Background: Very many social care clients have dementia, but few social care workers receive dementia-specific training. Objective: To systematically review dementia training interventions for social care, review past policies and hold stakeholder workshops considering how future policy can support quality dementia training in social care. Methods: We searched electronic databases, November 2015 to February 2024, including studies describing dementia training and support interventions for social care workers, assessing risk of bias with the Mixed Methods Appraisal Tool. We reviewed English policies January 2015 to April 2024 to identify social and policy contexts relevant to dementia training. We consulted home care and care home stakeholders regarding how findings could inform future policy. Results: We included 56 studies (50 in care homes, 6 in home care). There was good quality evidence that dementia training interventions in care homes that engaged staff champions to integrate practice-based learning reduced agitation, neuropsychiatric symptoms and antipsychotic prescribing and improved life quality of residents with dementia. One study found this approach was cost-effective. In home care, evidence was limited; group training was valued, and improved staff sense of dementia care competence in one study. We identified 27 policies and related documents; and consulted 18 stakeholders. Stakeholders supported mandatory dementia training but considered implementation very challenging in current economic contexts. Conclusions: We found strong evidence for dementia training in care homes, but a relative lack of research in home care. Policy options identified to implement evidence require investment, which could deliver substantial savings across health and social care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research is funded through the NIHR Policy Research Unit in Dementia and Neurodegeneration Queen Mary University of London, reference NIHR206110. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors
Oral health is recognised as an essential component of a person's overall wellbeing, increasingly so in people with dementia. As dementia progresses, a person diagnosed with the condition may become more dependent on the support of the family carer to meet their personal care needs. Similarly, community nurses may be one of the first health professionals that a family carer may call on when difficulties in maintaining good oral care become a concern. An understanding of some of the main concerns and resources available can be helpful for community nurses in helping their patients and their carers. This article discusses some of the common issues using case examples to illustrate possible rationales and considerations for further action.
Emerging and increasing frailty often goes unidentified, and families living with dementia and frailty are missing vital opportunities to receive the right support at the right time. People living with frailty are less able to adapt to stress factors such as acute illness, injury, or changes in their environment, personal or social circumstances, leading to adverse health outcomes and an earlier loss of independence. We have developed a unique and innovative National frailty Consultant Admiral Nurse service to address this concern. This service was created alongside a recognition of the need for equal access to better national awareness, knowledge, resources, and support around the management of frailty and dementia. The service provides professional leadership, consultancy, education, and expert clinical practice to families. The service has been operational for 24 months, with excellent quantitative and qualitative outcomes. To date, 1196 people have received specialist frailty and dementia training. Clinical interventions equated to 4380 activities directly delivered to support families. Supporting Best Practice: 503 supporting best practice activities delivered. From carers surveyed, 100% stated that the service helped them manage symptoms of frailty alongside dementia, understand frailty, and cope with the challenges posed by frailty and dementia. The Dementia UK Frailty Consultant Admiral Nurse service has demonstrated significant positive impacts on families living with dementia and frailty. The service focuses on reducing barriers to care and support, ensuring equality in service provision. The involvement of Lived Experience partners in service planning and delivery has been crucial. The service aims to expand further, building on the successful outcomes of the first two years of operational practice.
Although the number of people diagnosed with dementia is increasing globally, it is estimated that only 2% are engaged in dementia research in the UK. In part, this may be due to a lack of confidence on the part of health and social care professionals to discuss research opportunities. Admiral Nurses are specialist dementia nurses. To support conversations about research, an interactive e-learning course was developed, comprising four modules to increase Admiral Nurses’ confidence to discuss research opportunities and participation with people with dementia and their family/carers. An evaluation of the course sought to understand if such a course increased Admiral Nurses’ confidence in discussing research opportunities with families affected by dementia and to promote their registration with the Join Dementia Research register. The authors used the Kirkpatrick model to evaluate the pilot of the e-learning course, which consists of four levels: reaction (level 1), learning (level 2), change to behaviour (level 3) and impact (level 4), and embedded both quantitative and qualitative approaches to the evaluation. Twenty-one Admiral Nurses completed all four modules of the course. Their reaction (level 1) to the course was evaluated as positive on the course content and format. Confidence was rated pre- and post-course. Using Wilcoxon signed-rank test the authors found greater statistical significance (z=-4.01, P <0.001) in self-rated confidence to undertake conversations about research after the course than before. Change to behaviour (level 3) and impact (level 4) show promise but would require further consideration. The pilot evaluation showed positive outcomes, particularly in increasing Admiral Nurses’ confidence to discuss research with families affected by dementia.
Shared decision-making is fundamental to person-centred dementia care but its practical application is often challenged by time, relationships, people's fluctuating capacity and organisational constraints. This article encourages nurses to reflect on the principles of shared decision-making in the context of dementia care, drawing on micro, meso and macro decision-making levels to illustrate how choices are shaped by personal values, culture, legal frameworks and the care environment. Using theory, a case study and time out activities, the article highlights how nurses can adopt communication and partnership approaches that prioritise the inclusion of people with dementia in decisions about their care. The authors also examine the emotional burden associated with the responsibility of families as decision partners, thereby supporting nurses to provide compassionate and culturally sensitive decision-making support.
