Dr. Yumiko Arai: the Head of Department of Gerontological Policy (Health Policy for the Aged)

Burden of caregivers
One of the salient methodological issues attached to burden research is to objectively measure the degree of psychological burden of caregivers. Dr. Steve Zarit developed the Zarit Caregiver Burden Interview in 1980, which has been widely used in North America. The lack of objective burden scales in Japanese led Dr. Yumiko Arai to devise the Japanese version of the Zarit Caregiver Burden Interview. Currently, we have been investigating caregiver burden in several communities located in different regions in Japan.

Selected Publications

Arai Y, Washio M. Burden felt by family caring for the elderly members needing care in southern Japan. Aging Ment Health 1999; 3: 158-164.

Arai Y, Zarit S, Sugiura M, Washio M. Patterns of outcome of caregiving for the impaired elderly: a longitudinal study in rural Japan. Aging Ment Health 2002; 6(1): 39-46.

Arai Y, Masui K, Sugiura M, Washio M. New Japanese Long-Term insurance system slashes carer time but problems remain. Int J Geriatr Psychiatry 2002; 17(5): 489-491.

Arai Y, Kumamoto K, Washio M, Ueda T, Miura H, Kudo K. Factors related to feelings of burden among caregivers looking after impaired elderly in Japan under the Long-Term Care Insurance system. Psychiatry Clin Neurosci 2004; 58(4): 396-402.

Arai Y, Tamiya N, Yano E. The short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8): its reliability and validity. Jpn. J. Geriat. 2003; 40: 497-503.

Kumamoto K, Arai Y, Ueda T, Washio,M. Cross-validation of the short version of the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI_8). Jpn. J. Geriat. 2004; 41(2): 204-210.

Kumamoto K, Arai Y. Validation of “Personal Strain” and “Role Strain”: Subscales of the short version of the Japanese version of the Zarit Burden Interview (J-ZBI_8) Psychiatry Clin Neurosci 2004; 58(6): 606-610.

Miura H, Arai Y, Yamasaki K. Feelings of burden and health-related quality of life among family caregivers looking after the impaired elderly. Psychiatry Clin Neurosci 2005; 59(5): 551-555.

Schreiner AS, Morimoto T, Arai Y, Zarit SH. Assessing family caregiver’s mental health using a statistically derived cutoff score for the Zarit Burden Interview. Aging Ment Health 2006; 10(2): 107-111.

Oura A, Washio M, Wada J, Arai Y, Mori M: Factors related to institutionalization among the frail elderly with home-visiting nursing service in Japan. Gerontology 2006; 52(1): 66-68.

Kumamoto K, Arai Y, Zarit SH. Use of home care services effectively reduces feelings of burden among family caregivers of disabled elderly in Japan: Preliminary results. Int J Geriatr Psychiatry 2006; 21(2): 163-170.

Sasaki M, Arai Y, Kumamoto K, Abe K, Arai A, Mizuno Y. Factors related to potentially harmful behaviors towards disabled older people by family caregivers in Japan. Int J Geriatr Psychiatry 2007; 22(3): 250-257.

Oura A, Washio M, Arai Y, Ide S, Yamasaki R, Wada J, Kuwahara Y, Mori M. Depression among caregivers of the frail elderly in Japan before and after the introduction of the Public Long-Term Care Insurance System. Z Gerontol Geriatr 2007; 40: 112-118.

Arai A, Matsumoto T, Ikeda M, Arai Y. Do family caregivers perceive more difficulty when they look after patients with early onset dementia compared to those with late onset dementia? Int J Geriatr Psychiatry 2007; 22(12): 1255-1261.

Arai Y, Zarit SH. Exploring strategies to Alleviate Caregiver Burden: The Effects of the National Long-term Care Insurance Scheme in Japan. Psychogeriatrics 2011 (in press).

Invited talks

Arai Y. Caregiver issues: a Japanese perspective (Symposium). The 13th Congress of International Psychogeriatric Association (IPA), 2007 October 14-18 (Presentation: October 15), Osaka, Japan.

Arai Y. Paradigm shift away from family caregiving for the aging Japanese population (Symposium). 8th Asia/Oceania Regional Congress of Gerontology and Geriatrics, 2007 October 22-25 (Presentation: October 23), Beijing, China.

