and 2.1 h in the “IADLs” area.[27]
Subsequently, a study that used the occupational therapy classification of the Occupational Therapy Practice Framework-Fourth Edition (OTPF-4) was reported.[9] This study investigated “the average time usage by occupational area per day of the dementia family and non-dementia family during weekdays.”[9] Result of the study showed that the dementia family spent 1.98 h more in the “IADLs” area than the non-dementia family and 1.77 h more in the “IADLs” subarea “Caring for adult family members and household members requiring long-term care.”[9] Although various studies have been conducted on the time usage of dementia families, most of them were comparative studies on the total caring time usage according to occupational area classification (“ADLs” and “IADLs”) through the previous OTPF-3. Although there was one study using the occupational area classification of OTPF-4, time consumption was analyzed only on weekdays.[9] As such, there is no detailed comparative study that considers additional factors other than time use reflecting the characteristics of weekdays and weekends and “life satisfaction” and “leisure satisfaction.”
Therefore, this study aimed to determine the characteristics of time use reflecting the characteristics of weekdays and weekends that were not known in previous studies targeting dementia family and how this use of time affects the dementia family.
Methods
Study subjects
In this study, secondary data analysis was conducted using Statistics Korea’s 2019 “time use survey” data. The family caregivers of dementia patients (hereafter referred to as dementia family) were selected for a total of 29,000 respondents to the 2019 time use survey. The dementia family was designated as the family of the subject who responded to the “dementia” item in “reasons for needing care,” which is a subitem of the “household-related matters” item. The “reason for needing care” was entered directly by selecting the reason for needing care from the options for each household member. Dementia is a condition in which cognitive functions in various areas such as memory, language, and judgment are reduced, making it difficult to carry out ADLs properly, and the dementia category is checked when care is needed in ADLs. The non-family caregivers of dementia patients (hereafter referred to as non-dementia family) were selected from all families other than the dementia family who responded to the 2019 time use survey through a random sampling technique in proportion to the dementia family’s gender, number of people by age, and average/weekend. The study was initiated after an exemption form was submitted and approved by the Bioethics Committee of Kangwon National University (KWNUIRB-2021-07-001-001), as it involved secondary data analysis using Statistics Korea’s 2019 “time use survey” data.
Study tools
2019 Time use survey
Time use survey is a nationwide survey that has been conducted every 5 years since 1999 and is a survey that identifies the average lifestyle of the people by collecting data on time consciousness and time usage status for 24 h. For the recruitment of subjects, 27,000 people from 12,435 sampled households were selected from among Korean nationals aged 10 years or older residing in Korea, using stratified two-stage cluster sample design. Stratified two-stage cluster sample design used probability proportionate sampling, which is the first sampling stage to select 829 survey districts out of 361,166 survey districts in 26 regions. Then, simple random sampling, which is a two-sampling stage, was used to survey the 15th household from the starting household within the sample survey household. In this survey, the respondent’s behavior was directly recorded in a time diary for 2 days (48 h) at 10-min intervals. Regarding the writing method, actions performed for more than 5 min were regarded as 10 min, and when various actions were performed for 10 min, the longest action was recorded as the main action. The time diaries were divided into weekdays, Saturdays, and Sundays. In this study, the weekdays were designated from Monday to Friday and the weekends as Saturday and Sunday together. The Korean classification of activities system, which was revised to reflect the international classification of activities for time use statistics 2016 of the United Nations, was used for the behaviors performed. The behaviors performed were classified into nine major categories, 45 middle categories, and 153 small categories. These were analyzed by converting them into minutes based on 1 day (24 h).
Satisfaction on weekdays and weekends between the two groups
“Lack of time” is a subitem of “personal matters” among the questionnaire items of the 2019 time use survey of the National Statistical Office. For the question “How do you feel about your usual time?,” responses from “I always feel free” (1 point) to “always feeling inadequate” (4 points) were coded, and higher scores indicate less time.
