• Palliative care in dementia: Does it work?

      Dening, Tom; Dening, Karen H. (2016)
      The topic of palliative care in dementia has attracted increasing interest in recent years. Entering palliative + care + dementia into PubMed yields only 10 papers before 1990, the first from 1982. In contrast, there have been 100 or so papers in each of the last three years. The question we have set in this editorial is deliberately ambiguous. ‘Does it work?’ can be either a question about effectiveness in practice or a question about the concept of palliative care as applied to dementia and, in this regard, it is a question as to how palliative care fits in with the journey of dementia and the other models of care that may be relevant.
    • Participatory arts in care settings: A multiple case study: Innovative practice

      Broome, Emma; Dening, Tom; Schneider, Justine (2018)
      This paper describes two case studies of arts interventions in UK care settings. Visual arts and dance movement interventions were regularly held in two settings. This paper draws on data from qualitative interviews, reflective diary sheets and narrative monitoring reports to examine the content, context, and process of the arts interventions within the care settings. Activity coordinators play a crucial role in the success of arts interventions in care setting through their knowledge and support of residents. We recommend that preparatory consultations should take place between arts practitioners and care personnel, as this seems to improve participation and overall satisfaction.
    • Participatory visual arts activities for people with dementia: A review

      Barroso, Aline Cavalcanti; Rai, Harleen; Orrell, Martin; Schneider, Justine (2020)
      AIMSTo report and summarise the effects of interventions using participatory visual arts activities in dementia research through a narrative synthesis systematic review.METHODSWe searched four databases MEDLINE, EMBASE, PsycINFO and Applied Social Sciences Index & Abstracts (ASSIA). Of the 3263 records retrieved, 20 were included in this review. Quality was assessed with the Critical Appraisal Skills Programme (CASP) and the Downs and Black checklist.RESULTSThe use of participatory visual arts has positive effects on cognition, social and psychological functioning of people with dementia, although the diversity of the studies provided inconsistent evidence of an overall positive effect. Participants evaluated the interventions as enjoyable and engaging.CONCLUSIONSThis review adds to previous work done by Deshmukh et al. and Windle et al. with a focus on studies that had participatory visual art-making activities made by people with dementia. The use of participatory arts may bring benefits for people with dementia. The heterogeneity of the interventions prevented generalisation of the results. Criteria associated with positive outcomes of the intervention are reported to aid on the design of participatory visual arts interventions for people with dementia. Future research in participatory arts should have a more detailed description of the methods and art interventions.
    • Peer support and reminiscence therapy for people with dementia and their family carers: A factorial pragmatic randomised trial

      Orrell, Martin (2016)
      OBJECTIVE: The objective of this study was to evaluate peer support and reminiscence therapy, separately and together, in comparison with usual care for people with dementia and their family carers.
    • Peer support for carers of people with dementia

      Chappell, Mike (2017)
      Purpose: The purpose of this paper is to describe the development of Compass workers: a commissioned peer support model to support those caring for someone with dementia. Design/methodology/approach: The paper offers a descriptive summary of how Compass workers came to be and is informed by consultations with key stakeholders and a service evaluation encompassing both quantitative and qualitative aspects. Findings: The findings suggest that it is possible to make use of a peer support model to support those caring for someone with dementia in the context of support being provided to the cared for by statutory services. Both quantitative and qualitative data supported improvements in the quality of life for carers. Originality/value: Both health and social care are facing increasing pressures. This paper offers a positive approach to addressing these pressures utilising a peer support model to support carers that may be of value to others facing similar challenges.
    • Peripheral insulin resistance does not correlate with cerebral glucose metabolic rate in non-diabetic Alzheimer's patients

