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Aim Being an informal carer for a person living with dementia can be a demanding role which can have detrimental effects on personal well-being and affect a person’s ability to provide care for their loved one. This evaluation of support courses, offered by a leading UK charity dedicated to dementia family carers, highlights the impact of training to support the caring role. Setting Participants completed booklets at the training venue and subsequently online or by post. Interviews with participants took place by telephone. Participants: 84 participants completed booklets containing measures which generated quantitative data whilst 19 family carers participated in qualitative telephone interviews. Design A mixed methods approach was taken using booklets of validated measures to capture quantitative data, including capture of demographic information, together with semi-structured interviews conducted by telephone which were recorded, transcribed and subsequently analysed using thematic analysis. Results Overall, both the quantitative and qualitative analysis demonstrate that attending the carers support courses had a positive impact on carers with improvements being maintained over time. Outcomes indicated that carers generally remained in a better physical, mental and emotional situation than that experienced before the course. Conclusion Being prepared for the trajectory of the caring role when providing care for a person living with dementia can help informal carers to be better prepared, better supported and better informed. Evidence gained from this evaluation demonstrates the impact of the courses and adds to the current weak evidence base relating to dementia courses aimed at preparing carers to care.

Purpose The COVID-19 pandemic caused major disruption in community support for vulnerable older people and is thought to have exacerbated existing issues within UK adult social care. This study aims to examine the legacy of that disruption on how meeting centres for people affected by dementia have been impacted in continually evolving circumstances. Design/methodology/approach Semi-structured interviews and focus group discussions were conducted at three meeting centre case study sites. Ninety-eight participants, including people living with dementia, family carers, staff, volunteers, trustees and external partners, were asked about the impact and legacy of the pandemic upon meeting centres. A thematic analysis was carried out on the data. Findings Ten themes were identified: ability to re-open venues; increased health decline and loss of members due to isolation; closure or halting of linking services and dementia community support; disruption to diagnosis and referrals; increase in outreach, building communities and overall reach; digital access and use of technology (boom and decline); changes to carer involvement and engagement; continued uncertainty and changes to funding, resources and governance; staff and volunteer recruitment issues; and relief at/wish for return to pre-pandemic norms. Originality/value This paper offers new insight into a still-developing situation, namely, the legacy effects of the pandemic upon third-sector community support for people affected by dementia and the health and social care services that support it. The reduction in maintenance of pandemic-era technological innovations is a key finding.

Purpose Meeting Centres (MCs) are a complex community-based psychosocial intervention to support people affected by dementia. The purpose of this paper is to describe the process of identifying the essential features of MCs from a UK perspective. Design/methodology/approach The essential features were examined within a concept analysis framework, which combines both static and evolutionary methods, enabling multiple stakeholder groups to be included in the process in an iterative manner. Findings Eleven essential features were developed, providing a conceptual model of the UK MCs. The underpinning rationale is sufficiently flexible to enable community-based development, while at the same time providing a robust platform upon which to build the evidence base. Originality/Value While some features may be common to other types of community-based support, the combination of characteristics and the underpinning ethos differentiates MCs and enables each one to meet the needs of its own community.

Purpose When new interventions are piloted, the implementation process often takes a back seat but can be key to ensuring that an intervention is successful. This paper aims to highlight the enablers and challenges encountered when implementing a nature-based intervention for people living with dementia. Design/methodology/approach The evaluation adopted a mixed methods approach including case studies, telephone interviews with delegates and interviews with participants. Thematic analysis was used to identify overarching themes relating to the enablers and challenges of implementing the intervention. Findings Challenges related to understanding how the intervention fitted with existing work and practicalities of what an organisation can offer to support the implementation process. A stable underlying support structure for delegates is required, along with suitable advertising, transport and facilities to support participants. While there is no “one size fits all” approach to implementing an intervention, these findings will help organisations to consider where to focus their support. Originality/value The implementation of interventions is often poorly understood but is important when supporting the wider roll out of an intervention. While this paper reports on a nature-based intervention, the learning will be relevant and applicable more broadly for organisations aiming to implement a new intervention and complements previous work relating to the challenges of implementing arts activities.

Purpose The purpose of this paper is to report on an independent evaluation of a three-year “Creative Ageing” programme, focussing on the impacts for participants and factors promoting successful delivery of sessions. Design/methodology/approach Artists provided feedback through reflective journals and questionnaires, while the views of care staff and participants were also captured in a standard format at the end of each arts session. Thematic analysis of the qualitative data identified common themes. Findings Twenty-three arts projects were delivered across a range of settings and through diverse art forms including dance, drama, music, visual arts and poetry. They reached nearly 2,200 participants who recorded over 8,100 session attendances in total. Participation in high quality creative experiences improved well-being for older people, as well as increasing social interaction and reducing isolation. Several factors facilitated successful implementation and delivery of the activities, particularly the need to hold planning meetings with staff to provide guidance around participant numbers and suitability, minimising disruption of the sessions and the supportive role of staff during the sessions. Opportunities for reflection enabled artists to address potential challenges and adapt their practice to meet the needs and preferences of participants and to the complexities of diverse settings. Originality/value Previous research has largely focussed on the impact of activities in a single setting. This study supports the role of creative arts in increasing social interaction as an attempt to tackle isolation and loneliness, both for older people living in the community and for those living in a communal setting such as care homes and supported living schemes.

