Journal of Cross-Cultural Gerontology

, Volume 27, Issue 2, pp 149–161 | Cite as

Informal and Formal Support among Community-Dwelling Japanese American Elders Living Alone in Chicagoland: An In-Depth Qualitative Study

Original Article


A key public health approach to promote independent living and avoid nursing home placement is ensuring that elders can obtain adequate informal support from family and friends, as well as formal support from community services. This study aims to describe the use of informal and formal support among community-dwelling Nikkei elders living alone, and explore perceived barriers hindering their use of such support. We conducted English and Japanese semi-structured, open-ended interviews in Chicagoland with a convenience sample of 34 Nikkei elders age 60+ who were functionally independent and living alone; 9 family/friends; and 10 local service providers. According to participants, for informal support, Nikkei elders relied mainly on: family for homemaking and health management; partners for emotional and emergency support; friends for emotional and transportation support; and neighbors for emergency assistance. Perceived barriers to informal support included elders’ attitudinal impediments (feeling burdensome, reciprocating support, self-reliance), family-related interpersonal circumstances (poor communication, distance, intergenerational differences); and friendship/neighbor-related interpersonal situations (difficulty making friends, relocation, health decline/death). For formal support, Nikkei elders primarily used adult day care/cultural programs for socializing and learning and in-home care for personal/homemaking assistance and companionship. Barriers to formal support included attitudinal impediments (stoicism, privacy, frugality); perception of care (incompatibility with services, poor opinions of in-home care quality); and accessibility (geographical distance, lack of transportation). In summary, this study provides important preliminary insights for future community strategies that will target resources and training for support networks of Nikkei elders living alone to maximize their likelihood to age in place independently.


Social support Asian Americans Nikkei Older adults Community health 



We are extremely grateful to the individuals who graciously agreed to participate in this study. We also thank the following individuals for their guidance: Frances Chikahisa, Asayo Horibe, Gayle Y. Iwamasa, Tak Mizuta, Helen Nakayama, Melba Ristow, and Kiyo Yoshimura. We express special gratitude to Jean M. Fujiu for her intellectual contribution and leadership in the conception and execution of this project. We further thank Kay Kawaguchi, Beth M. Funk, Maria Papachrysanthou, and Ashlyn Pyfer for their research assistance. We also thank the Japanese American Service Committee and its staff members for their collaboration throughout the study.

Funding source

This project was conducted under a grant from the United Way of Metropolitan Chicago Venture Investment Fund Program and the United Way of Suburban Chicago Venture Investment Fund Program (Academic co-PI: Denys T. Lau, PhD; Community co-PI: Jean M. Fujiu). The funding organizations played no role in the design or conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. The authors declare no conflict of interests (personal, commercial, political, academic, or financial) related to the subject matter of this manuscript.


