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Abstract Background The increasing care complexity of nursing home residents living with dementia requires new care models that strengthen professional collaboration. To contribute to the sustainable implementation of new care models, it is important that they are linked to the care reality. However, little is known about intra- and interprofessional organization and provision of care in German nursing homes. Therefore, the aim of this study was to explore the current care situation, problems and strengths regarding intra- and interprofessional collaboration in the care of residents living with dementia. Methods We conducted a holistic multiple case study. The individual care units in which residents living with dementia are cared for were defined as cases. The context was built by the respective nursing homes and their regional affiliation to the federal state of North Rhine-Westphalia. We used qualitative face-to-face interviews, documents and context questionnaires for data collection. The different sources of evidence served to capture complementary perspectives and to validate the findings. First, the collected qualitative data were analyzed using deductive-inductive content analysis. Second, similarities and differences between the cases were identified to elaborate case-specific and cross-case patterns and themes. The reporting followed the EQUATOR reporting guideline for organizational case studies. Results We included four care units comprising 21 professionals (nurses, physicians, social worker, physiotherapist, pharmacist) and 14 relatives of residents living with dementia. The analysis revealed four categories to describe current intra- and interprofessional collaboration in all cases: actors and their roles, service delivery, coordination and governance, and communication channel. Moreover, we identified three categories that relate to the strengths and problems of intra- and interprofessional collaboration in all cases: role understanding, teamwork, and communication and exchange. Although we examined similar care units, we found differences in the realization of professional collaboration and resulting problems and strengths that are connected to the organizational contexts and strategies used. Conclusions Even though professional collaboration follows given patterns; these patterns do differ context-specifically and are perceived as problematic and fragmentary. Therefore, the identified differences and problems in collaboration need to be addressed in future research to develop and successfully implement tailored innovative care models.

The concept of social health has recently received increasing attention in dementia research. Various notions of what social health is and how it can be measured are circulating. They may pose challenges for comparing results and interpreting them for the development of interventions. This systematic review aims to classify existing instruments that measure various domains of social health. To achieve this, we applied a new multidimensional framework consisting of six key domains of social health. A systematic review was conducted following the PRISMA 2020 guidelines. PubMed/MEDLINE, PsychINFO, and CINAHL were searched for studies published between January 2000 and July 2023. A total of 227 studies (longitudinal, case–control, and cross-sectional cohort studies) with 102 single instruments were included. The search terms were as follows: (1) dementia (i.e., Alzheimer’s, cognitive impairment); (2) social health markers (i.e., decision-making, social participation, loneliness); and (3) instruments (i.e., tools, measures). The instruments are mainly self-reported, and the number of items ranges from 3 to 126. Despite the wide array of instruments available, most focus on individual domains of social health. We recommend the development of more conceptually robust instruments that can comprehensively evaluate psychosocial interventions and adequately capture all domains of social health.

Objective This study aimed to identify factors that hinder or facilitate the implementation of an exergaming technology, SilverFit Mile, which offers virtual cycling, for nursing home residents with dementia in and its potential impact on feelings of loneliness. Methods The study followed a descriptive qualitative approach using semi structured interviews with eight care professionals in nursing homes in the Netherlands and based on the Consolidated Framework for Implementation Research (CFIR). Thematic text analysis was used to analyze the interviews. Results We identified three main themes and twelve subthemes based on the CFIR. The main themes were residents’ personal characteristics, implementation factors, and loneliness. SilverFit Mile was more suitable for those familiar with cycling and those who enjoyed more solitary activities. Organizational factors such as staff's low digital literacy, lack of time, and need for training were found barriers to implementation, while facilitators included fostering social interaction. Conclusions SilverFit Mile was considered positively by care staff based on observations of persons living with dementia. We identified loneliness as a relevant outcome of SilverFit Mile implementation. We argue that SilverFit Mile can foster social interaction between residents and staff through reminiscence or the physical aspect of cycling. However, a better understanding of the connection between loneliness and the use of SilverFit Mile is needed. Overall, our research provides initial ideas about how exergaming technology might address loneliness in dementia.

Abstract Background This article examines the concept of autonomy in the context of person-centred dementia research and care, which is frequently being used but not clearly defined. Also, there is no clear conceptual relation between autonomy and personhood in this context. Methods Therefore, literature on person-centred dementia research and care was examined to answer the following question: How is the concept of autonomy discussed in person-centred dementia research and care literature? Results This analysis revealed heterogeneous perspectives on autonomy within the context of dementia. These were assigned to two different perspectives on personhood: one that links personhood to the existing cognitive abilities and the other one, that understands personhood relationally as the result of a socially constructed process. These results are discussed with regard to a nursing and care practice that could be considered as being deficit-oriented, but also with regard to the concept of social health in dementia. Conclusions Derived from this analysis, there is a clear need for general conceptual sensitivity in this field. Also, an in-depth examination of the social constructionist approach to personhood in the context of dementia is warranted.

Background: The policies and mission statements of nursing homes support the implementation of person-centred dementia care. The Dementia Policy Questionnaire assesses the content of person-centred dementia care in policies. To date, it is unknown whether these policies exist exclusively in dementia care units and whether the policies are consistent with the mission statements of nursing homes. Objective: We aimed to (1) investigate nursing home care unit types regarding the existence of policies measured by the Dementia Policy Questionnaire, (2) explore whether these policies are addressed in the mission statements of the nursing homes, and (3) integrate both results. Design: This is a convergent mixed methods study performed with a quantitative and qualitative dataset that was collected in the BeStaDem survey (2020). Setting: The BeStaDem survey included licensed nursing homes in Germany. Participants: A total of 134 nursing home administrators provided informed consent to participate in the BeStaDem survey. Methods: For quantitative data, we performed Fisher's exact test to identify differences in the Dementia Policy Questionnaire item distribution of several types of care units (aim 1). To support the results of Fisher's exact test, we additionally applied logistic regression analysis. For qualitative data, we analyzed the mission statements deductively with the qualitative content analysis method (aim 2). For integration, we used a convergent triangulation approach (aim 3). Results: The quantitative data collected from 134 German nursing homes show significant associations among person-centred dementia care policies, such as behavior assessment, and nursing homes with dementia care units. Regarding the qualitative data, of the 60 mission statements in total, eight mission statements of nursing homes with dementia care units exclusively address aspects such as dementia-specific interventions. The convergent triangulation approach shows that the answers given by the nursing homes in the quantitative survey are not always consistent with what they address in their mission statements. Conclusions: Nursing homes with dementia care units provide more person-centred dementia care policies than other care unit types do but mostly do not address these aspects in their mission statements. The implementation of person-centredness benefits from the existence of policies and mission statements if nursing homes clearly address what is meant by person-centred dementia care in their nursing home.

