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Harleen Kaur Rai,1 Justine Schneider,2 Martin Orrell3 1Department of Computer & Information Sciences, University of Strathclyde, Livingstone Tower, Glasgow, Scotland, G1 1HX, UK; 2School of Sociology & Social Policy, Law & Social Sciences Building, University of Nottingham, University Park, Nottingham, England, NG7 2RD, UK; 3Institute of Mental Health, University of Nottingham, Jubilee Campus, Nottingham, England, NG7 2TU, UKCorrespondence: Harleen Kaur RaiDepartment of Computer & Information Sciences, University of Strathclyde, Livingstone Tower, Glasgow, G1 1HX, UKEmail harleen.rai@strath.ac.ukBackground: There is a lack of digital resources that support the cognition and quality of life (QoL) of people with dementia. The individual cognitive stimulation therapy application (iCST app) aims to provide cognitive stimulation and social interaction to people with dementia and carers through interactive touch-screen technology. This study set out to determine the feasibility of conducting a full-scale, randomized controlled trial (RCT) with the iCST app.Methods: This was a single blind, feasibility RCT including people with mild to moderate dementia and their carers. Multiple trial components were assessed including recruitment and retention rates, intervention fidelity and usability, and acceptability of the outcome assessments which included measures of cognition and QoL. A sample of the intervention group was invited to a semi-structured post-trial interview to examine the experience of using the iCST app.Results: Sixty-one dyads were randomised to the iCST app (n = 31) or treatment-as-usual (TAU) control group (n = 30) for 11 weeks. In the iCST app group, 77% used the intervention for 20 minutes or more each week. Carers using the iCST app rated their QoL better at follow-up 2 compared to the TAU control group (EQ-5D, MD = 7.69, 95% CI = 2.32– 13.06, p = 0.006). No significant differences were found on the other outcome measures.Conclusion: The iCST app was deemed usable and enjoyable. Most participants completed the activities more quickly than anticipated and did not have enough activities to continue using the app frequently. Expansion of the iCST app is needed to maintain engagement for longer. Findings indicate that computerised cognitive stimulation can be beneficial, and a large-scale RCT is feasible with modifications to trial components. The results are relevant to researchers, software developers, policy-makers, people with dementia and carers who are looking to be involved in such interventions.Trial Registration: ClinicalTrials.gov, NCT03282877. Registered on 19 July 2017.Keywords: cognitive stimulation, application, feasibility trial, touch-screen

Emese Csipke,1 Aisha Shafayat,2 Kirsty Sprange,2 Lucy Bradshaw,2 Alan A Montgomery,2 Reuben Ogollah,2 Esme Moniz-Cook,3 Martin Orrell4 1Division of Psychiatry, University College London, London, UK; 2Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK; 3Faculty of Health Sciences University of Hull, Hull, UK; 4Institute of Mental Health, University of Nottingham, Nottingham, UKCorrespondence: Emese CsipkeDivision of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UKEmail e.csipke@ucl.ac.ukBackground: There is a need for interventions to foster and maintain independence for people with dementia to support community living, improve morale, and reduce stigma. We investigated a social intervention to promote living well and enhance independence for people with mild dementia.Methods: In this two arm parallel group, feasibility RCT at six sites in England, participants were randomized (1:1) to the PRIDE intervention (encompassing social, physical, and cognitive domains supported by a facilitator over three sessions) compared to usual care only. The main objective was to determine the feasibility of a main trial with respect to measures of recruitment, retention, and adherence to the intervention.Results: During a 7-month period, 402 people were invited to the trial, 148 were screened (37%, 95% confidence interval (CI)=32– 42%), 137 were eligible at pre-consent, 94 consented to the trial (69% of those eligible, 95% CI=60– 76%), and 92 were randomized (46 to each group). Of those allocated to the intervention, 42 (91%) received at least one of three intervention sessions. Outcome assessment follow-up visits were completed for 73 participants at 6 months (79%, 95% CI=70– 87%), and this was similar for both groups.Conclusion: A large multi-center trial of the PRIDE intervention in community-dwelling people with mild dementia is feasible using systematic recruitment strategies. The intervention was successfully delivered and well received by participants. Findings from this study will be used to refine the design and processes for a definitive RCT.Trial Registration: ISRCTN, ISRCTN11288961, registered on 23 October 2018.Keywords: dementia, feasibility trial, randomized controlled trial, psychosocial intervention

Lauren Yates1,*, Emese Csipke2,*, Esme Moniz-Cook3, Phuong Leung2, Holly Walton4, Georgina Charlesworth5, Aimee Spector5, Eef Hogervorst6, Gail Mountain7, Martin Orrell1 1Institute of Mental Health, University of Nottingham, Nottingham, UK; 2Division of Psychiatry, University College London, London, UK; 3Department of Psychological Health and Well-Being, Faculty of Health Sciences, School of Health and Social Work, University of Hull, Hull, UK; 4Department of Applied Health Research, University College London, London, UK; 5Department of Clinical, Educational and Health Psychology, University College London, London, UK; 6National Centre for Sports and Exercise Medicine, Loughborough University, Loughborough, UK; 7Centre for Applied Dementia Studies, University of Bradford, Bradford, UK*These authors contributed equally to this workCorrespondence: Emese CsipkeDivision of Psychiatry, University College London, 149 Tottenham Court Road, London W1T 7NF, UKTel +44 207 679 9306Email e.csipke@ucl.ac.ukObjective: Support after a diagnosis of dementia may facilitate better adjustment and ongoing management of symptoms. The aim of the Promoting Independence in Dementia (PRIDE) study was to develop a postdiagnostic social intervention to help people live as well and as independently as possible. The intervention facilitates engagement in evidence-based stimulating cognitive, physical and social activities.Methods: Theories to promote adjustment to a dementia diagnosis, including theories of social learning and self-efficacy, were reviewed alongside self-management and the selective optimization model, to form the basis of the intervention. Analyses of two longitudinal databases of older adults, and qualitative analyses of interviews of older people, people with dementia, and their carers about their experiences of dementia, informed the content and focus of the intervention. Consensus expert review involving stakeholders was conducted to synthesize key components. Participants were sourced from the British NHS, voluntary services, and patient and public involvement groups. A tailored manual-based intervention was developed with the aim for this to be delivered by an intervention provider.Results: Evidence-based stimulating cognitive, physical, and social activities that have been shown to benefit people were key components of the proposed PRIDE intervention. Thirty-two participants including people with dementia (n=4), carers (n=11), dementia advisers (n=14), and older people (n=3) provided feedback on the drafts of the intervention and manual. Seven topics for activities were included (eg, “making decisions” and “getting your message across”). The manual outlines delivery of the intervention over three sessions where personalized profiles and plans for up to three activities are developed, implemented, and reviewed.Conclusion: A manualized intervention was constructed based on robust methodology and found to be acceptable to participants. Consultations with stakeholders played a key role in shaping the manualized PRIDE intervention and its delivery. Unlike most social interventions for dementia, the target audience for our intervention is the people with dementia themselves.Keywords: self-management, public patient involvement, behavior change, manual, cognitive impairment

