Third-party disability in family caregivers of disabled elderly after stroke based on ICF framework: a qualitative study in Shanghai, China

Third-party disability in family caregivers of disabled elderly after stroke based on ICF framework: a qualitative study in Shanghai, China | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Third-party disability in family caregivers of disabled elderly after stroke based on ICF framework: a qualitative study in Shanghai, China Na Li, Yongqing Zhang, Yili Gao, Jiawen Qin, Yang Liao, Xiaoshan Rong, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4605875/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Mar, 2026 Read the published version in BMC Geriatrics → Version 1 posted 13 You are reading this latest preprint version Abstract Background In China, family care remains the main form of care for the disabled elderly. As the degree of disability of the disabled elderly increases, the challenges faced by family caregivers also increase. Based on the International Classification of Functioning, Disability and Health (ICF), it is essential to explore the third-party disability status of family caregivers of the disabled elderly after stroke and to understand the blocking factors, which will help to improve the quality of life of the family caregivers. Methods This study was a qualitative descriptive study based on semi-structured face-to-face interviews. To explore the caring experience of 27 family caregivers of disabled elderly in Shanghai by purposive sampling. The Colaizzi 7-step analysis method was used to analyze the data and form themes. Finally, identify the elements of third-party disability for family caregivers. Results Third-party disability among family caregivers of disabled elderly after stroke can be summarized into eight themes: physical health impairment, mental health impairment, increase in care tasks, estrangement of close relationships, termination of entertainment and social interaction, increasing economic pressure, lack of support system, care difficulties and needs. Conclusions : Third-party disabilities are more severe among family caregivers of the disabled elderly. All sectors of society should attach great importance to the needs of family caregivers of the disabled elderly and address practical difficulties to achieve healthy aging. Third-party disability Family caregiver Disabled elderly International Classification of Functioning Disability and Health Qualitative study Background The incidence rate of stroke in China is 345.1 per 100,000, and there are currently about 2 million new strokes in China, with 70 to 80 percent of post-stroke survivors losing their ability to live independently [ 1 , 2 ] , resulting in a large number of disabled elderly. The ICF is a standard linguistic framework proposed by the WHO for assessing health status, considers “health” to consist of two components (functioning and disability), which are in turn influenced by two contextual factors (environmental and personal) [ 3 ] , and emphasizes that disability is primarily a result of impaired body functions and limitations in activities and participation [ 4 ] . The majority of disabled elderly after stroke have speech, motor, and swallowing dysfunction and must rely on others for basic activities of daily living [ 5 ] . Family care remains the primary mode of care for the disabled elderly in China. The more severe the degree of disability of the disabled elderly, the greater the challenges faced by family caregivers [ 6 , 7 ] . Exploring the impairment of the physical and mental health of family caregivers as a result of caring for disabled elderly has been a hot topic of domestic and international research [ 8 , 9 ] . In the past, scholars tended to use the term “caregiver burden” to describe the negative impact of caring on family caregivers [ 10 ] . In addition, in 2001, the WHO introduced the concept of “third-party disability” as a future direction for the ICF, defined as impairments in the functioning and social participation of family members due to the health status of immediate family members and significant others in the ICF framework [ 3 ] . According to WHO, "disability" refers to impairments in body function and structure that result in limitations in activity and participation, not only in the functioning of limbs and organs [ 3 ] . “Third-party disability” (i.e., changes in functioning and disability due to environmental factors critical to the health status of significant others) is an extension of “disability” (i.e., the result of the interaction between environmental factors and the health status of the individual), with a significant emphasis on family member functioning and social participation limitations. Although the ICF framework originated relatively recently, it has been widely used in third-party disabilities in patients both nationally and internationally, such as aphasia after stroke [ 11 ] , hearing impairment [ 12 ] , dysphagia [ 13 ] , and children with disabilities [ 14 ] , taking advantage of a common language that facilitates global communication across different disciplines and fields. Family caregivers of the disabled elderly are impaired in all aspects of functioning. Still, the ICF framework has not yet been applied to family caregivers of the disabled elderly after a stroke. Therefore, this study is a qualitative study of third-party disability in disabled elderly after stroke based on the ICF framework, aiming to provide a reference for solving the dilemma of family caregiving for disabled elderly after stroke. Methods Study design A purposive sampling method was used to select family caregivers of disabled, elderly people after strokes in Shanghai from January to May 2024 for interviews. We obtained approval from the Ethics Committee of Dong Fang Hospital, Affiliated with Tongji University (NO.2022 − 130). Researcher characteristics The two investigators (NL and YZ) are nursing students with a geriatric care background who are trained in qualitative interviewing. They had more than eight months of internship experience in the neurorehabilitation department. Before the interview, they had no relationship with the participants. Participants The disabled elderly after a stroke should be: 1) at least ≥ 60 years old; 2) stroke diagnosed by cranial CT or MRI [ 15 ] ; 3) Activity of Daily Living (ADL) [ 16 ] score ≤ 60. The family caregiver should be: 1) at least ≥ 18 years old; 2) total time spent caring for the disabled elderly ≥ 6 months, ≥ 4 hours per day; 3) the caregiver is a family member or close relative of the disabled elderly, lives with the disabled elderly and has been caring for the disabled elderly for the longest time; 4) no communication barriers, informed consent, and voluntary participation. Exclusion criteria for family caregivers: 1) caregivers who are in an employment relationship and receive remuneration; 2) visual, hearing, and speech impairments; 3) serious illnesses (e.g., cancer, severe cardiovascular disease). Data collection According to the purpose of the study, we searched the databases for studies on family caregivers' feelings of caring for the disabled elderly after stroke, using the keywords “international classification of functioning, disability and health”, “stroke”, “ the disabled elderly” and “qualitative research” [ 9 , 17 ] . Subsequently, the group developed preliminary interview guidelines based on the ICF framework, integrating local disabled elderly care policies [ 18 ] and expert opinions (one expert in qualitative research methodology, one expert in neurorehabilitation, and two experts in geriatric nursing), and refined the interview guidelines after pre-interviewing six caregivers (See Table 1 for interview guidelines). Data were collected using observation and face-to-face semi-structured in-depth interviews. The interviews were conducted in a separate, quiet room in the hospital department and lasted 15–40 minutes. Recording was done with the consent of the participants, and non-verbal information was acknowledged and recorded promptly until the participants had finished expressing their feelings. Analyses When no new information emerged from the participants, both researchers agreed to end the participant's recruitment process [ 9 ] . The audio recordings were transcribed into text within 24 hours after each interview and kept together with the general information questionnaire, diary, and transcript. The Colaizzi 7-step analysis method was used to analyze the data and form themes [ 19 ] . Repeatedly read the interview transcripts to familiarise themselves with the text and then extracted meaningful statements to create nodes for initial coding. Then, we will look for coding of familiar concepts to form themes. Finally, the analyses were fed back to the participants. Return participants and researcher collegiality were used to increase the study's credibility. The first author transcribed the manuscript, and the second author, who knew the dialect, checked it against the recording. Then, the first and second authors coded the transcribed manuscripts separately and discussed the contradictions with the third author. Finally, the seven group members conferred together to refine the themes. Findings and interview transcripts were returned to the participants for verification to enhance authenticity. Table 1 Interview guidelines Corresponding ICF domain Questions Body Functions How do you recall your physical and mental health changing since caring for disabled elderly? Body Structures What parts of your body have gone wrong since caring for disabled elderly? Activities and Participation Since caring for disabled elderly, how do you recall your daily life being different from the past? Environmental Factors Since caring for the disabled elderly, recalling the environment in which you lived and the conditions in which you lived, what aspects of your life do you feel have impacted your life? Personal Factors What difficulties have you encountered since caring for the disabled elderly? How did you cope with these difficulties? What kind of help would you like to receive? Results Demographic characteristics Following the principle of data saturation, 27 family caregivers of disabled elderly after stroke were finally selected, out of which five were male and 22 were female with the age of (62.48 ± 10.10) years. All family caregivers gave informed consent and participated voluntarily. The caregivers were numbered according to the order of interview (F1 ~ F27), and the general information of the family caregivers is shown in Table 2 . Table 2 Demographic information of family caregivers( N = 27) number gender age Average daily care hours (hour) Time of caring(year) Relationship with the disabled elderly Caregiver assistance Degree of disability of older people* F1 female 55 8 0.5 daughter-in-law spouse severe F2 female 70 24 6 spouse none severe F3 female 63 24 9 daughter none moderate F4 male 50 24 0.5 son sister severe F5 female 46 24 1.25 daughter-in-law caregiver moderate F6 female 45 24 0.5 daughter brother moderate F7 male 53 24 3 son none severe F8 male 64 24 1 spouse caregiver severe F9 male 70 24 1 spouse none severe F10 female 83 24 1 spouse son severe F11 female 59 24 4 daughter sister severe F12 male 74 24 3 spouse son moderate F13 female 60 12 7 daughter mother severe F14 female 74 24 5 spouse caregiver moderate F15 female 53 24 5 daughter none severe F16 female 76 24 2 spouse none severe F17 female 62 12 0.9 spouse caregiver severe F18 female 65 24 0.7 spouse caregiver moderate F19 female 70 24 1.4 spouse caregiver severe F20 female 43 24 0.6 daughter caregiver severe F21 female 68 24 0.5 spouse caregiver severe F22 female 76 24 0.7 spouse none moderate F23 female 60 24 1.3 spouse none moderate F24 female 60 24 0.5 spouse none moderate F25 female 70 24 0.5 spouse caregiver severe F26 female 63 24 0.5 spouse caregiver severe F27 female 55 24 0.5 spouse none moderate *Based on the Activity of Daily Living (ADL, severe disability = 0 ~ 40 scores, moderate disability = 40 ~ 60 scores). This tool was used to measure the degree of disability of disabled elderly. Theme 1: Physical health impairment Family caregivers described negative body changes, including aging, lack of sleep, fatigue, and weight changes. Almost all family caregivers agree that caring for disabled elderly is exhausting. F17: “My heart is tired; he (the disabled elderly) went to get a gold injection. I quickly came here to lie down a little, my eyes closed for a while. I could not sleep but would have been tired if I had not lied down.” Family caregivers indicated that the onset or recurrence of certain diseases may also be associated with disabled elderly, such as high blood pressure, coronary heart disease, palpitations, stomach pain, fatty liver disease, and menstrual disorders. F7: “I am in a hurry to fly, hurry, do you know? I'm so anxious that I have snakebite sores, my immunity is lowered, and I get sick easily; I'm so anxious that I want to sigh; my liver is bad; I have a fatty liver, and I'm gaining weight (sigh).” By moving the disabled elderly or doing household chores over a long period, family caregivers can also suffer from a range of illnesses, such as retinal detachment, urinary incontinence, back and leg