Objectives This review identifies and examines theoretical approaches (components and objectives) to person-centred dementia care in order to obtain a better understanding of what is meant by the concept of person-centred dementia care.Design Following the approach of Whittemore and Knafl, an integrative literature review was conducted to answer the following questions: (1) Which theoretical approaches to person-centred dementia care have been published? (2) What are the components of the theoretical approaches to person-centred dementia care thus identified, and which objectives can be identified?Data sources MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO) were searched through to 26 April 2021.Eligibility criteria We included any kind of published literature that describes theoretical approaches to person-centred dementia care and that was written in German or English.Data extraction and synthesis Two independent reviewers extracted data. Data were pooled using a data extraction form developed by the Joanna Briggs Institute. A qualitative content analysis was conducted.Results The analysis revealed heterogeneous perspectives within the identified approaches to person-centred dementia care. Statements pertaining to the components and objectives could be assigned to three different subcategories (microlevel, macrolevel and application level). This analysis enabled an enhanced understanding of how person-centred dementia care is currently described and whether and how the theoretical approaches differ in terms of their orientations and their focus on the individual and/or on sociality, which allows conclusions regarding the underlying conceptual idea of personhood.Conclusions There is a clear challenge for future research to overcome the dominance of the focus on the individual and to consider aspects of sociality to be at least equally important. This is needed in order to understand dementia as a multifaceted phenomenon that demands a differentiated consideration of theoretical notions of how to understand personhood in this context.

In this article, we explore how pet robots come into being in a Danish nursing home for people with dementia, based on five months of ethnographic fieldwork. We argue that the researcher and the robot become an assembled temporary figure in the nursing home: the woman with the dog. We show how pet robots are characterized by their fluidity and can go from being mechanical robots to living animals in a matter of seconds during interactions with nursing home residents. The social robots are fragile technologies that disappear and cease to be used if people in the nursing home stop caring for them. Through relationships, the pet robots come into being together with other actors in the nursing home – a process that requires tinkering (Mol, Moser, and Pols 2010) and flexibility from those working with the robots. We argue that the woman with the dog can develop caring relations with the residents, but although there are hopes that pet robots are one of the technologies that can save a welfare state and care system under pressure, this is not something that can be done by the pet robots alone. Rather, the robots need care and tinkering to become embedded in the nursing home.

Abstract Background To become a dementia-friendly hospital (DFH) is increasingly being discussed in health care practice, research, politics and society. In our previous integrative review, we identified six characteristics of DFHs. To thoroughly discuss and contextualize these characteristics in relation to hospitals in Germany, we involved professional dementia experts in our review process. Methods At the end of our review process, we involved professional dementia experts at the ‘contributing’ level of the ACTIVE framework to discuss and reflect on the six DFH characteristics we identified. We conducted a group process in the form of a one-day workshop. The workshop consisted of four steps: 1. presentation of review results (input), 2. modification of DFH characteristics and rating of their relevance in smaller working groups, 3. discussion of group results in plenary and 4. questionnaire for prioritization and rating of feasibility. The data were analyzed in MAXQDA using content analysis and descriptive statistics. Results A total of 16 professional dementia experts working in hospitals participated in the workshop. All the previously identified characteristics of a DFH were rated as relevant or very relevant for patients with dementia, their relatives and health care professionals from the professional dementia experts’ perspective. They made a few modifications of the six characteristics at the level of subcategories, aspects, and descriptions. The feasibility of the characteristics in hospitals was critically discussed regarding resources, hospital structures and processes, the role of nurses, and the current care situation of people with dementia in hospitals. More than half of the subcategories of the characteristics were considered very difficult or difficult to implement by most professional dementia experts. Conclusion The involvement of professional dementia experts helped us contextualize our review findings within the German hospital setting. These results highlight the need to consider resources, funding options, influencing factors, and the current situation and culture of care provided by hospitals before implementing DFH characteristics. Beside the involvement of professional dementia experts and various health care professionals, the involvement of other stakeholders, such as people with dementia and their relatives, is necessary in future research for the development of a DFH.

Abstract Background To provide an overview of the available evidence on the implementation of direct and capacity-building interventions to promote and maintain the functional mobility of nursing home residents. Methods We conducted a scoping review following the methodological guidance for the conduct of scoping reviews as described by the Joanna Briggs Institute. We searched for studies in MEDLINE (via PubMed) and CINAHL (via EBSCO). We conducted a qualitative content analysis of the included studies with deductive categories based on the Consolidated Framework for Implementation Research (CFIR). Results Ultimately, we included 8 studies on direct interventions, 6 studies on capacity-building interventions, and 2 studies on both types of interventions in our review. Seven studies provided evidence on implementation strategies comprising discrete as well as multifaceted, multilevel strategies. Most of the studies did not systematically evaluate the strategies but remained at a descriptive level. All 16 studies provided evidence of influencing factors. We identified 32 of the 37 influencing factors of the CFIR. The five most frequent influencing factors were available resources (n = 14), access to knowledge and information (n = 12), patient needs and resources (n = 10), knowledge and beliefs about the intervention (n = 10) and compatibility (n = 9). Conclusions The available evidence on the implementation of functional mobility interventions in nursing homes is rather limited. This emphasizes the need for further research. Regarding implementation strategies, the systematic evaluation and further development of the reported promising approaches might be a starting point.

Abstract Background Caring for people with dementia is complex, and there are various evidence-based interventions. However, a gap exists between the available interventions and how to implement them. The objectives of our review are to identify implementation strategies, implementation outcomes, and influencing factors for the implementation of evidence-based interventions that focus on three preselected phenomena in people with dementia: (A) behavior that challenges supporting a person with dementia in long-term care, (B) delirium in acute care, and (C) postacute care needs. Methods We conducted a scoping review according to the description of the Joanna Briggs Institute. We searched MEDLINE, CINAHL, and PsycINFO. For the data analysis, we conducted deductive content analysis. For this analysis, we used the Expert Recommendations for Implementation Change (ERIC), implementation outcomes according to Proctor and colleagues, and the Consolidated Framework for Implementation Research (CFIR). Results We identified 362 (A), 544 (B), and 714 records (C) on the three phenomena and included 7 (A), 3 (B), and 3 (C) studies. Among the studies, nine reported on the implementation strategies they used. Clusters with the most reported strategies were adapt and tailor to context and train and educate stakeholders. We identified one study that tested the effectiveness of the applied implementation strategy, while ten studies reported implementation outcomes (mostly fidelity). Regarding factors that influence implementation, all identified studies reported between 1 and 19 factors. The most reported factors were available resources and the adaptability of the intervention. To address dementia-specific influencing factors, we enhanced the CFIR construct of patient needs and resources to include family needs and resources. Conclusions We found a high degree of homogeneity across the different dementia phenomena, the evidence-based interventions, and the care settings in terms of the implementation strategies used, implementation outcomes measured, and influencing factors identified. However, it remains unclear to what extent implementation strategies themselves are evidence-based and which intervention strategy can be used by practitioners when either the implementation outcomes are not adjusted to the implementation strategy and/or the effects of implementation strategies are mostly unknown. Future research needs to focus on investigating the effectiveness of implementation strategies for evidence-based interventions for dementia care. Trial registration The review protocol was prospectively published (Manietta et al., BMJ Open 11:e051611, 2021).

