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Background: Fifty percent of medications are not taken as prescribed. This is a major public health issue yet there is very limited evidence on the factors associated with medicines adherence in people with mild to moderate Intellectually Disabilities and diabetes (IDD). This study evaluated the frequency of, and factors associated with, medicines non-adherence in this group compared to people without ID but with diabetes (non-IDD).Methods: A systematic review of the literature informed the theoretical model tested. A two-stage, sequential mixed methods study with 111 people with type 1 and 2 diabetes, (IDD = 33, non-IDD = 78) was then carried out. Stage one (quantitative) compared frequency of medication adherence in the group overall, IDD and non-IDD. Univariate and multiple regression analysis evaluated associations between factors (ID, depression, side effects, self-efficacy and perceived level of social support) and medicines non-adherence. Stage two (qualitative) explored findings of stage one with 12 stage one participants' carers using semi-structured interviews. Results: Data were collected between July 2014 and May 2016. The frequency of medicines adherence was similar in the IDD and non-IDD population (70% vs 62%, p = 0.41). The theoretical model did not predict medicines non-adherence. After controlling for support with medicines and complexity of regime (number of medications and use of insulin), depression was an independent predictor in the non-IDD and group overall (p < 0.001). In the IDD group, perceived side effects was an important, but non-significant, predictor of non-adherence (p = 0.06). Carers' perceptions of adherence and depression were consistent with stage one findings. Conclusions: Optimising adherence to diabetes medicines is equally challenging in IDD and non-IDD populations. Associations between independent factors and adherence differed between the two groups: in the non-IDD population, depressive symptoms were associated with non-adherence whereas in the IDD population perceived level of side effects appeared most dominant. Due to small sample sizes findings were inconclusive therefore, a sufficiently powered study further investigating the relationship between adherence and side effects in people with ID and diabetes is recommended.

Younger People with Dementia (YPwD) are those who receive a diagnosis of dementia under the age of 65. In Scotland the number of people with dementia who meet this definition is approximately 3200 (Alzheimer Scotland, 2017). The purpose of this study was to explore the human experience of living with dementia at a younger age and to consider interpretations of well-being as defined by the subjective experience of the participants. At the start of this study there was limited quality research available which explored the lives and experiences of YPwD. At that time there was some recognition within professional groups and practitioners that YPwD would benefit from age appropriate services. This study used an Interpretive Phenomenological design to explore the experiences of YPwD and used in-depth qualitative interviews with eight people who were diagnosed with dementia under the age of 65, to capture their journey through pre-diagnosis, diagnosis and beyond. Interpretive Phenomenological Analysis was utilised for the primary analysis. A secondary analysis was then conducted with the initial findings using Self-determination Theory, Basic Psychological Needs Theory, autonomy, competence and relatedness to identify areas of well-being. The study identified four superordinate themes situated within a four phase transition pathway, which identified how a diagnosis of dementia impacted on the person and the process they underwent following diagnosis. These are:pre-diagnosis phase, living in a changing world, awareness of the changing self, discombobulation; diagnostic phase, anger and relief, the fragmented self, consideration; post diagnostic phase, the challenge of learning to livewith dementia as a younger person, the evolving self, assimilation; and the phase living well beyond dementia, consolidated self, consolidation. The study highlighted that while having a diagnosis of dementia at a younger age is a challenging and devastating experience, it is possible to live a good and productive life beyond the diagnosis of dementia. The secondary analysis using Self-determination Theory, Basic Psychological Needs Theory identified that where the basic psychological needs were supported, this enabled participants to embrace their lives living with and beyond dementia with improved wellbeing. The findings suggest that the basic psychological needs were thwarted in the pre-diagnostic phase and during and immediately after diagnosis, creating feelings of ill-being. The study acknowledges the strong sense of identity around the younger person with dementia and suggests that this group perceive their dementia, and the support they need to live with the condition to be a different experience to that of older people. The ability of a number of the participants to live an active life within a supported community cannot be underestimated, and suggests that this area of care and support needs to be evaluated in light of the changing needs of people living with dementia, particularly those who are diagnosed at such an early part of their lifecycle.