Practitioners' identification of informal caregivers' difficulties with activities of daily living interventions for older people with dementia in Japan.

BACKGROUND: Older people with dementia who cannot perform daily activities independently due to cognitive impairment need support at home and in the community. This study identified aspects of activities of daily living (ADL) interventions that advanced dementia care practitioners recognise as challenging for informal caregivers to perform. METHODS: We conducted a self-administered cross-sectional survey on advanced dementia care practitioners, including certified nurses, specialising in gerontological, community health, home care, and visiting nursing, nurses specialising in dementia certified by the Japanese Nursing Association, and dementia care leaders certified by prefectural governors. The participants rated a caregivers' extent of difficulty in aspects of ADL interventions on a four-point Likert scale. Factor analysis was performed to determine ADL intervention aspects that are recognised by advanced dementia care practitioners as challenging for informal caregivers. RESULTS: The highest loaded factors for mild, moderate, and severe cognitive impairment stages were 'right time to draw attention,' 'opportunities to perform ADL,' and 'communicating how to perform ADL without giving up,' respectively. Therefore, it is imperative to educate informal caregivers about the effects of cognitive impairment on ADL performance in people with dementia and enable them to provide concrete ADL interventions and tips to support the persons' autonomy and independence. The Cronbach's alpha values of the highest loaded factors for mild, moderate, and severe cognitive impairment stages were 0.851, 0.925, and 0.946, respectively. Moreover, the cumulative contribution ratios of each stage were 46.04%, 50.52%, and 47.36%, respectively. CONCLUSION: This study dealt with identifying informal caregivers' difficulties with ADL interventions across the stages of dementia. Informal caregivers should be supported on aspects of ADL interventions that are potentially difficult for them to perform. Useful educational content and approaches in training programs for informal caregivers should be developed to enable them to help people with Alzheimer's disease maintain ADL performance toward 'ageing in place' even as the disease progresses.

Multidisciplinary pharmacotherapy collaboration for home-based older adults with dementia: a study focusing on physicians, pharmacists, and nursing professionals.

BACKGROUND: It is imperative that a team consisting of a physician, pharmacist, and nursing professional provides pharmacotherapy support to achieve the optimal effect of pharmacotherapy for older adults with dementia. This study reviewed Japanese publications on the process of pharmacotherapy support practised by various professionals for home-based older adults with dementia and investigated healthcare professionals' perceived importance and practice of pharmacotherapy support. METHODS: This study aimed to shed light on basic pharmacotherapy support for behavioural and psychological symptoms among home-based older adults with dementia using multidisciplinary collaboration, through a literature review of Japanese publications. Based on the literature review, 13 items pertaining to basic pharmacotherapy support for home-based older adults with dementia were extracted. A mail-based, self-administered, anonymous questionnaire survey was conducted with professionals including physicians, pharmacists, and nursing professionals who provide pharmacotherapy support to home-based older adults with dementia. Participants rated 13 items on their perceived importance and practice of basic pharmacotherapy support using a four-point Likert scale. RESULTS: The results indicated that participants recognised the importance of all 13 items. At least 80% of all professionals indicated that they practised seven out of 13 items. Less than 80% of all professionals indicated they practised the other six items that should be provided after the commencement of pharmacotherapy. A relatively high proportion of nursing professionals (70%) indicated they practised the remaining six items. The 13 items were indeed deemed important for characterising pharmacotherapy support. However, in Japan, suboptimal support is provided following the commencement of medication. This may be because appropriate modifications to dementia care are not made as the patient's condition progresses. CONCLUSIONS: It is suggested that multidisciplinary collaboration focusing on the progression of dementia and the process of pharmacotherapy, especially after the commencement of pharmacotherapy, may help provide effective, continuous pharmacotherapy.

The diary of a nonagenarian-centenarian woman with dementia: Memory loss, life changes, and community care in Japan.

