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.
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.
Background Accessing a diagnosis and receiving adequate care and support for dementia can often be subject to various inequalities. Personal-, community-, and infrastructure-level factors can contribute to and often intersect in causing unequal health and care outcomes. With a paucity of evidence to inform solutions for dementia inequalities, the aim of this public consultation exercise was to explore potential solutions to inequalities in dementia diagnosis and care with different dementia stakeholders. Methods Utilising a future workshop approach, we conducted 11 in-person and remote consultation workshops to discuss experienced barriers of accessing diagnosis and care; discuss an ideal-world scenario where no barriers exist; and solutions to reach more equitable dementia diagnosis and care with people with dementia, unpaid carers, health and social care professionals, and third sector representatives. Discussions were synthesised by the research team and one public consultation group and mapped against the Dementia Inequalities model. Results A total of 131 different stakeholders in dementia attended 11 workshops across England. Solutions were identified across three layers of inequalities, with the majority of solutions proposed on a community and infrastructure level. Examples included link workers, a social care career pathway, Community Champions, adequate home equipment, and digital training. Some solutions require Governmental input, such as creating career pathways in the social care workforce, similar to the NHS, to train and maintain good paid carers, as well as a cross-UK national dementia strategy raising the priority of dementia and required changes. Conclusions Dementia inequalities could be addressed via diverse and holistic approaches. With limited evidence to date on the impact of some of the proposed solutions, future research needs to build on these recommendations and design and test suitable interventions.
Introduction People with dementia are more likely than people without dementia to be hospitalized and to experience in-hospital preventable adverse events, such as falls, skin injury, and infection, compared to other hospitalized groups. Negative attitudes towards people with dementia are common among acute healthcare workers and have been linked to a cascade of negative adverse events in this population. However, no qualitative systematic review has ever been conducted to synthesize the existing evidence in this area, which hampers the development of preventative measures. Aim This is a protocol for a qualitative systematic review aimed at exploring and synthesizing existing qualitative evidence regarding the attitudes of nursing staff towards the prevention of adverse events among hospitalized people with dementia. Methods Literature searches will be performed in PubMed, CINAHL, PsycINFO, Web of Science, Biblioteca Virtual de Salud, Scopus, The Cochrane Library, and Google Scholar. The references of eligible studies will be checked for eligibility. All primary qualitative or mixed-methods studies with a qualitative component published in peer-reviewed academic journals in English, Portuguese, or Spanish will be eligible. There will be no limitations to the date of publication. The selection process will be conducted independently by two researchers using the software Rayyan and then compared and discussed. Any disagreements regarding eligibility will be discussed among the entire research team and resolved via consensus. Methodological quality will be assessed using Cochrane’s guidance. A meta-aggregative approach will be employed to extract and synthesize the evidence using the software package QARI from the JBI. The confidence in the findings will be graded using ConQual. Implications This review will help identify and better understand specific attitudinal and psychosocial aspects that influence nursing care delivery for people with dementia in hospital settings. Such data can be used to generate novel explanatory models of nursing behaviors in dementia care, as well as capacity building and training to enhance hospital care for people with dementia globally.
Dementia is a syndrome caused by progressive neurological conditions. The majority of people will be diagnosed with late-onset dementia and will be over the age of 65 years, though a significant number may also be diagnosed before this age, termed young-onset dementia. People with dementia, especially late-onset, are more likely to have other comorbid conditions, and often multiple health conditions, more so in number than age-equivalent populations without dementia. One of the common comorbid conditions experienced by people with dementia is diabetes, which may have been present before any diagnosis of dementia is made, or onset may also be after the person's diagnosis of dementia. The ongoing management of diabetes as a person's dementia progresses can often raise significant anxiety in both health and care professionals and family carers alike. This article discusses some of the issues to consider in the management of diabetes in a person with dementia.