Abstract Background Systematic reviews summarize and evaluate relevant studies to contribute to evidence-based practice. Internationally, researchers have reached a consensus that the active involvement of the public leads to better research. Despite this agreement, there are many reviews of research concerning healthcare interventions intended to promote the care of people living with dementia and those from their social network (e.g., close contacts, both family and non-family members) primarily involve only healthcare professionals and other experts. Due to the lack of a dementia-sensitive framework to actively involve people living with dementia and those from their social network, and healthcare professionals as co-researchers in systematic reviews, it is important to develop a framework to inform practice. Methods For this framework development process, we will recruit four people living with dementia and a total of four people from their social network, and three healthcare professionals working in acute or long-term care settings. We will conduct regular meetings with these groups of the public and healthcare professionals to include them in all stages of the systematic review. We will also identify and develop methods necessary to ensure meaningful involvement. The results will be documented and analyzed for the development of a framework. For the planning and preparation for these meetings, as well as the conduct of the meetings themselves, we will be guided by the principles of the INVOLVE approach. In addition, the ACTIVE framework will be used to guide the degree of involvement and the stage in the review process. Discussion We assume that our transparent approach to the development of a framework to support the active involvement of people living with dementia and those from their social network, and healthcare professionals in systematic reviews will serve as an impetus for and provide guidance to other researchers with the goal of increasing researchers’ focus on this topic and facilitating systematic reviews that apply participatory approaches. Trial registration: Trial registration is unnecessary as no intervention study will be conducted.

Abstract Background Currently, there is a lack of interaction between research and healthcare practice. As a result, research findings reach healthcare practice only late, and topics relevant to practice are often not known in research. Involving people living with dementia (PlwD), their relatives and healthcare providers in dementia care research can accelerate this process. For inclusion, firm and reliable structures are needed, which are to be established with the help of the Translational Network for Dementia Care Research in Germany. However, there is only limited knowledge about the priorities, expectations and conditions of stakeholders (healthcare providers and dementia researchers) for such cooperation within a network. Objectives The aim is to gather stakeholders' views on (i) future research topics to be addressed within the dementia care research network, (ii) the nature of collaboration within the network and (iii) the facilitating and hindering factors for establishing such a network. Methods Within an exploratory sequential mixed‐method study, we interviewed 87 stakeholders within eleven semistructured focus group interviews. The interviews were transcribed, pseudonymized and analyzed using qualitative content analysis. The qualitative data were analyzed with MAXQDA. Based on the qualitative results found in the focus group interviews, a supplementary online questionnaire was developed to prioritise and rank these findings afterwards. Results Stakeholders prioritized a comprehensible transfer of research results into practice, increased involvement of PlwD and their relatives (additionally marginalized groups such as people with a migrant background) in research and exchange between researchers. Cooperation should preferably occur in a regional context with local contacts, and the latest research results should be made available via an online database. The stakeholders' time, finances and human resources should be considered. Conclusion Stakeholders have partly similar preferences and goals for cooperation and involvement, emphasizing that such interaction in a network offers the possibility of long‐term, effective collaboration and added value for practice and research. Patient or Public Contribution For this study, dementia healthcare providers and dementia care researchers were asked about their perspectives. Their involvement is further elucidated in the manuscript text.

BackgroundSpecific challenges in the health care sector, such as hierarchical structures, shortages of nursing staff, and high turnover of nursing staff, can be addressed by a change process of organizational culture into shared governance. Data from business organizations show that the use of digital voice channels provides employee voice. This approach makes concrete the opportunity for employees to raise their voices by answering surveys and making comments in an anonymous forum, which subsequently positively influences staff turnover and sick leave. Since there is no clear understanding of how a digital voice channel can be used in long-term care to address employee voice, a research gap has been identified. ObjectiveThe purpose of ADVICE (Understanding Employee Voice Behavior; the acronym for this study) is to understand how the use of a digital voice channel performs in long-term care (residential long-term care and home care facilities). The aim of this study is to understand how the digital voice channel can support staff in making their voices heard and to see what managers need to use the voice channel to change the work environment. MethodsAn embedded multiple-case study will be used to explore the experiences of 2 health care providers who have already implemented a digital voice channel. ADVICE is organized into two main phases: (1) a scoping review and (2) an embedded multiple-case study. For this purpose, focus group interviews with employees, discursive-dialogical interviews with managers, meeting protocols, and data from the digital voice channel will be analyzed. First, all units of analysis from every embedded unit will be separately analyzed and then comprehensively analyzed to obtain a case vignette from every embedded unit (within-analysis). In the second stage, the analyzed data from the embedded units will be compared with each other in a comparative analysis (cross-analysis). ResultsThe results will provide insight into how digital voice channels can be used in long-term care to address employee voice. We expect to find how the digital voice channel can empower nurses to speak up and, consequently, create a better work environment. Data collection began in August 2023, and from a current perspective, the first results are expected in summer 2024. ConclusionsIn summary, the results may help to better understand the use of a digital voice channel in the health care sector and its transformative potential for leadership. At the organizational level, research can help to improve the attractiveness of the workplace by understanding how to give employees a voice. International Registered Report Identifier (IRRID)PRR1-10.2196/48601