Deborah Oliveira,1 Lidia Sousa,2 Martin Orrell1 1Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK; 2Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal Background: Providing care for a family member with dementia can leave little time for carers to look after their own health needs, which makes them more susceptible to mental and physical health problems. This scoping review aimed to explore potential health benefits of interventions aimed at improving health-promoting self-care in family carers of people with dementia. Methods: A scoping review was carried out using Arksey and O’Malley’s methodological framework. EMBASE, MEDLINE, PsycINFO and Google Scholar were consulted. Original and peer-reviewed research published in English up to April 2017 were included. Publications were selected by two reviewers independently. Eight experts from several countries provided extra relevant information, which was triangulated with the review results. A narrative approach was used to describe and discuss the review findings. Results: Seven interventions were identified. These were highly heterogeneous in content, method of delivery, and outcome measures. None was specifically focused on improving and evaluating health-promoting self-care, instead they often focused on health promotion and healthy lifestyle (eg, physical activity). Some of the multi-component interventions included “self-care” as a domain, but none used a specific measure of health-promoting self-care, so we were unable to affirm that the improvements found in the interventions were due to an improvement in this area. Interventions helped reduce carer depression and burden and increased quality of life, positive affect, and physical activity. The expert panel recommended to consider carers’ preparedness and capacity to adhere to self-care practices, as well as carers’ age and culture. Future interventions should be context specific, flexible, and person-centered. Conclusion: Psychosocial interventions may improve health-promoting self-care behavior, but more research is needed to establish efficacy. Interventions should be flexible, use a person-centered approach, be implemented with fidelity and use the right dosage. Keywords: Alzheimer’s disease, dementia, carers, health promotion, scoping review, self-care, psychosocial interventions

Amy Streater,1,2 Donna Maria Coleston-Shields,2 Jennifer Yates,2 Miriam Stanyon,2 Martin Orrell2 1Research and Development, North East London NHS Foundation Trust, Ilford, 2Institute of Mental Health, University of Nottingham, Nottingham, UK Background: Research on crisis teams for older adults with dementia is limited. This scoping review aimed to 1) conduct a systematic literature review reporting on the effectiveness of crisis interventions for older people with dementia and 2) conduct a scoping survey with dementia crisis teams mapping services across England to understand operational procedures and identify what is currently occurring in practice.Methods: For the systematic literature review, included studies were graded using the Critical Appraisal Skills Programme checklist. For the scoping survey, Trusts across England were contacted and relevant services were identified that work with people with dementia experiencing a mental health crisis.Results: The systematic literature review demonstrated limited evidence in support of crisis teams reducing the rate of hospital admissions, and despite the increase in number of studies, methodological limitations remain. For the scoping review, only half (51.8%) of the teams had a care pathway to manage crises and the primary need for referral was behavioral or psychological factors.Conclusion: Evidence in the literature for the effectiveness of crisis teams for older adults with dementia remains limited. Being mainly cohort designs can make it difficult to evaluate the effectiveness of the intervention. In practice, it appears that the pathway for care managing crisis for people with dementia varies widely across services in England. There was a wide range of names given to the provision of teams managing crisis for people with dementia, which may reflect the differences in the setup and procedures of the service. To provide evidence on crisis intervention teams, a comprehensive protocol is required to deliver a standardized care pathway and measurable intervention as part of a large-scale evaluation of effectiveness. Keywords: dementia, home treatment, crisis resolution, crisis, mental health, community mental health services

Jennifer Cove,1 Nicola Jacobi,2 Helen Donovan,3 Martin Orrell,4 Josh Stott,5 Aimee Spector5 1Department of Clinical, Educational and Health Psychology, University College London, London, 2Department of Psychology, City University, London, 3Clinical Psychology Service, South Essex Partnership NHS Foundation Trust, Bedford, 4Department of Psychiatry, 5Department of Clinical, Educational and Health Psychology, University College London, London, UKPurpose of the study: Cognitive stimulation therapy (CST) is a widely used, evidence-based intervention for people with dementia (PwD). Although designed as a 14 session, twice weekly intervention, many services in the UK deliver CST once a week for 14 weeks. However, this method of delivery has yet to be evaluated. In addition, CST does not include any formal carer training. This study aimed to evaluate the effectiveness of once weekly CST and determine any additional impact when enhanced with a carer training program.Design and methods: A single blind, randomized controlled trial was conducted. Sixty eight PwD and their carers were recruited through three community Memory Assessment Services. PwD and their carers were randomized to one of three conditions: CST plus carer training, CST only, or a wait list control. PwD were administered standardized measures of cognition, quality of life, and quality of relationship with carer at baseline and the 15 week follow-up.Results: There were no baseline differences across the three groups. At follow-up, there were no significant differences between PwD in the three groups on any outcomes. Implications: Weekly CST with or without carer training may not be an effective form of delivery. Several possible explanations for the outcomes are proposed. Weekly CST may not offer the necessary “dose” required to combat decline, and equally the carer training may have been too brief to have made a difference. Services currently offering weekly CST should collect routine outcome data to support its use and provide practice-based evidence.Keywords: Alzheimer’s disease, cognition, intervention, caregiver

Lauren A Yates,1,2 Phuong Leung,2 Vasiliki Orgeta,2 Aimee Spector,1,3 Martin Orrell1,2 1North East London Foundation Trust, 2Division of Psychiatry, University College London, 3Research Department of Clinical, Educational and Health Psychology, University College London, London, UK Background: Adopting a systematic approach to the development of an intervention, supported by robust theoretical, empirical, and clinical rationales represents best practice. The Medical Research Council (MRC) provides a framework for a systematic step-wise approach to the evaluation of complex interventions. This study describes the development phase of the individual cognitive stimulation therapy (iCST) for dementia trial, within this framework.Methods: In the preclinical phase, a recent Cochrane Review of cognitive stimulation for dementia and the current literature on individual cognitive stimulation interventions were examined to establish an evidence base. In addition, people with dementia, carers, and care staff were consulted regarding the acceptability of iCST, and a panel was put together to advise the team on the adaptation of group cognitive stimulation therapy (CST). Phase I (modeling) involved consultations with service users and experts in a series of focus groups, interviews, an online survey, and a consensus conference. Finally, Phase II field testing of the intervention was carried out.Results: Two drafts of the materials were produced before a final version ready for use in the main randomized controlled trial (RCT). Key changes between the drafts included: editorial amendments to improve the clarity of instructions, emphasize the person centeredness of the approach, and reduce the overall length of the introduction section; the simplification of academic terminology and activities deemed “too difficult”; adjustments made to the monitoring-progress forms and session rating scale to enhance user-friendliness; the addition of a “Getting started” section; amendments made to the content of the toolkit; and clearer distinction made between the level of difficulty of activities.Conclusion: The rigorous development of the intervention was beneficial as the feasibility of the intervention was explored both in theory and practice, and consulting with service users ensured that materials were appropriately tailored to their needs. A Phase III RCT is currently being conducted to determine the effectiveness of iCST. Keywords: cognitive stimulation, Delphi consensus, MRC framework, intervention development, intervention evaluation