“Tiredness” was measured from “ not at all tired” (1 point) to “very tired” using the subitem “How tired do you usually feel after a day’s work is over?” Responses to the item of 4 points were coded, and higher scores indicate more tiredness.
For “life satisfaction”, a subitem of “individual-related matters,” the question “How do you generally think about your life?” was used. Responses from “very dissatisfied” (1 point) to “very satisfied” (5 points) were coded and a higher score indicates higher life satisfaction.
“Leisure satisfaction” was measured from “very dissatisfied” (1 point) to “very satisfied” using “How do you generally feel about your leisure time?” Responses to the item of 5 points were coded, and a higher score indicates more leisure satisfaction is felt.
For “House chores sharing,” which is a subitem of “personal matters,” the question “What do you think about the division of household chores in your household?” was used. Responses from “very dissatisfied” (1 point) to “very satisfied” (5 points) were coded, and higher scores indicate more satisfaction.
For “role division,” a subitem of “individual-related matters” was used: “What do you think about the statement that men are at work and women are at home?” Responses from “very dissatisfied” (1 point) to “very satisfied” (4 points) were coded, and a higher score means more satisfaction.
Study process
Classification of activities based on occupational areas
In the 2019 time use survey, the behaviors of the subjects were classified into nine major categories, 45 middle categories, and 153 small categories. In this study, OTPF-4 suggested time usage to be analyzed by reclassifying based on the occupational area. ADL refers to activities oriented toward taking care of one’s own body and completed on a routine basis, and IADL refers to activities to support daily life within the home and community.[20] Occupational areas were classified into “ADLs,” “IADLs,” “health management,” “rest and sleep,” “education,” “work,” “leisure,” and “social participation.” The classification of behavior by occupational area is shown in Table 1.
Table 1.
Categorization of lifetime based on Occupational Therapy Practice Framework-4
| Area | Code | Activities | Code | Activities | Code | Activities |
|---|---|---|---|---|---|---|
| ADLs | 12 | Meals and snacks | 14 | Personal maintenance | ||
| IADLs | 41 | Food preparation | 42 | Clothes care | 43 | Cleaning |
| 44 | Management of housing | 45 | Vehicle care | 46 | Care of animals and plants | |
| 47 | Purchase of items and services | 49 | Other home management | 51 | Care for children under 10 years of age | |
| 52 | Care for elementary, middle, and high school students over 10 years of age | 53 | Care for adult families and household members with long-term care needs | 54 | Care of independent adult families | |
| 73 | Religious activities | 74 | Ritual activities | 91–98 | Locomotion | |
| Health management | 13 | Personal medical care | ||||
| Rest and Sleep | 11 | Sleep | 85 | Rest | ||
| Education | 31 | School activities | 32 | Out-of-school learning | ||
| Work | 21 | Employed work | 22 | Self-employment work | 23 | Unpaid work in family business |
| 24 | Other work | 25 | Job-seeking activity | 26 | Purchasing goods related to job | |
| 61 | Non-organization–based volunteer work | 62 | Organization-based volunteer work | 63 | Unpaid training | |
| Leisure | 81 | Leisure activities using media | 82 | Cultural and tourism activities | 83 | Sports and leisure sports |
| 84 | Game and play | 89 | Other leisure | |||
| Social participation | 71 | Relationship activities | 72 | Participating activities |
ADLs: activities of daily living, IADLs: instrumental activities of daily living
Statistical analysis
In this study, the Statistical Package for the Social Sciences (SPSS) 25.0 program was used to analyze the data, with significance level of the data set at 0.05. Frequency analysis was used for the general characteristics of the study subjects, the time usage by group, “lack of time,” “tiredness,” “life satisfaction,” “leisure satisfaction,” “house chores sharing,” and “role division.” The difference analysis was performed with an independent t-test, and Cohen’s d was used to determine the effect size.
