Future perspective of psychiatric home-visit nursing provided by nursing stations in Japan.

Psychiatric home-visit nursing supports the lives of people with mental disorders in the community and plays an important role in the "community-based integrated care system" which is rapidly being implemented in Japan. Although the number of responsive home-visit nursing stations (HVNS) is increasing, the current situation of service provision has not yet been clarified. This study aimed to investigate the characteristics and difficulties of psychiatric home-visit nursing provided by HVNS. We further discussed future care provisions and service improvements. We conducted a questionnaire survey of 7,869 member stations of the National Association for Visiting Nurse Service; of this number 2,782 facilities (35.4%) responded. Of the 2,782 facilities, 1,613 (58.0%) provided psychiatric home-visit nursing. The HVNS that provided psychiatric home-visit nursing were diverse, and the percentage of users with mental disorders ranged widely. Majority of the HVNS reported having "difficulty in caring for users/families who refuse care" (56.3%), "difficulty in care for psychiatric symptoms" (54.0%), and "difficulty in assessment of psychiatric symptoms" (49.1%), with differences in difficulty depending on the percentage of psychiatric users. As user needs and HVNS characteristics diversify, it is necessary to take advantage of the characteristics of each station to develop consultation and training systems and collaborative network platforms within each community for future sustainable service provision.

Service contents and recovery orientation of psychiatric home-visit nursing evaluated by users in Japan.

The aim of this study was to clarify the differences perceived by users of home-visit nursing care between providers from medical institutions and services from independent home-visit nursing stations, as well as to examine the recovery orientation from the perspectives of the users. We conducted a questionnaire survey of 32 home-visit nursing stations and 18 medical institutions. From these facilities, 10 users of psychiatric home-visit nursing services who were being treated for schizophrenia and bipolar disorder were selected. With regard to the care that they thought was good, the home-visit nursing station users responded more often than users of home-visit nursing care provided by medical institutions regarding "help with hobbies and fun" and "support to empower you". Regarding what users wanted from home-visit nursing care, a statistically significant difference was found between users of home nursing stations who answered, "I want the same person to come", and users of home-visit nursing services provided by medical institutions, who answered, "I want various people to come". Brief INSPIRE-J score for study participants was 81.9 (standard deviation; SD 18.1) for users of home-visit nursing care services from medical institutions and 83.7 (SD 15.5) for home-visit nursing station users. It is conceivable that the care provided by psychiatric home-visit nursing services may have a greater potential for promoting recovery. However, since the characteristics of users and facilities may differ, future research is needed to clarify which recovery factors are effectively promoted by each service.

Foreseeing the unforeseen: Towards mental health and gerontic nursing perspectives.

With the theme of "Foreseeing the Unforeseen: Towards a New Era of Nursing", this special issue on nursing includes a variety of articles from different countries and institutions. Several key features of this issue include: i) the impact and responses/countermeasures to the coronavirus disease (COVID-19) pandemic; ii) innovative nursing practice, management, education, research, and policy in response to the issues raised; iii) nursing toward a low fertility and a super-aged society, internationalization, or cultural diversity; and iv) human resource development, systems development, and policy recommendations for health, medical care, and welfare in the next era. In this Editorial article, we summarize the issues during the COVID-19 pandemic and the implications for the next era, particularly in the fields of mental health and gerontic nursing. We also provide several perspectives on mental health issues in the general population and for nurses, as well as gerontic nursing issues related to older adults.

How Do Psychiatrists in Japan Choose Involuntary Admission, and What Do They Think of Supported Decision Making? A Thematic Analysis of Peer to Peer Interviews.