pain, and a frozen shoulder. F14: “He (the disabled elderly), with a bad temper, insisted that I carry a 150kg box. I had no choice but to do so, as I am diabetic and highly nearsighted, and if I exerted myself a little too much, my retina would fall off in a few days." Theme 2: Mental health impairment Family caregivers reported poor memory and high levels of stress. F27: “I'm a bit unhappy, I'm very stressed, I have insomnia, I forget a lot of things, I forget a lot of things, I'm in a bad mood in the hospital.” Family caregivers say anxiety and depression are getting worse after caring for disabled elderly. F20: “I have insomnia, then anxiety, and a little bit of depression; it's annoying, every day it's annoying. I'm still on medication, an anti-anxiety and depression medication, which is Synthroid, and every day it's annoying." F25: “I've asked the doctor before non-stop, reflecting on his situation (the disabled elderly), chasing after him, crying, and finding someone else to cry to for three hours at a time, and they've told me I'm anxiety-ridden.” Many family caregivers say they often feel irritable, anxious, and sad. F7: “Now the job is gone, no salary, the child has not found a job, ah ~ (long sigh), a family is not like this, ah ~ (long sigh), I am anxious to death." F25: "Sometimes it's just a bad mood, suddenly very depressed, want to cry, want to talk to someone, like to find someone to cry about, harassing others all over again." Difficulties in communication lead to family caregivers feeling anxious. F15: “When he (the disabled elderly) is confused and can't speak clearly with her, I am particularly anxious, and I feel very depressed." Research findings mapped to the ICF's body functions and structures component in Table 3 . Table 3 Research findings mapped to the body functions and structures component of the ICF in Table 3 Themes Number(%)of family caregivers reporting a change in this themes Corresponding effect on family caregivers ICF category ICF chapter Mental health impairment* 1 (4%) Age suddenly b122 Global psychosocial functions b1 Mental functions 24 (89%) fatigue b1300 Energy level 3 (11%) insomnia b134 Sleep functions 6 (22%) Insufficient sleep time b1340 Amount of sleep 3 (11%) Difficulty falling asleep b1341 Onset of sleep 1 (4%) Easily awakened b1342 Maintenance of sleep 3 (11%) Ineffective sleep b1343 Quality of sleep 1 (4%) forgetfulness b144 Memory functions 15 (56%) anxiety b152 Emotional functions 8 (30%) sadness 4 (15%) depression 5 (19%) irritated 4 (15%) depressed 5 (19%) stress 1 (4%) compassion 1 (4%) Stop overthinking b160 Thought functions Physical health impairment* 1 (4%) Heart palpitations b4100 Heart rate b4 Functions of the cardiovascular, hematological, immunological, and respiratory systems 1 (4%) Coronary ischemia b415 Blood vessel functions 2 (7%) Blood pressure increased or decreased b420 Blood pressure functions 2 (7%) Immune system decline b435 Immunological system functions 14 (52%) Weight loss or gain b530 Weight maintenance functions b5 Functions of the digestive, metabolic and endocrine systems 1 (4%) stomachache b535 Sensations associated with the digestive system 1 (4%) Poor urination control b620 Urination functions b6 Genitourinary and reproductive functions 2 (7%) Poor arm and shoulder movement b710 Mobility of joint functions b7 Neuromusculoskeletal and movement-related functions 5 (19%) Pain in the cervical spine, upper arm, lower back, and knee b780 Sensations related to muscles and movement functions 1 (4%) Retinal detachment s2203 Retina s2 The eye, ear, and related structures 1 (4%) Liver dysfunction s560 Structure of liver s5 Structures related to the digestive, metabolic and endocrine systems 1 (4%) There are blisters on the waist s810 Structure of areas of skin s8 Skin and related structures *Note that within this theme, some family caregivers' reports were considered health status (e.g., fatty liver), which is outside the scope of ICF. Theme 3: Increase in care tasks Assist in communication Linguistic and cognitive dysfunction in the disabled elderly leads to communication difficulties for family caregivers. F15: “She (the disabled elderly) can't express herself, the nursing assistant doesn't understand, and if there are problems the nursing assistant asks me, I handle them all." F26: “His speech is not very sharp, some expressions are unclear, simple is OK, long is not good." Assisted in self-care Cognitive and motor dysfunction in disabled elderly means that family caregivers have to look after disabled elderly holistically. F1: "There are many things that need to be done, including life care, feeding, pooing, and wiping." F4: "I need to keep an eye on him 24 hours a day, pooping, peeing, and eating for him, and mostly just taking care of his food and drink." Family caregivers also need to help older people move around. F10: "We couldn't get out and tried to get a hangnail at home, but the family doctor wouldn't do it for us, so we had to call 120 to take us to the hospital." F15: "No matter how close, I had to call 120; I couldn't move him alone." Assist in rehabilitation Family caregivers also need to support the disabled elderly in rehabilitation. F17: "When we returned to the ward, I had to continue to rehabilitate him (the disabled elderly), and in the treatment room, the doctor only gave him 20 minutes of treatment, so how do you think that was enough?" F24: “When I had time, I would give him rehabilitation exercises such as hand rubs and body massages.” Assist in daily affairs. Family caregivers must also help disabled older adults with finances, insurance, medical paperwork, and errands (e.g., supermarkets, hospitals, banks). F25: “I didn't know he (the disabled elderly) had insurance, or which bank he deposited his retirement pay, or where he kept his bank card, all of which I don't know.” Theme 4: Estrangement of close relationships Disability seriously affects the harmony of close relationships. F3: “I talked to my sister about caring for our mum (the disabled elderly), and she wouldn't take care of her; I said, what if you don't take care of her and I can't take care of her when I'm not well enough to be in hospital, my sister said I don't want to take care of it (grunts and bitter laughs), and she said her husband would be angry if she took care of her." F 17: “I want to divorce him (the disabled elderly), but no one wants him after the divorce.” F18: "Our family now says that if one person in the family has a stroke, the whole family goes crazy." Many family caregivers report that their relationships with friends have also ended. F16: “I don't have time to talk to my friends, and I don't want to.” F17: “I couldn't possibly meet up with my friend again, wasn't in the mood, and our relationship stopped (eager to answer)." Theme 5: Termination of entertainment and social interaction Almost all family caregivers said they did not have the time and mood to engage in recreational activities. F17: “Now I don't go anywhere, I don't go to class reunions, and I don't have time to check my phone." F18: “I have no recreational activities now because I look after him (the disabled elderly), only play on my phone in the evenings, watch TV sometimes at home, and haven't gone out for two and a half years looking after him.” Many family caregivers say there is no time to socialize. F19: “When he (the disabled elderly) wasn't sick, I still went to the Senior Citizens' University and learned poetry recitation, opera, musical theatre, and Huangmei Opera performance, but I've stopped all that now." Theme 6: Increasing economic pressure Family caregivers say their jobs stop because they have to care for the disabled elderly. F5: “I'm out of work now and taking care of him (the disabled elderly) full time.” F20: "I was out of the country before, immigrated to Canada, worked there, and now I can't work to care for her." Job suspensions affect the financial situation of family caregivers. F7: "Now I don't have a job; I can't make any money." F19: "You see, for 12 months a year, the medical expenses for one month are $ 828 to $ 966. The medical fees are just as expensive no matter which hospitals we go to. There is also the cost of a nursing assistant. The cost of a nursing assistant is $ 1035 a month, so the medical expenses and the cost of a nursing assistant are $ 2070 to $ 2208 a month, and we still have to eat. It is about $ 2760 a year, so I said I could not afford it." F20: "For my mother's convenience, our home is being retrofitted for aging, and it costs $ 828 for two bathrooms, which is expensive." Research findings are mapped to the activities and participation sections of the ICF in Table 4 . Table 4 Research findings mapped to the activities and participation sections of the ICF Themes Number(%)of family caregivers reporting a change in this themes Corresponding effect on family caregivers ICF category ICF chapter Increase in care tasks 1 (4%) Many decisions need to be made d177 Making decisions d1 Learning and applying knowledge 3 (11%) multitasking d220 Undertaking multiple tasks d2 General tasks and demands 2 (7%) Take responsibility d240 Handling stress and other psychological demands 9 (33%) Communication difficulties d350 conversation d3 communication 2 (7%) Take a bus d470 Using transportation d4 mobility 1 (4%) Take exercise d570 Looking after one’s health d5 self-care 2 (7%) Renting a place to live d610 Acquiring a place to live d6 Domestic life 6 (22%) Paying more attention to the balance of nutrients d630 Preparing meals 1 (4%) Doing laundry and mopping floors d640 Doing housework 12 (44%) Assisting older people in self-care d6600 Assisting others with self-care 11 (41%) Assisting older people in the movement d6601 Assisting others in the movement 3 (11%) Assisting older people in communication d6602 Assisting others in communication 5 (19%) Assisting older people in health maintenance d6605 Assisting others in health maintenance The estrangement of close relationships 8 (30%) Neighbors, friends, and fellow patients d750 Informal social relationships d7 Interpersonal interactions and relationships 5 (19%) Alienation from family d760 Family relationships Increasing economic pressure 1 (4%) Feeling like a nursing assistant d8450 Seeking employment d8 Major life areas 5 (19%) Job stopped d8452 Terminating a job 14 (52%) Economic crisis d8700 Personal economic resources Termination of entertainment and social interaction 3 (11%) Reduced social activities d9100 Informal associations d9 Community, social, and civic life 6 (22%) Stopped traveling d920 Recreation and leisure 4 (15%) Only play with mobile phone d9200 play 3 (11%) Musicals, plum operas, and poetry readings have all stopped d9202Arts and culture 6 (22%) No face-to-face meetings, just communication through WeChat d9205 socializing Theme 7: Lack of support system Lack of family and social support systems Family caregivers expressed a lack of family and social support. F7: "She (the disabled elderly) has five sisters, but they don't care about her; they just came before New Year's Eve this year, and now it's been a few months, they don't even call, it's as if they don't have her." F3: “My sister didn't want to take care of her (the disabled elderly), so I had no choice but to take her to live with me." Most family caregivers felt that the training and management of nursing assistants needed to be standardized and regulated. F20: “The nursing assistants only worked for six days, and on the first day, she said how much her previous employer had given her in red packets every month, and she kept saying it all the time.” Lack of government and health support systems Long-term care insurance (LTC) needs to be better promoted and regulated by governments and relevant organizations. F10: "Long-term insurance? Never heard of it, we haven't applied for it, where do we apply?" F20: "I hired the LTC worker; she was not punctual at the job; she came a little late and left a little early every day and did nothing; she usually fried two dishes for my father, and after almost 40 minutes of work or so, she left because she knew I wouldn't sack her." High medical fees and low reimbursement systems increase the financial burden of family caregivers. F12: “Alas, wages have risen a little, but the cost of medicine has risen a lot, in addition to reimbursement of the rest are paid by themselves, but also quite a lot, a lot of them can not be reimbursed.” Family caregivers say that family doctors provide too few services. F10: "He (the disabled elderly) now has bedsores, and no one is there to see us. The family doctor doesn't care about this and doesn't even give you an injection. When you ask him, he says, "We can at most take your blood pressure, but I don't know how. What is the use of it? It is useless; it is just for display. We hope that such disabled older adults can have a doctor or a nurse to come to their homes and provide services to us, and we can pay for them, right? The problem is that no one seems to care about this. There is nothing I can do about it." Theme 8: Care difficulties and needs Family caregivers are eager to be able to communicate more with their doctors about their condition to improve their understanding of the course of the disease and increase their confidence in rehabilitation. F1: “I hope that doctors can always explain the course of treatment in detail to patients and their families. I am in the medical profession and know that sometimes doctors are too busy to explain things in detail. But from the patient's point of view, he wants to know. Although some of the questions are very naive, I hope the doctor can explain patiently so we will not be anxious.” Family caregivers would like to prolong the length of hospitalization of disabled elderly, as frequent changes in hospitals seriously affect the speed of recovery of the elderly and the well-being of the caregivers. F25: "Medicare should give a wide berth to a severely disabled patient like the disabled elderly and extend his length of stay in hospital. If we change the hospital, the environment, the doctors, and the nurses when he is just beginning to make progress, it will be challenging for him to adapt to the environment, and when we change the Yikang Hospital, he will be changed for the worse." F19: "It's a real pain to change hospitals so often, but there's no way around it, health insurance has to be so screwed up, and we have no choice but to go out on a turnaround, come back in 15 days, and go back and forth like that." Family caregivers want the government to pay more attention to the prevention and treatment of the disabled elderly. F19: "The most important thing to write a thesis is to call on the country to pay attention to these people, you know, this kind of disability, now is too much, but also younger, you must call on the country is quick to figure out how to prevent and treat, to take measures, or else it will cause a severe burden on the country." Research findings mapped to the environmental factors component of the ICF in Table 5 . Table 5 Research findings mapped to the environmental factors component of the ICF Themes Number(%)of family caregivers reporting a change in this themes Corresponding effect on family caregivers ICF category ICF chapter Type of environmental factor Lack of support system 2 (7%) The hospital's family canteens are too bad, and some even have no canteens e1100 food e1 Products and technology Direct barrier 2 (7%) Hypnotic and antidepressant e1101 drugs Direct facilitator 1 (4%) Dryer, washing machine, vacuum robot e1150 General products and technology for personal use in daily living Direct facilitator 1 (4%) Aging modification of toilet, threshold, and handrail e1151 Assistive products and technology for personal use in daily living Indirect facilitator 2 (78%) Wheelchairs, mobility aids, ambulances, private cars e120 Products and technology for personal indoor and outdoor Mobility and transportation Indirect facilitator 5 (19%) Mobile phone e1250 General products and technology for communication Direct facilitator 1 (4%) Wear a blindfold after retinal surgery e1251 Assistive products and technology for communication Direct facilitator 1 (4%) The ward is too far from the recovery room e150 Design, construction, and building products and technology of buildings for public use Direct barrier 14 (52%) Lack of funds e165 assets Direct barrier 2 (7%) The ward is too noisy at night e250 sound e2 Natural environment and human-made changes to environment Direct barrier 2 (7%) Reject/provide assistance e310 Immediate family e3 Support and relationships Direct barrier/facilitator 4 (15%) Provide assistance e320 friends Direct facilitator 11 (41%) Nursing assistants are lazy and ask for tips e340 Personal care providers and personal assistants Direct barrier 2 (7%) The doctors did not inform the family caregivers of the treatment in detail e355 Health professionals Direct barrier 8 (30%) The family doctor's services are limited e450 Individual attitudes of health professionals e4 attitudes Direct barrier 9 (33%) Caring for the disabled elderly is an obligation and responsibility e465 Social norms, practices, and ideologies Direct facilitator 3 (11%) No lift in the community e515 Architecture and construction services, systems, and policies e5 Services, systems, and policies Indirect barrier 1 (4%) Remote reimbursement convenience e530 Utility services, systems, and policies Direct facilitator 12 (44%) Medical insurance, disability benefits, LTC, state student loans e570 Social Security services, systems, and policies Direct facilitator 9 (33%) The training and management of nursing assistants and LTC providers are inadequate e580 Health services, systems, and policies Indirect barrier Discussion The results of this study showed that most ICF categories were linked to body function and Structure (b and s), including eight chapters on psychological function, cardiovascular and cerebrovascular function, and endocrine system function (b1,b4 ~ b7,s2,s5,s8). It can be seen that caring for the disabled elderly seriously affects the physical and mental health of family caregivers. Among the linked ICF categories, the top three are energy levels (b1300), emotional functions (b152), and Sleep functions (b134), indicating that these three physical functions are more damaged. The results are similar to previous studies [ 20 , 21 ] . However, in contrast to prior research, this study links the interview results with the ICF framework to find the specific impairment of the physical function and Structure of family caregivers, which is conducive to the formulation of targeted intervention programs. In this study, family caregivers indicated that they often felt tired physically and mentally, especially mentally. It may be related to the traditional Chinese concept that family caregivers must help disabled, older adults manage daily affairs and make complex decisions. Previous studies pointed out that fatigue seriously affected the quality of life of family caregivers [ 22 ] . It is recommended that medical staff use comprehensive health education [ 23 ] , cognitive behavioral intervention [ 24 ] , and photo-heuristic interview follow-up based on "4Y in place" [ 25 ] to reduce family caregiver fatigue. This study also found that anxiety and depression are common emotional symptoms of family caregivers, and previous studies [ 26 , 27 ] have confirmed that negative emotions seriously affect family caregivers' quality of life and the prognosis of disabled, older adults after stroke. However, the family caregiver in this study mentioned that the medical staff did not help their negative emotions but that a caregiver in the same ward informed them about the treatment. Previous research has shown that mindfulness-based stress reduction training [ 28 ] , emotional freedom techniques [ 29 ] , self-guided interventions [ 30 ] , and enhanced self-efficacy [ 31 ] can be effective in alleviating negative emotions in family caregivers. It suggests that medical staff should pay attention to the negative emotions of family caregivers, evaluate them in time, and take corresponding psychological intervention measures. Compared to the first two issues, family caregivers receive less attention to sleep disorders. However, relevant studies [ 32 , 33 ] have confirmed that persistent sleep disorders can cause psychological disorders such as depression and eventually lead to suicidal behavior. It is recommended to select appropriate medications and non-medications (electroacupuncture, cognitive behavioral therapy, sleep hygiene education, exercise therapy, and phototherapy) to improve the family caregiver's sleep status according to the type of insomnia and duration of drug effects [ 34 , 35 ] . The results of this study are addressed in the nine chapters (d1 to d9) of the activities and participation (d) part of the ICF, suggesting that family caregivers face more activities and limited participation in their daily lives. In the ICF-associated category, the top three are recreation and leisure (d920), assisting others (d660), and personal economic resources (d8700); this indicated that these three domains of activities and participation were more severely restricted. Previous studies [ 20 , 36 ] have also reported that family caregivers face economic problems, changes in close relationships, and social isolation. This may be related to the fact that the most affected activities and participation of the disabled elderly after stroke are walking (d450), and family caregivers have to take complete care of the diet and daily life of the disabled elderly [ 21 , 37 ] . Strong social Support is crucial in alleviating barriers to family caregiver activities and participation. However, in the category of environmental factors (e), the top three biggest obstacles affecting the quality of life of family caregivers were as follows: products and technology for personal indoor and outdoor Mobility and transportation (e120), assets (e165), and personal care providers and personal assistants (e340) reflecting the needs of caregivers for indoor and outdoor transportation, money, and quality nursing assistant. Products and technology for personal indoor and outdoor mobility and transportation (e120) was the ICF category with the most links in the section on environmental barriers. During the interviews, family caregivers mentioned that hospitals required them to make frequent transfers to other hospitals, which seriously affected the rehabilitation process of the disabled elderly and their enthusiasm for caring for them, and that they desperately wanted to prolong their stay in the hospital. This may be related to China's imperfect payment system for rehabilitation care. Studies have shown that, although income level and medical privilege affect the length of stay, most disabled older adults are required to be "discharged frequently" by medical insurance [ 38 ] . In this view, the Second Hospital of Jinhua City, Zhejiang Province, takes the lead in implementing the patient-oriented model point payment method of bed-day payment in China, which can effectively alleviate the embarrassing situation of "being discharged frequently" and achieve the "double reduction" of out-of-pocket payment and medical insurance expenses for the disabled elderly. At the same time, family caregivers perceive high medical costs, low reimbursement systems, and loss of employment as adding to their financial burden. To address this social problem, the report of the 20th Party Congress in 2022 proposed the establishment of LTC nationwide to provide primary life care, medical care, and financial compensation, thereby easing the problem of crowding out medical resources and the burden of medical care on families. In this study, the awareness rate and purchase rate of LTC are low, and there are product defects. It may be related to the insufficient publicity of LTC. In this regard, the insurance company and the government should strengthen the product publicity investment, optimize the product design, and improve the claims service. On the other hand, the long-term care insurance reimbursement catalog should be enhanced, and the reimbursement rate for the primary care portion for severely disabled elderly should be increased to promote the development of the long-term care insurance industry and alleviate the level of third-party disability of family caregivers. In addition, family caregivers report that there are too few responsible nursing assistants, and they are too expensive. The results are consistent with Wenchao Yu et al. [ 39 ] . To this, it is suggested that third-party training institutions strengthen care technology and moral training and construct a "digital care" star evaluation system to query a care professional level, professional ethics, and service satisfaction, such as data providing a reference for family caregivers when choosing nursing assistants. Family caregivers also indicated that the services provided by family doctors were too few to meet their basic needs. Therefore, the government should pay more attention to allocating primary medical resources, strengthening the training of primary professionals, building intelligent communities, and improving the service level of primary medical institutions. In addition, hospitals can design scientific home-based rehabilitation programs and implement them through community and home-based rehabilitation and elderly care models to realize the three-level interconnection of "home-community-institution" rehabilitation and elderly care and further improve the service level of primary medical institutions. Conclusion The problem of elderly care for the disabled elderly after a stroke needs to be solved urgently. Family caregivers face difficulties such as physical health impairment, mental health impairment, increase in care tasks, estrangement of close relationships, termination of entertainment and social interaction, increasing economic pressure, lack of support system, care difficulties, and needs. Relevant plans should be put forward based on the actual situation in local areas to further improve the quality of life of the disabled elderly after stroke and their family caregivers. This interview object is limited to parts and can be carried out in different areas of further study in the future. Declarations Acknowledgments The authors thank funding and all the professionals involved in research support and data collection. Author's contributions Na Li was responsible for designing the study, conducting the interviews, interpreting the data, and drafting the text. Yongqing Zhang was responsible for conducting the interviews and interpreting the data. Yili Gao was responsible for interpreting the data. Jiawen Qin was responsible for interpreting the data. Yang Liao was responsible for interpreting the data. Xiaoshan Rong was accountable for interpreting the data. Haiping Yu was responsible for designing the study and critically reviewing the article's intellectual content, support, and guidance. All authors reviewed the manuscript. The author(s) read and approved the final manuscript. Funding This work is supported by the Shanghai Pudong New Area Health Science and Technology Project (PW2022A-03), the Tongji University project (JS2210204), and the Shanghai Pudong New Area Health System Discipline Leader Training Project (PWRd2022-16). Availability of data and materials This paper represents essential data from the author's master's thesis. The data analyzed during the study is private, but the corresponding author can provide it upon reasonable request. Ethics approval and consent to participate The methods and protocol for this study were approved by the ethical review committee of East Hospital, Affiliated with Tongji University(NO.2022-130). The Declaration of Helsinki performed this study. All participants received written and verbal information about the study's aim. All participants gave informed consent and were anonymized before data collection. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. The study has yet to be peer-reviewed. Author Details 1 School of Medicine, Tongji University, NO. 500 Zhennan Road, Putuo District, Shanghai 200331, China. 2 Department of Cardiology, East Hospital Affiliated to Tongji University, NO. 1800 Yuntai Road, Pudong New Area, Shanghai 200120, China. 3 Department of Physical Examination Center, East Hospital Affiliated to Tongji University, NO. 1800 Yuntai Road, Pudong New Area, Shanghai 200120, China. 4 Department of Neurological Rehabilitation, Yangzhi Rehabilitation Hospital Affiliated to Tongji University, NO. 2209 Guangxing Road, Songjiang District, Shanghai 201619, China. 5 Department of Nursing, Yangzhi Rehabilitation Hospital Affiliated to Tongji University, NO. 2209 Guangxing Road, Songjiang District, Shanghai 201619, China. 6 Department of Nursing, East Hospital Affiliated to Tongji University, NO. 1800 Yuntai Road, Pudong New Area, Shanghai 200120, China. References Wang W, Jiang B, Sun H, et al. 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Chinese Journal of Mental Health. 2024; 38(4): 312-7.https://doi.org/10.3969/j.issn.1000-6729.2024.04.005 Chen YS, Yang SY, Jin M. Summary of the best evidence for managing sleep disorders in older patients [J]. Chinese Nursing Education. 2022; 19(1): 38-43.https://doi.org/10.3761/j.issn.1672-9234.2022.01.006 Wang YX, Yu Y, Wang XM, et al. Clinical research review of electroacupuncture for insomnia in the past ten years [J]. World Journal of Traditional Chinese Medicine. 2024; 19(05): 645-51.https://doi.org/10.3969/j.issn.1673-7202.2024.05.007 Sawatzky JE, Fowler KS. Impact of caregiving: listening to the voice of informal caregivers [J]. J Psychiatr Ment Health Nurs. 2003; 10(3): 277-86.https://doi.org/10.1046/j.1365-2850.2003.00601.x Ganesh S, Mohapatra S, Mohanty P, et al. Identification of the components associated with functioning using the international classification of functioning, disability, and health comprehensive core set for stroke in Indian stroke survivors [J]. Top Stroke Rehabil. 2017; 24(7): 517-26.https://doi.org/10.1080/10749357.2017.1330231 Ye CS, Ni X, Zhao R. Income inequality, positive selection, and resource misallocation in the healthcare market [J]. Management World. 2021; 37(05): 113-27+9.https://doi.org/10.19744/j.cnki.11-1235/f.2021.0068 Yu WC, Sun HJ, Chen Y, et al. Tianjin tertiary hospital nurse team construction and management practice research [J]. Health Economics Research. 2023; 40(01): 65-7.https://doi.org/10.14055/j.cnki.33-1056/f.2023.01.016 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4605875","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319995629,"identity":"e3c74292-39f6-4887-a917-2f2cd6b18d4a","order_by":0,"name":"Na Li","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Li","suffix":""},{"id":319995630,"identity":"9cc944d8-46d7-480b-bcdb-3e87a4cb2295","order_by":1,"name":"Yongqing Zhang","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Yongqing","middleName":"","lastName":"Zhang","suffix":""},{"id":319995631,"identity":"2db5e60e-55c5-41b4-ba1f-1e4a1390c74c","order_by":2,"name":"Yili Gao","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Yili","middleName":"","lastName":"Gao","suffix":""},{"id":319995632,"identity":"e431d013-a824-4c9f-a287-529051c950e0","order_by":3,"name":"Jiawen Qin","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Jiawen","middleName":"","lastName":"Qin","suffix":""},{"id":319995633,"identity":"c0e31fa0-9aca-480b-9733-169aed850d2c","order_by":4,"name":"Yang Liao","email":"","orcid":"","institution":"Tongji University","correspondingAuthor":false,"prefix":"","firstName":"Yang","middleName":"","lastName":"Liao","suffix":""},{"id":319995634,"identity":"e73752b2-61d1-4d2a-af2e-315417182bcd","order_by":5,"name":"Xiaoshan Rong","email":"","orcid":"","institution":"Shanghai Sunshine Rehabilitation Center","correspondingAuthor":false,"prefix":"","firstName":"Xiaoshan","middleName":"","lastName":"Rong","suffix":""},{"id":319995635,"identity":"9c23f5f2-6b63-4f26-8b03-cbfc4ade48bc","order_by":6,"name":"Haiping Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDACZhBhwMDAL/+w8QGIQbwWyYbkwwbEaYEBg4a0NAmiVJqz8x5+XVBwx24Dwxmzyh8Fd+QZ2A8f3YBPi2UzX5r1DINnydsZe8xu8xg8M2zgSUu7gdc9h3nMjHkMDidbNvOY3QZyGRskeMyI02JwjMes8IfBYXtitBg/BmqxMzjDlsYAZCQS1AJyD/MMg8MJkjOYD0uDrGsj5Bdz/jPGnwv+HLbnl2Bs/Pjjz2HbfvbDx/A7jIGBTRpIJzbARNjwKYdqYf4MpO0JKRwFo2AUjIIRDACir0kQZwr7TwAAAABJRU5ErkJggg==","orcid":"","institution":"Shanghai East Hospital","correspondingAuthor":true,"prefix":"","firstName":"Haiping","middleName":"","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2024-06-19 12:23:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4605875/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4605875/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-026-07249-5","type":"published","date":"2026-03-03T15:57:45+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":104251552,"identity":"3fa09e8d-408b-4626-a4ad-4dd927824557","added_by":"auto","created_at":"2026-03-09 16:13:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1798497,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4605875/v1/5197ac8d-6e8f-4197-abdd-0b6a16f54857.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Third-party disability in family caregivers of disabled elderly after stroke based on ICF framework: a qualitative study in Shanghai, China","fulltext":[{"header":"Background","content":"\u003cp\u003eThe incidence rate of stroke in China is 345.1 per 100,000, and there are currently about 2\u0026nbsp;million new strokes in China, with 70 to 80 percent of post-stroke survivors losing their ability to live independently\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, resulting in a large number of disabled elderly. The ICF is a standard linguistic framework proposed by the WHO for assessing health status, considers \u0026ldquo;health\u0026rdquo; to consist of two components (functioning and disability), which are in turn influenced by two contextual factors (environmental and personal)\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e, and emphasizes that disability is primarily a result of impaired body functions and limitations in activities and participation\u003csup\u003e[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/sup\u003e. The majority of disabled elderly after stroke have speech, motor, and swallowing dysfunction and must rely on others for basic activities of daily living\u003csup\u003e[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/sup\u003e. Family care remains the primary mode of care for the disabled elderly in China. The more severe the degree of disability of the disabled elderly, the greater the challenges faced by family caregivers\u003csup\u003e[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e. Exploring the impairment of the physical and mental health of family caregivers as a result of caring for disabled elderly has been a hot topic of domestic and international research\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. In the past, scholars tended to use the term \u0026ldquo;caregiver burden\u0026rdquo; to describe the negative impact of caring on family caregivers\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. In addition, in 2001, the WHO introduced the concept of \u0026ldquo;third-party disability\u0026rdquo; as a future direction for the ICF, defined as impairments in the functioning and social participation of family members due to the health status of immediate family members and significant others in the ICF framework\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. According to WHO, \"disability\" refers to impairments in body function and structure that result in limitations in activity and participation, not only in the functioning of limbs and organs\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e. \u0026ldquo;Third-party disability\u0026rdquo; (i.e., changes in functioning and disability due to environmental factors critical to the health status of significant others) is an extension of \u0026ldquo;disability\u0026rdquo; (i.e., the result of the interaction between environmental factors and the health status of the individual), with a significant emphasis on family member functioning and social participation limitations. Although the ICF framework originated relatively recently, it has been widely used in third-party disabilities in patients both nationally and internationally, such as aphasia after stroke\u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e, hearing impairment\u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e, dysphagia\u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e, and children with disabilities\u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e, taking advantage of a common language that facilitates global communication across different disciplines and fields. Family caregivers of the disabled elderly are impaired in all aspects of functioning. Still, the ICF framework has not yet been applied to family caregivers of the disabled elderly after a stroke. Therefore, this study is a qualitative study of third-party disability in disabled elderly after stroke based on the ICF framework, aiming to provide a reference for solving the dilemma of family caregiving for disabled elderly after stroke.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA purposive sampling method was used to select family caregivers of disabled, elderly people after strokes in Shanghai from January to May 2024 for interviews. We obtained approval from the Ethics Committee of Dong Fang Hospital, Affiliated with Tongji University (NO.2022\u0026thinsp;\u0026minus;\u0026thinsp;130).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eResearcher characteristics\u003c/h2\u003e \u003cp\u003eThe two investigators (NL and YZ) are nursing students with a geriatric care background who are trained in qualitative interviewing. They had more than eight months of internship experience in the neurorehabilitation department. Before the interview, they had no relationship with the participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe disabled elderly after a stroke should be: 1) at least\u0026thinsp;\u0026ge;\u0026thinsp;60 years old; 2) stroke diagnosed by cranial CT or MRI\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e; 3) Activity of Daily Living (ADL)\u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e score\u0026thinsp;\u0026le;\u0026thinsp;60. The family caregiver should be: 1) at least\u0026thinsp;\u0026ge;\u0026thinsp;18 years old; 2) total time spent caring for the disabled elderly\u0026thinsp;\u0026ge;\u0026thinsp;6 months, \u0026ge; 4 hours per day; 3) the caregiver is a family member or close relative of the disabled elderly, lives with the disabled elderly and has been caring for the disabled elderly for the longest time; 4) no communication barriers, informed consent, and voluntary participation. Exclusion criteria for family caregivers: 1) caregivers who are in an employment relationship and receive remuneration; 2) visual, hearing, and speech impairments; 3) serious illnesses (e.g., cancer, severe cardiovascular disease).