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，早期痴呆症的患病率很高，因此不仅需要对早期痴呆症患者进行干预，还需要对其家庭进行干预。目的：描述旨在增强早期痴呆老年人能力的认知康复方案以及旨在增强老年人能力的教育和咨询方案的实施情况和过程评价他们的家庭照顾者。设计：本研究采用社区卫生行动研究模式。通过一个规划、行动和反思的周期进行干预性行动研究（PAR），以确定有效的干预措施，以增强痴呆症（PsWD）参与者及其护理人员的能力。 ...更多信息 方法：采用焦点小组访谈法进行评估。开发了基于认知康复的每月活动方案，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，照顾者的书面意见，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组合供分析。为了使家庭照顾者，教育和咨询programmesoffered.Results：PAR持续了五年，并演变了三个周期：个人，团体和社区。在第一个周期，干预措施的主要重点是通过烹饪方案为每个残疾人重新获得程序技能。在第二个周期，为了增加与家庭成员和其他PsWD的互动，开展了促进家庭成员之间以及PsWD之间沟通的小组活动。PsWD这一代人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，通过与文化相关的连续活动规划和实施社区参与。PsWD展示了他们的专业技能并重新获得了信心。对于家庭照顾者，教育方案提供了有关痴呆症和利用社会资源的知识。根据需要提供面对面和电话咨询，以指导以问题为中心的应对。这些方案有助于解释痴呆症的症状，并减少行为problems.Conclusions认知康复理论是有用的，以恢复失去的程序技能和恢复PsWD的信心。这PAR说明了干预的重要性，为社区居住的老年人与早期痴呆症及其家庭照顾者。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