Simon Evans

Public health guidance to facilitate timely diagnosis of dementia: ALzheimer's COoperative Valuation in Europe recommendations

ALzheimers COoperative Valuation in Europe (ALCOVE) was a Joint Action co‐financed by the European Commission to produce a set of evidence‐based recommendations for policymakers on dementia. This paper reports on timely diagnosis.

Ethical issues in social research involving people with dementia

Involving people with dementia in research raises many ethical and practical issues for people with dementia, carers and family members, researchers and care professionals. Internationally, the legal, governance and ethical framework for such research is rapidly changing, and there is considerable debate about how these changes will affect social research that needs to involve people with advancing dementia. This article is based on challenges that the authors faced when trying to develop a follow-up research proposal that would have involved people with advancing dementia, and consequential loss of capacity, in social research. It explores a range of issues and concerns, including accessing data to identify potential participants, assessing mental capacity, obtaining consent and the role of gatekeepers. These issues are discussed in the context of emerging governance in social care research and current and new legislation in the UK, the rest of Europe and beyond. The existing processes of ethical review are outlined and the implications for research of the new Mental Capacity Act, recently implemented in England and Wales, are considered. The difficult balance between protecting vulnerable individuals, recognizing the importance and benefits to society of research and maintaining an individuals right to take part in research is discussed. The article concludes with recommendations for researchers planning to undertake projects that may include people with reduced capacity as participants.

Developing user involvement in a UK cancer network: professionals’ and users’ perspectives

This paper explores the results of a consensus development exercise that explored diverse perspectives and sought to identify key principles for the development of user involvement in a cancer network. The exercise took place within one of 34 UK cancer networks and was a collaboration between the NHS, two universities and two voluntary sector organizations. The paper explores professionals’ and users’ perspectives on user involvement with reference to the current sociopolitical context of user participation. British policy documents have placed increasing emphasis on issues of patient and public participation in the evaluation and development of health services, and the issue of lay participation represents an important aspect of a critical public health agenda. The project presented here shows that developing user involvement may be a complex task, with lack of consensus on key issues representing a significant barrier. Further, the data suggest that professional responses can partly be understood in relation to specific occupational standpoints and strategies that potentially allow professionals to define and limit users’ involvement. The implications of these findings and the impact of the consensus development process itself are discussed.

Community and ageing : maintaining quality of life in housing with care settings

Introduction What is community? Community and ageing Housing with care communities in the UK An international perspective on retirement villages Promoting a sense of community in housing with care settings Diversity, community and social interaction Changing communities and older people Conclusion.

Communities of place and communities of interest? An exploration of their changing role in later life

ABSTRACT Social gerontologists have long grappled with the meaning of ‘community’ to older people. This paper lies within this tradition and focuses on the extent to which the past emphasis upon communities of place needs to be rebalanced or rethought in the light of emerging evidence for the growing engagement of older people in communities of interest linked to friendships, enthusiasms and their increasing spending power. This theoretical paper highlights the traditional emphasis on the role of community and place in later life and explores the emergence of a debate about communities of interest linked to such factors as the ‘discovery’ of ‘the Third Age’, marketisation, consumerism, the importance of social interaction in the lives of many older people, and the impact of the internet and virtual communities. This debate is placed in an international policy context in which numerous governments are concerned about the greying of the global population and the consequent desire to promote ‘ageing well’ to offset resultant health and social care costs. The paper argues for a reconceptualisation of community through a more sophisticated view of ‘place’ and ‘interest’ that avoids false dichotomies between the two and acknowledges the impact of social, economic and cultural change upon the lives of older people.

FITS into practice: translating research into practice in reducing the use of anti-psychotic medication for people with dementia living in care homes

Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

The Role of Community Centre-based Arts, Leisure and Social Activities in Promoting Adult Well-being and Healthy Lifestyles

Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes—especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context.

Supporting independence for people with dementia in extra care housing

References Courtney, M., Tong, S., & Walsh, A. (2000). Acute-care nurses’ attitudes towards older patients: A literature review. International Journal of Nursing Practice, 6(2), 62–69. Kerr, B., Gordon, J., MacDonald, C., & Stalker, K. (2005). Effective social work with older people: A paper prepared for the Scottish Executive by the Social Work Research Centre, University of Stirling as part of the 21st century social work review. Edinburgh: Scottish Executive. McKinlay, A., & Cowan, S. (2006). “If you’re frail you’ve had it”: A theory of planned behavior study of student nurses’ attitudes towards working with older patients. Journal of Applied Social Psychology, 36(4), 900–917. Morhardt, D. (2006). Educating medical students on Alzheimer’s disease and related disorders: An overview of the Northwestern University Buddy Program. Dementia: The International Journal of Social Research and Practice, 5(3), 448–456. Vallelly, S., Evans, S., Fear, T., & Means, R. (2006). Opening doors to independence: A longitudinal study exploring the contribution of extra care housing to the care and support of older people with dementia. London: Housing 21.

Never a dull moment? Promoting social well‐being in extra care housing

Extra care housing is an increasingly popular form of housing with care for older people, largely because of its potential for maximising independence by providing flexible care and support. However, far less attention has been paid to another important aspect of quality of life, social well‐being. This article reports on a research project that explored good practice in promoting social well‐being in extra care housing. We identify several key factors in supporting the social lives of residents and present recommendations for good practice.

The development of environmental assessment tools to support the creation of dementia friendly care environments: Innovative practice:

The need for more dementia friendly design in hospitals and other care settings is now widely acknowledged. Working with 26 NHS Trusts in England as part of a Department of Health commissioned programme, The King’s Fund developed a set of overarching design principles and an environmental assessment tool for hospital wards in 2012. Following requests from other sectors, additional tools were developed for hospitals, care homes, health centres and housing with care. The tools have proven to be effective in both disseminating the principles of dementia friendly design and in enabling the case to be made for improvements that have a positive effect on patient outcomes and staff morale. This paper reports on the development, use and review of the environmental assessment tools, including further work that is now being taken forward by The Association for Dementia Studies, University of Worcester.