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Centre for Public Policy Studies 公共政策研究中
心
7-1997
Filial piety and caregiving burden in Shanghai,
People's Republic of China
William T. LIU
Elena S. H. YU
Shang Gong SUN
Yin KEAN
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Liu, W. T., Yu, E. S. H., Sun, S. G. & Kean, Y. (1997). Filial piety and caregiving burden in Shanghai, People's Republic of China (CPPS
Working Papers Series no.60). Retrieved from Lingnan University website: http://commons.ln.edu.hk/cppswp/104
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Working Paper Series
Centre for Public Policy Studies
No. 60 (1 6/97) CPPS
FILIAL PIETY AND CAREGIVING
BURDEN IN SHANGHAI, PEOPLE'S
REPUBLIC OF CHINA
by
William T. Liu
Elena S. H. Yu
Faculty of Social Sciences
Lingnan College
Hong Kong
香港嶺南學院
社會科學院
No. 60 (16/97) CPPS
FILIAL PIETY AND CAREGIVING
BURDEN IN SHANGHAI, PEOPLE'S
REPUBLIC OF CHINA
by
uu
啥
-bn
THMD 翎
缸
仙叫沁 U
W日制
UY-on
nsmk
為南學 院 竄書館
2 2 DEC 1997
UNGNA N COLLEGE Ll BRARY
Faculty of Social Sciences
Lingnan College
Hong Kong
July 1997
FILIAL PIETY AND CAREGJVING BU則)EN
IN SHANGHAI , PEOPLE'S REPUBlJC OF CHINA
CAPS and CPPS Working Papers are circulated to invite discussion and critical
comment. Opinions expressed in them are the author's and should not be taken as
representing the opinions of the Centres or Lingnan College. These papers may be
freely circulated but they are not to be quoted without the writtcn permission of the
autho r. Please address comments and suggestions to the author or the series editors.
(Ç)
Willianl T. Liu, Elena S. H. Yu, Sun Shang Gong and Yin Kean
Professor William T. Liu 1s Visiting Professor of Department of Politics
and Sociology, Lingnan College, l10ng Kong.
Professor Elena S. H. Yu is Professor of Epidelníology , CÌraduate School
of Public Hea1th, San Diego State lJniversity, lJSl\.
Professor Sun Shang Gong is Professor of Biostati stic 丸
University , Beijing, PRC.
Beij ing
Medical
Professor Yin Kean is Senior 11iostatistician, Alzheimer 、 s Disease
Cooperative Study , Universìty of Californ 坊， San Diego.
Facu 1ty of Social Sciences
Lingnan College
Tuen 恥1un
Hong Kong
Tel: 26167429-32
Fax: 2591 0690
Filial Piety and Caregiving Burden
in Shanghai, People's Republic of China
(Fifth revision , July 8, 1997)
William T. Liu 1
Elena S. H. Yu 2
Sun Shang Gong
3
and
Yin Kean 4
1 Professor Emeritus of Sociology, Public Health and Psychiatry,
The University of lllinois at Chicago , USA; and
Visiting Professor of Sociology, Hong Kong Lingnan College
2 Professor ofEpidemiology, Graduate School ofPublic Health,
San Diego State University, USA
3 Professor of Biostatistics, Beijing Medical University, Beijing , PRC
4 Senior Biostatistician, Alzheimer' s Disease Cooperative Study , University of
Califorrua , San Diego
FILIAL PIETY & CAREGIVING BURDEN
IN SHANGHAI, PEOPLE'S REPUBLIC OF CHINA
We begin our paper by discussing the importance of filial piety as a social value
in the Chinese society in the long historical past as a civilization.
To introduce a
的外
Confucían precept of filial piety for a scientific paper is a difficult intellectual task and
has been discussed in the literature of social gerontology in the context of the Japanese
society (Palmore and Maeda, 1985 , Koyano , 1996). Though with data of doubtful
validity, there is the strong consensus that the importance of filial piety has declined , or
should decline in the context of a modern and urban society. Since such conclusion
came about as a result of comparing generational co-residency in the household data of
the Census , there remain some unanswered questions as to whether physical
arrangement of family living is the best indicator of a strong semi-religious value which
has persisted over the years in East Asia. The impact of filial piety as a social value,
however , has not been systematically studied. When it comes to discuss parental care
by their adu 1t children in the context of filial piety, the burden and sacrifices borne by
./
the primary caregiver would have to be interpreted through the perspective of that
persisting value , and oot in the context of a Western vaJues of individualism.
Since
social science methodologies were derived primarily as a result of studying EuroAm erican societies , a study of the impact of ftlial piety as a. social value on e1 de r1 y care
policy is indeed not an easy task Yet , in a volume that attempts to contrast the value
of elderly care between the East from the West , this effort seems to be a worthy
endeavor
There are two
di缸iculties
in the use of filial piety as a social value and an
analytical concept in the study of elder1 y care.
First and forernost is the fact that
Sociologists prefer not to deal with cultural value as a variable. For example, the
research operation is simpler and more conventional to explain the declining
importance of family care for the elderly in terms of changes that has taken place in
\,..
他尸 于λ
/
μ ~ 叫';1勻弓
，~d
A
C/:'
~ Gv 、
other institutions, such as prOVlS10nS of social security and welfare legislations,
叫uisites of 的an industrial economy on 伽 household， and 伽 like; 叫her than on
伽
declining importance of filial piety. A second source of付diffi
缸伍
ncu
切
叫
Cαω
ult句
Y 臼
1 S 仙伽
前t 伽 re 臼
a
1S
斗令 L : ， r C a叫lr叫 a st叫叩men
J
l臼翎
昀
enn叫a訂ln叫叫1昀e盯
叭r忱 ofω1比叫
lClaωi
臼a叫
I
literature. A survey of literature led to two categories of research efforts that are
germane. There
的，
to begin , the widely held proposition that technology has led the
way to small families and the reduction of family
Ogburn (1921 , and
Ogb叮n
and
Nimk。在 1955).
functions歹 a
thesis that goes back to
In addition, the much quoted work
by Goode (1961) that posited a world-wide trend offamily change towards the nuclear
family system that , by implication , would have invariable impact on the way elder1 y will
be cared for in the future. Aside from these social change theories , there has been a
few important publications on the persistence of structured male authority in the
patriarchy, in spite of revolutionary changes in these societies, in which the female
child is the victim of exploitation (Davis-Friedman , 1976; Stacey, 1983 ;
Sala宜:
1981).
