Taeko Nakashima

Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems?

The Ministry of Health, Labour, and Welfare of the Japanese national government announced a “Five‐Year Plan for Promotion of Measures Against Dementia (Orange Plan)” in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies.

Physicians' and nurses' perceived usefulness and acceptability of a family information booklet about comfort care in advanced dementia

BACKGROUND Families of patients with advanced dementia need to be informed about the course of the dementia and comfort care. Conditional for health care providers educating families is their knowledge and comfort in family education. METHODS Perceived usefulness and acceptability of a Canadian family booklet explaining possible complications and comfort care in dementia was assessed by physicians and nurses caring for dementia patients in 14 nursing homes in Lombardy, Italy and 21 in the Netherlands. The practitioners received a questionnaire and translated versions adapted to local practice where needed. In 10 of 21 Dutch homes, physicians evaluated only the original Canadian version in English. A 15-item scale assessed the booklets acceptability, for example, to inform families, or for educational purposes. Perceived usefulness referred to proportion of families of dementia patients for whom the booklet would be useful. A total of 168 evaluations were available for multivariable regression analyses. RESULTS The practitioners anticipated that the booklet would be useful for most families. Evaluation of the Dutch translation of the booklet was similar to the English version. Country (Netherlands) and profession (nurses) were independently associated with better acceptability. Usefulness was perceived as better by Italian respondents and nurses, but only in analyses unadjusted for the higher educational needs of these respondents. CONCLUSION Overall, the concept of written information on comfort care was appreciated by practitioners of European countries differing in attitudes toward end-of-life care. A booklet may help practitioners, and in particular nurses, in providing comfort care for dementia patients and their families.

Quality of life of residents with dementia in a group-living situation: an approach to creating small, homelike environments in traditional nursing homes in Japan.

OBJECTIVES Group living is an approach that can create small, homelike environments in traditional nursing homes in Japan. The aim of the present study was to examine quality of life (QOL) of residents with dementia in group-living situations. METHODS The group-living group consisted of facilities that formed residential units. Each unit had a common area and stable staff assignments. The control group consisted of facilities that did not form residential units. The quality of life instrument for Japanese elderly with dementia (QLDJ) scale was used to rate QOL by direct care workers of 616 residents with dementia from 173 facilities in the group-living group and 750 residents from 174 facilities in the control group. QOL was based on the following subscales: interacting with surroundings; expressing oneself; and experiencing minimal negative behavior. RESULTS Multilevel regression analyses demonstrated a significantly greater QOL with respect to interacting with surroundings, expressing oneself, and experiencing minimal negative behavior for residents with dementia in the group-living group compared to the control group, as measured by the QLDJ. The total QLDJ score was also significantly higher for the group-living group. CONCLUSION The results suggest improved QOL of residents with dementia under group-living situations. Future studies should examine the effect of group-living on QOL of residents with dementia using a cohort design, following residents longitudinally from admission.

Disparities in systems development for elder abuse prevention among municipalities in Japan: Implications for strategies to help municipalities develop community systems

In April 2006, a national elder abuse prevention and caregiver support law was enacted in Japan, where elder abuse prevention is carried out by municipalities, and caregiver support and intervention are provided by a public long-term care insurance program. The aims of this study were (1) to examine factors at baseline affecting disparities in the progress of systems development for elder abuse prevention among municipalities, and (2) to determine what kind of support municipalities request from prefectural or national governments to help municipalities develop systems for elder abuse prevention. Written questionnaires were administered to the most knowledgeable person in the department responsible for reporting elder abuse in each municipal government between December 2006 and October 2008. The final sample for analysis consisted of 489 (26.6% of 1840) municipalities that provided complete information. Municipalities that achieved a high level of implementation originally had a higher rate of reports of abuse per 1000 elderly persons and greater involvement by police and advocacy groups at baseline. Since cities were the largest type of municipality, they had the greatest number of activities as of 2 years after implementation of the law. The results highlight that the prefectural or national government should offer different types of support according to the kind of municipality: sharing and using experts in an extended association for municipalities with limited resources and smaller size (towns and villages) and aggregating information on difficult cases for larger municipalities (cities). Further research should investigate specific strategies that the prefectural or national government can implement to help promote systems development for municipalities with low rates of reported cases of elder abuse, such as training programs to ensure that all care providers can recognize the signs and symptoms of elder abuse.

Japanese Care Location and Medical Procedures for People with Dementia in the Last Month of Life.

BACKGROUND Dementia-related societies worldwide have called for palliative end-of-life care for those suffering dementia; meanwhile, the Japanese dementia plan was revised on January 2015 to introduce into its objectives the support for end-of-life care via increased social and health care collaboration. OBJECTIVE The study focus was the use of medical procedures in the last month of life among dementia patients in different care locations in Japan. METHODS This study was conducted using a retrospective study design. Data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey of the public long-term care insurance services, were used. The 6,148 patients who received end-of-life care in their own home, nursing homes, or hospitals in September 2007, 2010, and 2013 were included for analysis. The primary disease of each patient was based on the ICD-10 code; a diagnosis of dementia included F00 (Alzheimers), F01 (vascular), F02 (other), and F03 (unspecified). RESULTS Of 6,148 patients, 886 (14.4%) had dementia as a primary disease; most received care in the last month of life in nursing homes (48.0%) or hospitals (44.8%) rather than in their own home (7.2%). Patients were less likely to undergo pain management when their primary disease was dementia (adjusted odds ratio, 0.44; 95% confidence interval, 0.21-0.91). CONCLUSION Education and policy efforts are required to provide palliative end-of-life care to people with dementia at home. The national dementia plan should also explore possible approaches regarding pain management for dying people who have dementia.

