Palliative care for advanced dementia
in Japan: knowledge and attitudes
Miharu Nakanishi and Yuki Miyamoto
ABSTRACT
This study examined factors contributing to the knowledge and attitudes of
nursing home staff regarding palliative care for advanced dementia in Japan.
A cross-sectional survey of 275 nurses and other care workers from 74 long-
term care facilities was conducted across three prefectures in August 2014.
The Japanese versions of the Questionnaire on Palliative Care for Advanced
Dementia (qPAD) and Frommelt Attitudes Toward Care of the Dying scale,
Form B (FATCOD-B-J) were used. Greater knowledge was exhibited among
nursing home staff in facilities that established a manual for end-of-life care.
Higher levels of positive attitudes were observed among nursing home staff
in facilities that had established a manual and those in facilities with a
physician’s written opinions on end-of-life care. An organisational effort should
be explored to establish end-of-life care policies among nursing home staff for
advanced dementia.
Key words: Attitude ■ Dementia ■ Long-term care ■ Nurse
■ Nursing homes ■ Palliative care
D
ementia is an important, growing public health
problem worldwide (World Health Organization,
2012). Nursing homes are important providers
of end-of-life care for people with dementia
(Houttekier et al, 2010; Callahan et al, 2012;Teno
et al, 2013). Meanwhile, providing the best possible quality of
care for people with dementia can be a challenge for nursing
homes. Residents with advanced dementia sometimes undergo
burdensome interventions including hospitalisation (Mitchell
et al, 2004a; Mitchell et al, 2009; Gozalo et al, 2011), tube
feeding (Mitchell et al, 2004b; Mitchell et al, 2009), and restraints
(Mitchell et al, 2004b)
In Japan, along with an ageing population, the annual number
of deaths owing to dementia has increased from 3309 in 1999
to 18 175 in 2013 (Ministry of Health, Labour and Welfare,
2014). Further, the percentage of deaths owing to dementia
compared with all nursing home deaths has risen from 15.7%
in 1999 to 36.6% in 2013. Mandatory public long-term care
Miharu Nakanishi, Chief Researcher, Mental Health and Nursing
Research Team, Department of Psychiatry and Behavioural
Science, Tokyo Metropolitan Institute of Medical Science;
Yuki Miyamoto, Associate Professor, Department of Psychiatric
Nursing, Graduate School of Medicine, University of Tokyo
Accepted for publication: June 2015
146 
British Journal of Nursing. Downloaded from magonlinelibrary.com by 128.119.168.112 on February 19, 2016. For personal use only. No other uses without permission. . All rights reserved.
insurance (LTCI) was established in 2000 for elderly individuals,
and the LTCI programme covers residential care packages
in nursing homes as well as home care services. Under the
public health insurance scheme, hospice service and the use
of opioids for pain relief are available only for patients with
end-stage cancer (Yamagishi et al, 2008). However, quality of
end-of-life care is highly important for residents with dementia
in Japan. Japanese residents in nursing homes receive several
burdensome interventions such as tube feeding (Ikegami and
Ikezaki, 2012; Nakanishi and Hattori, 2014), cardio-pulmonary
resuscitation (Ikegami and Ikezaki, 2012), and hospital transfer
in the end-of-life phase (Ikegami and Ikezaki, 2012; Ikegami
and Ikezaki, 2013). Knowledge and attitudes of nursing home
staff regarding palliative care may affect the implementation of
these interventions for dying residents.
Aim
Several studies in Japan have focused on the knowledge and
attitudes of physicians or nurses regarding dying patients,
typically patients with cancer (Morita et al, 2006; Yamagishi
et al, 2012). The general public of Japan have demonstrated
limited understanding of prognosis for dementia (Arai et al,
2008). However, no research has examined the factors related
to knowledge and attitudes of nursing home staff regarding
palliative care for patients with advanced dementia in Japan.
This was, therefore, the aim of the present study.
Methodology
The present study was conducted using a cross-sectional study
design, in nursing homes in Japan, in August 2014.
Subjects were recruited from long-term care facilities across