This argument can easily be applied to the care of elderly parents. While the first type
of research explains why there is declining importance of family care , the second type
of research tradition does just the opposite. Instead of explaining why the practice of
elderly care by offsprings has weakened , the patriarchal thesis explains how parental
care by offsprings in China had persisted and at unbearable cost to the daughters-inlaw in following her traditional role to serve the parents of her husband . (Wol f, 1972;
Hu , 1995 ; 1996)
2
The “ patriarchy" argument , valid as it may be, tend to view elderly care of
one's parents as a form of service that required personal sacrifice unwillingly. To
employ the “ patriarchy" concept in the study of Asian social relations is consistent with
assumptions behind similar studies conducted in the United States , where there is the
absence of patriarchy.
Women-abuse occur in every society, induding Western
European and North Am erican countries.
Patriarchy is , however, an institutional
practice that labels a bias in terms of male authority and power. In the West , ideal
egalitarian nu c1 ear family household prevailed , exploitation of women in elderly care is
not uncommon. F or example, it is widely ac c1 aimed that elderly care is largely the care
of elderly parents by unmarried middle-aged daughters , or "the woman in the middle."
between her duties to provide care for the elderly parents on one hand , and on the
other hand , to take care of her own young children at the same time (Brody, 1981)
主拉 立九
The women caregiver-being-exploited-under-the-patriarchy system argument
has some serious 1imitations. The assumption of the patriarchy thesis traces factors of
caregiving in the family to the structural problem of familial authority. It ignores the
various caregiving roles in the family as a small informal group in which caregiving
may be based on the necessity of dividion of labour. Furthermore, though difficult to
articulate, patriarchy and filial piety are not one and the same. Pilial Piety is perhaps
one of the characteristics of patriarchy type of kin-structure under Confucianism, it is
neither a necessary attribute nor a
rεsultant
value of patriarchy in non-Confucian
cu1tures. The inlportance of filial piety as the moral foundation of an intitutional
U
arrangement in the care of elderly in which caregiving by adult children is conceiveably
driven by the need for mutual parent-child dependency and which resulted in a
subjective definition of willingness in the care relationships. Pilial piety of this kind
3
have been illustrated in literally hundreds of traditional essays on bereavement in the
Confucian classical literature, and in modern cinemas, stage plays, and short stories
with strong themes of regrets and guilt of the caregiving offsþrings when death took
their parents (Davis-Friedman, 1981)
A second criticism against the use of filial piety as a research concept came
少 r P/~~，
from one current view in social sciences with respect to the social status of the elder1y
川γ
Palmore and Maeda (1985) cited the proposition in the literature that modernization of
(/1
vv á.'1
、 t. ~
a traditional society causes low status and social integration for the aged (Cottrell,
…
1960; Cowgill and Holmes , 1972). This view is consistent with Marxian assertion that
l
叫
I
of 伽 aged
可 mos討t
\"--t>
is determined by the
ir枷
elder1y in an industrial society are retired and are not connected
1the loss of social status in old age is therefore expected
-'、
1- ï h 以
叫d
悅伽…
e缸rm
叫
1
,
叫
wit出
h
production ,
Since one most important
attribute of filial piety is to honor and respect one' s elderly parents , it follows that ,
status 企om
?~ι(
without institutional support of the elder1y
J
d)/t (':
segments of the society, filial piety as a social norm in modernizing and modernized
societies is expected to decline
the political and economic
,
Filial piety is a difficult and elusive concept with which to deal in research.
Even though Classicists and Social Hi storians are welI aware of the impact of
Confucianism in the development of social institutions in a number of Asian societies ,
very few attempts have been made by Social Scientists to treat filial piety as a social
value that paralleled the way Max Weber treated Protestant Ethic to the development
of modern Capitalism iri Europe. Though Protestant Ethic is a mental construct that
exist only in the mind of the researcher, it nonetheless had profoundly altered the way
4
people think and behave after the Reformation. If one could accept Weberian thesis ,
there
shou心o prob叫en to 叫ept …手。的叫ecept 0叫 P川 a
conc削 in dealing with the theme of 你向 caregiving by the
offspring as a
supreme
filial 叫叫叫t in 心心
f企t切
om
a loss of social integration with the
soci昀
et句
y，
nor have they suffered from a loss of
social status as measured by a number of criteria (Palmore and Maeda, 1985; Lee, Lee ,
Sun, Yu , and Liu in this volume) is perhaps sufficient to illustrate the very existence of
such social values , in spite of structural changes in the socioeconomy. Am azingly little
change has taken place in the ideal norm of inter-generational dependency in J apan and
China, given the fact that both societies have experienced considerable industrial and
technological changes in the economy, urban transformation, women in labor force;
housing shortage, prolonged life expectancy, high degree of residentìal mobìlity, the
universal public education mandate , delayed marriage for women, demographic
transitions , and the like, all of which have been identified as factors associated with the
independence of the nu cI ear family in a modern socìety. In China in particular, forced
nuclearization of the family since 1950 along with attempts to destroy patriarchal
authority through confiscation of clan land and symbols of lineage, all or none has
contributed to the weakening of the persistence of filial piety as a social value. Instead
and contrary to expectation, some studies have also shown in fact that there is a
positive association between monetary/sociopolitical assets and chronological age in
Japan (Howe , 1996; and our own survey in Shanghai , Yu , et aI., 1989). The Shanghai
study showed that older people have more economic resources , a wider network of
social contacts , and command a higher degree of respect from others in spite of a
general deprivation of early childhood education prior to the socialist generation
5
戶 /
(Chen, 1987).
