Experiences of caregivers of people with dementia in a Korean dementia simulation program

Abstract

Objectives

Experiencing dementia-related challenges in a dementia simulation program can be useful for caregivers to understand perspectives of people with dementia possibly leading to improvement in the quality of care and positive outcomes in caregivers and people with dementia. Previous studies about dementia simulation programs have been conducted in Western countries and no research has been conducted in Asian countries. The purpose of this qualitative study was to explore experiences of caregivers of people with dementia who participated in a Korean dementia simulation program.

Methods

A descriptive phenomenological study using thematic analysis with ATLAS.ti 8 software was used. A total of 28 Korean caregivers were interviewed about two weeks after participating in the Korean dementia simulation program that was modified from a program developed in USA by considering Korean cultures.

Results

Three key themes with seven subthemes emerged. The present study demonstrated that participation in the program helped caregivers have more empathy, affected their care strategies positively leading to emotional and social benefits on the care dyads, and increased awareness in possible changes due to aging and the risk of dementia.

Conclusions

The present study was the first study that demonstrated caregivers’ positive experiences in and benefits from participation in a dementia simulation program in an Asian country. Caregivers in the other Asian countries may have similar benefits from participation in dementia simulation programs.

Keywords

Alzheimer’s disease caregivers dementia empathy simulation training

Around 50 million people live with dementia worldwide, and the number of people with dementia worldwide in 2050 is estimated to be 131.5 million (Alzheimer’s Disease International, 2015). With the increasing number of people with dementia worldwide, the need for better supporting and educating caregivers of people with dementia has increased. Due to the irreversible degenerative characteristics and challenging symptoms of dementia, caregivers of people with dementia experience caregiving burden, depression, and lowered level of health-related quality of life (Alfakhri et al., 2018; Karg, Graessel, Randzio, & Pendergrass, 2018).

Empathy is an essential component of person-centered care leading to improvement in the quality of care (Brooker, 2004). Empathy has been defined as a cognitive attribute involving an understanding of experiences, concerns, and perspectives of patients, along with the ability to communicate this understanding and the intention to help (Hojat, 2016). Empathy-building interventions and better understanding about challenges in living with dementia may prevent caregiving burnout, reduce caregivers’ distress, and encourage caregivers to have more positive caregiving experiences, such as satisfaction with caregiving and positive relationship with people with dementia (Hattink et al., 2015; Hayajneh & Shehadeh, 2014; Narme, 2018; Shim, Barroso, & Davis, 2012).

Because caregivers have not personally experienced symptoms of dementia and effects of dementia on daily lives involving emotions and behaviors, it is not easy for caregivers to understand and empathize with persons with dementia. Experiencing dementia-related challenges in a dementia simulation program can be useful for caregivers to understand perspectives of people with dementia possibly leading to improvement in the quality of care and positive outcomes in caregivers and people with dementia (Anderson, Bird, MacPherson, & Blair, 2016; Panyavin et al., 2015).

Although simulation has been increasingly used in health care, the majority of studies aiming to enhance empathy through simulation have focused on health professional students and health professionals rather than caregivers who provide direct care to patients (Bearman, Palermo, Allen, & Williams, 2015; Beville, 2002). For example, auditory hallucination simulations have been used to enhance health professional students’ empathy for patients with mental illness, and the students improved empathy and knowledge on auditory hallucinations (Mawson, 2014; Skoy, Eukel, Frenzel, Werremeyer, & McDaniel, 2016). Only a few studies examined benefits of dementia simulation programs on caregivers of people with dementia. For example, a pilot study of a virtual reality intervention that used a dementia simulation movie with an online e-learning course found informal caregivers’ increased level of empathy and competence in taking care of people with dementia (Wijma, Veerbeek, Prins, Pot, & Willemse, 2017).