Elisa Aguirre,1,2 Aimee Spector,3 Martin Orrell1,2 1Division of Psychiatry, University College London, London, UK; 2Research and Development Department, North East London Foundation Trust, Goodmayes Hospital, Essex, UK; 3Clinical, Educational and Health Research Psychology Department, University College London, London, UK Abstract: Cognitive stimulation therapy (CST) has been shown to be an useful and cost effective intervention that increases cognition and quality of life of people with mild to moderate dementia. It is increasing in popularity in the UK and worldwide, and a number of research teams have examined its effectiveness in other contexts and cultures. However, it is necessary to develop clear evidence-based guidelines for cultural modification of the intervention. This article describes a community-based developmental approach to adapt CST to different cultures, following the five phases of the formative method for adapting psychotherapy (FMAP), an approach that involves collaborating with service users as a first step to generate and support ideas for therapy adaptation. Examples based on clinical and practical experience are presented, along with suggestions for applying these changes in different cultural contexts. Keywords: CST, culture, adaptation, mild to moderate dementia, dementia, FMAP

This study explores (1) which platforms people with YOD use for online peer support, (2) reasons for using or not using online peer support, and (3) how to optimise potential benefits and accessibility. A mixed-methods online survey was conducted including fixed-choice and open questions. Participants were people with YOD recruited through dementia organisations, Join Dementia Research and the NHS using convenience sampling. Fixed-choice questions were analysed with Chi-square test of significance and free-text responses with thematic analysis. A total of 69 completed surveys were analysed. Zoom was most popular for online peer support, followed by Facebook and Twitter. Positives included sharing social support, joining from home, and the option to choose a preferred platform. However, it can be difficult to follow the conversation or understand others. Many were unaware about online peer support and some felt uncomfortable talking to strangers online. To improve access and benefits of online peer support organisations and healthcare professionals should advertise and signpost more and groups should have a clear description. Online platforms facilitate social support and make peer support accessible to those who do not have access to in-person options. Future research and practice should focus on raising awareness about online peer support. [ABSTRACT FROM AUTHOR]