In countries of East and Southeast Asia where Confucian Ethic
prevails, there seem to be c1 early stated government policies in promoting the 'mode of
elderly care by their adu1t children through legislation that provide tax inc. entives in
building multi-genera-tional residential housing that will keep stem families intact (see
Hu, Hu and Chou, Mehta, in this volume, and Lee , forthcoming)
Abundant evidence is available to show the persistence of filial piety in these
societies notwithstanding, some scholars preferred to
ar學le
that there may be a
tendency towards the weakening of filial piety (see Koyano , 1996 and in this volume,
and Philips, 1988). The evidence of the de c1 ining value of filial piety argument was
based on public opinion polls over the decades which asked both the younger and older
subjects about their preference in sharing residence. However , even with declining
figures in the case of Japan, two out of three elderly still do live with their offspring as
late as in the 1990s. Evidence can be marshalled to argue that the 20% decline of the
stem family household over a period of five decades can be better explained by other
factors , among which is the increasing and critical shortage of living space in urban
Japan. This explanation is partially
confinr，~d
by Koyano (1996) , who showed that the
percentage of co-residence with adult children is lower in Tokyo , the capital city in
which living space shortage is the most acute in the entire country. The point is that the\)
de c1 ining trend
of 山ring
residence with elderly parents may not be a valid
indication 冬 以
J
of the de c1 ining value of filial piety.
Filial Piety as a Social Fact
Most Sociologists , following the early theorists , bui1t asystem of explanation
of social change through the experience of 18th and 19th Century Europe. In the case
6
of relating the Reformation and the Protestant Ethic to the spirit of capitalism, Weber
was among the very few who sought to include a contrast between European
experience and the experience of lndia and China.
，九Teber' s
insight into the nature of
social values in shaping the social action and social structure has made an unique and
original contribution to both comparative historicism and to the science of society. The
methodology used by Weber (Weber, trans . 1951 ; trans. 1958 ; and Eisenstadt, 1968)
in dealing with social values led us to consider Confucian Ethic has the same
explanatory property as the Protestant Ethic 1 in our attempt to construct a valid
argument in dealing with change in Confucian societies
2
Confucianism has had a lasting in f1uence on the nationwide Civil Service
Examination , which provided an unusua) degree of opportunities for social mobility
through self-perpetuating validation of social status of Confucian literati.
Most
relevant to the present topic of elderly care , however, lies in the Confucian teaching of
moral principles of proper socia1 relations of different types of dyad , both familial and
空空n-fa哇哇lial
空空re
are fiv巳 basi立 。也~~ ruler and citizens; fi 1i al; conjugal; sibling; and
friendship . Fron1 these five sets of dyadic relationship , and because of the patriarchal
and patrilineal nature of the family system that existed , the relationships of secondary
dyads are derived following the basic rules of the original five dyads . These rules were
rigidly observed at one time through rituals that were particularly important during the
阿附1ω
叫
叫
O
d 叫
southeast China, including Hong Kong , Taiwan and ethnic Chinese cornmunities in
1 Similar v.ork was done on the Japanese society by Robert Bellah in his volumne, Tokugavva
Religion, New York: Free Press , 1961
A ve可T insight制， but less known paper by Adamantia Pol1 is that dealt with Modern Greek concept
of self had discuss this issue with respect to the di宜erence between Greek society and Western
European society. See A Pollis , (1 965) “ Political Implications of the Modern Greek Concept of Self'
2
The
B川 tish
Journa/ of
Socioloεy，
XVI, 1: 29-47
7
southeast Asia.
In the analysis of derivetive relations , a “ positiùn" is to follow a
general principle of generation (dai in Chinese, sei in Japanese) and gender. Gender
variation is further determined by marital status in the life cycle because, in an unilineal
system, a married woman is no longer a member of her own natallineage. Instead , she
is a member of her husband' s lineage.
She therefore lTIUst follow the rules of
relationship in that lineage, and her intra-clan status is derived from her husband status
modified by gender.
generαtion
t\
In short, the two dominant ascriptive status are gender and
in a partiarchal-patrilineal system
Of five basic dyads within the nuclear family , the dominant dyad in a Chinese
society is the father -son dyad 3 . In contrast to the Western society which emphasized
the husband-wife dyad , the father-son dyad was the principle building block of the the
social as well as the political system, typified by the authoritarian and collective
oriented values.
On theother hand , in a society where the dominant dyad is the
husband-wife dyad , the dominant attributes in institutional values are egalitarian and
individualism oriented values , an exposition which was first discussed in detail by Hsu
J mhmibl叫lon 0的叫
It is therefore possible to treat filial piety as a individual behavior embedded in
the culture such that an interpretative causal explanation of its course and
consequences can be understood .
Like Weber in his explanation of the Protestant
values to the development of economy (Weber, trans. 1958), we view Confucian
precept of filial piety as an explanation of the persistence of political and business
3 the five basic dyads in the nuclear family are not the same as the five relationships in the Confucian
socialorder. The dyads of the nuc1ear 臼 mily was made c1 ear by George P. Murdock in his classic
volume, The Social Structure, an ethnographic study of the Ulùversality of human families based on
the Yale University Human Areas Relations Fìle. The word “ dominant" is given a detailed definition
by Hsu , who introduced the notion of dominante dyad and dominant attributes , see H凹， 197 1.
8
solidarity of the clan prior to , and even include, the period of Socialist regime. Unless
and until it is substituted by another normative system, filial piety, for both its
protective function and not infrequently its coercive power in the multi-generational
family , should be viewed as an significant cultural attribute in Confucian societies. It is
against the context of the filial piety oriented social norm we interprete the data
collected in Shanghai in the late 1980s on careglvlng relations and the careglvlng
burden
The Shanghai Study
Caregiving study in China, compared to Japan , is underserved by social
scientists studying China and Chinese culture.
In view of the pervasive influence of
Confucianism and the social value of filial piety in the past , and subsequent efforts to
destroy the same by the State and the Party on mainland. China, the topic emerges as an
important research focus . At this time , because of longevity of life achieved for the
first time in the long history of China, coupled with a rapid decline of marital fertility ,
the state policy on elderly care has legally been assigned to , and loaded on , the
offspring , as clearly specified in the Chinese Constitution. During the period of antiConfucian and anti-old traditions campaign , a legal imposition without sufficient
respect to the moral foundation that supplied as the norm of the law raises questions
both in terms of law and in Sociology. There is woefully little data to address such
issues as to how elderly care may become a major topic for debate in the future
4
.
