models of dementia care in the community a literature review

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Models of dementia care in the community a literature review 1l resume template

Models of dementia care in the community a literature review

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However, books and other online resources were considered to ensure a holistic view of the topic was gained. Due to the exponential growth in technological advancement, the date of material was an important factor in the decision process. For this reason, there was a greater emphasis on material published after However, peer-reviewed literature from before this year was considered, to build a better understanding of the progression of technology in dementia.

In addition to this, research on the provision of technological solutions was primarily focused on material published after , to build on a similar review conducted by Cook et al. Further consideration was given to the clarity of text, and the substantiation of points made, to ensure the accuracy and relevance to the topic. Table 1 shows a matrix of relevancy for the selected literature against the keywords detailed in the Search and Selection Strategy section.

Table 2 shows a breakdown of selected literature by year. Table 3 illustrates the provision of technological solutions and their relation to the domains defined in Dementia Quality of Life Instrument DQoL. Determining quality of life is a difficult task due to the subjectivity and individuality involved.

Patients and caregivers are able to rate each of the 13 factors to determine a quality of life rating. In contrast to QoL-AD, which is used by both people with dementia and their caregivers, DQoL is exclusively for people with dementia and allows an individual to rate factors under five domains: positive affect, negative affect, feelings of belonging, self-esteem and feelings of aesthetics.

The DQoL model table 4 has been selected for this review as a reference point for technologies discussed. Therefore, technological interventions will be compared against the five domains of DQoL deemed important to quality of life. DQoL domains and mean ratings adapted from Brod et al [ 24 ]. In , the WHO recognised a neglect in public policy for the provision of dementia care solutions. In response to the global action plan, the WHO developed iSupport, an online training programme for caregivers of people with dementia.

However, this definition does not consider the potential impact on some of the qualitative measures that improve quality of life, such as those defined in DQoL. Gibson et al 22 conducted a comprehensive study on the available assistive technology solutions for people with dementia in the UK and proposed a useful segregation of solutions. Figure 2 illustrates the categories and some example subcategories that fit under assistive technology. Categories and subcategories of assistive technology AT adapted from Gibson et al [ 36 ].

As one of the most prevalent symptoms of dementia is forgetfulness, 5 it inherently becomes more challenging for people with dementia to learn something new and unfamiliar. Due to the challenges of designing solutions to be used by someone with dementia, many examples are simple in design and function, with an aim of improving intuitiveness and ease of use. Other available examples have further simplified this by only displaying the day of the week, and a general time of day ie, morning, afternoon, evening, night , such as that provided by Day Clock.

Other technologies for time and place orientation, such as motion sensor lighting, are also available to mitigate some of the risks associated with dementia. One issue experienced by many people living with dementia and their caregivers is poor medicine adherence. Pill dispensers can help alleviate this problem, acting as alerts or reminders, in addition to preventing overdoses through the separation and locking of doses. Despite this, Hopkins 28 found that complex designs and difficulties learning to use such devices often proved restricting.

This is supported by Cook et al 9 who also highlight more successful outcomes through lower interaction requirements. Familiarity is also likely to play an important part, recognisable objects and familiar voices are more likely to be accepted and are easier to use intuitively. This could be attributed to healthy people often having trouble interacting with people with dementia, partly down to a lack of understanding. Enabling these dialogues and experiences also has the potential to positively influence feelings of worth and belonging and can help individuals with dementia to experience activities or environments that they can appreciate and enjoy with others—all of which being vital factors in the DQoL model.

This was found to improve communication with people with dementia at all stages of the disease. Games and applications for the enjoyment of people with dementia are becoming more common with increased accessibility and affordability of touchscreen devices. With negative social experiences or social isolation impacting self-confidence, 30 it is imperative that positive experiences are encouraged and facilitated to improve quality of life.

One method of achieving this is through reminiscence, proven to improve mood, cognition and behaviour, 6 while also increasing interpersonal communication. Huldtgren et al 30 point to many examples of technological solutions for reminiscence, including:. The use of photo, video and music to support one-to-one reminiscence sessions, with positive reported outcomes. An old-fashioned radio, and television that played music and news from to , proving popular although some participants had difficulties with a standard remote control.

Telecare refers to the remote monitoring of people often in their own homes and aims to promote greater independence. Other advancements, such as those in accelerometers, also allowed for devices such as fall detectors, which can be easily included due to the modularity of telecare services.

The use of such services, although endorsed by the Department of Health and having shown to prolong independent living, lacks evidence to support its cost-effectiveness in the context of dementia. Location monitoring is perhaps one of the most controversial areas of dementia care and is often used to counteract some symptoms of dementia, such as wandering.

These solutions generally use Global Positioning System GPS technology so that caregivers can monitor the geographic location of the person with dementia. However, in a study conducted by Robinson et al , 11 it was found that people with dementia occasionally resent the idea due to a perceived loss of confidence in their abilities.