      Junaid, Kehinde (2018)
      Background: Type 2 diabetes is a risk factor for Alzheimer disease (AD) and several studies have shown that insulin signalling is impaired in AD brain. Progressive brain hypometabolism is a hallmark of AD and can be evaluated using [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET). Peripheral insulin resistance (IR) also increases AD risk. Recent evidence suggests that peripheral IR is associated with significantly lower regional cerebral glucose metabolism in elderly individuals at risk for AD and also predicts medial temporal hypometabolism in AD patients. In this study we evaluated the relationship between IR and cerebral glucose metabolic rate measured by FDG-PET with arterial input in a population of non-diabetic AD subjects. Methods: 131 AD subjects form the Evaluating Liraglutide in Alzheimer's Disease (ELAD) trial (NCT01843075) were enrolled. Glucose and insulin levels were measured after a 4-hour fast on the day of the visit for the FDG-PET scan. Insulin resistance was calculated by both the homeostatic model assessment (HOMA-IR) and the modified HOMA2 calculator. For [18F]FDG analysis, both rCMRGlc parametric images were generated (using spectral analysis with an arterial plasma input function), as well as [18F]FDG ratios, calculated by dividing each target region cortical ROI value by the median value in the pons. Results: In this non-diabetic AD population, the prevalence of IR was about 16%. Subjects above and below the cut-off values for IR (2.9 for HOMA-IR and 1.7 for HOMA2) did not show significant differences in terms of cerebral glucose metabolism, cognitive measures and demographic characteristics. No significant correlation was observed between peripheral IR calculated by either HOMA-IR or HOMA2 and rCMRGlc or ROI uptake of [18F]FDG. Conclusions: In this study of non-diabetic AD population with invasive measurement of cerebral glucose metabolic rate, we have demonstrated that peripheral insulin resistance does not correlate with cerebral glucose metabolism and thus it does not represent a good measure of central insulin resistance.<br/>Copyright &#xa9; 2018 RN - 29702-43-0 (fluorodeoxyglucose); 63503-12-8 (fluorodeoxyglucose f 18); 50-99-7 (glucose); 84778-64-3 (glucose); 204656-20-2 (liraglutide)
    • Perspectives of healthcare professionals in England on falls interventions for people with dementia: a qualitative interview study

      Beck, Lyndsay (2019)
      Objective To explore the experiences of healthcare professionals working in falls prevention and memory assessment services in providing assessments and interventions for falls risk reduction in people with dementia.Design This is a qualitative study using 19 semistructured interviews. Interviews were analysed through thematic analysis.Setting Community-based falls and memory assessment services in the East Midlands, UK.Participants Nurses (n=10), physiotherapists (n=5), occupational therapists (n=3) and a psychiatrist (n=1).Results Three substantive themes were identified: challenges posed by dementia, adaptations to make falls prevention appropriate for people with dementia and organisational barriers. Patients’ poor recall, planning and increased behavioural risk associated with dementia were key problems. Healthcare professionals provided many suggestions on how to overcome these challenges, such as adapting exercise interventions by using more visual aids. Problems associated with cognitive impairment created a need for additional support, for instance longer interventions, and supervision by support workers, to enable effective intervention, yet limited resources meant this was not always achievable. Communication between mental and physical health teams could be ineffective, as services were organised as separate entities, creating a reliance on third parties to be intermediaries. Structural and organisational factors made it difficult to deliver optimal falls prevention for people living with dementia.Conclusions Healthcare professionals experience challenges in providing falls prevention to people with dementia at the individual and organisational levels. Interventions can be adapted for people with dementia, but this requires additional resources and improved integration of services. Future research is needed to develop and test the effectiveness and cost-effectiveness of such services.
    • Perspectives of policy and political decision makers on access to formal dementia care: Expert interviews in eight European countries

      Orrell, Martin (2017)
      BACKGROUNDAs part of the ActifCare (ACcess to Timely Formal Care) project, we conducted expert interviews in eight European countries with policy and political decision makers, or representatives of relevant institutions, to determine their perspectives on access to formal care for people with dementia and their carers.METHODSEach ActifCare country (Germany, Ireland, Italy, The Netherlands, Norway, Portugal, Sweden, United Kingdom) conducted semi-structured interviews with 4-7 experts (total N = 38). The interview guide addressed the topics "Complexity and Continuity of Care", "Formal Services", and "Public Awareness". Country-specific analysis of interview transcripts used an inductive qualitative content analysis. Cross-national synthesis focused on similarities in themes across the ActifCare countries.RESULTSThe analysis revealed ten common themes and two additional sub-themes across countries. Among others, the experts highlighted the need for a coordinating role and the necessity of information to address issues of complexity and continuity of care, demanded person-centred, tailored, and multidisciplinary formal services, and referred to education, mass media and campaigns as means to raise public awareness.CONCLUSIONSPolicy and political decision makers appear well acquainted with current discussions among both researchers and practitioners of possible approaches to improve access to dementia care. Experts described pragmatic, realistic strategies to influence dementia care. Suggested innovations concerned how to achieve improved dementia care, rather than transforming the nature of the services provided. Knowledge gained in these expert interviews may be useful to national decision makers when they consider reshaping the organisation of dementia care, and may thus help to develop best-practice strategies and recommendations.
    • Physical activity pre- and post-dementia: English Longitudinal Study of Ageing

