Businessmen s Perspectives Concerning Their Experiences
with People with Dementia and Information about Dementia
Survey on the Actual Situation of Participants in a Lecture on Dementia Care
Yoko Uchida
This study intends to elucidate the experiences of businessmen who have been involved with people with dementia, and the information they need about on dementia. The study was conduct against 100 members of B association consisting of A bank customers who participated in a lecture on dementia care, and who extended their cooperation in the survey. The methodology comprised an A4-sized self-report questionnaire. The result showed that 68％ subjects had prior experience of care for worrying about their relatives dementia, 26％ had interacted with them in business, and 62％ encountered them daily. Although, most commonly, the subjects were embarrassed when communicating each other with people having dementia, some of them had successful experiences,by accepting the latter through well thought of ways of treating them when they encountered difficulties. The main topics that the subjects had intentions to know were dementia prevention or its early diagnosis, matters concerning care, and services or systems. Furthermore, the proportion of subjects who wished to know about property management and adult guardianship was significantly high among elderly subjects aged 70 years or older (p＜0.05).（Kitakanto Med J 2011；61：127∼133）
Key words： dementia, businesspersons, involvement, successful experience, lecture
I Introduction
In Japan,the development of a quantitative/quali-tative dementia care framework is a challenge, as the number of people with dementia has increased with the rapidly aging community. In order to solve the prob-lem of caregivers,it is important not only to provide a sufficient number of care workers for aged people,but also to spread a better understanding about people with dementia to the public and increase their opportu-nities to interact with each other. Although,perhaps, the term dementia has spread to our community as our own problem,through specific television programs or films, few reports have investigated how business-men should communicate with people in debusiness-mentia or understand them.
Okita advocated the importance of dementia care by mutual support within local communities,and said that it was necessary to educate through lectures about dementia. The Campaign to Understand Dementia and Build Community Networks was launched in
2005, and trainings have been delivered for caravan mates, and supporters, namely people who give lec-tures across many places in Japan,to the caregivers of those suffering from dementia.
If the activities of these supporters grow, it can lead to the establishment of local communities in which people, particularly those with dementia, can live with peace of mind. However, the activities of supporters have not sufficiently spread to businessmen yet. A direct involvement with and support from companies or shop workers would be essential,so that people with dementia can lead economically and socially sound lives in their communities,independent-ly from famicommunities,independent-ly members, in the future.
In the past, while there have been surveys on the relationship between people with dementia and local residents, no survey has examined a specific group of people such as businessmen. Moreover,since busines-smen do not only assume responsibility for their economic activities but also have their own parents or family to care for, the problem of dementia nursing
1 Department of Nursing,Gunma University Graduate School of Health Sciences,3-39-22 Showa-machi,Maebashi,Gunma 371-8514, Japan
Received : January 5, 2011
Address: YOKO UCHIDA Department of Nursing, Gunma University Graduate School of Health Sciences, 3-39-22 Showa-machi, Maebashi, Gunma 371-8514, Japan
care could turn into a problem they would have to encounter in the future. Concerning the above con-siderations, the aim of this study intends to elucidate the perspectives of businessmen in their involvement with people who suffer from dementia and the informa-tion they want to know about dementia, in order to investigate some possible effective approaches for their education.
II Subjects and M ethods
1. Subjects
The respondents to our questionnaire survey were 100 members belonging to the B association of A bank with branches in the North Kanto areas. They had participated in a lecture on dementia care, which was held by the bank s five branches for their members. The theme of the lecture,which was held once at each branch from July 2008 to March 2009, was dementia care, and researchers served as the lecturers. The function of B association is to promote collaborations with local businesses so that A bank can contribute to the development of local companies. This associa-tion provides its members with informaassocia-tion or business support through activities including the organizing of lectures or various seminars and business reporting. At of the end of March 2009, it had 4,475 members. Local businesses, individual proprietors,and different organizations mainly joined the association, whose members are commonly managers of companies or independent businesses. These subjects were defined as the businessman in this study.
2. Survey content and method
The survey items were independently developed by narrowing them down to avoid burdening the subjects with complex survey procedures. An A4-sized sheet containing an anonymous self-report ques-tionnaire form was adopted. The primary items to be examined were defined as follows: (1)Subjects back-ground (sex, age, etc.); (2) Experiences involving people suffering from dementia; (3) Embarrassment felt by a subject when treating people with dementia and the content of successful experiences; and (4) Information that the subjects need on people with dementia. The answering field consisted of three columns to determine whether the subjects have had any experience or not; there was also a free-text col-umn for describing the experience, and a colcol-umn pertaining to the information that the subjects needed, which contained ten checkboxes. The subjects were instructed to check the appropriate items from among the ten that were predetermined on the basis of previ-ous literature. After an explanation of the objectives of the survey, method, and ethical considerations
fol-lowing the lecture,the subjects were asked to complete the questionnaire on the spot. To collect the questi-onnaires,the subjects dropped the forms into specially prepared boxes after the lecture (or after an explana-tion on the definiexplana-tion of dementia or the method of caring for dementia symptoms), and a responsible office staff member from each branch mailed the ques-tionnaires to the researchers. The definition of dementia given in the lecture was a summary of the guidelines for the diagnosis of dementia from the International Classification of Disease, Tenth Revi-sion, specified by the World Health Organization. Subjects were asked to make judgments on the basis of the symptoms specified in the abovementioned guide-lines for the responses.