Devices for safety and security generally aim to monitor or restrict a specific activity that could potentially become a risk. Examples include key safes for easy access to a house in an emergency, technology to automatically disable water flows or gas supply, geofencing to mitigate the risk of wandering and telephone blockers that can divert or cancel calls not on a predefined list.

Measuring the quality of life for a person living with dementia presents a unique and complex challenge, this is due to the subjectivity of determining quality of life and the cognitive impairment experienced by someone with dementia. To handle this complexity, models have been suggested that aim to be more accessible and often objective in order to determine the quality of life. One example is DQoL, an instrument that allows an individual to rate factors under five domains: positive affect, negative affect, feelings of belonging, self-esteem and feelings of aesthetics.

The use of technology in dementia care has become increasingly popular, coinciding with the exponential growth in technological innovation. This is due to their ability to enable someone to maintain independence despite their condition. Such growth could continue to empower users of solutions; however, care should be taken to avoid the appearance and feelings of dependence for people with dementia.

In addition, with the increased uptake of internet of things, devices such as fall detectors and carer alarms, the design and implementation of technological solutions should consider issues pertaining to system security and data privacy, in addition to the challenges of adoption. Although research is extensive, it often does not directly involve people with dementia, especially those in the severe stages of the condition. This is evident in the quality of life studies and those testing the effectiveness of assistive technologies, with many instead consulting the caregivers of people with dementia.

This could be seen to undermine the credibility of such research and explain the high level of disparity in the understanding of key factors, such as measuring quality of life or determining the acceptance of technology. These limitations would warrant further research and consolidation of the available techniques and, despite the ethical barriers, would benefit greatly from the involvement of people with dementia.

Such research would benefit from longitudinal data analysis due to the progressive nature of the condition. In addition, this analysis should consider changing quality of life priorities and therefore determine the applicability, relevancy and ability for an individual to use a solution over a period of time. Dementia care requires highly targeted and individual approaches due to the subjectivity of determining quality of life, and expansiveness of the condition combined with other health problems that a person might face.

However, multiple objective factors have appeared useful in determining subjective concepts such as quality of life and technology acceptance. The home environment of an individual and the care support they have available to them can act as useful indicators of general quality of life and technology acceptance.

To further tackle the complex challenges that face people with dementia, their caregivers and those creating solutions to support them, the following further research has been identified:. Research to further understand the progression of dementia and its effects on care needs and factors deemed important to quality of life. Greater emphasis on the inclusion of people with dementia in studies on technology acceptance. Research to understand the benefits of customisable solutions ie, those with the ability to alter the level of functionality available to an individual based on their cognitive abilities.

Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Competing interests: None declared. Patient consent for publication: Not required. Provenance and peer review: Not commissioned; externally peer reviewed. Data availability statement: No data are available. National Center for Biotechnology Information , U. Published online Jan David Sanders 1 and Philip Scott 2.

Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to Dr Philip Scott; ku. No commercial re-use. See rights and permissions. Published by BMJ. This article has been cited by other articles in PMC. Abstract Objectives Rapid technology-driven innovation in the healthcare sector has led to an increasing ability to effectively respond to health challenges. Methods Articles and journals were identified using keywords including those relating to quality of life, assistive technologies and technology adoption and acceptance.

Results 91 resources were identified, with 38 contributing to the final review. Keywords: dementia, quality of life, assistive technology, home care. Introduction Dementia care is arguably one of the most challenging domains in an already highly complex healthcare environment. This will be structured around the following research questions: How is quality of life for people with dementia defined and measured?

Methods Search and selection strategy The following tools were chosen for the identification of literature, as they were deemed most relevant to the topic: University of Portsmouth Discovery service, Sage Journals, British Journal of Healthcare Computing and PubMed. The following keywords were used as a search basis: Technology in dementia. Assistive technology in dementia.

Technology limitations in dementia. Quality of life in dementia. Dementia self-image. Dementia therapeutic methods. As some searches were returning tens of thousands of results, database filters were used to refine results, including: Date published.

Language of literature. Source journal type and publication type. Full text only. Quality appraisal There were several considerations made in the decision process for determining appropriate literature; this was to ensure the validity and relevance to the topic. Table 1 Literature relevancy matrix. Open in a separate window. Table 2 Selected literature results by year of publication.

Year of publication Quantity of references used 1 8 4 3 3 4 1 1 2 1 2 1 2 1 1 1 1 1 1 Undated 7. Table 3 Matrix of solution effectiveness in relation to the DQoL model. Figure 1. Discussion Determining the quality of life for a person living with dementia Determining quality of life is a difficult task due to the subjectivity and individuality involved.

