A Systematic Review of the Effectiveness of Educational Interventions in Promoting Person-Centred Care in Dementia Services.

OBJECTIVES: To review evidence about the effectiveness of educational programmes in promoting the delivery of person-centered care by staff in dementia services. METHODS: Several databases were searched, and the methodological quality of identified studies systematically evaluated. A summary mean effect size was calculated for several types of outcome (direct knowledge, applied knowledge, attitudes, self-reported and observed working practices). RESULTS: Eighteen studies were identified. Results were mixed, with findings of no change, significant improvement, and (in attitude) significant deterioration. Effect size was modest for direct knowledge (standardized mean difference = 0.6), but small or negligible for applied knowledge (0.29) and self-reported (0.06) and observed (0.25) working practices. There was a negative effect for attitudes (-0.17). CONCLUSIONS: The quality of evidence was poor. Apart from attitudes, the effect sizes are likely to be overestimates. There was little evidence that education programmes can reliably produce substantial improvements in working practices. CLINICAL IMPLICATIONS: Education alone is unlikely to be sufficient for establishing high standards of person-centered care in services. It needs to be supplemented by steps to ensure that staff develop skills in delivering such care in practice, and by organizational support to ensure staff have sufficient motivation, cues and opportunities for implementation.

Relationship continuity and person-centred care in how spouses make sense of challenging care needs.

Objectives: Some spouses providing care for a partner with dementia experience continuity in the relationship: Despite the changes that have occurred, the person with dementia and the relationship are felt to be essentially the same as they were before the dementia. Others experience discontinuity: The person and the relationship feel very different. Previous qualitative research has suggested that continuity may be linked with the delivery of more person-centred care. Using a mixed-methods approach, the present study aimed to provide a more robust test of this claim.Method: Twenty-six spousal carers completed the Birmingham Relationship Continuity Measure and the Caregiver Hassles Scale, and took part in an interview about their response to challenging care needs. Attributions about the causes of those needs were extracted from the interviews and coded. Codes referred either to dementia as a cause, or to a range of other causes that reflected a more person-centred focus. A measure of person-centred care was obtained by calculating the percentage of the total number of attributions that fell into these more person-centred categories.Results: Consistent with the hypothesis that continuity and person-centred care are linked, those who reported greater continuity reported a significantly higher percentage of person-centred attributions.Conclusions: Person-centred care is important for the well-being of those giving and those receiving the care. Little is currently known about how to support families to be more person-centred. The possibility of supporting person-centred care through enhancing the experience of continuity merits investigation.

Using technology to support the emotional and social well-being of nurses: A scoping review.

AIMS: (a) To review the literature on the use of technology to offer emotional and social support to nurses; (b) to identify and evaluate gaps in the research; (c) to assess whether a systematic review would be valuable and (d) to make recommendations for future research. DESIGN: A robust methodological scoping framework was used as the basis for this review design. A manualized systematic approach to quality appraisal was implemented. DATA SOURCES: Between 11-12 June 2018, five databases were searched. A search of the grey literature was conducted alongside hand searching reference lists of included studies. REVIEW METHODS: Two researchers conducted the literature search, data extraction and quality appraisal. Three searches were conducted, combining nursing and technological terms. A narrative review approach to knowledge synthesis was used to compare and evaluate included studies. RESULTS: Eleven articles were retrieved. Results are presented under three subheadings: (a) text messaging and messenger apps; (b) social media and online forums; and (c) online interventions accessible via PC, smartphone and tablet. All included studies described how such provision could be beneficial; decreasing stress, isolation and anxiety and fostering a sense of community. CONCLUSION: The review identified a dearth of research into how technology can support the well-being of nurses. A high proportion of studies were based on student nurse populations using small sample sizes, therefore further research is needed. IMPACT: Technology may offer a sustainable and accessible means of providing support for nurses who find it difficult to communicate in person due to time pressures at work. It is important that the psychological well-being of nurses is seriously addressed as more nurses are now leaving than joining the profession. Online interventions may offer a sustainable and accessible means of providing support for busy nursing staff who have difficulty finding time to communicate with one another face-to-face. Nurse retention is an international issue linked to quality of patient care. There are financial implications for healthcare providers who compensate for the workforce deficit by employing costly agency staff. This scoping review aims to map and evaluate the available literature on technology-mediated support for the emotional and social well-being of nurses. Recommendations for future research, policy and practice will be offered from the findings of the review.

