鈴村 彰太

A BSTRACT Introduction: The coronavirus disease 2019 pandemic prompted widespread restrictions on daily activities, leading to concerns over delayed medical consultations. However, limited social interaction outside the home may have increased the time family members spent with older adults, potentially facilitating earlier detection of dementia symptoms. This study aimed to examine changes in dementia severity, cognitive function, and caregiver burden at initial visits to a memory clinic before and during the pandemic and compare the patterns of initial visits to outpatient memory clinics. Materials and Methods: In total, 378 patient-family pairs (200 before and 178 during the pandemic) were evaluated at their first clinic visit. Cognitive function, dementia severity, and caregiver burden were assessed. Group comparisons were conducted using the Mann-Whitney U and χ ² tests. Results: While cognitive test scores and caregiver burden were similar between the two periods, patients who visited during the pandemic exhibited significantly lower dementia severity (clinical dementia rating: P = 0.001). The correlation between observed dementia severity and cognitive function remained strong in both periods. Conclusion: Contrary to expectations of delayed care, the pandemic period was associated with earlier clinical visits for patients with milder dementia. These results suggest that increased contact between family members and patients provided more frequent opportunities for support and intervention, which prevented a decline in activities of daily living among patients with the same cognitive impairment.

OBJECTIVES: This study aimed to clarify the differences in goal setting and achievement trends in home-visit rehabilitation at different levels of independence in mobility. METHODS: Goals set at the beginning of home-visit rehabilitation were retrospectively examined using the Canadian Occupational Performance Measure (COPM). All goals were classified into nine categories in three domains based on the principles of the COPM. The participants were divided into three groups according to their level of independence in mobility. The proportion of participants with goals in each category was compared. Additionally, the COPM performance and satisfaction scores at the beginning of rehabilitation and 3 months later were compared. RESULTS: In total, 245 participants were categorized into the assisted (n=48), supervised (n=65), and independent groups (n=132). Functional mobility (36.3%) was the most common goal, accounting for the largest number of patients within each group. The percentages of those with goals in the categories of personal care (P = 0.013), community management (P < 0.001), household management (P < 0.001), quiet recreation (P < 0.001), and active recreation (P = 0.024) were significantly different among the three groups. All three groups showed significant improvements in performance scores (assisted group, P = 0.014; supervised group, P < 0.001; independent group, P < 0.001) and satisfaction scores (P < 0.001 in all three groups) in the self-care domain. CONCLUSIONS: Goal categories for home-visit rehabilitation varied according to the level of independence in mobility. Nevertheless, goals in the self-care domain are likely to be achieved, regardless of mobility independence, after home-visit rehabilitation.