Results
General characteristics of study subjects
Regarding the general characteristics of the family caregivers of dementia patients (hereafter referred to as dementia family), 104 females (54.2%) and 88 males (45.8%) participated in the study. In terms of age, 106 people (55.2%) were over 60 years old and 40 people (20.8%) were 50–59 years old. In terms of marital status, 128 (66.7%) were married and 46 (24.0%) were single. In terms of the level of education, 60 people (31.3%) were in high school and 52 people (27.1%) were in elementary school or lower. Regarding weekdays and weekends, 121 people (63.0%) were on weekdays and 71 (37.0%) were on weekends. Among the general characteristics of non-family caregivers of dementia patients (hereafter referred to as non-dementia family), gender, age, and weekday–weekend showed the same ratio as the dementia family. In terms of marital status, 123 (64.1%) of the respondents were married and 30 (15.6%) were single. Regarding education level, 68 students (35.4%) were in high school and 26 students (13.5%) were in elementary school or lower [Table 2].
Table 2.
General characteristics of study subjects
| Characteristics | Dementia family (n=192) | Non-dementia family (n=192) | ||||
|---|---|---|---|---|---|---|
| Gender | ||||||
| M, n (%) | 88 (45.8) | 88 (45.8) | ||||
| F, n (%) | 104 (54.2) | 104 (54.2) | ||||
| M/F (%:%) | n (%) | M/F (%:%) | n (%) | |||
| Age (years) | ||||||
| 10–19 | 8:12 (40:60) | 20 (10.4) | 8:12 (40:60) | 20 (10.4) | ||
| 20–29 | 4:0 (100:0) | 4 (2.1) | 4:0 (100:0) | 4 (2.1) | ||
| 30–39 | 4:4 (50:50) | 8 (4.2) | 4:4 (50:50) | 8 (4.2) | ||
| 40–49 | 2:12 (14.3:85.7) | 14 (7.3) | 2:12 (14.3:85.7) | 14 (7.3) | ||
| 50–59 | 28:12 (70:30) | 40 (20.8) | 28:12 (70:30) | 40 (20.8) | ||
| 60 and above | 42:64 (39.6:60.4) | 106 (55.2) | 42:64 (39.6:60.4) | 106 (55.2) | ||
| Marital status | ||||||
| Single | 20:26 (43.5:56.5) | 46 (24.0) | 16:14 (53.3:46.7) | 30 (15.6) | ||
| Married | 58:70 (45.3:54.7) | 128 (66.7) | 64:59 (52.0:48.0) | 123 (64.1) | ||
| Divorced | 10:0 (100:0) | 10 (5.2) | 5:8 (38.5:61.5) | 13 (6.8) | ||
| Bereavement | 0:8 (0:100) | 8 (4.2) | 3:23 (11.5:88.5) | 26 (13.5) | ||
| Education level | ||||||
| Elementary school or lower | 12:40 (23.1:76.9) | 52 (27.1) | 12:34 (26.1:73.9) | 46 (24.0) | ||
| Middle school | 12:20 (37.5:62.5) | 32 (16.7) | 11:13 (45.8:54.2) | 24 (12.5) | ||
| High school | 36:24 (60:40) | 60 (31.3) | 34:34 (50:50) | 68 (35.4) | ||
| College | 16:8 (66.7:33.3) | 24 (12.5) | 7:9 (43.8:56.2) | 16 (8.3) | ||
| University | 6:12 (33.3:66.7) | 18 (9.4) | 20:14 (58.8:41.2) | 34 (17.7) | ||
| Master’s degree | 4:0 (100:0) | 4 (2.1) | 3:0 (100:0) | 3 (1.6) | ||
| Doctor’s degree | 2:0 (100:0) | 2 (1.0) | 1:0 (100:0) | 1 (0.5) | ||
| Weekday–weekend | ||||||
| Weekday | 56:65 (46.3:53.7) | 121 (63.0) | 53:68 (43.8:56.2) | 121 (63.0) | ||
| Weekend | 32:39 (45.1:54.9) | 71 (37.0) | 35:36 (49.3:50.7) | 71 (37.0) | ||
F: Female, M: Male
Difference in time usage by occupational area between the two groups
There was no significant difference in time usage by occupational area during weekdays between the dementia family and non-dementia family groups [Table 3]. However, there was a significant difference in time consumption by occupational area during weekends in the two groups. The dementia family (178.73 min) showed 28.03 min less time use in the “ADLs” area than the non-dementia family (206.76 min) (t = -2.678, P = 0.008) [Table 3].
