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Background: Tackling modifiable risk factors such as physical inactivity currently represents the only way to reduce the increasing prevalence of dementia worldwide. Aim: This study investigated attitudes to increasing physical activity to reduce risk of dementia in people over 50. Methods: Attitudes to increasing physical activity to reduce risk of dementia were assessed in a national online survey promoted via online forums and public adverts. The Motivation to Change Behaviour for Dementia Risk Reduction (MOCHAD-10) scale examined motivation for lifestyle change. Multivariable logistic regression was used to identify the predictors of willingness and motivation to increase physical activity. Results: Data from 3,948 individuals showed most people were moderately/very physically active (80%). People more likely to be physically active had better health and education, were older, male, and had a partner. People willing to increase physical activity (73%) were more likely to be younger, non-White, underweight, had better health and lifestyles, and had experience caring for someone with dementia. People with higher levels of motivation to change lifestyle (MOCHAD-10 subscales) were more likely to be female, younger, in poorer physical/mental health, had lower perceived mental activity, and were a carer for someone with dementia. Conclusion: Men and those with better health were more physically active. Those who were more motivated to increase physical activity were not necessarily able to be physically active. Multisectoral public health strategies should seek to use the high motivation levels among this group to mitigate the barriers related to physical activity for dementia risk reduction.

Objective: The Actifcare (Access to timely formal care) study investigated needs of people with dementia and their families during the phase in which formal care is being considered, and examined whether higher need levels are related to lower quality of life (QOL).Method: From eight European countries 451 people with dementia and their carers participated. Needs were measured with the Camberwell Assessment of Need for the Elderly. QOL was measured with the QOL-AD, and carer quality of life was measured with the CarerQol. The relationship between needs and QOL was analysed with multiple regression analyses.Results: Needs were expressed in the domains of psychological distress, daytime activities, company and information. People with dementia rated their unmet needs significantly lower than their carers: the mean number of self-rated unmet needs was 0.95, whereas the mean proxy ratings were 1.66. For met needs, the self-rated mean was 5.5 and was 8 when proxy-rated. The level of needs reported was negatively associated with QOL for both.Conclusion: The study results show that informal carers reported almost twice as many needs as people with dementia. The domains in which needs are expressed should be the primary focus for interventions to support QOL.The perspectives of people with dementia are informative when identifying needs.

In all aspects of research it is vital to develop the researchers and academics of the future by ensuring that there are suitable career paths and career development opportunities. To demonstrate i...

OBJECTIVES: Dementia is expected to affect one million individuals in the United Kingdom by 2025; its prodromal phase may start decades before its clinical onset. The aim of this study is to investigate whether use of internet from 50 years of age is associated with a lower incidence of dementia over a ten-year follow-up. METHODS: We analysed data based on 8,238 dementia free (at baseline in 2002–04) core participants from the English Longitudinal Study of Ageing. Information on baseline use of internet was obtained through questionnaires; dementia casesness was based on participant (or informant) reported physician diagnosed dementia or overall score on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Cox proportional hazards regression analysis was used for examining the relationship between internet use and incident dementia. RESULTS: There were 301 (5.01%) incident dementia cases during the follow-up. After full multivariable adjustment for potential confounding factors, baseline internet use was associated with a 40% reduction in dementia risk assessed between 2006–12 (HR=0.60 CI: 0.42 to 0.85; p

Objectives: To identify caregiver profiles of persons with mild to moderate dementia and to investigate differences between identified caregiver profiles, using baseline data of the international prospective cohort study Actifcare.Methods: A latent class analysis was used to discover different caregiver profiles based on disease related characteristics of 453 persons with dementia and their 453 informal caregivers. These profiles were compared with regard to quality of life (CarerQoL score), depressive symptoms (HADS-D score) and perseverance time.Results: A 5-class model was identified, with the best Bayesian Information Criterion value, significant likelihood ratio test (p

Objectives: Despite the popularity of music-based interventions in dementia care, there is a limited knowledge of how and why people with dementia find music beneficial for their well-being. A qualitative study was conducted to develop further insights into the musical experiences of people with dementia and explore the meaning of music in their lives.Method: Separate focus groups and interviews with (1) care home residents with dementia and their families, (2) day hospital clients with dementia, (3) care home staff, and (4) music therapists, were conducted. The findings of the thematic analysis were investigated further in the light of psychosocial factors with the aim of developing a theoretical model on music in dementia.Results: Six key themes were identified. The accessibility of music for people at all stages of dementia, close links between music, personal identity and life events, the importance of relationship-building through music making were particularly highlighted as valuable. The psychosocial model of music in dementia was developed. The model revealed the importance of music to support the personal psychology of people with dementia and the social psychology of the care home environment.Conclusion: The effects of music go beyond the reduction of behavioural and psychological symptoms. Individual preference of music is preserved throughout the process of dementia. Sustaining musical and interpersonal connectedness would help value who the person is and maintain the quality of their life.