Table 4 DQoL domains and mean ratings adapted from Brod et al [ 24 ]. Domain description Rating of importance on a scale of 1—5 Self-esteem : Thoughts and feelings about themselves frequency feels confident, satisfied with self, accomplished something, makes own decisions 3.

The implementation and challenges of technological solutions for people with dementia In , the WHO recognised a neglect in public policy for the provision of dementia care solutions. Figure 2. Huldtgren et al 30 point to many examples of technological solutions for reminiscence, including: The use of photo, video and music to support one-to-one reminiscence sessions, with positive reported outcomes.

Conclusion Measuring the quality of life for a person living with dementia presents a unique and complex challenge, this is due to the subjectivity of determining quality of life and the cognitive impairment experienced by someone with dementia.

To further tackle the complex challenges that face people with dementia, their caregivers and those creating solutions to support them, the following further research has been identified: Research to further understand the progression of dementia and its effects on care needs and factors deemed important to quality of life.

Footnotes Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. References 1. A systematic review of the economic evidence for home support interventions in dementia. Value in Health ; 20 — Glaser J, Salzberg C.

The strategic application of information technology in health care organizations. San Francisco: Jossey-Bass, Nair A, Dreyfus D. Technology alignment in the presence of regulatory changes: the case of meaningful use of information technology in healthcare. Int J Med Inform ; — Beyond adoption: a new framework for theorizing and evaluating Nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies.

J Med Internet Res ; 19 :e World Health Organization [Internet]. Reminiscence therapy for dementia. Cochrane Database Syst Rev ; Impact on carers [Internet]. Dementia Statistics Hub. Predicting the role of assistive technologies in the lives of people with dementia using objective care recipient factors. BMC Geriatr ; 16 The impact of ICT-based telecare technology on quality of life of people with dementia: review of the literature.

PLoS Med ; 6 :e Keeping in touch everyday KITE project: developing assistive technologies with people with dementia and their carers to promote independence. International Psychogeriatrics ; 21 Revell AJ, G. L W, et al. Other care management clinical trials have also shown improvement in the quality of care provided to older adults with dementia.

Vickrey et al. In a recently completed clinical trial, we significantly expanded the primary care reach and scope of collaborative care into the homes of vulnerable older adults and across multiple geriatric syndromes. We tested the effectiveness of a care management model that integrated care for multiple chronic comorbid conditions and provided for in-home support and education. Intervention patients received two years of home-based care management by a nurse practitioner and social worker who collaborated with the primary care physician and a geriatrics interdisciplinary team and were guided by 12 care protocols for common geriatric conditions.

This integrated and home-based geriatrics care management resulted in improved quality of care and health-related quality of life. Counsell et al. In early conversations with the community partner, we discussed why the health care system had not already acted on collaborative care evidence available in the literature.

There are, of course, numerous barriers to the adoption of collaborative care models from the perspective of the community partner. For example, the clinical practices simply do not have the financial resources to build such programs, and there is only partial evidence that such programs can save money or be cost-neutral. Given its role as a safety-net provider, our community partner faces financial challenges to new program development, including investment for startup costs.

For these reasons, unmet needs that have a vocal champion, that can generate resources, and that fit within the existing organizational structure tend to have a much greater opportunity for both adoption and long-term sustainability. Traditional organizational theory leads us to view health care systems as machine-like structures with replaceable parts. These machine-like structures are believed to exhibit behaviors that can be predicted based on past performance. Anderson et al.

Cohen et al. Stroebel et al. We initially envisioned a retreat-type seminar or conference where program leaders would assemble all stakeholders and end-users and indoctrinate them in the reflective adaptive process. A product of this retreat was to be the locally negotiated adaptation of the collaborative care models.

For numerous practical reasons, and because of the organic nature of the program adaptation and implementation, such a time-limited or cross-sectional approach is both ineffective and impractical. In practice, we implemented the reflective adaptive process in a snowballing fashion where we first engaged project stakeholders in key leadership positions and then began widening this circle to successive layers of end-users.

Reaching a shared vision, mission, and shared values was relatively straightforward. Within this broad agreement, however, we encountered three important initial hurdles. In many respects, none of the other principles of the reflective adaptive process or the implementation process can succeed without the time and space for the stakeholders to build a relationship in support of change. Given the complexity of the matrix of stakeholders represented by both the community and the academic partner, implementation researchers will find it difficult to maintain a reasonable size for the leadership group.

The difficulty is not in identifying who should be at the stakeholder table but identifying the time when all can be available. In practice, our implementation project began to suffer from the tyranny of time and space for meetings. If one closely adheres to a goal to have all key players around the same table, the project quickly loses momentum.

The primary problem is not that stakeholders cannot agree to a mutually suitable time although this is daunting. The larger problem is that the competing macro-level forces faced by the community partner may demand crisis intervention. Thus, time and space for stakeholders to build a relationship is simultaneously essential and paralyzing.