three prefectures (Shiga, Saga, and Tottori). The location was
selected based on the percentage of deaths in long-term care
facilities compared with all deaths in each prefecture as reported
in Vital Statistics 2012 (Ministry of Health, Labour and Welfare,
2013). The rates were 4.8% (low), 7.1% (middle), and 12.5%
(high) in Shiga, Saga, and Tottori, respectively. There were
337 facilities listed in total across the three prefectures’ online
databases at the end of April 2014.
The questionnaires were administered over a 4-week period
© 2016 MA Healthcare Ltd
in August 2014.A set of paper questionnaires was posted to each
participating facility. The completed questionnaires were also
collected by post. A reminder postcard was sent in September
2014. Each facility was asked to distribute questionnaires to
three nurses and three other care workers to include both
British Journal of Nursing, 2016, Vol 25, No 3
 employees who had provided end-of-life care to the elderly and
those who had not yet done so.There is no authorised training/
qualification for end-of-life care in long-term care in Japan.
A total of 89 facilities (response rate 26%) returned
written questionnaires. Among these, 9 facilities provided no
information regarding care workers and 80 facilities provided
313 employee-level (rather than facility-level) questionnaires.
The final sample for analysis consisted of 275 fully completed
questionnaires from 74 facilities (valid response rate 22%).The
275 employees included in the study had a higher rate of men
(c2 (1 degree of freedom (df)=5.80, p=0.016) and fewer nurses
(c2 (1 df)=4.93, p=0.026) compared to the 38 employees who
were excluded from the study owing to incomplete responses
on the questionnaire.
The 74 facilities included in this study included more
special nursing homes (facilities for permanent residence;
c2 (2 df)=16.20, p<0.001), welfare corporations (c2 (3 df)=13.65,
p=0.003), and facilities from Shiga prefecture (c2 (2 df)=6.54,
p=0.038) as compared to the 257 facilities that were excluded
from the study or that did not respond to the survey. Facilities
were excluded either because they provided facility-level
information but no care workers of the facility returned
questionnaires, or all care workers of the facility provided
incomplete responses.
Measurements
Subjects were asked to complete a self-administered questionnaire
anonymously. The questionnaire consisted of questions about
knowledge and attitudes regarding palliative care for advanced
dementia, attitudes toward care of terminally ill patients, and
personal and role-related characteristics. Each managing director
was also asked to provide information on the facility’s policy
on end-of-life care. Facility characteristics were obtained from
the long-term care service information in the nationwide
online database managed by the Ministry of Health, Labour
and Welfare. LTCI service providers are required to submit an
annual report on long-term care service information to the
prefectural government. Facility characteristics included type
of facilities, ownership, number of beds, and number of full-
time-equivalent (FTE) physicians per 100 beds.
Attitudes toward palliative care were assessed using two
independent scales to distinguish palliative care in dementia
from palliative care in the general population. Knowledge
and attitudes were assessed using the Japanese version of the
Questionnaire on Palliative Care for Advanced Dementia (qPAD)
scale. The qPAD is a two-part instrument with 23 knowledge
test items and 12 attitude scale statements (Long, 2009; Long
et al, 2012). Each item of the knowledge test is answered with
1 (agree), 2 (disagree), or 3 (don’t know). Responses are scored
as 1 (correct) or 0 (incorrect). The total number of correct
answers is used for the analysis. Higher scores represent greater
knowledge about palliative care for advanced dementia. Each
item of the attitude scale was evaluated using a 5-point Likert
scale ranging from 1 (strongly disagree) to 5 (strongly agree).
Subscale scores were computed for three dimensions: job
satisfaction, perceptions and beliefs, and work setting support
of families. Higher scores represent greater positive attitudes
148 
