結果・考察:対象者である認知症高齢者とケアスタッフはいずれもそれぞれ介入群14名、コントロール群は12名であった。ケアスタッフはそれぞれ6割以上が介護職であった。介入群の認知症高齢者は1ヵ月後のNPIの下位尺度の混乱とNPI合計、生活支障尺度の焦燥や混乱に関する生活支障が有意に改善した。ケアスタッフの認知症高齢者に対する介護の自己効力感、日本語版Maslach Burnout Inventoryの下位尺度の情緒的消耗、脱人格化などが有意に改善した。結論:生活支障尺度にケアのポイントを含めた生活支障ケアプランニングツールを用いたケア介入は認知症高齢者とケアスタッフの両方に有効であることが明らかになった。(著者抄録)
Care preferences of healthy, middle-aged adults in Japan and the USA if they acquired dementia: A cross-sectional observational study
Geriatrics & Gerontology International
Aim: Japan introduced dementia-friendly initiatives into its national policies to help people with dementia remain involved in society for as long as possible. However, some people might choose to live in a nursing home to avoid care burden on family members. Understanding middle-aged adults' preferences for place of care and identifying factors that influence their preferences would help policy decision-makers promote dementia-friendly initiatives. The present study aimed to investigate the care preferences of middle-aged adults if they acquired dementia in Japan and the USA.
Methods: We carried out a cross-sectional observational study using an internet-based questionnaire survey of Japanese residents with Japanese ethnicity, Japanese Americans, and non-Asian Americans aged 40-70 years. A total of 301 participants, including 104 Japanese residents, 93 Japanese Americans and 104 non-Asian Americans, completed the survey. Participants were asked to answer the items based on a hypothetical situation in which they had acquired dementia requiring regular care and supervision.
Results: Participants preferred nursing home care (29.9%), followed by professional home care (19.6%), family home care (17.6%) and hospital care (11.3%). Japanese residents had a significantly lower preference for professional home care than did Japanese or non-Asian Americans (adjusted odds ratio 0.28, 95% confidence interval 0.10-0.75). Between-ethnicity difference in care preferences was not observed.
Conclusions: A low preference for professional home care among the middle-aged adults might be influenced by country-specific long-term and dementia care systems. Policy decision-makers should develop professional home care services that are more available for families of people living with dementia. Geriatr Gerontol Int 2019; 19: 829-833.
Keywords: community care; cross-cultural comparison; dementia; healthcare policy; long-term care.
Dementia in the Workplace: Are Employers Supporting Employees Living With Dementia?
Aging & Mental Health
Objectives: As working lives extend and there is better recognition of early-onset dementias, employers need to consider dementia as a workplace concern. With suitable support, people living with dementia can continue employment - although, this is not appropriate for all. The requirement for employers to support employees living with dementia has human rights and legal foundations. This article considers whether employers consider dementia as a workplace concern; and the policies and/or practices available to support employees living with dementia. Thus, it develops understanding of whether employers are meeting their human rights/legislative obligations.
Method: A sequential mixed-methods approach was employed, with data collection undertaken in Scotland (United Kingdom). An online survey was sent to employers across Scotland, with 331 participating. Thirty employer interviews were conducted, with the survey results informing the interview approach. Results: The survey and interview data were analyzed separately and then combined and presented thematically. The themes identified were (1) Dementia as a workplace concern, (2) Support for employees living with dementia and (3) Employer policy development and awareness raising. The findings demonstrate dementia awareness, but this knowledge is not applied to employment situations. There was little evidence suggesting that the rights of employees living with dementia are consistently upheld.
Conclusion: This research sends out strong messages about the rights and legal position of person living with dementia which cannot be ignored. The continuing potential of employees living with dementia and their legal rights are not consistently recognized. This highlights the need for robust training interventions for employers.
Shared Decision Making About Housing Transitions for Persons With Dementia: A Four-Case Care Network Perspective
Background: Persons with dementia (PWDs) and their caregivers often face difficult housing decisions, that is, decisions about their living arrangements, in which the perspectives of all members of the care network should be involved.
Objective: We performed a qualitative data analysis to assess the extent to which housing decisions for PWDs with their formal and informal caregivers correspond to an interprofessional shared decision making (IP-SDM) approach, and what light this approach sheds on their experiences with decision making.
Research design and methods: We used the IP-SDM model to content-code and analyze data from 4 care networks, each consisting of a PWD, 2 informal and 2 formal caregivers.
Results: Decision making in all networks corresponded to most IP-SDM elements, but never included all network members. Decision making was guided by the wishes of the PWD, but their actual involvement decreased over time.
Discussion: Results show that while the IP-SDM model was helpful, the options change with cognitive decline and moving to a nursing home can become inevitable in spite of preferences.
Implications: Timely and honest communication helps to mitigate the distress of deciding against patient preferences, as could advance care planning about future housing transitions.
The Development of the Promoting Independence in Dementia (PRIDE) Intervention to Enhance Independence in Dementia
Clinical Interventions in Aging
Objective: Support after a diagnosis of dementia may facilitate better adjustment and ongoing management of symptoms. The aim of the Promoting Independence in Dementia (PRIDE) study was to develop a postdiagnostic social intervention to help people live as well and as independently as possible. The intervention facilitates engagement in evidence-based stimulating cognitive, physical and social activities.
Methods: Theories to promote adjustment to a dementia diagnosis, including theories of social learning and self-efficacy, were reviewed alongside self-management and the selective optimization model, to form the basis of the intervention. Analyses of two longitudinal databases of older adults, and qualitative analyses of interviews of older people, people with dementia, and their carers about their experiences of dementia, informed the content and focus of the intervention. Consensus expert review involving stakeholders was conducted to synthesize key components. Participants were sourced from the British NHS, voluntary services, and patient and public involvement groups. A tailored manual-based intervention was developed with the aim for this to be delivered by an intervention provider.