Our local solution was to schedule two separate meetings among 14 different stakeholders and allow these stakeholders to attend the meeting that best fit their schedule. Avoiding conflict is not a realistic goal when partnering with health care systems to implement quality improvement efforts. If conflict management is a prerequisite for a successful partnership, then mutual respect is a prerequisite for successful conflict management.

Mutual respect, in turn, requires time and space. In practice, the lack of tension and discomfort must be viewed as important warning signs that the partnership is failing. Notably, the presence of tension and discomfort is not necessarily evidence that the partnership is succeeding.

Thus, tension and discomfort are essential and demonstrate the health of the relationship, but the origins of this tension and discomfort must be continually and transparently investigated. In principle, stakeholders agreed that the end-users play a fundamental role in the success or failure of quality improvement. There are important examples of major quality improvement programs failing due to the inadequate inclusion of the end-users or failure to account for other important contextual variables.

Grimshaw et al. Hafferty, ; Snyder, Attention to the hidden curriculum must include key stakeholders as well as other key opinion leaders who may or may not be formal leaders. Notably, the hidden curriculum can be used to advance or undermine any quality improvement activity. Thus, it does not necessarily denote a negative force of change. In practice, one of the most influential components of the hidden curriculum in our partner organization is the potential for a mismatch in what leaders say is valued as compared to what is measured in performance evaluations, accounted for in financial evaluations, or accommodated in resource allocations.

For example, if the health care system truly values objective assessment of outcomes of mental illness in primary care, then end-users would expect that such activities would be afforded resources and assessed in quality or cost evaluations. Although our academic-community provider partnership began with the goal of implementing an integrated collaborative care model for late life depression and dementia, a different language emerged from the reflective adaptive process.

As anyone contemplating system-level changes in primary care in the US between and would recognize, the medical home became a widespread movement for the redesign, reengineering, and re-financing of primary care. The key components of a medical home include: a personal physician working in collaborative with a team of health care professionals; a whole person orientation; care that is coordinated and integrated; care that is safe, effective, and evidence-based; enhanced access to care; and payment that recognizes the added value of the medical home approach.

Fortuitously, collaborative care models targeting multiple chronic illnesses are well within the minimum specifications of the patient-centered medical home. In addition, collaborative care or care management provides a blueprint for initiating a medical home model. Thus, over a year of the reflective adaptive process, our collaborative care model was recast as the Aging Brain Care Medical Home. This has fundamental implication for key metrics of success from the perspective of the community partner.

Financial metrics of success must be weighed in addition to metrics typical of clinical trials such as patient-specific clinical outcomes, satisfaction, safety, and quality of care. In essence, the upfront costs of improving patient outcomes through the medical home model would ideally be offset through downstream savings in high-cost utilization patterns such as emergency department use, hospitalizations, re-hospitalizations, inappropriate diagnostic or therapeutic services, or institutionalization.

Current demonstration projects supported by Medicare, for example, seek to examine the potential of alternative methods of financing medical home models. The target patient population is older adults who receive their primary care from clinical practices affiliated with Wishard Health Services. The table at right summarizes the locally negotiated minimum care components of the ABC Medical Home.

The core components reflect the same care delivery components targeted in the Healthy Aging Brain Center. In the context of the ABC Medical Home, the care manager is working directly with the primary care physicians and within their suite of offices to facilitate this care. Thus, the role of the care manager is to tailor and facilitate the delivery of these components to individual patients in collaboration with the primary care physician.

Prior collaborative care models have used care managers from a variety of disciplines including nurses, social workers, and psychologists, among others. However, discussions about the local implementation of the dementia care managers resulted in a decision to employ an advanced practice nurse in this role.

The advanced practice nurse has enhanced training in diagnosis and treatment of chronic conditions and also has prescriptive authority. These health care professionals have also developed a high level of credibility within the targeted primary care practices and thus are accepted as co-managers of primary care patients.

In addition to their background in nursing, these care managers can also be provided additional training in: accessing community resources, providing brief problem-solving psychotherapy, medication management, the care of older adults with dementia and depression, and counseling and caring for family caregivers. The advanced practice nurse is supported in these roles by a medical director who is a physician with special expertise in the care of older adults with dementia and depression.

The medical director also serves as the primary liaison with the health care system leadership. Both the care manager and the medical director have access to an administrative assistant who is dedicated half-time to the ABC Medical Home activities. In order to efficiently deliver the components of the ABC Medical Home, the care team is supported by an array of information technology tools.

Recognizing the space limitations of primary care, the care coordinator utilizes patient examination rooms in conjunction with the other providers of care in the primary care suite of offices. However, the information technology described above provides the case manager with the flexibility to deliver care and access needed data in other clinical settings with the health care system, in facilities outside the health care system e.