AIM: This study aimed to explore the experiences and thoughts of a nonagenarian-centenarian woman with dementia living alone, through detailed analysis of her unsolicited diary. DATA SOURCE: After receiving consent from Aki (a pseudonym), her family and caregivers, copies of her diaries, hand-written in Japanese, were provided for analysis. METHODS: The content of the diaries was broadly organized into themes and qualitative content analysis carried out for each theme along a sequential timeline. Changes in perspective, expression, quality of script, and frequency of notations were noted over time are compared with clinical assessments of dementia and activities of daily living recorded by health care providers. Demographic history was obtained from family members. RESULTS: On recommendation by her nursing care manager, Aki began keeping a diary. By age 99, Aki was widowed and noted: "I'm lonely by myself." but still expressed hope: "I won't give up on myself." Concerning memory loss, she wrote: "I've already forgotten what happened this afternoon," and "I'll do things for myself." Regarding dependence, she said: "I get help from my children and others outside the family." And commented on the home care staff: "I don't know if they've come to help." "Is it someone I know well?" Although she thought that they took her belongings, she wrote: "I'll try not to forget to be grateful to them." DISCUSSION: The diaries show that even as the dementia progressed, Aki was aware of her cognitive decline compounded by family losses. She used the diary as a coping method and to address relationships with family and caregivers.

The mourning process of older people with dementia who lost their spouse.

AIMS: To explore the mourning process of people with dementia who have lost their spouse, using family caregivers' and professionals' perspectives and to devise grief care for people with dementia. BACKGROUND: There have been studies on the loss of one's spouse; however, little is known about widows and widowers with dementia as they may find it hard to tell their perception and feelings to others accurately because of cognitive impairment. DESIGN: Qualitative descriptive study using semi-structured interviews. METHOD: Seven family caregivers and six professional caregivers from day care centres were interviewed between June and September 2015. Qualitative content analysis was used to identify mourning behaviours of people with dementia. RESULTS: In the mourning process of people with dementia, different behaviours were found according to dementia stages and different circumstances. In FAST2, they could remember their spouse's death. In FAST4 -6, it took 1 year to be able to perceive their spouse's death and more time to store it. In FAST 7, people with dementia did not discern his spouse's death throughout the process. Furthermore, it was revealed that people with dementia followed a different mourning process from conventional ones. CONCLUSION: In the care of widows and widowers with dementia it is crucial to adjust circumstances to allow people with dementia to guess reality. Further studies are needed to clarify differences between the mourning process of people with dementia and that of intact older people to develop a grief model and educational programmes.

Sensing kuuki among visiting nurses.

This study aimed to explore how visiting nurses in Japan sense Kuuki (mood or atmosphere) in the homes of patients and families. Participants were 15 Japanese visiting nurses with experience sensing kuuki in homes of patients and families. Data were collected through two 90 min focus group interviews with experienced visiting nurses, and a qualitative content analysis was performed. The qualitative analysis showed that experienced visiting nurses sensed kuuki in eight ways. Kuuki differs based on type of illness, state of health and number of visits. Sensitivity to kuuki is thought to be linked to understanding of patient and family feelings, changes in the physical condition of patients and evaluation of nursing care delivery. Perception of kuuki also contributes to care planning especially on the very first home visit and when visiting terminally ill patients.

Association among cognitive function, daytime activities, and nighttime sleep in older adults in a long-term care facility.

AIM: To determine how the nighttime sleep patterns of older adults in a long-term care facility vary according to cognitive function and participation in daytime activities. METHODS: This observational study was conducted with older adults aged ≥65 years who are residents of a long-term care facility. Nighttime sleep was monitored using a non-wearable sleep monitor for 8 weeks. Based on the Mini-Mental State Examination scores for assessment of cognitive function, participants were classified into non-dementia, mild-to-moderate dementia, and severe dementia groups. The Mann-Whitney U test and Kruskal-Wallis test were used to analyze the data. RESULTS: Twenty three older adults were included in this study. Sleep onset latency was significantly longer in the severe dementia group than in the non-dementia (p = .027) and mild-to-moderate dementia (p = .041) groups. Sleep efficiency was significantly lower in the severe dementia group than in the mild-to-moderate dementia group (p = .003), whereas wakefulness after sleep onset was significantly longer in the severe dementia group than in the mild-to-moderate dementia group (p = .011). The number of days spent engaging in recreational activities was <50%, whereas those spent taking a nap was >60% in all older adults. Older adults with mild-to-moderate dementia had better sleep and participated in more daytime activities than those with severe or no dementia. Moreover, bathing in a bathtub improved sleep onset latency. CONCLUSIONS: This study demonstrates that participation in daytime activities and bathing in a bathtub affect nighttime sleep in older adults.

Home-care robots - Attitudes and perceptions among older people, carers and care professionals in Ireland: A questionnaire study.