      Orrell, Martin (2019)
      BACKGROUNDTo inform public health interventions, further investigation is needed to identify: (1) frequency/intensity of everyday physical activity (PA) needed to reduce dementia risk; (2) whether post-diagnosis reduction in PA is associated with cognitive outcomes in people with dementia.METHODSData from 11,391 men and women (aged ≥50) were obtained from the English Longitudinal Study of Ageing cohort. Assessments were carried out at baseline (2002-2003) and at biannual follow-ups (2004-2013).RESULTSOlder adults who carried out moderate to vigorous activity at least once per week had a 34%-50% lower risk for cognitive decline and dementia over an 8-10 year follow-up period. From pre- to post-dementia diagnosis, those who decreased PA levels had a larger decrease in immediate recall scores, compared to those who maintained or increased PA levels (analyses were adjusted for changes in physical function).CONCLUSIONPA was associated with cognitive outcomes in a dose-dependent manner. Reduction in PA after diagnosis was associated with accelerated cognitive decline and maintaining PA may reduce symptom progression in dementia.
    • Pilot Randomised Evaluation of Singing in Dementia (PRESIDE): Protocol for a two-arm, parallel-group randomised controlled feasibility study with waiting-list control

      Dowson, Becky; Schneider, Justine; Guo, Boliang; McDermott, Orii; Orrell, Martin (2021)
      BACKGROUNDAs the number of people living with dementia grows, so does the need to provide them with adequate psychosocial support. Many people with dementia live at home with family carers, who also require social and emotional support to cope with their role. Community group singing has received attention for its potential to support people with dementia and their carers. It is postulated that singing can improve cognitive function, strengthen the bonds between care partners and help to establish social support networks. However, there is a lack of rigorous evidence of singing's benefits for this population. This study aims to test the feasibility of a randomised controlled trial of community singing in dementia, to pave the way for a larger, conclusive study.METHODSThe PRESIDE study is designed as a two-arm, parallel-group randomised trial with a waiting list control. Dyads consisting of a person with dementia (n = 80) and their carer (n = 80) will be recruited. Each dyad will be randomised either to attend 10 weeks of community group singing sessions straight away or to wait for 3 months before attending the sessions. The singing sessions will be led by experienced professional musicians and will last about 90 min, including time for socialising. The primary outcome of this study is the attainment of feasibility criteria around recruitment, retention and the acceptability of the waiting list control. Secondary outcomes include the quality of life, mood, cognition, and musical engagement of the person with dementia, and quality of life, mood, and experiences/challenges of the carer. These data will be collected during home visits at baseline, and 3 and 6 months post-baseline.DISCUSSIONDespite growing public interest in the positive effects of singing, and encouraging findings from qualitative and non-randomised quantitative studies, there is a lack of rigorous evidence. This is the first randomised controlled trial of community group singing for people with dementia in Europe, to our knowledge. If the results favour a full trial, conclusively demonstrating the effectiveness of group singing could positively affect the opportunities available to community-dwelling people with dementia and their carers.TRIAL REGISTRATIONUnique identification number in ISRCTN registry: ISRCTN10201482 . Date registered: 12 May 2020.
    • Positive and negative experiences of social support and risk of dementia in later life: An investigation using the English longitudinal study of ageing