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eAccording to the purpose of the study, we searched the databases for studies on family caregivers' feelings of caring for the disabled elderly after stroke, using the keywords \u0026ldquo;international classification of functioning, disability and health\u0026rdquo;, \u0026ldquo;stroke\u0026rdquo;, \u0026ldquo; the disabled elderly\u0026rdquo; and \u0026ldquo;qualitative research\u0026rdquo;\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e. Subsequently, the group developed preliminary interview guidelines based on the ICF framework, integrating local disabled elderly care policies\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e and expert opinions (one expert in qualitative research methodology, one expert in neurorehabilitation, and two experts in geriatric nursing), and refined the interview guidelines after pre-interviewing six caregivers (See Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e for interview guidelines). Data were collected using observation and face-to-face semi-structured in-depth interviews. The interviews were conducted in a separate, quiet room in the hospital department and lasted 15\u0026ndash;40 minutes. Recording was done with the consent of the participants, and non-verbal information was acknowledged and recorded promptly until the participants had finished expressing their feelings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eAnalyses\u003c/h2\u003e \u003cp\u003eWhen no new information emerged from the participants, both researchers agreed to end the participant's recruitment process\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e. The audio recordings were transcribed into text within 24 hours after each interview and kept together with the general information questionnaire, diary, and transcript. The Colaizzi 7-step analysis method was used to analyze the data and form themes\u003csup\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Repeatedly read the interview transcripts to familiarise themselves with the text and then extracted meaningful statements to create nodes for initial coding. Then, we will look for coding of familiar concepts to form themes. Finally, the analyses were fed back to the participants. Return participants and researcher collegiality were used to increase the study's credibility. The first author transcribed the manuscript, and the second author, who knew the dialect, checked it against the recording. Then, the first and second authors coded the transcribed manuscripts separately and discussed the contradictions with the third author. Finally, the seven group members conferred together to refine the themes. Findings and interview transcripts were returned to the participants for verification to enhance authenticity.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eInterview guidelines\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCorresponding ICF domain\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuestions\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHow do you recall your physical and mental health changing since caring for disabled elderly?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBody Structures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat parts of your body have gone wrong since caring for disabled elderly?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eActivities and Participation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSince caring for disabled elderly, how do you recall your daily life being different from the past?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnvironmental Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSince caring for the disabled elderly, recalling the environment in which you lived and the conditions in which you lived, what aspects of your life do you feel have impacted your life?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal Factors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWhat difficulties have you encountered since caring for the disabled elderly? How did you cope with these difficulties? What kind of help would you like to receive?\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics\u003c/h2\u003e \u003cp\u003eFollowing the principle of data saturation, 27 family caregivers of disabled elderly after stroke were finally selected, out of which five were male and 22 were female with the age of (62.48\u0026thinsp;\u0026plusmn;\u0026thinsp;10.10) years. All family caregivers gave informed consent and participated voluntarily. The caregivers were numbered according to the order of interview (F1\u0026thinsp;~\u0026thinsp;F27), and the general information of the family caregivers is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic information of family caregivers(\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;27)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003enumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAverage daily care hours (hour)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTime of caring(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRelationship with the disabled elderly\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCaregiver assistance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDegree of disability of older people*\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esister\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter-in-law\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ebrother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003esister\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eson\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003emother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003edaughter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003ecaregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esevere\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003espouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003enone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003emoderate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Based on the Activity of Daily Living (ADL, severe disability\u0026thinsp;=\u0026thinsp;0\u0026thinsp;~\u0026thinsp;40 scores, moderate disability\u0026thinsp;=\u0026thinsp;40\u0026thinsp;~\u0026thinsp;60 scores). This tool was used to measure the degree of disability of disabled elderly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eTheme 1: Physical health impairment\u003c/h2\u003e \u003cp\u003eFamily caregivers described negative body changes, including aging, lack of sleep, fatigue, and weight changes. Almost all family caregivers agree that caring for disabled elderly is exhausting.\u003c/p\u003e \u003cp\u003eF17: \u0026ldquo;My heart is tired; he (the disabled elderly) went to get a gold injection. I quickly came here to lie down a little, my eyes closed for a while. I could not sleep but would have been tired if I had not lied down.\u0026rdquo;\u003c/p\u003e \u003cp\u003eFamily caregivers indicated that the onset or recurrence of certain diseases may also be associated with disabled elderly, such as high blood pressure, coronary heart disease, palpitations, stomach pain, fatty liver disease, and menstrual disorders.\u003c/p\u003e \u003cp\u003eF7: \u0026ldquo;I am in a hurry to fly, hurry, do you know? I'm so anxious that I have snakebite sores, my immunity is lowered, and I get sick easily; I'm so anxious that I want to sigh; my liver is bad; I have a fatty liver, and I'm gaining weight (sigh).\u0026rdquo;\u003c/p\u003e \u003cp\u003eBy moving the disabled elderly or doing household chores over a long period, family caregivers can also suffer from a range of illnesses, such as retinal detachment, urinary incontinence, back and leg pain, and a frozen shoulder.\u003c/p\u003e \u003cp\u003eF14: \u0026ldquo;He (the disabled elderly), with a bad temper, insisted that I carry a 150kg box. I had no choice but to do so, as I am diabetic and highly nearsighted, and if I exerted myself a little too much, my retina would fall off in a few days.\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eTheme 2: Mental health impairment\u003c/h2\u003e \u003cp\u003eFamily caregivers reported poor memory and high levels of stress.\u003c/p\u003e \u003cp\u003eF27: \u0026ldquo;I'm a bit unhappy, I'm very stressed, I have insomnia, I forget a lot of things, I forget a lot of things, I'm in a bad mood in the hospital.\u0026rdquo;\u003c/p\u003e \u003cp\u003eFamily caregivers say anxiety and depression are getting worse after caring for disabled elderly.\u003c/p\u003e \u003cp\u003eF20: \u0026ldquo;I have insomnia, then anxiety, and a little bit of depression; it's annoying, every day it's annoying. I'm still on medication, an anti-anxiety and depression medication, which is Synthroid, and every day it's annoying.\"\u003c/p\u003e \u003cp\u003eF25: \u0026ldquo;I've asked the doctor before non-stop, reflecting on his situation (the disabled elderly), chasing after him, crying, and finding someone else to cry to for three hours at a time, and they've told me I'm anxiety-ridden.\u0026rdquo;\u003c/p\u003e \u003cp\u003eMany family caregivers say they often feel irritable, anxious, and sad.\u003c/p\u003e \u003cp\u003eF7: \u0026ldquo;Now the job is gone, no salary, the child has not found a job, ah ~ (long sigh), a family is not like this, ah ~ (long sigh), I am anxious to death.\"\u003c/p\u003e \u003cp\u003eF25: \"Sometimes it's just a bad mood, suddenly very depressed, want to cry, want to talk to someone, like to find someone to cry about, harassing others all over again.\"\u003c/p\u003e \u003cp\u003eDifficulties in communication lead to family caregivers feeling anxious.\u003c/p\u003e \u003cp\u003eF15: \u0026ldquo;When he (the disabled elderly) is confused and can't speak clearly with her, I am particularly anxious, and I feel very depressed.\"\u003c/p\u003e \u003cp\u003eResearch findings mapped to the ICF's body functions and structures component in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResearch findings mapped to the body functions and structures component of the ICF in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber(%)of family caregivers reporting a change in this themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorresponding effect on family caregivers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICF category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eICF chapter\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental health impairment*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge suddenly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb122 Global psychosocial functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eb1 Mental functions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003efatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb1300 Energy level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003einsomnia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb134 Sleep functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInsufficient sleep time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb1340 Amount of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDifficulty falling asleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb1341 Onset of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEasily awakened\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb1342 Maintenance of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIneffective sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb1343 Quality of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eforgetfulness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb144 Memory functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eanxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb152 Emotional functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003esadness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eirritated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edepressed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003estress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecompassion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStop overthinking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb160 Thought functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhysical health impairment*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHeart palpitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb4100 Heart rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eb4 Functions of the cardiovascular,\u003c/p\u003e \u003cp\u003ehematological, immunological, and\u003c/p\u003e \u003cp\u003erespiratory systems\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoronary ischemia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb415 Blood vessel functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBlood pressure increased or decreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb420 Blood pressure functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImmune system decline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb435 Immunological system functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWeight loss or gain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb530 Weight maintenance functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eb5 Functions of the digestive, metabolic\u003c/p\u003e \u003cp\u003eand endocrine systems\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003estomachache\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb535 Sensations associated with the digestive system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor urination control\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb620 Urination functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eb6 Genitourinary and reproductive\u003c/p\u003e \u003cp\u003efunctions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePoor arm and shoulder movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb710 Mobility of joint functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eb7 Neuromusculoskeletal and movement-related functions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePain in the cervical spine, upper arm, lower back, and knee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eb780 Sensations related to muscles and movement functions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRetinal detachment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003es2203 Retina\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003es2 The eye, ear, and related structures\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLiver dysfunction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003es560 Structure of liver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003es5 Structures related to the digestive,\u003c/p\u003e \u003cp\u003emetabolic and endocrine systems\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThere are blisters on the waist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003es810 Structure of areas of skin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003es8 Skin and related structures\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e*Note that within this theme, some family caregivers' reports were considered health status (e.g., fatty liver), which is outside the scope of ICF.