Many countries face major challenges to ensure that their health and social care systems are ready for the growing numbers of older people (OP). As a way of realising ageing in place, assistive technologies such as home-care robots are expected to play a greater role in the future. In Asia and Europe, robots are gradually being adopted as a public policy solution to the workforce shortage. Yet, there is still a strongly held belief that such technologies should not be part of human and personal care services such as OP's care. However, there has been little research into attitudes and perceptions of potential users regarding home-care robots which can provide companionship and support with activities of daily living. To explore these in more detail, a questionnaire study was carried out in Finland, Ireland and Japan. This study reports findings from the Irish cohort (114 older people [OP], 8 family carers and 56 Health and Social Care Professionals [HSCPs]). Seventy per cent of the total respondents (N = 178) reported being open to the use of home-care robots, and only one quarter had a negative image of robots. People with care responsibilities in their private capacity expressed more interest in, and readiness to use, home-care robots, while stressing the importance of 'privacy protection' and 'guaranteed access to human care'. Both OP and HSCPs identified observation and recording of OP's mental and physical condition as desirable functions of such robots, whereas practical functions such as fall prevention and mobility support were also deemed desirable by HSCPs. There is generally positive interest in home-care robots among Irish respondents. Findings strongly suggest that the interest is generated partly by great need among people who deliver care. Should such robots be developed, then careful consideration must be given to user-centred design, ethical aspects and national care policy.

Difficulties and associated coping methods regarding visual hallucinations caused by dementia with Lewy bodies.

Individuals who have dementia with Lewy bodies present various symptoms that differ from those associated with Alzheimer's disease. Of the several characteristic symptoms of dementia with Lewy bodies, visual hallucinations often appear in the early stages of the disease, and some hallucinations cause people with dementia with Lewy bodies to experience unique difficulties in their daily lives. The aim of this paper is to clarify the visual hallucination-related difficulties experienced by people with dementia with Lewy bodies as well as their coping methods. Participants were 10 people with dementia with Lewy bodies who were living at home, with input also obtained from their family members. Data were collected through semi-structured interviews, and a qualitative content analysis was consequently performed. The qualitative analysis showed four primary difficulties in the period before a patient realizes that their visual hallucinations are a symptom of an underlying disease; these included "feeling something strange is happening" and "restrictions on activities." Realizing that what they were experiencing was not real was a significant turning point for the participants, with some discovering this by discussing their apparitions with their families. It was consequently determined that, after an individual realizes that their hallucinations are indicative of a more serious condition, two further difficulties arise, including the "inability to discuss the visual hallucinations with friends and family." With regard to coping methods, some participants reported rearranging their living environments to hide areas where hallucinations commonly appeared. This paper suggests that care is needed to help people with dementia with Lewy bodies recognize that their visual hallucinations are a manifestation of their illness. In particular, psychological support should be made available to address the anxiety caused by the appearance of visual hallucinations and to help patients adjust their environments to reduce or prevent the appearance of such hallucinations.

Exploring perceptions toward home-care robots for older people in Finland, Ireland, and Japan: A comparative questionnaire study.

PURPOSE: To clarify potential users' perceptions toward the development and social implementation of home-care robots in Japan, Ireland, and Finland. METHODS: Unsigned, self-administered questionnaires were distributed to adults aged 65 or older, family caregivers, and home-care/health and social care professionals (HSCPs). A total of 1004 responses were collected. RESULTS: In Japan, many people were already familiar with robots in their daily lives. The most notable finding about their perspectives on home-care robots was related to safety. Moreover, 93.7 % of the Japanese respondents said, "If the user cannot decide whether to use a home-care robot, family members who know the user well should decide," followed by 76.4 % in Ireland and 83.1 % in Finland (p < .001). In Ireland, 81.8 % of the respondents said, "I want to help other people and society by participating in the research and development of home-care robots" (Japan: 69.9 %; Finland: 67.5 %) (p = .006). In Finland, many people had a negative impression of robots compared to the other two countries. Finland had the highest percentage (75.4 %) of respondents who said, "Health care professionals should be allowed to use secondary information collected by a home-care robot" (Japan and Ireland: 64 %) (p = .024). Moreover, Ireland and Finland emphasized the need to guarantee the entitlement to receive human care. CONCLUSIONS: Devising optimal strategies for the development and social implementation of home-care robots by incorporating various perspectives while valuing human dignity will require examination of each country's characteristics with respect to history, culture, policies, and values related to robots.

Characteristics of care methods for daily life disabilities in Alzheimer's type dementia that respect autonomy and independence.