British Journal of Nursing. Downloaded from magonlinelibrary.com by 128.119.168.112 on February 19, 2016. For personal use only. No other uses without permission. . All rights reserved.
toward palliative care for dementia. Satisfactory validity and
reliability was reported for the original version (Long et al,
2012) and Japanese version (Nakanishi et al, 2015a). A total
score for the Japanese qPAD attitude scale was used for analysis.
Attitudes toward palliative care for terminally ill patients were
assessed using the short version of Japanese Frommelt Attitudes
Toward Care of the Dying Scale, Form B (FATCOD-B-J).
The FATCOD-B-J was developed from the English version
of the FATCOD (Frommelt, 1991; Frommelt, 2003).The short
version of FATCOD-B-J has six items, and total scores range
from 6 to 30. A higher score indicates a more positive attitude
toward palliative care for terminally ill patients. The Japanese
version of FATCOD-B-J has demonstrated acceptable reliability
and validity (Miyashita et al, 2007).
Personal characteristics that were measured included age,
gender, profession, and education level. Education level was
scored on a scale of 1–4 (1=junior high school; 2=high school;
3=vocational school or junior college; 4=university). Role-
related characteristics included profession and tenure as a
care worker. The authors also asked about the total number
of residents for whom the care worker provided end-of-life
care; however, some care workers responded with ambiguous
answers such as: ‘10–20 cases,’ ‘a little,’ and ‘many’ (n=29, 11%).
Therefore, the authors simply used the presence of experience
with providing end-of-life care for the analysis.
The facility’s policy on end-of-life care included the following
four measures: establishment of a manual, implementation of
staff training, presence of physician’s written opinion on the
appropriateness of end-of-life care in the facility, and routine
documentation of each resident’s preferences regarding end-
of-life care in the facility. These items were derived from the
quality measures for end-of-life care under the long-term care
service information system, and they were incorporated to
cover all three types of facility.
Ethical considerations
The study was approved by the Ethics Review Board of the
Institute for Health Economics and Policy (H25-003) and the
Tokyo Metropolitan Institute of Medical Science (14-20).The
study protocol was in line with the provisions set forth in the
Declaration of Helsinki.
The questionnaire contained an introductory section
explaining the purpose of the study, the voluntary nature of
participation, and the assurance of respondents’ anonymity.
Participating care workers were not required to sign consent
forms, and returning the questionnaire implied consent.
Identification numbers were assigned to facilities and respondents.
Analysis
To test consistency between attitudes toward palliative care
for advanced dementia and for terminally ill patients, pairwise
correlation was examined for total scores of qPAD knowledge
© 2016 MA Healthcare Ltd
test, qPAD attitude scale, and FATCOD-B-J.
Multilevel linear regression analyses were performed using
qPAD knowledge test, qPAD attitude scale, and FATCOD-B-J
score as the dependent variables. Multilevel linear regression
analysis allows for dependency of outcome measures within
British Journal of Nursing, 2016, Vol 25, No 3
 Table 1. Characteristics of nursing home staff
facilities and examines the extent of between-facility variation
in the outcome (Peugh, 2010). Independent variables included
Variable Mean (SD) or n (%) personal and role-related characteristics, facility characteristics,
Age 42.6 (11.9) and the facility’s policy on end-of-life care.As data were collected
from nursing home staff nested in facilities, a multilevel linear
Gender, female 212 (77.1)
regression analysis was employed using a linear mixed model
Profession, nurse 121 (44.0) with a variance component structure and restricted maximum
likelihood. The model included facility as a random effect to
Educational level attained
account for within-facility correlation.
Junior high school 2 (0.7) All statistical analyses were conducted using Stata for
High school 61 (22.2) Windows, version 13.0 (StataCorp, College Station, Texas).
The significance level was set at 0.05 (2-tailed).
Vocational school/junior college 180 (65.5)