Background People with dementia find it increasingly difficult to carry out daily activities (activities of daily living), and may require increasing support from family carers. Researchers in the Netherlands developed the Community Occupational Therapy in Dementia intervention, which was delivered in 10 1-hour sessions over 5 weeks to people with dementia and their family carers at home. Community Occupational Therapy in Dementia was found to be clinically effective and cost-effective. Objectives Translate and adapt Community Occupational Therapy in Dementia to develop the Community Occupational Therapy in Dementia - the UK version intervention and training programme and to optimise its suitability for use within the UK. To estimate the clinical effectiveness and cost-effectiveness of Community Occupational Therapy in Dementia - the UK version for people with mild to moderate dementia and their family carers compared with treatment as usual. Design The development phase used mixed methods to develop Community Occupational Therapy in Dementia - the UK version: translation, expert review, and adaptation of the manual and training materials; training occupational therapists; focus groups and interviews, including occupational therapists, managers, people with dementia and family carers; consensus conference; and an online survey of occupational therapists to scope UK practice. A multicentre, two-arm, parallel-group, single-blind individually randomised pragmatic trial was preceded by an internal pilot. Pairs were randomly allocated between Community Occupational Therapy in Dementia - the UK version and treatment as usual. A cost–utility analysis, fidelity study and qualitative study were also completed. Setting Community services for people with dementia across England. Participants People with mild to moderate dementia recruited in pairs with a family carer/supporter. Interventions Community Occupational Therapy in Dementia - the UK version is an activity-based, goal-setting approach for people with dementia and family carers, and is delivered at home by an occupational therapist for 10 hours over 10 weeks. Treatment as usual comprised the usual local service provision, which may or may not include standard occupational therapy. Main outcome measures Data were collected through interviews conducted in person with dyads at baseline and at 12 and 26 weeks post randomisation, and then over the telephone with a reduced sample of just carers at 52 and 78 weeks post randomisation. The primary outcome was the Bristol Activities of Daily Living Scale at 26 weeks. The secondary outcomes were as follows: person with dementia – cognition, activities of daily living, quality of life and mood; carer – sense of competence, quality of life and mood; all participants – social contacts, leisure activities and serious adverse events. Results The Community Occupational Therapy in Dementia manual and training materials were translated and reviewed. In total, 44 occupational therapists were trained and delivered Community Occupational Therapy in Dementia to 130 pairs. A total of 197 occupational therapists completed the survey, of whom 138 also provided qualitative data. In total, 31 people attended the consensus conference. Community Occupational Therapy in Dementia - the UK version has more flexibility than Community Occupational Therapy in Dementia in terms of content and delivery; for example, occupational therapists can use the wider range of assessment tools that are already in regular use within UK practice and the time span for delivery is 10 weeks to better meet the needs of pairs and be more feasible for services to deliver. In total, 31 occupational therapists provided Community Occupational Therapy in Dementia - the UK version within the randomised controlled trial. A total of 468 pairs were randomised (249 pairs to Community Occupational Therapy in Dementia - the UK version, 219 pairs to treatment as usual). People with dementia ranged in age from 55 to 97 years (mean 78.6 years), and family carers ranged in age from 29 to 94 years (mean 69.1 years). The majority of those with dementia (74.8%) were married; 19.2% lived alone. Most family carers (72.6%) were spouses but 22.2% were adult children. At 26 weeks, 406 (87%) pairs remained in the trial, and the Bristol Activities of Daily Living Scale total score did not differ at the 5% level when comparing groups (adjusted mean difference estimate 0.35, 95% confidence interval –0.81 to 1.51; p = 0.55). The adjusted (for baseline Bristol Activities of Daily Living Scale total score and randomised group) intracluster correlation coefficient estimate at week 26 was 0.043. There were no significant differences in secondary outcomes. At 52 and 78 weeks, there were no differences between the two groups in Bristol Activities of Daily Living Scale total score and secondary outcomes. The probability that Community Occupational Therapy in Dementia - the UK version is cost-effective at a threshold of willingness to pay per quality-adjusted life-year of £20,000 is 0.02%. In the qualitative interviews, participants reported positive benefits and outcomes. Of the 249 pairs allocated to Community Occupational Therapy in Dementia - the UK version, 227 reached the goal-setting phase, and 838 of the 920 goals set (90.8%) were fully or partially achieved. Limitations The development phase took longer than estimated because of translation time and organisational delays in delivering the intervention. Recruitment to the randomised controlled trial took longer than expected. Fidelity overall was moderate, with variation across sites and therapists. It is possible that Community Occupational Therapy in Dementia - the UK version did not work well in the UK service model in which usual care differs from that in the Netherlands. Conclusions This programme used a rigorous process to develop Community Occupational Therapy in Dementia - the UK version but found no statistical evidence of clinical effectiveness or cost-effectiveness compared with usual care. Qualitative findings provided positive examples of how Community Occupational Therapy in Dementia - the UK version had enabled people to live well with dementia. Future work Developing tools to measure more meaningful outcomes, such as goals achieved or the quantity and quality of activity participation, with less reliance on proxy data, to collect the views and experiences of people with dementia themselves. Trial registration This trial was registered as ISRCTN10748953 (WP3 and WP4). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information. Plain language summary Maintaining everyday and meaningful activities can be difficult for a person with dementia. Their family carer/supporter can feel stressed from needing to give increasing support. Occupational therapists assist people to improve their health and well-being by helping them to do the activities that are important to them. Dutch researchers developed an occupational therapy programme for people with mild to moderate dementia and their supporters. Delivered at home, it improved the person’s ability to carry out daily activities, plus their mood and quality of life. Supporters’ sense of competence, mood and quality of life also improved, and it was also value for money. We built on this by translating and adapting the Dutch materials to develop a version better suited to the UK health and social care services context: Community Occupational Therapy in Dementia – UK version. The Community Occupational Therapy in Dementia – UK version comprises 10 hours of occupational therapy provided at home over 10 weeks. We tested whether or not it was more beneficial in terms of helping people with dementia to continue with activities and improving mood and quality of life than the usual service provided (treatment as usual), which may or may not include occupational therapy. In total, 468 pairs comprising a person with dementia and their supporter agreed to take part. Pairs were allocated at random to receive either The Community Occupational Therapy in Dementia – UK version or treatment as usual. We asked questions about daily activities performance, quality of life, mood, and the health and social care services used. We did this at the beginning of the programme and again at 12, 26, 52 and 78 weeks. The statistical analysis showed no evidence that Community Occupational Therapy in Dementia – UK version benefited the pairs on the outcomes selected or was value for money compared with the usual care already provided. We spoke in depth to some of the pairs and occupational therapists who participated in Community Occupational Therapy in Dementia – UK version, and they provided positive examples of meaningful activities that they had resumed or established as a result of the programme. Future research should develop ways of measuring the outcomes that really matter to people with dementia and their supporters, and to collect the views of people with dementia themselves. Scientific summary Background People with dementia find it increasingly difficult to carry out activities, and require increasing support from their family carers, who often experience stress. Occupational therapists support people to improve their health and well-being by enabling them to participate in activities that are meaningful to them. Researchers in the Netherlands developed the Community Occupational Therapy in Dementia (COTiD) intervention, in which occupational therapists delivered in 10 1-hour sessions over 5 weeks to people with mild to moderate dementia and their family carers at home. The Dutch researchers found that COTiD improved the person with dementia’s ability to perform daily living activities [activities of daily living (ADL)], quality of life and mood; improved their family carer’s sense of competence, quality of life and mood; and was cost-effective. Aims and objectives The aim of this applied research programme funded by the National Institute for Health and Care Research (NIHR) was to translate, adapt, evaluate and implement this community occupational therapy intervention designed to promote independence, meaningful activity and quality of life for people with mild to moderate dementia, and thus to benefit their family carers. Objectives •To translate and adapt COTiD into the Community Occupational Therapy in Dementia – UK version (COTiD-UK) intervention and training programme and optimise it for UK use. •To test the feasibility of implementing COTiD within UK health and social care services. •To field test the proposed outcome measures through an internal pilot trial of COTiD-UK compared with treatment as usual (TAU). •To estimate the effectiveness of COTiD-UK in improving the functional independence of people with mild to moderate dementia through a multicentre, pragmatic, single-blind, randomised controlled trial (RCT). •To evaluate cost-effectiveness of COTiD-UK compared with TAU. •To assess the implementation of COTiD-UK through monitoring and budget impact analysis. •To widely disseminate the findings of the Valuing Active Life in Dementia (VALID) research programme. The programme consisted of three phases, including five work packages (WPs): development (WP1 and WP2), piloting and evaluation (WP3 and WP4), and implementation (WP5). Development phase (work packages 1 and 2) Aim To translate and adapt the COTiD guideline and training package to optimise its suitability for use within the UK and, therefore, develop the COTiD-UK intervention ready for evaluation in WP3 and WP4. Method We used a mixed-methods approach, including the following activities. Work package 1: translation and adaptation This WP included the translation, expert review and adaptation of the manual and training materials used to train occupational therapists to deliver COTiD sessions to ‘pairs’ or dyads, comprising a person with mild to moderate dementia and their family carer; focus groups with occupational therapists who delivered COTiD, people with dementia and family carers who had not received COTiD; and semistructured interviews with pairs who had taken part in COTiD, managers of occupational therapists who delivered COTiD, and professionals who had referred pairs to receive COTiD. Finally, a consensus conference was held to finalise the content of the UK version of the intervention, COTiD-UK, with people with dementia and family carers, some of whom had participated in COTiD; occupational therapists who had received the training and delivered COTiD; and managers and other team members. Work package 2: survey of current practice This WP comprised an online survey collecting both quantitative and qualitative data from occupational therapists to scope current UK occupational therapy practice for people with dementia and their carers. Results Work package 1: translation and adaption We established a reference group of UK occupational therapists with experience of working with people with dementia and their family carers in practice. They provided expert opinion and guidance throughout the programme independent of the research team. This Occupational Therapy Reference Group reviewed the translated intervention and training materials, which were then adapted in consultation with the original author. We trained 44 occupational therapists from 10 organisations to deliver COTiD, of whom 28 took part in one of five focus groups. A total of 130 pairs took part in the COTiD sessions. We conducted semistructured interviews with nine pairs: four managers and five referrers. Thirty-nine people who had not received COTiD took part in one of six focus groups. Thirty-one people attended the consensus conference. Work package 2: survey of current practice A total of 230 occupational therapists consented to take part, of whom 197 (86%) provided quantitative data and 138 (60%) provided qualitative data also. Over half of the respondents undertook primarily profession-specific work. Occupational therapy-specific assessments were the most common profession-specific task, and the median time spent per person with dementia was 2.5 hours. Conclusion This phase took twice as long to complete as planned, partly because we underestimated the time needed to complete translation and partly because several organisational and governance issues delayed the occupational therapists delivering the intervention in practice, which in turn delayed the remainder of the data collection activities. We developed the COTiD-UK intervention ready for evaluation in WP3 and WP4. COTiD-UK retains the same aim and principles as COTiD, in that it aims to enable the person with dementia and family carer to carry out meaningful activities. This is achieved through adapting the environment and activity and coaching the family carer in problem-solving and supervision skills. It is similar to COTiD in that it comprises 10 hours of face-to-face intervention provided at home but is more flexible in content and delivery. For example, occupational therapists can use a wider range of assessment and intervention tools that are already in regular use within UK practice, and the time span for delivery is extended from 5 to 10 weeks to better meet the needs of pairs and be more feasible for service delivery. We restructured the training programme into 2 consecutive days followed by a third day once the therapists had delivered COTiD-UK in practice. We also used audio-recording rather than video-recording for the competence assessment process to better meet the needs of UK occupational therapists, many of whom had extensive experience of working with people living with dementia and their family carers or in the community. Piloting and evaluation phase (work packages 3 and 4) Aims Work package 3: internal pilot trial The aim of WP3 was to field test the outcome measures and trial procedures, and finalise the COTiD-UK intervention training, mode of delivery and supervision. Work package 4: full randomised controlled trial To estimate the clinical effectiveness and cost-effectiveness of COTiD-UK compared with TAU. Method We designed WP3 as an internal pilot trial with the intention of progressing to WP4, the full RCT, if it met predefined success criteria. The study design was a multicentre, two-arm, parallel-group, single-blind individually randomised pragmatic trial with an internal pilot. We allocated pairs at random between COTiD-UK and TAU, which may or may not include standard occupational therapy. The primary outcome was the Bristol Activities of Daily Living Scale (BADLS) score at 26 weeks. Secondary outcome measures were as follows: •for person with dementia – cognition (Mini Mental State Examination), ADL performance (Interview of Deterioration in Daily activities of Dementia), quality of life [Dementia Quality of Life (DEMQOL) scale] and mood (Cornell Scale for Depression in Dementia) •for the family carer – sense of competence (Sense of Competence Questionnaire), quality of life (DEMQOL scale) and mood (Hospital Anxiety and Depressions Scale) •for all participants – social contacts, leisure activities and serious adverse events. These outcomes were selected to reflect those measured in the previous trials of COTiD. We undertook a cost–utility analysis of the COTiD-UK intervention relative to TAU using costs and outcome data from the trial. Our analysis adopted the perspective of the NHS and Personal Social Services, as well as a societal perspective. The time horizon was 26 weeks, reflecting the trial’s primary end point. We assessed the effectiveness of the intervention in quality-adjusted life-years (QALYs) estimated from mortality and health-related quality-of-life data collected using the DEMQOL scale for carers, DEMQOL-Proxy for people with dementia and EuroQol-5 Dimensions, five-level version, and health and social care services used for both. We embedded two qualitative studies within the trial: •We explored the experience of undertaking the COTiD-UK intervention from the perspective of people with dementia, family carers and occupational therapists. We conducted semistructured interviews over the telephone with occupational therapists and face to face with pairs. We audio recorded and transcribed all interviews, checked them for accuracy, anonymised them and used inductive thematic analysis. •We explored why pairs declined to take part in the trial. We interviewed a convenience sample of carers identified during the screening process as being eligible but who subsequently declined to take part. We approached them only if we judged that it was unlikely to cause distress. We audio recorded and transcribed the telephone interviews, checked them for accuracy, anonymised them and used inductive thematic analysis. Results The independent Programme Steering Committee reviewed the internal pilot trial and agreed that we should carry the data collected to date forward to the main trial data set. We recruited 15 NHS trusts; however, one trust did not proceed to recruiting pairs owing to unforeseen service reorganisation that resulted in the occupational therapists whom we had trained no longer being available to take part. We trained 44 occupational therapists to deliver COTiD-UK, of whom 32 proceeded to the RCT and were allocated at least one pair each, although one was subsequently unavailable to provide the intervention as planned owing to ill health. We randomised 468 pairs: 249 to COTiD-UK and 219 to TAU. As we expected, the demographic and clinical characteristics of both groups were very similar at baseline. People with dementia ranged in age from 55 to 97 years, with a mean age of 78.6 years, and family carers ranged in age from 29 to 94 years, with a mean age of 69.1 years. The majority of people with dementia (74.8%) were married; 19.2% lived alone. Most family carers (72.6%) were spouses but 22.2% were adult children. At 26 weeks, 406 (87%) pairs remained in the trial. We collected and analysed outcome data from 368 (79%) pairs: 207 (83%) allocated to COTiD-UK and 161 (74%) allocated to TAU. At 26 weeks, there was no evidence to suggest a difference between the COTiD-UK and TAU groups in the primary outcome (BADLS score) or in any secondary outcome. Further analysis of BADLS scores and secondary outcomes at 52 and 78 weeks also showed no difference between the COTiD-UK and TAU groups. The non-adherence rate was 4.64%, compared with the target of 5%. The number of goals set per pair ranged from one to thirteen, with a mean of 4.09 goals. The total number of goals set was 920, of which 729 (79.24%) were achieved, 107 (11.63%) were partially achieved and 84 (9.13%) were not achieved. A total of 239 serious adverse events were recorded over the course of the trial, but none was assessed as being related to the COTiD intervention or trial participation. If decision-makers were willing to pay £20,000 (or £30,000) for a QALY, the probability that COTiD-UK is cost-effective would be 0.02% (or 0.04%). None of these statistical or economic findings changed when we re-ran analyses without adjustment or restricted to complete cases. Qualitative study 1 We interviewed seven occupational therapists and 22 pairs. We identified six themes from the occupational therapist interviews: (1) valuing the occupational focus of COTiD-UK, (2) timing and relationships, (3) achieving goals, (4) developing COTiD-UK knowledge and skills, (5) delivering COTiD-UK within current organisational models, and (6) delivering COTiD-UK in the future. We identified four themes from the interviews with people with dementia and their family carers: (1) achieving goals, (2) working together, (3) effect of dementia and (4) COTiD-UK outcomes. Qualitative study 2 We interviewed 10 family carers and identified two themes: (1) protectiveness and (2) ‘It’s not for us’. Conclusion This trial recruited 97.5% of the target sample, and attrition and non-adherence rates were low. Sites had fewer available occupational therapists than expected, and drop-out rates were higher than expected; therefore, we recruited more sites than originally planned, which took longer than expected. Our design required sites to access researchers, often from the local Clinical Research Network, to recruit participants and collect data, and occupational therapists to deliver the COTiD-UK intervention. Only 2 of the 15 trial sites acquired ‘excess treatment costs’, namely the additional funding that is required within the UK to deliver the clinical intervention being evaluated, as the research grant funding does not cover this. This inevitably reduced capacity to deliver the intervention in some sites because the occupational therapists’ availability was dependent on the goodwill of their managers, who had to balance their support for the study with the need to continue providing the usual service being commissioned. Hence, recruitment rates varied across sites, with some sites exceeding their recruitment target and more not achieving it. The trial statistical results showed no evidence that COTiD-UK was better than the usual care being provided, nor did the economic evaluation provide support for COTiD-UK. By contrast, many people with dementia and family carers described the intervention and its impact in very positive terms, providing examples of how they had resumed old activities and felt empowered to continue participation in future. Implementation phase (work package 5) This phase was amended in response to the cumulative delays outlined above, and the number of data already collected, taking into account the lack of statistically significant results and the growing body of implementation science knowledge. Aim The aims of this WP were to assess the intervention fidelity and to explore why the intervention was, or was not, delivered as planned. Methods We used a longitudinal observational design nested within the trial to assess fidelity to the COTiD-UK intervention. We audio-recorded as many COTiD-UK sessions as was feasible. We developed, piloted and refined fidelity checklists and coding until we achieved good agreement between coders. We purposively sampled 10% of sessions, and estimated percentages of components delivered for each session, occupational therapist and site. We reviewed data collected during the earlier development, piloting and evaluation phases using the theoretical domains framework to identify factors that enabled or hindered intervention delivery. Results A reliable measure of intervention fidelity was developed. Application of this measure found that COTiD-UK was delivered with moderate fidelity overall, although the mean range varied across sites and occupational therapists. The key domains affecting COTiD-UK implementation in practice were knowledge, skills (capability), environmental context and resources (opportunity) and beliefs about capabilities (motivation). Recommendations for future research Traditionally, psychosocial intervention research has focused on assessing outcomes such as cognition, daily living abilities and quality of life as core domains potentially impacted by dementia, using measures of deterioration and impairment. We noted that, in the main, pairs set goals relating to a wider range of activities than those covered within the BADLS, for example leisure, creative, social and community based. Given that over 90% of goals set by the dyads taking part in COTiD-UK were fully or partially achieved, further analysis of the goals set and met could inform the future selection and development of more meaningful occupational outcome measures, tools and processes. It is important to develop ways of measuring the outcomes of complex interventions, such as COTiD-UK, and to measure what is meaningful and prioritised by people with dementia and their family carers. There is also a need to develop such patient-related outcome measures in formats that make them suitable for self-report, to enable data to be collected directly from people with dementia themselves, in turn meaning researchers do not have to rely on proxy data. Implications for practice The trial statistical results did not indicate any benefit of the COTiD-UK intervention as delivered in this trial compared with usual care in the outcomes measured. However, the qualitative findings provided positive examples of dyads resuming or establishing meaningful activities. There is no evidence to suggest that occupational therapy input in general does not continue to be a highly valued and important part of multiprofessional teamworking and service provision. We therefore suggest that occupational therapists do not change their practice, but continue to contribute to community teamwork and memory service provision for people with cognitive problems and their families. Conclusion This applied research programme used a rigorous and thorough process to translate and adapt the original Dutch intervention to the UK version. We found no statistical evidence for clinical effectiveness or cost-effectiveness of COTiD-UK compared with the usual care provided. By contrast, people with dementia, family carers and occupational therapists provided positive examples of meaningful activities being resumed or established. We have shown that it is possible to conduct and effectively deliver a well-designed, high-quality, highly complex clinical trial of occupational therapy across 15 sites and requiring intervention delivery by experienced occupational therapists. Trial registration This trial was registered as ISRCTN10748953 (WP3 and WP4). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 11, No. 5. See the NIHR Journals Library website for further project information.