Results: Evidence-based stimulating cognitive, physical, and social activities that have been shown to benefit people were key components of the proposed PRIDE intervention. Thirty-two participants including people with dementia (n=4), carers (n=11), dementia advisers (n=14), and older people (n=3) provided feedback on the drafts of the intervention and manual. Seven topics for activities were included (eg, "making decisions" and "getting your message across"). The manual outlines delivery of the intervention over three sessions where personalized profiles and plans for up to three activities are developed, implemented, and reviewed.
Conclusion: A manualized intervention was constructed based on robust methodology and found to be acceptable to participants. Consultations with stakeholders played a key role in shaping the manualized PRIDE intervention and its delivery. Unlike most social interventions for dementia, the target audience for our intervention is the people with dementia themselves.
The Use of Everyday Information Communication Technologies in the Lives of Older Adults Living With and Without Dementia in Sweden
Background: Increasingly services and interventions involve everyday information communication technologies (EICTs) in provision, however, use of EICTs among people with dementia is little known. Therefore, this study aimed to investigate the relevance, use, and ability to use EICTs between a group of older adults with dementia and a comparison group with no known cognitive impairment.
Method: Interviews with 35 people with dementia, 34 comparison participants using the standardized Everyday Technology Use Questionnaire. Variables were compared using descriptive statistics, t-tests and correlation analyses.
Results: Median 7 EICTs (maximum 31) were relevant to the group with dementia; significantly less than the comparison group's 11 (p< .05, d= 0.64). The difference in use appeared more pronounced (group with dementia 5, comparison group 10.5; p< .001, d= 0.93). Large, significant relationships were evident between ability to use technology, and relevant or used EICTs in the group with dementia. No such relationships in the comparison group.
Conclusion: Differences in the amounts of EICTs relevant and used among people with and without dementia are further reflected in the dementia group's ability to use technology. Accommodating the demands that EICTs place on users and harnessing the dominant EICT relevancies and abilities of people with dementia better contributes towards an inclusive, dementia-friendly society.
Dementia-friendly Prisons: A Mixed-Methods Evaluation of the Application of Dementia-Friendly Community Principles to Two Prisons in England
Objectives: To apply and evaluate dementia-friendly community (DFC) principles in prisons.
Design: A pilot study and process evaluation using mixed methods, with a 1-year follow-up evaluation period.
Setting: Two male prisons: a category C sex offender prison (prison A) and a local prison (prison B).
Participants: 68 participants-50 prisoners, 18 staff.
Intervention: The delivery of dementia information sessions, and the formulation and implementation of dementia-friendly prison action plans.
Measures: Study-specific questionnaires; Alzheimer's Society DFC criteria; semi-structured interview and focus group schedules.
Results: Both prisons hosted dementia information sessions which resulted in statistically significant (p>0.05) increases in attendees' dementia knowledge, sustained across the follow-up period. Only prison A formulated and implemented a dementia action plan, although a prison B prisoner dedicated the prisoner magazine to dementia, post-information session. Prison A participants reported some progress on awareness raising, environmental change and support to prisoners with dementia in maintaining independence. The meeting of other dementia-friendly aims was less apparent. Numbers of older prisoners, and those diagnosed with dementia, appeared to have the greatest impact on engagement with DFC principles, as did the existence of specialist wings for older prisoners or those with additional care needs. Other barriers and facilitators included aspects of the prison institution and environment, staff teams, prisoners, prison culture and external factors.
Conclusions: DFC principles appear to be acceptable to prisons with some promising progress and results found. However, a lack of government funding and strategy to focus action around the escalating numbers of older prisoners and those living with dementia appears to contribute to a context where interventions targeted at this highly vulnerable group can be deprioritised. A more robust evaluation of this intervention on a larger scale over a longer period of time would be useful to assess its utility further.
How Healthcare Professionals Can Support Older LGBTQ+ People Living With Dementia
Nursing Older People
Older lesbian, gay, bisexual, trans, queer and others (LGBTQ+) people living with dementia have specific needs related to their sexual orientation and identity that should be addressed to maintain their personhood. They may face challenges in health and social care settings, such as heteronormativity and lack of awareness of older LGBTQ+ needs. Service provision for older LGBTQ+ people with dementia is lacking. Healthcare professionals' attitudes towards older LGBTQ+ people with dementia are often poor and there is a clear need for better training, while increased knowledge and awareness would help to challenge the concept of heteronormativity. This article explores some of the needs of older LGBTQ+ people with dementia, the role of legislation and regulation and how healthcare professionals can provide support.
Creating a Dementia-Friendly Environment Through the Use of Outdoor Natural Landscape Design Intervention in Long-Term Care Facilities: A Narrative Review
Health & Place
There is an increasing volume of literature on the positive effects of outdoor natural landscapes on health and well-being. However, to date, there is a paucity of research on the effect of outdoor natural landscapes designed for people with dementia living in long-term care (LTC) facilities, in particular, those which have incorporated the characteristics of a dementia-friendly environment (DFE). This narrative literature review synthesizes current knowledge on the effect of outdoor natural landscape design, which is aligned with the characteristics of a DFE, to improve agitation, apathy and engagement of people with dementia living in LTC facilities. The reviewed studies predominantly support the positive effects of outdoor natural landscapes on agitation, apathy and engagement of people with dementia. However, there are concerns about the methodological approaches, principles incorporated in the applied outdoor natural landscapes' designs, and the environmental assessment. Further rigorous research is required to understand the impact of the outdoor natural landscapes, with the application of DFE characteristics in the design, on agitation, apathy and engagement of people with dementia living in LTC facilities.