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTheme 3: Increase in care tasks\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eAssist in communication\u003c/h2\u003e \u003cp\u003eLinguistic and cognitive dysfunction in the disabled elderly leads to communication difficulties for family caregivers.\u003c/p\u003e \u003cp\u003eF15: \u0026ldquo;She (the disabled elderly) can't express herself, the nursing assistant doesn't understand, and if there are problems the nursing assistant asks me, I handle them all.\"\u003c/p\u003e \u003cp\u003eF26: \u0026ldquo;His speech is not very sharp, some expressions are unclear, simple is OK, long is not good.\"\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eAssisted in self-care\u003c/h2\u003e \u003cp\u003eCognitive and motor dysfunction in disabled elderly means that family caregivers have to look after disabled elderly holistically.\u003c/p\u003e \u003cp\u003eF1: \"There are many things that need to be done, including life care, feeding, pooing, and wiping.\"\u003c/p\u003e \u003cp\u003eF4: \"I need to keep an eye on him 24 hours a day, pooping, peeing, and eating for him, and mostly just taking care of his food and drink.\"\u003c/p\u003e \u003cp\u003e Family caregivers also need to help older people move around.\u003c/p\u003e \u003cp\u003eF10: \"We couldn't get out and tried to get a hangnail at home, but the family doctor wouldn't do it for us, so we had to call 120 to take us to the hospital.\"\u003c/p\u003e \u003cp\u003eF15: \"No matter how close, I had to call 120; I couldn't move him alone.\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eAssist in rehabilitation\u003c/h2\u003e \u003cp\u003eFamily caregivers also need to support the disabled elderly in rehabilitation.\u003c/p\u003e \u003cp\u003eF17: \"When we returned to the ward, I had to continue to rehabilitate him (the disabled elderly), and in the treatment room, the doctor only gave him 20 minutes of treatment, so how do you think that was enough?\"\u003c/p\u003e \u003cp\u003eF24: \u0026ldquo;When I had time, I would give him rehabilitation exercises such as hand rubs and body massages.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003cb\u003eAssist in daily affairs.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Family caregivers must also help disabled older adults with finances, insurance, medical paperwork, and errands (e.g., supermarkets, hospitals, banks).\u003c/p\u003e \u003cp\u003eF25: \u0026ldquo;I didn't know he (the disabled elderly) had insurance, or which bank he deposited his retirement pay, or where he kept his bank card, all of which I don't know.\u0026rdquo;\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTheme 4: Estrangement of close relationships\u003c/h2\u003e \u003cp\u003eDisability seriously affects the harmony of close relationships.\u003c/p\u003e \u003cp\u003eF3: \u0026ldquo;I talked to my sister about caring for our mum (the disabled elderly), and she wouldn't take care of her; I said, what if you don't take care of her and I can't take care of her when I'm not well enough to be in hospital, my sister said I don't want to take care of it (grunts and bitter laughs), and she said her husband would be angry if she took care of her.\"\u003c/p\u003e \u003cp\u003eF 17: \u0026ldquo;I want to divorce him (the disabled elderly), but no one wants him after the divorce.\u0026rdquo;\u003c/p\u003e \u003cp\u003eF18: \"Our family now says that if one person in the family has a stroke, the whole family goes crazy.\"\u003c/p\u003e \u003cp\u003eMany family caregivers report that their relationships with friends have also ended.\u003c/p\u003e \u003cp\u003eF16: \u0026ldquo;I don't have time to talk to my friends, and I don't want to.\u0026rdquo;\u003c/p\u003e \u003cp\u003eF17: \u0026ldquo;I couldn't possibly meet up with my friend again, wasn't in the mood, and our relationship stopped (eager to answer).\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eTheme 5: Termination of entertainment and social interaction\u003c/h2\u003e \u003cp\u003eAlmost all family caregivers said they did not have the time and mood to engage in recreational activities.\u003c/p\u003e \u003cp\u003eF17: \u0026ldquo;Now I don't go anywhere, I don't go to class reunions, and I don't have time to check my phone.\"\u003c/p\u003e \u003cp\u003eF18: \u0026ldquo;I have no recreational activities now because I look after him (the disabled elderly), only play on my phone in the evenings, watch TV sometimes at home, and haven't gone out for two and a half years looking after him.\u0026rdquo;\u003c/p\u003e \u003cp\u003eMany family caregivers say there is no time to socialize.\u003c/p\u003e \u003cp\u003eF19: \u0026ldquo;When he (the disabled elderly) wasn't sick, I still went to the Senior Citizens' University and learned poetry recitation, opera, musical theatre, and Huangmei Opera performance, but I've stopped all that now.\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eTheme 6: Increasing economic pressure\u003c/h2\u003e \u003cp\u003eFamily caregivers say their jobs stop because they have to care for the disabled elderly.\u003c/p\u003e \u003cp\u003eF5: \u0026ldquo;I'm out of work now and taking care of him (the disabled elderly) full time.\u0026rdquo;\u003c/p\u003e \u003cp\u003eF20: \"I was out of the country before, immigrated to Canada, worked there, and now I can't work to care for her.\"\u003c/p\u003e \u003cp\u003eJob suspensions affect the financial situation of family caregivers.\u003c/p\u003e \u003cp\u003eF7: \"Now I don't have a job; I can't make any money.\"\u003c/p\u003e \u003cp\u003eF19: \"You see, for 12 months a year, the medical expenses for one month are \u003cspan\u003e$\u003c/span\u003e828 to \u003cspan\u003e$\u003c/span\u003e966. The medical fees are just as expensive no matter which hospitals we go to. There is also the cost of a nursing assistant. The cost of a nursing assistant is \u003cspan\u003e$\u003c/span\u003e1035 a month, so the medical expenses and the cost of a nursing assistant are \u003cspan\u003e$\u003c/span\u003e2070 to \u003cspan\u003e$\u003c/span\u003e2208 a month, and we still have to eat. It is about \u003cspan\u003e$\u003c/span\u003e2760 a year, so I said I could not afford it.\"\u003c/p\u003e \u003cp\u003eF20: \"For my mother's convenience, our home is being retrofitted for aging, and it costs \u003cspan\u003e$\u003c/span\u003e828 for two bathrooms, which is expensive.\"\u003c/p\u003e \u003cp\u003eResearch findings are mapped to the activities and participation sections of the ICF in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResearch findings mapped to the activities and participation sections of the ICF\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber(%)of family caregivers reporting a change in this themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorresponding effect on family caregivers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICF category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eICF chapter\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003eIncrease in care tasks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMany decisions need to be made\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed177 Making decisions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed1 Learning and applying knowledge\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003emultitasking\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed220 Undertaking multiple tasks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed2 General tasks and demands\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTake responsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed240 Handling stress and other psychological demands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCommunication difficulties\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed350 conversation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed3 communication\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTake a bus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed470 Using transportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed4 mobility\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTake exercise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed570 Looking after one\u0026rsquo;s health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed5 self-care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRenting a place to live\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed610 Acquiring a place to live\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed6 Domestic life\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePaying more attention to the balance of nutrients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed630 Preparing meals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoing laundry and mopping floors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed640 Doing housework\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssisting older people in self-care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed6600 Assisting others with self-care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssisting older people in the movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed6601 Assisting others in the movement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssisting older people in communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed6602 Assisting others in communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAssisting older people in health maintenance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed6605 Assisting others in health maintenance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eThe estrangement of close relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeighbors, friends, and fellow patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed750 Informal social relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed7 Interpersonal interactions and\u003c/p\u003e \u003cp\u003erelationships\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlienation from family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed760 Family relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eIncreasing economic pressure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFeeling like a nursing assistant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed8450 Seeking employment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed8 Major life areas\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eJob stopped\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed8452 Terminating a job\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEconomic crisis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed8700 Personal economic resources\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTermination of entertainment and social interaction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReduced social activities\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed9100 Informal associations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ed9 Community, social, and civic life\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eStopped traveling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed920 Recreation and leisure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOnly play with mobile phone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed9200 play\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMusicals, plum operas, and poetry readings have all stopped\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed9202Arts and culture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo face-to-face meetings, just communication through WeChat\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ed9205 socializing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eTheme 7: Lack of support system\u003c/h2\u003e \u003cp\u003eLack of family and social support systems\u003c/p\u003e \u003cp\u003eFamily caregivers expressed a lack of family and social support.