Arai Y. Exploring Measures to Prevent Caregiver Burden: The Effects of the National Long-term Care Insurance Scheme in Japan (plenary lecture). The 14th Congress of International Psychogeriatric Association (IPA), 2009 September 1-5 (Presentation: September 3), Montreal, Canada.

Arai Y. Support systems for family caregivers of older people with dementia in Japan (Symposium). The 3rd Congress of the Asian Society Against Dementia (ASAD 2009), 2009 October 11-13 (Presentation: October 13), Seoul, Korea.

Arai Y. A population-based approach could reduce caregiver burden: a community education intervention in Japan (Symposium). Alzheimer’s Association International Conference on Alzheimer’s Disease 2010 (ICAD), 2010 July 10-15 (Presentation: July 12), Honolulu, Hawaii.

Presentations

Sasaki M, Arai A, Arai Y. Factors related to institutionalization among disabled older people; a two-year longitudinal study. The 13th Congress of International Psychogeriatric Association (IPA), 2007 October 14-18 (Presentation: October 15-16), Osaka, Japan.

Arai A, Matsumoto T, Ikeda M, Arai Y. Comparative study of the perceived difficulties of caring for relatives with early and late onset dementia. The 13th Congress of International Psychogeriatric Association (IPA), 2007 October 14-18 (Presentation: October 15-16), Osaka, Japan.

Attitude towards using social services
In the past, family values and self-help were over-emphasized for a long time, which consequently led to the stigmatization of social services in Japan. Such stigma attached to using social services prevents those in need from taking up the services even since the Long Term Care (LTC) insurance was implemented in April of 2000. Thus, we have been investigating people's attitude towards using social services. We have identified "the experience of having been a caregiver" as a statistically significant factor related to service utilization.

Selected Publications

Arai Y. Insurance for long-term care planned in Japan. Lancet 1997; 350: 1831.

Arai Y, Sugiura M, Miura H, Washio M, Kudo K．Undue concern for others' opinions deters caregivers of impaired elderly from using public services in rural Japan. Int J Geriatr Psychiatry 2000; 15: 961-968.

Arai Y. Japan’s new long-term care insurance. Lancet 2001; 357(9269): 1713.

Arai Y, Ueda T. Paradox revisited: still no direct connection between hours of care and caregiver burden. Int J Geriatr Psychiatry 2003; 18(2): 188-189.

Arai Y, Zarit S, Kumamoto K, Takeda A. Are there inequities in the assess ment of dementia under Japan’s LTC insurance system? . Int J Geriatr Psychiatry 2003; 18: 346-352.

Arai Y, Kumamoto K. Caregiver burden not “worse” after new public Long-Term Care (LTC) insurance scheme took over in Japan. Int J Geriatr Psychiatry 2004; 19: 1205-1206.

Quality of care

Care inspection
Drawing on her intensive study of the system for inspecting institutional care in the UK, Dr Arai has identified a number of problem areas for consideration in the Japanese context. Our intention is to develop effective ways of monitoring institutional care in Japan and, later, to apply a similar approach to the monitoring of domiciliary care.

Home Care Quality Assessment Index (HCQAI)

Our previous work on home care involved the development of the Home Care Quality Assessment Index (HCQAI) by which the quality of input, process and outcome of home care can be scientifically assessed. We are now linking research directly to practice by incorporating items used routinely by district nurses into the Index for practical application in their daily work.

Selected Publications

Arai, Y, Kumamoto, K, Sugiura, M, Washio, M, Miura, H and Kudo, K. Development of the Home Care Quality Assessment Index (HCQAI). Jpn J Geriatric 2005; 42(4), 432-443.

Kumamoto K, Arai, Y. Validation of the Home Care Quality Assessment Index (HCQAI). Jpn J Geriatric 2006; 43(4): 518-524.

Dementia and driving

With the prevalence of dementia at 4-6% and the number of older divers standing at 8.79 million, it is estimated that there may be around 350,000 people with dementia who continue to drive. The revised Road Traffic Act 2002 includes dementia for the first time as a reason for license revocation. Our research, based on interviews with local licensing officers, investigates the way in which the Act is being applied at local level.

