認知症を引き起こす原因疾患の可能性について身近な支援者が分析することを見立てと呼び，原因疾患を見つけ，取り除くことで低下した脳機能が回復する認知症がある．介護従事者が見立てのプロセスを学べるようにするため，治療可能な認知症と学習者の知識を表現するための見立て表現モデルを設計した．協調学習会にて学習者の見立てを分析した結果，見立ての表現モデルが学びの評価に有用であり，学習者のもつ知識に基づいた見立ての知識の集積につながる見通しを得た．

筆者らは，マルチモーダルケア技法のユマニチュード®️に着目し，認知症ケアスキルの情報学的評価と，Minskyの多重思考モデルを用いた認知症ケア知のモデル設計を進めてきた． 本稿では認知症ケア協調学習環境における指導行為に着目し，指導者の指導知識を多重思考モデルを用いて表出化した結果について述べる．

包括的な社会課題解決に向けて，住民，行政，企業が持続的に共創するために，地域密着型リビングラボの研究に取り組んでいるが，共創の一つの課題は，抱えている問題を表現できない/しづらい人がいることである．本稿では，彼らとの共創に向けて，福岡県大牟田市の認知症ケアの哲学と実践を踏まえたパーソンセンタードデザインという方法論を提案する．このウェルビーイング志向のアプローチにより，合理主義的な近代社会における社会課題解決を目指す．

本稿では認知症のある人の個性表現を基にした自立を重視した生活環境デザインの評価について述べる． 筆者らは生活支援を評価する環境を構築するため，認知症のある人の自立支援において先駆的な取り組みを実施している介護施設の記録を分析し，個性表現モデルの構造を設計した．設計を基に作成した個性表現ツリーによって，生活データの繋がりが見て取れ，施設ごとの記録の比較や分析が可能となった。これにより施設の実績を客観的に評価することが可能となり，ツリーを導入した学習は介護スタッフの自立支援に対する意識改革に有効であることが示唆された。

目的：
高齢者の薬物治療は多剤併用による有害事象の出現など課題が多い．しかし認知症高齢者の薬物治療の影響についての詳細な報告は未だ乏しい．

方法：
愛知県豊橋市の病院に，2012年1月～2016年12月に入院，死亡退院し，剖検により臨床神経病理学的に認知症と確定診断された患者を対象に後ろ向き観察研究を行った．基本属性，入院時臨床症状，入院前一年間のBPSD・老年症候群等を収集，対象患者を入院時持参の薬剤数で二群間に分け（≥5剤/多剤併用vs. ≤4剤/非多剤併用）比較した．多剤併用及び慎重に投与すべき薬剤の生命予後期間への影響をKaplan-Meier法及びCox回帰分析にて推定した．薬効分類は薬価基準収載医薬品コードに，慎重に投与すべき薬剤は「高齢者の安全な薬物療法ガイドライン2015（日本老年医学会編集）」に従った．

結果：
対象者76名の平均持参薬剤数は4剤であった．内，39.5％が多剤併用であった．観察項目の二群間比較では老年症候群の歩行障害が多剤併用群（93.3％）に有意に多かった．慎重投与薬剤の処方は多剤併用群に有意に多かった（p＜0.001）．Kaplan-Meier法による生存期間の二群間比較では≥5剤群が≤4剤群より短い傾向が示された（p=0.067）．生命予後期間への影響は，多剤併用で短縮リスクが高い傾向にあり，これは性別及び入院時年齢での調整でより顕著であった（調整ハザード比，1.631；95%CI，0.991～2.683；p=0.054）．慎重投与薬剤の有無及び，睡眠鎮静剤，抗不安剤，精神神経用剤，その他の中枢神経用薬，ベンゾジアゼピン系薬剤は，生命予後への影響は観察されなかった．

