Development of the dementia assessment sheet for community‐based integrated care system

Abstract

A series of our studies on the development of the Dementia Assessment Sheet for Community-based Integrated Care System 21-items (DASC-21) were reviewed. Study 1: to examine the distribution of scores and internal reliability of DASC-21, trained nurses and researchers visited the homes of 1341 participants aged 65 years and older and living in the community. The nurses interviewed the participants and, when possible, their family members, to complete the DASC-21. Then, the Mini-Mental State Examination was carried out to select the participants of study 2. Study 2: to examine the concurrent and discriminant validity, experienced psychiatrists and psychologists, who were blind to the findings of study 1, visited the homes of 131 subjects who were selected from the participants of study 1 and completed the Clinical Dementia Rating (CDR), the Mini-Mental State Examination and the Frontal Assessment Battery (FAB). Cronbach's coefficient alpha of the DASC-21 was 0.808-0.950. Scores of the DASC-21 significantly correlated with CDR total and box scores, Mini-Mental State Examination and Frontal Assessment Battery. In an analysis of variance, CDR had the main effect on the score of the DASC-21. Receiver operating characteristic analysis showed that the DASC-21 had sufficient discriminatory ability between dementia (CDR1+) and non-dementia (CDR0 or CDR0.5; area under the curve = 0.804-0.895). When using a cut-off point of 30/31, sensitivity was 83.3-94.1% and specificity was 77.3-86.4%. The DASC-21 has sufficient reliability and validity as a tool to evaluate impairments in daily functioning and in cognitive functions, to detect dementia, and to assess the severity of dementia in the community. Geriatr Gerontol Int 2016; 16 (Suppl. 1): 123-131.Keywords: assessment tool, cognitive impairments, dementia, impairments in daily functioning, severity of dementia. IntroductionThe community-based integrated care system is a new way of providing services. Through applying the concepts of community-based care (care that is rooted in a community) and integrated care (care that is provided in an integrated manner), it is expected to improve economic efficiency and users' satisfaction, as well as services' quality and access.1 This provision system seems especially adequate for people with dementia at risk of a deteriorating clinical condition with complex physical, mental and social problems. 2 The 2012 reform of the Long-term Care Insurance Act in Japan entrusted to local governments the task of implementing a community-based integrated care system. The Japanese Ministry of Health, Labor and Welfare used this opportunity to announce the implementation of a Five-Year Plan for Promotion of Dementia Measures (Orange Plan).3 This plan involves the creation of "Initial-phase Intensive Support Team (IPIST) for Dementia" to improve access to diagnosis and post-diagnostic community-based integrated care from the early stages of dementia. 4 This plan is nothing less than a practical attempt to implement a community-based integrated care syst...

Distribution of Mini‐Mental State Examination scores among urban community‐dwelling older adults in Japan

“…The residents were visited in their homes by trained nurses. From November to December 2013, the nurses assessed cognitive function using the MMSE, and physical and mental health status, including blood pressure, currently prescribed medications, and daily functioning using the Dementia Assessment Sheet for Community-based Integrated Care System (Awata et al, 2015(Awata et al, , 2016.…”

Development of the Dementia Assessment Sheet for Community‐based Integrated Care System 8‐items, a short version of the Dementia Assessment Sheet for Community‐based Integrated Care System 21‐items, for the assessment of cognitive and daily functions

“…The Dementia Assessment Sheet for Community‐based Integrated Care System 21‐items (DASC‐21; Appendix S1) was originally developed as a simple assessment tool for cognitive function in community‐dwelling people in Japan. The DASC‐21 was confirmed to be a valid and reliable tool for evaluating cognitive impairment and ADL disabilities . Because the DASC‐21 includes questions about the IADL, basic ADL (BADL) and cognition, it can be useful in classifying older patients with diabetes mellitus to the appropriate category for the glycemic target.…”

“…The DASC-21 was confirmed to be a valid and reliable tool for evaluating cognitive impairment and ADL disabilities. 12 Because the DASC-21 includes questions about the IADL, basic ADL (BADL) and cognition, it can be useful in classifying older patients with diabetes mellitus to the appropriate category for the glycemic target.…”

Everyday challenges facing high-risk older people living in the community: a community-based participatory study

“…DASC-21. The Dementia Assessment Sheet for Community-based Integrated Care System -21 items (DASC-21) [26] was used to assess the progression of dementia symptoms. Because the DASC-21 is easy to score and allows observation-based ratings, it is widely used by caregivers who are part of the Japanese national dementia strategy.…”