Purpose Because of COVID-19 restrictions, Meeting Centres (MCs) for people affected by dementia in the UK ceased to meet physically but continued to provide remote support. The aim was to understand the extent to which MCs were able to operate when physical meetings were not possible and how they achieved particularly in relation to the adaptation and coping model and practical, emotional and social adjustment. Design/methodology/approach Semi-structured interviews and focus groups were conducted with people affected by dementia, staff, volunteers, managers and trustees from MCs. Data were collected on the type and quantity of contact MCs had with people affected by dementia during lockdown. Data were coded and mapped against adaptation and coping strategies, i.e. practical understanding and empowerment, optimising emotional well-being and opportunities for social engagement. Findings A range of remote approaches, both technological (e.g. using online platforms) and non-technological (e.g. newsletters and post) were implemented alongside limited face-to-face contact. Regular MC activities were adapted using the different approaches. It was possible to map all the adaptation and coping model support strategies to the activities delivered in this way. MCs were able to adapt rapidly to continue to support people to adjust to change. Social implications Moving forward, combining approaches (usual MC and remote) means person-centred support could be optimized, addressing social isolation and reaching those who cannot attend MCs. Originality/value This paper offers new insight into the extent to which community-based support for people with dementia can continue when face-to-face contact is not possible because of COVID-19.

Purpose The purpose of this paper is to populate a theoretical cost model with real-world data, calculating staffing, resource and consumable costs of delivering Namaste Care Intervention UK (NCI-UK) sessions versus “usual care” for care home residents with advanced dementia. Design/methodology/approach Data from five care homes delivering NCI-UK sessions populated the cost model to generate session- and resident-level costs. Comparator usual care costs were calculated based on expert opinion and observational data. Outcome data for residents assessed the impact of NCI-UK sessions and aligned with the resident-level costs of NCI-UK. Findings NCI-UK had a positive impact on residents’ physical, social and emotional well-being. An average NCI-UK group session cost £220.53, 22% more than usual care, and ran for 1.5–2 h per day for 4–9 residents. No additional staff were employed to deliver NCI-UK, but staff-resident ratios were higher during Namaste Care. Usual care costs were calculated for the same time period when no group activity was organised. The average cost per resident, per NCI-UK session was £38.01, £7.24 more than usual care. In reality, costs were offset by consumables and resources being available from stock within a home. Originality/value Activity costs are rarely calculated as the focus tends to be on impact and outcomes. This paper shows that, although not cost neutral as previously thought, NCI-UK is a low-cost way of improving the lives of people living with advanced dementia in care homes.

IntroductionImproving support for people with early to moderate dementia to live at home in their communities is a global public health goal. Community adult social care is not robust in many parts of the UK, however, with the pandemic increasing pressure on services for this population. Community-led interventions can play a key role in supporting people postdiagnosis, helping delay decline, but many interventions struggle to sustain beyond 1–2 years. Meeting Centres (MCs) are one such intervention, which many UK community groups find attractive and achievable. However, it is not understood how these communities can ensure they are putting in place strategies that will help them sustain in the longer term, beyond start-up phase.Methods and analysisThis realist evaluation aims to understand the factors affecting sustainability of MCs in rural areas and learn lessons from MCs that have sustained beyond 3 years. Data will be collected using mixed methods: interviews and group discussions with stakeholders involved at every level in three case study locations in England and Wales, analysed with Soft Systems modelling; a Discrete Choice Experiment exploring what people across the UK value and are willing to pay for MCs, analysed with regression modelling. All data will be synthesised using a Realist logic of analysis to build a theoretical model of how, why, for whom, in what contexts and to what extent MCs can be successfully implemented for the long term.Ethics and disseminationAs participants may lack capacity for informed consent, favourable ethical opinion was received from a Health Research Authority research ethics committee. Resulting recommendations will be of interest to stakeholders including those commissioning, planning, running, supporting or attending MCs, as well as policy-makers and healthcare professionals. Knowledge will be shared with emerging MCs to help accelerate scale up of this intervention.

Views in the care home community are divided regarding whether or not staff should wear a uniform. There is little research on the topic and the views of care home residents and their relatives are rarely sought.To capture the views of staff, residents, relatives and visiting professionals in two care homes on the use of uniforms.This small-scale exploratory study used photographs showing three clothing options: a formal option, a polo shirt option and an 'own clothes' option. Each option was modelled in two different poses, one 'approachable' and the other 'unapproachable'. Staff, relatives, the wider care home team and visiting professionals expressed their preferences by replying to a short survey. Residents, all of whom had dementia, expressed their preferences through a table-top activity.Overall, the formal clothing option was preferred for formal care activities and the 'own clothes' option was preferred for social activities. The polo shirt option often obtained the second-highest number of preferences. The photographs featuring the 'unapproachable' pose were rarely selected.The approachability of staff is just as important as the clothes they wear. An alternative to formal uniforms could be for staff to wear polo shirts, possibly as an interim measure to explore the effects of changing the care home's staff uniform policy.