Table 3.
Difference in time usage by occupational area between the two groups during weekdays and weekends (unit:minutes)
| Characteristics | Weekdays |
Weekends |
||||||
|---|---|---|---|---|---|---|---|---|
| M±SD |
t (P) | Effect size (Cohen’s d) | M±SD |
t (P) | Effect size (Cohen’s d) | |||
| Dementia family (n=121) | Non-dementia family (n=121) | Dementia family (n=71) | Non-dementia family (n=71) | |||||
| ADLs | 190.91±61.24 | 204.30±56.77 | -1.764 (0.079) | 0.227 | 178.73±54.09 | 206.76±69.65 | 2.678 (0.008)** | 0.450 |
| IADLs | 257.27±188.98 | 222.40±157.16 | 1.561 (0.120) | 0.201 | 271.41±189.97 | 245.49±166.18 | 0.865 (0.388) | 0.145 |
| Health management | 49.26±92.13 | 44.63±57.55 | 0.469 (0.640) | 0.060 | 45.21±105.30 | 42.96±81.60 | 0.143 (0.887 | 0.024 |
| Rest and sleep | 502.31±114.77 | 499.92±98.64 | 0.174 (0.862) | 0.022 | 542.54±108.56 | 551.13±93.68 | -0.505 (0.614) | 0.085 |
| Education | 39.83±122.04 | 51.16±143.44 | -0.661 (0.509) | 0.085 | 10.85±40.52 | 20.00±85.24 | -0.817 (0.415) | 15.96 |
| Work | 167.93±216.95 | 150.74±200.24 | 0.640 (0.522) | 0.082 | 80.56±145.13 | 108.59±194.95 | 0.972 (0.333) | 0.163 |
| Leisure | 180.08±162.61 | 217.27±151.44 | -1.841 (0.067) | 0.237 | 239.72±146.59 | 212.68±147.44 | 1.096 (0.275) | 0.184 |
| Social participation | 52.40±71.17 | 49.59±48.81 | 0.358 (0.721) | 0.041 | 70.99±70.86 | 52.39±47.37 | 1.838 (0.068) | 0.006 |
ADLs: activities of daily living, IADLs: instrumental activities of daily living, M: mean, SD: standard deviation. **P<0.01
During weekends, the time usage of the “ADLs” subarea of the two groups showed a significant difference in the “personal hygiene” area. The time usage of the dementia family (51.27 min) was 20.98 min less than that of the non-dementia family (72.25 min) (t = -3.912, P = 0.000) [Table 4].
Table 4.