      Orrell, Martin (2017)
      BACKGROUND: Having a network of close relationships may reduce the risk of developing dementia. However, social exchange theory suggests that social interaction entails both rewards and costs. The effects of quality of close social relationships in later life on the risk of developing dementia are not well understood. OBJECTIVE: To investigate the effects of positive and negative experiences of social support within key relationships (spouse or partner, children, other immediate family, and friends) on the risk of developing dementia in later life. METHODS: We analyzed 10-year follow up data (2003/4 to 2012/13) in a cohort of 10,055 dementia free (at baseline) core participants aged 50 years and over from the English Longitudinal Study of Ageing (ELSA). Incidence of dementia was identified from participant or informant reported physician diagnosed dementia or overall score of informant-completed IQCODE questionnaire. Effects of positive and negative experiences of social support measured at baseline on risk of developing dementia were investigated using proportional hazards regression accommodating interval censoring of time-to-dementia. RESULTS: There were 340 (3.4%) incident dementia cases during the follow-up. Positive social support from children significantly reduced the risk of dementia (hazard ratio, HR = 0.83, p = 0.042, 95% CI: 0.69 to 0.99). Negative support from other immediate family (HR = 1.26, p = 0.011, CI: 1.05 to 1.50); combined negative scores from spouse and children (HR = 1.23, p = 0.046, CI: 1.004 to 1.51); spouse, children, and other family (HR = 1.27, p = 0.021, CI = 1.04 to 1.56); other family & friends (HR = 1.25, p = 0.033, CI: 1.02 to 1.55); and the overall negative scores (HR = 1.31, p = 0.019, CI: 1.05 to 1.64) all were significantly associated with increased risk of dementia. CONCLUSION: Positive social support from children is associated with reduced risk of developing dementia whereas experiences of negative social support from children and other immediate family increase the risk. Further research is needed to better understand the causal mechanisms that drive these associations.
    • The Positive Psychology Outcome Measure (PPOM) for people with dementia: Psychometric properties and factor structure

      Orrell, Martin (2018)
      OBJECTIVESTo conduct an in-depth psychometric assessment of the PPOM; a measure of hope and resilience.METHODAn observational study at five NHS trusts across England. Participants either completed the study using self-complete or interview led procedures, depending on their preference. Assessments were internal consistency, floor and ceiling effects, test-retest reliability, convergent validity and factor structure.RESULTS225 participants were recruited and completed the study, with a subsample of 48 comprising the test-retest sample. Internal consistency was excellent α = 0.94, and significant correlations were observed between quality of life (r = 0.627, p < .001), depression (r = -0.699, p < .001) and the Control, Autonomy, Self-realisation and Pleasure Scale (CASP-19; r = 0.73, p < .001). The PPOM remained moderately stable over a one week period (ICC: 880) and factor analyses indicated a two-factor structure solution with acceptable fit indices.DISCUSSIONThe PPOM has robust psychometric properties and is now suitable for use research and practice. People who met the clinical criteria for depression were more likely to have lower scores on the PPOM, indicating criterion validity. Future work is needed to establish the PPOM as sensitive to change and to investigate the relationship between hope, resilience and depression further.
    • Positive psychology outcome measures for family caregivers of people living with dementia: A systematic review

      Orrell, Martin (2017)
      BACKGROUNDFamily caregivers of people living with dementia can have both positive and negative experiences of caregiving. Despite this, existing outcome measures predominately focus on negative aspects of caregiving such as burden and depression. This review aimed to evaluate the development and psychometric properties of existing positive psychology measures for family caregivers of people living with dementia to determine their potential utility in research and practice.METHODA systematic review of positive psychology outcome measures for family caregivers of people with dementia was conducted. The databases searched were as follows: PsychINFO, CINAHL, MEDLINE, EMBASE, and PubMed. Scale development papers were subject to a quality assessment to appraise psychometric properties.RESULTSTwelve positive outcome measures and six validation papers of these scales were identified. The emerging constructs of self-efficacy, spirituality, resilience, rewards, gain, and meaning are in line with positive psychology theory.CONCLUSIONSThere are some robust positive measures in existence for family caregivers of people living with dementia. However, lack of reporting of the psychometric properties hindered the quality assessment of some outcome measures identified in this review. Future research should aim to include positive outcome measures in interventional research to facilitate a greater understanding of the positive aspects of caregiving and how these contribute to well-being.
    • Power, empowerment, and person-centred care: Using ethnography to examine the everyday practice of unregistered dementia care staff

