Alison Dawson

Physical activity for people with dementia: a scoping study

BackgroundThis scoping study aimed to identify how physical activity may benefit people with dementia; how and/or if current service provide these benefits; and what support they need to do so.MethodsMethods included an evidence review using literature; mapping current service provision through a survey; and in-depth interviews with a sample of service providers.ResultsThe 26 studies included in the review indicated the potential effectiveness of physical activity for people with dementia, including improvements in cognition and mood, behaviour and physical condition. Mechanisms of action and the link with outcomes were poorly defined and implemented.The mapping survey and related interviews showed that service providers were delivering a range of services broadly consistent with the scientific evidence. They tended to take a holistic view of possible benefits, and focused on enjoyment and well-being, more than specific cognitive, physical and behavioural outcomes highlighted in literature. Service providers needed more evidence based information and resources to develop services and realise their potential.ConclusionDespite potential benefits demonstrated in literature and practice, there is a need for further research to optimise interventions and to consider some neglected issues including delivery at home and in communities; impacts for carers; physical activities through ADLs; and individual needs. Studies are needed which take a more holistic approach to the effects of physical activity, and outcomes should be broader and include mental health and wellbeing.

Ethical implications of lifestyle monitoring data in ageing research

Lifestyle monitoring systems, intelligent proactive systems incorporating passive monitoring capabilities and allowing contemporaneous remote access to data promise potential benefits to service providers, service users and their carers and families and those engaged in ageing research. Research to date has focused primarily on technical issues, generally at the expense of detailed consideration of the ethical issues raised by these systems. The paper, which is based on a literature review, identifies ethical issues and questions for researchers around: informed consent; working with people who are cognitively impaired; surveillance and the passivity of monitoring; processes of care and using and linking lifestyle monitoring data. It concludes by emphasizing the importance of all parties exploring and discussing the tradeoff between potential benefits to multiple stakeholder groups and actual costs to the individual.

Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach

BackgroundThis paper synthesises research evidence about the effectiveness of services intended to support and sustain people with dementia to live at home, including supporting carers. The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards. However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes.MethodsSystematic searches of relevant electronic bibliographic databases crossing medical, psychological and social scientific literatures (CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science) in November 2012 were followed by structured review and full-text evaluation processes, the latter using methodology-appropriate quality assessment criteria drawing on established protocols.ResultsOf 131 publications evaluated, 56 were assessed to be of ‘high’ quality, 62 of ‘medium’ quality and 13 of ‘low’ quality. Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence conclusions. Thematic analysis revealed multiple gaps in the evidence base, including in relation to take-up and use of self-directed support by people with dementia, use of rapid response teams and other multidisciplinary approaches, use of technology to support community-dwelling people with dementia, and support for people without access to unpaid or informal support.ConclusionsIn many areas, policy and practice developments are proceeding on a limited evidence base. Key issues affecting substantial numbers of existing studies include: poorly designed and overly narrowly focused studies; variability and uncertainty in outcome measurement; lack of focus on the perspectives of people with dementia and supporters; and failure to understanding the complexities of living with dementia, and of the kinds of multifactorial interventions needed to provide holistic and effective support. Weaknesses in the evidence base present challenges both to practitioners looking for guidance on how best to design and deliver evidence-based services to support people living with dementia in the community and their carers and to those charged with the inspection of services.

A social science data-fusion tool and the Data Management through e-Social Science (DAMES) infrastructure

The last two decades have seen substantially increased potential for quantitative social science research. This has been made possible by the significant expansion of publicly available social science datasets, the development of new analytical methodologies, such as microsimulation, and increases in computing power. These rich resources do, however, bring with them substantial challenges associated with organizing and using data. These processes are often referred to as ‘data management’. The Data Management through e-Social Science (DAMES) project is working to support activities of data management for social science research. This paper describes the DAMES infrastructure, focusing on the data-fusion process that is central to the project approach. It covers: the background and requirements for provision of resources by DAMES; the use of grid technologies to provide easy-to-use tools and user front-ends for several common social science data-management tasks such as data fusion; the approach taken to solve problems related to data resources and metadata relevant to social science applications; and the implementation of the architecture that has been designed to achieve this infrastructure.

