京都大学 / 新制・課程博士 / 博士(人間健康科学) / 甲第24096号 / 人健博第103号 / 新制||人健||7(附属図書館) / 京都大学大学院医学研究科人間健康科学系専攻 / (主査)教授 青山 朋樹, 教授 恒藤 暁, 教授 今中 雄一 / 学位規則第4条第1項該当 / Doctor of Human Health Sciences / Kyoto University / DFAM

Introduction: More than half a million Canadians are living with dementia and 260,000 of these individuals live at home. As dementia progresses, persons with dementia require more assistance from caregivers to meet their daily needs including stimulation and emotional support. However, caregivers receive little training in this role. Namaste Care is a program originally developed for use in long-term care homes promoting a structured routine, a slow pace of care, and multisensorial activities for persons with advanced dementia. The program has not yet been adapted or evaluated for use by caregivers of community-dwelling older adults with moderate to advanced dementia. The objective of this study is to explore the feasibility, acceptability and preliminary effectiveness of a version of Namaste Care adapted by caregivers. Methods: A multiphase mixed methods design was used. In the adaptation phase, six caregivers participated in workshop sessions to adapt Namaste Care for home use. In the evaluation phase, 12 caregivers received training to use the adapted program. Surveys were used to collect data on caregiver quality of life, perceptions of caregiving, self-efficacy, and burden at baseline and 3-month follow-up. Qualitative interviews at 3-month follow-up were also completed to assess the acceptability of the program and implementation facilitators and barriers. Findings: All caregivers used the program for a minimum of twice a week as planned and used a variety of program activities. The retention rate was 83%. Caregivers perceived that the program improved their relationships with persons with dementia. Implementation facilitators were receiving a Namaste Care Toolbox and written resources about Namaste Care. No statistically significant effects were found with regards to the outcome measures listed above. Conclusions: The adapted Namaste Care program was feasible and acceptable for use by caregivers. There is a need to conduct a larger trial to determine the extent of its effects. / Thesis / Doctor of Philosophy (PhD) / With the growing numbers of family and friend caregivers across Canada supporting people living with dementia at home, there is a need to better prepare caregivers for their role. The aim of this study is to adapt, implement and evaluate a sense-based, skill-building program called Namaste Care delivered by caregivers of older adults living with moderate to advanced dementia. First, workshops for caregivers were held to adapt the Namaste Care program for home use. Afterwards, 12 caregivers received training in using the adapted program and delivered the program for three months. Caregivers used the program at least twice a week as intended and delivered a variety of activities. The program improved relationships with persons with dementia. No significant changes for caregiver quality of life, positive beliefs of caregiving, burden, and confidence were found. Next steps are to further test the effects of the program in a larger trial.

Yes / Background People with dementia or mild cognitive impairment (MCI) and their family carers face challenges in managing medicines. How medicines self-management could be supported for this population is unclear. This review identifies interventions to improve medicines self-management for people with dementia, MCI and their family carers, and which core components of medicines self-management they address. Methods A database search was conducted for studies with all research designs and ongoing citation searches from inception to December 2021. Selection criteria included community dwelling people with dementia and MCI and their family carers, and interventions with a minimum of one medicine self-management component. Exclusion criteria were wrong population, not focusing on medicines management, incorrect medicines self-management components, not in English and wrong study design. Results are presented and analysed through narrative synthesis. The review is registered [PROSPERO (CRD42020213302)]. Quality assessment was carried out independently applying the QATSDD quality assessment tool. Results Thirteen interventions were identified. Interventions primarily addressed adherence. A limited number focused on a wider range of medicine self-management components. Complex psychosocial interventions with frequent visits considered the person’s knowledge and understanding, supply management, monitoring effects and side-effects and communicating with healthcare professionals; and addressed more resilience capabilities. However, these interventions were delivered to family carers alone. None of the interventions described patient and public involvement. Conclusion Interventions, and measures to assess self-management, need to be developed which address all components of medicines self-management, to better meet the needs for people with dementia and MCI and their family carers.

Home and community based services (HCBS) are designed to provide services that meet the increasing and diverse needs of the older adult population who wish to age-in-place for as long as possible in their homes and community. Yet, little is known about the choices people make when selecting services. The purpose of this study was to assess HCBS use among vulnerable older adults. Andersen’s (1995) behavioral model of health services use provided theoretical guidance for selecting and explaining predisposing, enabling, and need-based variables associated with service use within the Community Living Program (CLP) federal initiative. Through consumer direction of services, 18 routine or one-time services were offered to 76 participants enrolled in the Virginia CLP. Two-step cluster analysis identified four distinct profiles of service users, ranging in size from 7 to 34 members. Services used within the groups ranged from 11 to 16 services. Use of personal care services (p=.033) and respite (p=.010) were significantly associated with group membership differentiation. Within each cluster, the percentage of participants using each service varied greatly. The most important variables that differentiated service user membership were caregiver relationship to participant, participant living arrangement, participant disability type, and length of time caregiver provided care. Between-cluster membership was significantly different with regard to average service cost per day for services used (p=.002) and the likelihood of moving to a nursing home if services were not provided (p=.034). Findings inform future research and have implications for practitioners assisting vulnerable older adults in selecting services to meet different care needs. / Master of Science

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abstract: This study aimed to understand the factors that influence Chinese American older adults’ advance care planning (ACP) on end-of-life care. The Theory of Planned Behavior (TPB) and Health Belief Model (HBM) were primarily applied to explain Chinese American older adults’ intentions toward two behaviors: 1) discussion of end-of-life care plans with family members and 2) completion of an advance directive (AD). Additionally, acculturation and family cohesion were considered to examine their impacts on the TPB and HBM. A cross-sectional survey was conducted through face-to-face interviews on a sample of 298 community-dwelling Chinese-American adults aged 55 and older living in the metropolitan Phoenix area of Arizona. Based upon random assignment, 161 participants answered questions regarding discussing end-of-life care plans with family members, while 137 participants answered questions related to the completion of an AD. Hierarchical multiple regression analysis was used to focus on the influence of TPB and HBM measures on behavioral intentions toward the two behaviors. Results indicated that both the TPB and HBM had predictive power to explain the target population’s intentions. However, the predictability of TPB and HBM measures varied across the two behaviors. Acculturation moderated the relationship between attitudes and intentions to complete an AD negatively. Family cohesion moderated the relationship between perceived benefits and intentions to discuss end-of-life care plans with family members negatively. These findings would help inform future interventions for improving the target population’s ACP awareness and engagement. / Dissertation/Thesis / Doctoral Dissertation Communication 2018

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