The
To date, we know of only one published systematic study (Yu, Liu , Levy et al., 1993) of Chinese
careglvlng. This previous paper a1so emerged from the same 1a.rge dataset on which the present paper
is based. The previous paper (Y u, Liu , Wang , Levy , et al. 1993) dealt with the comparative burden
studies between caregivers who took care of cognitively demented elderly and those who took care of
physically dependent elderly , including those who su宜ered from blindness and deafness. Interesting
but not surprising1y, the authors reported t11at caregivers to physically dependent relatives reported
4
9
Shanghai Epidemiological Study of the Elderly and Senile Dementia is perhaps thefirst
attempt to address this question
Detailed description of the sample design and data collection of the Shanghai
Study of Elderly are available elsewhere in several other jounral publications (Yu， L心，
et a1., 1989; Le內已 Yu ， Liu, et al. , 1989; Katzman, Zhang, et al., 1988; and Yu, Liu,
Wang, Levy, et a1., 1993) and shall not be repeated here.
Briefly, a community
population sample of 5, 055 elderly individuals was drawn in 1987 from one of the
eight health districts in Shanghai. Subjects were 55 years old and over. The Shanghai
Study has published more than a dozen journal papers is known as the Shαnghai
Epiemiological Study of the Aged and Senile Dementia. lnitially,in 1987 , the study
s
consisted of two phases . The first phase dealt with socio-demographic information,
cognitive impairment screening instrument, measures of depression by CES-D , and a
series of querries concerning the
li袋，
health, and soci a1 support measures. The second
phase consists of intensive evaluation of those who were screened as probable
dementia through the use of a Chinese version of
(CMMSE) by a team of experts in Neurology ,
Mini-弘1ental
Status Examination
Neuropsycholog)九 Psychometricians，
and Psychiatry
The Caregiver Interview
The Caregiver interview had followed and in parallel with the first phase study
When the subject scored below a certain cut-off point on the C孔心的 E， the rest of the
more burden and sacrifices than those who took care of demented relatives. In this regard, it is a
surprising finding against papers published in the Western journals that described caregiving to
demented and victims of Alzheimer's Disease suffered most in terms ofburden
5 The Shanghai Epidemiological Survey continues as at the time of this writing in 1997 , ten years
after the initial first wave interview, to obtain panel data 2, 5 , and 10 years from survivors ofthe
original 5 ,055 individuals.
-aAAU
interview was then conducted with a caregiver, or someone who was closest to the
subject. A more detailed procedural descrption is available in Yu , Liu , Wang , et al
(1993).
1n that paper, the authors identified two types of caregivers that are
functionally and linguistically (in Chinese) differentiated , namely:
kαnhuren
(one who
watches and protects the elderly) , and zhao /i ao zhe (one who cares , manages , or
attends to
someo 肘 's
needs). There were, as expected, some overlap in the precise
duties of the two types of caregiver. Kanhuren can can be assumed by a child or an
elderly caregiver, \vhereas the
zhαoliαo
zhe does the actual serving, and is normally an
adu1t who takes the responsibilitíes of routine care. The extend to whích their duties
overlaped vary from one family to another , and assignments are subject to be
negotiated among family members , it suffice here to say that the total number of
caregivers in the generic sense for this study is 292 for cognitively impaired and 212
for those who were seriously ill, physically dependent , blind , and deaf, etc. Al togather
there were 504 caregivers in the study
Measures of Tolerance and Burden of Care
A
Caregiνer
Tolerance
Scαle
(Zarit, Reever, and Back-Peterson, 1980; Zarit et
al., 1985) was used to assess the caregiver's tolerance with each of the 28 behavioral
problems of the elderly (for check list, see
Zerit , 0[[, and
Zar泣， 1982~
Zerit and
Zer此，
1985). The tolerance scale is recorded on
a five point scale , from 0 (can tolerate when it occurs) to 4 (can not tolerate). 1n other
word , the higher the score , the less the individual caregiver can tolerate
The burden of care was assessed using the Montgome!y and Borgatta Burden
Scale (1986) . The scale requires the caregiver to compare his/her situation between
11
the time of interview and a year prior to the interview in the following areas: time to
onesel f, stress in relationship with care recipient, personal privacy, attempts by care
recipient to manipulate caregiver, time to spend in recreational activities, vacation
activities and trips
taken ，的rvousness
and depression concerning relationship with care
recipient , time to do own work and daily chores , demands by care recipient over and
above needs , and time for own friends/relatives. Responses range from 1 (a lot less) to
5 ( a lot more) , with 3 representing the same. Responses in 1 and 2 ( a lot less or less)
are considered no burden
The Burden Scale was subsequent1y divided into Subjective Burden and
Objective Burden in the current paper. Objective Burden measures
the loss of personal time to caregiving.
There are six questions incIuded in the
objective burden, they are : time to oneself; personal privacy; time for activities; time
for vacation; time for own work , and time for own friends and relatives.
Subjective Burden means burden as a resu1t of having difficulties with the carerecipient.
There are four questions that include: stressful relationship with the care
recipient; being manipulated; feeling nervousness or depressed , and unreasonable
demands from the recipient of caregiving
Sacrifice measures how much caregiver has to sacrifice as a resu1t of taking
care of the elderly.
The ten-items that caregivers may have to sacrifice are: change
job , quit job , shorten work hours , change work hours , change residence , change sleep
place , change diet , rearrange furniture , hire someone to help taking care of elderly, and
pinch pennies
12
CES-D is a measure of depressive symptomologies developed by the Center of
Epidemiologic Studies of the U. S. N ational Institute of Mental Health. It has 20 items
scoring from 0 to 3 with a total sum ranges from 0 to 60
The Hypotheses
The asymmetric nature of an patrilineal family system that favors the male line
of authority and inheritance has also clearly defined the gender specified filial
obligations.
In the course of social change, the actual behavior that adheres to
Confucian ideal norm may vary.