Abstract Background Care counseling is an important psychosocial intervention for people with care needs and their relatives and can contribute to maintaining and/or improving a patient’s quality of life and reducing the burden of caregivers. This is especially the case for people with dementia and their relatives, in which the methods of care counseling need to be different than those for individuals with non-dementia related care needs. Furthermore, the counseling content needs to be adjusted to the specific form and stage of dementia. In Germany, every person who receives support per the German Social Law Book XI (SBG XI) can take advantage of care counseling according to §7a SGB XI. To date, there is no systematic overview of counseling services for people with dementia and their relatives related to this specific provision in Germany. Methods We conducted a gray-shaded scoping review with a focus on the evaluation of care counseling according to §7a SGB XI for people with dementia and their relatives. For this purpose, we applied five search strategies. We researched (1) national electronic databases, (2) Google, (3) targeted websites, (4) experts, and (5) academic electronic databases. Additionally, for the included gray literature, we conducted backward citation tracking via reference lists and forward citation tracking via Google Scholar for scientific articles. Screening of the identified potentially relevant records was performed independently by two reviewers. Results We identified 985 records and included 6 studies in our review. We divided the identified studies into three themes: understanding conceptual dimensions, digitalization of counseling, and understanding the perspective of those being counseled. No studies investigated the perspective and experience of people with dementia and their relatives regarding the counseling service according to §7a SGB XI. Conclusions Our results show that further research is needed, especially regarding the experience of people with dementia and their relatives who participated in counseling according to §7a SGB XI. It seems essential to understand the perspective of people with dementia and their relatives to improve and tailor counseling services in Germany. Registration The review protocol was prospectively published (BMJ Open 12:e059771, 2022).

Abstract Background Most people with dementia live at home and are supported by informal carers. During the care trajectory, the creation of a stable care situation is a guiding principle of informal carers, who often manage complex care arrangements. A recently developed theory – ‘Stability of home-based care arrangements for people living with dementia' (SoCA-Dem) – conceptualises how such care arrangements develop over time, and it highlights the relevance of the dyadic relationship, carer role, and resources with regard to the continuation of home-based care throughout the course of dementia. To further explore these three concepts, and to provide feedback for a further refinement of SoCA-Dem theory, this study aims to gain a deeper understanding of (1) how informal carers perceive their dyadic relationship, their carer role, and the resources of the care arrangement, and (2) how these concepts are interrelated. Methods This study was a secondary data analysis of n = 11 problem-centred interviews. Data were interpreted by a thematic qualitative text analysis. Results The findings distinguished subthemes within the concepts and uncovered their interrelations. The kinship relation, living situation and character of the dyadic relationship shaped informal carers’ self-conception of the carer role. This influenced the integration of resources into the care arrangement. Conversely, the quantity and quality of informal and formal support resulted in a feeling of relief or overload in the carer role, that shaped the informal carers’ way of living their dyadic relationship. The respective forming of the concepts had a significant impact with regard to the perceived stability or instability of the care situation in the examined care arrangements. Conclusions This study provided valuable evidence for future research alignment and targeted refinement of the SoCA-Dem theory. Scholars should further explore the specifics of spousal versus parent–child-dyads to better understand the dyads' diverse strategies in the creation of stable home-based care arrangements. Furthermore, future research should focus on the complex dynamics of dyads, family networks, and service providers, and all actors’ perspectives should be integrated in SoCA-Dem theory. Based on this growing knowledge base, innovative care interventions and structures should be developed to support people with dementia and their informal carers in better living and caring in the place of their choice.

Abstract Background To ensure the sustainable implementation of dementia-specific person-centred care (PCC) in nursing homes, internal policies are crucial. The preliminary German Dementia Policy Questionnaire, which features 19 dichotomous items, assesses the existence of and evaluates these policies. This article reports the results of an exploration of the construct validity of the preliminary Dementia Policy Questionnaire. Methods This study is a cross-sectional study that references a secondary data set drawn from a national survey study of a randomized, stratified sample of 134 nursing homes in Germany. To explore the construct validity of the preliminary Dementia Policy Questionnaire, we conducted an adjusted multiple correspondence analysis of the pretested 19-item assessment. We included data assessed using the preliminary Dementia Policy Questionnaire from 134 care units associated with 134 nursing homes; these data were collected via telephone interviews with nursing home administrators or their representatives. Results Two items assessing visitor regulations and regulations regarding the inclusion of residents in staff selection were less frequent and were therefore excluded from the adjusted multiple correspondence analysis. In total, nine items were assigned to two dimensions. The items assigned to the first dimension assess existing regulations for PCC as well as existing regulations regarding the involvement of the resident, relatives and the multiprofessional team in the collection of information concerning preferences, case conferences or decision making. The items assigned to the second dimension assess existing regulations regarding the systematic assessment of resident preferences and their requirements. Conclusion The study produces exploratory evidence concerning the preliminary Dementia Policy Questionnaire. Since the dimensions of the items included in this questionnaire cannot be conceptualized clearly, the instrument in its current state requires further development.

Abstract Background Most persons with dementia live at home and want to stay there as long as possible. In most cases, informal carers such as spouses or children care for them. Together with other family members and professional carers, they form care arrangements to address the complex needs of persons with dementia. One major aim of informal carers is to keep the care arrangement stable. The middle-range theory of ‘stability of home-based care arrangements for people living with dementia’ (SoCA-Dem theory) offers a theory to understand what constitutes and influences the stability of home-based care arrangements. Based on this theory, the aim of this study was to (1) uncover the underlying structures of differences and commonalities of home-based care arrangements for persons living with dementia, (2) construct types of these care arrangements, and (3) compare these types with regard to their stability. Method This is a secondary analysis of data from a convenience sample of n = 320 care arrangements for persons with dementia obtained in the observational DemNet-D study. Data were analysed using multiple correspondence analysis and hierarchical cluster analysis. Sociodemographic data and variables related to the structure of the care arrangement (D-IVA), burden of the informal carer (BICS-D), dementia severity (FAST), and quality of life of the person with dementia (QOL-AD) were included. Results The multiple correspondence analysis identified 27 axes that explained the entire variance between all care arrangements. The two axes ‘dementia and care trajectory’ and ‘structure of the dyadic relationship’ best distinguished care arrangements from each other and together explained 27.10% of the variance. The subsequent cluster analysis identified four types of care arrangements. Two types included spouse-centred care arrangements, and two types included child-centred care arrangements at different phases of the dementia and care trajectory. The types differ with regard to their stability. Conclusion The results highlight the heterogeneity and commonality of care arrangements for persons living with dementia. They contribute to a better understanding of informal dementia home care. Furthermore, the results can guide the development of tailored support for persons living with dementia and their caring families.