Individual goal-oriented cognitive rehabilitation to improve everyday functioning for people with early-stage dementia: A multicentre randomised controlled trial (the GREAT trial).

OBJECTIVES: To determine whether individual goal-oriented cognitive rehabilitation (CR) improves everyday functioning for people with mild-to-moderate dementia. DESIGN AND METHODS: Parallel group multicentre single-blind randomised controlled trial (RCT) comparing CR added to usual treatment (CR) with usual treatment alone (TAU) for people with an ICD-10 diagnosis of Alzheimer, vascular or mixed dementia, and mild-to-moderate cognitive impairment (Mini-Mental State Examination [MMSE] score ≥ 18), and with a family member willing to contribute. Participants allocated to CR received 10 weekly sessions over 3 months and four maintenance sessions over 6 months. Participants were followed up 3 and 9 months post randomisation by blinded researchers. The primary outcome was self-reported goal attainment at 3 months. Secondary outcomes at 3 and 9 months included informant-reported goal attainment, quality of life, mood, self-efficacy, and cognition and study partner stress and quality of life. RESULTS: We randomised (1:1) 475 people with dementia; 445 (CR = 281) were included in the intention to treat analysis at 3 months and 426 (CR = 208) at 9 months. At 3 months, there were statistically significant large positive effects for participant-rated goal attainment (d = 0.97; 95% CI, 0.75-1.19), corroborated by informant ratings (d = 1.11; 95% CI, 0.89-1.34). These effects were maintained at 9 months for both participant (d = 0.94; 95% CI, 0.71-1.17) and informant (d = 0.96; 95% CI, 0.73-1.2) ratings. The observed gains related to goals directly targeted in the therapy. There were no significant differences in secondary outcomes. CONCLUSIONS: CR enables people with early-stage dementia to improve their everyday functioning in relation to individual goals targeted in the therapy.

Evaluation of a carers' information programme culturally adapted for South Asian families.

OBJECTIVES: The Alzheimer's Society has culturally adapted an Information Programme for South Asian families (IPSAF) who support an individual living with dementia. The objectives of this evaluation were to establish whether IPSAF had an immediate and medium-term impact on those who attended and how it impacted on the wider family and the person with dementia. METHODS: An inclusive, pluralistic approach was adopted. Seven focus groups were conducted with 42 participants, and 37 participated in a pre-post knowledge quiz. Seven family interviews were conducted with 17 participants, and 3 families were followed up after 6 months. Thematic analysis was conducted on the data. FINDINGS: The IPSAF was found to improve participants' knowledge of dementia leading to increased understanding of the person with dementia. Participants became more aware of available services and accessed services to make use of practical support. IPSAF was reported to have an impact for people living with dementia, with carers' newfound understanding resulting in some changes in care practice that promoted empowerment and independence for people living with dementia. There was also some evidence to suggest that IPSAF had an impact on the wider family, with participants sharing information about dementia with family members who had not attended the programme. Families were continuing to make changes to improve the lives of people living with dementia 6 months later, suggesting IPSAF had a sustained impact. CONCLUSION: This culturally adapted programme was found to have a significant impact on carers, the person with dementia, and the wider family.

Development of the Adolescent Attitudes towards Dementia Scale (A-ADS).