This is particularly relevant in cases where social
change itself involves the change of population dynamics that led to the increased life
expectations and the declining fertility in a society, and the subsequent change of
relationships between the old and the young
When such norm is found to be inconsistent with the
social structural
characteristics and demands of competing values in that society, there is the compelling
force for b elievers to
traditional value
6
“ stretch
the value" in one' s interpretation of the blue-print of a
.
For example , in an U.S. based exploratory study, subjects (students from Taiwan in the United
States
were asked to give a simple answer in a hypothetical situation that ended in a moral dilemma with
reference to Confucian Ethic. The hypothetical situaüon is that the subject had been scheduled to give
a seminar paper which could provide the basis for a reference letter from the professor relative to
future employment opportunities. But later the subject was told just a day before the scheduled
seminar that his father would arrive on the smne day scheduled for the seminar. The stop-over at the
airport would be the OIÙy chance for the father to see him and that there was no opportunity for them
to have another meeting in the foreseeable 臼ture . The father insisted that he find an excuse so that
they could meet at the airport. When he went to see the professor, the professor made it c1 ear that
either the paper is given on the scheduled hour, or there would be no presentation from him at a11, the
resu1t would be very unfavorable with respect to the letter needed for future employment seeking. The
conflicting demands made it impossible for the subject to meet both responsibilities on the same day
The subject was-asked to make a decision 剖ld give reasons
6
In the course of answering t1ùs question , an overwhelming majority of the subjects , facing a
different and American social pressure , chose to present the seminar paper rather 出an rneeting the
13
Our hypothesis will first take up the asymmetrical nature of the obligation in
filial piety first in terms of gender. We assert that there is a gender difference between
men and women in terms of the sense of filial obligation and the feeling of parental
care-burden:
。k
In a Confucian society, the unequal filiaI responsibilities tend to be
assigned to the son rather than the daughter with respect to caregiving
to the elder1y parents
CorollaηT
A. Parental care is viewed essentially a filial duty , sons are more
tolerant than daughters with respect to caregiving burden
Corollary B. There is no ditference between sons and daughters when it
comes to measure objective burden because objective burden is
determined by the tasks involved, rather than feelings of obligations
Corollary C . When objective burden is removed歹 there is a wider margin of
ditference between sons and daughters as caregivers to their elderly
parents with respect to total burden fe 1t in giving such care
Corollary D. There is a difference between sons and daughters with respect
to feelings of personal sacrifice in giving care to elder1y parents. This is
so because it is easy for the son to keep his routine if his wife can help
with chores in his place than it is for the daughter to ask her husband to
do the same, in terms of the customery gender role obligations. For this
reason daughters are more likely than sons to repo 討 personal sacrifices
in providing caregiving duties
CoroUary E . Daughters, as compared to sons, have a higher level of
depressive symptoms associated with being the caregiver to their aged
parents because of higher subjective burden and higher sacrifice scores.
至今
Regardless of ger飢 employment 吼叫 is an impo口創 factor in
determining feelings of burden, tolerance level , and sense of sacrifice
fathe r. As to the reason for choosing that as a course action, most said that filial piety has two m句 or
components: please one's parents; and glorify them. Subjects argued that they would glorify the
parents if they could land on a good job later , even though the parent would be disappointed at the
airport. To strech the value of filial piety in a changing situation is the justification for the subject to
choose a more immediately disappointing solution over an immediately gratifying so.lution to the
father. In stretching the value , it proves that the value is nonetheless an important constraint, and
there is a solution to dischargìng one's filial obligations. ln either case , subjects splitted
requirements of filial piety in order to llla1 ntain old values in a new situation in which the dìlemma
must be resolved
14
Corollary A. In general , caregivers with outside employment tend to be less
tolerant, feeling sacrificed more, but at the same time give lower level
of depressive symptoms than caregivers without outside employment.
Corollary B. ün the other hand, caregiver without outside employment, tend
to have much less subjective feelings of care-burden than caregivers
with outside jobs. 1n other word , subjective feelings of burden tend to
This
be lnuch inf1 ated when the caregiver has an outside job.
assumption is based on the social comparison theory if the outside job is
rewarding , the care chores would be comparαtively boring and
burdensome
The age of the caregiver is an important facto r. Y ounger caregivers tend to be
less tolerant than older (than 55 years of age) caregivers who must have had the taste
of disability themselves.
However , older caregivers (defined here as 55 years old and
over and in China entering a retirement age for women and for early retired men),
because of age , have fewer other responsibilities , are less likely to feel that taking care
of a spouse, for exalnple, is a waste of personal time and activities. There is, however,
the possibility that older caregivers may feel that taking someone else' s disability
problem is an added burden to one' s own health , and must therefore sacrifice more in
order to carry out such duties.
1n a non-Confucian society where filial piety is a less
significant social norm , younger caregivers would probably show a higher senses of
“ sacrifice" because caregiving is time and energy consuming. It goes without saying
that younger caregivers would at the same time have higher subjective feeling of careburden
戶:
ülder caregivers tend to have greater tQl~旦旦旦旦 -坦vel ， higher level of
objective , but lower subjective , burden; and a higher level of fee 1ings of
sacrifice than younger caregivers
The concept of objective versus subjective feeling of burden is worthy further
explication. 1t is suggested (see Hong and Liu, in this volume), that care-burden is a
15
function of the type of social relationship prior to the disability of the elderly. As such,
it is defined by a sense of obligations owed , and appreciation given, to the elderly
These are not subj ect to precise measuring except in the manner of assessing the
strength and direction (i.e., positive/negative) of the attitude.
These are subjective
feelings (of careburden)
On the other hand , the number of hours one must spend to take care of the
elderly relative , and how such caring chores may interfere with personal goals and daily
activities may be considered as objective measures of care-burden.
It is therefore reasonable to disaggregate scores of care-burden to show
separately subjective
vs. objective care-burden.
We have earlier in this paper
discussed that in the Confucian society, there is an asymmetrical djstribution of filial
duties in the falnily on the basis of gender.