Introduction The positive influence of a well-designed built environment in dementia-specific care has been known for several years. Many studies focusing on the built environment have captured the perspectives of people living with dementia. However, it remains unclear to what degree and with which methods these individuals have been actively involved in research especially when attempting to understand their perspective. The planned scoping review aims to (1) synthesise methods and results from research about the built environment according to active involvement of people living with dementia and (2) describe facilitators and barriers to this active involvement to capture their perspectives in research.Methods and analysis We will use four search strategies: (1) searches in academic databases MEDLINE via PubMed, CINAHL and APA PsycINFO via EBSCO, and Scopus; (2) grey literature searches via Google Scholar; (3) handsearches of non-academic environmental planning and design journals and (4) identifying other publications of key authors in the field. Additionally, backward and forward citation tracking will be performed via reference lists and Google Scholar, respectively. Relevant literature published between 2013 and 2023 will be identified for data extraction and synthesis. One researcher will perform each strategy. Title-abstract/full text-screening will be conducted using Covidence by two researchers. Results will be displayed in a table and through figures illustrating identified facilitators and barriers.Ethics and dissemination We raised no ethical concerns for the planned scoping review. We will prepare the findings including the identified barriers with long-term care practitioners from our network to identify how changes in practical application methods can be addressed. This dialogue can serve as a basis for including people living with dementia to discuss highlighted barriers when researching their perspectives on the built environment. The scoping review results will be reported in both academic and non-academic journals and at academic conferences.

BackgroundIn the lives of people with dementia, loneliness is an important issue with psychological and physical consequences. Active assisted living (AAL) technology has been gaining visibility in the care of persons living with dementia, including addressing loneliness. However, to the best of our knowledge, there is a lack of evidence concerning the factors influencing the implementation of AAL technology within the context of dementia, loneliness, and long-term care (LTC). ObjectiveWe aimed to identify the familiarity with AAL technology that is promising for addressing loneliness in persons living with dementia in LTC in Europe and the factors influencing AAL technology implementation. MethodsA web-based survey was developed based on findings from our previous literature review. The Consolidated Framework for Implementation Research guided the development and analysis of the survey. Participants included 24 representatives of Alzheimer Europe member associations from 15 European countries. The data were analyzed using basic statistical methods (descriptive statistics). ResultsThe baby seal robot Paro was reported to be the most familiar AAL technology by 19 of 24 participants addressing loneliness in people with dementia living in LTC. Participants from Norway (n=2) reported familiarity with 14 AAL technologies, and participants from Serbia (n=1) reported zero familiarity. It seems that countries that invest less in LTC facilities are familiar with fewer AAL technologies. At the same time, these countries report a more positive attitude toward AAL technology, express a higher need for it, and see more advantages than disadvantages than those countries that invest more in LTC. However, a country's investment in LTC facilities does not seem to be linked to other implementation aspects such as costs, planning, and the impact of infrastructure. ConclusionsImplementation of AAL technology to address loneliness in dementia seems to be linked to familiarity with the technology in a country as well as national investment in LTC facilities. This survey confirms the literature on higher investment countries’ critical stance in regard to AAL technology implementation to address loneliness in persons living with dementia living in LTC. Further research is needed to clarify the potential reasons why familiarity with more AAL technology does not seem to be directly linked with acceptance, positive attitude, or satisfaction with AAL technology addressing loneliness in persons living with dementia.

Abstract Background/Objectives Dementia-friendly initiatives are becoming common in society, politics, and research, including health care. Regarding efforts to improve care for patients with dementia in hospitals, the term dementia-friendly hospital is being used increasingly. However, a theoretical understanding of this term and the underlying concept are missing. This integrative review aims to identify current descriptions of dementia-friendly hospitals and to analyze their characteristics. Methods An integrative review was conducted. The databases MEDLINE, CINAHL, PsycInfo, Cochrane Library, and additional resources were searched. Two reviewers independently screened publications for inclusion. We extracted data from the included publications and analyzed the descriptions of dementia-friendly hospitals using inductive content analysis in an iterative process. Results We identified 4191 records and included 34 publications on 17 descriptions of dementia-friendly hospitals. These were found in the context of practice projects (n = 8), recommendations (n = 6) and research (n = 3). Our analysis resulted in six characteristics of dementia-friendly hospitals. Characteristics related to the patients and their care are continuity, person-centeredness, consideration of phenomena within dementia and environment. Additional characteristics are valuing relatives and knowledge and expertise within the hospital. Conclusion Dementia-friendly hospitals are currently characterized more by healthcare practices and professional dementia experts than by the results of empirical studies. Additionally, the perspective of people with dementia is underrepresented in current descriptions. Accordingly, further research is needed that involves people with dementia in order to develop a theoretical understanding and suitable concepts of dementia-friendly hospitals, since their perspective is essential.

Aim: Evidence on effective communication in antenatal consultations between midwives and pregnant women is lacking. In a study, antenatal consultations implementation outcomes were evaluated. From the data, relevant aspects emerged concerning communication during consultations. This paper presents selected results and proposes a theoretical foundation for antenatal consultations. Design: A qualitative design. Methods: Semi-structured interviews were conducted with ten midwives, eight pregnant women, eight managers, and eight physicians in two hospitals. The interviews were audiotaped, transcribed, and analyzed with framework analysis using the following steps: 1) Familiarization; 2) Coding: first, inductive coding (open coding to identify new themes), followed by deductive coding (by theory-predefined codes); 3) Development and application of an analytic framework; 4) Data-charting in a matrix; and 5) Interpretation. Results: Amongst others, the following findings emerged from the data: communication about childbirth is influenced by the perceptions and conceptions of the midwife and the pregnant woman herself; pregnant women's degree of participation in the consultation process depends to a significant extent on the attitude of the midwife. Conclusion: To assure the success of consultations, we propose a consultation model comprising the following elements: the life world of the woman and midwife, the construction of a social reality, and the mediation of mutual goals, expectations, intentions, wishes, and beliefs.

Introduction The concept of personhood is particularly important in person-centred dementia care because its overall aim is to maintain the personhood of people living with dementia despite disease progression. In a previous review on autonomy for people with dementia, two different underlying concepts of personhood were identified: a rationalistic and a social constructionist concept of personhood. The present integrative review aims to (1) identify existing theoretical approaches in person-centred dementia care, (2) describe the constitutive components for these theoretical approaches, (3) report the goals and/or outcomes to be achieved by person-centred care for people living with dementia and (4) identify the underlying concepts of personhood.Methods and analysis For our integrative review the search terms were derived from the research questions and clustered according to the ‘PICo’ (Population, Interest, Context) framework. A systematic literature search for theoretical approaches of ‘person-centred dementia care’ will be performed on MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). The title/abstract and full-text screening will be performed independently by two researchers according to the inclusion criteria. The data analysis procedure will have two steps: (1) identification and extraction of general information (e.g., type of publication and name of theoretical approaches described) and (2) a qualitative content analysis to analyse the components, goals, outcomes and understanding of the respective underlying conceptions of personhood within the theoretical approaches. The extraction of general information (e.g., authors) will be performed by one researcher and qualitative content analysis will be performed independently by two researchers using MAXQDA software. Any disagreements will be resolved through discussion between the two researchers or, if no consensus can be reached, with all coauthors.Ethics and dissemination Due to the nature of a review, ethical approval is not required. We will disseminate our results in peer-reviewed journals and at (inter)national conferences.