To include people with disabilities as equal citizens, CRPD (Convention on the Rights of Persons with Disabilities) promotes direct or supported decision-making by people with disabilities. However, involuntary psychiatry admission is considered in many countries to be necessary for people with psychosocial disabilities. To overcome the tension and implement CRPD, it is essential to understand the experiences and concerns of service users, family members, and medical professionals in each country. To understand the process and the factors that make psychiatrists decide involuntary psychiatric admission in Japan, and explore their attitudes toward direct or supported decision-making by people with psychosocial disabilities. Psychiatrists who had authorized involuntary admission and who were in charge of the service users were recruited at hospitals in Japan. The interviews were individual, peer to peer, and semi-structured. The interviews were audio-recorded, transcribed verbatim, and the analysis followed reflexive thematic analysis using NVIVO 12. Six psychiatrists (five designated psychiatrists and one psychiatric resident) participated in the study at two hospitals in urban Japan. The study found that the psychiatrists assessed symptoms, behaviors, and perceptions of the service users together with supports and wishes of their families. The psychiatrists decided on involuntary admission when they saw self-harm or violence, weak insights and judgment abilities, family's wishes, or when they wanted to avoid the service users leaving the hospital with incomplete treatment. The psychiatrists felt that the service users would not understand any explanations, which made their communications minimal. The psychiatrists thought it was hard to imagine a system other than the current involuntary admission mechanism. If it was to change, they felt the essential things were to avoid abuse, clarify who is responsible, make plans medically valid and feasible, and assess and plan through everyday life, not just in crisis. During a crisis, the psychiatrists were most careful about complying with the Mental Health Act and responded to the family's wish. The psychiatrists justified involuntary admission as they believed that people in a psychiatric crisis cannot decide or understand and need protection. Related protocols, laws, and expectations from family members shapes the values and practices of psychiatrists in Japan. The paper concludes with several recommendations to regard people with psychosocial disabilities as equal citizens, and promoting the aim of reducing or ending involuntary admission.

Concerns and desires of healthcare workers caring for patients with COVID-19 in April and July 2020 in Japan: a qualitative study of open-ended survey comments.

OBJECTIVES: The prolonged effects of the COVID-19 pandemic continue to have a serious impact on healthcare workers. We described and compared the experiences of healthcare workers in Japan during the first wave of the COVID-19 pandemic from March to May 2020, and during the lull from June to July 2020. DESIGN: In this qualitative study, we used a web-based survey to obtain comments from healthcare workers about their experiences during the pandemic, and explored these using inductive content analysis. SETTING: A tertiary emergency hospital in Tokyo, in April and July 2020. PARTICIPANTS: Participants were staff in the hospital, including physicians, nurses, pharmacists, radiological technicians and laboratory medical technicians. Many, but not all, had directly cared for patients with COVID-19. RESULTS: In total, 102 participants in the first survey and 154 in the second survey provided open-ended comments. Three themes were extracted: concerns, requests and gratitude. There were four subthemes under concerns: the hospital infection control system, fear of spreading infection to others, uncertainty about when the pandemic would end and being treated as a source of infection. There were 53 requests in the first survey and 106 in the second survey. These requests were divided into seven subthemes: compensation, staffing, information, facilities, leave time, PCR tests and equitable treatment. The theme on gratitude had two subthemes: information and emotional support, and material support. The fears and desires of healthcare workers included two types of uncertainty-related concerns, and requests were very different across the two surveys. CONCLUSIONS: It is important to apply a balance of information to help staff adjust to their new work environment, as well as support to minimise the burden of infection and impact on their families.

Development and field testing of a decision aid to facilitate shared decision making for adults newly diagnosed with attention-deficit hyperactivity disorder.

BACKGROUND: The number of individuals who are diagnosed with attention-deficit hyperactivity disorder (ADHD) during adulthood has increased in recent years. However, there is still no decision aid (DA) to help adults newly diagnosed with ADHD make decisions regarding further treatments. OBJECTIVE: This study aimed to describe the development process of a DA for adults newly diagnosed with ADHD and its field testing during the shared decision-making (SDM) process in a clinical setting. METHODS: The development process involved the creation of a DA prototype using the International Patient Decision Aid Standards criteria and revision of the prototype through the stakeholders' reviews. The field testing of the DA compared scores before and after the SDM process on the service users' knowledge scale, decisional conflict scale and the Conners Adult ADHD Rating Scales. RESULTS: The developed DA contained options of watchful waiting with own coping skills and pharmacological treatment, which consisted of several kinds of drug options. Fifteen adults newly diagnosed with ADHD participated in the field testing. The participant decision-making quality outcomes such as their knowledge and decisional conflict improved after the SDM process. ADHD severity did not change. CONCLUSION: A DA for adults with ADHD was systematically developed following the international criteria. Field testing indicated that the DA could serve as a tool to facilitate the SDM process. Further research on this DA is necessary before its routine implementation. PATIENT OR PUBLIC CONTRIBUTION: During the development process of the DA, the service users who had already been diagnosed with ADHD reviewed the DA prototype and provided feedback, which improved the final version of the DA.