Purpose Recent years have seen a growing interest in and awareness of the importance of environmental design to the well-being of people living with dementia, in terms of both policy and practice. This trend has been accompanied by a plethora of advice, guidance and tools that aim to encourage and promote the development of inclusive environments. Not all of these are evidence-based, and even those that claim to be so are limited by a paucity of good quality, comprehensive research studies. This paper aims to consider the current state of knowledge in the field of dementia-friendly design and describes a project that refreshed and updated the suite of Environmental Assessment Tools originally developed by The Kings Fund and now managed by the Association for Dementia Studies. Design/methodology/approach The mixed methods project reported on in this paper comprised a review of the literature, a survey of people who have used the five design assessment tools and an iterative process of updating the tools to make them as evidence-based and user-friendly as possible. Findings The suite of five assessment tools was refreshed and updated to reflect the latest evidence and the views of professionals and others who use the tools. The authors conclude that while a focus on dementia-friendly design is to be welcomed, there remains a need for relevant high-quality evidence to inform such work. In particular, there is a lack of research within people’s own homes and studies that include the perspectives of people living with dementia. Originality/value Few assessment tools and guidelines for dementia-friendly environments are truly evidence-based. This paper reports on a project that combined a comprehensive literature review with the views of practitioners to update a widely used suite of tools that aim to make a range of settings more suitable for people living with dementia.

Purpose There is growing interest in and evidence for the benefits of connecting with nature for people living with dementia, sometimes known as “green care”, including reduced stress, improved sleeping and even enhanced cognition. However, many people living with dementia are denied such opportunities, often because of practitioner perceptions of risk and poor design of outdoor spaces. This paper reports on the evaluation of a project that worked with national providers to give people living with dementia opportunities and support to access the natural environment. Design/methodology/approach The evaluation adopted a mixed-methods approach, using a combination of bespoke and commonly used tools and in-depth case study work to identify the facilitators and challenges to delivering the project and explore the experiences of activity participants. Findings Qualitative measures indicated a significant improvement in mental well-being for participants with dementia and family carers following attendance at activity sessions. Research interviews indicated that participants enjoyed activities based on connecting with nature. Being outdoors was a major factor in the experience, along with taking part in activities that were meaningful and opportunities for social interaction. Originality/value This paper provides evidence for the benefits of connecting with nature for people living with dementia. This paper concludes that access to the outdoors is not a luxury, it is a basic human right and one which has become increasingly important in light of restrictions that have emerged as a result of the COVID19 pandemic.

This article reports on the experiences of artists working in UK care homes across residencies that focused on poetry, dance and drama. Data were collected from reflective diaries and focus group discussions to explore the key challenges when working in settings that can be unfamiliar, complex and disruptive. We also describe a range of strategies that artists developed in response to these challenges (enablers) and how this supported successful delivery of their sessions. We conclude that artists need time and support to understand and adapt to the complexity of care homes, and conclude that ultimately the overarching culture of a care home is the key determinant of how successfully artists can facilitate the engagement of residents with meaningful creative activities. Experience of working with people living with dementia can be particularly valuable, as can knowing how to facilitate participation by residents with a range of sensory, physical and cognitive impairments.

Originating in the US, Namaste Care aims to improve quality of life for people with advanced dementia. However, recognition in the UK is sparse. This article reports on research that aims to create consistent understanding of the purpose, application and effect of Namaste Care. Using an online survey, telephone interviews and discussion group with UK practitioners we explored Namaste Care practice, its components and implementation challenges. Findings show that Namaste Care has potential to improve quality of life in advanced dementia and is held in high regard by practitioners. However, understanding is inconsistent and practical implementation highly varied.

Objectives:To develop a representative full cost model for a UK version of the multi-component, non-pharmacological Namaste Care intervention for care home residents with advanced dementia.Design:The Namaste Care Intervention UK comprises multiple individual cost components, and a comprehensive list of all possible resources that could be expended in each cost component formed the initial stage of the cost model development. Resource use was divided into three key areas: staff, capital and consumables. Representative costs were identified for each of the possible resources, with a standard approach being used for all resources within each of the three key areas.Assumptions were made regarding the number and duration of sessions, group size, involvement of different staff members, and additional activity before and after a session, as these all have an impact on resource use and hence cost. A comparable ‘usual care’ session for residents not receiving Namaste Care was also costed to enable the ‘additional’ cost of delivering Namaste Care to be calculated.Results:The full cost model indicates that Namaste Care Intervention UK costs approximately £8-£10 more per resident per 2-hour session than a comparable period of usual care. However, positive impacts on resident and staff well-being resulting from receiving Namaste Care will also have their own associated costs/benefits which may negate the ‘additional’ cost of the intervention.Conclusions:The cost model provides the first opportunity to investigate the full costs associated with Namaste Care, and will be refined as additional information is captured during subsequent phases of the research.