Previous studies about dementia simulation programs have been conducted in Western countries such as USA and Netherlands. No research regarding dementia simulation programs has been conducted in Asian countries. Studies, therefore, are needed to examine experiences of caregivers of people with dementia in a dementia simulation program in Asian Countries and the benefits of such programs on caregivers and people with dementia.

The current study is part of a pilot research project which used both quantitative and qualitative approaches to explore impacts of a Korean dementia simulation program on caregivers of people with dementia. A Wilcoxon signed-rank test indicated that the family caregivers’ post-test scores on the Dementia Attitude Scale (O’Connor & McFadden, 2010) were statistically significantly higher than the pre-test scores on the Dementia Attitude Scale (p < .05). The quantitative part has been submitted to another journal (under review). The purpose of this qualitative study was to explore the experiences of caregivers of people with dementia who participated in the Korean dementia simulation program.

Methods

Design

The design of this study is a descriptive phenomenological study using thematic analysis and semi-structured interviews with caregivers of people with dementia who participated in the Korean dementia simulation program.

Participants

Participants were recruited using convenience sampling which is suitable for a qualitative research. A total of 28 Korean caregivers participated in the present study, including 16 family members of community-dwelling people with dementia and 12 formal caregivers of residents with dementia in nursing homes in Wonju city, South Korea. Table 1 describes characteristics of all 28 caregivers who participated in the present study. Formal caregivers included 12 females with a mean age of 50.3 years old (range: 44–55 years old). All of the formal caregivers spent more than 40 hours per week in caring for people with dementia. Family caregivers included 13 females and 3 males with a mean age of 57 years old (range: 25–78 years old). Among 16 family caregivers, 6 caregivers spent more than 40 hours per week, 4 caregivers spent between 9 and 20 hours per week, and 6 caregivers spent 8 hours or less than 8 hours per week.

Table 1.

Characteristics of participants (n = 28).

Categorical variable	n	%
Gender
Male	3	10.7
Female	25	89.3
Education
Elementary school graduation	1	3.6
Middle school graduation	2	7.1
High school graduation	17	60.7
University graduation	7	25
Graduate school graduation	1	3.6
Employment status
Employed full time	16	57.1
Employed part time	5	17.9
Unemployed	3	10.7
Retired	4	14.3
Caregiving relationship
Formal caregiver	12	42.8
Daughter	8	28.6
Spouse/partner	6	21.4
Daughter-in-law	1	3.6
Granddaughter	1	3.6
Living with people with dementia
Living	11	39.3
Non-living	17	60.7
Caregiving hours per week
More than 40 hours	18	64.3
9–20 hours	4	14.3
8 hours or less	6	21.4
Numerical variable	Mean (SD); range
Age	54.1 (12.2); 25–78

Intervention

The Korean dementia simulation program was modified from Dementia Live™ (DL) program with permission from the original developer of the DL program. The DL program was developed by the AGE-u-cate Training Institute, USA, to give a realistic simulation of living with dementia. The entire DL program takes about 30–40 minutes. A small group of participants (up to four) don specially designed headphones with MP3 players, eyewear, and gloves imitating sensory, perceptual, or cognitive changes associated with dementia. Headphones with MP3 players playing noises and sounds from televisions and radios are used to confuse participants by affecting their attention level and hearing. The eyewear is used to restrict participants’ peripheral vision and gloves are used to diminish their sense of touch and fine motor skills.

Right before entering the experience room, each of the participants is told different five daily tasks. When reading the list of tasks, a trained person stands side to side with the participant and gently places his or her hand on the participant’s shoulder, not looking directly at the participant. This challenges the participant by not allowing the participant to see lips moving and comprehend more of what the trained person is saying and emphasizes the importance of eye contact and clear speech. Four different versions of five tasks are used, so none of the participants is given the same task. The experience room is set up with needed items and unneeded items for task completion. Participants’ behaviors are being observed by observers who take notes on the observation form of the manual with the list of tasks and behaviors. The list of behaviors includes: asking for help; following; gathering; giving up/shutting down; an expression of negative self-image, frustration, anger, and confusion; rummaging; talking to self; and wandering. These behaviors may be exhibited by people with dementia as expressions of their needs to understand and make sense of their environment and find purpose in the moment. After approximately 7 minutes, participants are told by the observers the experience is over and they will be led to the empowerment area for post-experience discussion.