Dementia behaviour management programme at home : impact of a palliative care approach on care managers and professional caregivers of home care services

ABSTRACT Objectives: Care managers and professional caregivers of home care services are sometimes unaware of the psychosocial approaches to the challenging behaviour of dementia. Therefore, we developed a Behaviour Analytics & Support Enhancement (BASE) programme. We investigated the effects of the programme on the attitudes towards dementia care among professionals. Method: Forty-six participants in Japan received training in August 2016. The ongoing monitoring and assessment system was introduced to the participants for repeated measures of challenging behaviour. A 1-day follow-up meeting for debriefing was also performed after two months. A baseline and follow-up questionnaire survey was administered to the participating caregivers using a Japanese version of the Approaches to Dementia Questionnaire (ADQ) and the Zarit Burden Interview (ZBI). Results: A significant improvement was observed in the total ADQ score among the participating caregivers from baseline to follow-up assessment. There was no significant difference between the baseline and follow-up assessment in the ZBI scores. In the follow-up meeting, several participants reported challenges and suggested solutions in facilitating a discussion on an action plan among professionals from various organizations. Conclusion: The implementation of the programme resulted in enhanced attitudes towards dementia care among the participants without an increased burden of care. Future studies should examine the programmes effectiveness on the challenging behaviour of persons with dementia.

Systems Development and Difficulties in Implementing Procedures for Elder Abuse Prevention Among Private Community General Support Centers in Japan

The present study examines differences in systems development and difficulties in implementing procedures for elder abuse prevention in 1,119 private and 606 public community general support centers under the public long-term care insurance program in Japan. The private community general support centers showed more difficulty implementing procedures than the public community general support centers. Controlling for the type of municipality, progress in systems development did not differ between the private and public community general support centers. Further research should examine how the characteristics of municipal governments are related to systems development in community general support centers.

Community-Based System, Reports, and Substantiated Cases of Elder Abuse: Disparities Between Municipalities and Relating Factors in Japan

This study examines (1) the staffing and financial characteristics of systems for elder abuse detection and intervention in the municipal governments of Japan and (2) the relationship among the development of detection and intervention systems, the reporting rates of suspected elder abuse cases, and substantiated abuse rates in 927 municipalities across Japan. Progressive systems for the detection and intervention of elder abuse were significantly associated with a larger number of public officers than in non-progressive systems. Furthermore, greater rates of both suspected and substantiated cases of abuse were associated with progressive systems for elder abuse detection and intervention. Per capita annual expenditures on the comprehensive support project and the community general support centers catchment under the Long-Term Care Insurance (LTCI) program showed no significant association with the development of systems, the rate of suspected cases, or the number of substantiated cases. National social policy makers should examine strategies that would help municipalities assign sufficient staff to elder abuse detection and intervention programs.

Who Is Responsible? A Man With Dementia Wanders From Home, Is Hit by a Train, and Dies

The impact of dementia and Alzheimers disease extends far beyond the healthcare needs of the person with dementia. As the disease progresses, individuals with dementia often require ongoing formal or informal care for their basic daily routine because of behavior changes and continuing loss of cognitive function. Most of the care for people with dementia takes place at home, and the unpaid, informal caregivers are often spouses or other relatives. Providing long-term informal care at home for someone with dementia is psychologically, physically, and financially draining. The tragedy described in this case elucidates the far-reaching societal impact of dementia care and the implicit health policy considerations. In 2007, a 91-year-old Japanese man with dementia was in the care of his wife when he wandered from home, was hit by a train, and died, immediately affecting the Central Japan Railway Company operations and, subsequently, legal practice as well as Japanese elder care policy. The railway sued the mans wife and son for negligence and lost revenue, winning both trials at the local and district courts. This ruling shocked families and caregivers in Japan, where care for elderly parents traditionally falls on the oldest son, and brought attention to the complex issues related to dementia care. A decade later, we revisit this case to provoke a renewed dialogue about the matrix of responsibilities and liabilities associated with caregiving; to illuminate the unmet needs of the person with dementia, as well as his or her informal caregivers; and the financial implications related to long-term care policy. We close with 2 practical suggestions which preserve the dignity of the individual and provide reassurance for caregivers.

Substitution of Formal and Informal Home Care Service Use and Nursing Home Service Use: Health Outcomes, Decision-Making Preferences, and Implications for a Public Health Policy

Objectives The purposes of this study are: (1) to empirically identify decision-making preferences of long-term health-care use, especially informal and formal home care (FHC) service use; (2) to evaluate outcomes vs. costs based on substitutability of informal and FHC service use; and (3) to investigate health outcome disparity based on substitutability. Methodology and data The methods of ordinary least squares, a logit model, and a bivariate probit model are used by controlling for socioeconomic, demographic, and physical/mental health factors to investigate outcomes and costs based substitutability of informal and formal health-care use. The data come from the 2013 Japanese Study of Aging and Retirement (JSTAR), which is designed by Keizai-Sangyo Kenkyu-jo, Hitotsubashi University, and the University of Tokyo. The JSTAR is a globally comparable data survey of the elderly. Results There exists a complement relationship between the informal home care (IHC) and community-based FHC services, and the elasticity’s ranges from 0.18 to 0.22. These are reasonable results, which show that unobservable factors are positively related to IHC and community-based FHC, but negatively related to nursing home (NH) services based on our bivariate probit model. Regarding health-care outcome efficiency issue, the IHC is the best one among three types of elderly care: IHC, community-based FHC, and NH services. Health improvement/outcome of elderly with the IHC is heavier concentrated on IHC services than the elderly care services by community-based FHC and NH care services. Conclusion Policy makers need to address a diversity of health outcomes and efficiency of services based on providing services to elderly through resource allocation to the different types of long-term care. A provision of partial or full compensation for elderly care at home is recommendable and a viable option to improve their quality of lives.