Differences in time usage in the ADLs subarea between the two groups during weekends (unit:minutes)
| Characteristics | M±SD |
t (P) | Effect size (Cohen’s d) | |
|---|---|---|---|---|
| Dementia family (n=71) | Non-dementia family (n=71) | |||
| Eating food | 85.92±29.01 | 91.41±32.48 | -1.063 (0.290) | 0.178 |
| Snack and beverage intake | 25.63±31.57 | 32.68±42.19 | -1.126 (0.262) | 0.002 |
| Personal hygiene | 51.27±23.90 | 72.25±38.37 | -3.912 (0.000)*** | 0.656 |
| Appearance management | 8.17±10.60 | 9.01±12.55 | -0.433 (0.665) | 0.072 |
| Receive hairdressing-related services | 0.00±0.00 | 1.55±13.05 | -1.000 (0.319) | 0.168 |
| Other personal maintenance | 0.85±3.27 | 0.14±1.19 | 1.705 (0.092) | 0.289 |
ADLs: activities of daily living, M: mean, SD: standard deviation. ***P<0.001
Differences in time usage by gender and occupational area of the two groups during weekdays
Men’s time use during weekdays for the two groups showed a significant difference in the “leisure” area, with the dementia family (182.86 min) showing 63.56 min less time use than the non-dementia family (246.42 min) (t = -2.025, P = 0.045) [Table 5]. Women’s time usage of the two groups during weekdays showed a significant difference in the area of “social participation,” and the dementia family (41.85 min) showed 17.27 min less time usage than the non-dementia family (59.12 min) (t = -2.013, P = 0.037) [Table 5].
Table 5.
Differences in time usage by gender and occupational area of the two groups during weekdays (unit:minutes)
| Characteristics | Male |
Female |
||||||
|---|---|---|---|---|---|---|---|---|
| M±SD |
t (P) | Effect size (Cohen’s d) | M±SD |
t (P) | Effect size (Cohen’s d) | |||
| Dementia family (n=65) | Non-dementia family (n=68) | Dementia family (n=65) | Non-dementia family (n=68) | |||||
| ADLs | 193.04±52.81 | 202.64±49.03 | -0.983 (0.328) | 0.188 | 189.08±68.02 | 205.59±62.47 | -1.459 (0.147) | 0.207 |
| IADLs | 212.86±176.94 | 159.43±136.64 | -1.757 (0.082) | 0.338 | 295.54±191.94 | 271.47±155.46 | 0.796 (0.427) | 0.218 |
| Health management | 75.36±120.68 | 51.89±66.04 | 1.250 (0.214) | 0.241 | 26.77±47.86 | 38.97±49.72 | -1.441 (0.152) | 0.250 |
| Rest and sleep | 481.43±111.41 | 494.72±100.40 | -0.653 (0.515) | 0.125 | 520.31±115.41 | 503.97±97.81 | 0.882 (0.379) | 0.002 |
| Education | 21.96±86.64 | 42.45±122.44 | -1.013 (0.313) | 0.193 | 55.23±144.75 | 57.94±158.45 | -0.103 (0.918) | 0.018 |
| Work | 207.86±243.13 | 205.09±220.99 | 0.062 (0.951) | 0.787 | 133.54±186.69 | 108.38±172.49 | 0.808 (0.421) | 0.140 |
| Leisure | 182.86±165.72 | 246.42±161.78 | -2.025 (0.045)* | 0.388 | 177.69±161.14 | 194.56±139.89 | -0.645 (0.520) | 0.112 |
| Social participation | 64.64±93.36 | 37.36±41.79 | 1.950 (0.054) | 0.377 | 41.85±41.98 | 59.12±51.97 | -2.103 (0.037)* | 0.366 |
ADLs: activities of daily living, IADLs: instrumental activities of daily living, M: mean, SD: standard deviation. *P<0.05
Differences in time usage by gender and occupational area for the two groups during weekends
There was no significant difference in male time usage during weekends between the two groups in all areas [Table 6]. However, the difference in women’s time usage between the two groups during weekends showed a significant difference in the “ADLs” area. It was found that the dementia family (171.28 min) used 36.78 min less than the non-dementia family (208.06 min) (t = -2.538, P = 0.013) [Table 6].
Table 6.