In the empowerment session, a trained person who completed the DL program coach training starts the small group discussion about how they felt and experienced during the experience room session and expands on their reactions by using prompts. The group discusses their performance, reactions, and behaviors in the experience room and why people with dementia might be exhibiting some of the behaviors. The group then discusses why and what changes in care strategies for people with dementia are needed by relating participants’ experiences in the experience room into participants’ daily interactions with people with dementia.

The original manual of the DL program was translated to Korean. Some of the daily tasks which each of the participants to complete in the experience room were modified by considering Korean culture. For example, the task of “stacking the measuring cups together” is uncommon in Korean older adults, so the task was switched to the task of “putting small sizes of plastic food containers into the biggest food container” by considering Korean culture. Whether the Korean dementia program was feasible to implement and accepted to Koreans was checked by conducting a program demonstration session to four Koreans before implementing the program to caregivers for the research purpose. The program demonstration session seemed to be feasible and well accepted by the four Koreans. The whole program was implemented by the first author who completed the DL program coach training and had considerable experience in implementing the program to caregivers of people with dementia in USA.

Procedure

The study was conducted with Institutional Review Board approval from the host university, South Korea (protocol # 1041849-201804-BM-032-04). Formal caregivers of residents with dementia were recruited from two nursing homes in Wonju city, Gangwon Province, South Korea. Informal caregivers of community-dwelling people with dementia were invited from an outpatient clinic in the same city. The research team (all three authors) visited the nursing homes and outpatient clinic and informed potential participants about research by giving information on the purpose of research, possible benefits and risks of the study participation, and responsibilities as a study participant. Each of the participants gave informed consent, including consent for audio-recording of interviews, and completed the demographic information form and questionnaires right before participating in the program. About two weeks after the program participation, each of the participants completed the same questionnaires and face-to-face individual interviews took place to explore their experiences in the program and perceived impact of participation in the program on their day-to-day interactions with people with dementia. All the interviews were conducted between late January and mid-June 2018 by the first author who had extensive training and experience in semi-structured interviews and qualitative data analysis.

Data collection

A semi-structured interview guide was developed by the first author with extensive experiences in developing the interview guide and qualitative research based on recommendations made by Smith, Flowers, and Larkin (2009) to use as a flexible general guide during the interview. Each interview began with a general question asking about the experience of participating in the simulation program and further open-ended questions were used to explore the perceived impact of participating in the program on their perspectives and caring for people with dementia. These questions included: “Could you tell me about your experience of participating in the program?”, “How do you think participating in the program has affected you?”; and “How do you think participating in the program has affected your strategy in caring for people with dementia?” Minimal open-ended probes were used such as “Can you tell me more about that?”, “What do you mean by that?”, and “How did you feel about that?” The interviews lasted from 7 to 23 minutes (mean: 13 minutes).

Data analysis

Audio recorded interviews were transcribed verbatim. Interview transcripts in Korean were translated into English by the first author who was bilingual in Korean and English. ATLAS.ti 8 software (https://atlasti.com) was used to analyze each interview transcript. Braun and Clarke’s six analytic steps for doing thematic analysis was used (Braun & Clarke, 2006; Maguire & Delahunt, 2017). These six analytic steps include: familiarizing with data (step 1) by reading and rereading the transcripts and making notes of initial ideas; generating initial codes (step 2) by using line-by-line coding/open coding to organize data into small chunks of meaning; searching for themes (step 3) by selecting similar codes and grouping them into potential themes; reviewing themes (step 4) by checking if the preliminary themes work relative to the coded extracts and modifying themes as needed; defining and naming themes (step 5) by refining each theme and generating clear definitions and names for each theme; and producing the report (step 6) by selecting vivid extract examples and producing a report of the analysis.