Self-management tools to enhance the skills of the patient and caregiver skills in managing symptoms and navigating the health care system. Pharmacological interventions for care-recipients that target the cognitive, functional, and behavioral and psychological symptoms. We describe our experience in building a community-based research partnership with a tax-supported urban medical institution in the US to facilitate the implementation of an integrated collaborative care model for dementia and late-life depression within a primary care practice.

The Aging Brain Care Medical Home is now operational, and we are currently collecting evaluation data. Overall, we would conclude that the process was successful in the implementation phase but with three important lessons learned. First, the laboratory, methods, and tools of implementation research are substantively different from those of clinical trials. Researchers and research programs who have demonstrated expertise and infrastructure for conducting controlled clinical trials are not necessarily equipped to conduct implementation research.

This is also true for clinical and administrative counterparts who may have expertise in program development, health care administration, or quality improvement but have not prepared themselves or their infrastructure for implementation research. Second, time and space to build relationships are a fundamental requirement for implementation research and for community-based participatory research. Unfortunately, the amount of time and energy needed to build and maintain these relationships was substantially more than we anticipated.

The excess time and timeline translate into excessive costs related to the conduct of implementation research. These costs can be measured directly in terms of the salary and related costs of senior researchers and health-system leaders. These costs can also be measured in terms of opportunity costs.

The national resource of senior clinical researchers and health system administrators is already very limited. Retooling and reallocating this limited resource to implementation research should be done with considerable care. Third, it is difficult to over-estimate the impact of external forces on the success, evaluation, and relevance of implementation projects. Changes in Medicare payments policies, for example, can speed, slow, or kill implementation projects regardless of any local efforts.

There are many more subtle external forces that influence the outcomes of implementation research. This is precisely why the typical clinical trial research project shields itself from these forces and precisely why the results of clinical trials often are not relevant to day-to-day clinical practice. Some of these forces, such as the patient-centered medical home movement, represent a vehicle to facilitate successful implementation. National Center for Biotechnology Information , U.

Aging Ment Health. Author manuscript; available in PMC Jan 1. Christopher M. Callahan , MD, a, b, c Malaz A. Beck , MD, b Lee R. Livin , d Jeffrey J. Kellams , MD, d Deanna R. Willis , MD, e and Hugh C. Malaz A. Robin A. Lee R. Jeffrey J. Deanna R.

Hugh C. Author information Copyright and License information Disclaimer. Address correspondence to: Christopher M. Copyright notice. The publisher's final edited version of this article is available at Aging Ment Health. See other articles in PMC that cite the published article. Abstract Objectives The purpose of this paper is to describe our experience in implementing a primary care-based dementia and depression care program focused on providing collaborative care for dementia and late-life depression.

Results Findings from three recent randomized clinical trials provided the rationale and basic components for implementing the new memory care program. Conclusions We have successfully overcome many system-level barriers in implementing a collaborative care program for dementia and depression in primary care.

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The search yielded 14 articles, with almost all articles available as full text articles. A review of the abstracts of all articles was done to select only primary research studies conducted in the last five years. Polit et al. Literature older than five years old may be outdated. However, this also increases the risk of excluding landmark studies Aveyard, For the present review, the selection of studies was only restricted to the last five years to ensure that more recent evidence on music therapy were evaluated and critiqued.

There was also no restriction on the place where the studies were conducted since dementia affects people of different ethnicities. Learning from the experiences of other nurses or healthcare practitioners on the use of music therapy for dementia patients would also help improve nursing practice in the UK.

The following articles were chosen for critique and evaluation:. Simmons-Stern et al. Sakamoto et al. Dermot et al. As previously stated, I am interested in how music therapy could help me assist my patients delay the progression of dementia and help them and their carers self-manage the signs and symptoms of dementia. Hence, all articles are relevant my work as a community nurse.

For the quantitative studies, Long et al. Both critiquing frameworks are easy to use and help researchers investigate the quality and rigour of research articles. A review of the title of the study shows that it reflected the main aim and objectives of the study. The title was concise and provided information to the readers that the study aimed to present the limitations of music-based memory enhancement as well as its possible application to nursing practice.

The abstract of the study failed to mention the type of study design used. While the abstract summarises the aims and main findings of the study, it did not follow the usual structure of an abstract in a journal article where the methodology or methods used are explicitly stated. Although it was difficult to determine why the researchers of this study failed to present the methodology in the abstract, readers of the study could have benefited from an abstract that states the methodology of the study.

Reading of the body of the article would show that the quantitative study design was used. Apart from the excellent use of literature, there was also a very good review of the previous studies and a gap in literature was clearly presented. Hence, the literature review of the study was well written and provided the readers with good background on why there is a need to carry out the present study. Importantly, Simmons-Stern et al. Burns and Grove explain that the use of jargon should be avoided since this excludes readers of the article that have no nursing or medical background.