University 30 (10.9) Results

The 275 respondents consisted of 121 nurses and 154 other
Graduate school 2 (0.7)
care workers (certified care workers or others who provide
Experience personal care but do not have specific qualifications) (Table 1).
Tenure as a care worker, years 9.9 (6.4) The 275 nursing home staff had a mean standard deviation
(SD) score of 12.7 ± 3.6 for the qPAD knowledge test and
Has experience with end-of-life care for the elderly 204 (74.2)
43.6 ± 5.0 for the attitude scale. The average score of the
FATCOD-B-J was 23.0 ± 2.5.
Table 2. Characteristics of long-term care facilities The majority of facilities established a manual on end-of-
Variable Mean (SD) or n (%)
life care (n=54, 73.0% ), implemented staff training (n=46,
62.2%), and routinely documented each resident’s preferences
Type of facility regarding end-of-life care (n=42, 56.8%). Nearly half of
Special Nursing Home (permanent residence) 55 (74.3) facilities had a physician’s written opinions on end-of-life care
(n=35, 47.3%).This information is shown in Table 2. As a result
Geriatric Intermediate Care Facility (rehabilitation) 15 (20.3)
of only local governments and social welfare corporations
Care Medical Facility (heavy medical care) 4 (5.4) being allowed to run special nursing homes (Nakanishi et al,
Ownership
2012), type of facility correlated with ownership, number of
beds, staffing ratio, and annual number of decedents.Therefore,
Welfare corporation 59 (79.7) for the following multivariate analyses, the authors used type
Medical corporation 12 (16.22) of facility (special nursing home or not) instead of other
facility characteristics.
Local government 1 (1.4)
The pairwise correlations were significant between total
Other private sector 2 (2.7) qPAD knowledge score and FATCOD-B-J (r=0.12, p= 0.039),
Capacity and clinical staff
qPAD attitude scale and FATCOD-B-J (r=0.29, p<0.001), and
qPAD knowledge test and attitude scale (r=0.25, p<0.001).
Number of beds 61.2 (27.1) The results of the multilevel linear regression analysis
FTE number of physicians per 100 beds 1.7 (4.9) demonstrated a significantly higher total qPAD knowledge
score among care workers with higher education levels, those in
FTE number of nurses per 100 beds 14.7 (28.4)
facilities that had a manual on end-of-life care, and facilities in
Annual number of decedents 10.2 (8.9) Shiga prefecture.The total qPAD attitude score was significantly
Location (prefecture)
higher among care workers with a longer tenure, those in
facilities that had a manual on end-of-life care, facilities that
Shiga 35 (47.3) had a physician’s order regarding end-of-life care, and facilities
Saga 18 (24.3) in the Shiga prefecture. The total FATCOD-B-J score was
significantly greater among care workers who were nurses and
Tottori 21 (28.4)
those with a longer tenure as a care worker (Table 3).The total
Policy on end-of-life care qPAD knowledge and attitude scores did not differ between
Establishment of manual 54 (73.0)
nurses and other care workers.
© 2016 MA Healthcare Ltd

Staff training 46 (62.2) Discussion

Physician’s written opinions 35 (47.3) This study examined factors that contribute to knowledge and
attitudes of nursing home staff on palliative care for advanced
Preference documented 42 (56.8)
dementia in Japan. The results showed that the presence of an
FTE: full-time equivalent active policy on end-of-life care for residents was significantly

150 British Journal of Nursing, 2016, Vol 25, No 3

British Journal of Nursing. Downloaded from magonlinelibrary.com by 128.119.168.112 on February 19, 2016. For personal use only. No other uses without permission. . All rights reserved.
 Table 3. Results of multilevel linear regression analysis of knowledge and attitudes regarding palliative care.
qPAD, knowledge qPAD, attitude FATCOD-B-J
(0–23) (12–60) (6–30)

Coefficient p-value Coefficient p-value Coefficient p-value

Fixed effect

Intercept 8.90 <0.001 39.55 < 0.001 20.45 <0.001

Individual characteristics

Age 0.01 0.719 0.01 0.723 -0.00004 0.998

Gender, female -0.43 0.418 -0.48 0.509 -0.29 0.428

Profession, nurse 0.20 0.696 -0.80 0.261 1.10 0.002

Education level 0.91 0.009 0.53 0.264 0.04 0.873

Tenure as a care 0.03 0.343 0.14 0.005 0.06 0.018

worker, years

Experience with -0.22 0.665 -0.45 0.537 0.42 0.237

end-of-life care for
the elderly

Facility characteristics

Special nursing 0.28 0.639 0.53 0.557 0.21 0.675

home

Policy on end-of-life care

Establishment of 2.11 0.008 2.48 0.041 1.06 0.120

manual

Staff training -0.49 0.448 -0.48 0.620 -0.11 0.839

Physician’s written -0.58 0.267 1.65 0.037 -0.12 0.789

opinions

Preference 0.22 0.716 -0.48 0.600 0.82 0.112

documented

Location (prefecture, Shiga = 0)