Mental Health Difficulties and Countermeasures during the Coronavirus Disease Pandemic in Japan: A Nationwide Questionnaire Survey of Mental Health and Psychiatric Institutions.

The number of people with coronavirus disease (COVID-19) has been increasing worldwide. Anxiety about potential infection, fear of severe illness, death, economic problems, and loneliness and isolation brought on by social distancing are increasingly being experienced by people. Therefore, it is imperative to address and improve such mental health-related problems during COVID-19. We aimed to investigate the current mental health care and psychological intervention statuses related to COVID-19 in Japan. In a questionnaire survey, 55 of 69 (80%) mental health and welfare centers and 194 of 931 (21%) psychiatric institutions across Japan responded. COVID-19 patients, their family members, and the general public often consulted the mental health and welfare institutions through telephone. The questionnaire included various information of mental health difficulties related to COVID-19 such as the numbers and contents of the consultations, and the type of the interventions. The contents of consultation included psychological symptoms (anxiety, depression, insomnia, and alcohol problems) and psychosocial problems (interpersonal problems, prejudice, and discrimination). Overall, 9% of mental health and welfare centers provided psychological first aid as psychological intervention and 28% of consultations involved cases requiring urgent care. In Japan, consultations about COVID-19-related mental health problems occurred mainly in mental health and welfare centers. There is urgent need to establish a system that enables mental health triage and brief psychological interventions that are feasible in the centers.

St. Luke's International University and University of North Carolina at Chapel Hill collaboration project to develop the first DNP program in Japan.

We report an international collaborative project to develop the first Doctor of Nursing Practice (DNP) program in Japan. We described the development and implementation of the first DNP program at the St. Luke's International University in Tokyo and the collaboration with the University of North Carolina at Chapel Hill in the United States. Faculty perceptions in both parties gradually evolved from the traditional perspective of international collaboration to the transitional and the beginning of the holistic partnership perspectives. The collaboration resulted in an innovative DNP program that directly addressed the gap between nursing education programs and Japan's clinical needs. The collaborative project cultivated a holistic international partnership. Rather than reporting a manual for international collaboration, we present our reflections and outcomes as narratives that others could use to achieve a holistic global partnership.

The experiences of receiving a diagnosis of attention deficit hyperactivity disorder during adulthood in Japan: a qualitative study.

BACKGROUND: Although the number of adults with attention deficit hyperactivity disorder (ADHD) has increased considerably in recent years, there are few qualitative investigations of the experiences of adults with adult-diagnosed ADHD in Japan. This study aimed to explore in depth the diagnosis-related experiences and needs of such adults. METHODS: Participants were 12 psychiatric outpatients aged 23-55 years diagnosed with ADHD during adulthood. Individual semi-structured interviews were conducted to examine participants' experiences of receiving, and subsequently coping with, an ADHD diagnosis. A thematic analysis of the interview data was performed. RESULTS: Six themes emerged: difficulties in accepting the diagnosis, interest in ADHD, feelings of relief, identity concerns, dealing with symptoms, and acceptance of ADHD. Despite initial negative reactions, participants were willing to learn about the disorder, spending time seeking ADHD-related information and sharing it with loved ones. Participants felt relieved after the diagnosis, as they realized why they had experienced long-term problems and incorrect labeling. However, participants also had identity concerns. They gradually began to accept their ADHD symptoms and deal with them better. CONCLUSIONS: The results suggest that, when treating individuals with adult-diagnosed ADHD, it is important to promote self-understanding and reduce negative attitudes toward ADHD; to provide appropriate, brief, evidence-based information about ADHD; and to give individuals sufficient time to think about their ADHD symptoms, how they have affected their daily lives, and how to cope with them in the future.

Expanding Use of Nurse Home Visiting for Community Psychiatric Care in Japan.

In Japan, Community-based integrated care systems are being built in response to a super-aged society and policies of de-institutionalization. In this paper, we present findings and discussion of our review about Japanese psychiatric home visit nursing services provided by Home Visit Nursing Stations (HVNS). We have examined documents, investigated the implementation rate and summarized findings of the surveys of home visiting services from 2006 to 2016. The number of users of psychiatric home visiting services during 2007 to 2015 increased from 13,532 to 52,203. From 2013 to 2015 there was a large increase in user numbers, from 31,248 to 52,208. The implementation rate of psychiatric home visiting also increased steadily from 35.5% in 2006 to 58.3% in 2016. These changes reflected the impact of policy on psychiatric service usage in Japan. We should be able to detect the outcome of psychiatric home visiting nursing in influencing patient's quality of daily life and their recovery.