We examined the costs and cost-effectiveness of the Meeting Centre Support Programme (MCSP) implemented and piloted in the UK, Poland and Italy, replicating the Dutch Meeting Centre model. Dutch Meeting Centres combine day services for people with dementia with carer support. Data were collected over 2015–2016 from MCSP and usual care (UC) participants (people with dementia-carer dyads) at baseline and 6 months. We examined participants’ health and social care (HSC), and societal costs, including Meeting Centre (MC) attendances. Costs and outcomes in MCSP and UC groups were compared. Primary outcomes: Persons with dementia: quality-adjusted life years (EQ-5D-5L-derived); QOL-AD. DQoL was examined as a secondary outcome. Carers: Short Sense of Competence Questionnaire (SSCQ). Incremental cost-effectiveness ratios (ICER) and cost-effectiveness acceptability curves were obtained by bootstrapping outcome and cost regression estimates. Eighty-three MCSP and 69 UC dyads were analysed. The 6-month cost of providing MCSP was €4,703; participants with dementia attended MC a mean of 45 times and carers 15 times. Including intervention costs, adjusted 6-month HSC costs were €5,941higher in MCSP than in UC. From the HSC perspective: in terms of QALY, the probability of cost-effectiveness was zero over willingness-to-pay (WTP) ranging from €0 to €350,000. On QOL-AD, the probability of cost-effectiveness of MCSP was 50% at WTP of €5,000 for a one-point increase. A one-point gain in the DQoL positive affect subscale had a probability of cost-effectiveness of 99% at WTP over €8,000. On SSCQ, no significant difference was found between MCSP and UC. Evidence for cost-effectiveness of MCSP was mixed but suggests that it may be cost-effective in relation to gains in dementia-specific quality of life measures. MCs offer effective tailored post-diagnostic support services to both people with dementia and carers in a context where few evidence-based alternatives to formal home-based social services may be available.

Care homes can struggle to provide optimal care for residents with advanced dementia. Namaste Care provides a structured daily programme of physical, sensory and emotional care delivered by regular care workers. A three-year, mixed method process study of implementation and impact created a manualised Namaste Care Intervention for UK care homes (NCI-UK). This article reports on the impact of NCI-UK delivered consistently in five care homes for 12&ndash, 24 weeks. Impact for residents was assessed using, pre-post data, showing significant positive effects for QUALID (t = 2.92, p = 0.01, n = 31) and CMAI (t = 3.31, p = 0.002, n = 32), alongside many qualitative examples of positive impacts on wellbeing, responsiveness and communication. Pre-post staff questionnaire data (n = 20) were not significant. Qualitative data indicated that NCI-UK is a positive staff experience, providing sense of purpose, improved wellbeing and relationships. The care homes reported benefiting from implementing NCI-UK in terms of reputation and quality improvement. Family interviews were also positive, relating to seeing the difference, improving relationships and being involved. NCI-UK can therefore be recommended as an impactful intervention for residents, staff and families.

Objectives: The MEETINGDEM research project aimed to implement the combined Dutch Meeting Centre Support Programme (MCSP) for community-dwelling people with dementia and caregivers within Italy, Poland and UK and to assess whether comparable benefits were found in these countries as in the Netherlands. Method: Nine pilot Meeting Centres (MCs) participated (Italy-5, Poland-2, UK-2). Effectiveness of MCSP was compared to usual care (UC) on caregiver outcomes measuring competence (SSCQ), mental health (GHQ-12), emotional distress (NPI-Q) and loneliness (UCLA) analysed by ANCOVAs in a 6-month pre-test/post-test controlled trial. Interviews using standardised measures were completed with caregivers. Results: Pre/post data were collected for 93 caregivers receiving MCSP and 74 receiving UC. No statistically significant differences on the outcome measures were found overall. At a country level MC caregivers in Italy showed significant better general mental health (p = 0.04, d = 0.55) and less caregiver distress (p = 0.02, d = 0.62) at post-test than the UC group. Caregiver satisfaction was rated on a sample at 3 months (n = 81) and 6 months (n = 84). The majority of caregivers reported feeling less burdened and more supported by participating in MCSP. Conclusion: The moderate positive effect on sense of competence and the greater mental health benefit for lonely caregivers using the MCSP compared to UC as found in the original Dutch studies were not replicated. However, subject to study limitations, caregivers in Italy using MCSP benefitted more regarding their mental health and emotional distress than caregivers using UC. Further evaluation of the benefits of MCSP within these countries in larger study samples is recommended.

There are an estimated 5,153 nursing homes and 12,525 residential homes in the UK with around 426,000 residents of whom 80% have some form of dementia or memory problem. Only 38% of staff working in residential and domiciliary services say they use technology in direct work with residents. Objectives The objectives of this study were to (i) explore the experiences and potential benefits and barriers of iPad use in 63 care homes for residents with dementia, their family/friends and care staff; (ii) develop recommendations based on different ways in which iPads can be used in care settings and what needs to be in place to support their successful introduction and usages. Method A mixed methods approach based on data from staff interviews and a self-administered questionnaire, resident case studies, family interviews and observation of activity sessions. Results The main findings were: (i) iPads provided a flexible and adaptable means of engaging residents, their relatives and staff in both one-to-one and group sessions; (ii) iPads offered a new means to increase social interaction and resident engagement. Conclusion Systematic incremental implementation of the use of iPads in a care home can help promote digital inclusion for both residents and staff and participation by family members.

This paper explores the impact of the My Musical Memories Reminiscence Programme (MMMRP), an innovative intervention that adopts a music-based reminiscence approach. MMMRP builds on the format of the popular Singing for the Brain sessions with the aim of increasing opportunities for interaction and reminiscence amongst people living with dementia. Data were collected pre- and post-intervention and three months later using structured observation, interviews and focus groups. Results suggest that the programme had a positive impact on participants by promoting engagement, reminiscence and social interaction. For some individuals the impacts continued beyond their participation in the programme. A range of key facilitators for successful implementation of this approach were identified including the Session Leader role, the involvement of informal carers and the input of volunteers.

