Psychosocial Factors That Shape Patient and Carer Experiences of Dementia Diagnosis and Treatment : A Systematic Review of Qualitative Studies

Funding: This article presents independent research commissioned by the UK National Institute for Health Research (NIHR) under Research for Patient Benefit (Grant Reference Number PB-PG-0808-16024). The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR, nor the Department of Health. The sponsor of the study had no role in study design, data analysis, data interpretation or writing of the reportEarly diagnosis and intervention for people with dementia is increasingly considered a priority, but practitioners are concerned with the effects of earlier diagnosis and interventions on patients and caregivers. This systematic review evaluates the qualitative evidence about how people accommodate and adapt to the diagnosis of dementia and its immediate consequences, to guide practice. Methods and Findings: We systematically reviewed qualitative studies exploring experiences of community-dwelling individuals with dementia, and their carers, around diagnosis and the transition to becoming a person with dementia. We searched PubMed, PsychINFO, Embase, CINAHL, and the British Nursing Index (all searched in May 2010 with no date restrictions; PubMed search updated in February 2012), checked reference lists, and undertook citation searches in PubMed and Google Scholar (ongoing to September 2011). We used thematic synthesis to identify key themes, commonalities, barriers to earlier diagnosis, and support identified as helpful. We identified 126 papers reporting 102 studies including a total of 3,095 participants. Three overarching themes emerged from our analysis: (1) pathways through diagnosis, including its impact on identity, roles, and relationships; (2) resolving conflicts to accommodate a diagnosis, including the acceptability of support, focusing on the present or the future, and the use or avoidance of knowledge; and (3) strategies and support to minimise the impact of dementia. Consistent barriers to diagnosis include stigma, normalisation of symptoms, and lack of knowledge. Studies report a lack of specialist support particularly post-diagnosis. Conclusions: There is an extensive body of qualitative literature on the experiences of community-dwelling individuals with dementia on receiving and adapting to a diagnosis of dementia. We present a thematic analysis that could be useful to professionals working with people with dementia. We suggest that research emphasis should shift towards the development and evaluation of interventions, particularly those providing support after diagnosis.Peer reviewedFinal Published versio

A mathematical model of tree harvesting in age-structured forests subject to beetle infestations

In this paper, we investigate a mathematical model for age-structured forest–beetle interactions that includes harvesting of trees. The aim is to broaden the understanding of the synergistic effects of harvesting and insect infestation on the age structure of the forests and the harvesting benefit. In the first part of this study, we consider different scenarios of the forest infestation by beetles and observe that the quantitative age profile of the forest depends significantly on whether the beetle population is in its endemic or epidemic states. In the second part, we also include harvesting of the forest trees and analyze two different harvesting strategies: cutting all trees older than a certain age, and cutting a fixed proportion of trees older than a certain age. Numerical simulations are implemented to determine the optimal cutting age for both harvesting strategies. The numerical simulations reveal that, independent of the steady state of the beetle population (that is, no beetles, endemic or epidemic state) clear cutting all trees older than a given age provides a higher harvesting benefit. Our numerical simulations further indicate that to obtain a fixed harvesting yield, a forest under a beetle epidemic state has to be cut at a younger age than if the forest were at an endemic beetle state or a no-beetle state