Comparison of hospital admission rates for psychiatric patients cared for by multidisciplinary outreach teams with and without peer specialist: a retrospective cohort study of Japanese Outreach Model Project 2011-2014.

OBJECTIVE: This study examined whether having peer specialists (PS) in psychiatric multidisciplinary outreach teams was associated with a lower risk of hospitalisation, improved social functioning and decreased problem behaviours. DESIGN AND SETTING: This study was a retrospective cohort study based on medical records. This study was conducted as a part of the Japanese Outreach Model Project 2011-2014, which provides services for persons diagnosed mainly as ICD-10 F0, F2 and F3, who have a high possibility of hospital admission/readmission with regular Japanese outpatient care. PARTICIPANTS: A total of 292 participants (clients) from 31 multidisciplinary outreach teams with and without PS (n=108 and 184, respectively) fulfilled the inclusion criteria and were included in the analysis. OUTCOME MEASURES: The primary outcome measure was hospitalisation during follow-up. The difference in hospitalisation during the follow-up between teams with and without PS was analysed by Kaplan-Meier survival curves and a Cox proportional hazards model. The secondary outcome measures were social functioning (Global Assessment of Functioning, GAF) and problem behaviours (Social Behaviour Schedule, SBS) of clients, and were assessed at baseline and at 6-month follow-up. Changes in social functioning and problem behaviours were compared between clients cared for by the two team types. Amount and content of the service were also compared. RESULTS: The clients cared by teams with PS had a significantly decreased probability of hospitalisation in Cox proportional hazards models adjusting for baseline characteristics (HR=0.53, 95% CI 0.31 to 0.89). The 6-month change in GAF or SBS was not significantly different between the two groups. CONCLUSION: This is an observational study in which the presence of a PS appeared to be associated with a reduced rate of hospitalisation. A randomised study would be required to demonstrate a causal relationship.

Japanese Outreach Model Project for patients who have difficulty maintaining contact with mental health services: Comparison of care between higher-functioning and lower-functioning groups.

AIM: The Japanese Ministry of Health, Labor and Welfare sponsored the current examination of a new community mental health service, the Japan Outreach Model Project (JOMP), for persons with mental illnesses and who find it difficult to continue with ongoing treatment. Shorter readmission rates and hospital stays were found. In this study, the amount and type of care that were delivered by the JOMP were examined in order to inform the process of establishing the public insurance system. METHODS: The data were collected from 32 JOMP outreach teams from 21 prefectures in Japan that agreed to participate; 415 patients were included in the analysis. The clients' characteristics, social functions, problematic behavior score, and the amount and type of care that were delivered were examined. RESULTS: Higher amounts of care were delivered in the first month, compared to the remaining months, and the care was relatively stable from months 2-5. This suggests that consistently high care was needed for the JOMP clients who found it difficult to maintain contact with mental health services. Those clients with an increased overall global assessment functioning score at 6 months (n = 151) had received significantly more care than those whose functioning had decreased or remained stable (n = 150). The types of increased care that were provided to the higher functioning group were: "assistance with daily living tasks," "medical support for psychiatric symptoms," "empowering the client," "communication and coordination," "support for physical health," and "vocational and educational support." CONCLUSION: The type and amount of care can positively influence good functional outcomes for those in the community who find it difficult to maintain contact with mental health services.

Consumer providers' experiences of recovery and concerns as members of a psychiatric multidisciplinary outreach team: A qualitative descriptive study from the Japan Outreach Model Project 2011-2014.

OBJECTIVE: The objective of this study was to clarify consumer providers (CPs) subjective experiences as members of a psychiatric multidisciplinary outreach team that provided services to individuals with a mental illness living in the community. METHODS: A qualitative descriptive study was conducted through semi-structured interviews. Participants were clients hired as CPs in the Japanese Outreach Model Project from September 2011 until March 2014. Of the seventeen CPs, nine participated in this study. We looked at the CPs' subjective experiences of fulfillment and difficulty. RESULTS: In the process of providing services, CPs experienced both achievements and concerns. They had a sense of achievement by caring for their clients and they experienced that they themselves were recovering. They were also concerned about having inadequate knowledge and skills to provide psychiatric services to their clients. Further, there were concerns about their dual role on the multidisciplinary team and being support staff while they were still using mental health services themselves. CONCLUSION: The results show that the activities of CPs included fulfillment, recovery, and dilemmas. Clarifications will likely contribute to an increase in understanding and cooperation between CPs and other professionals with whom they work. Further studies are needed to investigate policies related to mental health consumers who are also providers of mental health services.

