Hiromi Hirata



Document Type


Degree Name



Oregon Health & Science University


Aggressive behaviors (ABs) related to dementia among older adults have been associated with increased occupational stress among care workers (CWs) in the US and other Western countries and may contribute to staff turnover. However, few studies related to this issue have been done in Japan, where care worker reaction to ABs might be different because of cultural and customary differences in how care is provided for older adults. This mixed-methods, cross-sectional study developed a Japanese version of the Exposure to Disruptive Behavior scale, and examined mediating and moderating effects on the relationship between frequency of exposure to ABs and occupational stress from exposure to ABs using the Cohen-Mansfield model. Care workers in 10 nursing homes in the northern and western areas of Japan were recruited as participants for this study. The translated Japanese version of the EDB scale showed strong internal consistency, reliability, and preliminary evidence for construct validity. The translated scale was administered to 137 care workers employed in dementia special care units in Japan. The major findings were that care workers with higher exposure to AB had higher levels of job burnout and intention to resign. On the other hand, caring for dependents (a child or an older adult) did not affect the level of response to ABs. In responses to the vi three open-ended questions, the majority of the participants stated that ABs were a result of residents’ stress from dementia or a result of interactions with unskilled care workers. Approximately one-fourth of the participants responded that Japanese values such as chu and joge influenced their work with residents with AB. Moreover, about one-third of the participants indicated that ABs influenced the quality of care they provided positively, while about one-fifth of the participants indicated that those behaviors influenced quality of care negatively. Findings from this study may be used to develop culturally relevant training and educational interventions targeted at reducing ABs in individuals with dementia and reducing occupational stress from exposure to ABs.




School of Nursing

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Nursing Commons



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