A good paper is one that is written for a general audience and not only for a scientific community Burns and Grove, Brown states the importance of obtaining the informed consent of participants before commencing the study. An informed consent will also ensure that debriefing is provided to the participants to avoid any harm and psychological distress to the participants Oermann, Apart from getting the informed consent, it was also crucial that an ethics committee has evaluated and approved the study protocol.

An evaluation of the study reveals that this was observed and an ethics committee approved the study. This would have taken a randomised controlled study design since a control group was used to compare the effects of music therapy on the patients with a healthy control. However, the investigators specifically state that this study was comparative. An inclusion and exclusion criteria were used when recruiting the patients, suggesting that participants were not randomly selected.

Since the study was quantitative and employed the experimental study design, random sampling of the participants who have been more applicable Crookes and Davies, It should be noted that it would also be difficult to randomise participants since this study was only conducted in one healthcare setting and it was crucial that participants have developed AD. While randomisation of participants was not observed, it is noteworthy that the investigators stated how many of the participants were excluded from the study and the reasons of their exclusion.

This was essential since failure to explain why participants who gave their informed consents to participate in the study but were later excluded in the actual experiment would make the data collection process unclear Moule and Goodman, Despite the small sample size, the demographic characteristics of the two groups were not significantly different when t-test was done.

There were no significant differences in prior musical training, formal or informal, years of education and age between the participants of the two groups. This allowed the investigators to determine if there were differences after the study, this might have been due to the intervention employed. After informed consents were taken, the authors of the study declared that they paid the participants for the hours spent during the study. Compensating the participants for the time is considered as ethical since considerable time has been taken away from the subjects for their participation in the study Hek and Moule, The interventions were clearly stated.

This increased the rigour of the study since a clearly stated research method would help other investigators replicate the methods in future studies and verify whether similar findings are obtained Hek and Moule, Results section of the study clearly presented the main findings of the study. Appropriate statistical tests were also utilised to test the hypotheses of the research. Despite having a small sample size, the researchers were able to establish that music in patients with AD enhances memory in terms of familiarisation of sung lyrics but not in spoken stimuli.

This suggests that in patients with AD, they can enhance their memory when familiarising with the lyrics or listening to music but not when they hear spoken language. There were also no significant differences in the healthy control and experimental groups in terms of memory after hearing the lyrics of a song compared to hearing the lyrics as a spoken stimuli. Since this study has a small sample size, the applicability of the findings to a larger and more heterogeneous population would be difficult Burns and Grove, Although a control was used, it should be noted that participants in the experimental group are in the early stages of AD.

This could have affected the findings of the study since it is unclear if patients with severe dementia would also yield similar reactions and results. At present, the findings are applicable to the sample population of the study and importantly, only on individuals in the early stages of dementia.

While there were several limitations of the study, findings are noteworthy since these show that music therapy is promising as a non-pharmacologic intervention for enhancing memory in individuals with early stage dementia. The conclusion of the study was clearly presented and summarises the key points presented in the study. Although the discussion states future areas of study, there were no clear recommendations in the conclusion.

Specific recommendations could have been made at the end to help future researchers identify areas of investigation. Despite the lack of clear recommendations, readers can still read through the study and identify areas that need further investigation. For example, there is a need to replicate the study in a larger and randomly selected sample population to strengthen the validity and reliability of the findings. There is also a need to compare findings with patients suffering from moderate to severe dementia to determine if music still has similar effects on the memory of those in advanced stages of the illness.

There are a number of implications of the study in nursing practice. Nurses can use music to help enhance memory or prevent deterioration of memory amongst individuals with early stages of the disease. It is essential to consider the acceptability of music therapy in those suffering from dementia.

As a whole, the study was of high quality and effort was made to reduce bias within the study. Although the investigators failed to blind assessors to the study, findings were presented objectively. It is also difficult to blind assessors because of the very small sample size Burns and Grove, All investigators were familiar with the background of the participants and blinding them to the intervention was difficult since these investigators were also responsible in implementing the interventions.

Finally, there were no conflicts of interest Polit et al. This was essential Long et al. A quantitative study design would help investigators answer the research aims and objectives through experimentation, surveys or a randomised controlled trial RCT Brown, In Sakamoto et al. Compared to other quantitative study designs, a RCT reduces risk of selection bias and bias in interpretation of findings Moule and Goodman, Selection bias occurs when participants are not randomly selected and do no have equal chances of being assigned to a control or experimental groups Crookes and Davies, This is avoided in RCT since all participants are randomly assigned to an experimental or control group.