Abstract Background Complex interventions in health care are characterized by multiple interacting components as well as by numerous nonlinear interactions with the social systems within which they are being implemented. The process of developing, evaluating and implementing complex interventions is therefore challenging. Established guidance such as the MRC (Medical Research Council) framework for developing and evaluating complex interventions refers to process evaluations as an integral part of the development of complex evidence-based interventions. Even though the need for process evaluations is recognized, the realization of such approaches is challenging because methodological instruction is sparse, and the phenomenon of interest is complex. A number of theoretical approaches indicating how to conduct process evaluations of complex interventions in health care exist, but a systematic and comprehensive overview of these is missing. Thus, the objective of the systematic scoping review described herein is to provide an overview and analysis of theoretical approaches suitable for the planning and conducting of process evaluations. Methods The design and conduct of this review will follow the procedures of a systematic scoping review. The search strategy will be developed following the BeHEMoTh (Behaviour of interest; Health context; Exclusions; Models or Theories) template which has been conceptualized for structured reviews of theory. The systematic search of the MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycInfo (via EBSCO) electronic databases will be complemented by “hand searching” techniques. Study selection, data extraction, and data analysis will be performed by tandems of two researchers independently of each other. Divergent decisions and judgements between the two researchers will be discussed by the whole review team. Discussion The findings from this scoping review will provide an overview and comparison of theoretical approaches suitable for process evaluations of complex interventions in health care. The review results will support researchers in choosing the theoretical approach that best fits the respective focus of their process evaluation study. Systematic review registration This study has been registered with PROSPERO (International Prospective Register of Systematic Reviews) under registration number CRD42020211732 .

Introduction Worldwide, our societies are characterised by increasing diversity, which is greatly contributed to by people who have migrated from one country to another. To provide person-centred care, healthcare staff need to consider the personal background, biography and preferences of people with care needs. Little is known about the care preferences of older migrants and minority ethnic groups. The purpose of this planned scoping review is to explore and systematically investigate current research addressing the care preferences of older migrants and minority ethnic groups. In addition, gaps requiring further research will be identified. To the best of our knowledge, this scoping review will be the first to synthesise the literature regarding the preferences in nursing care of older migrants and minority ethnic groups.Methods A scoping review will be conducted to identify and analyse the care preferences of older migrants and minority ethnic groups (population 60 years or older with various care needs). Based on the research aim, we will systematically search the electronic databases MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). We will include literature published in English and German with no restrictions regarding the publication date. The identified records will be independently screened (title/abstract and full text) by two reviewers. Data from the included studies will be extracted by one and verified by a second researcher. We will analyse the identified preferences with an inductive content analysis and will narratively present the review results in the form of tables.Ethics and dissemination There are no ethical concerns related to conducting this study. We will discuss our results with practitioners in the field of nursing care of older people with migration backgrounds. We will present our results and make them available to the public at (inter)national conferences and in the form of peer-reviewed and practice articles.

Abstract Background Dementia is regularly associated with behavioral and psychological symptoms of dementia (BPSD, also referred to as challenging behavior). Structured dementia-specific case conferences (DSCCs) enable nursing staff in nursing homes (NHs) to analyze and handle the BPSD of residents with dementia. The FallDem trial estimated the effectiveness of the structured DSCC intervention WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) in NHs in Germany. No significant change in the overall prevalence of challenging behavior was found. A multipart process evaluation was conducted to explain this result. Methods This qualitative process evaluation of the response of individuals, perceived maintenance, effectiveness, and unintended consequences was part of the multipart process evaluation that followed the framework by Grant et al. (Trials 14: 15, 2013). It used the data from semi-structured telephone interviews and focus group interviews with nurses and managers as secondary data. Selected domains of the Consolidated Framework for Implementation Research (CFIR) were used as deductive categories for a directed content analysis. Results The interviewees in all NHs appraised WELCOME-IdA as generating positive change, although it proved important that some adjustments were made to the intervention and the organization. Thirteen CFIR constructs out of the domains intervention characteristics, inner setting, and process proved to be essential for understanding the different course that the implementation of WELCOME-IdA took in each of the four NHs. This is reflected in three types of WELCOME-IdA implementation: (1) priority on adjusting the intervention to fit the organization, (2) priority on adjusting the organization to fit the intervention, and (3) no setting of priorities in adjusting either the organization or the intervention. Conclusion The unsatisfying results of the FallDem effectiveness trial can in part be explained with regard to the interplay between the intervention and the implementation which was revealed in the processes that occurred in the organizations during the implementation of the WELCOME-IdA intervention. Future implementation of WELCOME-IdA should be tailored based on an analysis of the organization’s readiness, resources, and capacities and should also define custom-made intervention and implementation outcomes to measure success. Furthermore, our results confirm that the CFIR can be used beneficially to conduct process evaluations.

Abstract Background All evidence-based knowledge and improvement strategies for quality care must be implemented so patients can benefit from them. In Germany, national expert standards (NES) contribute to quality care in nursing and midwifery. The NES defines for several action levels a dedicated level of quality, which is operationalized by structure, process, and outcome (SPO) criteria. An NES to promote normal childbirth was developed and implemented in 2014. The first action level involves midwife-led antenatal consultation (ML-AC) being conducted in a structured way. Most implementation processes aim to accomplish sustainability, but implementation studies rarely use definitions or a theory of sustainability, even when assessing sustainability. This lack led to the assumption that intervention sustainability after implementation is still a largely unexplored domain. The aim of this study is to investigate the sustainability of midwife-led antenatal consultation (ML-AC) implemented at two hospitals, in Germany. Methods In a qualitative approach, 34 qualitative interviews were conducted (between March and October 2017) using semi-structured interview guides. All interviews were transcribed verbatim, anonymized and analyzed thematically using framework method. Four groups of stakeholders in two hospitals offering ML-AC were interviewed: managers (n = 8), midwives conducting ML-AC (n = 10), pregnant women who attended ML-AC (n = 8), and physicians working in obstetrics (n = 8) at the hospitals. Results The interviewees identified key benefits of ML-AC on a personal and unit level, e.g., reduced obstetric interventions, easier admission processes. Furthermore, the participants defined key requirements that are needed for routinized and institutionalized ML-AC, such as allocating working time for ML-AC, and structural organization of ML-AC. All study participants saw a need to establish secure long-term funding. Additionally, the interviewed staff members stated that ML-AC topics need evaluating and adapting in the future. Conclusions Implementing ML-AC in the hospital setting has led to manifold benefits. However, reimbursement through the health care system will be needed to sustain ML-AC. Hospitals implementing ML-AC will need to be aware that adaptations of the NES are necessary to accomplish routinization and institutionalization. After initial implementation, sustaining ML-AC will generally require on-going monitoring and evaluating of benefits, routinization/institutionalization and further development.