Saga -1.79 0.001 -1.86 0.026 -0.70 0.136

Tottori -0.35 0.517 -1.32 0.100 -0.23 0.602

Random effect

Residual 11.39 20.38 4.63

Facility: intercept 10-15×0.47 1.40 0.91

Intraclass correlation < 0.001 0.06 0.16
coefficient
Fitness of model

c2 (13 df) 30.68 0.004 33.65 0.001 40.17 < 0.001

Log likelihood -724.71 -813.00 -620.57

Akaike’s information 1481.43 1657.99 1273.14

criterion

qPAD: Questionnaire on Palliative Care for Advanced Dementia. FATCOD-B-J: Frommelt attitudes toward care of the dying scale, df: degrees of freedom
© 2016 MA Healthcare Ltd

Significant at p<0.05

related to the knowledge and attitudes of nursing home staff. Attitudes toward palliative care for advanced dementia were
Personal and role-related characteristics were also related to significantly more positive among nursing home staff with
knowledge and attitudes among nursing home staff. longer tenures as care workers. However, being a nurse rather

152 British Journal of Nursing, 2016, Vol 25, No 3

British Journal of Nursing. Downloaded from magonlinelibrary.com by 128.119.168.112 on February 19, 2016. For personal use only. No other uses without permission. . All rights reserved.

KEY POINTS
■■ Quality of end-of-life care is highly important for residents with dementia
in Japan
■■ Knowledge and attitudes of nursing home staff regarding palliative care
may affect the implementation of burdensome interventions for dying
residents
■■ This study examines factors contributing to knowledge and attitudes of
nursing home staff regarding palliative care for advanced dementia
■■ The presence of an active policy on end-of-life care for residents was
significantly related to the knowledge and attitudes of nursing home staff
■■ Organisational efforts to establish end-of-life care policies among nursing
home staff for advanced dementia should be explored
than another healthcare worker and experience in end-of-life
care did not correlate with attitudes towards palliative care for
advanced dementia. A more positive attitude was observed in
facilities that had established a manual on end-of-life care as well
as in facilities that had a physician’s written opinions on end-of-
life care. Having a manual is likely to contribute to clarification
and sharing of end-of-life care policies among nursing home
staff. Especially in a care team, physician involvement encourages
comfort with care goals among residents with dementia (van
Soest-Poortviet et al, 2014). However, managing directors of
special nursing homes usually had social-work qualifications
and there was only part-time physician staffing. Therefore, the
national government should explore long-term care strategies
to enhance establishment of manuals on end-of-life care in
collaboration with other healthcare agencies.
Knowledge of palliative care for advanced dementia was
greater among nursing home staff with higher education
levels and those in facilities that had a manual. Meanwhile,
implementation of staff training in the facility did not correlate
with knowledge. Experience of end-of-life care also showed
no significant relationship to knowledge or attitudes regarding
palliative care for advanced dementia. As current practices do
not necessarily achieve optimal palliative care for advanced
dementia (Ikegami and Ikezaki, 2012; Nakanishi and Hattori,
2014; Ikegami and Ikezaki, 2013), respondents in this study
may have had difficulty learning about the provision of end-
of-life care from their experiences. Care workers in long-term
care facilities generally seek adequate educational programmes
concerning end-of-life care (Hirakawa et al, 2009). Educational
programmes have been developed with regard to palliative care
for individuals with cancer in Japan (Nakazawa et al, 2014).
However, educational programmes or national guidelines on
palliative care for advanced dementia in Japan have not yet
been established (Nakanishi et al, 2015b) unlike in Europe (van
der Steen et al, 2014). Further development of guidelines and
educational programmes is necessary to facilitate the provision of
good-quality palliative care for people with advanced dementia.
Location of the facility was significantly associated with
perspectives on palliative care for advanced dementia. Greater
knowledge and more positive attitudes were observed in facilities
in Shiga prefecture, where death in hospitals occurred less
154
British Journal of Nursing. Downloaded from magonlinelibrary.com by 128.119.168.112 on February 19, 2016. For personal use only. No other uses without permission. . All rights reserved.
frequently. Regional availability of medical services influences
the distribution of place of death in the region (Yang et al,
2006). Shiga prefecture also has active end-of-life care policies
in the local action plan for healthcare (Health and Medical Care
Division, Shiga Prefecture, 2013). These local policies might
have affected perspectives of nursing home staff in the area.
Attitudes towards palliative care for terminally ill patients
were more positive among nursing home staff who were nurses
and those who had a longer tenure as a care worker. Their
attitudes toward palliative care for terminally ill patients appeared
to be compatible with those nursing home staff in a previous
study in Japan (Matsui and Braun, 2010). The FATCOD-B-J
assumes care for patients expected to live less than 6 months.
Nurses may have shown better knowledge about medical care in
the authors’ sample. In addition, the facility’s policy on end-of-
life care exhibited no relationship with the total FATCOD-B-J
score. Further, the correlation between the qPAD attitude scale
and the FATCOD-B-J was rather small (r<0.30). The results
of this study imply that positive attitudes towards caring for
terminally ill patients may not be applicable to palliative care
for advanced dementia in long-term care facilities.
There are several limitations to this study. There was a low
response rate and sample bias may have occurred because the
long-term care facilities included in the analysis comprised
only one fifth of those originally targeted. Participating
facilities may have had more policies regarding end-of-life
care compared with non-responding facilities. Therefore, the
results may have underestimated the effects of end-of-life care
policies on perspectives among nursing home staff. It is not
possible to validate a causal model with the cross-sectional data
available for active policies and perspectives on palliative care
for advanced dementia.
Conclusion
Despite these limitations, this study was the first to examine the
perspectives of nursing home staff on palliative care focused on
advanced dementia in Japan. In conclusion, the results suggest
that the perspectives of nursing home staff correlate with the
end-of-life care policies in long-term care facilities. Organisational
efforts to establish end-of-life care policies among nursing home
staff for advanced dementia should be explored.
Declaration of interest: none
Grant and funding information: this study was supported by
a grant from the Pfizer Health Research Foundation in Japan
(grant number 25-8).The sponsor provided funding for conducting
the study but was not involved in determining the study design
and methods; subject recruitment; data collection, analysis, and
interpretation; or preparation of the manuscript.
© 2016 MA Healthcare Ltd
Arai Y, Arai A, Zarit SH (2008) What do we know about dementia?: a survey
on knowledge about dementia in the general public of Japan. Int J Geriatr
Psychiatry 23(4): 433–8. doi: 10.1002/gps.1977
Callahan CM, Arling G, Tu W et al (2012) Transitions in care for older
adults with and without dementia. J Am Geriatr Soc 60(5): 813–20. doi:
10.1111/j.1532-5415.2012.03905.x
Frommelt KH (1991) The effects of death education on nurses’ attitudes
British Journal of Nursing, 2016, Vol 25, No 3
 DEMENTIA