結論：
本研究により人生の終末期にある認知症高齢者への多剤併用は，生命予後短縮のリスクとなる傾向が示唆された．

本研究の目的は，「認知症高齢者のその人らしさを尊重したケア」に関する認識と実践の実態とその影響要因を明 らかにすることである．全国329か所のグループホームのうち研究同意の得られた32施設のケア提供者250名を対象に先 行研究で得られたその人らしさを尊重したケアを示す14項目についての認識と実施に関する質問紙調査を行った．その結果,「その人らしさを尊重したケア」14項目とも十分認識されていたが，実施は有意に低かった．「その人らしさを尊重したケア」14項目に影響する要因は，僅かではあるが，認知症ケア経験年数が14項目中4 項目に影響し，研修回数が 1 項目に影響していた

本研究の目的は，認知症の行動・心理症状（BPSD）を有する要支援者の要介護状態への移行予防についての示唆を得ることである．A 市の2014 年度と2016 年度の介護保険認定調査データより，心身機能や日常生活動作（ADL），手段的日常生活動作（IADL）の観点からBPSD 関連項目に該当する要支援高齢者が要介護状態へ悪化する要因についてロジスティック回帰分析を用いて検討した．その結果，介護度の悪化には，「薬の内服」，「日常の意思決定」，「金銭の管理」が，維持・改善には，「歩行」が有意に関連していた．つまり，BPSD 関連項目に該当する要支援高齢者に対しては，介護度の悪化を予防するために，早期よりIADL の低下予防に介入し自立を支援することや日常生活場面での意思決定を支援することが重要であり，また，歩行能力の向上を図ることは，介護度の維持・改善へつながることが示唆された．

超高齢社会の到来により，高齢者がどこに住まうか/どのようにして住み慣れた地域に住まい続けるか，という高齢者の 居場所をめぐる課題・問題が顕在化している。本研究では，認知症等により，判断能力が不十分となった高齢者の居場所について，成年後見人による支援事例を通して検討する。これにより，後見人による居住環境支援のあり方，および後見 人の居住環境支援の機能について明らかにする。そして（任意後見制度を含む）成年後見制度を用いた，超高齢社会での 高齢者の住まい方について，自宅や地域で最期まで暮らし続けることを目指す"Aging in Place"の観点から考察する。

目的：
認知症者やその家族の心情を再現するバーチャルリアリティ（以下「VR認知症」）装置を用いて，地域住民の認知症に対する理解の促進と偏見の軽減・除去に関する有用性を実証した．

方法：
T県N町のA地区85名を介入群，B地区95名を非介入群としてVR認知症体験をA地区のみ実施し，介入前後に35項目の理解度・偏見度テストを両地区とも行った．

結果：
分析対象としたのは，A地区77名，B地区82名であり，性別，年齢，理解度・偏見度テストにおける介入前のベースラインは近似していた．A地区では35項目中9項目（理解度7項目，偏見度2項目）に，B地区では2項目（理解度1項目，偏見度1項目）に有意な得点上昇が認められた．VR認知症の学習効果として，有意に得点が上昇した項目数を単純に比較した場合，A地区は9/35（25.7%），B地区は2/35（5.7%）であり，A地区の方が20%以上高かった．また，B地区に比べ，A地区の方が認知症に対する理解度と偏見度との関連が体験後に高まっていた．

結論：
VR認知症は，地域住民における認知症者に対する理解の促進および偏見の軽減・除去にとって有用な技術である一方，VR認知症の一般化をより図る上で，他の普及啓発方法との比較検討，VR装置やコンテンツの進化が望まれる．

訪問看護師が行っている、在宅で生活する認知症高齢者に対する疼痛マネジメントの内容を明らかにすることを目的とし、10名の訪問看護師を対象に半構造化インタビューを実施、質的帰納的に分析した。その結果24のサブカテゴリー、8のカテゴリーが得られた。訪問看護師は標準的な認知症高齢者の疼痛マネジメントに加え、在宅看護のヘルスアセスメントの特性から生活全体を視野に入れた疼痛マネジメントを実施していた。また自らの訪問時の情報に加え、家族や他職種から得た情報から、利用者の生活全体を想像し総合的にアセスメントする視点が重要であり、多職種でアセスメントの視点と情報を共有する工夫が求められていることが示唆された。さらに訪問看護師は疼痛の存在が明確でなくとも、疑われる場合は薬物・非薬物療法を実施し、平常時の日常生活の行動変化から疼痛評価を実施していた。今後全国調査により疼痛マネジメントの実際を明らかにする必要がある。