Objectives To assess the quality of research evidence for the different activity components for the psycho-social Namaste Care intervention for care home residents with advanced dementia. Design Namaste Care is a multi-component intervention delivered on a daily basis to people living with advanced dementia or people at end of life with dementia. A significant part of its operationalisation within care homes is the delivery of a number of activities delivered by trained in-house Namaste Care workers to a group of residents with similar high dependency needs. The Namaste Care workers focus on touch, music, nature, sensory experience, aromas and interactions with objects delivered in a way to enhance feelings of enjoyment and wellbeing. This review evaluated the evidence for using these activities with people living with advanced dementia. A systematic search of peer-reviewed research articles was conducted between November 2016 and September 2018 using search terms of activities used in Namaste Care. The quality of each accepted article was rated using the Rapid Evidence Assessment scale. Results The initial literature search returned 1341 results: 127 articles including 42 reviews were included. The majority of activity interventions yielded between 10 and 20 peer-reviewed papers. The use of smells and aromas, interacting with animals and dolls, the use of various forms of music (e.g. background music, singing, personalised music), nature, lighting, various forms of touch/massage and sensory interventions (including Snoezelen) all appear to have proven efficacy with people living with advanced dementia. Conclusions There is generally a limited number of research papers and reviews in this area, but overall there is a good evidence base for including these activities within Namaste Care for people living with advanced dementia.

This article reports on the evaluation of a mentoring approach that was adopted to support the sustainable provision of activities in UK care homes across three creative art forms: poetry, dance, and drama. Data are presented from multiple sources including questionnaires, focus groups, reflective diaries and interviews to explore implementation and impact of the approach. Artists reported that the support of their mentors enabled them to develop the confidence, skills and strategies required to work effectively in care homes as a new setting. For the mentors, being involved in the project led to professional development. Diverse methods of mentor- to- artist contact were a key feature of the approach, including face-to-face meetings, telephone calls, emails and tele-conferencing. Peer support, although not planned, emerged as an important mechanism for sharing skills and information among artists. The impact of the mentoring approach continued beyond the life of the project, with some artists extending their practice to additional care homes and other settings including homeless adults, young children and hospitals.

Background: Admiral Nurses undertake complex work with families living with dementia. Dementia UK commissioned The Association for Dementia Studies to refresh the Admiral Nurse Competency Framework and enable Admiral Nurses to articulate and critically reflect on their own practice progression. The Admiral Nurses were involved throughout the process to refresh the framework to ensure it was evidence based. Method: To encourage engagement with the framework, The Association for Dementia Studies worked with the Admiral Nurses during a roll-out phase. An exercise was developed to initiate critical reflective discussion. Critiquing a colleague's practice is a skill, provoking defensiveness if not facilitated thoughtfully. Results: An exercise combining art cards with case study analysis worked well, promoting critical reflective dialogue between Admiral Nurses as peers. Engagement and feedback were positive, and the neutrality of the exercise provided a safe environment with the flexibility to allow in-depth and meaningful discussions. Conclusion: This technique could benefit work-based learning, facilitating creative critical reflection within practice. [ J Contin Educ Nurs. 2019;50(5):205–210.]

The majority of people with dementia live in their own homes, often supported by a family\ud member. While this is the preferred option for most, they often face multiple challenges due to\ud a deterioration in their physical and cognitive abilities. This paper reports on a pilot study that\ud aimed to explore the impacts of aids and adaptations on the wellbeing of people with dementia\ud and their families living at home. Quantitative data were collected using established measures of\ud wellbeing at baseline, 3 months and 9 months. In-depth case studies were carried out with a sample of\ud participants. Findings from the pilot suggest that relatively inexpensive aids can contribute towards\ud the maintenance of wellbeing for people with dementia in domestic settings. The project also increased\ud the skills and confidence of professionals involved in the project and strengthened partnerships\ud between the collaborating organisations across health, housing and social care. Providing aids that\ud can help people with dementia to remain living at home with a good quality of life, often with the\ud support of a family member, is an important element in the development of age-friendly communities.

Purpose The benefits of “green dementia care”, whereby people living with dementia are supported to connect with nature, are increasingly being recognised. Evidence suggests that these benefits span physical, emotional and social spheres and can make a significant contribution towards quality of life. However, care settings often present specific challenges to promoting such connections due to a range of factors including risk-averse cultures and environmental limitations. The purpose of this paper is to report on a project that aims to explore the opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in residential care and extra care housing schemes in the UK. Design/methodology/approach Data were gathered from 144 responses to an online survey by managers/staff of extra care housing schemes and care homes in the UK. In depth-case studies were carried out at three care homes and three extra care housing schemes, involving interviews with residents, staff and family carers. Findings A wide variety of nature-based activities were reported, both outdoor and indoor. Positive benefits reported included improved mood, higher levels of social interaction and increased motivation for residents, and greater job satisfaction for staff. The design and layout of indoor and outdoor spaces is key, in addition to staff who feel enabled to promote connections with nature. Research limitations/implications This paper is based on a relatively small research project in which the participants were self-selecting and therefore not necessarily representative. Practical implications The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes. Social implications Outdoor activities can promote social interaction for people living with dementia in care settings. The authors’ findings are relevant to the recent policy focus on social prescribing. Originality/value The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.

