provided enlightening information on the diculty of Japanese caregivers in terms of various correlates along with their resulting mental fatigue, in a university hospital setting. However, I fear that the authors reached some rather gratuitous conclusions based on so-called `cultural dierences'. The patient gender, they concluded, was signiยฎcantly related to the caregiver burden and patient behavioral disturbances.
The fact that there have been few studies in Western countries demonstrating relationships between (1) patient gender and patient behavioral disturbances (Donaldson et al., 1997), and/or (2) patient gender and caregiver burden, should give one reason to pause for thought (Dunkin and Anderson, 1998). In my own caregiver burden study in northern Japan (Arai et al., 1997), using the Japanese version of the Zarit Caregiver Burden Scale, I found no such relationships. Nor was there any evidence in my more recent study (Arai and Washio, 1999).
Could these so-called cultural dierences' be a misnomer for dierences deriving rather from dierent ways of measuring caregiver burden and/ or the type of subjects? Since the scale used in the Nagatomo study was validated in Japanese but not in other languages, their results would not be comparable to those of studies conducted in Western countries. University hospital patients, moreover, would not necessarily be representative. With all the current talk of geriatrics and the gentle crusade' of caregiving as the new frontier, there is a tempting undertow in cross-cultural studies to leap to conclusions. When comparable measures are used, the observed dierences' tend to disappear between East and West'.