OBJECTIVE: There has been an increasing interest in establishing dementia friendly communities leading to the development and delivery of various dementia awareness initiatives. These initiatives have generally been aimed at adults; however, to sustain dementia friendly communities, the involvement of young people is imperative. Very few dementia awareness initiatives exist for young people, and none have been independently evaluated to establish their impact. This research aimed to design and develop a scale to measure adolescents' attitudes towards dementia to allow such initiatives to be evaluated. METHODS: The Adolescent Attitudes toward Dementia Scale was developed in 2 stages. Firstly, cognitive interviews were conducted with 15 young people, and secondly, a new scale (based on items from 2 existing scales) was piloted with 262 young people, recruited through schools. RESULTS: A scale consisting of 23 items was developed. Exploratory factor analysis demonstrated that this captured 3 factors: perceptions of dementia, personal sacrifice, and empathy with people living with dementia. The 3 sub-scales showed adequate internal consistency (>.60), correlated with the original scales (r = .79-.91, P < .001) and correlated with an existing measure of attitudes towards older people at a similar level to the original scales (r = .47, P < .001). DISCUSSION: The scale will allow the evaluation of educational initiatives for young people and provide a validated and standardised measure to establish adolescents' attitudes towards dementia.

Relationship continuity and emotional well-being in spouses of people with dementia.

OBJECTIVES: Qualitative research has suggested that spousal experiences of discontinuity in their relationship with a person who has dementia (i.e. the relationship is experienced as radically changed) may contribute to heightened feelings of burden, entrapment, isolation, guilt and intolerance of behaviours that challenge. By contrast, continuity in the relationship may contribute to a greater sense of achievement and gratification from providing care. The present study served as a quantitative test of these suggestions. METHOD: A convenience sample of 71 spouses of people with dementia completed three questionnaires - the Zarit Burden Interview (ZBI), the Positive Aspects of Caregiving measure (PAC) and the Birmingham Relationship Continuity Measure (BRCM). RESULTS: In accordance with the hypotheses, the experience of greater relationship continuity (higher BRCM scores) was correlated with fewer negative emotional reactions to caregiving (lower ZBI scores; rho = -.795) and more positive emotional reactions (higher PAC scores; rho = .764). CONCLUSIONS: The study provided some quantitative support for suggestions arising from qualitative research about how perceptions of continuity/discontinuity in the relationship may impact on the caregiving spouse's emotional well-being. Helping couples to maintain a sense of continuity and couplehood may assist their emotional adjustment to dementia.

Development and psychometric evaluation of an observational coding system measuring person-centered care in spouses of people with dementia.

BACKGROUND: The notion of person-centered care has been important in investigating relationships between people with dementia and paid carers, and measures are available to assess this. It has been suggested that person-centered care may be a useful construct to apply to understand family-care relationships. However, no measures of person-centered care in this context exist. The study aimed to develop an observational measure of person-centered care for this purpose. METHOD: First, a coding system incorporating a range of behaviors that could be considered person-centered or non-person-centered was constructed. Examples included a code relating to whether the person with dementia was involved in planning a task, and a code relating to how the spouse responded to confusion/distress. Second, 11 couples, where one partner had a dementia, were recruited and videotaped cooperating on an everyday task. The system was applied to the care-giving spouse's behaviors, labeling examples of behavior as person-centered or non-person-centered. The final step involved assessing the inter-rater reliability of the system. RESULTS: The system captured nine categories of behavior, which were each divided into person-centered and non-person-centered types. The system had good reliability (Cohen's κ coefficients were: 0.65 for category and whether behaviors needed to be placed in a category; 0.81 for category excluding the decision about whether behaviors needed to be placed in a category; and 0.79 in relation to whether behaviors were person-centered or non-person-centered.). CONCLUSIONS: Although the small sample size limits the implications of the results, the system is a promising quantitative measure of spousal person-centered care.

The Birmingham Relationship Continuity Measure: the development and evaluation of a measure of the perceived continuity of spousal relationships in dementia.

