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Family caregivers’ liability for damage inflicted by persons with dementia under their care: a study of the 2016 Japanese Supreme Court ruling
- Author:
- MURAYAMA Kayo
- Journal article citation:
- Journal of Social Welfare and Family Law, 43(2), 2021, pp.143-152.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
By analysing the 2016 Japanese Supreme Court case concerning family caregivers’ liability for damages caused by a person with dementia who was killed by a train while wandering, this article suggests how to address similar cases in the future, considering the rights of persons with dementia to live in the community. The Court absolved the deceased’s wife and son from liability and defined four criteria to find a person liable for damages: (a) the caregiver’s living, mental, and physical conditions; (b) the conditions of the caregiver’s involvement with a person with a mental disability; (c) the nature and incidence of the problematic behaviours of the person with a mental disability; and (d) the circumstances surrounding their supervision and care. This was the Supreme Court’s first presentation of the criteria for establishing liability for a ‘Person Equivalent to a Supervisor’. To guarantee the rights of a person with dementia to live in the community, the burden on family caregivers must be reduced, and the range of caregivers broadened to include non-family providers. The Court sought to reduce the caregivers’ burden, and if these criteria are applied appropriately, the human rights of dementia patients and caregivers will be protected. (Edited publisher abstract)
Spouse caregivers and behavioral and psychological symptoms of dementia
- Authors:
- YOSHIOKA Eiji, et al
- Journal article citation:
- Aging and Mental Health, 17(8), 2013, pp.966-972.
- Publisher:
- Taylor and Francis
Only a few studies have specifically considered the role of caregiver characteristics in the presence of behavioral and psychological symptoms of dementia (BPSD). This study examines whether there were differences in the presence of BPSD between community-dwelling dementia care recipients with spouse caregivers and those with non-spouse caregivers. One hundred and nine care recipients and their primary caregivers were recruited from memory clinic outpatients at the public psychiatric hospital in Sapporo City, Japan. Data were collected by questionnaire. Relationship with the care recipient was categorized as either ‘spouse’ or ‘non-spouse.’ The frequency of BPSD occurrence observed by the caregiver was assessed using the Troublesome Behavior Scale (TBS). Logistic regression analyses were performed to examine whether there were differences with regard to each of the 14 TBS items between spouse and non-spouse caregivers. The number of spouse caregivers was 47 (43.1%). TBS items presented by >50% care recipients were ‘repetition and/or clinging’ and ‘ill-natured denial and/or distortion.’ After adjustment for the characteristics of caregivers and care recipients, non-spouse caregivers were found to be significantly associated with the presence of ‘hiding and/or losing things,’ ‘rummaging,’ ‘crying and/or screaming,’ and ‘interfering with a happy home circle,’ compared with spouse caregivers. The results suggest that non-spouse caregivers need more support with regard to certain symptoms of individual BPSD compared with spouse caregivers. Identifying caregiver characteristics that are independently associated with each individual BPSD may help customise interventions for caregivers with specific characteristics. (Edited publisher abstract)
When a family member has dementia: steps to becoming a resilient carergiver
- Author:
- MCCURRY Susan M.
- Publisher:
- Praeger
- Publication year:
- 2006
- Pagination:
- 184p.
- Place of publication:
- Santa Barbara, CA
This book describes a core set of principles to help caregivers become more spontaneous, flexible and resilient as they deal with the challenges of caring for a loved one with dementia. The author, a clinical psychologist, draws on her many years of experience working with family members who live with and care for a relative with dementia. In addition to the inevitable decline in memory and physical function, most persons with dementia develop one or more troublesome behaviour problems, such as depression, fearfulness, sleep disturbances, paranoia, or physical aggression at some point in their disease. Behavioural challenges in dementia are highly idiosyncratic; no two patients are alike, and interventions that work well with one person are often ineffective with another. McCurry’s program is called “The Dementia Dance” or DANCE, an acronym for the five core principles: D: Don’t Argue, A: Accept the Disease, N: Nurture Yourself, C: Create Novel Solutions, and E: Enjoy the Moment. In the final part of the book she shares advice that can help caregivers not to become overwhelmed and give up trying to become more resilient carers. Vignettes taken from practice are included throughout to illustrate the theory and the book concludes with a list of caregiving resources and a bibliography.
