A qualitative study of the views of residents with dementia, their relatives and staff about work practice in long-term care settings

Background: Most people living in 24-hour care settings have dementia, and little is known about what makes long-term care a positive experience for them.Method: This carer-led qualitative study examined working practices in 24-hour long-term care-settings, including hospitals, nursing and residential homes, with the aim of finding out and making recommendations about such settings. Using semi-structured interviews, managers, nurses and care assistants were asked about work practices, such as how they coped with difficult behavior, about shifts, staffing levels, staff retention and training. Relatives of residents with dementia were asked about their role and perceptions of the care provided, and residents were asked for their opinions of their care.Results: Staff reported that residents presented with increasingly challenging behavior compared to the past, and that sometimes staffing levels and skills were inadequate. Of all the settings, hospitals had the most problems with staffing levels and retention, staff-relative relationships and staff support systems. Relatives saw their own role as positive. People with dementia of varying severity could usefully evaluate some of the services they received.Discussion: Dementia-specific training and education of staff in all long-term care-settings, including induction, should address the management of problem behavior in dementia and thereby improve staff fulfilment and relatives' satisfaction. The long-stay hospital may not be appropriate as a "home for life" for those with dementia, and we recommend that long-stay care settings should be able to cater flexibly for a range of resident needs

The relationship of dementia prevalence in older adults with intellectual disability (ID) to age and severity of ID

Background: Previous research has shown that adults with intellectual disability (ID) may be more at risk of developing dementia in old age than expected. However, the effect of age and ID severity on dementia prevalence rates has never been reported. We investigated the predictions that older adults with ID should have high prevalence rates of dementia that differ between ID severity groups and that the age-associated risk should be shifted to a younger age relative to the general population. Method: A two-staged epidemiological survey of 281 adults with ID without Down syndrome (DS) aged >60 years; participants who screened positive with a memory task, informant-reported change in function or with the Dementia Questionnaire for Persons with Mental Retardation (DMR) underwent a detailed assessment. Diagnoses were made by psychiatrists according to international criteria. Prevalence rates were compared with UK prevalence and European consensus rates using standardized morbidity ratios (SMRs). Results: Dementia was more common in this population (prevalence of 18.3%, SMR 2.77 in those aged >65 years). Prevalence rates did not differ between mild, moderate and severe ID groups. Age was a strong risk factor and was not influenced by sex or ID severity. As predicted, SMRs were higher for younger age groups compared to older age groups, indicating a relative shift in age-associated risk. Conclusions: Criteria-defined dementia is 2–3 times more common in the ID population, with a shift in risk to younger age groups compared to the general population

Criminal neighbourhoods: does the density of prior offenders encourage others to commit crime?

Using crime data over a period of a decade for Glasgow, this paper explores whether the density of prior offenders in a neighbourhoods has an influence on the propensity of others to (re)commence offending. The study shows that the number of ‘newly active’ offenders in a neighbourhood in the current quarter is positively associated with the density of prior offenders for both violent and property crime from the previous two years. In the case of ‘newly active’ property offenders, the relationship with active prior offenders is only apparent when prior offender counts exceed the median. The paper postulates that intraneighbourhood social mechanisms may be at work to create these effects. The results suggest that policies which concentrate offenders in particular neighbourhoods may increase the number of ‘newly active’ offenders, and point to evidence of a threshold at which these effects take place

Comparison of in situ aerosol measurements with SAGE 2 and SAM 2 aerosol measurements during the airborne Antarctic ozone experiment

Models indicate that stratospheric aerosols play a major role in the destruction of ozone during the Austral winter. Although many in situ measurements of stratospheric aerosols were made during the Airborne Antarctic Ozone Experiment, changes of aerosol concentration and size distributions across the polar vortex are important to understanding changes of chemical species taking place during this time. Therefore comparing the in situ measurements with measurements made by satellites scanning wider areas will give a clearer picture of the possible role played by aerosols during this period. The wire impactor size distributions are compared to those from the aerosol spectrometers and a best fit size distribution determined. Aerosol extinctions are calculated from the in situ measurements and compared to the extinctions measured by the satellites. Five comparisons are made with SAGE 2 and four with SAM 2. Extinctions agree as close as a factor of two

The AdHOC study of older adults’ adherence to medication in 11 countries

BACKGROUND: Compared with the resources expended developing, evaluating and making clinical decisions about prescribing medication, we know little about what determines whether people take it. Older adults are prescribed more medication than any other group. Poor adherence is a common reason for nonresponse to medication. OBJECTIVES: To investigate cross-nationally the impact of demographic, psychiatric (including cognitive), physical health, behavioural and medication factors on adherence to medication in older adults. METHODS: Researchers interviewed 3881 people over 65 who receive home care services using a structured interview at participants’ places of residence in eleven countries. The main outcome measure was the percentage participants not adherent to medication. RESULTS: 12.5% (n= 456) of people reported they were not fully adherent to medication. Non-adherence was predicted by problem drinking (OR=3.6), not having a doctor review medication (OR=3.3), dementia (OR=1.4 for every one point increase in impairment), good physical health (OR=1.2), resisting care (OR=2.1) being married (OR=2.3) and living in the Czech Republic (OR=4.7) or Germany (OR=1.4). CONCLUSION: People, who screen positive for problem drinking and with dementia, often undiagnosed are less likely to adhere to medication. Therefore doctors should consider dementia and problem drinking when prescribing for older adults. Interventions to improve adherence in older adults might be more effective if 4 targeted at these groups. It is possible that medication review enhances adherence, by improving the patient-doctor relationship, or by emphasising the relevance of medications

Improved simulation of aerosol, cloud, and density measurements by shuttle lidar

Data retrievals are simulated for a Nd:YAG lidar suitable for early flight on the space shuttle. Maximum assumed vertical and horizontal resolutions are 0.1 and 100 km, respectively, in the boundary layer, increasing to 2 and 2000 km in the mesosphere. Aerosol and cloud retrievals are simulated using 1.06 and 0.53 microns wavelengths independently. Error sources include signal measurement, conventional density information, atmospheric transmission, and lidar calibration. By day, tenuous clouds and Saharan and boundary layer aerosols are retrieved at both wavelengths. By night, these constituents are retrieved, plus upper tropospheric, stratospheric, and mesospheric aerosols and noctilucent clouds. Density, temperature, and improved aerosol and cloud retrievals are simulated by combining signals at 0.35, 1.06, and 0.53 microns. Particlate contamination limits the technique to the cloud free upper troposphere and above. Error bars automatically show effect of this contamination, as well as errors in absolute density nonmalization, reference temperature or pressure, and the sources listed above. For nonvolcanic conditions, relative density profiles have rms errors of 0.54 to 2% in the upper troposphere and stratosphere. Temperature profiles have rms errors of 1.2 to 2.5 K and can define the tropopause to 0.5 km and higher wave structures to 1 or 2 km