The Role of Home Nursing Visits in Supporting People Living with Dementia in Japan and Australia: Cross-National Learnings and Future System Reform.

Japan and Australia are two western Pacific countries with divergent cultures and histories but they share a common public health concern of providing services for their increasing number of people living with dementia. Age is the greatest risk factor for developing dementia, and Japan is leading the world in aging populations. In 2016 in Japan 27.2% of the total population were over 65, while in Australia 15% were over 65. Both countries have responded to social preferences for community aged care. As a result, in Japan the Visiting Nurse Service Stations (VNSS) and in Australia community aged care service providers such as the Royal District Nursing Service (RDNS) are increasingly addressing the needs of people with dementia and their families. This article presents three sets of data to compare developments in the two health systems and to describe the scope of nursing services for people with dementia in the community. For Japan we analyzed an annual survey of VNSS activities, checked the number of people with a primary diagnosis of dementia, and collected data on presenting conditions on 2012. For Australia we analyzed a sample of two Home and Community Care cohorts of RDNS clients. Results indicated that both generalist service systems include tailored person-centered care for people with dementia. The Japanese system has introduced Dementia Support Doctors while in Australia access to psychogeriatric care is still sparse. As the Asia Pacific region experiences aging populations, community services for people with dementia can use these two systems as models.

Community outreach for patients who have difficulties in maintaining contact with mental health services: longitudinal retrospective study of the Japanese outreach model project.

BACKGROUND: Japan still has the highest ratio of beds devoted to psychiatric patients in the world. In 2011, in order to reduce re-hospitalization of patients who became disconnected from regular contact with outpatient medical services, the Japanese Ministry established the Japanese Outreach Model Project (JOMP). In this study, we will explicate the JOMP project protocol and investigate the rate and length of hospital admission, impairments of social function and problematic behavior at the follow-up period (6- and 12-month) and time of services provided by JOMP. METHOD: This longitudinal retrospective study used survey data collected from 32 outreach teams of 21 prefectures in Japan during September 2011 to July 2013. The outcome variables were assessed at baseline, 6-month and 12-month as to whether or not participants had been admitted to the hospital. Data from 162 participants with mental illness who had difficulties in maintaining contact with mental health services were analyzed. Repeated measures analysis of variance provided a significant effect of the intervention over time. RESULTS: The rate of hospital admission of JOMP participants was 24.1% at 6-months and 27.2% at the 12-month follow-up. The average length of hospital-stay at baseline and 12-months was 38.7 days (SD 84.7). Compared with the baseline, the average score of the Global Assessment Functioning and the Social Behavioral Schedule were significantly improved after the 6-month and 12-month follow-up. The activity log showed that among the most often delivered JOMP services were to "prevent exacerbation of somatic symptoms" and "care for families". CONCLUSION: These results suggest that JOMP has a strong potential to both reduce readmission rates and the length of hospital stay compared with the Japanese regular outpatient care by public insurance, and improve social function and problematic behavior. The JOMP teams provided long-term support for families. As of April 2014 JOMP was included in the National Health Insurance program in a limited way therefore an evaluation of JOMP team fidelity on readmissions must be examined.

Experiences of municipal public health nurses following Japan's earthquake, tsunami, and nuclear disaster.

OBJECTIVE: The purpose of this study was to explore the experiences of municipal public health nurses in the wake of the March 2011 massive earthquake and tsunami and resulting nuclear accident in Fukushima, Japan, from the time of the disaster until December 2013. DESIGN AND SAMPLE: Thirty-two public health nurses working in three cities in Fukushima prefecture were divided into four focus groups and took part in interviews, which were analyzed using a qualitative descriptive method. RESULTS: Two major themes were extracted: (1) experiences of difficulties and dilemmas, and (2) professional challenges and the meaning of excellence as a public health nurse. Subjects recounted their experiences based on the timeline of events. The process of overcoming various dilemmas--between prescribed roles and actual needs on the ground, being both civil servants and private citizens with families, and having to be publicly accountable while lacking adequate information--caused participants to reexamine the meaning of excellence in the practice of public health. CONCLUSION: The strenuous and complex demands of extended disaster management caused subjects to grow professionally. Helping them process their emotions should also help these nurses give focus to their posttraumatic growth, and strengthen their sense of professionalism.

