Published papers

A paradigm shift has recently been seen in how health is understood and measured, and studies on happiness have become increasingly popular. Although previous research dealt with happiness for people with dementia (PwD), its usefulness to their supporters, including caregivers, has not been shown. The present study focuses on the importance of small participation experiences and proposes a recommendation system to propagate small participation experiences for PwD, which are referred to as "micro-happiness"in this study. The authors collected data on 1,124 micro-happiness episodes, developed the propagation system to promote micro-happiness among PwD, and evaluated its propagation effects by conducting in-depth interviews of 10 people and an online survey of 309 caregivers. The survey demonstrated a strong positive correlation (r=0.81) between the smallness of the happiness experiences and the propagation effects, indicating the importance of smallness in happiness to provide care for PwD.

Background: Smartphones have become deeply embedded in daily life, supporting a range of social and practical activities. Individuals with dementia can potentially use smartphones to compensate for cognitive decline and maintain independence. However, while smartphones are widely studied in controlled research settings, little is known about how individuals with dementia spontaneously use them in everyday life. Understanding usage patterns and their potential link to social participation could inform strategies to support smartphone use in their social and practical daily activities. Objective: This study aimed to identify factors associated with spontaneous smartphone use, describe usage patterns, and examine whether smartphone use is associated with participation in social activities. Methods: In 2024, we conducted a cross-sectional survey among community-dwelling individuals with mild to moderate dementia from 17 medical facilities in Tokyo. Structured questionnaires were completed by the participants, their families, and attending physicians. Participation in social activities was assessed using the “Spending Time with Others” subscale of the Social Functioning in Dementia (SF-DEM) scale. Factors associated with smartphone use were analyzed using multinomial logistic regression. Associations with participation in social activities were assessed via hierarchical linear regression. Results: Among 151 participants with a mean age of 82.9 (SD 6.6) years, 43 (29%) participants were regular smartphone users. Smartphone use was negatively associated with older age (odds ratio [OR] 0.41, 95% CI 0.21‐0.80) and positively associated with longer education (OR 1.82, 95% CI 1.00‐3.30), living alone (OR 3.17, 95% CI 1.08‐9.31), and better cognitive function (OR 2.14, 95% CI 1.24‐3.69). Common uses included calling, texting, taking photos and videos, and checking the news and weather. Smartphone users reported marginally more frequent participation in social activities than nonusers did (b=1.41, 95% CI –0.01 to 2.83), particularly visiting the homes of friends or family (b=0.43, 95% CI 0.08‐0.78) and shopping together (b=0.49, 95% CI 0.15‐0.83). Conclusions: Despite their limited use at the time of this writing, commercial-based smartphones have the potential to support participation in social activities among individuals with dementia. Targeted support may help bridge the gap between this usage and the broader capabilities of these devices, enhancing their role in sustaining meaningful social participation.

It is important to explore not only what is lost with the progression of dementia, but also what is left and what can be compensated or developed by adapting to the special needs of the conditions. Some studies suggest that as dementia progresses, people become less emotionally expressive and have difficulties in distinguishing between other people's facial expressions. On the other hand, it is also said as cognitive function declines, anger and anxiety increase, placing a burden on caregivers. Here we report the richness of emotions in people with dementia expressed in their interviews. We analysed the transcripts of 88 interviews of people with dementia (4.8 years after diagnosis), which lasted about 60–90 min, sometimes even longer. Those transcripts are valuable, as they show that people with dementia can express themselves verbally for a long time. From the analysis of the transcripts using Paul Ekman's basic emotions, we found that the strongest emotion expressed in the interviews was happiness. We also conducted a survey of the general public recruited through X about the emotions of people with dementia, and found that people without dementia imagined that the strongest emotion felt by people with dementia was fear. Our results suggest that the cognitive abilities and emotional states of people with dementia can be more robust than people without dementia typically perceive. It might be possible to augment happiness-related emotions by the support of those around people with dementia, and the cognitive efforts of the affected people themselves.