Purpose The purpose of this paper is to describe the process of developing a contemporary competency framework for admiral nurses in dementia care. Design/methodology/approach Information and evidence was gathered from research and policy literature regarding competencies to deliver advanced practice within dementia care. An online survey completed by 75 admiral nurses with follow-up interviews clarified current practice across the range of service contexts in which they work. A focus group (FG) of people living with dementia and family carers, and a reference group of practitioners helped to develop a competency framework which was refined through FGs with admiral nurses working in different areas. Findings The literature review, survey and interviews provided a framework grounded in up-to-date evidence and contemporary practice. There was broad agreement in the literature and the practitioners’ priorities regarding the core competencies of advanced practice, with constructive suggestions for making the framework useable in practice. This resulted in a robust framework articulating the competencies of admiral nurses which could be used for continuous professional development. Originality/value Engaging the admiral nurses ensured the competencies were contemporary, succinct and applicable within practice, and also cultivated a sense of ownership. Developing the competency framework with the admiral nurses not for them provides an approach which may have value for professionals undertaking a similar process in their specialist area. It is anticipated the competency framework will provide further evidence of the benefits of specialist nurse support for families affected by dementia.

Objectives: MEETINGDEM investigated whether the Dutch Meeting Centres Support Programme (MCSP) could be implemented in Italy, Poland, and the UK with comparable benefits. This paper reports on the impact on people living with dementia attending pilot Meeting Centres in the 3 countries.\ud Methods: Nine pilot Meeting Centres (MCs) participated (Italy—5, Poland—2, UK—2). Effec- tiveness of MCSP was compared with Usual Care (UC) on outcomes measuring behavioural and psychological symptoms (NPI), depression (CSDD), and quality of life (DQoL, QOL‐AD), analysed by ANCOVAs in a 6‐month pre‐test/post‐test controlled trial.\ud Results: Pre/post data were collected for 85 people with dementia and 93 carers (MCSP) and 74 people with dementia /carer dyads' receiving UC. MCSP showed significant positive effects for DQoL [Self‐esteem (F = 4.8, P = 0.03); Positive Affect (F = 14.93, P < 0.00); Feelings of Belong- ing (F = 7.77, P = 0.01)] with medium and large effect sizes. Higher attendance levels correlated with greater neuropsychiatric symptom reduction (rho = 0.24, P = 0.03) and a greater increase in feelings of support (rho = 0.36, P = 0.001).\ud Conclusions: MCSPs showed significant wellbeing and health benefits compared with UC, building on the evidence of effectiveness from the Netherlands. In addition to the previously reported successful implementation of MCSP in Italy, Poland, and the UK, these findings suggest that further international dissemination of MCSP is recommended.

This is the fourth and final article in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Dementia training in hospitals is often inadequate and staff do not always have sufficient knowledge of dementia to provide appropriate care. It can also be difficult for them to identify when patients with dementia are in pain, especially when their communication skills deteriorate. The case studies presented illustrate how two NHS trusts have worked to ensure that their staff are fully equipped to care for people with dementia in hospital. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex made dementia training a priority by including dementia awareness in staff induction across a range of roles and providing additional training activities tailored to meet staff needs. Nottingham University Hospitals NHS Trust focused on pain assessment, aiming to standardise its approach for patients with dementia. The pain assessment in advanced dementia tool was chosen and piloted, and is being implemented across the trust after a positive response.

The hospital environment is often disorientating for people with dementia and can be particularly distressing when a patient is admitted in an emergency. Subsequent ward moves can also be disruptive and confusing, especially if they take place out of hours. Two NHS trusts aimed to improve the experience for patients with dementia by addressing the physical environment along with practical aspects of care provision at different stages in the hospital journey. The Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust in Norfolk enhanced its emergency department environment by redesigning four bays and an observation area to be dementia-friendly. The hospital has supported these changes by providing dementia awareness training for all staff in these areas. Walsall Healthcare NHS Trust focused on minimising ward moves by implementing procedures to identify patients who should not be moved. Since introducing the new process, adherence has been good and there have been fewer ward moves.

This is the second in a short series that presents case study examples of the positive work achieved by trusts that participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Staff often think that there is insufficient time to get to know patients and carers, especially with large and challenging workloads. Combined with a lack of activities and stimulation for patients with dementia in hospital, this can result in poor engagement and a disconnect between staff and patients. To improve these relationships and give staff more time with patients, Cambridge University Hospitals NHS Foundation Trust has introduced bay nursing for patients with dementia, where one nurse is responsible for monitoring a bay alongside a healthcare assistant for an entire shift. Part of Betsi Cadwaladr University Health Board, Glan Clwyd Hospital in north Wales has focused on improving stimulation by creating an activity room with a specially trained activity worker, providing a relaxed and friendly setting where patients with dementia can take part in a range of activities and have lunch together.

