Subrata Banerjee

What do we know about quality of life in dementia? A review of the emerging evidence on the predictive and explanatory value of disease specific measures of health related quality of life in people with dementia.

Given its complexity, there is growing consensus on the need to measure patient‐rated broad outcomes like health‐related quality of life (HRQL) as well as discrete functions like cognition and behaviour in dementia. This review brings together current data on the distribution, determinants and course of HRQL in dementia to investigate the predictive and explanatory value of measures of HRQL in people with dementia.

Clinical and cost effectiveness of services for early diagnosis and intervention in dementia

This paper analyses the costs and benefits of commissioning memory services for early diagnosis and intervention for dementia.

Helping carers to care-The 10/66 Dementia Research Group's randomized control trial of a caregiver intervention in Russia

Dementia is a rapidly growing public health problem in low and middle income countries. There is an urgent need, in the absence of formal services, to develop interventions designed to improve the lives of people with dementia, and their families. This study tests the effectiveness of the 10/66 caregiver intervention among people with dementia, and their carers.

Living well with dementia-development of the national dementia strategy for England

Dementia is one of the greatest societal challenges that we face. The profound negative impacts of dementia on people with dementia themselves, their families, and in terms of health and social service use are not in doubt. Powerful misconceptions exist concerning dementia including it being a normal part of aging; that there is nothing that can be done to help; and that it is better not to know. These have resulted in a situation where dementia has not been a priority for health policy makers and commissions. The direct result of this is that the large majority of people with dementia and their family carers do not benefit from the positive intervention and support that can promote wellbeing and prevent crises for all involved. At times it can seem that services have been designed to result in the avoidance of diagnosis and the consequent denial of care. In the UK only about a third of people with dementia receive a diagnosis of dementia.When they do it is usually late in the disorder, often at a time of crisis when it is too late to prevent the harm that has been caused to the person with dementia and their family (National Audit Office [NAO], 2007). In this paper we will focus on the development and the content of the English National Dementia Strategy which attempts to address this.

'They're all depressed, aren't they?' - A qualitative study of social care workers and depression in older adults

Statutory and voluntary social services provide care and support for vast numbers of vulnerable older adults, yet little is known about how social care practitioners respond to depression in this high risk population. This study elicited the perceptions and conceptualizations of this condition among social care staff, and views on how the response of social care and other agencies might be improved. Qualitative interviews were conducted with 20 social care practitioners working in generic services for older adults in south London. Depression was perceived to be remarkably common among clients, a phenomenon largely attributed to the adverse circumstances of old age, particularly social isolation. A key message from participants was that social causes indicate a need for social interventions. While primary care was criticised for not taking depression seriously in older people, mental health services were generally praised. Expansion of social, recreational and psychological interventions was advocated.

Commentary on "Health economics and the value of therapy in Alzheimer's disease." Quality of life in dementia: Development and use of a disease-specific measure of health-related quality of life in dementia

1. Has our intervention helped? Generally when we intervene in a particular situation, we want to know whether the intervention has been of use overall as well as whether specific aims have been achieved. Therefore, if one were to invade a country to depose a despotic leader and one was successful in doing so, then by using a discrete, specific outcome measure (the deposition of the despot), one might assess the intervention as a success. However, if a broad view of the costs of the intervention were undertaken and that showed undesirably high casualties for combatants and the general population and widespread impairment in living conditions for those freed from the despot, one might question the value of the intervention at a global level. In evaluating interventions in dementia there are two possible scenarios that follow from the above considerations. First, we might imagine a spouse caregiver reporting that her husband has repetitive questioning and some agitation in moderate Alzheimer’s disease (AD); a physician consulted might prescribe antipsychotic medication. This might result in sedation, with the individual sitting in the corner doing nothing with markedly decreased social communication of all kinds, not just the questioning. If measured with a specific measure of agitation or behavioral disturbance, then the treatment might be deemed to be a success, even though the lives of the person with dementia and their family caregiver might be far less rewarding. A global measure of overall impact would be expected to pick up this negative impact. Second, it might be possible for an antidementia medication to have only an equivocal effect on cognition or activity limitation in an individual with mild dementia and so to be believed to be not worth persevering with. However, if this medication also, for example, improved communication, social behavior, and the initiation of conversation and purposeful activity, then it might overall be having a useful positive effect. This might well not be picked up by prespecified discrete measures, but again one would expect a measure of overall impact to identify this beneficial impact. Thus, a lack of broad outcome measurement in intervention in dementia and a reliance on measures of discrete functions such as cognition or activity limitation could lead to the positive effects of treatments being overlooked or to potential negative effects of intervention being missed.

Modernizing mental health services for older people: a case study.

BACKGROUND This paper describes an evaluation of a redevelopment program in a mental health service for older people, stimulated by U.K. Department of Health policy. IQCOL (Improving Quality of Care for Older People in Lambeth) was a two-year program to modernize and expand an inner-city service, with objectives to improve access, embed new functions, and tune the service towards the needs of the local community. The program evaluation aimed to contribute to knowledge on service planning and methodology for evaluating complex interventions. METHODS The study evaluated the progress and outcomes of this multifaceted program. The realist model of evaluation was followed, with a dual emphasis on utility and generalizability. With an iterative approach, the pragmatic, longitudinal design comprised a combination of qualitative and quantitative methods to explain the process of change and to measure achievement of objectives. RESULTS A high level of participation in evaluation activities was achieved. The workforce generally responded well to the program. However, progress in one team was hindered by understaffing and resistance to change, emphasizing that while localized provision may be desirable, team viability requires adequate resources and professional support. Improved access was indicated by a 13% increase of referrals. Data suggested earlier referral of dementia cases. Carer support was implemented, but assertive outreach was impeded by professional boundary issues. Ethnicity data showed that the service was responding to demographic trends. Positive views towards the program were associated with team resources and recent professional training. CONCLUSIONS This case study demonstrates how whole system change can be achieved if sufficient attention is given to the needs of staff implementing the program. The evaluation emphasizes the importance of context in producing generalizable evidence on service development, and contributes useful methodological insights.

The Stroud/ADI dementia quality framework: a cross-national population-level framework for assessing the quality of life impacts of services and policies for people with dementia and their family carers.

To generate an internationally applicable framework for the systematic assessment of the quality of life impacts of services and policies for people with dementia and their family carers.