AIM: To clarify the characteristics of appropriate care methods for people with daily life disabilities due to Alzheimer's type dementia. DESIGN: A cross-sectional survey study. METHODS: A survey was implemented targeting 2,156 advanced care practitioners for dementia. The postal, self-administered anonymous questionnaire was rated on a 4-point Likert scale to assess the benefits of care for daily life disabilities depending on severity. We conducted factor analysis to determine characteristics of the appropriate care. RESULTS: There were 568 valid responses, a valid response rate of 26.3%. The characteristics found were "Simplicity of necessities" and "Communication using verbal language on what should be done next" for mild cases; "Opportunities for completion of a task are provided with verbal communication," "Marks" and "Arrange the environment with verbal communication" for moderate cases; and "Explain the process in the order of each individual action," "Prevent non-starts and interruptions" and "Confirm intention" for severe cases.

A novel ER membrane protein Ehg1/May24 plays a critical role in maintaining multiple nutrient permeases in yeast under high-pressure perturbation.

Previously, we isolated 84 deletion mutants in Saccharomyces cerevisiae auxotrophic background that exhibited hypersensitive growth under high hydrostatic pressure and/or low temperature. Here, we observed that 24 deletion mutants were rescued by the introduction of four plasmids (LEU2, HIS3, LYS2, and URA3) together to grow at 25 MPa, thereby suggesting close links between the genes and nutrient uptake. Most of the highly ranked genes were poorly characterized, including MAY24/YPR153W. May24 appeared to be localized in the endoplasmic reticulum (ER) membrane. Therefore, we designated this gene as EHG (ER-associated high-pressure growth gene) 1. Deletion of EHG1 led to reduced nutrient transport rates and decreases in the nutrient permease levels at 25 MPa. These results suggest that Ehg1 is required for the stability and functionality of the permeases under high pressure. Ehg1 physically interacted with nutrient permeases Hip1, Bap2, and Fur4; however, alanine substitutions for Pro17, Phe19, and Pro20, which were highly conserved among Ehg1 homologues in various yeast species, eliminated interactions with the permeases as well as the high-pressure growth ability. By functioning as a novel chaperone that facilitated coping with high-pressure-induced perturbations, Ehg1 could exert a stabilizing effect on nutrient permeases when they are present in the ER.

Efficient Active Sensing with Categorized Further Explorations for a Home Behavior-Monitoring Robot.

Mobile robotics is a potential solution to home behavior monitoring for the elderly. For a mobile robot in the real world, there are several types of uncertainties for its perceptions, such as the ambiguity between a target object and the surrounding objects and occlusions by furniture. The problem could be more serious for a home behavior-monitoring system, which aims to accurately recognize the activity of a target person, in spite of these uncertainties. It detects irregularities and categorizes situations requiring further explorations, which strategically maximize the information needed for activity recognition while minimizing the costs. Two schemes of active sensing, based on two irregularity detections, namely, heuristic-based and template-matching-based irregularity detections, were implemented and examined for body contour-based activity recognition. Their time cost and accuracy in activity recognition were evaluated through experiments in both a controlled scenario and a home living scenario. Experiment results showed that the categorized further explorations guided the robot system to sense the target person actively. As a result, with the proposed approach, the robot system has achieved higher accuracy of activity recognition.

Assessment scale for caregiver experience with dementia. Development of an instrument in Japan.

A great deal of research has been conducted concerning the burden on care-givers of elderly patients with dementia, but only a small number of qualitative studies discuss actual ways individuals with dementia are being cared for and describe the caregiving experience. Scales for assessing caregiver experience have not yet been developed. The aim of this study was to develop an instrument on the basis of the caregiver experience model developed by Kobayashi [Suwa], Masaki, and Noguchi (1993) in Japan. Psychometric evaluations of the scale were conducted. A sample of 116 caregivers were asked to fill out a questionnaire on a self-rating 5-point scale measuring their sense of caregiving burden, and 90 responses were obtained. The data measured with this original scale was subjected to factor analysis and an assessment scale was developed. As a result, the Assessment Scale for Caregiver Experience with Dementia (ASCED) was created. It consists of 24 items, divided into three subscales--the empathetic caregiving experience, the disciplinary caregiving experience, and the resigned caregiving experience. It also divides caregivers into six types. Work needs to be performed not only to further evaluate changes in the caregiving experience through refinement of the ASCED, but also to qualitatively and quantitatively investigate the nature of the care given to elderly individuals with dementia.