Dementia-friendly communities: challenges and strategies for achieving stakeholder involvement.

Dementia-friendly communities (DFCs) are a UK policy initiative that aims to enable people with dementia to feel supported and included within their local community. Current approaches to DFC creation rely on stakeholder involvement, often requiring volunteer assistance. There is though a lack of evidence that examines the reality of achieving this. This paper critically assesses the challenges and strategies for achieving stakeholder involvement in DFCs. The evidence base is drawn from an inter-agency project funded by the National Health Service in the South of England where seven DFCs were developed by steering group partners and four part-time project workers (PWs). Data from the independent evaluation undertaken in the first year (2013-2014) of the project were analysed: 14 semi-structured interviews and a focus group examined PWs' experiences; while progress and key milestones are determined from monthly progress forms, good news stories, locality steering group minutes and press releases. Analysis was undertaken using a directed content analysis method, whereby data content for each locality was matched to the analytical framework that was drawn from Alzheimer's Society guidance. Challenges to achieving stakeholder involvement were identified as: establishing networks and including people representative of the local community; involving people affected by dementia; and gaining commitment from organisations. Strategies for achieving stakeholder involvement were recognised as: a sustainable approach; spreading the word; and sharing of ideas. By highlighting these challenges and the approaches that have been used within communities to overcome them, these findings form the foundation for the creation of DFC initiatives that will become embedded within communities. Stakeholder involvement is unpredictable and changeable; therefore, reliance on this approach questions the long-term sustainability of DFCs, and must be considered in future policies designed to enhance quality of life for people affected by dementia

Medication review plus person-centred care:a feasibility study of a pharmacy-health psychology dual intervention to improve care for people living with dementia

BACKGROUND: "Behaviour that Challenges" is common in people living with dementia, resident in care homes and historically has been treated with anti-psychotics. However, such usage is associated with 1800 potentially avoidable deaths annually in the UK. This study investigated the feasibility of a full clinical trial of a specialist dementia care pharmacist medication review combined with a health psychology intervention for care staff to limit the use of psychotropics. This paper focuses on feasibility; including recruitment and retention, implementation of medication change recommendations and the experiences and expectations of care staff. METHODS: West Midlands care homes and individuals meeting the inclusion criteria (dementia diagnosis; medication for behaviour that challenges), or their personal consultee, were approached for consent. A specialist pharmacist reviewed medication. Care home staff received an educational behaviour change intervention in a three-hour session promoting person-centred care. Primary healthcare staff received a modified version of the training. The primary outcome measure was the Neuropsychiatric Inventory-Nursing Home version at 3 months. Other outcomes included quality of life, cognition, health economics and prescribed medication. A qualitative evaluation explored expectations and experiences of care staff. RESULTS: Five care homes and 34 of 108 eligible residents (31.5%) were recruited, against an original target of 45 residents across 6 care homes. Medication reviews were conducted for 29 study participants (85.3%) and the pharmacist recommended stopping or reviewing medication in 21 cases (72.4%). Of the recommendations made, 57.1% (12 of 21) were implemented, and implementation (discontinuation) took a mean of 98.4 days. In total, 164 care staff received training and 21 were interviewed. Care staff reported a positive experience of the intervention and post intervention adopting a more holistic patient-centred approach. CONCLUSIONS: The intervention contained two elements; staff training and medication review. It was feasible to implement the staff training, and the training appeared to increase the ability and confidence of care staff to manage behaviour that challenges without the need for medication. The medication review would require significant modification for full trial partly related to the relatively limited uptake of the recommendations made, and delay in implementation. TRIAL REGISTRATION: ISRCTN58330068 . Registered 15 October 2017. Retrospectively registered

Improving inpatient hospice environments for older people in England:a documentary analysis

Objective: To assess the extent to which a grants programme to fund improvements to English inpatient hospice buildings achieved its goals of involving and directly benefiting older people. Method: Qualitative content analysis was undertaken of all grant application forms which (a) resulted in funding, and (b) proposed to refurbish or replace inpatient hospice buildings. Data were extracted, and themes identified, on the nature and extent of the benefits envisaged for older people, and how older people were involved in the proposed building projects. Results: Of 227 grant applications, 139 (from 111 hospices) met the inclusion criteria. Four categories of building improvement were identified: interior decoration or equipment (n = 386, or 36% of the total); public spaces (n= 291, or 27%), private spaces (n = 283, or 26%), and health and safety (n= 116, or 11%). These improvements, while generally beneficial, were rarely targeted at older people. Most grant applicants stated that they had consulted service users, but only 13 specified that they consulted older people. Limited information was supplied about the methods or findings of these consultations. In 15 grant applications, older people were not mentioned at all. Conclusions: Older hospice inpatients, their relatives and advocacy groups should be involved more fully in decisions relating to the physical environment of care. Staff who prepare funding bids should receive training in conducting consultations with service users, and identifying and evaluating other relevant evidence. To ensure a consistently high standard of environmental provision for older people in hospices, evidence based assessment tools and guidelines should be developed