Differences in time usage by gender and occupational area between the two groups during weekends (unit:minutes)
| Characteristics | Male |
Female |
||||||
|---|---|---|---|---|---|---|---|---|
| M±SD |
t (P) | Effect size (Cohen’s d) | M±SD |
t (P) | Effect size (Cohen’s d) | |||
| Dementia family (n=65) | Non-dementia family (n=68) | Dementia family (n=65) | Non-dementia family (n=68) | |||||
| ADLs | 187.81±50.02 | 205.43±71.76 | -1.155 (0.252) | 0.285 | 171.28±56.76 | 208.06±68.53 | -2.538 (0.013)* | 0.585 |
| IADLs | 183.44±144.66 | 209.43±148.44 | -0.725 (0.471) | 0.177 | 343.59±193.77 | 280.56±176.81 | 1.468 (0.147) | 0.005 |
| Health management | 71.88±144.90 | 39.14±67.10 | 1.203 (0.233) | 0.290 | 23.33±46.98 | 46.67±94.42 | -1.371 (0.175) | 0.349 |
| Rest and sleep | 546.88±118.66 | 550.29±106.37 | -0.124 (0.902) | 0.030 | 538.97±100.96 | 551.94±80.99 | -0.610 (0.543) | 0.181 |
| Education | 4.38±24.75 | 12.00±70.99 | -0.576 (0.567) | 0.143 | 16.15±49.61 | 27.78±97.52 | -0.658 (0.513) | 0.150 |
| Work | 116.25±174.30 | 139.14±211.00 | -0.482 (0.629) | 0.533 | 51.28±109.84 | 78.89±175.85 | -0.822 (0.414) | 0.188 |
| Leisure | 275.31±151.19 | 238.00±160.42 | 0.977 (0.332) | 0.239 | 210.51±137.82 | 188.06±131.21 | 0.721 (0.473) | 0.230 |
| Social participation | 54.06±69.74 | 46.57±40.07 | 0.545 (0.588) | 0.132 | 84.87±69.58 | 58.06±53.50 | 1.860 (0.067) | 0.432 |
ADLs: activities of daily living, IADLs: instrumental activities of daily living, M: mean, SD: standard deviation. *P<0.05
During weekends, women’s time usage in the subarea of “ADLs” showed a significant difference in the areas of “eating food” and “personal hygiene” between the two groups. It was found that the dementia family (76.00 min) spent 16 min less in the “eating food” area compared to the non-dementia family (92.00 min) (t = -2.240, P = 0.028). It was also found that the dementia family (50.25 min) used 29.18 min less in the “personal hygiene” area compared to the non-dementia family (79.43 min) (t = -3.597, P = 0.001) [Table 7].
Table 7.
Differences in time usage in the subdomains of women’s ADLs between the two groups during weekends (unit:minutes)
| Characteristics | M±SD |
t (P) | Effect size (Cohen’s d) | |
|---|---|---|---|---|
| Dementia family (n=39) | Non-dementia family (n=36) | |||
| Eating food | 76.00±27.81 | 92.00±34.02 | -2.240 (0.028)* | 0.515 |
| Snack and beverage intake | 27.75±35.77 | 22.57±26.16 | 0.707 (0.482) | 0.165 |
| Personal hygiene | 50.25±23.48 | 79.43±44.78 | -3.597 (0.001)** | 0.816 |
| Appearance management | 10.75±11.85 | 11.14±15.49 | -0.124 (0.901) | 0.035 |
| Receive hairdressing related services | 0.00±0.00 | 3.14±18.59 | -1.070 (0.288) | 0.239 |
| Other personal maintenance | 1.00±3.79 | 0.29±1.69 | 1.029 (0.307) | 0.242 |
ADLs: activities of daily living, M: mean, SD: standard deviation. *P<0.05, **P<0.01
Comparison of satisfaction between the two groups
Satisfaction on weekdays between the two groups showed a significant difference in terms of “lack of time” and “tiredness.” The dementia family (2.63 points) showed a 0.49-point higher score in “lack of time” compared to the normal family (2.14 points) (t = 3.583, P = 0.000). In addition, the dementia family (3.14 points) showed a higher score of 0.4 points in “tiredness” compared to the normal family (2.74 points) (t = 3.714, P = 0.000) [Table 8].
Table 8.
