Development of a Daily Living Self-Efficacy Scale for Older Adults in Japan.

OBJECTIVES: Older adults tend to experience decreased enjoyment and fulfillment in life, social interactions, and independent living, with aging. These situations often result in lower levels of daily living self-efficacy in activities, which is one of the factors resulting in a decline in the quality of life (QOL) among older individuals. For this reason, interventions that help maintain daily living self-efficacy among older adults may also help maintain a good QOL. The objective of this study was to develop a daily living self-efficacy scale for the elderly that can be used to evaluate the effects of interventions aimed at enhancing self-efficacy. METHODS: An expert meeting involving specialists in dementia treatment and care was held, to prepare a draft for a daily living self-efficacy scale. In the meeting, previous studies on self-efficacy among older adults, which were collected in advance, were reviewed, and the experiences of the specialists were discussed. Based on the reviews and discussions, a draft of a daily living self-efficacy scale comprising 35 items was prepared. This study on daily living self-efficacy was conducted from January 2021 to October 2021. The internal consistency and concept validity of the scale were evaluated based on the assessment data. RESULTS: The mean age ± standard deviation of the 109 participants was 84.2 ± 7.3 years. The following five factors were extracted based on factor analysis: Factor 1, "Having peace of mind"; Factor 2, "Maintaining healthy routines and social roles"; Factor 3, "Taking personal care of oneself"; Factor 4, "Rising to the challenge"; and Factor 5, "Valuing enjoyment and relationships with others". The Cronbach's alpha coefficient exceeded 0.7, thereby suggesting sufficiently high internal consistency. Covariance structure analysis confirmed sufficiently high concept validity. CONCLUSIONS: The scale developed in this study was confirmed to be sufficiently reliable and valid, and when used during dementia treatment and care to assess the levels of daily living self-efficacy among older adults, it is expected to contribute to the improvement of QOL among older adults.

The effects of quality of life on behavioral and psychological symptoms in elderly people with dementia residing at long-term care facilities.

PURPOSE: The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly). METHODS: Elderly individuals with dementia were evaluated to determine their activities of daily living (ADL; Katz), Mini-mental State Examination (MMSE), Neuropsychiatric Inventory (NPI), and Quality of life inventory for the elderly with dementia (QOLD) scores. RESULTS: The subjects were recruited from intermediate welfare facilities (n = 226, 43.7%), hospitals with supportive care (n=91, 17.6%), and intermediate care facilities (n = 200, 38.7%). The mean age of the subjects was 85.18±7.13 years. The NPI scores revealed that Agitation/Aggression was high among subjects who resided in healthcare health facilities and sanatorium-type medical facilities, while Apathy/Indifference was high in those who resided in special nursing homes. Additionally, a multiple regression analysis found that most of the NPI items, when set as independent variables, displayed a significant association with the same subscale of the QOLD. CONCLUSION: When each item of the NPI was set as a dependent variable in a multiple regression analysis, the scores were significantly related to both subscales of the QOLD. It is suggested that QOL should be maintained or improved in an effort to reduce the incidence of the associated BPSDs in long-term care facilities.

[How quality of life indices reflect the behaviors of elderly people with dementia on dementia care mapping and the relationship among well-being, ill-being and the behavior category code].