Behavioral and psychological symptoms of dementia and caregivers’ stress appraisals: intra-individual stability and change over short-term observations
- Authors:
- FAUTH E. B., et al
- Journal article citation:
- Aging and Mental Health, 10(6), November 2006, pp.563-573.
- Publisher:
- Taylor and Francis
Dementia is commonly associated with memory loss, but Behavioral and Psychological Symptoms of Dementia (BPSD) such as disruptive behaviours, agitation, and problems with mood, usually have a more significant impact on caregivers’ stress. It is known that BPSD and caregivers’ stress reactions vary in frequency over the long-term course of dementia, however little is known about the variability over the short-term. The current study included 85 people with dementia and their primary caregivers assessed over three months. Caregivers used a 24-hour log on multiple, consecutive days to report behavioural symptoms of dementia on seven domains of behaviour, as well as their stress reactions for each domain. Using latent growth curve analysis, most BPSD and caregiver stress appraisals were found to be, on average, stable over the three-month time frame. For many BPSD and stress appraisal models, however, intra-individual differences in rate of change were significantly different from the mean trend, indicating behaviours and stress are not stable over three months when assessed at the level of the individual. Covariates were used to explain individual differences in rates of change; however few variables were significantly associated with intra-individual short-term change over time.
Gentle persuasion
- Author:
- LYON Christina
- Journal article citation:
- Care Weekly, 16.2.95, 1995, p.11.
There has been a dearth of official guidance on caring for children with learning disabilities and severely challenging behaviour. Offers guidance drawn from the work of the Mental Health Foundation.
Nursing facility social work with family behavioral health challenges
- Authors:
- MYERS Dennis R., et al
- Journal article citation:
- Journal of Family Social Work, 24(2), 2021, pp.136-156.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Nursing facility social workers play a prominent role in promoting behavioral health among family members with compromised responses to their loved one’s residing in a skilled care nursing facility. Familial behaviors in nursing home settings and social workers’ responses to them have not been systematically investigated. This study addresses the issue through quantitative and qualitative analyzes of face to face, in-depth interviews with 20 BSW/MSW licensed nursing facility social workers averaging 8.8 years of experience. The analysis conducted by a five-member research team yielded six recurring categories of compromised family behaviors: verbally aggressive, controlling/demanding, denial/unrealistic expectations, abuse/exploitation, manipulation, and disengaged/resistant. Respondents reported five categories of responses to these family behaviors: relating (tuning in, active listening, trust-building), mediating, limit-setting, educating, and advocating. Narratives of family behaviors and social worker responses revealed creative ways social workers engaged family member role ambiguity and worked to improve transactions among struggling family members, residents, and facility staff and policy. The findings provide previously unavailable evidence on the social worker’s role in promoting family behavioral health and document an empirical basis for future study. Five recommendations are offered for enriching social work practice and education with families in the context of skilled nursing facility care. (Edited publisher abstract)
Commentary on a “unified approach to behaviours that challenge”: getting it right? A family carer perspective
- Author:
- COOPER Vivien
- Journal article citation:
- Tizard Learning Disability Review, 25(3), 2020, pp.153-157.