It is gender that probably provides an
important clue to the study of care-burden. We therefore propose
H4
Male caregiver 、 s subjective burden is expected to be higher than female
caregiver' s burden when measured sub)叮tively if the careglvlng is
given to elderly who are laterally related kins , a relation that does not
imply filial duties
An d, for similar reasons
H5
On the other hand , the subjective care-burden is expected to be lower
for male than female caregiver if the relationship is lineal or
intergenerational because of the demands of male gender-role
obligations in the context offi lial pìe 矽
16
The Findings
Table 1 and Figure 1 showed Corollary A of Hypothesis 1 is confirmed in that
male caregiver has a lower tolerance score (lneaning can tolerate without much
difficulty) than female caregivers
In reading these tables , figures are given in average z-scores of each scale (e.g. ,
tolerance , objective and subjective burden sub-scales, CES-D scale). A mean z-score
below 0 suggests that the average score of a particular stratified group is below the
average of the unstratified group . For example in figure 1 under tolerance scale, the
average score for male is lower than the overall average score (the average of both
male and female combined) , which means higher tolerance attitudes when the carerecipient behaves badly. The higher the tolerance score, the less one is tolerant given
the way these scores are assigned.
In comparison, female had higher tolerance scores
than male as well as higher than the average score of combined male and female
subjects. It means females are less tolerant when recipients of care behave badly as
indicated on the Tolerance Scale.
Furthermore , rnale and female have the biggest
difference in their subjective burden score compared with tolerance, objective burden ,
sacrifice, CES-D scores as we hypothesized
Figure 1 shows the same as figures shown in Table 1, that essentially confirmed
all of the corollaries included in Hypothesis 1: Sons are rnore tolerant than daughters;
the difference of objective burden between sons and daughters are nil , difference
between subjective burden between male and female caregiver was at its greatest
discrepency of al1 contrasts; sons sacrificed less than daughters and had fewer
depressive symptomologies
17
Sociodenlographic Characteristics for Shanghai E lderly and Caregivers.
Table 1.
\Veighted
Unweighted
Elderly
Age
55-64
65-74
75+
Mean (SE lY1ean)
Sex
(945 .4 6)
16.2
28 .4
55 .4
(613)
6.5
24.1
69.3
77.15 (8.09)
74 .5 1 (0.53)
(613)
22.0
78.0
(945 .4 6)
20.8
79.2
Education
Il li terate
S e m i-Li t e r a t e (S ish u )
Elementary
High School or more
(612)
59.3
14.7
15.5
10.5
(944.24)
57.2
15 .4
16 .4
1 1. 0
Ï\1arital Status
(613)
2.6
6 1. 0
36 .4
(945 .4 6)
3.3
55.7
4 1. 0
Clinical Diagnoses *
Al zheimer
Dementia
Possible
Normal
Reversable
(397)
2 1. 7
12.6
15.9
48.6
1. 3
(628 .4 8)
17.3
12 .1
16.9
52.2
1. 5
M Ì\ 1SE
0-13
(397)
40.6
34.3
25.2
( 628 .4 S)
36.1
35.9
28.0
Male
Female
Single
Spouseless
~1arried
14~17
18~20
Ì\1ean (SE Ì\ 1ean)
13.80 (4.57)
18
14.23 (0.24)
Table 1. (Continue)
、Veighted
Unweighted
Caregiver
Ag e
15-24
25-34
35-44
45-54
55-64
65-74
75+
4 .4
10 .4
13 .4
14.8
23.7
19.2
14.0
Mean (SE Mean)
Sex
Male
Female
Education
Illiterate
Semi-Literate (Sishu)
Elementary
High School or more
d--2.
20. 。
13.3
(613)
45.2
54.8
(945 .4 6)
47 .4
52.6
(611)
13.9
8.2
17.7
60.2
(943.02)
(613)
(945 .4 6)
12.7
13. 。
8.1
17 .4
61.5
11. 9
叮
A 川 lJ
a
11. 9
12.2
75.9
••
BA
75 .4
Relationship be twee n Caregiver
and Elderly
(613)
Spouse
28.2 .
ChildrenjChildren-in-la\v
5 1. 9
ParentsjSiblingsjRelatives 13.2
Other
6.7
(945 .4 6)
3 1. 7
49.9
12.0
6.4
Ij
/
F
、 du
、‘
~lderl y
n
u
、
on
'
di3gnosεs perforn1εd
a 可
川
、
ny
一門 δ-，
司.
1可們 64i
/'t 、 、
Living Si tuation
(611 )
Livin g: \丸.ith eld 己 rl v
88 .5
1 1. 5
Living apart from el derly
*N o cl iíli cal
54.71 (0.90)
55.26 (17.05)
冉、
v
『、 4
σ。
n 泊
S-UU
扎
Ma -mSSL
s-3
ui--'ivtpEdMU
uti
••
(945 .4 6)
4.7
12.3
13.0
13.3
23 .4
(613)
who did not do l\1ì\1S E (:\ =2 16).
19
FfiG
l
Gender Differences in Tolerence , Burden , S<l crifice , and CES.D Scale
。 15
0.1
0.05
。
5O
U草
r、」
c
~ -0.05
E
Tolerence
~.l.
Burden
Objective
M. Burden
Subjective
20
Sacrifice
CES.D
Figure 2 shows the effect of employment (having an outside job in addition to
caregiving at home) on care-burden, tolerance , sacrifi伐， and CES-D symptomologies
Here the data suggest that unemployed had lower tolerance score, which means they
are more tolerant than those who did not have outside employment. Employed outside
the home also had lower objective burden lower subjective burden, and lower CES-D
scores. There was virtually no difference in the feeling of sacrifice one must make in
taking care of the elderly between those who had , and those who did not have ,
employment at the time of interview. Taking together, we are led to believe that full
time careglvlng was more stressful than careglvlng with outside employment
diversions
Figure 3 shows more tolerance (1 ower score on tolerance scale) for the older
caregivers than younger caregivers. The old versus young has the cut-off age at 55
years of age. This is indeed a rather crude measure , the difference is barely discernible
The objective burden for the younger caregiver was higher for younger caregiver than
older one. Older caregiver manifested a much higher subjective burden than younger
caregiver , but similar sacrifice pattern.