\u003c/p\u003e \u003cp\u003eF7: \"She (the disabled elderly) has five sisters, but they don't care about her; they just came before New Year's Eve this year, and now it's been a few months, they don't even call, it's as if they don't have her.\"\u003c/p\u003e \u003cp\u003eF3: \u0026ldquo;My sister didn't want to take care of her (the disabled elderly), so I had no choice but to take her to live with me.\"\u003c/p\u003e \u003cp\u003eMost family caregivers felt that the training and management of nursing assistants needed to be standardized and regulated.\u003c/p\u003e \u003cp\u003eF20: \u0026ldquo;The nursing assistants only worked for six days, and on the first day, she said how much her previous employer had given her in red packets every month, and she kept saying it all the time.\u0026rdquo;\u003c/p\u003e \u003cp\u003eLack of government and health support systems\u003c/p\u003e \u003cp\u003eLong-term care insurance (LTC) needs to be better promoted and regulated by governments and relevant organizations.\u003c/p\u003e \u003cp\u003eF10: \"Long-term insurance? Never heard of it, we haven't applied for it, where do we apply?\"\u003c/p\u003e \u003cp\u003eF20: \"I hired the LTC worker; she was not punctual at the job; she came a little late and left a little early every day and did nothing; she usually fried two dishes for my father, and after almost 40 minutes of work or so, she left because she knew I wouldn't sack her.\"\u003c/p\u003e \u003cp\u003eHigh medical fees and low reimbursement systems increase the financial burden of family caregivers.\u003c/p\u003e \u003cp\u003eF12: \u0026ldquo;Alas, wages have risen a little, but the cost of medicine has risen a lot, in addition to reimbursement of the rest are paid by themselves, but also quite a lot, a lot of them can not be reimbursed.\u0026rdquo;\u003c/p\u003e \u003cp\u003eFamily caregivers say that family doctors provide too few services.\u003c/p\u003e \u003cp\u003eF10: \"He (the disabled elderly) now has bedsores, and no one is there to see us. The family doctor doesn't care about this and doesn't even give you an injection. When you ask him, he says, \"We can at most take your blood pressure, but I don't know how. What is the use of it? It is useless; it is just for display. We hope that such disabled older adults can have a doctor or a nurse to come to their homes and provide services to us, and we can pay for them, right? The problem is that no one seems to care about this. There is nothing I can do about it.\"\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eTheme 8: Care difficulties and needs\u003c/h2\u003e \u003cp\u003eFamily caregivers are eager to be able to communicate more with their doctors about their condition to improve their understanding of the course of the disease and increase their confidence in rehabilitation.\u003c/p\u003e \u003cp\u003eF1: \u0026ldquo;I hope that doctors can always explain the course of treatment in detail to patients and their families. I am in the medical profession and know that sometimes doctors are too busy to explain things in detail. But from the patient's point of view, he wants to know. Although some of the questions are very naive, I hope the doctor can explain patiently so we will not be anxious.\u0026rdquo;\u003c/p\u003e \u003cp\u003eFamily caregivers would like to prolong the length of hospitalization of disabled elderly, as frequent changes in hospitals seriously affect the speed of recovery of the elderly and the well-being of the caregivers.\u003c/p\u003e \u003cp\u003eF25: \"Medicare should give a wide berth to a severely disabled patient like the disabled elderly and extend his length of stay in hospital. If we change the hospital, the environment, the doctors, and the nurses when he is just beginning to make progress, it will be challenging for him to adapt to the environment, and when we change the Yikang Hospital, he will be changed for the worse.\"\u003c/p\u003e \u003cp\u003eF19: \"It's a real pain to change hospitals so often, but there's no way around it, health insurance has to be so screwed up, and we have no choice but to go out on a turnaround, come back in 15 days, and go back and forth like that.\"\u003c/p\u003e \u003cp\u003eFamily caregivers want the government to pay more attention to the prevention and treatment of the disabled elderly.\u003c/p\u003e \u003cp\u003eF19: \"The most important thing to write a thesis is to call on the country to pay attention to these people, you know, this kind of disability, now is too much, but also younger, you must call on the country is quick to figure out how to prevent and treat, to take measures, or else it will cause a severe burden on the country.\"\u003c/p\u003e \u003cp\u003eResearch findings mapped to the environmental factors component of the ICF in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eResearch findings mapped to the environmental factors component of the ICF\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber(%)of family caregivers reporting a change in this themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCorresponding effect on family caregivers\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eICF category\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eICF chapter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eType of environmental factor\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of support system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe hospital's family canteens are too bad, and some even have no canteens\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee1100 food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ee1 Products and technology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHypnotic and antidepressant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee1101 drugs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDryer, washing machine, vacuum robot\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee1150 General products and technology for personal use in daily living\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAging modification of toilet, threshold, and handrail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee1151 Assistive products and technology for personal use in daily living\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWheelchairs, mobility aids, ambulances, private cars\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee120 Products and technology for personal indoor and outdoor Mobility and transportation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (19%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMobile phone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee1250 General products and technology for communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eWear a blindfold after retinal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee1251 Assistive products and technology for communication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe ward is too far from the recovery room\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee150 Design, construction, and building products and technology of buildings\u003c/p\u003e \u003cp\u003efor public use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (52%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of funds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee165 assets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe ward is too noisy at night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee250 sound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ee2 Natural environment and human-made\u003c/p\u003e \u003cp\u003echanges to environment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eReject/provide assistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee310 Immediate family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ee3 Support and relationships\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier/facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eProvide assistance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee320 friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11 (41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNursing assistants are lazy and ask for tips\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee340 Personal care providers and personal assistants\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe doctors did not inform the family caregivers of the treatment in detail\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee355 Health professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe family doctor's services are limited\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee450 Individual attitudes of health professionals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ee4 attitudes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCaring for the disabled elderly is an obligation and responsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee465 Social norms, practices, and ideologies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo lift in the community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee515 Architecture and construction services, systems, and policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ee5 Services, systems, and policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRemote reimbursement convenience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee530 Utility services, systems, and policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMedical insurance, disability benefits, LTC, state student loans\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee570 Social Security services, systems, and policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDirect facilitator\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eThe training and management of nursing assistants and LTC providers are inadequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ee580 Health services, systems, and policies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIndirect barrier\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this study showed that most ICF categories were linked to body function and Structure (b and s), including eight chapters on psychological function, cardiovascular and cerebrovascular function, and endocrine system function (b1,b4\u0026thinsp;~\u0026thinsp;b7,s2,s5,s8). It can be seen that caring for the disabled elderly seriously affects the physical and mental health of family caregivers. Among the linked ICF categories, the top three are energy levels (b1300), emotional functions (b152), and Sleep functions (b134), indicating that these three physical functions are more damaged. The results are similar to previous studies\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. However, in contrast to prior research, this study links the interview results with the ICF framework to find the specific impairment of the physical function and Structure of family caregivers, which is conducive to the formulation of targeted intervention programs. In this study, family caregivers indicated that they often felt tired physically and mentally, especially mentally. It may be related to the traditional Chinese concept that family caregivers must help disabled, older adults manage daily affairs and make complex decisions. Previous studies pointed out that fatigue seriously affected the quality of life of family caregivers\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. It is recommended that medical staff use comprehensive health education\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e, cognitive behavioral intervention\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e, and photo-heuristic interview follow-up based on \"4Y in place\"\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e to reduce family caregiver fatigue. This study also found that anxiety and depression are common emotional symptoms of family caregivers, and previous studies\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e have confirmed that negative emotions seriously affect family caregivers' quality of life and the prognosis of disabled, older adults after stroke. However, the family caregiver in this study mentioned that the medical staff did not help their negative emotions but that a caregiver in the same ward informed them about the treatment. Previous research has shown that mindfulness-based stress reduction training\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e, emotional freedom techniques\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e, self-guided interventions\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e, and enhanced self-efficacy\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e can be effective in alleviating negative emotions in family caregivers. It suggests that medical staff should pay attention to the negative emotions of family caregivers, evaluate them in time, and take corresponding psychological intervention measures. Compared to the first two issues, family caregivers receive less attention to sleep disorders. However, relevant