Mentoring doctoral students for qualitative research: interviews with experienced nursing faculty in Japan.

This study aimed to describe the process of mentoring doctoral students for qualitative research in Japanese graduate programs in nursing. Nine experienced faculty-seven nurse researchers and two sociologists-were interviewed. Participants were asked about their process of mentoring students for qualitative nursing dissertations. Data analysis was conducted using a qualitative descriptive method. Participants' age ranged from 48 to 60 years. The first theme in the mentoring process is about the individualized, one-on-one mentorship process. The second theme occurs in a group process. The third theme is coordinating mentors and establishing a network to support the evaluation system. The mentoring processes identified in this study will be useful for future faculty development. The study elucidated much room for improvement in doctoral education programs for qualitative research methods in nursing science.

Is antipsychotic polypharmacy associated with metabolic syndrome even after adjustment for lifestyle effects?: a cross-sectional study.

BACKGROUND: Although the validity and safety of antipsychotic polypharmacy remains unclear, it is commonplace in the treatment of schizophrenia. This study aimed to investigate the degree that antipsychotic polypharmacy contributed to metabolic syndrome in outpatients with schizophrenia, after adjustment for the effects of lifestyle. METHODS: A cross-sectional survey was carried out between April 2007 and October 2007 at Yamanashi Prefectural KITA hospital in Japan. 334 patients consented to this cross-sectional study. We measured the components consisting metabolic syndrome, and interviewed the participants about their lifestyle. We classified metabolic syndrome into four groups according to the severity of metabolic disturbance: the metabolic syndrome; the pre-metabolic syndrome; the visceral fat obesity; and the normal group. We used multinomial logistic regression models to assess the association of metabolic syndrome with antipsychotic polypharmacy, adjusting for lifestyle. RESULTS: Seventy-four (22.2%) patients were in the metabolic syndrome group, 61 (18.3%) patients were in the pre-metabolic syndrome group, and 41 (12.3%) patients were in visceral fat obesity group. Antipsychotic polypharmacy was present in 167 (50.0%) patients. In multinomial logistic regression analyses, antipsychotic polypharmacy was significantly associated with the pre-metabolic syndrome group (adjusted odds ratio [AOR], 2.348; 95% confidence interval [CI], 1.181-4.668), but not with the metabolic syndrome group (AOR, 1.269; 95%CI, 0.679-2.371). CONCLUSIONS: These results suggest that antipsychotic polypharmacy, compared with monotherapy, may be independently associated with an increased risk of having pre-metabolic syndrome, even after adjusting for patients' lifestyle characteristics. As metabolic syndrome is associated with an increased risk of cardiovascular mortality, further studies are needed to clarify the validity and safety of antipsychotic polypharmacy.

Health-related quality of life among community-dwelling patients with intractable neurological diseases and their caregivers in Japan.

AIMS: The aims of this study were: (i) to clarify the general quality of life (QOL) of patients with intractable neurological disease; (ii) to clarify the general QOL of the caregivers of these patients; and (iii) to explore the association of QOL in patient-caregiver pairs. METHODS: A cross-sectional survey was conducted between November 2003 and May 2004 among community-dwelling patients diagnosed with Parkinson's disease (PD), spinocerebellar degeneration (SCD), multiple system atrophy (MSA), and amyotrophic lateral sclerosis (ALS) and their caregivers using a mailed, self-administered questionnaire. To measure QOL, we used the Medical Outcome Study 36-Item Short Form (SF-36) for patients and the short form of the health-related QOL scale SF-36 (SF-8) for caregivers. RESULTS: A total of 418 questionnaires were analyzed. For the patients, all of the general QOL domains of the SF-36 were significantly lower than the national standard value for all of the diagnoses. Physical function, role physical, and role emotional domains were also low. For caregivers, all of the QOL summary scores of the SF-8 for all diagnoses were significantly lower than the national standard value. Although there were several significant correlations of QOL between patients and caregivers, overall the correlations were low. CONCLUSIONS: Support for patients with neurological diseases and their caregivers is needed in order to maintain physical and mental QOL.