Family caregiver's concerns and anxiety about unaccompanied out-of-home activities of persons with cognitive impairment.

BACKGROUND: Although people with cognitive impairment highly value social participation in out-of-home activities, their families typically perceive concerns and experience anxiety over such activities. This study aimed to elucidate the underlying concerns and factors associated with family caregivers' anxiety over the individual's unaccompanied out-of-home activities. METHODS: In December 2021, we conducted a cross-sectional e-survey of family caregivers of individuals with early-stage cognitive impairment. Caregivers' concerns about ten common risks related to out-of-home activities were cross-tabulated by specific anxiety levels to examine trend associations. With the variables of caregivers and their individuals across the five domains, we ran logistic regression analyses to determine explanatory models for anxiety. RESULTS: The study participants were 1,322 family caregivers of people whose cognitive function varied from intact to possible mild dementia according to the Dementia Assessment Sheet for Community-based Integrated Care System 8-item. Significant associations were found between the prevalence of concerns and the degree of anxiety, even without actual experience with the issues of concern. Among the five domains, individual dementia characteristics and social behaviors were the predominant factors attributed to caregiver anxiety. Caregivers' no anxiety state was significantly associated with: younger age (OR 4.43, 95% CI 1.81-10.81), no detectable cognitive decline (OR 3.34, 95% CI 1.97-5.64), free from long-term care (LTC) (OR 3.52, 95% CI 1.72-7.21), no manifestation of behavioral and psychological symptoms of dementia (BPSD) (OR 13.22, 95% CI 3.06-57.01), and not engaging in unaccompanied out-of-home activities (OR 3.15, 95% CI 1.87-5.31). Their severe anxiety was positively associated with being on LTC (OR 3.39, 95% CI 2.43-4.72) and minor BPSD (OR 1.43, 95% CI 1.05-1.95), and negatively associated with engagement in unaccompanied out-of-home activities (OR 0.31, 95% CI 0.23-0.43). CONCLUSIONS: The study found that family caregivers' anxiety was associated with concerns about behavioral issues, regardless of actual experiences. There were two significant associations in opposite directions between caregivers' anxiety and the individual's engagement in out-of-home activities. In the early phase of cognitive impairment, caregivers may intuitively interpret the individual's behavior and feel anxious. Educational support may provide reassurance and enable caregivers to facilitate out-of-home activities.

Dementia Cafés as a Community Resource for Persons With Early-Stage Cognitive Disorders: A Nationwide Survey in Japan.

OBJECTIVES: Dementia cafés are expected to serve as a new community resource based on the national dementia strategy in Japan. The objective of the present study was to examine effective ways to manage dementia cafés through an overview of dementia cafés in Japan and an analysis of the factors related to their effectiveness on attendees. DESIGN: Cross-sectional analysis. SETTING AND PARTICIPANTS: Representatives of 1477 dementia cafés in Japan. MEASURES: Questionnaires regarding the dementia cafés' characteristics, management members, staff, their guests and effectiveness on people with dementia, their families, and community members were sent to the cafés, with instructions to have them completed by the café representatives. Logistic regression analysis was performed with the effect on each guest attribute as a dependent variable, and factors related to the effectiveness of dementia cafés were analyzed. RESULTS: Questionnaires were sent to a total of 2728 dementia cafés in Japan, and responses were received from 1477 (54.1%). The most common meeting frequency and meeting hours were once a month (64.8%) and 2 hours (53.8%), respectively. Analysis of the effectiveness of dementia cafés on 3 groups of guests indicated the following preferences for café program: people with dementia preferred frequent meetings and activities, families of people with dementia preferred having a place for private consultation and advice and peer meetings, and community members preferred frequent meetings and both mini-lectures and private consultation and advice. Logistic regression analysis further revealed that all types of guests preferred the presence of the same types of guests. CONCLUSIONS/IMPLICATIONS: This study revealed the multicomponent nature of dementia cafés. The results suggest that a good balance of programs and guests would enhance the cafés' effectiveness among the multiple stakeholders in regard to dementia, especially in the early stage of the disease.