Comparison of satisfaction between the two groups
| Characteristics | Weekday |
Weekend |
||||||
|---|---|---|---|---|---|---|---|---|
| M±SD |
t (P) | Effect size (Cohen’s d) | M±SD |
t (P) | Effect size (Cohen’s d) | |||
| Dementia family (n=121) | Non-dementia family (n=121) | Dementia family (n=121) | Non-dementia family (n=121) | |||||
| Lack of time | 2.63±1.18 | 2.14±0.92 | 3.583 (0.000)*** | 0.463 | 2.45±1.08 | 2.38±0.85 | 0.438 (0.662) | 0.072 |
| Tiredness | 3.14±0.87 | 2.74±0.79 | 3.714 (0.000)*** | 0.481 | 3.27±0.70 | 2.92±0.73 | 2.938 (0.004)** | 0.675 |
| Life satisfaction | 2.93±1.16 | 3.15±0.80 | -1.676 (0.095) | 0.221 | 3.14±0.95 | 3.08±0.75 | 0.393 (0.695) | 0.070 |
| Leisure satisfaction | 2.97±1.07 | 3.14±0.90 | -1.366 (0.173) | 0.172 | 3.25±0.92 | 3.00±0.89 | 1.663 (0.098) | 0.276 |
| House chores sharing | 3.09±1.08 | 3.21±0.89 | -0.882 (0.379) | 0.121 | 2.99±1.13 | 2.56±1.50 | 1.897 (0.060) | 0.324 |
| Role division | 2.19±0.88 | 2.21±0.89 | -0.218 (0.827) | 0.023 | 2.13±0.77 | 2.21±0.86 | -0.615 (0.539) | 0.098 |
M: mean, SD: standard deviation. **P<0.01, ***P<0.001
Weekend satisfaction between the two groups showed a significant difference in terms of “tiredness,” with the dementia family (3.27 points) showing a 0.35-point higher score than the non-dementia family (2.92 points) (t = 2.938, P = 0.004) [Table 8].
Discussion
This study aimed to analyze the time usage of the dementia family and non-dementia family during weekdays and weekends in terms of occupational area. In addition, this study sought to determine the difference in satisfaction on weekdays and weekends between dementia family and non-dementia family with regard to “lack of time”, “tiredness”, “life satisfaction”, “leisure satisfaction”, “house chores sharing”, “leisure satisfaction”, and “role division”. To this end, the 2019 time use survey of the National Statistical Office was used to analyze the usage of time on weekdays and weekends, which can make us understand the daily life of the dementia family. Time usage was analyzed by reclassifying time use survey into occupational areas of OTPF-4.
First, the general characteristics of dementia family showed that the participants consisted of 54.2% female and 45.8% male. The high proportion of women is thought to be due to the characteristics of the dementia family, where spouses, daughters, or daughters-in-law mainly take on the caring role.[28] With regard to the age of the dementia family, 60 years of age or older showed the highest rate at 55.2% and 50–59 years old showed the next highest rate at 20.8%. Looking at the recent care patterns, it seems that the ratio of those aged 60 and older and those aged 50 and older was high as the care between spouses increased.[29] The age and gender of members of the non-dementia family were simple random sampled at the same rate as those of the dementia family through the SPSS 25.0 program; so, they showed the same rates.
The time usage of dementia family and non-dementia family was divided into weekdays and weekends for a comparative analysis. Comparative analysis of time usage on weekdays and weekends showed an important difference because weekdays and weekends showed different patterns of time usage.[30] There was no significant difference between dementia family and non-dementia family on weekday time usage. However, on weekends, the dementia family showed less time usage in the “ADLs” area than the non-dementia family and less time usage in the “personal hygiene” area, a subarea of “ADLs.” This is because in a previous study, there was no difference in time in the “ADLs” area between the dementia family and the non-dementia family on weekdays, but the dementia family showed different results from studies that showed more time usage in the “IADLs” area and “IADLs” subarea (caring for adult families and household members in need of long-term care).[9] These results are attributed to the difference between weekdays, when people mainly work, and the characteristics of weekends, when they can have time to take care of themselves and look back.[19] This means there is not enough time for the dementia family to spend on “ADLs,” the area of taking care of their own body, even on weekends.
