【アブストラクト】
目的：認知症患者のQOL（quality of life）について，本人による評価と介護者による代理評価との一致に関する研究はあるが，在宅療養患者のためのQOL評価票をもちいて検討したものはない．本研究の目的は，主介護者などの代理人に回答を求めるQOL評価票の作成と，本人の回答との一致性について検討することとした．
　
方法：この研究は在宅患者の観察研究である．我々が開発した，4つの質問からなるQOL評価票であるQOL-HC（QOL for patients receiving home-based medical care）（本人用）に基づいて，QOL-HC（介護者用）を作成した．また，QOL-HC（本人用）とQOL-HC（介護者用）を用いて，患者本人と主介護者から回答を求め，それぞれの質問への回答の一致率についてクロス集計表を用いて考察した．また，合計得点についてはSpearmanの順位相関係数を求めた．
　
結果：質問1「おだやかな気持ちで過ごしていますか．」，質問2「現在まで充実した人生だった，と感じていますか．」，質問3「話し相手になる人がいますか．」，質問4「介護に関するサービスに満足していますか．」について，本人と介護者の回答の一致率は，それぞれ52.3％，52.3％，79.5％，81.8％であった．また，QOL-HC（本人用）合計点とQOL-HC（介護者用）合計点について有意な弱い相関を認めた（Spearmanのρ＝0.364*，p=0.015）．結論：本人と介護者による評価とに50％以上の一致率をみとめ，合計点について有意な相関をみとめた．介護者による評価を参考にできる可能性はあるが，評価のかい離の要因およびQOL-HC（介護者用）の信頼性の検討が必要である．

【アブストラクト】
目的：本研究の目的は高齢者施設における認知症高齢者の生活支障を具体的に明らかにするために，認知症高齢者の生活支障尺度を開発することである．
　
研究方法：平成29年3月～5月に介護老人保健施設に入居しており，認知症と診断された高齢者，または認知症高齢者の日常生活自立度II以上と評価されている高齢者で研究協力の同意が得られた者を対象に，生活支障尺度などを調査した．対象者は191名（男性47名：24.6％，女性144名：75.4％）であった．平均年齢は85.72（±6.96）歳，平均要介護度は3.73（±1.22），平均MMSEは9.11（±8.80）であった．生活支障尺度の因子分析の結果，第1因子は「基本的生活行動やコミュニケーションに関する生活支障」，第2因子は「焦燥や混乱に関連した生活支障」，第3因子は「感情や判断力低下に関連した人間関係のトラブル」，第4因子は「意識の変化や繰り返される行動に関連した生活支障」と命名された．4因子ともクロンバッハのα係数は0.705～0.884，NPIおよびクリクトン高齢者行動尺度と有意な相関が認められた．
　
結論：以上の結果から，生活支障尺度の尺度としての信頼性・妥当性は確保され，今後，老人保健施設の生活上のトラブルを解決する有効な尺度であることが明らかになった．

【アブストラクト】
わが国における急性期病院で，認知症高齢者をケアする看護師の困難感に関する研究の動向を文献検討により明らかにした。医学中央雑誌Web版とCiNiiを用いて，キーワードは「認知症高齢者」，「看護師」，「困難」とし検索した。対象期間は1982年から2017年12月とした。急性期病院で認知症高齢者をケアする看護師を対象とした困難感が記載されている9件の文献を分析対象とした。文献は，著者・対象・目的・方法・結果ごとに整理した。9件の研究において，質的研究7件と量的研究2件それぞれ分析した。急性期病院で認知症高齢者をケアする看護師の困難感に関する研究は，超高齢社会に伴い，2002年から報告され，2012年以降に増加していた。質的研究では，急性期病院で認知症高齢者をケアする看護師の困難感は，認知症高齢者の理解に対する困難感，病院という環境に関連する困難感，認知症高齢者に対する尊重した看護に関する困難感の3つに分類された。量的研究では，多くの看護師が困難感を抱いていることが明らかにされつつあるが，今後は，困難感の程度やどのような看護師が困難感を強く感じるのかなど関連要因を明らかにしていくことが望まれる。

【アブストラクト】
Aim
To build a dementia screening system in the community to facilitate collaboration among patients/caregiver(s), family clinic physicians and memory clinic specialists.