Background: The MEETINGDEM study aims to implement and evaluate an innovative, inclusive, approach to supporting community dwelling people with mild to moderate dementia and their family carers, called the Meeting Centers Support Program (MCSP), in three countries in the European Union (EU): Italy, Poland and United Kingdom. Demonstrated benefits of this person-centered approach, developed in The Netherlands, include high user satisfaction, reduced behavioral and mood problems, delayed admission to residential care, lower levels of caregiving-related stress, higher carer competence, and improved collaboration between care and welfare organizations.Methods: The project will be carried out over a 36 month period. Project partners in the three countries will utilize, and adapt, strategies and tools developed in the Netherlands. In Phase One (month 1-18) activities will focus on establishing an initiative group of relevant organizations and user representatives in each country, exploring pathways to care and potential facilitators and barriers to implementing the program, and developing country specific implementation plans and materials. In Phase Two (month 19‑36) training will be provided to organizations and staff, after which the meeting centers will be established and evaluated for impact on behavior, mood and quality of life of people with dementia and carers, cost-effectiveness, changes in service use, user satisfaction and implementation process.Discussion: An overall evaluation will draw together findings from the three countries to develop recommendations for successful implementation of MCSP across the EU. If the Meeting Centers approach can be widely implemented, this could lead to major improvements in dementia care across Europe and beyond.Trial Registration: The trial was retrospectively registered in May 2016: trial number: NTR5936 . [ABSTRACT FROM AUTHOR]