toward caring for terminally ill persons and their families. Am J Hosp Palliat
Care 8(5): 37–43
Frommelt KHM (2003) Attitudes toward care of the terminally ill: an
educational intervention. Am J Hosp Palliat Care 20(1): 13–22
Gozalo P, Teno JM, Mitchell SL et al (2011) End-of-life transitions among
nursing home residents with cognitive issues. N Engl J Med 365(13): 1212–
21. doi: 10.1056/NEJMsa1100347
Health and Medical Care Division, Shiga Prefecture (2013) Local Action
Plan for Health and Medical Care in Shiga. Medical Care and Welfare
Promotion Division, Shiga (in Japanese)
Hirakawa Y, Kuzuya M, Uemura K (2009) Opinion survey of nursing or
caring staff at long-term care facilities about end-of-life care provision
and staff education. Arch Gerontol Geriatr 49(1): 43–8. doi: 10.1016/j.
archger.2008.04.010
Houttekier D, Cohen J, Bilsen J, Addington-Hall J, Onwuteaka-Philipsen
BD, Deliens L (2010) Place of death of older persons with dementia.
A study in five European countries. J Am Geriatr Soc 58(4): 751–6. doi:
10.1111/j.1532-5415.2010.02771.x
Ikegami N, Ikezaki S (2012) Japan’s policy of promoting end-of-life care in
nursing homes: impact on facility and resident characteristics associated
with the site of death. Health Policy 105(2-3): 303–11. doi: 10.1016/j.
healthpol.2012.01.009
Ikegami N, Ikezaki S (2013) Nursing homes and end-of-life care in Japan. J
Am Med Dir Assoc 14(10): 718–23. doi: 10.1016/j.jamda.2013.02.008
Long CO (2009) Palliative care for advanced dementia. J Gerontol Nurs 35(11):
19–24. doi: 10.3928/00989134-20091001-02
Long CO, Sowell EJ, Hess RK, Alonzo TR (2012) Development
of the questionnaire on palliative care for advanced dementia
(qPAD). Am J Alzheimers Dis Other Demen 27(7): 537–43. doi:
10.1177/1533317512459793
Matsui M, Braun K (2010) Nurses’ and care workers’ attitudes toward death
and caring for dying older adults in Japan. Int J Palliat Nurs 16(12): 593–8.
doi: 10.12968/ijpn.2010.16.12.593
Mitchell SL, Morris JN, Park PS, Fries BE (2004a) Terminal care for persons
with advanced dementia in the nursing home and home care settings. J
Palliat Med 7(6): 808–16. doi: 10.1089/jpm.2004.7.808
Mitchell SL, Kiely DK, Hamel MB (2004b) Dying with advanced dementia
in the nursing home. Arch Intern Med 164(3): 321–6. doi: 10.1001/
archinte.164.3.321
Mitchell SL, Teno JM, Kiely DK et al (2009) The clinical course of advanced
dementia. N Engl J Med 361(16): 1529–38. doi: 10.1056/NEJMoa0902234
Ministry of Health, Labour and Welfare [Japan] (2013) Vital Statistics
2012,Volume 1, Table 5-7, Deaths by place of occurrence:Japan, each
prefecture and 21 major cities, 2012. Health, Labour, and Welfare Statistics
Association, Tokyo
Ministry of Health, Labour and Welfare [Japan] (2014) Vital Statistics 2013.
Health, Labour, and Welfare Statistics Association, Tokyo (in Japanese)
Miyashita M, Nakai Y, Sasahara T et al (2007) Nursing autonomy plays an
important role in nurses’ attitudes toward caring for dying patients. Am J
Hosp Palliat Care 24(3): 202–10. doi: 10.1177/1049909106298396
Morita T, Fujimoto K, Imura C, Nanba M, Fukumoto N, Itoh T (2006)
Self-reported practice, confidence, and knowledge about palliative care