Methods
We placed a Dementia Network Promoter (DNP) in four cities in Mie prefecture, Japan. Based on requests from patients/caregiver(s), family clinic physicians ordered dementia screening from the DNP. The DNP carried out screenings at the clinic using an IT device (iPad), and sent the results to a dementia specialist at the Mie University Hospital Dementia Center. The dementia specialist assessed the results of the screening tests, and made a treatment recommendation for a follow‐up consultation with a memory clinic or continuing observation by the family clinic. The DNP reported the recommendation of the dementia specialist to the family clinic physician, who provided this information to the patients/caregiver(s). We investigated the characteristics of the patients referred for consultation with the memory clinic.

Results
A total of 158 patients participated in the screening. The majority of patients were in vulnerable living situations characterized by minimal social and family support. The mean score on the Mini‐Mental State Examination was 24.1 ± 5.2. Of patients screened, 62% were referred for consultation at the memory clinic, and 57% of those referred completed a consultation at the memory clinic. Patients referred to the memory clinic showed significantly worse cognitive function and ability to complete activities of daily living.

Conclusions
A dementia screening system might facilitate early consultation and intervention for patients with dementia, and build a more effective network to connect families and memory clinics.

【アブストラクト】
Objectives: This study evaluated the effectiveness of a Compassion-Focused Therapy (CFT) group on reducing anxiety, depression, and respiratory rate (RR) in people with dementia (PwD) and their spouses, and improving quality of life (QoL) of PwD.

Method: Sixty-four participants completed six weekly CFT sessions. Baseline and post-intervention assessments were analyzed using t-tests and Reliability Change Index.

Results: Mean baseline and post-assessment anxiety and depression scores fell in the ‘normal range’; although a significant reduction in depression with moderate effect was observed for PwD. Fifty-seven percent of PwD with borderline to abnormal baseline scores showed clinically significant improvement in anxiety and depression. For spouses, 80% showed clinically significant improvement in depression and 50% in anxiety. RR reduced for PwD and spouses with large and medium effects respectively. QoL of PwD improved with a large effect.

Conclusions: CFT appears effective in improving QoL and depression in PwD and reducing RR in PwD and spouses. CFT reduces anxiety and depression in most PwD and spouses with borderline to abnormal symptoms.

Clinical Implications: This study indicates benefits of a group-CFT intervention delivered to people with a range of dementia diagnosis and their spouses. The service should investigate whether individuals in greater distress are not accessing the group and improve engagement.

【アブストラクト】
Aims and objectives
To explore the impact of early‐stage dementia on care recipient/carer dyads’ confidence or belief in their capacity to manage the behavioural and functional changes associated with dementia and to access appropriate support networks.

Background
Living with dementia has predominantly been explored from the carer perspective and focused on the stress and burden of supporting a person with dementia. There has been a shift towards a more positive discourse to accommodate the role of self‐efficacy in supporting self‐management by people living with dementia. However, little has been reported on the dyadic experience of self‐efficacy in managing life with dementia.

Design
A qualitative study using an interpretive descriptive approach. Semi‐structured interviews were conducted with 13 dyads in the early stages of dementia. The collected data underwent a process of thematic analysis. The study followed the COnsolidated criteria for REporting Qualitative research (COREQ) checklist.

Results
Dyadic adjustment to dementia was dynamic, involving shifts between loss and adaptation. Threats to self‐efficacy, declining autonomy and stigma, were significant causes of concern for both members of the dyad. Dyadic self‐efficacy was demonstrated through recognition of and adaptation to dementia‐related changes and development of coping strategies to integrate impairment into everyday life.

Conclusions
Solution‐focused approaches that improve knowledge and skills enable the dyad to adjust. The considerable impact of stigma on self‐efficacy indicates that supportive disclosure strategies developed in mental health may also have a role to play in dementia interventions.

Relevance to clinical practice
Nurses play a significant role in advising and supporting care recipient/carer dyads with dementia, and a better understanding of the dyadic perspective provides them with essential information to support self‐management. A proactive approach including information and support, offered at the beginning of the condition/care trajectory, may have the potential to delay progression into more dependent stages.

【アブストラクト】
Background: Staying in the hospital can be a very stressful experience for older people with dementia. A familiar face and reassuring voice of a family member or friend can offer a sense of safety and comfort.

Aims: To explore the feasibility and acceptability of using an iPad Simulated Presence Therapy intervention with hospitalized older people with dementia.