Background: The efficacy of cognitive stimulation therapy (CST) has been demonstrated, but little is known about the characteristics of people with dementia, which may predict a more positive response to CST. This study sought to investigate which factors may predict response to CST.Methods: Two hundred and seventy-two participants with dementia took part in a 7-week CST intervention. Assessments were carried out pre-treatment and post-treatment. The results were compared with those of a previous comparable CST randomised control trial. A comparison of mean scores pre-CST and post-CST groups was undertaken, and contributing factors that predicted change in outcomes were examined.Results: CST improved cognition and quality of life, and the results showed that the benefits of CST were independent of whether people were taking acetylcholinesteraseinhibitor (AChEI) medication. Increasing age was associated with cognitive benefits, as was female gender. Care home residents improved more than community residents on quality of life, but the community sample seemed to benefit more in relation to behaviour problems.Conclusions: These results demonstrate that CST improves cognition and quality of life for people with dementia including those already on AChEIs. Older age and being female were associated with increased cognitive benefits from the intervention. Consideration should be given to aspects of CST, which may enhance the benefits for people with dementia who are male and those younger than 80 years. [ABSTRACT FROM AUTHOR]

Considerable effort has been invested in improving assessment processes for older people, some of the most vulnerable of whom live in care homes. The paper compares two well-known assessment tools used in care homes, the CANE and the Minimum Data Set/Resident Assessment Instrument. There was poor agreement between the tools in terms of domains of need covered. Nineteen pairs of items could be compared, with agreement greater than 60% found on 11 items. Of the 15 items where κ could be computed, seven significant values were found. High levels of agreement existed in relation to behaviour, psychological wellbeing, mood state, psychotic symptoms, incontinence, mobility and inadvertent self-harm (risk). The study suggests that tools commonly used for assessment are not interchangeable and that the selection of assessment tool should be determined by the setting in which it is used, the needs of the population being assessed, the skills and knowledge of those undertaking the assessment and the purpose of the assessment itself. [ABSTRACT FROM AUTHOR]

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 dependency and depression, but not with cognitive function or dementia severity. Improvement in quality of life was associated with being female, low quality of life at baseline, reduced depression and increased cognitive function. Changes in cognitive function mediated the effects of treatment in improving QoL. These results suggest that whilst QoL in dementia appears to be independent of level of cognitive function, interventions aimed at improving cognitive function can, nonetheless, have a direct effect on QoL. [ABSTRACT FROM AUTHOR]

Background: Mounting evidence implicates diets high in fats and processed sugars with increased generation of free radicals in animals. It is still not clearly established whether such a diet alters antioxidant balance in dementia patients, where an oxidative stress status may already exist. The disruption to lipid metabolism by oxidative stress has been recently linked to neurodegeneration and clinical disease. The aim of this study is to assess the relationship between fat, sugar, carbohydrate and caloric intake levels, and antioxidant status in patients with mild to moderate dementia.Methods: The levels of 3 essential endogenous antioxidants (superoxide dismutase, catalase, glutathione peroxidase) were measured in the blood of 26 dementia subjects and 26 cognitively unimpaired controls. Concurrently, the intake levels of relevant nutrients and dietary antioxidants were assessed in all subjects.Results: A statistically significant positive association was observed in the dementia group between glutathione peroxidase activity and the intake of fats (r = 0.44; p = 0.023), carbohydrates (r = 0.46; p = 0.018), total sugars (r = 0.51; p = 0.007) and calories (r = 0.47; p = 0.14). The only significant association in the control group was observed between glutathione peroxidase and fat (r = 0.47; p = 0.015).Conclusion: The higher glutathione peroxidase activity among subjects with greater intake of fats, carbohydrates and sugars may represent a compensatory response to the additional increase in oxidative stress in dementia. Our data shed light on the influence of dietary intake on the oxidant-antioxidant system in mild to moderate dementia patients. [ABSTRACT FROM AUTHOR]