3. Analytical method
Data were digitized to be entered and the statisti-cal processing of them or, namely, the χ test and Fishers exact test,were performed using SPSS version 15.0. Descriptive data were entered into Excel sheets, where one data was printed on one card. Subsequent-ly, from among a number of cards, those with similar data were grouped together into a specifically named category.
4. Ethical considerations
The survey was conducted with the permission of the senior staff of the A bank in charge of the lecture and the general manager of each branch. An explana-tion of the following was given to the subjects after the lecture: the objectives and method of the survey; the fact that the questionnaire form is anonymous and no information that allows the identification of an indi-vidual person is to be collected ; participation in the survey can be declined by the subject (no disadvantage would be created even if they refused); on submission of the questionnaire form, it would be assumed that each subjects personal consent has been obtained ; data are digitized to be entered ; questionnaire form and data are supposed to be destroyed after completion of the analysis; and the results would be announced at the meetings of societies or others.
III Results
1. Subject s background and the presence or absence of an experience involving people with dementia
The 100 subjects comprised 71 males(71.0％)and 29 females (29.0％). The number of subjects within the age group of 40 to 59 years was 52, while those in their 60s were 29. The number of branch mem-bers located within Gunma prefecture was 66,and that within Saitama and Tochigi prefectures was 23,and 11,
respectively. The number of subjects who have expe-riences involving people with dementia was 68; of these, the number of those who had experiences in business was 26 and that of those who had experiences in daily life were 62. The number of subjects who have experienced feelings of embarrassment when treat-ing people with dementia was 27 and that of those who have had successful experiences was 19 (Table 1).
2. The contents of those who experienced feelings of embarrassment when treating people with dementia and those who had successful experi-ences
When treating people with dementia, the types of embarrassments included reasons such as I felt embar-rassed because I could not have a good conversation with him, I was troubled because he became aggres-sive, I was troubled because he repeated whatever he told me, I was in trouble when treating him because he was very forgetful, and others. Successful experi-ences in treating people with dementia included I accepted him, I worked out an appropriate way to treat him, I listened to him empathically, and
others. From among these, there was a single differ-ent description,which was I pretended to understand what he said even though he said something I did not understand (Table 2).
3. Information that subjects need about people with dementia
In their descending order of frequency, the responses to the information that the subjects needed on people with dementia included dementia preven-tion in 42 subjects, early hospital visit/diagnosis/ treatment in 32 subjects, way of treating people with dementia in 30 subjects, physical and mental care of caregivers in 23 subjects, symptoms or progression of dementia in 20 subjects, what people with dementia want in 18 subjects, actual status of the nursing care method in 16 subjects, available nursing services in 16 subjects, property management in 6 subjects,and
adult guardianship in 3 subjects (Table 3).
Table 1 Subjects Background （n＝100）
Items Answer n ％ Male 71 71.0 Sex Female 29 29.0 20s∼30s 9 9.0 40s∼50s 52 52.0 Age 60s 29 29.0 ＞70s 10 10.0 C branch in Gunma prf. 45 45.0 D branch in Gunma prf. 21 21.0 Branch of the bank to which the subjects belong E branch in Saitama prf. 12 12.0 F branch in Saitama prf. 11 11.0 G branch in Tochigi prf. 11 11.0
Yes 68 68.0
Involvement with people with dementia No 31 31.0
No answer 1 1.0
Yes 26 26.0
Experience of involvement with people with dementia in business No 73 73.0
No answer 1 1.0
Yes 62 62.0
Experience of daily involvement with people with dementia No 37 37.0
No answer 1 1.0
Yes 27 27.0
Embarrassment when treating people with dementia No 59 59.0
No answer 14 14.0
Yes 19 19.0
Successful experience in the method of treating people with dementia No 65 65.0
Table 2 Embarrassments and successful experiences when treating people with dementia
Category Code (Actual descriptions)
Embarrassment I was troubled because I could not have a good conversation.
Difficulty in having conversations, dialogues, and treating them.
Difficulty in judging whether his response is normal when I talk to him.