The aims of this study were to identify which factors may lead to crisis for people with dementia and their carers and identify interventions these individuals believe could help in crisis. Qualitative study using focus groups to compare the perspectives of people with dementia, family carers and healthcare professionals on causes of crises and crisis interventions. To help in a crisis, people with dementia were favourable towards support from family and friends, access to mobile phones and home adaptations to reduce risks. Carers were keen on assistive technology and home adaptation. Both carers and staff valued carer training and education, care plans and well-coordinated care. Staff were the only group emphasizing more intensive interventions such as emergency home respite and extended hours services. In terms of causes of crises, people with dementia focused on risks and hazards in their home, whereas family carers emphasized carer stress and their own mental health problems. Staff, in contrast were concerned about problems with service organization and coordination leading to crises. Physical problems were less commonly identified as causes of crises but when they did occur they had a major impact. Practical interventions such as home adaptations, assistive technology, education and training for family carers, and flexible home care services were highly valued by service users and their families during times of crisis and may help prevent hospital admissions. Specialist home care was highly valued by all groups.

The lack of a consistent model means that the quality and characteristics of memory services can vary greatly. Quality standards have been successfully applied in a range of healthcare settings which allow services to implement improvements where necessary. A nationally agreed set of quality standards would help fulfil this need for UK memory services.To develop a set of standards for memory services to form the basis of a quality improvement initiative (Memory Services National Accreditation Programme [MSNAP]).The standards development process involved five main elements: Literature review/content analysis; key stakeholder workshop; email and postal consultation; consensus meeting; and final consultation/obtaining endorsements. Thirteen memory services in the northwest of England participated in the pilot programme, during which the draft set of quality standards were applied through the processes of self review and peer review.The finalised version consisted of 148 quality standards categorised along the following domains: management; resources available to support assessment and diagnosis; assessment and diagnosis; and ongoing care management and follow-up. The pilot stage highlighted standards representing common areas where improvements had been made, such as ascertaining whether the patient wished to know their diagnosis, and areas where more attention was still required, for example surveying referrers, patients and carers about their experiences of the service.It was possible to develop and field test nationally agreed quality standards for memory services. We believe that by implementing MSNAP it will be possible to improve the quality of UK memory services.

Older people with dementia living in care homes often lack appropriate activities. Although homes are expected to offer a range of activities to meet residents' needs, little is known about what makes activities meaningful for people with dementia. This study explores concepts of meaningful activity, as defined by older people with dementia living in care homes, staff and family carers.This qualitative study used focus groups including 17 residents, 15 staff and eight family carers from three care homes. Transcripts of the groups were subjected to thematic content analysis using a grounded theory approach.Four activity themes emerged -- 'reminiscence', 'family and social', 'musical' and 'individual'. There were also two related themes -- 'lack of meaningful activity' and 'what makes activity meaningful'. Residents found meaning in activities that addressed their psychological and social needs, which related to the quality of the experience of an activity rather than specific types of activities. In contrast, staff and family carers viewed activities that maintained physical abilities as meaningful.People with dementia staff and carers had differing views about what made activities meaningful. Organisational limitations and social beliefs limited the provision of meaningful activities for this population. The study also indicates areas for improving activity provision in care homes.

Quality of life (QoL) is now seen as a key outcome in many aspects of dementia care. In a recent randomized controlled trial of Cognitive Stimulation Therapy (CST) groups, significant improvements in self-reported QoL were identified as well as changes in cognitive function. This further analysis of results from the trial examines whether the changes in these two domains occurred independently, perhaps for different reasons, or whether the effect of treatment on QoL was mediated by the changes in cognition. In all, 201 people with dementia living in residential homes or attending day centres were assessed using the Quality of Life-Alzheimer's Disease (QOL-AD) scale and a range of measures of cognition, dementia level, mood, dependency and communication. Participants were randomized to receive an intervention programme of CST or to receive treatment as usual. The QoL-AD and other measures were repeated eight weeks later. At baseline, higher QoL in dementia was significantly correlated with lower levels of ...

Depression is common in older people, but in primary care it is frequently under-detected and usually untreated.This study used a questionnaire survey of general practitioners (GPs) in 12 areas of England and Wales to investigate their views about the detection and management of depression, and also conducted a local assessment of service characteristics. Most GPs recognized the importance of making an early diagnosis of depression, but 30% of them were unclear whether they needed further training. Only half of the GPs were satisfied with the local specialist services for depression. Services that used the care programme approach or had keyworker systems, and those that had made efforts to contact and educate GPs were seen as better quality. Providers of specialist services should ensure that they consider the needs of primary care. National and local initiatives to educate and support GPs in identifying and managing depression should be a high priority.

Stresses such as relocation and life events can lead to deterioration in dementia. However it is not known how the severity of dementia influences the occurrence or impact of such stress. This study investigated the relationship between severity of dementia, life events in the preceding six months, and hospital admission. Seventy elderly patients with senile dementia admitted to a geriatric psychiatry unit were compared with 50 dementia sufferers in the community. In general, mild dementia sufferers tended to have a higher frequency of severe threat independent life events. Life events appeared to increase the relative risk of admission for people with less severe dementia, but only when the relatives' accounts of cognitive impairment were used (CAPE & ADS) rather than GMSS rated cognitive impairment. Logistic regression suggested that sensitivity to the effects of threatening life events may be inversely related to the severity of cognitive deficit, but only for the CAPE rating. Clinician's should be awa...

We are pleased to announce the creation of a third editorial office for Aging & Mental Health to be located in Hong Kong, and the appointment of Kee-Lee Chou as editor. He will join our two editors...