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.

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.

Impact of the elder abuse prevention and caregiver support law on system development among municipal governments in Japan.

OBJECTIVES: Japan enacted the elder abuse law in April 2006. The present study was aimed to examine the progress of systems development and difficulties with implementing activities in municipal governments for dealing with elder abuse after the law. METHODS: Between 11 and 22 December 2006 a paper questionnaire was sent to all 1840 Japanese municipalities and received 917 responses (49.8%). The municipalities were divided into three groups according the number of elder abuse management activities they had implemented: an advanced group (N=257), a middle group (N=348), and a less advanced group (N=312). RESULTS: The law increased the implementation of activities related to reporting systems (46.2-49.1%) and activities for increasing awareness of elder abuse among service providers (30.7-35.8%). The most frequent activities with no plans for implementation were the establishment of intervention teams (43.7-55.5%) and multi-agency networks (47.7-64.2%). All groups reported difficulties carrying out home visits to investigate reported cases of abuse (53.6-61.5%) and difficulties approaching reported cases where there was resistance to outside support (42.4-76.6%). CONCLUSIONS: The law was significant step in activities related to reporting systems and activities for increasing awareness among service providers. Further policy should address how to establish intervention teams and multi-agency networks, how to carry out home visits to investigate reports, and how to approach cases resistant to outside support.