Chatting: Family Carers' Perspectives on Receiving Support from Dementia Crisis Teams.

Family caregivers are vital to enabling people with dementia to live longer in their own homes. For these caregivers, chatting with clinicians-being listened to empathetically and receiving reassurance-can be seen as not incidental but important to supporting them. This paper considers and identifies the significance of this relational work for family carers by re-examining data originally collected to document caregivers' perspectives on quality in crisis response teams. This reveals that chatting, for family caregivers, comprises three related features: (i) that family caregivers by responding to a person's changing and sometimes challenging needs and behaviors inhabit a precarious equilibrium; (ii) that caregivers greatly appreciate 'chatting' with visiting clinicians; and (iii) that while caregivers appreciate these chats, they can be highly critical of the institutionalized character of a crisis response team's involvement with them.

Care for older forensic mental health patients: A consensus guidance document.

BACKGROUND: It is important to investigate the needs, experiences, and outcomes of older forensic mental health inpatients. In this consensus document, we offer practitioners working with older forensic inpatients recommendations to meet the unique older-age-related needs of this group. METHOD: We report on the findings of a scoping review of service provision and age-responsive interventions for this population. We complement this with a review of qualitative studies investigating staff and patient views on age-responsive inpatient care. RESULTS: The guidance synthesizes this evidence into sections on: epidemiological studies of demographic, clinical, and legal profiles; qualitative studies; investigations of patient need; evidence for interventions tailored to this patient group; future directions for research; and finally, recommendations for practice. Forensic patients over the age of 50 years have a different set of psychological and physical health needs from their peers. There is a dearth of dedicated interventions and support to assist patients through secure services and into the community. CONCLUSIONS: We suggest service providers involve older patients in treatment and service organization decisions, adapt interventions to be responsive to this group, train staff to recognize physical vulnerabilities and cognitive decline, and embrace methods of communication developed in other areas of care, such as dementia Care.

Quality of life, wellbeing, recovery, and progress for older forensic mental health patients: a qualitative investigation based on the perspectives of patients and staff.

PURPOSE: There is a lack of research informing service requirements for older (aged≥55 years) forensic mental health patients. The aim of this research was to increase knowledge about older forensic mental health patients' quality of life, wellbeing, recovery, and progress, in order to make recommendations of how to facilitate and enhance these factors. METHODS: In-depth interviews with patients (N = 37) and staff (N = 48) were undertaken; data were analysed using thematic analysis. RESULTS: Environmental (e.g., physical, structural and facilities), relational (staff, family and friends) and individual (characteristics, feelings, behaviours) factors were identified as enablers and/or obstacles to wellbeing, recovery, progress and quality of life. CONCLUSIONS: The physical and psychological environment of services needs to be adapted to meet the needs of patients. Therapeutic relationships with staff should be encouraged and a person-centred and individual recovery approach adopted. Prosocial relationships with peers, friends and family need to be fostered to enable positive recovery outcomes. Older patients should be empowered to develop a sense of autonomy to enable quality of life, wellbeing, and recovery, and progress.

Going for gold: Sports and exercise groups for people with dementia and carers contribute to their well-being.

Background: Interventions involving exercise appear to have positive effects, both for people with dementia and for their carers. Quality of life and well-being are especially important outcomes. This study investigated how a sports and exercise group for people with dementia and their carers could contribute to the well-being of those attending the group. Methods: The study was a qualitative investigation, comprising semi-structured interviews, a focus group and observations. Participants included people with dementia and carers attending the group sessions, as well as staff providing the programme. The group sessions were provided weekly by the charitable trust of a leading sports venue. Data were analysed using thematic analysis. Results: A total of 16 participants were interviewed, including four people with dementia, eight carers, and four members of staff. Five main themes were identified: "Support to keep active and engaged is highly valued by people with dementia and carers"; "The challenges of being a carer are significant but sharing the experience really helps"; "People with dementia can have flourishing social lives"; "The group helps to maintain identity despite physical and role changes"; and "There are practical aspects of the group that make it appealing". Discussion: People with dementia enjoy physical activity and experience the benefits of it. The sports and exercise group had an important role in providing access to activities that people with dementia and their carers value and enjoy, but would be difficult to undertake without a facilitated and safe environment. The group benefited the well-being of both people with dementia and carers in various ways, with peer support being of particular importance for carers.