The CES-D manifestation of depression
showed the largest difference was between older and younger caregivers. Y ounger
caregivers had a much lower score than older ones
Consistent with hypothesis 1, H4 assumes , in terms of gender difference , male
caregiver had a lower subject burden than female caregiver when the care recipient is a
spouse. The reverse is true if the recipient is a non-specified relative. In the case if the
caregiver is an adult child and recipients is either of the parents , or if the caregiver is an
son or daughter in-law , within the framew ork of a lineal structure of the family,
daughter-in-laws ' subject burden is the second highest of any dyadic relations . The
21
F' C-r
2
Care Burden and Employment
0.1
0.08
0.06
0.04
。
。
u
0.02
"
一x- Unemp!oyed
O
卜」
c
-0一-
~
主 -0.02
-0 .04
Tolerence
Fi cf
3
M.8urden
Objective
M. Burden
Subjeclive
Sac 而 fice
CES-D
Age Differences in Tolerence , 8urden , S<l crifice , and CES-D Scale
4l
nu
D
戶
nu
T|||l 止------­
戶口
nunu
向。
。」。
υ的
2
-NC
-0.05 一
-0 .1
-0.15
<
2vF C
什
們
V
戶』
Ti(
CV
t,\. EC1 rden
Objsctive
~，\.
Burden
Subjective
Sacri fic e
22
CE S-D
Employed
highest subjective burden is felt when the woman had to take care of her husband
When the caregiver is a relative of unspecified nature , the male and female subjective
burden score differences is the samllest of any pair relations , and that female caregiver
has shown in rare occasions lower than the male relative caregiver.
This is shown in
Figure 4 . Figure 4 confirmed H 4.
Figure 5 shows that there is an interactive effect between having an outside
employment and the nature of social relationships and how they may impact on
subjective burden. Since social relations is the basis of measuring subjective burden,
the question one must ask is if having an outside employment wi Jl dilute or increase the
feeling of burden when the focus is on providing care to an elderly
Apparently , when the caregiver was a spouse , employment was a relief and it
contributed positively to the caring relationship . On the other hand , jf the relationship
was one that was filial , employment seem to contribute negatively to the feeling of
subjective burden . Without a job outside the home , the subjective feeling of burden
was much lowe r. This seems to be true also for someone who took care of an in-law ,
where having a job seemed to have such a negative effec t. When the social relation
was that of an ordinary and unspecified relative, havi ng an employment outside home
had no particular negative effect and the difference between having a job and not
having a job was small
Figure 6 is intended to show the relationship between tolerance (for bad
behavior on the part ofthe recipient) ofthe caregiver and the type of relationship . We
speculate that in a society dominated by the traditional value of filial
piety歹 the
only would have the feeling of the lO\\lest level of subjective burden , he
\;v ould
son not
have the
highest tolerance level with respect to unreasonable demand and bad behavior from his
23
F"~
4-
Subjective Burden and Gender
RJ
門，
ι4l
〈U
T|||Tili---1lTi--寸 lil
Aμ
可
OOOOA
。』。υ的N
﹒ C肉。三
Ai
十
lBIl--
句句
ι
呵，
-0.3
-0.4
Spouse
FI 司.5
Chi td
In Law
Rela tives
Other
Subjective Burden and Job
0.4
0.3
0.2
。』。
υ的
-NC向。三
0.1
C
-0 .1
SpOUS8
Child
In La'.
R31a tives
24
Other
r- ((qι
Tolerence and Relations
0.4
0.3
υ的N
﹒ C悶。三
。』。
0.2
0.1
ιie
明附
U
土
O
WINU sinhd
-df
.月
UH
』﹒內心
p
iJ
t PV
.0.1
.0.2
-一「
Spouse
Child
In Law
25
Rela tives
O~hε 「
parents (e.g. lowest tolerance scale scores) . On the other hand , daughters-in-law,
being the most exploited person in the framework of a patriarchal system, would have
the least tolerance when it comes to deal with her mother-in-law. We do not really
know what is the function of spousal relationship in this case. ln the previous section ,
we had speculated that tolerance level was , in the case of spousal relationship , lower
(higher scale score) for women than for men. Figure 6 shows consistent result , though
gender is not specified here. Given the fact that there were more female caregivers
who took care of their elderly husbands , it is not surprise that the total impact of
spousal care would elicit higher intolerance than the father-son relationship.
Discussion
The debate as to whether Confucian ideal of filial piety has weakened in the
post-modern Asian societies that are Westernized , modernized , and urbanized is an
important socio-historical question. The current paper is not an essay to engage in the
polemics of Confucianism in the modern world.
It
芯，
however , important to treat
"filial piety" as a explanatory social value that has consequences in individual' s
precepts and behavio r. Confucian societies are , and have been, charting their elder1 y
care policy according to the Confucian value in the absence of better, more fitting with
respect to Confucian societies, and workable altematives.
These values are being
enacted into laws with regard to elder1 y welfare , housing , tax relief, and inheritance
code. To ignore the value of “ filial piety" as non-fact does not serve the socìal
scientific community well
On the research end , the argument as to whether caregivers are over-burdened
or not , whether they are exploited or not , or whether there is a fairly balanced
26
exchange between caregiver and caregiving recipient are in need of being rigorously
studied.
The paradigm that older people wanted thejr independence and unpaid
caregiver are overburdened to the point of suffering from depression and other types of
psychological symptonls also needs to be examined in depth .
This paper deals with several questions. The function of Confucianism in the
future policy of elderly care is the moral context through which we examine the
various dyadic relationships within the nuclear family relative to one ' s sense of
subjective and objective burden experienced , levels of tolerance to the manifested
problems by the frail and increasingly dependent elderly who have real problems to
function both physically and mentally. We wish to examine the conditions under which
a person reported high or low burden for the record . We think that there are too many
variables that go into equation of rendering care , and care burden for which there is
very little data to answer these questions .