This is the first in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. When a person with dementia is in hospital, poor understanding of individual needs and preferences can contribute to a lack of person-centred care. Similarly, the needs of family carers can often be overlooked and staff do not always appreciate these needs at such a stressful time. This article illustrates how three NHS trusts have addressed these issues. To help staff get to know patients with dementia, Salford Royal NHS Foundation Trust has implemented a patient passport. Similarly, The Shrewsbury and Telford Hospital NHS Trust has implemented a carer passport that overcomes the restrictions imposed by hospital visiting hours. Royal Devon and Exeter NHS Foundation Trust also focused on carers, holding a workshop to elicit feedback on what was important to them. This was a useful means of engaging with carers and helped staff to realise that even simple changes can have a significant effect.

Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs). Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

A short series of articles in Nursing Older People, starting in September, presents case study examples of the positive work achieved by trusts that participated in the RCN’s development programme to improve dementia care in acute hospitals. This introductory article reports on the independent evaluation of the programme. The programme included a launch event, development days, site visits, ongoing support by the RCN lead and carer representatives and a conference to showcase service improvements. The evaluation drew on data from a survey, the site visits, trust action plans and a range of self-assessment tools for dementia care. The findings highlight substantial progress towards programme objectives and learning outcomes and suggest that the programme provided the focus, impetus and structure for trusts to make sustainable changes. It also equipped participants with the strategies and confidence to change practice. Recommendations are made for taking the programme forward.

Objective: ALzheimer’s COoperative Valuation in Europe (ALCOVE) was a Joint Action co-financed by the European Commission to produce a set of evidence-based recommendations for policymakers on dementia. This paper reports on timely diagnosis. Methods: Evidence was reviewed from scientific, policy and qualitative research. An online questionnaire was completed by experts from 24 European Union countries detailing current practice. An iterative process with people with dementia, family carers and professionals was utilised to develop recommendations. Results: Advances in the technical aspects of diagnosis have changed what is understood by early diagnosis. Although research into preclinical stages is crucial, diagnosing at these very earliest stages is not recommended as regular practice. On balance, it is suggested that citizens should have access to accurate diagnosis at a time in the disease process when it can be of most benefit to them. The term timely diagnosis is used to reflect this. The diagnosis can help citizens and their families make sense of what is happening and make lifestyle changes and plans for the future. The central principles identified to maximise benefit and to reduce harm associated with diagnosis at an earlier stage included reducing stigma about dementia; respecting the rights of the individual; recognising that how the diagnosis is given will impact on subsequent adjustment and that post diagnostic support are required for the person and their family. Detailed recommendations are provided for timely detection, the diagnostic process, complex diagnoses, response to early cognitive changes and workforce. Conclusions: The recommendations can be utilised at a local, national and European level to benchmark progress.

Whilst memory loss is a significant feature of dementia, it is important to remember that people experience dementia in very unique and individual ways. In addition to physical symptoms, people living with dementia can be impacted upon by a range of behavioural and psychological symptoms which are debilitating for the person experiencing them and challenging for those around them, whether in a familial or caring capacity. Behaviour is often misunderstood when it is not considered within the context of a person’s individual life history. Following a person-centred approach is therefore an essential part of appreciating someone’s identity and identifying the underlying reason for the behaviour.

This is the fourth and final article in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Dementia training in hospitals is often inadequate and staff do not always have sufficient knowledge of dementia to provide appropriate care. It can also be difficult for them to identify when patients with dementia are in pain, especially when their communication skills deteriorate. The case studies presented illustrate how two NHS trusts have worked to ensure that their staff are fully equipped to care for people with dementia in hospital. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex made dementia training a priority by including dementia awareness in staff induction across a range of roles and providing additional training activities tailored to meet staff needs. Nottingham University Hospitals NHS Trust focused on pain assessment, aiming to standardise its approach for patients with dementia. The pain assessment in advanced dementia tool was chosen and piloted, and is being implemented across the trust after a positive response.

This article is the third in a series presenting examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. The hospital environment is often disorientating for people with dementia and can be particularly distressing when a patient is admitted in an emergency. Subsequent ward moves can also be disruptive and confusing, especially if they take place out of hours. Two NHS trusts aimed to improve the experience for patients with dementia by addressing the physical environment along with practical aspects of care provision at different stages in the hospital journey. The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust in Norfolk enhanced its emergency department environment by redesigning four bays and an observation area to be dementia-friendly. The hospital has supported these changes by providing dementia awareness training for all staff in these areas. Walsall Healthcare NHS Trust focused on minimising ward moves by implementing procedures to identify patients who should not be moved. Since introducing the new process, adherence has been good and there have been fewer ward moves.

This is the second in a short series that presents case study examples of the positive work achieved by trusts that participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Staff often think that there is insufficient time to get to know patients and carers, especially with large and challenging workloads. Combined with a lack of activities and stimulation for patients with dementia in hospital, this can result in poor engagement and a disconnect between staff and patients. To improve these relationships and give staff more time with patients, Cambridge University Hospitals NHS Foundation Trust has introduced bay nursing for patients with dementia, where one nurse is responsible for monitoring a bay alongside a healthcare assistant for an entire shift. Part of Betsi Cadwaladr University Health Board, Glan Clwyd Hospital in north Wales has focused on improving stimulation by creating an activity room with a specially trained activity worker, providing a relaxed and friendly setting where patients with dementia can take part in a range of activities and have lunch together.