To increase the trustworthiness of the data analysis process, specific strategies recommended by Nowell, Norris, White, and Moules (2017) were used. Member checking was used actively during interviews by a process of reflecting and probing and member checking at the end of the interviews was done again to verify correct understanding of what the participant had said and meant. The interviewer (the first author) asked the participant further explanations on what the participant had said and summarized what the participant had said through the interview to check if the interviewer correctly understood what the participant said and meant. Records of all the analysis process was kept by using ATLAS.ti 8 software and additional excel and word documents, so the analysis process was auditable. The interpretations and derived meanings against the transcript text were constantly checked to verify that the themes remained reflective of the transcript text, in an effort to increase analytical rigor. A process of peer debriefing among the research team (the authors) was used to check whether emerging themes were well grounded and represented in the transcripts. The research team reviewed and discussed the themes with the relevant transcript text and no change was needed.

Results

Three key themes with seven subthemes emerged relating to caregivers’ perspectives on the dementia simulation experience (Figure 1).

Figure 1.

Themes for caregivers. This figure illustrates three key themes with seven subthemes identified relating to caregivers’ perspectives on the Korean dementia simulation experience.

Theme 1. Empathy

Participants stated that the dementia simulation experience helped them have more empathy toward people with dementia. Being in their shoes through the dementia simulation experience helped participants have overall understanding about what people with dementia would experience in their daily lives (subtheme 1a). In particular, participants could gain more empathy toward people with dementia by relating emotions they had during the simulation experience to how people with dementia would feel in their daily lives (subtheme 1b), and matching the behaviors of the participant himself/herself during the experience to the usual behaviors of people with dementia in their daily lives (subtheme 1c).

Subtheme 1a. Overall understanding about the world from the perspectives of people with dementia

The dementia simulation experience helped participants be in the shoes of people with dementia. Participants reported that they could understand better about the difficulties in daily life of people with dementia through the simulation experience, and they realized that living with dementia as a whole would be harder than they thought. Participants stated that the dementia simulation experience was good and helpful, so they recommended the dementia simulation program to other people and were very willing to participate in other programs for caregivers. Examples of participants’ statements include: “I did not really understand what it was like to live with dementia mentally before participating in the dementia simulation program. If people with dementia are in this state, I thought living everyday would be very hard and painful” (formal caregiver 2).

I did not know the situation of people with dementia. I thought dementia was simply amnesia, but when I experienced it in the program, I came to think that living with dementia was more than amnesia and it would be very difficult to do daily tasks. I felt confused and I did not know what to do during the simulation experience. I understand that it would be very difficult to live with dementia, and I also felt the feelings of people with dementia. I now have a different attitude toward people with dementia. (family caregiver 7)

Subtheme 1b. Relating emotions

Participants related emotions they had during the simulation experience to how people with dementia would feel in their day-to-day lives. Participants reported that they could better understand about the emotions of people with dementia by the dementia simulation experience as they faced barriers and realized they could not complete simple daily tasks that they used to do easily. The most commonly mentioned emotions are in the following order: frustration; embarrassment; confusion; fear; the pressure/anxiety to do anything; and overall mental distress. Examples of participants’ statements include: “I realized that my mother would have been very frustrated like me in this situation”; and “The simulation experience helped me to understand people with dementia a lot by realizing they could be embarrassed and confused in this situation like me.”