Design: We used a mixed-method design, incorporated video-ethnographic methods, video-recorded observations, and staff interviews.

Methods: Four people with dementia from an older adult mental health hospital unit in British Columbia, Canada participated in two weeks of iPad Simulated Presence Therapy intervention. The intervention involved the older person watching a one-minute video prepared by their family prior to receiving care. The video included a reassuring, comforting and supportive message to be played to the older adult with dementia while staff perform a specific care task. The care interactions with the iPad intervention were video-recorded. Staff interviews were conducted to elicit perceived enabling factors and barriers to use the iPad intervention in their practice. Using an inductive and deductive approach, we applied a qualitative thematic analysis to identify themes in our data set.

Results: We identified four themes: (a) positive responses, (b) person-centred care, (c) video content, and (d) technical skills.

Conclusion: The iPad delivered Simulated Presence Therapy is an acceptable and feasible means of supporting the care of older people with dementia in the hospital setting. Considerations for future research and clinical practice are presented.

【アブストラクト】
Aim
The aim of the present study was to investigate the association between the activities of daily living and the oral health‐related quality of life and dementia in older adults.

Methods
Over a period of 18 months, we visited 12 elderly care facilities and recruited 375 participants, 345 of whom were selected to undergo oral health examinations and oral health‐related surveys. Each investigation was carried out face‐to‐face by a professional worker.

Results
Cognitive ability was found to be good when the results of the activities of daily living and the oral health‐related quality of life examinations were good. If the results of the activities of daily living examination were bad, the odds ratio of dementia was 2.66, and adjusted odds ratio for age, sex, residence type, education level and denture was 2.99, representing a significant difference (P < 0.05).

Conclusions
Most oral problems are not simply the outcome of aging, with oral hygiene management being the most important determining factor. Oral health problems can be prevented, and in order to improve the quality of life of older adults, attention must be paid to oral healthcare.

【アブストラクト】
Patients with semantic dementia (SD) can rapidly and successfully re-learn word labels during cognitive intervention. This new learning, however, usually remains rigid and context-dependent. Conceptual enrichment (COEN) training is a therapy approach aimed to produce more flexible and generalisable learning in SD. In this study we compare generalisation and maintenance of learning after COEN with performance achieved using a classical naming therapy (NT). The study recruited a 62-year-old woman with SD. An AB1ACAB2 experimental design was implemented, with naming performance assessed at baseline, post- intervention, 3 and 6 weeks after the end of each treatment phase. Three generalisation tasks were also assessed pre- and post-intervention. Naming post-intervention improved significantly following both therapies, however, words trained using COEN therapy showed a significantly greater degree of generalisation than those trained under NT. In addition, only words trained with COEN continued to show significant improvements compared with baseline performance when assessed 6 weeks after practice ceased. It was concluded that therapies based on conceptual enrichment of the semantic network facilitate relearning of words and enhance generalisation in patients with SD.

【アブストラクト】
Background: The prevalence of dementia is rising globally. Many patients suffer from the burdensome complications of advanced dementia as they are still poorly addressed.

Aims: To describe the development of an interdisciplinary palliative homecare program for patients with advanced dementia and to develop a workflow that delineates the seamless continuation of care between the hospital and community with the homecare program.

Design: Palliative care needs of patients and caregivers were established through a qualitative review of the literature. Appraisal tools were chosen based on their validity and feasibility in the homecare setting. Gaps in the healthcare system were identified and addressed as part of the integration of care between the hospital and the community. Setting/participants: Patients at Functional Assessment Staging (FAST) 7 with pneumonia, albumin level <35 g/L and/or enteral feeding were enrolled from a tertiary care hospital into the homecare program.

Results: Patients’ symptom burden and quality of life were assessed. Caregivers were engaged in the planning of patients’ care. With the homecare program, patients and caregivers received support at home. Two physicians, seven nurses, and three social work professionals were educated about advanced dementia palliative care and medical information was communicated between different healthcare sites. Preliminary analysis of 306 patients revealed the presence of pain and neuropsychiatric behaviors. Impact of caregiving was mild to moderately severe.

Conclusion: Advanced dementia is under-recognized as a terminal illness requiring specialized palliative intervention. Integrating a homecare palliative program into advanced dementia care is the first step towards palliating suffering at the end-of-life."