目的:
本研究ではPearlinの「認知症介護ストレスモデル」に基づいた概念モデルを作成し、在宅認知症者の介護者がうつ状態に至る要因を明らかにすることを目的とした。

方法・結果:
質問紙調査を行い、男性103名、女性124名を分析対象とした。介護者の64.8%にうつ状態がみられたが、性差はみられなかった。介護負担感、自己効力感、自尊感情の得点も性差はなかった。介護者の背景要因の因子分析を行い、抽出した因子をモデルに投入して性差による多母集団同時分析を実施し、良好な適合度を得た。介護者は、背景要因が最もうつ状態に影響していた。男性介護者は、介護負担感、自己効力感のパス係数が女性と比較して大きかったが、女性介護者は自尊感情が大きかった。

結論:
介護者の背景要因に加え、男性介護者では自己効力感、女性では自尊感情の維持に働きかけることが、うつ状態の予防において重要な要因となることが考えられた。

Those who have the greatest need for excellent design are often the most vulnerable in society. These people may find it difficult or impossible to articulate their design requirements due to physical, sensory or memory impairment as a result of accident or disease. Finding ways to understand the challenges they face moment-by-moment and day-by-day is vital. Empathic and compassionate approaches that place an individual central to the design process can inform outcomes that significantly benefit the user as well as those that care for them.

This paper presents research that aims to support the wellbeing of people living with advanced dementia by designing to promote pleasure and positive emotion. The LAUGH project is a recently completed international three-year UK AHRC funded design research project. Outputs from the study include a collection of playful objects, designed to provide comfort, pleasure and fun. This paper describes the research process underpinning the development of the designs and the Compassionate Design methodology that has informed the work.

The design narratives behind the playful objects will be explained in relation to the three key themes of Compassionate Design, which stress the importance of personalization, sensory stimulation and maintaining connections between people and the world.

Objectives:
There is a lack of understanding about how adolescents perceive dementia, and what their dementia related experiences are. Without such information, it is hard to make a case for the need to raise awareness of dementia in adolescents, and the best strategies to achieve this.

Methods:
In a cohort of 901 adolescents (aged 13–18) from the South East of England, we explored what the experiences and perceptions of dementia were using a series of questionnaires. Descriptive data of individual items were reported, comparing differences between genders.

Results:
The adolescents within this study tended to have positive or neutral attitudes towards dementia, though there was evidence that a proportion of adolescents had misconceptions or held negative attitudes (e.g. 28.5% of adolescents disagreed with the statement ‘In general, I have positive attitudes about people with dementia’). We also identified that the adolescents had a range of experiences of dementia including providing some form of care for someone with dementia (23.2%), though most had indirect contact with dementia through TV and movies (77.3%), or adverts (80.2%). Females nearly always had better attitudes towards dementia and had significantly more contact with dementia.

Conclusions:M35 Considering that adolescents are already forming negative attitudes and misconceptions of dementia, it is important that we raise awareness about dementia in this age group.

Objectives:
The quality of the relationship between people with dementia and their informal caregiver maybe an important determinant of life satisfaction and well-being for both members of the dyad. Taking a dyadic perspective, the aim of this study was to examine whether self- and partner-rated relationship quality influences life satisfaction and well-being for both people with dementia and their caregivers.

Design and methods:
Using data from 1283 dyads in the Improving the Experience of Dementia and Enhancing Active Life (IDEAL) cohort, we examined the impact of current relationship quality on life satisfaction and well-being in dementia caregiving dyads. Data were analysed using the Actor–Partner Interdependence Model (APIM) framework.

Results:
Self-rated relationship quality was associated with own life satisfaction and well-being for both people with dementia and caregivers. Partner-rated relationship quality did not influence own life satisfaction or well-being for either member of the dyad.

