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This study aims to draw together what is known regarding the characteristics and context of adult family violence, and to consider what practitioners and organisations in the UK might learn from the literature.

This study reviews literature on adult family violence and parricide and includes illustrative cases from a study of domestic homicide review reports involving older adults.

Adult family violence most often involves mothers killed by their adult sons. Mental health issues, alcohol/substance misuse and criminality are common themes for perpetrators. Caregiving responsibilities is a theme for both victims and perpetrators. Previous research identified two main categories of adult family homicide: perpetrators with major psychotic illness, and victims-perpetrators in complex relational contexts.

This study considers how practitioners respond to situations of adult family violence and learning for policymakers, agencies and practitioners.

This paper summarises what is known, argues that more research is needed and suggests practical ways forward for policymakers, relevant agencies and practitioners.

The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).

The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.

NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.

The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.

NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.

NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.

This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.

Over the past few years there has been increasing interest in the importance of spirituality for those in the fourth age of life in care settings. The emphasis on person‐centred approaches has led to recognition of spiritual needs as well as the need for spiritual assessment and care planning. In this paper we reflect on what makes life worth living at different stages, and review the spiritual needs of the fourth age in relation to those inner needs with which many of us would identify.We suggest that several approaches are required in order to understand and meet the spiritual needs of people in the fourth age. While a person‐centred approach is essential, much can also be gained from a broader understanding that places the older person in the context of the wider community. Spiritual and other needs may be met through addressing social inclusion.If we are to properly understand and meet the spiritual needs of those in the fourth age, both in the community and in care settings, we need a new paradigm. The insights and practice tools developed in other areas (through the Valuing People and social inclusion agendas) could provide a useful framework to assist in meeting the spiritual needs of the fourth age. This paper aims to contribute to, and extend, the debate about meeting spiritual needs of people in care settings.

Through consultation with people living with dementia and carers, this paper aims to identify skills that patients and carers feel need to be developed in the workforce. This work is part of a project to develop competencies for the West Midlands dementia workforce.

People living with a dementia and carers were contacted through cafés, a carers' group and memory group, and two people contributed interviews to the analysis. All materials were analysed qualitatively using thematic analysis.

Feedback was received from 69 individuals. In total, six major themes were identified: knowledge about dementia, person centred care, communication, relationships, support and helping people engage in activities.

It is argued that people living with dementia and carers bring unique and valuable perspectives to an analysis of the skills of the dementia workforce, which grounds the required skills in the relationship between the worker and the person and family they are working with. This different emphasis needs to be considered and addressed throughout dementia training and education.

The important initiative from the Department of Health (Working Group on Copying Letters to Patients, 2002) to require that letters between clinicians should be copied to the patient has not been implemented as widely as was intended. There have been concerns about logistics and fears that patients might be confused or frightened by communications they are not equipped to understand. Yet, modifications of the system to allow patients the choice to receive or not receive such letters and suitable training for clinicians offer safeguards. There is no doubt that copying letters provides an inexpensive mechanism for involving patients in their own care and treatment, offering transparency and confirming respect for equality in the relationship between patient and clinician. This paper reports experience with copying letters to patients and families with dementia. The process was warmly received by patients and carers, including families in a black and minority ethnic (BME) community, and few adverse comments were made. The routine application of this initiative will have benefits for the quality of service experience for older people, including those with dementia.

The Royal College of Psychiatrists set up an interface group to look at the interface between old age psychiatry and learning disability and, as part of its work, the group commissioned a survey of learning disability and old age psychiatrists to investigate their experience of working across the boundary between the two specialities. This paper is based on the report produced. It summarises the findings of the survey and sets out eight recommendations to further the work. There was no clarity on how services should be provided to older people with a learning disability who develop a mental health problem in later life but the need for collaboration between the two specialities is compelling.

This paper describes a service improvement project with two aims: to identify and screen all adults with Down's syndrome aged over 30 years in a defined locality using a standardised instrument to establish functional baselines; and to set up a database to facilitate early diagnosis of dementia in this population.

An assistant psychologist used a standardised instrument to screen participants who were identified through contact with health, social, and third sector, and housing services.

Eligible people were identified and screened using an informant‐based measure. Three groups were identified: group 1 showed no significant change; group 2 showed significant change but no signs of dementia; and group 3 showed significant change plus signs of dementia. People with suspected dementia were referred on for further investigation/assessment and supportive services.

Terminology is important in engaging families in a screening project, as is the opportunity to provide information. A proactive screening project can be established by employing working partnerships between intellectual disability and older adult services to aid diagnosis.

Adults with Down's syndrome aged over 30 years in a defined locality can be identified through contact with health, social, and third sector, and housing services. Those identified can be screened using a standardised instrument and a database of screening results established in order to establish baselines against which future re‐screening can be conducted. Partnership working between older adult mental health services and intellectual disability services can improve the diagnostic service to adults with Down's syndrome.

The pattern of prosecutions forfood offences has changed very little in the past decade. Compositional offences have rarely exceeded 5 per cent and, since the 1967 batch of regulations for meat products, are mostly in respect of deficient meat content. Food hygiene offences have also remained steady, with no improvement to show for all the effort to change the monotony of repulsive detail. The two major causes of all legal proceedings, constituting about 90 per cent of all cases—the presence of foreign matter and sale of mouldy food—continue unchanged; and at about the same levels, viz. an average of 55 per cent of the total for foreign matter and 35 per cent for mouldy food. What is highly significant about this changed concept of food and drugs administration is that almost all prosecutions now arise from consumer complaint. The number for adulteration as revealed by official sampling and analysis and from direct inspectorial action is small in relation to the whole. A few mouldy food offences are included in prosecutions for infringements of the food hygiene regulations, but for most of the years for which statistics have been gathered by the BFJ and published annually, all prosecutions for the presence of foreign matter have come from consumer complaint. The extent to which food law administration is dependent upon this source is shown by the fact that 97 per cent of all prosecutions in 1971 for foreign bodies and mouldy food—579 and 340 respectively—resulted from complaints; and in 1972, 98 per cent of prosecutions resulted from the same source in respect of 597 for foreign matter and 341 for mouldy food. Dirty milk bottle cases in both years all arose from consumer complaint; 41 and 37 respectively.