of nurses in a Japanese Regional Cancer Center: longitudinal study after
1-year activity of palliative care team. Am J Hosp Palliat Care 23(5): 385–91.
doi: 10.1177/1049909106292168
Nakanishi M, Hattori K (2014) Percutaneous endoscopic gastrostomy (PEG)
tubes are placed in elderly adults in Japan with advanced dementia
regardless of expectation of improvement in quality of life. J Nutr Health
Aging 18(5): 503–9. doi: 10.1007/s12603-014-0011-9
Nakanishi M, Hattori K, Nakashima T, Sawamura K (2012) Priority for elderly
persons with behavioral and psychological symptoms of dementia on
waiting lists for placement in nursing homes in Japan: do nursing homes
change priorities based on their own guidelines? J Am Med Dir Assoc 13(9):
794–9. doi: 10.1016/j.jamda.2012.08.010
Nakanishi M, Miyamoto Y, Long CO, Arcand M (2015a) A Japanese booklet
about palliative care for advanced dementia in nursing homes. Int J Palliat
Nurs 21(8): 385–91. doi: 10.12968/ijpn.2015.21.8.385
Nakanishi M, Nakashima T, Shindo Y et al (2015b) An evaluation of palliative
care contents in national dementia strategies in reference to the European
Association for Palliative Care white paper. Int Psychogeriatr: 27(9):1551-61.
doi: 10.1017/S1041610215000150
Nakazawa Y, Kizawa Y, Hashizume T, Morita T, Sasahara T, Miyashita M (2014)
One-year follow-up of an educational intervention for palliative care
consultation teams. Jpn J Clin Oncol 44(2): 172–9. doi: 10.1093/jjco/hyt183
Peugh JL (2010) A practical guide to multilevel modeling. J Sch Psychol 48(1):
85–112. doi: 10.1016/j.jsp.2009.09.002
Teno JM, Gozalo PL, Bynum JPW et al (2013) Change in end-of-life care
for Medicare beneficiaries: site of death, place of care, and health care
transitions in 2000, 2005, and 2009. JAMA 309(5): 470–7. doi: 10.1001/
jama.2012.207624
Van der Steen JT, Radbruch L, Hertogh CMPM et al (2014) White paper
defining optimal palliative care in older people with dementia: a Delphi
study and recommendations from the European Association for Palliative
Care. Palliat Med 28(3): 197–209. doi: 10.1177/0269216313493685
Van Soest-Poortvliet MC, van der Steen JT, de Vet HCW, Hertogh CMPM,
Onwuteaka-Philipsen BD, Deliens LHJ (2014) Factors related to
establishing a comfort care goal in nursing home patients with dementia: a
cohort study among family and professional caregivers. J Palliat Med 17(12):
1317–27. doi: 10.1089/jpm.2014.0205
World Health Organization (2012) Dementia: a public health priority. http://
tinyurl.com/lwlgq53 (accessed 26 June 2015)
Yamagishi A, Morita T, Miyashita M et al (2008) Palliative care in Japan:
current status and a nationwide challenge to improve palliative care by the
Cancer Control Act and the Outreach Palliative Care Trial of Integrated
Regional Model (OPTIM) study. Am J Hosp Palliat Care 25(5): 412–8. doi:
10.1177/1049909108318568
Yamagishi A, Morita T, Miyashita M et al (2012) Providing palliative care
for cancer patients: the views and exposure of community general
practitioners and district nurses in Japan. J Pain Symptom Manage 43(1):
59–67. doi: 10.1016/j.jpainsymman.2011.03.012
Yang L, Sakamoto N, Marui E (2006) A study of home deaths in Japan from
1951 to 2002. BMC Palliat Care 5: 2. doi: 10.1186/1472-684X-5-2