I went inside and I was embarrassed because I could not remember the tasks well. One of the tasks given to me was setting the alarm for 7:30, and I found myself that I was doing it with clock hands. I was annoyed with myself when I found myself doing the wrong action for the moment. I realized that my mother would felt the same way when she did the wrong thing for the daily activities that she had used to do so easily. (family caregiver 3)

Subtheme 1c. Overlapped behaviors

As the behaviors of the participant himself/herself during the experience and the behaviors of people with dementia that the participant observed during the daily lives are matched/overlapped, participants reported that they gained a better understanding of the usual behaviors of people with dementia in their daily lives. The most commonly mentioned behaviors by those participants are in the following order: understanding of slow and confusing behaviors; more understanding that doing abnormal behaviors is not due to intention but is due to dementia; understanding of doing the same things again because the person with dementia cannot remember what he/she did; understanding about doing things to find something to do; and understanding that behaviors seen by people with dementia can be caused by situations/environments surrounding them rather than exacerbation of dementia symptoms. Participants talked about their own behaviors during the simulation experience, including giving up, rummaging and wandering to figure out what to do; mumbling and looking around as an expression of asking for help; doing things without thought accompanied with confusion; talking to self to remember what to do; and pretending to do something while worrying that it might look weird if she stood still. Examples of participants’ statements include: “After participating in the program, I observed my mother’s behaviors to be matched to my behaviors in the experience room. I gained more understanding of my mothers’ slow and confusing behaviors” (family caregiver 3); and “I heard a few words, and I could not remember what I heard. I tried to guess tasks, but I gave up eventually. I thought this was the situation that residents with dementia gave up and did nothing” (formal caregiver 12).

Theme 2. Care strategies

Participants stated that participation in the program affected their care strategies positively, by promoting establishment or increased use of helpful strategies (subtheme 2a) and thus discovering emotional and social benefits on the care dyads (subtheme 2b).

Subtheme 2a. Newly or increased use of helpful care strategies

Participants stated that the dementia simulation experience helped establishing new care strategies or promoting the use of care strategies more frequently than before. Participants reported that they realized why certain strategies are important and needed for people with dementia as they personally experienced how difficult it was to complete simple tasks during the simulation experience. The most commonly mentioned care strategies by those participants are in the following order: not yelling at, getting angry, or nagging people with dementia; not rushing/giving more time; speaking slowly and clearly, speaking the same thing again with patience; giving encouragement or reassurance; making eye contact; trying to understand and accept what happened; and being friendly with more affection and physical contact. Examples of participants’ statements include: “I changed myself into having eye contact always when I talk to residents with dementia after the simulation experience.” (formal caregiver 1); and “I came to understand that it is important not to rush and to speak clearly and slowly through the simulation experience. I try not to rush residents with dementia” (formal caregiver 9).

The dementia simulation experience helped me a lot. I could understand how frustrating my husband would be through the simulation experience. I had been irritated by my husband before participating in the simulation program, but I became more patient with my husband. (family caregiver 14)

Subtheme 2b. Emotional and social benefits on caregivers and people with dementia from the changed care strategies

Participants discovered emotional and social benefits on themselves and people with dementia after they changed care strategies in their daily lives through the dementia simulation experience. The most commonly mentioned benefits by those participants from the changed care strategies through the dementia simulation experience are in the following order: improved communication between people with dementia and caregivers; comfort and enjoyment expressed by people with dementia; feeling intimacy and comfort to people with dementia; and decreased anger and rejection response by people with dementia. Examples of participants’ statements include: “As I changed into talking to residents with dementia one at a time slowly, we communicated better with each other. I think we became more comfortable with each other” (formal caregiver 4).

Before the simulation experience, I was very angry with my mother and our conversations ended with anger. As I changed my attitude of accepting the situation a little more, keeping my anger down, and treating my mother kindly after the simulation experience, my mother also does not show me anger and I feel less stressed. (family caregiver 7)

Theme 3. Increased awareness

Participants expressed that participation in the program increased awareness of having more attention and affection toward people with dementia (subtheme 3a) and awareness of possible changes due to their own aging process and the risk of dementia (subtheme 3b).