Introduction Literature reviews represent an important type of study for the various professions in healthcare. The consideration and inclusion of grey literature is gaining importance in all types of reviews. However, searching for grey literature is challenging for different reasons and the search is often insufficiently transparently reported in reviews. The aim of this protocol is to describe our planned methodical approach for a scoping review with a specific focus on grey literature related to the topic of consulting according to §7a of the German Social Law, Book XI (SGB XI) for people with dementia and their relatives in Germany.Methods and analysis We will use the following search strategies: (1) search in the German electronic databases, for example, Livivo and GeroLit (via GBV), (2) google search engines, (3) targeted websites, for example, Alzheimer’s association and (4) contact experts, for example, stakeholders of private care insurance companies who provide consulting according to §7a SGB XI. Additionally, we will conduct a search in the academic electronic databases MEDLINE (via PubMed) and CINAHL (via EBSCO). For included grey literature, we will conduct a backward citation tracking via reference lists. For included scientific articles, we will conduct a backward (via reference lists) and forward (via Google scholar) citation tracking. Each strategy will be conducted by one reviewer. Screening of the identified potentially relevant records will be conducted in Covidence by two reviewers independently. Results will be charted in a table and illustrated descriptively.Ethics and dissemination There are no ethical concerns with conducting a scoping review. We will discuss our results regarding consulting according to §7a SGB XI for people with dementia and their relatives with a variety of stakeholders in Germany. We will disseminate the thematic results and the methodological reflection of our search approach in the form of articles in peer-reviewed and non-peer-reviewed journals.

Abstract Background The implementation of clearly structured dementia-specific case conferences could be an important tool to enable nursing staff to properly analyse and manage challenging behaviour in nursing home residents with dementia. A process evaluation of the responses of nursing homes to the implementation of WELCOME-IdA (Wittener model of case conferences for people with dementia – the Innovative dementia-oriented Assessment tool) was carried out to gain insight into which key elements of the intervention were adopted by the nursing homes and which elements were adapted. Methods This study was part of a larger process evaluation using a qualitative design. Thirty-four semi-structured telephone interviews and 15 focus group interviews were conducted in four nursing homes. The interviews were analysed using deductive content analysis, although inductive categories have been developed. Results Nursing home staff adopted the roles of moderator, case reporter, keeper of the minutes and reflection partner in WELCOME-IdA, but the selection of the staff members who filled these roles differed across nursing homes. The recommended group size of 5–8 participants per case conference was sometimes adopted. The key element of having core nursing teams who participated continuously in all case conferences was not adopted at all. Instead, there was a high level of rotation among staff members. The pre-defined process structure of WELCOME-IdA was adapted in such a way that the assessment of the residents’ behaviour and the selection of the relevant domain for the behaviour analysis were conducted in advance of the case conference. The evaluation of the interventions was also organized differently. Conclusion The scope of the response implies that WELCOME-IdA requires further adaptation to the requirements of nursing processes in nursing homes. The results provide important information on the selection of role keepers and offer insights into a) how knowledge of the structured training was circulated and transformed into self-organized case conferences and b) how knowledge was circulated throughout the entire processing of one case. Thus, these results can be used to optimize intervention and implementation. Overall, the intervention should allow more possibilities for tailored adaptation than it currently does.

Introduction Leisure activities appear to be an important factor in maintaining and improving health in old age. To better understand what people want to do when visiting an adult day service (ADS), it is important to systematically assess their preferences. Currently, there is no instrument for assessing preferences for leisure activities for people receiving ADS. Accordingly, the planned study aims to develop or modify and psychometrically test an instrument to assess leisure activities preferences for use with people receiving ADS.Methods and analysis A mixed-method design with a participatory research approach was chosen for this study (Preferences for Everyday Living-Deutschland, PELI-D II). In the first step of this study, leisure activities will be identified on the basis of an evidence map. In the second step, the results from the evidence map will be empirically supplemented, and leisure activities will be categorised and prioritised within a concept mapping approach by people who receive ADS. Subsequently, based on this categorisation, either an instrument that was piloted in a previous study (PELI-D I) will be modified or an instrument with a focus on preferences for leisure activities in ADS will be explored. In the last step of this study, the instrument will be psychometrically tested. Data will be analysed via content analysis as well as descriptive and inferential statistics and statistical tests. The results will be presented in various tables and graphs (eg, pattern matching).Ethics and dissemination This study was approved by the ethics committee of the Witten/Herdecke University (application number 226/2020). The results will be made available to the public at (inter)national conferences, in peer-reviewed articles and in articles for practitioners.

Introduction Consideration of the preferences for everyday living of older people with various care needs is a prerequisite for person-centred and evidence-based nursing care. Knowledge of and respect for these preferences by nursing staff are associated with better care outcomes for older people with various care needs. To assess preferences in a structured way, instruments focusing on different topics of everyday living appear to be useful. It is unclear which instruments exist for assessing preferences for everyday living. The aim of this planned review is to identify relevant instruments for assessing the preferences for everyday living of older people with various care needs in the form of an evidence map. Additionally, gaps requiring further research will be presented.Methods and analysis To identify the different instruments, we will conduct a systematic search in the electronic databases MEDLINE (via PubMed), CINAHL and PsycINFO (via EBSCO). In addition, we will perform backward and forward citation tracking via reference lists and Google Scholar. The identified records will be independently screened (title/abstract and full text) by two reviewers. Data from the included studies will be extracted independently by the same two reviewers. In all three steps, the results will be checked for deviations, and if there are any deviations, they will be discussed. If no consensus can be achieved through discussion, a third reviewer will be engaged. All study designs will be included, and there will be no limitations regarding the publication status or time period. We will include all studies published in English and German that use instruments focusing on the assessment of preferences for everyday living in people older than 60 years of age with various care needs. For data charting, we will extract the number, categories and types of preferences, the care setting for which the instrument was developed and, if available, psychometric properties. Finally, the various extracted results will be presented in the form of tables and a bubble plot.Ethics and dissemination There are no ethical concerns related to the construction of an evidence map, and ethical approval was given by the Witten/Herdecke University (application number 226/2020). We will discuss our results with practitioners in the field of nursing care and persons with various care needs. We will also make our results available to practitioners in an upcoming Project (PELI-D II) and to the public at (inter)national conferences and in the form of practice and peer-reviewed articles.