BACKGROUND: Qualitative research has suggested that spousal carers of someone with dementia differ in terms of whether they perceive their relationship with that person as continuous with the premorbid relationship or as radically different, and that a perception of continuity may be associated with more person-centered care and the experience of fewer of the negative emotions associated with caring. The aim of the study was to develop and evaluate a quantitative measure of the extent to which spousal carers perceive the relationship to be continuous. METHODS: An initial pool of 42 questionnaire items was generated on the basis of the qualitative research about relationship continuity. These were completed by 51 spousal carers and item analysis was used to reduce the pool to 23 items. The retained items, comprising five subscales, were then administered to a second sample of 84 spousal carers, and the questionnaire's reliability, discriminative power, and validity were evaluated. RESULTS: The questionnaire showed good reliability: Cronbach's α for the full scale was 0.947, and test-retest reliability was 0.932. Ferguson's δ was 0.987, indicating good discriminative power. Evidence of construct validity was provided by predicted patterns of subscale correlations with the Closeness and Conflict Scale and the Marwit-Meuser Caregiver Grief Inventory. CONCLUSION: Initial psychometric evaluation of the measure was encouraging. The measure provides a quantitative means of investigating ideas from qualitative research about the role of relationship continuity in influencing how spousal carers provide care and how they react emotionally to their caring role.

Relatives' experiences of frontal-variant frontotemporal dementia.

In this article we address how relatives of people with frontal-variant frontotemporal dementia (fvFTD) experience the illness and how it impacts their lives. We interviewed 6 participants and carried out interpretative phenomenological analysis. We report on 11 themes that reflect distinctive challenges. Five themes relate to witnessing bizarre and strange changes: changed appetites and drives, loss of planning ability, loss of inhibition leading to social embarrassment, risky behavior, and communication problems. Four relate to managing these changes and two to the impact on the person and his or her relationships. Relatives must live with unusual changes in the person with fvFTD and the stigma this carries in social settings. They learn to act assertively for their relatives and put effort into promoting quality of life, using strategies adapted for fvFTD. Relatives grieve the loss of the person with fvFTD and their mutual relationship, but nonetheless find sources of solace and hope.

Lessons learnt from delivering the public and patient involvement forums within a younger onset dementia project.

Including the 'voices' of people living with dementia in a meaningful way is pivotal in shaping local, national and international health and social dementia care research. The Alzheimer's Society (United Kingdom) funded Angela Project (2016-19) was aimed at improving the diagnosis and post-diagnostic support for younger people living with dementia. From the outset, the Project Team ensured that the knowledge and expertise of people living with a younger onset dementia was integral to all decisions taken in respect to overall project design, implementation, and dissemination processes. This was achieved by establishing two project public and patient involvement (PPI) forums; a London PPI Forum and a Bradford-based local PPI Hub. This paper describes how the two groups were formed; the format of the meetings; and the key points learnt by the Project Team from involving people with dementia in all aspects of developing and delivering the Angela Project. Ultimately, the aim is to demonstrate to other researchers in the dementia field how the perspectives of those with a diagnosis can be included in research studies in an active and meaningful way.

Helpful post-diagnostic services for young onset dementia: Findings and recommendations from the Angela project.