Subtheme 3a. Increased awareness of having more attention and affection toward people with dementia

Participants reported that understanding the perspectives, emotions, and behaviors of people with dementia through participation in the dementia simulation program increased awareness of having more attention and affection toward people with dementia. For example, participants stated that they decided to take better care of people with dementia by understanding emotions such as frustration and embarrassment and challenges in daily activities people with dementia would have through the simulation experience: “I heard one or two words, but I forgot what I even heard because of embarrassment. I could understand that my wife would feel frustrated in daily lives. I realized that I should understand and help her better” (family caregiver 6); and “My attitude changed a lot. I now try to think from the perspective of my mother and help her a little more in advance so that my mother would not be uncomfortable in daily activities” (family caregiver 8). The busy schedule in the nursing homes prevented some formal caregivers from giving attention to individual residents with dementia. However, those caregivers reported that participation in the dementia simulation program became an opportunity for them to self-reflect on their own habituated care behaviors and try to change their care behaviors even in the busy schedule:

I had a lot of self-reflection. Because of the busy work schedule, I hurried residents with dementia to finish my job quickly. I am trying to think more about the perspectives of residents with dementia and give them more attention. (formal caregiver 2)

Subtheme 3b. Increased awareness in possible changes due to aging and the risk of dementia

Participants stated that they gained increased awareness in possible changes due to aging and dementia. For example, participants reported that functional changes made by wearing the equipment in the simulation program could happen to themselves when they get older: “I thought that this could happen to me when I get older. I thought all the body functions would not work well when I get older like what I experienced in the simulation experience” (formal caregiver 7). Participation in the program increased some participants’ worry and fear of having dementia as they realized that living with dementia would be so hard: “Experiencing what would be like to live with dementia through the simulation program has increased my fear of dementia” (formal caregiver 9); and “I am more likely to get dementia due to family history of dementia. I became more afraid of having dementia after participating in the program” (family caregiver 9). Increased awareness of changes due to aging and dementia through the program participation encouraged some participants to change their lifestyles into a healthier lifestyle to reduce the risk of dementia after participating in the program:

I realized that I have a chance to have dementia like my mother as I am getting older. After I participated in the program, I started exercising a little more and caring more about my family’s diet to prevent dementia. (family caregiver 3)

Discussion

The present study was the first study that explored experiences of caregivers of people with dementia in a dementia simulation program in an Asian country. The present article demonstrated that participation in the Korean dementia simulation program helped caregivers have more empathy toward people with dementia, affected their care strategies positively, and increased awareness in possible changes due to aging and the risk of dementia. In addition, caregivers’ changed care strategies through the dementia simulation experience could lead to emotional and social benefits on caregivers and people with dementia such as improved communication and relationship between the care dyads and enhanced emotions of caregivers and people with dementia. Benefits of family caregivers’ improved strategies on emotional and social outcomes, such as depressive symptoms, distress, and negative communication, have been found in the literature (Kales et al., 2018; Kuo et al., 2017). These qualitative findings of the present study partly support the quantitative outcomes of our whole pilot study which showed improved attitude toward people with dementia involving empathy. Also, these findings of the present qualitative study support the findings of Wijma et al. (2017) that demonstrated informal caregivers’ increased level of empathy and competence in care and more positive interactions with people with dementia through a virtual reality intervention using a dementia simulation movie. The DL program involved actual social interactions with a trained person who told five daily tasks in a way that challenged participants before entering the experience room and indirect or direct interactions among the four participants (i.e. being in the same place together, talking to another participant) during the experience room session. On the other hand, the virtual reality intervention in Wijma et al. (2017) had no social interaction during the experience. The present study adds to a lack of research in simulation programs for caregivers of people with dementia, especially in Asian countries. More research is needed if caregivers of people with dementia in the other Asian countries could have similar benefits from participation in dementia simulation programs.