Introduction Various evidence-based interventions are available to improve the care of people with dementia in different care settings, many of which are not or are only partially implemented in routine care. Different implementation strategies have been developed to support the implementation of interventions in routine care; however, the implementation of complex interventions remains challenging. The aim of our reviews is to identify promising strategies for, significant facilitators of and barriers to the implementation of evidence-based interventions for very common dementia care phenomena: (A) behaviour that challenges supporting a person with dementia in long-term care, (B) delirium in acute care and (C) the postacute care needs of people with dementia.Methods and analysis We will conduct one scoping review for each preselected dementia care phenomenon (A, B and C). For this, three literature searches will be carried out in the following electronic databases: MEDLINE (via PubMed), CINAHL (via EBSCO) and PsycINFO (via EBSCO). Additionally, we will perform backward and forward citation tracking via reference lists and Google Scholar. Identified records will be independently screened by two reviewers (title/abstract and full text) using the defined inclusion criteria. We will include all study designs and publications in the German or English language. For the data analyses, we will conduct a deductive content analysis using two different analytical approaches: Expert Recommendations for Implementation Change and the Consolidated Framework for Implementation Research.Ethics and dissemination Due to the nature of a review, ethical clearing is not required. We will disseminate our results in peer-reviewed journals, workshops with stakeholders, and (inter)national conferences.

Abstract Background A system of dementia-specific case conferences (WELCOME-IdA) was evaluated using a stepped-wedge design in six nursing homes (NHs) to enable nursing staff to analyse properly the behavioural and psychological symptoms (BPSD) of residents with dementia. A process evaluation of the context, the recruitment and target populations reached (residents and nursing staff) and the delivery of the intervention and implementation strategy was carried out to explore the lack of effectiveness of WELCOME-IdA on the residents’ prevalence of BPSD. Methods This study was part of a larger process evaluation using a mixed-methods design. Standardised questionnaires, semi-structured interviews, attendance lists, standardised protocols and written self-reports were used to collect the data. The quantitative data were analysed by calculating descriptive statistics. The qualitative interviews were analysed using deductive content analysis and the self-reports were analysed using a documentary analysis. Results None of the NHs had prior experience with dementia-specific case conferences on a specific concept related to BPSD. The number of residents for whom a dementia-specific case conference was held was lower than expected. The number of nursing staff reached was high, although as defined in the study protocol, core nursing teams continuously participating in all components of the intervention were not established throughout the study. An analysis of the delivery of the intervention showed a reduction in the frequency of dementia-specific case conferences and deviations in the process structure and role structure of WELCOME-IdA. The strategy used to facilitate the implementation of WELCOME-IdA was mostly followed. An analysis of the recruitment of residents indicated that the variation in which residents were included in the study sample was high and that the intended sample size required to achieve a power >80% was not reached. Conclusion An analysis of the process evaluation data indicated that there were inaccuracies in the implementation of WELCOME-IdA and there were methodological limitations within the design of the effectiveness trial, both of which could explain the lack of effectiveness of WELCOME-IdA. To optimise the process structure of WELCOME-IdA, an assessment of BPSD and a pre-selection of possible domains for the behavioural analysis could be conducted prior to a dementia-specific case conference. Trial registration ISRCTN20203855. Registered on 10 July 2013.

Background Most people with dementia and their informal carers live at home and strive to create a stable care situation for as long as possible. This preference of dyads is consistent with the global policy of ageing in place. Therefore, we aimed to develop a middle-range theory of stability guided by two research questions: How is stability of home-based care arrangements for people living with dementia constituted? What are the essential factors influencing stability?Methods Within the 'Stability of home-based care arrangements for people living with dementia' project (SoCA project) at the German Center for Neurodegenerative Diseases (DZNE), we conducted a meta-study on mixed research. The analytical steps of meta-data analysis, meta-method and meta-theory are merged in an integrative synthesis. Eligible publications were identified through systematic database searches (MEDLINE, CINAHL and PsycINFO; last searched on 3 January 2017), backward/forward citation tracking and snowballing. All publications were screened against predefined inclusion criteria and evaluated through a quality appraisal. The analytical approach was thematic synthesis.Results 99 publications were included. The middle-range theory conceptualises stability as a complex phenomenon comprising three components including eight concepts that are dynamically inter-related. The conceptual model visualises: (1) the trajectory of the dementia care arrangement, which involves a cyclic process of change and balancing over time; (2) the characteristics of the care arrangement, including needs, the carer role, the dyadic relationship and resources; and (3) the context, which is determined by society and culture and the respective healthcare system. The relevance of each concept in relation to stability changes over time. The forming of each concept is actively shaped by the informal carer.Discussion This middle-range theory provides a thorough understanding of the stability of home-based care arrangements for people living with dementia and can be used to guide future research and practice.Other This meta-study was funded by the DZNE and registered in PROSPERO (registration number CRD42016041727).

Background Dementia special care units represent a widely implemented care model in nursing homes. Their benefits must be thoroughly evaluated given the risk of exclusion and stigma. The aim of this study is to present an initial programme theory that follows the principles of realist methodology. The theory development was guided by the question of the mechanisms at play in the context of dementia special care units to produce or influence outcomes of interest in people with dementia. Methods The initial programme theory is based on qualitative interviews with dementia special care stakeholders in Germany and a realist review of complex interventions in dementia special care units. The interviews were analysed using content analysis techniques. For the realist review, a systematic literature search was conducted in four scientific databases; studies were appraised for quality and relevance. All data were analysed independently by two researchers. A realist informed logic model was developed, and context-mechanism-outcome (CMO) configurations were described. Results We reviewed 16 empirical studies and interviewed 16 stakeholders. In the interviews, contextual factors at the system, organisation and individual levels that influence the provision of care in dementia special care units were discussed. The interviewees described the following four interventions typical of dementia special care units: adaptation to the environment, family and public involvement, provision of activities and behaviour management. With exception of family and public involvement, these interventions were the focus of the reviewed studies. The outcomes of interest of stakeholders include responsive behaviour and quality of life, which were also investigated in the empirical studies. By combining data from interviews and a realist review, we framed three CMO configurations relevant to environment, activity, and behaviour management. Discussion As important contextual factors of dementia special care units, we discuss the transparency of policies to regulate dementia care, segregation and admission policies, purposeful recruitment and education of staff and a good fit between residents and their environment.