PURPOSE: Dementia Care Mapping (DCM) is an observation and evaluation technique intended to improve the quality of care for elderly people with dementia, based on aims of person-centered care. The purpose of this study was to clarify that well-being and ill-being (WIB) levels affects the behavior category code (BCC) in long-term care insurance facilities. METHODS: In this study, we evaluated people with dementia who used care facilities between April 2005 and July 2007. The evaluation indices used were the 6-hour DCM, the Mini-Mental State Examination (MMSE), and the Gottfries-Brane-Steen Scale (GBS). RESULTS: The total number of subjects whose families submitted written informed consent to participate was 256 (50 men and 206 women). The mean MMSE score of the total subjects was 10.83 (±8.58), and that of individuals receiving home care was the highest 17.14 (±6.38). The next highest mean MMSE score was that of the group home residents: 16.56 (±6.83). The lowest mean MMSE score was of individuals in health services facilities for the elderly (serious dementia ward), at 2.16 (±3.88). Multiple regression analysis was performed after controlling for age, sex, type of dementia and GBS, and we used the WIB value as dependent variables. The BCC variables of L (Labor) in group homes, and E (Expression) and H (handicrafts) variables in welfare institutions and long-term care facilities for the elderly significantly promoted WIB value. CONCLUSIONS: Among BCC indices such as L in group homes, and E and H in welfare institutions and long-term care facilities for the elderly, which reflect WIB values (and therefore, quality of life), it was found that those activities associated with work reflected quality of care. However, the BCC indices of B (Borderline) C (Cool), and U (Unresponsiveness) significantly inhibited WIB level; these behaviors are categorized as passive behaviors in the DCM. It is probable that these behaviors in elderly people with dementia reflect problems in long-term care insurance facilities. It is necessary to further examine these passive behaviors, because they can accurately reflect the quality of care for elderly people with dementia.

[Dementia Care Mapping-Japanese version(DCM-J) as a research evaluation method for measuring quality of life among elderly patients with dementia: reliability and validity of Well-being and Ill-being value].

AIM: Dementia Care Mapping is a behavior evaluation tool that can be used to measure and improve the quality of life of elderly patients with dementia. However, the reliability and validity of the Dementia Care Mapping-Japanese version (DCM-J) has not yet been established. Therefore, the purpose of this research was to clarify the reliability and validity of the Well-being and Ill-being (WIB) value of the DCM-J as a method for evaluating quality of life. METHODS: The study was conducted from April 1, 2005 to June 30, 2006. The participants included 130 elderly patients (men 31, women 99, average age 82.65+/-7.69 years) who were given a diagnosis of dementia. We established inter-rater reliability during a parallel observation method and also used test-retest for reliability. The correlation between the WIB value of the DCM-J and the Japanese Quality of Life Inventory for Elderly with Dementia (QOL-D) was used to establish criterion-related validity. RESULTS: Forty-nine (37.7%) subjects were given a diagnosis of dementia of Alzheimer's type, 80 (61.5%) had vascular dementia and 1 (0.8%) had dementia with Lewy bodies. The results showed correlation between the WIB value and social withdrawal measured by the behavioral category code (BCC) on the DCM-J and the three subscales of QOL-D: "interacting with surroundings", "expressing self", and "experiencing minimum negative behaviors". There was good internal consistency among these items. The interclass correlation coefficient was 82.32 (+/-5.85) for the WIB value of the DCM-J. The correlation coefficient of the retest, administered one week later, was 0.836 (p=0.001). The WIB value was significantly correlated with three sub-scales of QOL-D, and the correlation coefficient was greater than 0.53. CONCLUSION: We demonstrated that the WIB value of the DCM-J has good inter-rater reliability and test re-test reliability and criterion-related validity. In this study, the WIB value was shown to have similar reliability to the WIB value of the original DCM. Furthermore, our results suggest that the DCM-J could be useful for evaluating quality of life among elderly Japanese patients with dementia.

[Follow-up study on subjective quality of life for elderly persons with dementia using the Japanese version of Dementia Quality of Life Instrument (JDQoL)].