Staff perspectives on barriers to and facilitators of quality of life, health, wellbeing, recovery and reduced risk for older forensic mental-health patients: A qualitative interview study.

OBJECTIVES: There is a lack of research informing service delivery for older forensic mental health patients. This study explored service provision in forensic mental health inpatient and community services in England, investigating what is required for progress in terms of quality of life, health, wellbeing, recovery and reduced risk, and the barriers and facilitators associated with this. METHODS: Semi-structured interviews were undertaken with 48 members of staff working with older forensic mental health patients in secure inpatient units or the community in England. Data were analysed using thematic analysis. RESULTS: Two global themes 'What works' and 'What doesn't work' were identified comprising themes representing environmental, interpersonal and individual factors. 'What works' included: positive social support and relationships; individualised holistic patient-centred care; hub and spoke approach to patient care; and suitable environments. 'What doesn't work' included: absence of/or maladaptive relationships with family and friends; gaps in service provision; and unsuitable environments. CONCLUSIONS: For older patients to progress to improved quality of life, health, wellbeing and reduced risk, multilevel and comprehensive support is required, comprising a range of services, interventions, and multidisciplinary input, and individualised to each patient's needs. The physical environment needs to be adapted for older patients and provide a social environment that seeks to include supportive families, friends and expert professional input. A clear patient progression pathway is required; this must be reflected in policy and provision.

Older forensic mental healthcare patients in England: demographics, physical health, mental wellbeing, cognitive ability and quality of life.

Background: Older individuals (e.g., 55 years and over) constitute a growing proportion of the forensic mental health patient population. As a group, they are vulnerable to health outcomes similar to other individuals with serious mental disorders of the same age; however, these concerns can be compounded by complex forensic-related care backgrounds and clinical presentations, lengthy periods of time spent in prison or psychiatric hospitals, substance use histories, and crime perpetration or victimisation. The healthcare needs and strengths of this group are not well understood.The aim of this study was to identify and describe the demographic, physical health, mental wellbeing, cognitive ability, and quality of life profiles of older forensic patients in community, low, medium, and high security settings in England. Methods: A cross-sectional quantitative study design was used. N=37 forensic patients aged 55 years and over completed six questionnaires. Data were also collected from patient records. Results: Most patients were male and were diagnosed with psychosis. The most frequently committed index offence types were violent offences. Patients were prescribed 7.6 medications on average and had average anticholinergic effect on cognition scores of 2.4. Nearly half the sample had diabetes, with an average BMI score of 31.7 (indicating obesity). Possible cognitive impairment was identified in 65% of the sample. Patients' assessments of their recovery-related quality of life and mental wellbeing were comparable to published UK general population values. Assessments of quality of life were positively correlated with the ability to undertake everyday activities and cognitive performance. Conclusions: We suggest that forensic services are well-placed to provide holistic mental and physical care to this group but that they should co-develop with patients a greater range of age-appropriate meaningful activities that are mindful of mobility issues and consider implementing more cognition-based and physical health interventions.

Forensic mental health services provide care for people who have committed a crime or are at risk of harm to themselves or others. This care takes many forms, including mental health support, physical health care, and assistance to re-enter the community after spending time in secure mental health hospitals. Due to changes in the general population, there is a growing number of patients over the age of 55 in care. Despite this, we do not know enough about the healthcare needs of this older patient group and how these needs differ from younger patients. This study aimed to find out more about this patient group. In the current study, thirty-seven forensic patients aged 55 years and older were recruited from low, medium and high security hospitals and community care. These patients completed six questionnaires. Patients were asked about their physical health, mental wellbeing, cognitive ability, and quality of life. Information about medical diagnoses and socio-demographic backgrounds were collected from hospital records. The study found that these patients had complex health needs. Most patients were diagnosed with psychosis (e.g., schizophrenia), were men, and had committed a violent criminal offence. On average patients were prescribed 7.6 medications, many of which carry significant side effects. Nearly half of the patients had diabetes, and most patients were obese or overweight. Quality of life scores were lower for patients who also reported having problems undertaking everyday activities and patients with cognitive impairment. Patients subjectively rated their mental wellbeing and quality of life similarly to the general population's ratings as reported in other studies. We suggest that services should work with patients to develop a greater number of age-appropriate activities and interventions aimed at improving cognitive and physical health.