Support and care for patients About the book

Providing support and care for
individuals with a long-term condition
health care. Over 15 million people
these numbers will continue
in England currently have a long-term
is an essential feature of modern
Fundamental Aspects of
with long-term conditions
to rise. Treating the range of condition, and it is predicted
long-term conditions that affect that

Long-Term Conditions
will therefore play an important the population
role for health professionals.
conditions, exploring the key This book is an essential guide
Fundamental Aspects of Long-Term Condit

principles of practice, skills and to long-term

as stand-alone chapters, or the policy. The chapters in this book
book can be read in sequence can be read
. Full references are provided.
Like other books in this series,
Fundamental Aspects of Long-Term
basis from which both student Conditions provides a succinct,
nurses and adult nurses can extend useful
their knowledge and skills.
About the author
Helen McVeigh is a Senior Lecturer

Helen McVeigh
in Primary Care at De Montfort
District Nurse. She has over
city practices.
20 years experience of working
University Leicester. She is a
in Primary Care working in both
qualified
rural and inner
Edited by Helen McVeigh
Other titles in the Fundam
ental Aspects of Nursing
series:
nnEssential guide to long-term conditions, exploring the key principles of practice,
Children & Young Peoples Nursing Procedure
Community Nursing s Nursing Adults with Respiratory
Disorders
Complementary therapies Nursing the Acutely Ill Adult

skills and policy Finding Information Pain Assessment & Management

Mental Health Nursing Palliative Care Nursing 2nd edition
*Low cost for landlines and mobiles

Research for Nurses

Series Editor: John Fowler

nnPart of the successful Fundamental Aspects of Nursing series

ions

nnEach chapter presents learning points, using a reflective approach

nnCase history examples included to illustrate issues discussed
© 2016 MA Healthcare Ltd

ISBN-13: 978-1-85642-392-2; 234 x 156 mm; paperback; 280 pages; publication 2010; £24.99
Edited by Helen McVeigh

ISBN 1-85642-392-1

Order your copies by visiting or call

www.quaybooks.co.uk +44 (0) 333 800 1900* www.quaybooks.co.uk
9 781856 423922
Fundamental Aspects of Nursin
g series

FA LTCs cover.indd 1

18/1/10 12:38:13

British Journal of Nursing, 2016, Vol 25, No 3 155

British Journal of Nursing. Downloaded from magonlinelibrary.com by 128.119.168.112 on February 19, 2016. For personal use only. No other uses without permission. . All rights reserved.