      Schneider, Justine (2017)
      The social positioning and treatment of persons with dementia reflects dominant biomedical discourses of progressive and inevitable loss of insight, capacity, and personality. Proponents of person-centred care, by contrast, suggest that such loss can be mitigated within environments that preserve rather than undermine personhood. In formal organisational settings, person-centred approaches place particular responsibility on ‘empowered’ direct-care staff to translate these principles into practice. These staff provide the majority of hands-on care, but with limited training, recognition, or remuneration. Working within a Foucauldian understanding of power, this paper examines the complex ways that dementia care staff engage with their own ‘dis/empowerment’ in everyday practice. The findings, which are drawn from ethnographic studies of three National Health Service (NHS) wards and one private care home in England, are presented as a narrative exploration of carers’ general experience of powerlessness, their inversion of this marginalised subject positioning, and the related possibilities for action. The paper concludes with a discussion of how Foucault's understanding of power may help define and enhance efforts to empower direct-care staff to provide person-centred care in formal dementia care settings. (PsycINFO Database Record (c) 2017 APA, all rights reserved) (Source: journal abstract)
    • Prediction of dementia risk in low-income and middle-income countries (the 10/66 Study): an independent external validation of existing models

      Stephan, Blossom C. M. (2020)
      Background: To date, dementia prediction models have been exclusively developed and tested in high-income countries (HICs). However, most people with dementia live in low-income and middle-income countries (LMICs), where dementia risk prediction research is almost non-existent and the ability of current models to predict dementia is unknown. This study investigated whether dementia prediction models developed in HICs are applicable to LMICs. Methods: Data were from the 10/66 Study. Individuals aged 65 years or older and without dementia at baseline were selected from China, Cuba, the Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela. Dementia incidence was assessed over 3–5 years, with diagnosis according to the 10/66 Study diagnostic algorithm. Discrimination and calibration were tested for five models: the Cardiovascular Risk Factors, Aging and Dementia risk score (CAIDE); the Study on Aging, Cognition and Dementia (AgeCoDe) model; the Australian National University Alzheimer's Disease Risk Index (ANU-ADRI); the Brief Dementia Screening Indicator (BDSI); and the Rotterdam Study Basic Dementia Risk Model (BDRM). Models were tested with use of Cox regression. The discriminative accuracy of each model was assessed using Harrell's concordance (c)-statistic, with a value of 0·70 or higher considered to indicate acceptable discriminative ability. Calibration (model fit) was assessed statistically using the Grønnesby and Borgan test. Findings: 11 143 individuals without baseline dementia and with available follow-up data were included in the analysis. During follow-up (mean 3·8 years [SD 1·3]), 1069 people progressed to dementia across all sites (incidence rate 24·9 cases per 1000 person-years). Performance of the models varied. Across countries, the discriminative ability of the CAIDE (0·52≤c≤0·63) and AgeCoDe (0·57≤c≤0·74) models was poor. By contrast, the ANU-ADRI (0·66≤c≤0·78), BDSI (0·62≤c≤0·78), and BDRM (0·66≤c≤0·78) models showed similar levels of discriminative ability to those of the development cohorts. All models showed good calibration, especially at low and intermediate levels of predicted risk. The models validated best in Peru and poorest in the Dominican Republic and China. Interpretation: Not all dementia prediction models developed in HICs can be simply extrapolated to LMICs. Further work defining what number and which combination of risk variables works best for predicting risk of dementia in LMICs is needed. However, models that transport well could be used immediately for dementia prevention research and targeted risk reduction in LMICs. Funding: National Institute for Health Research, Wellcome Trust, WHO, US Alzheimer's Association, and European Research Council. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
    • Preferences of informal carers on technology packages to support meal production by people living with dementia, elicited from personalised AT and ICT product brochures

      De Filippis, Maria L.; Craven, Michael P.; Dening, Tom (2017)
      Assistive technology (AT) can help support the continued independence of people living with dementia, supported by informal carers. Opinions and preferences of informal carers towards a range of assistive and digital information and communication technologies (ICT) to support food purchase and menu selection, including navigation and online shopping, and safe meal-making by individuals living with dementia were investigated. General attitudes and experiences with assistive technologies were first probed by means of a focus group with carers (n = 6), organised through the Alzheimer’s Society in Nottingham, England. A series of AT/ICT product brochures were then produced, describing packages of technologies to enable meal production. Task-specific questions were asked of carers (n = 10) at local Memory Cafés as to the perceived capabilities of each individual for shopping and meal-making. Carers were asked to make pair-wise choices in order to select a personalised brochure and to complete a questionnaire to elicit the practicality, desirability and affordability of specific products and to probe for preferences amongst key features. Opinions on ease-of-use, aesthetics, expected safety-in-use, independence of use and stigma related to the technology packages were also collected. Results showed that carers are able to make detailed choices and express preferences about assistive and digital technologies for the individuals in their care, and customise their enabler package. Most believed that having an enabler package would improve safety. Greater exposure of carers to newer digital products would be beneficial. The brochure method could be employed on consumer websites and by AT assessors.
    • Prevalence and risk of mild cognitive impairment in low and middle-income countries: A systematic review