During weekdays, men from the dementia family showed less time usage in the “leisure” area than the men from regular families. These results are similar to previous studies which reported that the dementia families gave up leisure and group activities because they were caring for patients with dementia.[31] This means that the dementia family spends less time for its own leisure life because the family members are preoccupied with caring for the dementia patient in the family. Women of the dementia family showed less time usage in the area of “social participation” than those in non-dementia family during weekdays. Those in the dementia family find it difficult to attend social gatherings, and these results are similar to those of previous studies.[14] As such, it is thought that various measures are needed to increase the leisure time and social participation opportunities of members of the dementia family. However, during weekends, men in the two groups did not show significant differences in time usage in all occupational areas. However, in the case of women, the dementia family showed less time usage in the “ADLs” area than the non-dementia family and less time usage in “eating food” and “personal hygiene” subareas of “ADLs.” This means that women in the dementia family spend less time eating food and taking care of themselves than those in regular families. Since eating food and taking care of oneself are related to life satisfaction,[32] limited ADL can also affect health by reducing life satisfaction.[33] It is thought that time use interventions are needed to increase the time spent in ADL activities for women in the dementia families to take care of themselves more. For example, it is believed that it will be a way to improve the lives of dementia care families through the establishment of social systems and active support through cooperation between the national and local governments for women in dementia care families.[14]
During weekdays, the dementia family showed higher scores in “lack of time” compared to the non-dementia family. The difference in scores is interpreted as the dementia family having less time than the non-dementia family. These results are supported by previous studies showing that the dementia families are constrained in the time they spend on themselves because they continuously care for patients with dementia.[11] It was found that on weekdays and weekends, the dementia family always felt more tired, as their scores of “tiredness” were higher than those of the non-dementia family. These results are similar to a study in which the dementia family felt considerable tiredness while caring for patients with dementia.[14] Dementia families have the characteristic of always taking care of patients with dementia, regardless of whether it is a weekday or weekend,[11] and it is judged that due to this, they feel tired a lot and lack time. It is also believed that long-term national and community-based interventions and the establishment of support networks will be needed to compensate for these challenges.
This study has several limitations. The general characteristics of the dementia family and time usage according to family members were not investigated, and characteristics other than those described in the questionnaire of the time use survey were not examined. In addition, the inability to account for memory bias and social desirability is considered a potential limitation of self-reported surveys. However, this study included all members of the dementia family, and it is meaningful because it confirmed the difference in time usage by occupational area on weekdays and weekends as well as the various satisfaction levels of the dementia family. Through this, it was found that all members of the dementia family recognized the imbalance in time use between weekdays and weekends, and that attention and practical support were needed to resolve it.
Conclusion
Differences in time usage and satisfaction by occupational area between weekdays and weekends between the family caregivers of dementia patients and the non-family caregivers of dementia patients were examined. On a weekday basis, men in the dementia family showed less time usage in the “leisure” area than the men in the non-dementia family, while women in dementia family showed less time usage in “social participation” area than those in the non-dementia family. On weekends, the dementia family showed less time usage in the “ADLs” area than the non-dementia family, while women in the dementia family showed less time usage in the “ADLs” area than women in the non-dementia family. In terms of satisfaction, on weekdays, the dementia family showed higher scores in “lack of time” and “tiredness” than the non-dementia family, while on weekends, the dementia family showed higher scores in “tiredness” than the non-dementia family.
The results of this study are expected to be used as basic data for efficient use of time for dementia family caregivers on weekdays and weekends as well as balanced use of time according to gender. In the future, various policies and active support from the government and local governments are needed for dementia family, and this suggests that time usage should be considered in support policies.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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