Conclusion:
This study is the first to use the APIM framework to explore the dyadic associations between relationship quality and life satisfaction and well-being in a large cohort of dementia caregiving dyads. The obtained findings suggest that the individual perception of the quality of the caregiving relationship held by each member of the caregiving dyad is an important factor for that member’s life satisfaction and well-being, while the partner’s perception of relationship quality is not. The findings highlight the importance of considering the individual perspective of both the person with dementia and the caregiver and enabling each to maintain positive perceptions of relationship quality.

Aims:
To understand factors influencing the experience of carers for people with dementia, when that person moves from living in the community to living in residential care. Specifically, we aimed to identify facilitators and inhibitors of M38carer adjustment during this transition.

Method: A systematic search of CINAHL, EMBASE, PubMed, and PsycINFO databases was conducted. Nine qualitative articles published between 2001 and 2017, based on the experiences of 141 carers, were included. Thematic analysis was applied to the data, with the concepts of transition inhibitors and facilitators being used to structure the analytic process.

Results: Analysis produced five themes, representing factors that could affect carer experiences of the focal transition-process: modifying the difficulty of this process according to their presence or absence. The themes were (1) Connection, pertaining to the carer feeling connected to the person with dementia and professionals during this transition; (2) Informed & Informing, relating to exchange of information between the carer and facility staff or health professionals; (3) The facility: welcoming & skilful, dealing with carer perceptions of the facility and their confidence in the staff; (4) It’s What You Make of It, discussing the meaning the carer made of the admission and the impact this had; and (5) Sharing Responsibility, addressing how carers were affected by the perceived sharing of responsibility for care-provision.

Conclusions: A supportive network has a significant role to play in facilitating this transition for carers. However, further research into what carers would find useful during this time is needed.

Objectives:
To compare quality of life (QOL) of family carers of persons with young- (YOD) to late-onset dementia (LOD).

Methods:
This was a cross-sectional comparison of 88 carers of persons with YOD and 100 carers of persons with LOD. The Quality of Life – Alzheimer’s Disease questionnaire (QOL–AD) was used to measure QOL of both carers and persons with dementia. Depressive symptoms were measured by the Geriatric Depression Scale (GDS) for carers and the Cornell Scale for Depression in Dementia for persons with dementia. Care burden was measured by the Relatives’ Stress Scale. Activities of Daily Living (ADL) of the persons with dementia were assessed using the total score from the Lawton & Brody Instrumental-ADL scale and the Physical Self-Maintenance Scale. Multiple linear regression models with interactions between covariates and group (YOD versus LOD) were estimated.

Results:
The QOL–AD scores of YOD-carers were significantly poorer compared to LOD-carers (mean difference 2.5 (95% CI 0.7; 4.3), p = 0.006). Poorer QOL of carers was associated with more depressive symptoms (mean QOL-AD change −0.5 (−0.6; −0.3), p < 0.001), but with no difference between the two groups. In contrast to LOD, QOL of carers of people with YOD was also significantly associated with symptom duration (p = 0.002), depressive symptoms of the persons with dementia (p = 0.030), ADL (p = 0.001), and carer burden (p = 0.002).

Conclusion:
YOD-carers reported significantly poorer QOL compared to LOD-carers. QOL was significantly associated with depressive symptoms in carers of both groups.

Aim:
The present study examined the association between depression of persons with dementia and family caregiver burden, as well as whether the association depended on the level of caregivers’ ability to find positives in caregiving.

Method:
Based on the medical records of local mental health hospital and the statistics of an epidemiological survey, this cross-sectional study included 157 major family caregivers of non-institutionalized dementia patients in the rural sector of Western China’s Sichuan Province. They responded to the Cornell Scale for Depression in Dementia (CSDD), a short version of Zarit Burden Interview (ZBI), a sub-scale of a caregiver meaning scale, and demographic questions.

Results:
Controlling for the demographic variables of the caregivers, this study found that dementia patients’ depression level was significantly associated with caregiver burden (p < .001), and the caregivers’ levels of finding positives in caregiving significantly moderated the association (p< .05). Moreover, the positive correlation between dementia patients’ depression and caregiver burden was weaker among the family caregivers with high level of finding positives in caregiving, compared with those with low level of finding positives in caregiving.

