Interventions for empowering the elderly with early dementia and family caregivers living in a rural community : participatory action research study

背景：痴呆症患者人数的增加日益引起全球关注。一项关于日本农村社区老年人生活状况的调查显示，早期痴呆的患病率很高，不仅对早期痴呆的老年人，而且对他们的家庭都有干预的必要性。目的：描述一项基于认知康复的方案的实施和过程评估，该方案旨在增强患有早期痴呆的老年人的能力，同时也旨在增强其家庭照顾者的能力。设计：本研究采用社区卫生行动研究模型。参与式行动研究（PAR）通过规划、行动和反思的循环进行，以确定有效的干预措施，赋予痴呆症患者（PsWD）及其照顾者权力。背景：日本的一个乡村小镇。参与者：该项目涉及37名患有早期或轻度痴呆症的社区老年人和31名家庭护理人员。方法：采用焦点小组访谈法进行评估。制定了基于认知康复的月度活动计划，以改善认知功能。收集了三种类型的数据：活动期间收集的观察数据、照顾者的书面评论、电话访谈记录和与照顾者的咨询。这些数据按时间顺序汇编成一个作品集供分析。为了增强家庭照顾者的能力，提供了教育和咨询方案。结果：PAR持续5年，分为个体、群体和社区三个周期。在第一个周期，干预的主要重点是通过烹饪计划重新获得每个残疾人士的程序技能。在第二个周期，为增加与家庭成员及其他社署人员的互动，我们举办了小组活动，促进家庭成员及社署人员之间的沟通。社会福利署这一代的集体价值观和信仰，通过一系列的寺庙和神社之旅得到了验证。在第三个周期中，通过与文化相关的连续活动规划和实施社区参与。社会福利署展示了他们的专业技能，重拾信心。对于家庭照顾者，教育方案提供了有关痴呆症和社会资源利用的知识。根据需要，提供面对面和电话咨询，指导以问题为中心的应对方式。这些方案有助于解释痴呆症的症状并减少行为问题。结论认知康复理论有助于PsWD患者程序性技能的恢复和信心的恢复。这一PAR说明了干预措施对社区居住的早期痴呆老年人及其家庭照顾者的重要性。少

Background: The increase in the number of people suffering from dementia is of increasing global concern. A survey on the living conditions of the elderly in a Japanese rural community revealed a high prevalence of early dementia and the necessity for interventions not only for the elderly with early dementia but also for their families.Objective: To describe the implementation and process evaluation of a programme based on cognitive rehabilitation aimed at empowering the elderly with early dementia and education and counseling programmes aimed at likewise empowering their family caregivers.Design: This study used a community health action research model. Participatory action research (PAR)was conducted through a cycle of planning, action, and reflection to identify effective interventions to empower participants with dementia (PsWD)and their caregivers.Setting: A rural town in Japan.Participants: This project involved 37 community-dwelling elderly with early or mild dementia and 31 fa … More mily caregivers.Methods: A focus group interview was used for assessment. A monthly activity-based programme based on cognitive rehabilitation was developed to improve cognitive function. Three types of data were collected: observational data collected during the activities, written comments from the caregivers, the record of phone interviews and counselings with caregivers. These data were compiled in chronological order into a portfolio for analysis. To empower family caregivers, educational and counseling programmes were offered.Results: The PAR lasted for five years and evolved over three cycles: individual, group and community. In the first cycle, the major focus of the intervention was to regain procedural skills for each PWD through a cooking programme. In the second cycle, to increase interactions with family members and with other PsWD, group activities that promoted communication among family members as well as among PsWD were implemented. The collective values and the beliefs of the PsWD's generation were validated by a series of trips to temples and shrines. In the third cycle, community participation was planned and implemented through culturally relevant sequential activities. PsWD demonstrated their expert skills and regained confidence. For family caregivers, the educational programme provided knowledge about dementia and utilization of social resources. Face-to-face and phone counselings were offered as needed to coach problem-focused coping. These programmes helped to interpret the symptoms of dementia and to reduce the behavioural problems.Conclusions Cognitive rehabilitation theory was useful to restore lost procedural skills and regain confidence for PsWD. This PAR illustrated the importance of interventions for both community dwelling elderly with early dementia and their family caregivers. Less