Conversation is not established.
Difficulty in determining the truth from what they say.
I was troubled because he became aggressive. He yells easily.
He is skeptical of the family, gets grumpy, and is hateful of everything.
He got angry and said that I took his money and that I was to blame.
I was troubled because he repeated whatever he told me.
He repeated what he said many times over. He told me the same story over and over. I felt embarrassed when treating him because he
was very forgetful.
He easily forgets things.
I was mistaken for another person even though I had just met him.
I was in trouble for his problematic behavior. I was to stay in his house.
He was so languid that I was in trouble. I had no idea what to do to with him because he was discouraged, with deadened eyes and a bowed head. I did not know what to do with the difference
between his thoughts and reality.
He considers himself to be a steady person,although he actually is not.
Successful experiences I accepted him I accepted him without denying what he said. Just accepted him without saying No, wait, if he was obsessed about going back home.
I could accept him, feeling the truth behind his words.
I worked out an appropriate way to treat him. I treated him gently. I treated him respectfully.
I treated him such that he felt dependable. I listened to him empathically. I listened to him carefully.
I made conversation.(Even though he said meaning less things, I pretended to understand them.)
-I cooperated with his family. I consulted with his family members who attended to
him.
Table 3 Information that subjects need about people with dementia （n＝100）
Items of information that subjects need n ％
Dementia prevention 42 42.0
Early hospital visit/diagnosis/treatment 32 32.0
Way of treating people with dementia 30 30.0
Physical and mental care of caregivers 23 23.0
Symptoms or processes 20 20.0
What people with dementia want 18 18.0
Actual status of the nursing care method (meals/excretion/taking a bath) 16 16.0
Available local services 16 16.0
Property management 6 6.0
Adult guardianship system 3 3.0
Others 1 1.0
4. Relationship between background conditions and experiences of involvement/information that the subjects need
Subjects who belong to the bank s branches in Saitama prefecture had a significantly more frequent involvement with people with dementia on business than those in other prefectures (Gunma/Tochigi pre-fectures) (p＜0.05) (Table 4). Subjects aged 70 years or over showed significantly higher rates in property management and adult guardianship system than the younger subjects (p＜0.05) (Table 5).
V Discussion
1. Characteristics of the relationship shared between businessmen and people with dementia
In this study, subjects who had prior experience being involved with people with dementia accounted for 68.0％. A survey on public local residents by Maruo et al.reportedly showed 42.5％, demonstrating that the value shown in this study was higher. This might be due to the fact that the subjects might be in an easy-to-answer situation because they can specifi-cally envisage people with dementia owing to a num-ber of opportunities to learn the disease name and an explanation of its symptoms during the lecture as well. In the days ahead, businessmen will be expected to have an increased number of opportunities to be involved with people with dementia, as the aging population increases and enlightenment spreads in the local communities along with the increasing number of people with dementia.
While most subjects in this study were male,aged
40 through 50 years and in their prime now,those who had the opportunity to meet people with dementia on business accounted for 26％. This fact suggests that people with dementia have yet to sufficiently engage themselves in economic activities.
Meanwhile,subjects who have the opportunity of meeting people with dementia in their daily lives accounted for over 50％. This result indicates that they often have opportunities to observe their own family members or neighbors who suffer from dementia, as the age of the subjects parents just over-lap the generation of the latter-stage elderly people in need of nursing care.
A possible reason why the subjects who live within Saitama prefecture often saw people with dementia on business as compared with those in Gunma/Tochigi prefectures was the impact of more opportunities to be involved with people with dementia, made available because of the higher num-ber of companies as compared with those of other prefectures.
The propagation of activities to avoid difficulties, which persons with dementia would often face in our society, have recently flourished, including campaigns on community planning for people with dementia to live with a sense of security or community planning allowing for the safe life of people with dementia . In this field of study, the effect of an indoctrination program on dementia care for citizens reportedly varies,depending on whether they have been involved with people with dementia. In the future,it is neces-sary to teach subjects an effective way to be involved
Table 4 Comparison between inhabitants of Saitama prf. and other subjects
Experience of meeting people with dementia on business Location of the branch that the subjects belong to Yes
n ％ No n ％ χ value Saitama prf. 11 47.8 12 52.2 7.2 ＊ Others (Gunma/Tochigi prf.) 15 19.7 61 80.3 ＊ p＜0.05
Table 5 Comparison of information that the subjects need by age
Property management
Subjects age Checked
n ％
Unchecked
n ％ χ value
＜70 yrs. 3 3.3 87 96.7 11.3＊
≧70 yrs. 3 30.0 7 70.0
Adult guardianship system
Subjects age Checked
n ％ Unchecked n ％ χ value ＜70 yrs. 1 1.1 89 98.9 11.0＊ ≧70 yrs. 2 20.0 8 80.0 ＊ p＜0.05
with people with dementia in various aspects, by fur-ther elevating the general level of the transfer of knowl-edge about dementia.