On the other hand, bias in interpretation of findings is lessened especially if investigators and assessors are blinded to the interventions and standard treatment Oermann, A critical analysis of the study shows all participants in the study were randomly assigned to the treatment and standard care groups. It would be difficult to transfer findings to a larger and more heterogeneous group due to the representativeness of the sample population Ellis, While it is difficult to transfer findings to other settings due to the relatively small sample size, community nurses may consider the applicability of the findings to their own practice.

It is noteworthy that it would be difficult to recruit participants in the advanced stages of dementia since their ability to give their informed consent is severely limited Department of Health, While an ethics board approved the study and informed consents were taken from the respondents or their representatives Burns and Grove, , involving individuals who suffer from severe cognitive impairment would be difficult.

This also carries some ethical issues since their ability to understand the procedures of the study is compromised Hek and Moule, Although the Mental Health Act in the UK acknowledges that carers can act in behalf of the individual with mental health condition, ethics regarding their participation in research studies remains debatable Department of Health, For example, they used the Faces Scale Sakamoto et al. The introduction and review of literature also made excellent use of previous studies.

It is also important to note the gaps in practice in recent studies were highlighted in the literature review section Ellis, A good literature also argues why there is a need for the new study and how this could be applied to current healthcare practices Ross, Methodology and methods used were also appropriate for the research question.

Since the study aimed to determine the effectiveness of music therapy, it is appropriate that a RCT is used to compare music therapy with standard care. Comparing music therapy with standard care is ethical Ross, since all patients in the study received interventions. It would be unethical to withdraw treatment or assign participants to a control group that would receive no intervention Crookes and Daives, The evaluation tools used to measure the responses of the patients were appropriate and have been previously validated and standardised.

This was necessary to convey to the readers that validated measurement tools were used in the study Moule and Goodman, A clear description of the research methods was presented. This would allow future researchers to replicate the present study Oermann, and determine if similar findings could be observed. This also increases rigour of the study Burns and Grove, since it is essential for other researchers to also test the hypothesis of the study and ensure that results are consistent across different healthcare settings.

Results of the study were well presented and appropriate statistical tests were used. The discussion section of the study presented the strengths and limitations of the study. Since weaknesses of the study were presented, readers and other healthcare practitioners can determine the extent in which the findings can be applied to current and future nursing practice Burns and Grove, The conclusion of the study succinctly captures the main points raised in the research study. This helped the researchers identify the main highlights of the study Ellis, However, recommendations for other researchers and areas of improvement of the study were not cited.

While the discussion section presented these limitations and areas for future studies, brief recommendations at the end of the study could have added rigour to the research study. Importantly, there were no conflicts of interest. This assured the readers that bias in reporting of data was reduced Ellis, Findings of this study have important implications in nursing practice.

All participants received either the passive or interactive music intervention while the control group received no music intervention. There was careful choice of music in the interactive group. For example, healthcare workers assigned to the interactive group helped investigators choose music for the patient participants.

Music played during the intervention all had special meaning to the participants. All interventions were given individually for 30 minutes per session at once a week for 10 weeks. Those in the interactive group were allowed to clap, sing or interact with the music. Meanwhile, those in the passive group only listened to the music. The music chosen for the passive group also had special meaning to the participants. Those in the control group sat in silence for 30 minutes during the once a week session.

Interestingly, findings show that music associated with special memories led to significant changes in the parasympathetic nervous system of the participants. Investigators note that music significantly increased relaxation of the individuals immediately after intervention when compared to baseline data. However, these were not noted in the control group. Significant changes were also seen on the emotional states of the participants in the interactive and passive music intervention groups.

Music appeared to elicit pleasant emotional states. However, when passive and interactive groups were compared, the latter was significantly more relaxed following the music intervention. It should be noted that patients with severe dementia are more sensitive to environmental stimuli and may experience stress when placed in a new environment Morris and Morris, Further, patients with cognitive impairments may express feelings of stress and fear through disruptive behaviour Morris and Morris, The difficulty in verbalising their emotional needs could aggravate their responses to their surroundings Department of Health, Hence, the study of Sakamoto et al.

Nurses can encourage family members to play music that have special meaning to their loved ones suffering from dementia to illicit positive emotional states. The calming effect of music could be an advantage for patients cared in home or care settings since this would not only prevent stress but also allow patients to enjoy quality of life.

Readers could easily understand that the study explored the experiences of individuals with dementia, their carers, staff and music therapists when music interventions are employed. The CASP tool for qualitative studies contains three screening questions that should be used to determine if a study is worth reviewing. The study of Dermot et al. Findings have important implications in nursing practice since music intervention Miller, is not costly and could yield positive results for patients suffering from early to advanced stages of dementia.

Further review of the study shows that aims and objectives of the research were clearly stated. The main aim of the study was to explore the meaning of music in the lives of individuals suffering from dementia. Investigators of this study state that there is limited knowledge on why or how individuals find music beneficial to their wellbeing.