In recent years, the increasing prevalence of nuclear families and the weakening of local communities have made solo parenting a significant social issue. In this context, there has been growing interest in chatbot systems that can offer parenting support anytime and anywhere. In particular, chatbots powered by Large Language Models (LLMs) are expected to address a wide variety of parenting concerns. However, the nature of these concerns is diverse. Some users simply seek someone to listen, while others wish to organize their thoughts or obtain specific information. Because each user’s purpose differs, chatbots are required to respond in a flexible and personalized manner. Traditional systems have struggled to provide such adaptability. To address this challenge, we developed a chatbot based on ChatGPT-4o, designed to adapt its responses flexibly according to the user’s underlying intent. We conducted user studies in which real participants engaged with the chatbot, and we analyzed both the chat logs and questionnaire responses to evaluate its effectiveness. Additionally, we carried out comparative experiments using Qwen-2.5-7B-Instruct, a lightweight open-source model, to explore future considerations such as privacy protection and local deployment. The results demonstrated that our chatbot based on ChatGPT-4o is capable of accurately inferring users’ goals and adjusting its conversational strategies accordingly. This capability contributed to greater user satisfaction and trust. On the other hand, Qwen-2.5-7B-Instruct exhibited limitations in language capability and prompt interpretation. The main contributions of this study are threefold: (1) proposing a novel approach to designing chatbots that can adapt their conversational style based on user intent; (2) the validation of the proposed approach through user studies to evaluate its effectiveness and identify potential issues; and (3) a comparative analysis of ChatGPT-4o and Qwen-2.5-7B-Instruct to highlight the challenges associated with using lightweight open-source models.

Introduction: Public participation by people with dementia in relevant policymaking has been advocated to improve the quality of health systems and democratic processes. Public officials’ attitude is a key determinant of public participation. This study aimed to explore Japanese local-government officials’ attitudes towards public participation by people with dementia in policymaking and associated factors. Methods: This cross-sectional study, utilising an online survey conducted in December 2022, included public officials (n = 997) in charge of dementia policy in Japanese municipalities, with one respondent from each municipality. Participants’ certifications were administrative, public-health nurse, or other professionals. Univariate and mediation analyses were performed with attitudes towards public participation by people with dementia as a dependent variable, attitudes towards people with dementia as a mediating variable, and demographic characteristics, contact opportunities with people with dementia, and sources of dementia-related information as exploratory variables. Results: The mean attitude towards people with dementia and towards public participation was 45.1 (SD: 5.1) and 12.6 (SD: 1.8), respectively. Positive attitudes towards people with dementia were a significant determinant of supportive attitudes towards public participation. Participation in collaborative activities with people with dementia and a larger municipality population had positive and significant direct effects on attitudes towards public participation by people with dementia. Additionally, the public officials’ sex and exposure to information about dementia directly from people with dementia showed a significant positive indirect effect mediated by attitude towards people with dementia. Discussion: Attitudes towards people with dementia are the most significant factor influencing their public participation; therefore, reducing stigma among public officials is essential to foster public participation by people with dementia. Active involvement of public officials in collaborative activities with people with dementia at the micro level and valuing the perspectives of people with dementia as essential contributions can enhance public participation by in local policymaking.

Developing support technology for elderly people with dementia is an urgent issue. The purpose of this study was to propose a computational method for designing "micro happiness" by applying the concept of subjective experience to dementia. In this paper, subjective experiences that can positively affect the quality of life are referred to as micro happiness. The proposed method provides experience recommendations by evaluating both the similarity of life functions and the similarity of experiences among elderly people. To verify the effectiveness of the method, the authors created a database consisting of 1124 subjective experiences of 77 people with dementia using a knowledge graph. The authors confirmed that the prototype data service system could recommend plausible social events considering the life functions and past subjective experiences of a target person with dementia. From the evaluations, it was suggested that the proposed method could be used to present candidates for positive experiences to elderly people with dementia.

Background: Although people with cognitive impairment highly value social participation in out-of-home activities, their families typically perceive concerns and experience anxiety over such activities. This study aimed to elucidate the underlying concerns and factors associated with family caregivers’ anxiety over the individual’s unaccompanied out-of-home activities. Methods: In December 2021, we conducted a cross-sectional e-survey of family caregivers of individuals with early-stage cognitive impairment. Caregivers’ concerns about ten common risks related to out-of-home activities were cross-tabulated by specific anxiety levels to examine trend associations. With the variables of caregivers and their individuals across the five domains, we ran logistic regression analyses to determine explanatory models for anxiety. Results: The study participants were 1,322 family caregivers of people whose cognitive function varied from intact to possible mild dementia according to the Dementia Assessment Sheet for Community-based Integrated Care System 8-item. Significant associations were found between the prevalence of concerns and the degree of anxiety, even without actual experience with the issues of concern. Among the five domains, individual dementia characteristics and social behaviors were the predominant factors attributed to caregiver anxiety. Caregivers’ no anxiety state was significantly associated with: younger age (OR 4.43, 95% CI 1.81–10.81), no detectable cognitive decline (OR 3.34, 95% CI 1.97–5.64), free from long-term care (LTC) (OR 3.52, 95% CI 1.72–7.21), no manifestation of behavioral and psychological symptoms of dementia (BPSD) (OR 13.22, 95% CI 3.06–57.01), and not engaging in unaccompanied out-of-home activities (OR 3.15, 95% CI 1.87–5.31). Their severe anxiety was positively associated with being on LTC (OR 3.39, 95% CI 2.43–4.72) and minor BPSD (OR 1.43, 95% CI 1.05–1.95), and negatively associated with engagement in unaccompanied out-of-home activities (OR 0.31, 95% CI 0.23–0.43). Conclusions: The study found that family caregivers’ anxiety was associated with concerns about behavioral issues, regardless of actual experiences. There were two significant associations in opposite directions between caregivers’ anxiety and the individual’s engagement in out-of-home activities. In the early phase of cognitive impairment, caregivers may intuitively interpret the individual’s behavior and feel anxious. Educational support may provide reassurance and enable caregivers to facilitate out-of-home activities.