There is a significant lack of evidence regarding optimum models for service provision in young onset dementia (YOD). Our study aim was to gather detailed information about services experienced as helpful by those with YOD and family carers. The objective was to identify the core features of these services to inform service design, delivery and improvements. A qualitative approach based on appreciative inquiry was used, posing open-ended questions about services experienced as helpful, as part of a national UK survey of people with YOD and carers. We used inductive thematic analysis to analyse the free-text responses. The resulting template was used as a basis for analysis of in-depth follow-up interviews, conducted to acquire greater in-depth understanding. Two hundred and thirty-three survey respondents provided 856 examples of helpful support. Twenty-four follow-up interviews were conducted (two with dyads, so 26 participants in total: 8 with people with YOD, 14 with carers, 2 with dyads). Twelve themes capturing the features of helpful services were clustered into three super-ordinate themes. 'Person-centredness' reflects micro levels of person-professional interaction (positive attitude, flexibility, collaborative, user-friendly materials, and in-person). 'Functional consistency' captures the meso level, demonstrating that services were helpful when organised consistently with needs (age-appropriate, holistic, responsive, and accessible). 'Organisational coherence', at the macro level, emphasises the need for service integration, specialist services and service continuity. Key conclusions are that the needs for flexibility and a collaborative stance may be particularly important for those under 65 years with dementia, who have full lives and are used to being in control; to be age-appropriate, helpful services need to provide activities and opportunities suitable for active middle-aged people; and to be holistic, services need to provide for needs associated with rare dementias and be family-centred. Specialist services need to be commissioned and arrangements need to be stable over time to enable continuity.

An investigation into the validity of effort tests in a working age dementia population.

OBJECTIVES: Performance on neuropsychological tests can be influenced by non-cognitive factors, including deliberate underperformance, stress, the need to fulfil a sick role, depression, un-cooperativeness, fatigue and unhappiness with the evaluative situation. Tests to detect suboptimal effort are becoming widely used in clinical practice and are based on their reported insensitivity to cognitive dysfunction. A diagnosis of dementia has life-changing implications for an individual of working age. It is therefore crucial that clinicians can be confident they have obtained a valid estimate of current cognitive functioning. This study aimed to establish whether mood or cognitive functioning adversely influenced performance on symptom validity tests (SVTs) in individuals with working age dementia, who were judged to be using full effort. METHOD: Forty-two participants with dementia diagnosed before the age of 65 completed measures of emotional and cognitive functioning and six SVTs. RESULTS: There were no significant correlations between emotional functioning and measures of effort. However, cognitive functioning, in particular new learning, was significantly related to SVT performance. Participants with mild dementia performed significantly better on all six SVTs than those with moderate/severe dementia. The results also suggest that the SVTs are not equally sensitive to cognitive dysfunction. Rey's Dot Counting Test (DCT) (times criterion) achieved 100% specificity, and was the only test passed by every participant. CONCLUSION: Rey's DCT is the only SVT that can be recommended for use in those under 65 years with possible dementia at this time until further validation studies are undertaken.

Use of the Distress Thermometer for the Elderly in the identification of distress and need in nursing and care homes.

BACKGROUND: Previous studies have found high levels of undetected psychological distress and unaddressed need among care home residents. The aim of this study was to investigate the usability and usefulness of the Distress Thermometer for the Elderly (DTE; modified from a measure used in cancer care) in the identification of distress and need with older people in care homes. METHOD: This was a single group, cross-sectional study. Staff in 12 nursing homes and one care home in England completed the DTE and a measure of depression with their older residents (n = 66). Quantitative methods were employed to investigate the relationship between the Distress Thermometer rating, depression scores and problems or needs selected on the DTE. RESULTS: The DTE was found to be feasible for completion by residents with assistance from staff. The level of distress on the DTE was significantly related to depression, number of problems and practical-physical problems. Each of 50 problems in the checklist was checked by at least one of the respondents. More problem items and physical-practical problems were selected by individuals who reached clinical levels of depression. CONCLUSIONS: In this preliminary study, results indicate promising potential for the use of the DTE as a simple screening tool for distress, as well as to enable residents to record their perceived needs as part of care-planning and a broader person-centred approach.

How people of African Caribbean or Irish ethnicity cope with long-term health conditions in UK community settings: A systematic review of qualitative, quantitative and mixed method studies.