BACKGROUND: Quality of life (QoL) is becoming an increasingly used outcome measure in both clinical practice and research but little is known about QoL in dementia and how it may change over time. OBJECTIVE: To study longitudinal change in quality of life over a period of one year in 60 people with dementia aged 65 years or over. METHODS: The original sample was selected from inpatient, day hospital, nursing home and residential home settings within a London Mental Health Trust. The QoL-AD, DQoL and EQ-5D were assessed at baseline and repeated one-year later. At follow-up the CSDD, MMSE and RAID were also completed. RESULTS: Fifty-eight people were traced and of these 40 (69%) were alive at follow up. There was no mean change in quality of life over the one-year period, however around half of the people had increases or decreases in their quality of life. The only significant predictor of quality of life at follow-up was initial quality of life (p < 0.0005). Quality of life at follow-up correlated significantly with depression (p < 0.0005) and anxiety (p <0.01) but not with cognition. CONCLUSION: The main finding of this study is that people with dementia do not perceive that their quality of life declined over a period of one-year. More people were able to complete the QoL-AD than the DQoL or EQ-5D at follow-up and it seemed easier to use for people with severe dementia. Future research should investigate how quality of life changes over longer time periods with larger samples and in relation to specific interventions. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Recent research has highlighted the influence of psychosocial factors on the course of dementia, and previous studies have demonstrated an association between the experience of life events and depression. This study aimed to investigate the interrelationships between life events, depression and social support in people with dementia. DESIGN: Participants were 72 people with dementia and their carers. Data were collected on severity of dementia, cognitive impairment, depression, life events and social support.RESULTS: The results showed that 62% of people with dementia who had experienced a severely threatening and independent life event in the preceding 3 months were depressed, compared with only 28% of those people with dementia without such events (p = .005). No relationships were found between social support and depression in people with dementia.CONCLUSIONS: This study builds on previous research indicating that people with dementia who experience stressful life events have a higher risk of depression. Copyright 2004 The British Psychological Society [ABSTRACT FROM AUTHOR]

Quality of life (QoL) is becoming an increasingly used outcome measure in both clinical practice and research. There are now more than 1000 scales available to measure QoL, and it is important that they are assessed for reliability and validity. This study aims to assess the reliability and validity of the Quality of Life-Alzheimer's Disease (QoL-AD) scale, which is dementia specific and brief and uses the patient's own responses. Two separate samples of people with dementia (sample 1, n = 60; sample 2, n = 201) were assessed. Five focus groups were conducted involving both people with dementia and their caregivers; the focus groups showed that people with dementia had higher hopes for their QoL than their caregivers did for them. Questionnaires about the scale were completed by 71 health care professionals working with people with dementia. The scale was found to have good content validity with no additional items required and all items necessary. It also correlated well with the Dementia Quality of Life scale (0.69) and with the Euroqol-5D scale (0.54), indicating good criterion concurrent validity. Construct validity was also good with the principal components analysis showing all 13 items of the QoL-AD loaded on component 1. Interrater reliability was excellent with all Cohen's kappa values >0.70. Internal consistency was excellent with a Cronbach's alpha coefficient of 0.82. Some people with severe dementia and a Mini-Mental State Examination score as low as 3 were able to satisfactorily complete the QoL-AD. The QoL-AD has very good psychometric properties and can be completed with people with a wide range of severity of dementia. [ABSTRACT FROM AUTHOR]

There is little evidence to indicate how far psychiatric day hospitals for older people can identify and address the needs of older people who attend. The current practice of Care Programme Approach (CPA) in which multidisciplinary team members, patients and their families meet, may provide a suitable forum for needs to be discussed and interventions planned and implemented. One hundred and twelve new day hospital patients over a period of one year were randomly allocated to an experimental group in which the Camberwell Assessment of Need for the Elderly (CANE). Assessment reports were fed back to day hospital staff but not to the control group in which routine practice was maintained. Similar follow-up assessments were performed after three months in the day hospital or at the time of discharge. At follow-up, both the experimental and control groups had over 60% of their initial unmet needs being adequately met. In both groups, the Health of the Nation Outcome Scales 65+ scores and number of unmet needs were reduced indicating an improvement for both groups. However, there were no significant differences in outcome at follow-up between the experimental and control groups. Day hospitals for older people with mental health problems appear effective in identifying and meeting needs. The feedback from CANE made no difference in terms of outcome. [ABSTRACT FROM AUTHOR]

Eighty-seven residents from three sheltered accommodation schemes for people over 60 years, were interviewed about: their physical and mental health, social networks, social support, decision to move in, and how they found living in sheltered housing. Twenty-four percent had a diagnosis of depression and 8% dementia, but few had ever seen a mental health professional. Over half (55%) had clinically significant levels of activity limitation and 37% had significant somatic symptoms. Despite provision of glasses or aids 31% could not see satisfactorily and 23% could not hear adequately. Locally integrated social networks were most common (41%). Residents with a private network (16%) were more likely than those with a locally integrated network to have significant activity limitation and to report often being lonely. There were no differences between network types in levels of depression or dementia. Poor health of a person or their spouse was the most commonly reported reason for moving to sheltered housing, followed by the possibly related reasons of problems with their old home no longer being suitable e.g. stairs, and because they wanted to have a warden or alarm system available should the need arise. Most residents were happy living in sheltered accommodation. Many made use of 'sheltered' features such as the common room, the communal laundry, the warden and the alarm. A minority of residents were lonely and a few were unhappy with sheltered accommodation. [ABSTRACT FROM AUTHOR]

Objective: Investigation of the reaction of elderly patients to the disclosure of their diagnosis of dementia compared with depression.Design: Elderly patients suffering from dementia and depression were asked to complete a questionnaire about the diagnosis and other aspects of their clinical summary sent to them by post. Demographic data included age, gender, marital status and occupation; degree of dementia or depression was established by administering the mini-mental state examination and the geriatric depression scale, respectively.Setting: Patients were consecutive attendees of outpatient clinics (old age psychiatry) located in two suburban areas near London.Measures: Demographic data included age, gender, marital status and occupation; degree of dementia or depression was established by administering the mini-mental state examination and the geriatric depression scale, respectively.Results: One hundred cases were recruited, 53 with dementia and 47 with depression. Most depressed and dementia patients ( > 75%) liked the idea of reading their diagnosis but 25% of dementia cases felt upset. Within the dementia group, the majority of patients with mild or severe dementia welcomed the idea of knowing their diagnosis; and 13 (100%) of the patients with vascular dementia wished to know (compared with 68% cases with Alzheimer's disease). None felt upset, and only 39% of them felt pessimistic after reading their own clinical summary. However, among dementia patients who also happened to be depressed, a higher proportion (60%) expressed an unfavourable view towards knowing their diagnosis, but only a minority (40%) of them were actually upset. Most older married females, especially those with depression and Alzheimer's disease, felt pessimistic afterwards.Conclusions: There was no significant difference between patients with dementia or depression in their wish to know their diagnosis. Patients with severe dementia, even if they felt upset, preferred to be told their diagnosis. Patients with vascular dementia tended to express a more favourable view. [ABSTRACT FROM AUTHOR]