- Publisher:
- Emerald
Purpose: The purpose of this paper is to provide an individual family-carer perspective on navigating the complex child, adult, education, health and social care systems focussing on what might be needed to get the right support in the right place at the right time for individuals with learning disabilities who display behaviour that challenges. Design/methodology/approach: This is a conceptual analysis, drawing on lived experience, policy and practice. Findings: Policy and best practice advocate a holistic, person-centred, outcome-focussed approach to supporting individuals with learning disabilities whose behaviour challenges, but the existing complex multiple organisational structures are not conducive to delivering this. Making the system work for people requires focussed leadership across all levels to co-ordinate and align the component parts. It is certainly possible to achieve, but it is currently unclear who will take responsibility for making this happen. Originality/value: Families are often the only constant in the lives of people with disabilities. This commentary highlights what is important to and for families when attempts are made to get the right support in the right place at the right time for individuals with learning disabilities who display behaviour that challenges. (Edited publisher abstract)
Caregiver and care recipient characteristics as predictors of psychotropic medication use in community-dwelling dementia patients
- Authors:
- GRACE Elsie L., et al
- Journal article citation:
- Aging and Mental Health, 20(12), 2016, pp.1297-1304.
- Publisher:
- Taylor and Francis
Objectives: The current practice of prescribing psychotropic medication for the management of dementia-related behavioural disturbances is under substantial debate. Using Pearlin's stress process model as theoretical underpinning, the aim of this investigation is to identify caregiver and care recipient characteristics as predictors of anxiolytic, antipsychotic, and antidepressant use among community-dwelling dementia patients. The authors hypothesised that caregiving burden and patient characteristics, particularly behaviour disturbances and pain, would be positively associated with psychotropic medication use. Methods: Data for this exploratory, cross-sectional study were drawn from the baseline assessment of the Resources for Enhancing Alzheimer's Caregiver Health II trial. Only participants with full baseline information were examined (N = 598). Caregiver characteristics, such as confidence managing problematic behaviours, and care recipient characteristics including pain, problem behaviours, cognitive impairment, and functional impairment, were examined in relation to care recipient psychotropic medication use. Results: Contrary to the hypothesis, behavioural disturbances and burden associated with these disturbances were not significantly associated with psychotropic use. Rather, caregiver characteristics such as race and overall vigilance, and care recipient characteristics such as cognitive status, functional status, and pain were significantly associated with the use of psychotropic medication. Findings differed by class of medication. Conclusion: These exploratory findings suggest the utility of a holistic approach to understanding the factors associated with pharmacotherapy among community-dwelling elders with dementia. Significant associations between caregiver characteristics and care recipient psychotropic medication use suggest that educating caregivers in non-pharmacologic strategies hold promise for a more balanced biopsychosocial approach to maintaining dementia patients in the community. (Edited publisher abstract)
A dementia first aid course for family carers
- Author:
- PODGSON Richard
- Journal article citation:
- Nursing Times, 111(41), 2015, p.24.
- Publisher:
- Nursing Times
Many people with dementia are cared for by family members, who will receive little advice or support. This article describes a course developed to help carers deal with frustrating and challenging behaviour. The course provides an overview of dementia, provides coping strategies for carers and introduces cares to mindfulness meditation to help them deal with stress. (Edited publisher abstract)
Changes in attributions as a consequence of training for challenging and complex behaviour for carers of people with learning disabilities: a systematic review
- Authors:
- WILLIAMS Sophie, et al
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 25(3), May 2012, pp.203-216.
- Publisher:
- Wiley
The overall aim of this paper was to critically review studies of staff training in challenging behaviour, which included the measurement of staff beliefs about challenging behaviour. It had three specific objectives: to review the main constructs and measures that were used to identify the theoretical assumptions that underpinned them; to discover whether carers’ beliefs were changed as a result of training; and to make suggestions on further work focusing on staff cognitive change in challenging behaviour training. Papers were included if they reported outcomes for carer training on the behaviour of people with intellectual disabilities and used a measure of carer attribution of the behaviour of people with intellectual disabilities. Eleven papers were reviewed, most studies using behavioural curricula for their training, and none explicitly set out to change attributions. Eight of the 11 papers reviewed reported changes in attribution although core characteristics of training did not distinguish those papers that reported such changes and those that did not. The authors conclude that changes in beliefs and attributions occur even though these are not identified as a focus within the training provided. They suggest that the formulation processes involved in behavioural training may play a key part in changing attributions as a consequence of this training.