Selected Publications

Arai Y. Implementation and implications of the 2002 Road Traffic Act of Japan from the perspective of dementia and driving: A qualitative study. Jpn Bull Soc Psychiat 2006; 14: 158-161.

Arai A, Mizuno Y, Arai Y. Differences in perceptions regarding driving between young and old drivers and non-drivers in Japan. Int J Geriatr Psychiatry 2010; 25(12): 1239-1245.

Mizuno Y, Arai A, Arai Y. Measures for enhancing the mobility of older people with dementia in Japan: Should it be a matter of self-help? J Am Geriatr Soc 2010; 58(10): 2048-2049.

Invited talks

Arai Y. The impact of downloadable information on dementia and driving, which targets family caregivers and professionals in municipalities (Symposium). The 15th Congress of International Psychogeriatric Association (IPA), 2011 September 6-9, Hague, Netherlands.

Presentations

Arai, Y. Problems of family caregivers with demented elderly behind the wheel: the Road Traffic Act of Japan revisited, Presentation to the 18th International Conference on Social Psychiatry (Kobe), 2004

Mizuno Y, Arai A, Arai Y. Status quo for determining driving cessation of older adults with dementia in Japan. The 13th Congress of International Psychogeriatric Association (IPA), 2007 October 14-18 (Presentation: October 17-18), Osaka, Japan.

Arai A, Mizuno Y, Arai Y. Perceptions about driving among the general public in Japan: Implications for possible barriers to driving cessation of dementia patients. The 3rd Congress of the Asian Society Against Dementia (ASAD 2009), 2009 October 11-13 (Presentation: October 12), Seoul, Korea.

Mizuno Y, Arai A, Arai Y. Measures aimed at enhancing the mobility of older people in Japan: exploring possible implications for older drivers with dementia. The 3rd Congress of the Asian Society Against Dementia (ASAD 2009), 2009 October 11-13 (Presentation: October 12), Seoul, Korea.

General public’s perceptions of ageing

We have conducted a survey of 2000 people in Japan into the general public’s perceptions of ageing, in terms of their attitudes to long life and worries about growing old, especially their fears of developing dementia. They were also questioned about their worries about becoming bedridden, ill, losing part of their income on retirement, and possible deterioration in family/spouse/friend relationships. Preliminary analysis has revealed some interesting findings and further analysis is planned.

Selected Publications

Arai Y, Kumamoto K, Zarit SH, Dennoh H, Kitamoto M. Angst in Shangri-la: Japanese fear of growing old. J Am Geriatr Soc 2005; 53(9): 1641-1642.

Arai Y, Arai A, Zarit SH. What do we know about dementia?: A survey on knowledge about dementia in the general public of Japan. Int J Geriatr Psychiatry 2008; 23(4): 433-438.

Arai Y, Arai A, Mizuno Y. The National Dementia Strategy in Japan. Int J Geriatr Psychiatry 2010; 25(9): 896-899.

Invited talks

Arai Y. Knowledge and attitude towards dementia among the Japanese (Symposium). The 3rd World Congress of Asian Psychiatry (WCAP 2011), 2011 July 31-August 4, Melbourne, Australia.

Chewing activity and the quality of life of the elderly
We have been investigating the relationship between chewing activity and the quality of life of the elderly residing in a community.
Search words: nursing, caring sciences, psychology, Japan, the elderly, caregivers, Kaigohoken.

Selected Publications

Miura H, Arai Y, Sakano S, Hamada A, Umenai T, Isogai E. Subjective evaluation of chewing ability and self-rated general health status in elderly residents of Japan. Asia-Pacific J Public Health 1998; 10: 43-45.

Miura H, Kariyasu M, Yamasaki K, Arai Y, Sumi Y. Relationship between general health status and the change in chewing ability: A longitudinal study of the frail elderly in Japan over a 3-year period. Gerodontology 2005; 22: 200-205.

Miura H, Kariyasu M, Yamasaki K, Arai Y.　Evaluation of chewing and swallowing disorders among frail community-dwelling elderly individuals. J Oral Rehabil 2007; 34: 422-427.

Presentations

Miura H, Arai Y. Oral Health Care Needs and Provision for the impaired elderly. 84th General Session & Exhibition of IADR (Internation Association for Dental Research), 2006 June 28-July 1 (Presentation: June 29), Brisbane, Australia.