Increasing the level of empathy in Korean caregivers of people with dementia is important because the level of empathy is associated with the quality of care and empathy was the most influential factor that influence caring behaviors (Yun & Ryu, 2015). Also, empathy toward people with dementia can prevent caregivers’ burnout by decreasing personal distress and motivate caregivers to comfort and help people with dementia (Narme, 2018; Samra, Griffiths, Cox, Conroy, & Knight, 2013). Dementia simulation programs may decrease caregivers’ depression and anxiety symptoms leading to caregivers’ increased quality of life by better understanding about living with dementia from perspectives of people with dementia (Jeyagurunathan et al., 2017; Liang et al., 2016). Further longitudinal studies are needed to observe if caregivers’ participation in dementia simulation programs decreased caregivers’ depression, anxiety, and burden and increased quality of life of both caregivers and people with dementia by measuring outcomes repeatedly over a longer period of time.

Since the present qualitative study interviewed participants about two weeks after the program participation, the present study could discover if and how caregivers changed their care strategies and the following emotional and social benefits on caregivers and people with dementia. One-time participation in dementia simulation programs, however, will not be enough for caregivers to maintain newly and increased use of helpful care strategies as caregivers become forgetting about what caregivers experienced and thought through the simulation program and they experience greater challenges and burden in caring people with dementia. Further education and supporting programs following participation in dementia simulation programs are needed to help caregivers apply what caregivers experienced through dementia simulation programs to day-to-day challenges continuously and cope with changing challenges as dementia progresses further. Also, various versions of scenarios in dementia simulation programs (i.e. challenging behavioral and psychological symptoms of dementia) need to be developed, so providing programs to caregivers can be tailored better depending on the severity and type of dementia and different needs in care. Further studies are needed to explore what scenarios in dementia simulation programs are needed from perspectives of caregivers of people with dementia and how various versions of scenarios in dementia simulation programs help caregivers in different needs in care.

Because the current study was a qualitative study focusing on experiences of caregivers in the Korean dementia simulation program using convenience sampling, it cannot verify generalizability of the findings to all caregivers of people with dementia in South Korea and the other Asian countries. Further studies with a high-level quantitative research design such as randomized controlled trials are needed to verify effectiveness of dementia simulation programs in Western and Asian countries because the previous studies used one-group pre-test–post-test designs. Also, further studies with a high-level quantitative research design are needed to examine effectiveness of dementia simulated learning programs on health professional students and health professionals since there are a very few studies with a low level of evidence (i.e. Beville, 2002).

Conclusion

The present study was the first study that explored experiences of caregivers of people with dementia in a dementia simulation program in an Asian country. The present study found Korean caregivers’ positive experiences in and potential benefits of a Korean dementia simulation program on caregivers of people with dementia. The present study also demonstrated that a program developed in USA could be modified by considering Korean culture and the modified program could be beneficial to caregivers of people with dementia in South Korea. Caregivers in the other Asian countries may also benefit from participation in dementia simulation programs and modifying existing programs developed in Western countries by considering their own cultures can be one easy and useful way.

Footnotes

Acknowledgements

We appreciate the support of AGE-u-cate Training Institute, USA, for the research process. We thank all the study participants for their precious time and goodwill in volunteering for the present study.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the Yonsei University Wonju Campus Future-Leading Research Initiative of 2017(RMS 2 2017-52-0126).

Areum Han is an assistant professor in the Department of Occupational Therapy at Yonsei University in South Korea. She has expertise in both quantitative and qualitative research and has contributed to research in person-centered, relationship-based care programs for people with dementia and their caregivers in the United States and Korea.

Tae Hui Kim is a psychiatrist and a clinical assistant professor in the Department of Psychiatry at Yonsei University Wonju Severance Christian Hospital in South Korea. Currently, she serves as a committee member of the Central Dementia Center. Kim has contributed greatly to education and research on neurocognitive disorders in South Korea.

Hyeon Hong is a master’s student in the Department of Occupational Therapy at Yonsei University in South Korea. Her research interests are older adults including people with dementia and caregivers. She is currently working on her master’s thesis.

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