ALzheimer's COoperative Valuation in Europe (ALCOVE) was a Joint Action co-financed by the European Commission to produce a set of evidence-based recommendations for policymakers on dementia. This paper reports on timely diagnosis.Evidence was reviewed from scientific, policy and qualitative research. An online questionnaire was completed by experts from 24 European Union countries detailing current practice. An iterative process with people with dementia, family carers and professionals was utilised to develop recommendations.Advances in the technical aspects of diagnosis have changed what is understood by early diagnosis. Although research into preclinical stages is crucial, diagnosing at these very earliest stages is not recommended as regular practice. On balance, it is suggested that citizens should have access to accurate diagnosis at a time in the disease process when it can be of most benefit to them. The term timely diagnosis is used to reflect this. The diagnosis can help citizens and their families make sense of what is happening and make lifestyle changes and plans for the future. The central principles identified to maximise benefit and to reduce harm associated with diagnosis at an earlier stage included reducing stigma about dementia; respecting the rights of the individual; recognising that how the diagnosis is given will impact on subsequent adjustment and that post diagnostic support are required for the person and their family. Detailed recommendations are provided for timely detection, the diagnostic process, complex diagnoses, response to early cognitive changes and workforce.The recommendations can be utilised at a local, national and European level to benchmark progress.

This paper argues for the adoption of a single, detailed, component-based, Building Information Model as a strategy for handling all design and construction information about a building at any stage of design. Using the recladding efforts for the Aronoff Center for Design and Art at the University of Cincinnati as a backdrop, the paper frames current issues that plague the building design and construction industry then illustrates how a single, parametrically driven, component-based model can reunite the fragmented industry and deal with vast amount of information that accretes during the design-construction process. The paper also describes how the detailed, comprehensive, single model paradigm opens the possibility of more sophisticated structural or energy modeling and analysis taking into account contributions of interior walls, mechanical systems etc. to overall structural stability, thermal mass, etc. The paper concludes with implications to practice in the current splintered AEC industry and a candid discussion about obstacles and limitations. BACKGROUND The processes of designing and constructing a complicated building in a contemporary society have grown exponentially more complex over the past century. As more knowledge of building behavior is explicated, new strategies and technologies are developed to improve building design. (Eastman 2008) These new areas of expertise have resulted in a dramatic departure from the “craft” model of design (Alexander 1979) where a single individual can be expected to have all the knowledge and skill required to design and construct a solution to a problem. In the contemporary building environment it is impossible for one individual to possess all knowledge and skill required to design and construct a complex, technologically intense building and the consequence is a very complex and fragmented industry.

The anachronistic ascription of membership of the Moslem faith to the persecutors of Christians in the period before the Peace of the Church appears in Anglo-Norman hagiography in the late twelfth century, or early thirteenth, and in English lives later in the thirteenth century. It may be, at least in part, the result of the corruption in meaning of a derivative of the word Mahomet, found in Anglo-Norman as mahumez in the early twelfth century and in English by the end of the same century in the form of maumez, idols. The confusion in identification was made possible by the attribution of the rôle of the Roman officials to the Moslems—both groups martyred Christians in large numbers—and by an association of practices and qualities based on the opposition, real or alleged, of both Romans and Moslems to the Christian faith.

Influence of charge on filtration across renal basement membrane films in vitro. The filtration of differently charged species of myoglobin and dextran across films of isolated basement membrane in vitro showed that the filtration behavior of both polymers was influenced by charge. Rejection increased with increasing negative charge. Titration of the isolated basement membrane revealed an isoionic point of pH 5.5 and an isoelectric point of pH 5.7. The net negative charge at pH 7.4 was 0.15 mEq/g protein; this charge was attributed to carboxylate anion. Glycosaminoglycan sulphate did not contribute significantly to the net charge. Filtration of narrow range dextran fractions across films of basement membrane at the isoelectric point markedly reduced differences in filtration due to charge confirming that the differences in behavior found at pH 7.4 were due to charge interactions between the solutes and the membranes. Physical characterization of the charged and uncharged dextran fractions revealed no substantial differences in size or shape for the differently charged species. Influence de la charge sur la filtration a travers des films de membrane basale renale in vitro. La filtration d'especes differemment chargees de myoglobine et de dextran a travers des films de membrane basale isolee in vitro a montre que le comportement de filtration des deux polymeres etait influence par la charge. Le rejet s'elevait lorsque la charge negative augmentait. La titration de la membrane basale isolee a revele un point isoionique de pH 5,5 et un point isoelectrique de pH 5,7. La charge negative nette a pH 7,4 etait de 0,15 mEq/g proteines; cette charge a ete attribuee a l'anion carboxylate. Le sulfate de glycosaminoglycan ne contribuait pas significativement a la charge nette. La filtration de fractions d'etendues etroites de dextran a travers des films de membrane basale au point isoelectrique reduisait de facon marquee les differences de filtration dues a la charge, confirmant que ses differences de comportement trouvees a pH 7,4 etaient dues a des interactions de charge entre les solutes et les membranes. La caraterisation physique des fractions de dextran chargees ou non n'a pas revele de difference substantielle dans la taille ou la forme des especes de charges differentes.