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The purpose of this paper is to consider the experiences and perspectives of residents with dementia living in a care home.

The paper reviews current sources of evidence about “the care home experience”, including material drawn from: research instruments, interviews, observational methods and phenomenological research which aims to capture the lived experiences of residents.

Research that is attempting to capture the lived experiences of residents further adds to the understanding of quality of life (QoL) and quality of care. Specifically, residents prioritise non‐disease‐related domains of QoL, which is somewhat different than those identified by relatives, care home staff and “objective” measures.

Not only is it evident that residents are able to describe aspects of their situation but they appear to retain a sense of self and identity. There is a distinctive need for assessment of QoL amongst residents with dementia that places their subjective view of this concept at its core.

The purpose of this paper is to explore evidence about the role played by micro-cultures in long-term care (LTC) settings in shaping residents’ mental health and wellbeing.

A scoping review on micro-cultures in LTC, including database search of academic and grey literature using pre-determined combinations of key terms and specific inclusion/exclusion criteria. The review followed the methodological framework of Arksey and O’Malley (2005).

Micro-cultures (localised, distinctive cultures of a small group of people) in LTC are complex, multi-faceted and multi-directional; they include social dynamics as well as structural and environmental factors. Although much work has been done on the nature of micro-cultures, limited work has focused on LTC for older people. Initiatives to promote the mental health and wellbeing of residents rarely consider micro-cultures in any holistic way; they tend to be taken into account either as part of a contextual backdrop, or as a uni-directional process often equated with the concept of “care culture” or “organisational culture”.

The role played by micro-cultures in influencing the mental health and wellbeing of older people living in LTC settings is significantly under researched. The findings of this review suggest that their complexity and multidimensionality challenges researchers. However if the authors are to develop interventions that promote the mental health and wellbeing of residents it is important to invest in work to explore their nature and systemic influence.

Caring in Later Life is a review of the needs and roles of older carers (Milne et al, 2001). It brings together a wide‐ranging review of academic and policy literature with an original meta‐analysis of the 1995 General Household Survey (OPCS, 1995). This paper focuses on the findings of the GHS analysis. The picture of older carers that emerges is significantly different from that of carers overall.It is clear that older carers constitute a large and growing number of the carers and represent an increasingly large proportion of the total number of UK carers. They can be distinguished from other groups of carers in a number of ways: older carers are more likely to live with the person they care for, caring is likely to take place within the context of a long term relationship, dementia is a dominant feature and carers are more likely to be involved in intimate and personal care. Many also have health problems of their own. The analysis confirms a distinction between older carers who offer support on a co‐resident basis and those who are extra resident. There is clearly a high level of devotion to caring amongst many co‐resident carers, with many providing intensive care over long periods of time with little or no support from services. Most of these carers are spouses. The authors suggest that more should and can be done by policy and services to improve the health and quality of life of older carers.

The number of older Asians in the UK is increasing placing greater numbers at risk of developing dementia. The emerging need to address early diagnosis is especially prominent in areas where Asian communities are long established. This was the specific focus of a Dementia Collaborative Project in North West Kent. The project, working through a primary care practice, aimed to raise awareness of dementia and to facilitate early intervention and access to specialist dementia services. Using an evaluation methodology adopted by the Collaborative and working through a multiagency steering group, the pilot project successfully identified an appropriate primary care practice, established a link with a specially trained Asian nurse and devised a set of project materials. By inviting older Asian patients with memory problems to make an appointment with the nurse, and enclosing a culturally relevant information leaflet, older people were encouraged to come forward. Although the number of individual patients identified was small, the project outcomes include: significantly increased referral rates from black and minority ethnic communities to specialist services and greater awareness of dementia‐related issues in both primary care and Asian care services. Overall, the evaluation suggests that by engaging with a committed primary care practice it is possible to engage a hitherto marginal group of older people in early intervention in dementia and raise awareness about its benefits. That this approach underpins the development of a larger scale five year project in the same area additionally endorses its relevance for the mainstream population.

This paper presents the findings of two research projects focusing on sharing a diagnosis of dementia. The first paper analyses the attitudes of GPs towards early diagnosis and the second explores the user experience of receiving a diagnosis (Milne et al, 2000; Pratt & Wilkinson, 2001). The authors draw upon these ‐ as well as wider research ‐ in suggesting ways that diagnostic practice can be improved by taking account of the user perspective. The findings are relevant to all those professionals working in a primary care context.

Protecting my mother offers a moving account of a daughter's experiences of her mother's placement(s) in long term care and her exposure to poor care and/or abuse. The article highlights a number of the key features of the care of nursing home residents that need to addressed if standards are to improve and abuse become a rarity. The very dependent and frail nature of most residents renders them vulnerable to receiving poor care which may, if unchecked, become routinised abusive or neglectful practice. Risk is compounded for residents with dementia who often have limited communication skills and high levels of need. The fact that most residents are not known by care staff on admission is a primary challenge to offering good care, an issue that is compounded by a focus on tasks rather than relationships. The combined impact of dependency on staff for survival and having no, or few, opportunities for advocacy places residents in a profoundly powerless position to complain about mistreatment. This experience is mirrored by relatives. A primary deficit is that the emotional well‐being of residents is given limited attention by the care home sector or agencies tasked with inspecting them. Raising the status of care home work; improving pay, conditions and training; and embedding person‐centred values in care home practice are key to raising standards. Ensuring that all residents have access to an advocate and improving the capacity of safeguarding systems to address abuse in care homes are also important elements of reducing risk.

Despite evidence that early identification of dementia is of growing policy and practice significance in the UK, limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice‐based evidence on the utility, efficacy and quality of dementia screening measures. The study has three elements: a review of research literature; a small‐scale survey of measures employed in three primary care trusts; and a systematic clinical evaluation of the most commonly used screening instruments. The authors integrated data from research and clinical sources. The General Practitioner Assessment of Cognition (GPCOG), Memory Impairment Screen (MIS) and Mini‐Cognitive Assessment Instrument (Mini‐Cog) were found to be: brief; easy to administer; clinically acceptable; effective; minimally affected by education, gender, and ethnicity; and to have psychometric properties similar to the Mini Mental State Examination (MMSE). Although the MMSE is widely used in the UK, this project identifies the GPCOG, MIS and Mini‐Cog as more appropriate for routine use in primary care. A coherent review of evidence coupled with an in‐depth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

About five per cent of ‐ generally very frail ‐ older people live in long‐term care in the UK; approximately a fifth of all deaths occur in care homes. Depression and dementia are prevalent mental health conditions in care homes; depression is reported in around a third of residents and dementia in two thirds. While there is some evidence about efficacy of medication in treating psychiatric and behavioural symptoms among residents, much less is known about the potential role of psychosocial interventions in enhancing mental health and quality of life. Quality of care varies widely across the carehome sector including support from primary and specialist health and quality and level of training. In terms of enhancing care quality, there is evidence that investing in staff training and conditions, establishing good links with healthcare providers, and developing care standards that genuinely promote good practice are likely to improve resident quality of life. This is an exciting area for research development and practice innovation for the future; taking account of users perspective, holds particular potential.