      Stephan, Blossom C. M. (2020)
      BACKGROUNDMild cognitive impairment (MCI) is a cognitive state associated with increased risk of dementia. Little research on MCI exists from low-and middle-income countries (LMICs), despite high prevalence of dementia in these settings.OBJECTIVEThis systematic review aimed to review epidemiological reports to determine the prevalence of MCI and its associated risk factors in LMICs.METHODSMedline, Embase, and PsycINFO were searched from inception until November 2019. Eligible articles reported on MCI in population or community-based studies from LMICs. No restrictions on the definition of MCI used as long as it was clearly defined.RESULTS4,621 articles were screened, and 78 retained. In total, n = 23 different LMICs were represented; mostly from China (n = 55 studies). Few studies from countries defined as lower-middle income (n = 14), low income (n = 4), or from population representative samples (n = 4). There was large heterogeneity in how MCI was diagnosed; with Petersen criteria the most commonly applied (n = 26). Prevalence of aMCI (Petersen criteria) ranged from 0.6%to 22.3%. Similar variability existed across studies using the International Working Group Criteria for aMCI (range 4.5%to 18.3%) and all-MCI (range 6.1%to 30.4%). Risk of MCI was associated with demographic (e.g., age), health (e.g., cardio-metabolic disease), and lifestyle (e.g., social isolation, smoking, diet and physical activity) factors.CONCLUSIONOutside of China, few MCI studies have been conducted in LMIC settings. There is an urgent need for population representative epidemiological studies to determine MCI prevalence in LMICs. MCI diagnostic methodology also needs to be standardized. This will allow for cross-study comparison and future resource planning.
    • Preventing dementia by preventing stroke: The Berlin Manifesto

      Stephan, Blossom C. M. (2019)
      The incidence of stroke and dementia are diverging across the world, rising for those in low- and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action. (PsycINFO Database Record (c) 2020 APA, all rights reserved) (Source: journal abstract)
    • Principles and features to define and describe arts interventions for people with dementia: A qualitative realist study

      Cousins, Emily; Dening, Tom (2018)
      Background: There is currently no consensus regarding the definition and description of arts interventions for people with dementia. Developing a common language of classification will encourage reflection on artistic practice, support the evaluation and improvement of arts interventions, and enable their benefits to be communicated more effectively. Methods: Using a qualitative framework derived from taxonomy and realist methodology, a literature review was undertaken to identify what key principles underpin arts interventions. This analysis was complemented by focus groups and workshops incorporating the lived experience of carers, artists, practitioners and care staff. Results: Nine principles were identified as elements present in person-centred arts interventions for people with dementia: Animation, Transcendence, Selfhood, Humanity, Expression, Connection, Possibility, Involvement and Awareness. Conclusions: It is possible to identify the component parts of arts interventions for people with dementia. These principles form an empirical basis for understanding how arts interventions work, while still respecting their individual nature.
    • Principles of service provision in old age psychiatry

      Dening, Tom (2020)
      Globally increasing numbers of older people bring both challenges and opportunities for old age psychiatry services. This chapter outlines the history, underlying principles, and policy context for contemporary mental health services for older people. It discusses components of services, including community health teams, memory assessment services, consultation-liaison psychiatry, and in-patient mental health care, as well as newer types of service, such as crisis teams and outreach to care homes. Other recent developments include various models of case management and emphasis on post-diagnostic support. Equally important are issues of equality and access, and the chapter covers several key areas, such as age, gender, sexual orientation, religion and spirituality, and rurality. Major challenges to old age psychiatry come from limited resources and non-recognition of the distinct needs of older adults, as well as the demands of the growing older population, advances in science and technology, and the need to attract talented psychiatrists into this field.