Living with a chronic or mental health condition can be challenging and requires considerable adjustment. As ways of coping are culturally influenced, it is important to understand how minority ethnic populations cope, to inform appropriate services. This review aimed to explore the coping strategies used by UK residents from an African Caribbean or Irish background between 1960 and 2020. A systematic literature search on strategies used to cope with chronic health conditions in both populations living in the United Kingdom identified 26 relevant studies. Data were extracted, quality of papers was appraised and critical interpretive synthesis was applied. Two major foci of the studies were coping strategies and barriers to coping. The main coping strategies were denial/scepticism, self-management, spirituality and religion. Within each population, there was variation in ways of coping. The review highlights the complex role of religion in influencing coping strategies. It demonstrates how personal and minority ethnic populations' experiences of service use are connected with stigma, fear and mistrust, which also act as barriers to seeking help and to coping. Coping with a chronic or mental health condition in the Irish and African Caribbean populations is under-researched. Stigma, fear and mistrust in services act as key barriers to help-seeking and religion is a prominent coping strategy. However, few detailed examples were given on how it was used to assist individuals when managing a chronic or mental health condition. Also due to a lack of research, firm conclusions cannot be drawn for the Irish population.

Implementation processes in a cognitive rehabilitation intervention for people with dementia: a complexity-informed qualitative analysis.

OBJECTIVES: Healthcare is often delivered through complex interventions. Understanding how to implement these successfully is important for optimising services. This article demonstrates how the complexity theory concept of 'self-organisation' can inform implementation, drawing on a process evaluation within a randomised controlled trial of the GREAT (Goal-oriented cognitive Rehabilitation in Early-stage Alzheimer's and related dementias: a multi-centre single-blind randomised controlled Trial) intervention which compared a cognitive rehabilitation intervention for people with dementia with usual treatment. DESIGN: A process evaluation examined experiences of GREAT therapists and participants receiving the intervention, through thematic analysis of a focus group with therapists and interviews with participants and their carers. Therapy records of participants receiving the intervention were also analysed using adapted framework analysis. Analysis adopted a critical realist perspective and a deductive-inductive approach to identify patterns in how the intervention operated. SETTING: The GREAT intervention was delivered through home visits by therapists, in eight regions in the UK. PARTICIPANTS: Six therapists took part in a focus group, interviews were conducted with 25 participants and 26 carers, and therapy logs for 50 participants were analysed. INTERVENTION: A 16-week cognitive rehabilitation programme for people with mild-to-moderate dementia. RESULTS: 'Self-organisation' of the intervention occurred through adaptations made by therapists. Adaptations included simplifying the intervention for people with greater cognitive impairment, and extending it to meet additional needs. Relational work by therapists produced an emergent outcome of 'social support'. Self-organised aspects of the intervention were less visible than formal components, but were important aspects of how it operated during the trial. This understanding can help to inform future implementation. CONCLUSIONS: Researchers are increasingly adopting complexity theory to understand interventions. This study extends the application of complexity theory by demonstrating how 'self-organisation' was a useful concept for understanding aspects of the intervention that would have been missed by focusing on formal intervention components. Analysis of self-organisation could enhance future process evaluations and implementation studies. TRIAL REGISTRATION NUMBER: ISRCTN21027481.

Impact of dementia education and training on health and social care staff knowledge, attitudes and confidence: a cross-sectional study.