PURPOSE: There are few longitudinal studies on the subjective quality of life for elderly persons living in their own homes. The purpose of this study was to clarify the validity and reliability of the Japanese version of the Dementia Quality of Life Scale (JDQoL) used in a follow-up survey as part of a longitudinal study in Japan. METHODS: A baseline study was conducted from November 2002 to January 2003, and a year later a follow-up study was conducted from October 2003 to January 2004. The subjects included 72 (19 men and 53 women) elderly persons with dementia living in their own homes. Sixty-six were diagnosed with vascular dementia (VD) and 6 had senile dementia of Alzheimer's type (SDAT). The follow-up study included 60 subjects (VD: 56 and SDAT: 4); _10 of the original subjects were hospitalized, one died, and one was unable to attend daycare because of deterioration. Evaluation was conducted using the JDQoL, MiniMental State Examination (MMSE), and Geriatric Depression Scale (GDS). RESULTS: For the MMSE, the average score of the subjects in the follow-up study was 20.87 (+/- 4.80), which was significantly higher than the score of subjects that were excluded from the follow-up study (17.82 +/- 5.65). At baseline, reliability coefficient was demonstrated by Cronbach's alpha value of 0.744 approximately 0.886. One year later, Cronbach's alpha was 0.723 approximately 0.872. Among the subjects in the follow-up study, MMSE scores decreased significantly compared with the baseline study. In the subscales of the JDQoL, Negative Feelings (reversal item) significantly improved and Feeling of Belonging significantly decreased after one year (p<0.05). Each subscale of the JDQoL had significant correlation with the GDS at baseline and follow-up. Scores on the GDS at baseline had significant correlation with Self Esteem, Positive Feelings, Negative Feelings, and Feeling of Belonging of the JDQoL at follow-up (0.320 to 0.504; p<0.05). CONCLUSION: We demonstrated that the reliability and validity of the JDQoL was comparable to the English version of DQoL. Subjective QOL did not decline for all sub-scales, Negative Feelings in the JDQoL significantly improved compared to baseline.

[Development of the Dementia Quality of Life Instrument-Japanese version].

AIM: The aim of this study was to develop the Dementia Quality of Life Instrument-Japanese version (DQoL-Japanese Version). METHODS: The subjects were 72 elderly patients, 19 men and 53 women (Vascular Dementia: 66, Senile dementia Alzheimer type 6) using day care and day services who had obtained approval for participation in the investigation. The interview survey was conducted from October 2002 to January 2003. RESULTS: In the subscales of the DQoL-Japanese Version, "negative feelings" scored the highest and "affirmative feelings" the lowest. There was a significant correlation coefficient between the test and those of a conducted 2 weeks later, ranging from 0.730 to 0.857 (p<0.05). The internal consistency reliability for the five scales ranges from alpha=0.66 to 0.864. There was a significant correlation coefficient between the Geriatric Depression Scale (GDS) and DQOL sub-scales such as "self esteem," "positive affect", "negative feelings" and "feeling of belonging". On the other hand, there was no significant relationship between the GDS and "aesthetics" of the DQoL-Japanese Version. CONCLUSIONS: It was suggested that the DQoL-Japanese Version DQoL is useful to measure subjective QOL of elderly patients with dementia. The subjects who understood the questions of the DQoL-Japanese Version and were able to be interviewed, had a Mini-Mental State score of 13 points or more. It was clarified that DQoL-Japanese Version was reliable and showed evidence of validity as well as the original DQOL.

Behavioral and endocrinological evaluation of music therapy for elderly patients with dementia.

The present study investigated the effectiveness of music therapy for dementia patients using endocrinological and behavioral evaluations. The study comprised 10 patients with senile dementia who received music therapy; six had Alzheimer's dementia and four had vascular dementia. Music therapy was performed twice a week for 8 consecutive weeks (16 sessions). As a result, total scores on the Mini-Mental State Examination (MMSE) did not significantly change, but the scores of a subscale, "language", improved significantly. According to the Multidimensional Observation Scale For Elderly Subjects (MOSES), scores for "irritability" decreased significantly. Regarding changes in salivary chromogranin A (CgA) levels, the average was significantly decreased before session 16 compared to after this. These results suggest that the combination of endocrinological measurements, behavioral evaluations and functional assessment methods are useful in evaluating the effects of music therapy in persons with senile dementia.