The efficacy and safety of electroconvulsive therapy (ECT) have been established, yet widespread negative public attitudes towards the procedure remain. Little research has been carried out into the attitudes towards and knowledge of ECT among mental health staff of different disciplines. Method: Two hundred and sixty-eight staff from four mental health disciplines (psychiatrists, psychologists, nurses and social workers) were sent the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) and asked about demographic details. Attitudes and knowledge were compared by discipline and the results analysed using the Kruskal-Wallis test. Results: The response rate was 74% (n=198). The questionnaire revealed significant differences in attitudes to and knowledge of the therapy between the four disciplines, with psychiatrists being most favourably disposed and most knowledgeable, followed by nurses, social workers and psychologists. The attitudes scale was shown to have good internal consistency and split-half reliability. Conclusion: Discipline is an accurate predictor of attitudes towards ECT. There is a need for awareness of differences of opinion towards the treatment in multidisciplinary teams, as well as for better education about ECT for all members of the clinical team. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: There exists no instrument specifically designed to measure comprehensively the needs of older people with mental disorders.Aim: To develop such an instrument which would take account of patients', staff and careers' views on needs.Method: Following an extensive development process, the assessment instrument was subjected to a test-retest and interrater reliability study, while aspects of validity were addressed both during development and with data provided by sites in the UK, Sweden and the USA.Results: The Camberwell Assessment of Need for the Elderly (CANE) comprises 24 items (plus two items for career needs), and records staff, career and patient views. It has good content, construct and consensual validity. It also demonstrates appropriate criterion validity. Reliability is generally very high: kappa > 0.85 for all staff ratings of interrater reliability. Correlations of interrater and test-retest reliability of total numbers of needs identified by staff were 0.99 and 0.93, respectively.Conclusions: The psychometric properties of the CANE seem to be highly acceptable. It was easily used by a wide range of professionals without formal training. [ABSTRACT FROM AUTHOR]

Background: The Health of the Nation Outcome Scales (HoNOS) have been developed for assessing the effectiveness of mental health services.Aims: To investigate the validity and reliability of the HoNOS in patients in contact with mental health services.Method: Subjects (age range 19-64) came from day hospitals, acute in-patient units and out-patient clinics in general practice. We obtained the opinions of experienced professionals, advocacy groups and patient groups to evaluate consensual and content validity.Results: One hundred patients were assessed using the package of rating scales. Interrater and test-retest reliability were good for some items and poor for others. The HoNOS had good criterion validity: acute in-patients had higher scores than day patients and out-patients. HoNOS also had good concurrent validity, correlating well with other scales. Comments suggested that the HoNOS was a useful and suitable scale for this population but psychotic symptoms and certain social factors were not sufficiently covered.Conclusion: The HoNOS had good validity but variable reliability. It may be better than existing scales because of the wide range of areas which it covers. [ABSTRACT FROM AUTHOR]

A rating scale to measure anxiety in dementia sufferers was developed and evaluated in a sample of 51 inpatients and 32 day-hospital patients. Anxiety scores were not related to sex, age, accommodation or DSM-IV diagnosis of the type of dementia. However, both subjects with physical illnesses and subjects with insight into their memory problems had significantly higher anxiety scores.The kappa values for inter-rater reliability ranged from 0.51 to 1 and for test-retest reliability from 0.53 to 1, which indicates moderate to good reliability.The overall agreement on individual items ranged from 82-100% (inter-rater) and 84-100% (test-retest).The professionals working in the care of the elderly and carer groups felt that the scale was comprehensive and all the items in the scale were important, thereby confirming that it has good content validity. The scale significantly correlated with other anxiety scales and also with independent ratings both by a consultant psychiatrist and also nursing staff, indicating good concurrent validity. Anxiety scores were significantly higher in dementia patients who fulfilled modified DSM-IV criteria for anxiety and clinical diagnosis of anxiety disorder.This showed evidence of good criterion validity. Factor analysis showed five factors, including all items of the scale. Scores of 11 and above on the scale indicated significant clinical anxiety. Overall, the scale had good reliability and validity. It should be a useful clinical and research instrument for assessing anxiety in dementia sufferers. [ABSTRACT FROM AUTHOR]

The Health of the Nation Outcome Scales (HoNOS) have been introduced as a concise and brief instrument aimed at measuring outcome in mental health care in everyday practice in the United Kingdom. This study involved rating 100 patients twice, a year apart, using the HoNOS, Clifton Assessment Procedures for the Elderly-Behaviour Rating Scales (CAPE-BRS) and two Likert scales monitoring changes in quality of life and mental health. Improvement in the HoNOS scores were observed for mainly patients with depression who remained in the community or were discharged from hospital. Initial HoNOS scores were worse among patients who were deceased a year later followed by those who had been transferred into institutional care. The HoNOS did predict outcome a year later in the elderly mentally ill and appears to be a useful tool in monitoring mental health care and outcome, especially in dementia and depression, two of the most common psychiatric disorders in the elderly. [ABSTRACT FROM AUTHOR]

Background: Previous research in the elderly has linked threatening life events with depression. Dementia sufferers are known to be sensitive to stressful changes in their daily life such as relocation. This study investigates whether threatening life events are associated with depressive symptoms in dementia sufferers.Method: Using the Life Events and Difficulties Schedule, this study examined life events before admission in a group of 70 dementia patients compared with two control groups: dementia sufferers in the community and mentally fit elderly people matched for age and sex.Results: Life events with severe threat were not significantly more frequent in the dementia patients than in two control groups. However, depressive symptoms in the dementia sufferers were significantly associated with independent severe life events. This strong association was maintained when a multivariate analysis was used to control for the effects of other social factors and severity of cognitive impairment. This association appears to be specific to the threat aspect of life events since there was no association between depressive symptoms and events relating to change in the social environment.Conclusion: In dementia sufferers, threatening life events are associated with depressive symptoms. This means that dementia sufferers are responsive to stress in the same way as cognitively intact individuals, and clinicians need to be more aware of the social influences on them. [ABSTRACT FROM AUTHOR]

An elderly lady, of superior verbal intelligence and with no severe psychiatric condition, severely neglected herself, and required prolonged day patient care. Brain scans showed selective frontal atrophy, and both traditional and new computerised neuropsychological testing demonstrated severe frontal dysfunction. [ABSTRACT FROM AUTHOR]

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 aware that dementia sufferers may be particularly sensitive to the effects of psychosocial stress. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the needs assessment policies and practices of social services departments in England and Wales in dealing with elderly people who have mental illness. Methodology; Results of the study; Discussion.

A case of mania following open-heart surgery is reported and discussed, with reference to the concept of secondary mania and the psychiatric consequences of open-heart surgery. [ABSTRACT FROM AUTHOR]

Discusses the significance of the publication of the first January issue of the journal 'Aging & Mental Health.' Increase in the number of submissions of good quality papers; Faster publication of important papers; Growth in the journal's number of subscribers; Number of hits registered by the journal's web site; Story of how the journal came about.

Abstract Background Few reports have been published about differences in perspectives on perceived needs among community-residing people with dementia, their family caregivers, and professionals. The aim of this study was to compare these perspectives. Method During 2006 and 2007, one-hundred and fifty two interviews of people with dementia and their caregivers about the needs of the person with dementia were performed by four professionals using The Camberwell Assessment of Need for the Elderly (CANE). Professionals’ views on met and unmet needs of people with dementia were obtained for the total sample, family caregivers’ perspectives were gained for 125 people with dementia, and people with dementia’s views on their own needs were obtained for 125 persons with dementia. Results People with dementia reported fewer needs compared with the reports of their caregivers and the professionals. The most frequent unmet needs reported by people with dementia, caregivers and professionals were in the areas of daytime activities, company, and psychological distress; however, people with dementia rated psychological distress as the commonest unmet need. Conclusions Since the priorities of people with dementia can be different from those of caregivers and professionals, it is important to consider all perspectives when making care plans. Thus, compliance with treatment of people with dementia and also their quality of life could be potentially improved by a more collaborative partnership with them.