Conclusion:
This research suggests the importance of facilitating family caregivers of dementia patients to find positives in caregiving. It provides initial data for the development of dementia caregiver burden interventions that are based on the understanding of the deep meaning of dementia caregiving.

Dementia is a neurocognitive disorder that affects a person's abilities in daily functioning. Anxiety and depression symptoms are common among persons with dementia. Cognitive behavioural therapy (CBT) has been tested to manage their depression and anxiety symptoms. However, the purpose of CBT in managing these symptoms is unclear. Therefore, this paper aims to clarify whether CBT can be used to reduce depression and anxiety symptoms in persons with dementia. The electronic databases PubMed, PsycINFO, MEDLINE, and CINAHL were used to locate relevant studies. Eleven studies, which involved a total of 116 older adults, were identified. The findings suggest that CBT can be effective in reducing depression and anxiety symptoms. Based on our current review, the findings from previous studies form a promising foundation on which to conduct a major randomized controlled trial with a larger sample size. This review discusses some of the most important considerations in applying CBT to persons with dementia, and these may be beneficial for future studies that explore this area and seek more conclusive evidence on the use of CBT.

Aim:
The objective of this study was to elucidate the effects of a sense of attachment to the community (attachment) and participation in community activities (participation) on motivation to participate in dementia prevention and support activities (motivation).

Methods:
We conducted a nationwide Web‐based questionnaire survey of 1693 men and women aged ≥20 years. The questionnaire items used in the analysis asked about the following: (i) demographic characteristics (i.e. gender, age, marital status, household income (monitor‐registered data), elderly family members, number of years of residency); (ii) attachment; (iii) participation; (iv) self‐assessment of dementia knowledge; (v) nursing care experience; (vi) contact with individuals with dementia; (vii) attitudes towards dementia and people with dementia; and (viii) motivation.

Results:
Positivity towards dementia and negativity towards dementia were extracted as factors in exploratory factor analysis of attitudes towards dementia and people with dementia. Multiple regression analysis with extracted factors as dependent variables showed that attachment and participation exerted positive effects on attitudes towards dementia (both P < 0.001). The direct effects of attachment and participation on motivation were significant in hierarchical multiple regression analysis (both P < 0.001), and path analysis demonstrated the paths of the effects of attachment and participation on motivation (both P < 0.001). The bias‐corrected bootstrap method showed that both attachment and participation exerted direct and indirect (via the mediation of attitudes towards dementia) effects on motivation to participate in the community (all P < 0.001).

Conclusion:
The results showed that attachment and participation were both determinants of positive attitudes towards dementia and, thus, exerted effects on motivation, both directly and indirectly. These findings suggested that the enhancement of attachment and promotion of participation could lead to the promotion of dementia prevention and support activities in communities and increase dementia awareness.

Aim:
The positive effects of animal‐assisted interventions (AAIs) in people with dementia have been frequently reported in the literature. However, it remains unclear if the positive effects are directly due to the presence of the animal. The aim of this study was to investigate if the inclusion of an animal adds value to psychosocial interventions for people with dementia.

Methods:
The study followed a within‐subject design with two studied conditions (AAI and control intervention) and several measurement points (baseline (i.e. at beginning of the intervention), after 3 months, and after 6 months). Nineteen nursing home residents with dementia participated in the AAI (with a dog) and the control intervention. Both interventions were delivered as weekly group sessions over a period of 6 months. Outcomes examined were social interaction, emotional expression, and behavioural and psychological symptoms. These outcomes were evaluated by using video recordings at baseline and after 3 and 6 months.

Results:
Nineteen patients with moderate to moderately severe dementia who lived in two nursing homes in Germany were included. During the AAI, we detected significantly longer and more frequent periods of positive emotions (pleasure) and social interaction (e.g. touch, body movements) than during the control intervention.

Conclusion:
The presence of a dog appears to have beneficial effects on psychosocial intervention for people with dementia.