studies\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e have confirmed that persistent sleep disorders can cause psychological disorders such as depression and eventually lead to suicidal behavior. It is recommended to select appropriate medications and non-medications (electroacupuncture, cognitive behavioral therapy, sleep hygiene education, exercise therapy, and phototherapy) to improve the family caregiver's sleep status according to the type of insomnia and duration of drug effects\u003csup\u003e[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe results of this study are addressed in the nine chapters (d1 to d9) of the activities and participation (d) part of the ICF, suggesting that family caregivers face more activities and limited participation in their daily lives. In the ICF-associated category, the top three are recreation and leisure (d920), assisting others (d660), and personal economic resources (d8700); this indicated that these three domains of activities and participation were more severely restricted. Previous studies \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]\u003c/sup\u003e have also reported that family caregivers face economic problems, changes in close relationships, and social isolation. This may be related to the fact that the most affected activities and participation of the disabled elderly after stroke are walking (d450), and family caregivers have to take complete care of the diet and daily life of the disabled elderly \u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]\u003c/sup\u003e. Strong social Support is crucial in alleviating barriers to family caregiver activities and participation. However, in the category of environmental factors (e), the top three biggest obstacles affecting the quality of life of family caregivers were as follows: products and technology for personal indoor and outdoor Mobility and transportation (e120), assets (e165), and personal care providers and personal assistants (e340) reflecting the needs of caregivers for indoor and outdoor transportation, money, and quality nursing assistant. Products and technology for personal indoor and outdoor mobility and transportation (e120) was the ICF category with the most links in the section on environmental barriers. During the interviews, family caregivers mentioned that hospitals required them to make frequent transfers to other hospitals, which seriously affected the rehabilitation process of the disabled elderly and their enthusiasm for caring for them, and that they desperately wanted to prolong their stay in the hospital. This may be related to China's imperfect payment system for rehabilitation care. Studies have shown that, although income level and medical privilege affect the length of stay, most disabled older adults are required to be \"discharged frequently\" by medical insurance \u003csup\u003e[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]\u003c/sup\u003e. In this view, the Second Hospital of Jinhua City, Zhejiang Province, takes the lead in implementing the patient-oriented model point payment method of bed-day payment in China, which can effectively alleviate the embarrassing situation of \"being discharged frequently\" and achieve the \"double reduction\" of out-of-pocket payment and medical insurance expenses for the disabled elderly. At the same time, family caregivers perceive high medical costs, low reimbursement systems, and loss of employment as adding to their financial burden. To address this social problem, the report of the 20th Party Congress in 2022 proposed the establishment of LTC nationwide to provide primary life care, medical care, and financial compensation, thereby easing the problem of crowding out medical resources and the burden of medical care on families. In this study, the awareness rate and purchase rate of LTC are low, and there are product defects. It may be related to the insufficient publicity of LTC. In this regard, the insurance company and the government should strengthen the product publicity investment, optimize the product design, and improve the claims service.\u003c/p\u003e \u003cp\u003eOn the other hand, the long-term care insurance reimbursement catalog should be enhanced, and the reimbursement rate for the primary care portion for severely disabled elderly should be increased to promote the development of the long-term care insurance industry and alleviate the level of third-party disability of family caregivers. In addition, family caregivers report that there are too few responsible nursing assistants, and they are too expensive. The results are consistent with Wenchao Yu et al. \u003csup\u003e[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]\u003c/sup\u003e. To this, it is suggested that third-party training institutions strengthen care technology and moral training and construct a \"digital care\" star evaluation system to query a care professional level, professional ethics, and service satisfaction, such as data providing a reference for family caregivers when choosing nursing assistants. Family caregivers also indicated that the services provided by family doctors were too few to meet their basic needs. Therefore, the government should pay more attention to allocating primary medical resources, strengthening the training of primary professionals, building intelligent communities, and improving the service level of primary medical institutions. In addition, hospitals can design scientific home-based rehabilitation programs and implement them through community and home-based rehabilitation and elderly care models to realize the three-level interconnection of \"home-community-institution\" rehabilitation and elderly care and further improve the service level of primary medical institutions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe problem of elderly care for the disabled elderly after a stroke needs to be solved urgently. Family caregivers face difficulties such as physical health impairment, mental health impairment, increase in care tasks, estrangement of close relationships, termination of entertainment and social interaction, increasing economic pressure, lack of support system, care difficulties, and needs. Relevant plans should be put forward based on the actual situation in local areas to further improve the quality of life of the disabled elderly after stroke and their family caregivers. This interview object is limited to parts and can be carried out in different areas of further study in the future.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank funding and all the professionals involved in research support and data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNa Li was responsible for designing the study, conducting the interviews, interpreting the data, and drafting the text. Yongqing Zhang was responsible for conducting the interviews and interpreting the data. Yili Gao was responsible for interpreting the data. Jiawen Qin was responsible for interpreting the data. Yang Liao was responsible for\u0026nbsp;interpreting the data. Xiaoshan Rong was accountable for interpreting the data. Haiping Yu was responsible for designing the study and critically reviewing the article\u0026apos;s intellectual content, support, and guidance. All authors reviewed the manuscript. The author(s) read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work is supported by the Shanghai Pudong New Area Health Science and Technology Project (PW2022A-03), the Tongji University project (JS2210204), and the Shanghai Pudong New Area Health System Discipline Leader Training Project (PWRd2022-16).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis paper represents essential data from the author\u0026apos;s master\u0026apos;s thesis. The data analyzed during the study is private, but the corresponding author can provide it upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe methods and protocol for this study were approved by the ethical review committee of\u0026nbsp;East Hospital, Affiliated with Tongji University(NO.2022-130). The Declaration of Helsinki performed this study. All participants received written and verbal information about the study\u0026apos;s aim. All participants gave informed consent and were anonymized before data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests. The study has yet to be peer-reviewed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e School of Medicine, Tongji University, NO. 500 Zhennan Road, Putuo District, Shanghai 200331, China. \u003csup\u003e2\u003c/sup\u003eDepartment of Cardiology, East Hospital Affiliated to Tongji University, NO. 1800 Yuntai Road, Pudong New Area, Shanghai 200120, China. \u003csup\u003e3\u003c/sup\u003eDepartment of Physical Examination Center, East Hospital Affiliated to Tongji University, NO. 1800 Yuntai Road, Pudong New Area, Shanghai 200120, China. \u0026nbsp;\u003csup\u003e4\u003c/sup\u003eDepartment of Neurological Rehabilitation, Yangzhi Rehabilitation Hospital Affiliated to Tongji University, NO. 2209 Guangxing Road, Songjiang District, Shanghai 201619, China. \u003csup\u003e5\u003c/sup\u003eDepartment of Nursing, Yangzhi Rehabilitation Hospital Affiliated to Tongji University, NO. 2209 Guangxing Road, Songjiang District, Shanghai 201619, China. \u003csup\u003e6\u003c/sup\u003eDepartment of Nursing, East Hospital Affiliated to Tongji University, NO. 1800 Yuntai Road, Pudong New Area, Shanghai 200120, China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWang W, Jiang B, Sun H, et al. 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As the degree of disability of the disabled elderly increases, the challenges faced by family caregivers also increase. Based on the International Classification of Functioning, Disability and Health (ICF), it is essential to explore the third-party disability status of family caregivers of the disabled elderly after stroke and to understand the blocking factors, which will help to improve the quality of life of the family caregivers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e This study was a qualitative descriptive study based on semi-structured face-to-face interviews. To explore the caring experience of 27 family caregivers of disabled elderly in Shanghai by purposive sampling. The Colaizzi 7-step analysis method was used to analyze the data and form themes. Finally, identify the elements of third-party disability for family caregivers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Third-party disability among family caregivers of disabled elderly after stroke can be summarized into eight themes: physical health impairment, mental health impairment, increase in care tasks, estrangement of close relationships, termination of entertainment and social interaction, increasing economic pressure, lack of support system, care difficulties and needs.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: Third-party disabilities are more severe among family caregivers of the disabled elderly. All sectors of society should attach great importance to the needs of family caregivers of the disabled elderly and address practical difficulties to achieve healthy aging.\u003c/p\u003e","manuscriptTitle":"Third-party disability in family caregivers of disabled elderly after stroke based on ICF framework: a qualitative study in Shanghai, China","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-10 08:48:04","doi":"10.21203/rs.3.rs-4605875/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-07-31T17:58:45+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"262050096562937436140047459205494140612","date":"2025-07-24T06:08:16+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-21T14:08:25+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"170299626742389657161892429143105836986","date":"2025-07-16T12:42:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-02T16:45:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"9536476667607735244039747225163548938","date":"2024-08-26T16:10:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"90382482694361919961352576335518195579","date":"2024-08-24T16:26:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288902566236470323256373515217369154075","date":"2024-08-16T11:20:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-16T11:06:09+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-25T13:18:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-24T13:25:05+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-20T11:50:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2024-06-19T12:21:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1a46b3ca-d286-473a-90dc-6bf16e6a4f19","owner":[],"postedDate":"July 10th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-03-09T16:09:20+00:00","versionOfRecord":{"articleIdentity":"rs-4605875","link":"https://doi.org/10.1186/s12877-026-07249-5","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-03-03 15:57:45","publishedOnDateReadable":"March 3rd, 2026"},"versionCreatedAt":"2024-07-10 08:48:04","video":"","vorDoi":"10.1186/s12877-026-07249-5","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07249-5","workflowStages":[]},"version":"v1","identity":"rs-4605875","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4605875","identity":"rs-4605875","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}