Our study indicated that in a Confucian society, gender and age may be two
important "personal" and “ relational" characteristics that impact on subjective feelings
of burden, levels of tolerance, the degree of sacrifice one lnust
rnake歹 and
the like. If
we substituted Confucian society with another type of society that is based on the
value of independence and individualism, a different profile of these variables would
undoubtedly emerge
27
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29
Research Fellows
Centre for Asian Pacific Studies
Centre for Public Policy Studies
Professor Kueh , Yak-yeo\\心
Professor Ho , Lok-sang , Director
Director
Dr. Bridges , Brian , AEP
D r. Che , Wai-kin , USL
D r. Chan, Che-po , UL
Dr. Dixon , John , AEP
Dr. Cheung , Kui-yin , UL
Dr. Fan, C. Simon, UL
Dr. Fan, C. Simon, UL
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Dr. Hiroyuki ,
Im缸， ATP
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Ms. Siu, Oi-ling , A TP
Dr. Leung , Kit-fun , Beatrice , USL
Dr. Voon , Thomas , AEP
D r. Li , Pang-kwong , UL
Dr. Wei , Xiangdong , UL
Dr. Ren , Yue , A TP
Dr. Thomson , Elspeth , ATP
Dr. Voon , Thomas , AEP
Dr. Wei , Xiangdong , UL
D r. Wong , Yiu-chung , UL
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J01n the Centres as Research Fellows or Research Associates. Please contact D r. Brian
Bridges (Te l. 2616 7172) for further information.
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29 (1/96)CAPS
Explaining China's Business Cydes
Dr. Hiroyuki lmai
30 (2/96)CPPS
Stress at Work , Coping , and Workers' Health of
an Acquired Firrn in Hong Kong
Ms. Oi-ling Siu
31 (3/96)CPPS
A Universal Fully-ftmded Pension Scheme
Dr. Lok -sang Ho
32 (4/96)CPPS
Commercialising Government: A Challenging
Agenda
Dr. John Dixon
33 (5/96)CAPS
China' s Road to Exchange Rate Liberalisation
Dr. Lok-sang Ho
(6月 6)CAPS
The Role of Hong Kong in Sino-US Economic
Relations
Professor Y.Y. Kueh and
Dr. Thomas V oon
35 (7/96)CAPS
Export Competitiveness of China and ASEAN in
the US Market
Dr. Thomas Voon
36 (8/96)CPPS
Institutional Foundations for a Just Society
Dr. Lok-sang Ho
37 (9/96)CPPS
Piece Rate Payment Schemes and the
Employment of Women: The Case of Hong
Kong
Professor J ohn S. Heywood and
Dr. Xiangdong Wei
38 (1 O/96)CPPS
Public Policy on Local Administration in Hong
Kong: Past , Present and Future
Dr. Yiu-chung Wong
39 (11196)CPPS
Occupational Stress AlTIOng Factory Workers in
Hong Kong and China: A Comparison Study
Ms. Oi-ling Siu
40 (12/96)CPPS
Wage Subsidies as a Labour Market Policy Tool
Dr. Lok-sang Ho
41 (1 3/96)CAPS
Political Pragmatism on the Chinese Campus
since 1989
Dr. Che-po Chan
42 (14/96)CPPS
Delayed Compensation and the .Hiring of Older
Workers: Evidence from Hong Kong
Professor John S. Heywood ,
Dr. Lok-sang Ho and
Dr. Xiangdong Wei
43 (15/96)CAPS
lmpacts of Foreign Policies on the Gains from
Research and Promotion
Dr. Thomas V oon
34
No.
旦控
Author
44 (1 6/96)CPPS
Hedonic Pricing for Prawn and Shrimp in the
Philippines
Dr. Thomas Voon
45 (1197) CAPS
China and the Prospects for Economic
Integration within APEC
Professor Y. Y. Kueh
46 (2/97) CAPS
Export Competition Among China and ASEAN
in the US Market: Application ofMarket Share
Models
Dr. Thomas J. V oon and
Dr. Xiangdong Wei
47
(3 月 7)
CAPS
Hong Kong' s Outward Processing Investment in
China: It s Implications on Hong Kong Economy
Dr. Kui-yin Cheung
48
(4月 7)
CAPS
China - Taiwan's Trade and Investment
Relations and their Impact on Taiwan's Income
Distribution
Dr. K. C. Lei
49 (5/97) CAPS
Overseas Chinese and F oreign Investment in
China: An Application of the Transaction Cost
Approach
Dr. C. Simon Fan
Japanese FDI , Exports and Technology Transfer
to China
Dr. Elspeth Thomson
Income Protection and the Elderly: An
Examination of Social Security Policy in
Singapore
Dr. William Keng-mun Lee
50
(6月 7)
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51 (7/97) CPPS
52
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Old Ally Versus New Friend: China's Economic
Relations with the Two Koreas
Dr. Brian Bridges
53
(9月 7)
CAPS
Hong Kong as a Financial Centre of Greater
China
Professor Y. C. Jao
54 (10/97) CAPS
The Econolnic Li叫← up of Hong Kong and
Guangdong: Structural and Developmental
Problems
Professor Shu-ki Tsang and
Dr. Yuk-shing Cheng
55 (1 1197) CPPS
Electoral Cleavages and the Post -1997 Hong
Kong 吉 s Political Dynamics
Dr. Pang-kwong Li
56 (12/97) CPPS
A Study ofOccupational Stress , Job Satisfaction,
and Quitting Intention in Hong Kong Firms: The
Role of Locus of Control and Organizational
Commitment
Ms. Oi-ling Siu
No.
Topic
Author
57 (13 /97) CPPS
A Model of l!uman Nature and Personal
Development
Professor Lok-sang I-Io
58 (14/97) CPPS
Wage Compensation for Job Risks: The Case of
Hong Kong
Dr.引人 S.
59 (15/97) CPPS
Positive Effects of Modemization on Later Life
D r. Kenneth W. K. Law
60 (16/97) CPPS
Filial Piety and Caregiving Burden in Shanghai ,
People' s Republic of China
Professor William T. Liu,
Professor Elena S. H. Yu ,
Professor Sun Shang Gong and
Professor Yin Kean
Siebert and
Dr. Xiangdong Wei
Lingnan College Library
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