OBJECTIVES: The aim of this study was to establish the impact of dementia education and training on the knowledge, attitudes and confidence of health and social care staff. The study also aimed to identify the most effective features (content and pedagogical) of dementia education and training. DESIGN: Cross-sectional survey study. Data collection occurred in 2017. SETTINGS: Health and social care staff in the UK including acute care, mental health community care trusts, primary care and care homes. PARTICIPANTS: All health and social care staff who had completed dementia education and training meeting the minimal standards as set by Health Education England, within the past 5 years were invited to participate in an online survey. A total of 668 health and social care staff provided informed consent and completed an online survey, and responses from 553 participants were included in this study. The majority of the respondents were of white British ethnicity (94.4%) and identified as women (88.4%). OUTCOMES: Knowledge, attitude and confidence of health and social care staff. RESULTS: Hierarchical multiple regression analysis was conducted. Staff characteristics, education and training content variables and pedagogical factors were found to account for 29% of variance in staff confidence (F=4.13, p<0.001), 22% of variance in attitude (knowledge) (F=3.80, p<001), 18% of the variance in staff knowledge (F=2.77, p<0.01) and 14% of variance in staff comfort (attitude) (F=2.11, p<0.01). CONCLUSION: The results suggest that dementia education and training has limited impact on health and social care staff learning outcomes. While training content variables were important when attempting to improve staff knowledge, more consideration should be given to pedagogical factors when training is aiming to improve staff attitude and confidence.

Receiving a diagnosis of young onset dementia: Evidence-based statements to inform best practice.

INTRODUCTION: Better understanding of patient experience is an important driver for service improvements and can act as a lever for system change. In the United Kingdom, the patient experience is now a central issue for the National Health Service Commissioning Board, clinical commissioning groups and the providers they commission from. Traditionally, dementia care in the United Kingdom has focused predominantly on the individual experience of those with late onset dementia, while the voice of those with young onset dementia has been, comparatively, unheard. This study aims to improve the understanding of the personal experience of younger people undergoing investigation for dementia. METHODS: A modified Delphi approach was undertaken with 18 younger people with dementia and 18 supporters of people with young onset dementia. Questions were informed by a scoping review of the literature (O'Malley, M., Carter, J., Stamou, V., Lafontaine, J., & Parkes, J. (2019a). Receiving a diagnosis of young onset dementia: A scoping review of lived experiences. Ageing & Mental Health, 0(0), 1-12). Summary individual statements were refined over two rounds to a final list of 29 key statements. RESULTS: Twenty-seven of these statements were rated as absolutely essential or very important and included (1) for the general practitioner to identify dementia in younger people, (2) clinicians should be compassionate, empathic and respectful during the assessment and particularly sensitive when providing information about a diagnosis, and (3) remembering that receiving the diagnosis is a lot to absorb for a person with dementia and their supporter. Statistical analyses found no difference in the scoring patterns between younger people with dementia and supporters, suggesting similar shared experiences during the diagnostic process. CONCLUSION: Understanding the uniquely personal experience of young people going through the process of diagnosis for dementia is essential to provide person-centred, needs-led, and cost-effective services. Patient's values and experiences should be used to support and guide clinical decision-making.

Dementia care. 2: Exploring how nursing staff manage challenging behaviour.

BACKGROUND: This second in a three part series on dementia care explores different approaches to care; part 1 examined communication issues. Dementia care traditionally uses a medical approach to management, which focuses on the standard neurogenic disease paradigm, but now many care home staff and health professionals are moving towards a person centred approach, based on biopsychosocial explanations. AIM: This study sought to examine the extent to which care home staff have adopted a person centred approach. METHOD: Focus groups were carried out with 36 direct care staff from nine care homes. RESULTS: The study found evidence that both models of dementia care were in use. Three homes mainly used the medical approach, four the person centred approach and two were moving towards the latter. CONCLUSION: Training in biopsychosocial approaches to managing challenging behaviours in dementia is needed for care home staff, family and other health professionals.

Dementia care 1: Person centred approaches help to promote effective communication.

BACKGROUND: This first in a three part series on dementia care explores communication. The Gold Standards Framework includes a workstream on improving end of life care in care homes; communication is one of seven key tasks within the GSF. AIM AND METHOD: This study aimed to gather the views of care home staff on communication issues. Focus groups were conducted with 36 members of direct care staff from nine nursing and residential care homes. RESULTS: Three types of communication were identified: staff to staff, staff to resident, and staff to family. DISCUSSION AND CONCLUSION: The implications of different approaches to communication are discussed, and recommendations made for practice.