The impact of subject/respondent characteristics on a proxy-rated quality of life instrument for the Japanese elderly with dementia.

The development of a quality of life (QL) instrument for evaluating quality of services requires extensive validation. This study examines the impact of subject/respondent characteristics on a newly developed quality of life instrument for the Japanese elderly with dementia (QLDJ) as a part of the validity examination. In the QLDJ, QL is defined as a three-dimensional construct: 'interacting with surroundings', expressing self', and 'experiencing minimum negative behaviors'. Thus the QLDJ is a multi-dimensional, 24-item instrument, and it is answered by a proxy, the formal caregiver (respondent) because the elderly with severe dementia cannot be directly interviewed. Altogether 623 elderly persons experiencing dementia from 37 institutions (e.g., nursing homes, day care centers) in Japan were assessed using the QLDJ by their formal caregivers. In addition to the levels of dementia and independence in activities of daily living, factors such as gender of the elderly person and respondent, elderly person's age, participation in recreational activities, qualification of the respondent were significantly associated with 'interacting with surroundings' and 'expressing self'. The levels of dementia and independence as well as qualification of the respondent were associated with 'experiencing minimum negative behaviors'. Possible reasons for these associations and how to deal with them are discussed. Careful control for those factors is needed when the QLDJ is used in future research.

Development of instruments to measure appraisal of care among Japanese family caregivers of the elderly.

The purpose of this study was to develop two instruments for the evaluation of positive and negative appraisal of care among family caregivers of elderly Japanese care recipients within the framework of caregiver adaptation. The positive appraisal of care instrument (PAC) includes domains of relationship satisfaction, role confidence, consequential gain, and normative fulfillment. The negative appraisal of care instrument (NAC) includes domains of role exhaustion, isolation, relationship difficulty, and symptom management difficulty. The PAC and NAC are self-administered questionnaires and were developed from data collected from 337 family caregivers of relatives aged 65 years and over who were using visiting nursing services from 21 organizations in multiple areas of Japan. Out of 87 items, 21 PAC items and 14 NAC items were selected based on content and construct validity and internal consistency examination. Results show evidence of validity and reliability for the PAC and NAC, although some NAC domains may benefit from further refinement. The PAC and NAC will be useful research tools for examining elder caregiving experience and evaluating nursing care for elders.

The attitude of Japanese family caregivers toward the elderly with dementia.

This research examined family caregivers' attitudes toward their elderly relatives living with dementia. A convenience sample of fifty-nine Japanese caregivers was used. Caregiver attitudes were investigated multi-dimensionally (negative attitude, attitude of acceptance, and attitude of active interaction) using a questionnaire developed specifically for this study. The dimensions did not correlate with one another but were associated with different caregiver/elderly characteristics: i.e., negative attitude with short stay use, length of time caregivers and elderly relatives were living together and problem behaviors; attitude of acceptance with sleeping pill use and the type of relationship; and attitude of active interaction with dementia diagnosis. The results have implications for nurses in facilitating constructive caregiver attitudes.