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Educating and training the dementia workforce is a global challenge, given the expected increasing number of people living with dementia across the world as the population ages. Two projects from the UK (one regionally and one locality based) investigated courses available to the workforce and mapped the content of identified courses against a locally developed dementia care pathway. The locality project included a survey of what percentage of staff time was spent with people living with dementia, and what percentage of staff caseloads were devoted to people living with dementia. There was a great variation in the extent of education and training available, with some stages of the dementia care pathway poorly addressed. An educational strategy for the dementia workforce in the UK might include four categories of education and training: basic dementia awareness, intermediate level, advanced level, and dementia awareness for managers. Staff requiring education and training might be divided into three groups: those employed to work specifically with people living with dementia and their families; those working with people who have other conditions but some of whom will have a coincidental dementia; those working with other conditions but in settings where a high proportion of their patients have a comorbid dementia. To improve workforce skills in dementia care will require actions across the whole of education and training for professionals and untrained workers who provide services to this group. (Contains 2 tables and 3 figures.)

Whenever there are well-publicised pressures on acute care, there is a tendency for policy makers and the media to imply that a significant number of older people may be taking up hospital beds when they do not really need the services provided there. However, evidence to back up such claims is often lacking, and existing research tends to fail to engage meaningfully with older people themselves. In contrast, this research explores the emergency hospital admissions of older people in three English case study sites, drawing on the lived experience of older people and the practice wisdom of front-line staff to explore the appropriateness of each admission and scope for alternatives to hospital. Contrary to popular opinion, the study did not find evidence of large numbers of older people being admitted to hospital inappropriately. Indeed, some of the older people concerned delayed seeking help and only ended up at hospital as a very last resort, possibly due to concerns about being seen as a burden on scarce public resources. While older people and front-line staff identified a number of suggestions to improve services in future, there seemed few clear cut, easy answers to the longstanding dilemma of how best to reduce emergency admissions. Seeking to understand and potentially reduce emergency hospital admissions is complex, and it is important to consider the experiences and expertise of older people and front-line staff. [ABSTRACT FROM AUTHOR]

This paper reports the findings of a review of the literature on emergency admissions to hospital for older people in the UK, undertaken between May and June 2014 at the Health Services Management Centre, University of Birmingham. This review sought to explore: the rate of in/appropriate emergency admissions of older people in the UK; the way this is defined in the literature; solutions proposed to reduce the rate of inappropriate admissions; and the methodological issues which particular definitions of 'inappropriateness' raise. The extent to which a patient perspective is included in these definitions of inappropriateness was also noted, given patient involvement is such a key policy priority in other areas of health policy. Despite long-standing policy debates, relatively little research has been published on formal rates of 'inappropriate' emergency hospital admissions for older people in the UK NHS in recent years. What has been produced indicates varying rates of in/appropriateness, inconsistent ways of defining appropriateness and a lack of focus on the possible solutions to address the problem. Significantly, patient perspectives are lacking, and we would suggest that this is a key factor in fully understanding how to prevent avoidable admissions. With an ageing population, significant financial challenges and a potentially fragmented health and social care system, the issue of the appropriateness of emergency admission is a pressing one which requires further research, greater focus on the experiences of older people and their families, and more nuanced contextual and evidence-based responses., (© 2015 John Wiley & Sons Ltd.)