  1. Akhter, M. N., & Levinson, R. A. (2003). Eliminating health disparities associated with long-term care to promote graceful aging in place. Care Management Journals, 4, 88–93.Google Scholar
  2. Charles, K. K., & Sevak, P. (2005). Can family caregiving substitute for nursing home care? Journal of Health Economics, 24, 1174–1190.CrossRefGoogle Scholar
  3. Doi, M. (2003). Culture, community, and commitment: The Nikkei community assessment, 1999–2002. Chicago: Japanese American Service Committee.Google Scholar
  4. Endo, E. (2011). Who will take care of aging sansei? trends in Nikkei community foreshadow America’s future as seniors live longer, Rafu Shimpo, 19 May, 2011. Available:
  5. Hashizume, Y. (2000). Gender issues and Japanese family-centered caregiving for frail elderly parents or parents-in-law in modern Japan: From the sociocultural and historical perspectives. Public Health Nursing, 17, 25–31.CrossRefGoogle Scholar
  6. Jette, A. M., Tennstedt, S., & Crawford, S. (1995). How does formal and informal community care affect nursing home use? Journal of Gerontology. Series B, Social Sciences, 50, S4–S12.CrossRefGoogle Scholar
  7. Kamo, Y., & Zhou, M. (1994). Living arrangements of elderly Chinese and Japanese in the United States. Journal of Marriage and Family, 56, 544–558.CrossRefGoogle Scholar
  8. Kao, H. F., & Stuifbergen, A. K. (1999). Family experiences related to the decision to institutionalize an elderly member in Taiwan: An exploratory study. Social Science & Medicine, 49, 1115–1123.CrossRefGoogle Scholar
  9. Kirby, J. B., & Lau, D. T. (2010). Community and individual race/ethnicity and home health care use among elderly persons in the United States. Health Services Research, 45, 1251–1267.CrossRefGoogle Scholar
  10. LaPlante, M. P., Kaye, H. S., Kang, T., & Harrington, C. (2004). Unmet need for personal assistance services: Estimating the shortfall in hours of help and adverse consequences. Journal of Gerontology. Series B, Social Sciences, 59, S98–S108.CrossRefGoogle Scholar
  11. Lau, D. T., & Kirby, J. B. (2009). The relationship between living arrangement and preventive care use among community-dwelling elderly persons. American Journal of Public Health, 99, 1315–1321.CrossRefGoogle Scholar
  12. Lau, D. T., Scandrett, K. G., Jarzebowski, M., Holman, K., & Emanuel, L. (2007). Health-related safety: A framework to address barriers to aging in place. The Gerontologist, 47, 830–837.CrossRefGoogle Scholar
  13. Litwak, E., & Figueira, J. (1968). Technological innovation and theoretical functions of primary groups and bureaucratic structures. The American Journal of Sociology, 73, 468–481.CrossRefGoogle Scholar
  14. Machizawa, S., & Lau, D. T. (2007). Aging alone in Chicago and aging in the suburbs: An in-depth qualitative needs assessment of isolated Nikkei elders. Chicago: Japanese American Service Committee. November 2007. Available:
  15. Machizawa, S., & Lau, D. T. (2010). Psychological needs of Japanese American elders: Implications for culturally competent interventions. Journal of Cross-Cultural Gerontology, 25, 183–197.CrossRefGoogle Scholar
  16. Marek, K. D., & Rantz, M. J. (2000). Aging in place: A new model for long-term care. Nursing Administration Quarterly, 24, 1–11.Google Scholar
  17. McCormick, W. C., Ohata, C. Y., Uomoto, J., Young, H. M., Graves, A. B., Kukull, W., et al. (2002). Similarities and differences in attitudes toward long-term care between Japanese Americans and Caucasian Americans. Journal of the American Geriatrics Society, 50, 1149–1155.CrossRefGoogle Scholar
  18. Miles, M. B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded sourcebook (2nd ed.). Thousand Oaks: Sage.Google Scholar
  19. Muhr, T. (1997). ATLAS/ti-visual qualitative data analysis—management—model building in education, research and business. Berlin: Scientific Software Development.Google Scholar
  20. Nemoto, T. (1998). Subjective norms toward social support among Japanese American elderly in New York City: Why help does not always help. Journal of Community Psychology, 26, 293–316.CrossRefGoogle Scholar
  21. Olson, L. K. (2001). Age through ethnic lenses: Caring for the elderly in a multicultural society. Lanham: Rowman & Littlefield Publishers.Google Scholar
  22. U.S. Census Bureau (2012). Statistical abstract of the United States: 2012, 131st Edition, Washington, DC.Google Scholar
  23. Yamamoto, N., & Wallhagen, M. I. (1998). Service use by family caregivers in Japan. Social Science & Medicine, 47, 677–691.CrossRefGoogle Scholar
  24. Yoo, D. K. (2000). Growing up Nisei. Chicago: University of Illinois Press.Google Scholar
  25. Young, H. M., McCormick, W. M., & Vitaliano, P. P. (2002a). Attitudes toward community-based services among Japanese American families. The Gerontologist, 42, 814–825.CrossRefGoogle Scholar
  26. Young, H. M., McCormick, W. M., & Vitaliano, P. P. (2002b). Evolving values in community-based long-term care services for Japanese Americans. Advances in Nursing Science, 25, 40–56.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.College of Pharmacy, Department of Pharmacy AdministrationUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Department of Community PartnershipsThe Chicago School of Professional PsychologyChicagoUSA
  3. 3.Program Development Associate and Grant WriterMidwest Palliative & Hospice CareCenterGlenviewUSA

Personalised recommendations