Developing best practice guidelines for designing living environments for people with dementia and sight loss

ABSTRACT The paper considers a process of developing evidence-based design guidelines to be used in environments where people with dementia and sight loss are living. The research involved a systematically conducted literature review and a series of consultations with people affected by dementia and/or sight loss who lived or worked in care homes or in domestic settings. Findings from the literature and the consultations were used in an iterative process to develop the guidelines. The process is outlined, providing examples from the guidelines about lighting and colour and contrast. In discussing the research findings and the development process, the authors consider implications of the work including the weakness of the evidence base, the challenges of improving this and the need for innovative approaches to understanding the complexities of design for people with dementia and sight loss. They highlight the emphasis in the literature on independence for people with sight loss and the focus on control of people with dementia, arguing that this falls short of a genuinely person-centred approach, which recognises the active participation of people with dementia and sight loss.

Design of residential environments for people with dementia and sight loss: a structured literature review

A structured literature review concerning the design of living environments for people with dementia and sight loss was conducted. Following systematic searching, 33 items were included and quality was assessed. Findings are described covering colour and contrast, lighting, fixtures and fittings, entrances and exits, gardens, and outdoors. The discussion highlights the poor quality of evidence, combined nevertheless with useful suggestions for design; the tendency for the literature to be fragmented; and the need for improvements in terms of study focus, study quality, and an emphasis on independence and individual needs. The review was subsequently used to inform the development of design guidelines.

Long-term care for older people and EU Law: the position in England and Scotland

To what extent, if at all, is the current legal position on long-term care for older people in England and Scotland potentially inconsistent with the UKs obligations in EU law? The implications of EU law for UK healthcare provision have been tracked by the literature, exploited by litigation (Case C–372/04 Watts [2006] ECR I–4325, BetterCare [2002] CAT 7), and covered in EU legislation (Directive 2011/24/EU). However, long-term care for older people involves not only healthcare but also social care. Drawing on significant new empirical data gathered in early 2010 for a European Commission report (European Commission 2011), this article is the first to consider in detail how EU law might apply to the social care aspects of long-term care for older people in England and Scotland. It concludes that EU law is an important element of the long-term care policy context.

RemoDem: Delivering support for people with dementia in remote areas

RemoDem aimed to develop, test and evaluate services for people with dementia in remote areas of the Faroe Islands, Greenland, Sweden and Scotland. Formative and summative evaluation used a flexible research design including collection of baseline data, interviews and focus groups with key informants and data relating to service users, i.e. people with dementia and their carers. Challenges for service providers included organisational difficulties, lack of clear information about their populations with dementia and lack of knowledge in local communities. Test sites which developed services building on their particular local starting points adopted both specialist and ‘off the shelf’ technologies and found that these were generally helpful for people with significant support needs. The flexible research design was found to be essential in the real world conditions of the service development and evaluation. Services were more successful where more mature and less experimental technologies were used. The new services promised to address effectively challenges of remoteness including distance, communication and workforce deployment issues.

BEST PRACTICE IN THE DESIGN OF RESIDENTIAL ENVIRONMENTS FOR PEOPLE LIVING WITH DEMENTIA AND SIGHT LOSS: AN EVIDENCE-BASED RESOURCE

cardiovascular disease have highlighted its role in this system. We investigated a relation of Pulse Pressure with 25-hydroxyvitamin D (25(OH)D) in a population of elderly subjects with diagnosis of Alzheimer’s disease. We studied the relationship between arterial stiffness and 25(OH)D assessed by pulse pressure in 122 (F 77% age 78,8+ 5,21 years) consecutive elderly patients attending our Memory Clinics with diagnosis of Alzheimer’s disease. In our population hypovitaminosis D was present in 100%; 96 patients (78,7%) had 25(OH)D serum levels inferior to 20 ng/ml; 26 (21,3%) patients between 20 and 30 ng/ml. In our study we find that pulse pressure is inversely correlated with 25 (OH)D (Figure 1, r1⁄4 0,553, P1⁄40,000). After adjustment for age, gender, systolic blood pressure, cardiovascular diseases, and antihypertensive therapy, a significant relationship was observed between pulse pressure and 25(OH) (b1⁄4 -0,524; p1⁄40,000). Our results showed a relationship between Pulse Pressure and 25(OH)D suggesting that 25(OH) D could be involved in the onset of arterial remodelling. Certainly our results need confirmation with prospective studies, but this study could open theway to perform other investigations to better explore the correlation between arterial stiffness and vitamin D.

Some Useful Sources on Harm, Abuse, Agency and Resilience Across the Lifespan

The URL addresses listed here access websites holding an array of electronic resources relevant to the understanding of harm, abuse, agency and resilience across the lifespan. Many websites include links to additional reports, research papers, reviews and other sources of information. Due to the breadth of subject area and limitations on available space, the websites should be regarded as an indicative sample rather than an exhaustive list of relevant information currently available on the internet. Only English language sites have been included. All website addresses were available on 31 July 2009.