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BACKGROUND: Behaviours that challenge in dementia, often described and diagnosed as behavioural psychological symptoms of dementia, are experienced by 75% of people living with dementia in care homes or hospital environments, with 43% of nurses and care providers reporting these behaviours as moderately or severely distressing to them. During behaviours that challenge moments in dementia, there is the potential for an intersubjective relationship to take place between the people living with dementia and the nurse. AIMS: This review explores and synthesises literature to consider the presence of intersubjectivity in people living with dementia. If the ability to be intersubjective remains present for people living with dementia, it will consider how its presence can be nurtured to offer a positive intersubjective communication between the person living with dementia and their carer/nurse. METHODS: The review used meta-ethnography methodology to develop concepts that help us to understand the implications of existing research on the presence of intersubjectivity in people living with dementia, and its relationship to those providing their care. Sixteen electronic databases (including MEDLINE/PubMed, Wiley Online Library and Sage publications) and grey literature such as Alzheimer's Society and Department of Health across journals dating from 2000-2020 were searched. Eight studies were selected and reviewed for quality and relevance for a meta-ethnographic literature synthesis of intersubjectivity in dementia. CONCLUSION: The meta-ethnography concluded that people living with dementia continue to have the capacity to be intersubjective on an emotional level. Nurses and other care providers need to acknowledge the presence of "personhood" and "personness" in people living with dementia to nurture positive intersubjective care relationships. The meta-ethnography has also been reviewed for reporting clarity against the EQUATOR checklist in the form of the eMERGe guideline

Background Palliative care aims to support the family members of people with life-threatening illnesses, alongside those who are ill. In the United Kingdom (UK), family members have expressed concern about the management of diminishing drinking and its consequences, particularly in the hospital environment, and the area is a priority for research. Aim This research aims to explore the experiences of family members when witnessing the diminishing drinking of a dying relative in order to identify areas in which professional support of family members might be improved. The exploration is framed within key notions of pragmatism as espoused by William James and John Dewey. Methodology and Method Thirteen family members who had witnessed diminishing drinking of a relative dying in hospital were recruited through the hospital bereavement service of one National Health Service trust in the UK. Their experiences were collected and analysed using narrative inquiry methodology, derived by Jean Clandinin and her colleagues from pragmatism. Findings Participants experienced diminishing drinking as an unfolding process which was part of overall decline associated with advancing illness. They all believed it to be detrimental. Three groups of responses were identified: promoting, accepting and ameliorating. Participants reported positive experiences of healthcare when staff actively supported relatives to drink, but they also found that staff could sometimes be too busy to attend to drinking. Tension occurred within families, and between healthcare staff and families over different approaches to managing aspiration risk and clinically assisted hydration. Conclusion This thesis offers a unique understanding of family members’ experiences of diminishing drinking, which has the potential to inform new palliative endeavour in the field. It argues for a re-conceptualisation of diminishing drinking aligned to family members’ experiences; for supporting family members through

BACKGROUND: Behaviours that challenge in dementia, often described and diagnosed as behavioural psychological symptoms of dementia, are experienced by 75% of people living with dementia in care homes or hospital environments, with 43% of nurses and care providers reporting these behaviours as moderately or severely distressing to them. During behaviours that challenge moments in dementia, there is the potential for an intersubjective relationship to take place between the people living with dementia and the nurse. AIMS: This review explores and synthesises literature to consider the presence of intersubjectivity in people living with dementia. If the ability to be intersubjective remains present for people living with dementia, it will consider how its presence can be nurtured to offer a positive intersubjective communication between the person living with dementia and their carer/nurse. METHODS: The review used meta-ethnography methodology to develop concepts that help us to understand the implications of existing research on the presence of intersubjectivity in people living with dementia, and its relationship to those providing their care. Sixteen electronic databases (including MEDLINE/PubMed, Wiley Online Library and Sage publications) and grey literature such as Alzheimer's Society and Department of Health across journals dating from 2000-2020 were searched. Eight studies were selected and reviewed for quality and relevance for a meta-ethnographic literature synthesis of intersubjectivity in dementia. CONCLUSION: The meta-ethnography concluded that people living with dementia continue to have the capacity to be intersubjective on an emotional level. Nurses and other care providers need to acknowledge the presence of "personhood" and "personness" in people living with dementia to nurture positive intersubjective care relationships. The meta-ethnography has also been reviewed for reporting clarity against the EQUATOR checklist in the form of the eMERGe guideline

Background: The global population is ageing. It is estimated that in Europe, the proportion of adults aged over 80 years will increase from 5.1% in 2014 to 12.3% by 2080, an increase from 26.0 million to 63.9 million. Care home residents are arguably some of the most vulnerable service users, with higher levels of frailty, comorbidities and cognitive impairment than those residing in the community. Length of stay before death in European care homes is not well documented, demonstrating a need for representative, internationally comparable research. An understanding of anticipated length of stay is important in healthcare resource allocation, developing care plans, and informing the decisions of residents and their relatives. Aims: This paper has two aims; firstly, it will provide a systematic review of factors associated with length of stay, and summarize the strength of evidence to support them. Secondly, it will reflect upon the methodological challenges of conducting the review, including feasibility and quality of data sources. Methods: To identify factors associated with length of stay after admission to a care home, a systematic review of international literature was conducted. Key databases were searched for potential studies, including MEDLINE, EMBASE, PsycINFO, CINAHL, Proquest, the Cochrane Library, Web of Science, the Campbell Library, SCOPUS and Social Care Online. The review focused on older adults, defined as any adult aged 65 years or above. Studies were included in the review if participants resided in a care home or long term care facility. The review focused on one outcome measure, length of stay, measured as length of stay from admission, or any point post admission, to a care home until death. The review was restricted to observational studies, including prospective cohort, cross-sectional and case control studies. Studies that met the inclusion criteria were obtained, data extracted and assessed for quality using tools specifically developed for

Background People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. Objectives To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. Design The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. Setting Nursing homes in England providing care for people with dementia. Participants Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. Intervention Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. Main outcome measures The two contender primary outcome measures were Comfort Assessment in Dying – End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data – health economic outcomes, medication/service use and intervention activity. Results Phase 1 (realist review; 86 papers) iden

Background: People of Black and minority ethnic heritage are more likely to die receiving life supporting measures and less likely to die at home. End-of-life care decision making often involves adult children as advance care planning is uncommon in these communities. Physicians report family distress as being a major factor in continuing with futile care. Aim: To develop a deeper understanding of the perspectives of elders of Black and minority ethnic heritage and their children, about end-of-life conversations that take place within the family, using a meta-ethnographic approach Design: Systematic interpretive exploration using the process of meta-ethnography was utilised. Data sources: CINAHL, MEDLINE, PubMed and PsycINFO databases were searched. Inclusion criteria included studies published between 2005 and 2019 and studies of conversations between ethnic minority elders and family about end-of-life care. Citation snowballing was used to ensure all appropriate references were identified. A total of 13 studies met the inclusion criteria and required quality level using Critical Appraisal Skills Programme. Results: The following four storylines were constructed: ‘My family will carry out everything for me; it is trust’; ‘No Mum, don’t talk like that’; ‘I leave it in God’s hands’; and ‘Who’s going to look after us?’ The synthesis reflected the dichotomous balance of trust and burden avoidance that characterises the perspectives of Black and minority ethnic elders to end-of-life care planning with their children.