Background: People living with dementia face a constant struggle in re-establishing their means of living a meaningful life. Journal writing exhibits the potential to help them regain a sense of control over their lives. This study explores the experience, meaning, and value of journal writing for people living with dementia who autonomously engage in the activity. Methods: We conducted individual, semi-structured interviews with eight people living with dementia who each kept a personal, paper-based daily journal. The interviews were thematically analyzed. Results: We identified four main themes. Theme 1. Recognition of the harsh reality of life under dementia. Theme 2. Observation of and compensation for weaknesses. Theme 3. Reacknowledgement and reaffirmation of one's identity, and Theme 4. Resignation and regret over comparisons to one's ‘former’ self. Themes 2 and 3 suggest that journal writing enabled self-reflection on daily activity functions and sense of self. However, Theme 4 represents the downside where an individual more acutely realises their deteriorating condition and regrets over their perceived loss of self. Conclusion: While acknowledging the possible adverse effect of amplifying pessimistic perceptions toward life, journal writing is a powerful ‘self-help’ strategy for people living with dementia and provides an avenue to recover and thrive.

Background: This study aimed to identify reduced home care use among older people and its impact on user numbers and service provider revenues during the coronavirus disease 2019 (COVID-19) pandemic. Methods: We conducted this secondary analysis of cross-sectional data from long-term care providers in Japan and estimated the probability of client cancellations and service contraction for institutional and home care services adjusted for the service type, area, size, infection occurrence, and staff employment impacts. We then estimated the rate of change in user numbers and revenue related to reduced usage. Results: Seventy-two percent of home care providers experienced client cancellations and 42.1% experienced service contraction, both of which were more prevalent in home care than in institutional care (adjusted odds ratio [AOR]=11.09 and 1.60). Home-visit (AOR=0.70) and short-term stay (AOR=0.38) services were less likely to experience client cancellations compared with adult day services. Service contraction was less likely in home-visit services (AOR=0.60) but were more likely in short-stay services (AOR=1.49) compared to adult day services. The estimated reductions in user numbers and revenue related to service contraction for adult day services were 9.1% and 7.1%, respectively. Home-visiting services decreased by an estimated 3.4% owing to service contraction. Conclusion: The secondary effects of the COVID-19 pandemic include reduced use of home care services, especially adult day services that include social contact. These secondary effects of the COVID-19 pandemic may cause functional deterioration in non-infected clients and financially impact service providers.

Introduction: Reflecting the rapidly aging society, there has been a worldwide increase in the number of health cafés and dementia cafés which can provide a variety of support to people with illnesses and their families in the community. Nevertheless, health cafés organized by primary care physicians are rarely reported, and the social value of these activities has not yet been fully elucidated. Objectives: This study was aimed to investigate the value and impact that the health café organized by the primary care physician, brings to the visitors, the clinic, and the community. Methods: Conversations between the author (YO), who belongs to a medical clinic that has been operating for many years in Shizuoka City, and visitors of the health café were qualitatively analyzed using Steps for Coding and Theorization (SCAT), which is a sequential and thematic qualitative analysis technique consisting of 4 steps. Results: Sixteen people participated in the study. The values and impacts of holding a health café were social support, opportunities for cognitive and behavioral changes, complementary functions to outpatient care, advantages for medical care, the creation of encounters with diverse individuals, connections with local community organizations, and motivating visitors to become proactive actors. Conclusion: It was considered valuable for physicians in community-based medical clinics to have opportunities to interact with patients and local residents outside the clinical settings. Because they can potentially enhance their role as primary care physicians in the community. In addition, the impact on the community is that local residents can receive social support, increase community ties, and make people more proactive about their health.