2. Need to educate businessmen to improve their ability of communication with people with dementia
When it comes to the contents of embarrassment when treating people with dementia,most were related to problems of communication ; therefore, it was im-possible for the subjects to have a conversation with the people with dementia, since the latter could become aggressive or repeat everything they said. People with dementia become increasingly poor at recalling anything or retaining words owing to mem-ory loss or the like,resulting in an increasing disability to understand even a normal level of conversation. Moreover, when you communicate with people with dementia,the way you talk makes more sense than the meanings of words themselves. Specifically, you should bear in mind that you transfer an image by talking with an expressive face, speaking in as short sentences as possible with only a single piece of infor-mation contained in each sentence, and so on.
In this study,20％ of the subjects had a successful experience in treating people with dementia. As was the case for the embarrassing experiences, successful experiences, such as accepting people with dementia, working out the best way to treat them, or earnestly listening to them,were also related to communication. It was found that these subjects succeeded in treating people with dementia not by using special skills but by being considerate toward them. It is common knowl-edge that good manners are required for customer service; the ability to be considerate resulted from the attitude that each businessman acquired and what had long been established in their lifes experiences. In view of the increasing number of elderly people or people with dementia among their customers, the acquisition of a courtesy or communication method that is effective in treating the elderly, particularly people with dementia, might simultaneously lead to behaviors that reflect the good care of their customers -an education to which each company should devote itself.
While there was the description, I pretended to understand what he said, among the answers, the question remains: although this behavior is just a patchwork response,can this be considered a successful experience? At any rate,there is a need to develop an ability to speak in a particular way when people with dementia do not understand what you say,in order to accept what they want to express and correct the words of the reply. On the basis of the above-stated
consid-erations, an education on a specialized corresponding method is needed.
It has been reported that a successful experience may increase interactions with people with dementia in long-term human relations. Increasing the successful experiences with people with dementia among working people, by making the specialized corresponding methods pervasive,will create a truly local community that is easy for people with dementia to live in.
3. Holding lectures bearing in mind the age The subjects in this study were interested in the following three medical aspects: early hospital visits/treatment and matters concerning nursing care such as the method of treating people with dementia or nursing care and service systems. This observa-tions regarding the study suggests that as members of a society,the subjects have no idea about what they need to do about services for customers. It suggests that the subjects want to gain medical knowledge on the pre-vention or early diagnosis of dementia in order to prevent it when they become old, as they were adult-hood or later. Further, that they are interested in nursing care as members of the generation that is responsible for the care of other family members. Furthermore, they are assumed to be interested in the details of the Public Nursing Care Insurance System, which was launched in 2000 with the advent of differ-ent services. The 2004 basic survey of Nerima-ward s older inhabitants reported that dementia prevention ranked first (28.5％)among what the inhabitants want to know about health. The same holds true for the result of this study,which suggests that prevention is a matter of profound concern for inhabitants. Like-wise,the subjects were highly interested in nursing care this time,partly because this study was performed after a lecture on dementia care. It is necessary to disperse not only information about prevention but also about nursing care methods or systems for the future.
The proportion of people who wished to know about property management or adult guardianship was high among the more mature subjects. As highly -aged subjects in this study have property, partly in-fluenced by the fact that many of them hold middle management positions, a serious problem for them to worry about when they suffer from dementia is prop-erty management. In fact,the number of people who utilize the adult guardianship system or the project for guarding the local communitys welfare rights is increasing every year. Subjects should gather infor-mation, like that mentioned above, prior to the onset of dementia, since these are important matters to be transmitted, particularly for the elderly population, from an early stage before they develop dementia.
A course on dementia is reportedly effective in increasing the willingness to understand dementia and accept people with dementia. Furthermore, of late, sessions on experiencing nursing care and the like are held for transportation or hospitality workers who have more opportunities to treat handicapped people, albeit not with dementia, and their effects are report-ed. We, in the profession of nurses, are required to undertake specific enlightenment activities to increase the successful experiences involving people with dementia by voluntarily visiting the places of busy businessmen, educational places like schools, and other places like administrative offices.
VI Limitations of this study and
future challenges
In this study, the survey items were developed independently, and there were limitations to the selec-tion or extracselec-tion of the subjects. Thus,it is necessary to examine the reliability and validity of whether the survey items are consistent with the objective of this study and to examine the extraction method so that the subjects are generalized.
Acknowledgments
We thank A bank and all the members of the B association for their kind assistance during the survey. A part of this study was announced at the 13th meeting of the Gunma Nursing Society.
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