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Mental health problems in old age have attracted policy attention in the UK over the past decade. An important issue is how to improve services for people who have both mental health and other problems. This article sets out some of the challenges facing planners and commissioners in developing integrated services for older adults, by using the case study of people with dementia and incontinence problems. It uses integrated service models and observations from the EVIDEM‐C study to suggest some incremental actions that would help develop the long‐term strategy for integrated services.

The purpose of this paper is to discuss the question of how to meet the needs of older people living at home with dementia who have problems with continence. The paper is focused on social care practice in community settings.

This paper is practice focused and draws on the authors’ research and experiences in clinical care, workforce development and service improvement.

This paper summarises research on incontinence and its negative effects on quality of life and care relationships. It describes the impact of incontinence in terms of social embarrassment, restricted social activity, extra work (such as laundry) and costs, but also distress. It links research with care practice, with a focus on people with dementia who may be at particular risk of both continence problems and of assumptions that nothing can be done to assist them.

This paper provides questions that could be addressed in commissioning and provision of services and argues that they need to be informed by care practitioners’ experiences. It provides details of sources of support that are available at national and local levels.

This paper draws together research on continence and social care practice to provide a series of self-assessment questions for local services. It focuses on social care workers who are at the frontline of practice including personal assistants and carers.

The purpose of this paper is to examine the impact of a practice development program, “Essentials of Care” (EOC), on patient and staff outcomes, workplace culture and service delivery.

A descriptive study design was used to explore the impact of EOC in a district hospital rehabilitation ward. EOC focuses on embedding a person-centered culture within clinical areas and is structured from practice development methodologies. EOC was implemented in a metropolitan district hospital rehabilitation, older person 20-bed, ward.

Two projects were implemented during EOC. These projects led to nine significant patient and staff outcomes for medication and continence care practices. Outcomes included a reduction in older person complaints by 80 percent, pressure injuries by 62 percent, ward multi resistant staphylococcus aureus infection rates by 50 percent, clinical incidents by 22 percent, older person falls by 14 percent (per 1,000 bed days) and nursing sick leave by 10 percent. There was also a 13 percent improvement in the post nursing workplace satisfaction survey.

This is a single site study and findings may not be suitable for generalizing across ward settings and broader population groups.

The EOC program led to significant improvements for and in clinical practices, staff satisfaction and ward culture. Specifically, the EOC program also identified significant cost savings and brought together the healthcare team in a cohesive and integrated way not previously experienced by staff. Practice development strategies can champion service quality improvement, optimal patient outcomes and consistency within healthcare.

Many of the great cities of the ancient world had public toilets. It was not until Victorian times that they appeared in any large numbers in this country: the 1848 Public Health Act called for ‘Public Necessaries’ to be provided to improve sanitation. In recent years, public toilet closures have attracted much attention. Here, Pamela Holmes discusses the effects of incontinence on older people and argues that changes in approach can make a real difference to the quality of life for many older people.

This paper presents the results of a study evaluating a complete autonomous smart home installation in an apartment in a care home, and the impact it had on the behaviour and independence of someone with quite severe dementia (Mini Mental State Examination, or MMSE, of 10). It describes the technology that has been evolved for this purpose, and how the apartment was configured. The evaluation compared the behaviour of the resident before and after the switching on of a wide range of autonomous support technology, by analysing the logged sensor data, through a questionnaire‐based outcome measure, and through transcribed interviews. The technology enabled the client to retain a lot of independence. It helped him to regain urinary continence, improved his sleep from around 3.5 hours per night to 5.5, and halved the number of night‐time wanderings. The paper concludes with a series of recommendations for future work in this area.

What gets measured gets done” goes the cliché. Therefore, it is imperative for corporate communicators to understand the measurement of persuasive communication, starting with its antecedents. This paper will highlight the link between audience awareness/behavior and persuasive communication through an examination of how 1920s practitioners studied the effect their communications materials (specifically film and print brochures) had on key audiences.

The author used the cultural-economic model (CEM) of public relations (PR) as a framework to examine the various socio-cultural organizational factors that affected the production and the consumption of communication materials and messages.

The intent and techniques of PR measurement have not changed much in 100 years. A contemporary practitioner might conduct a study of communications materials in a similar manner as the 1920s social hygienists, and this study adds the concept of human agency to the discussion of PR measurement. This is not to engage in historical presentism and judge past practitioners on current standards. Instead, it is a call for contemporary practitioners to take a deeper look at the moment of consumption and all the variables that go into meaning making.

Most of the field's historical case studies focus on the production of communication messages and materials, while this paper examines those facets as well as audience consumption. Implications for contemporary practitioners are discussed.

The purpose of this paper, practice-based mixed methods small-scale study, is to explore the design features of a “dementia friendly” acute ward environment and, staff views on the implications of daily activity engagement for patients with dementia.

Eight staff members of the multidisciplinary team who work full time on an acute “dementia friendly” ward completed semi-structured questionnaires. Thematic analysis explored responses to the open-ended questions, and a further environmental assessment tool rated features of the “dementia friendly” ward design, on promoting aspects of well-being in patients with dementia.

Six overarching themes were found. These included: contrasting ward colours; clear ward signage; positive staff interaction; memorabilia, and activity rooms and items, had a positive influence on patient interaction, well-being and engagement in daily activities. The audit scores were rated highly for various aspects of the ward design. These included: the ward design promoting patient interaction, well-being, mobility, orientation, continence, eating and drinking and calm and security.

This practice-based small-scale study highlights the importance that a “dementia friendly” ward environment may have on patient engagement and well-being, from a daily activity perspective. Further research into the key aspects of design that enable meaningful daily activity engagement is required.

This study supports staff perceived views of the positive influence that “dementia friendly” design may have for patients with dementia. Both the physical design modifications of the ward and staff interaction were highlighted as positively influencing patient well-being, and daily activity engagement. Staff members also felt that they needed to balance the clinical ward priorities, with the contextual requirements of patients with dementia, to establish an effective “dementia friendly” ward.

The value of this research is the combined consideration of an environmental assessment tool and qualitative interviews with members of the multidisciplinary team.

The social ritual of apology is highly nuanced in Western cultures. At its profoundest, it represents felt and displayed feelings of remorse for injuring another party and transgressing a central moral code. The felt regret is accompanied by a strong impulse to right the wrongs caused. The absence of such apology is taken as denial or devaluation of the moral worth of the harmed party, hence the restorative significance of a sincere apology. The restoration, however, is likely to be more symbolic than literal for a deep hurt, as the injury itself cannot be reversed. What is restored by the apology is the dignity of the victim; recognition that they should not have been treated in the way they have been. The moral and relational value of such apologies is nicely captured by Kathleen Gill:The apology is not a thing; it is an act that displays a certain set of beliefs, attitudes, etc. experienced by the offender. More importantly, an apology is not a mechanism for offsetting losses. The apology does not compensate for loss; it is instead a way to acknowledge the value of what was lost. ( Gill, 2000, p. 16 )It follows that this kind of apology implicates emotions beyond feelings of remorse and regret. It involves the expression of feelings of empathy and shame, the former placing the perpetrator in the victim's shoes, the latter signaling ownership and responsibility for having crossed a moral line — and wishing to do something about it. Yet what is felt has also to be performed, and convincingly so if the apology is to provide what Goffman terms a “remedial exchange” (Goffman, 1971). Acts of apologizing are in part cultural and in part institutionalized. In the traditional Catholic Church, for example, the apology ritual contains a confession of sins, plus an act of prayer or restoration to the wronged party. It once also involved penances, such as fasts, sexual continence, pilgrimages, or floggings.