The present study is the first to generate objective data showing that difficulty in beginning a meal is a factor that hinders independence in eating in AD, in addition to the presence of dysphagia signs and the severity of dementia. Assisting AD patients in maintaining eating independence might be effectively achieved by eliminating environmental factors that interfere with beginning a meal, and by providing assistance that will promote beginning a meal. The present results show the necessity of developing effective methods for assisting elderly patients with AD.

Specific approach should be developed to minimise the physical restraint in long-term care hospitals in Japan.

Findings show some evidence for the reliability and validity of APS-J.

Results suggested that knowledge of oral care was related not only to the career but also to age and revealed a basic gap in the range of abilities between the respondent caregiver managers. Some did perform appropriate oral care and carried out the necessary processes.