Understanding the role of music according to the perceptions of the patients and their carers will help inform nursing practice on the relevance of music in the lives of people with dementia. Parahoo emphasises that a qualitative study allows researchers to explore the experiences and perceptions of individuals in more detail and depth.

Since open-ended questions are used, investigators can use probing questions Burns and Grove, to help participants articulate their experiences. Individuals suffering from dementia were recruited from care homes and those living in the community.

This allowed Dermot et al. Recruitment strategy employed was also appropriate for the research aims. There was also a clear explanation on the methods of data collection. Semi-structured interviews and focus group discussions were done. In the former, this would allow researchers to investigate perceptions of participants in more detail Parahoo, However, this requires more time to complete especially if there are many participants in a study. A focus group discussion, on the other hand, requires little resources and could be completed in one setting Polit et al.

However, if a dominant member would be included in a focus group discussion, interactions would be limited Burns and Grove, This could be avoided with a facilitator who knows how to redirect the discussion to all members of the focus group. A stregnth of the study of Dermot et al. It should also be noted that participants with dementia might display cognitive impairments, depending on the stage of their illness. Hence, requiring these patients to explain their experiences in more depth might be challenging.

However, the investigators tried to mitigate this challenge by including carers of the patients as part of the study participants. Inclusion of carers could provide researchers with more detailed information on how music impacts the wellbeing and quality of life of the patients since these carers are more acquainted with the individuals suffering from dementia Miranda-Castillo et al. It is also noteworthy that music therapy was individualised to the patients in the study.

This suggests that comparison of music therapy received by the patients was not done. Despite the differences in music intervention, it was common for the music therapists to use songs that were well-known to the patients. They also supported active music therapy with exploratory improvisation. There was also an explanation on the content of the guides used for the in-depth interviews and focus group discussions.

Irving and Lakeman acknowledge that the concept of person-centred care has become a catchphrase for good care but has not resulted in improvements in care for everyone with dementia. They explore the similarities and differences between it and person-centred care, the difficulties of using the concept of recovery in the context of a degenerative condition such as dementia and take a closer look at its relevance for dementia screening and early intervention.

They conclude that the recovery movement has much to offer dementia care and vice versa. Innes and Manthorpe critically assessed three influential theoretical perspectives biomedical, psycho-social and critical social gerontology in shaping dementia policy in different regions of the UK.

They argue that lessons from different theoretical perspectives need to be explicitly recognised, challenged and valued for a truly integrated dementia care policy model to evolve. A concept analysis of the conceptual and empirical literature was adopted. A range of surrogate terms were identified, falling into two clusters, respite as a service and respite as an outcome. The study identified two distinct, but inter-related categories previously associated with the concept of respite: client factors and services factors.

The former includes five factors dyadic relations, recognising and accepting need, carer psychological needs, restorative occupation and stigma and the latter four factors the service model and characteristics, care quality and staff expertise, meaningful occupation for the person with dementia, and communication and support]. For the carer, respite must be seen as mutually beneficial for both the carer and the person with dementia.

The article reports that the evidence shows mixed outcomes in relation to respite. It outlines a conceptual model for respite as it relates to dementia. The article compares the parallels and dissimilarities with concept analysis of respite in the area of older people and intellectual disabilities. Respite as a term it is argued is limited because of its almost exclusive concentration on the experiences of the carer.

Read more. Dichotomising dementia: is there another way? McParland, P. In this article Mc Parland et al. They suggest that these two discourses effectively sit in opposition to each other and do not reflect the complex reality of what it means to live with dementia. Accepting that the move to a positive or living well discourse was a necessary response to the tragedy discourse, they argue there is the potential that those who do not meet our notion of what it means to live well with dementia risk even further disenfranchisement and that this tension between the two discourses has the potential to create division among people with dementia themselves.

The authors suggest it is time to challenge these seemingly opposing discourses and create one that more accurately reflects and supports the multiple realities of dementia.

RAILROAD CLERK RESUME

Other work was excluded because it did not specifically consider dementia. For example, we reported limited evidence for restorative models of home care in dementia as most trials exclude people living with dementia [ 65 ]. We only systematically reviewed RCTs regarding the outcome of time lived at home. This is an indicator of living well at home, but quality of the lived experience is important too.

We did not meta-analyse outcomes due to heterogeneity of populations and outcomes and because our purpose was to identify effective interventions to inform development of our model. People from Black and minority ethnic backgrounds tend to access services less and are less likely to move to a care home [ 66 ], so there may be cultural differences in optimal models of home support.

Our theoretical model describes values, care strategies and service models that can be used in the design of future interventions to enable people with dementia to live well and for longer at home. Google Scholar. Lord K, Livingston G, Robertson S, Cooper C How people with dementia and their families decide about moving to a care home and support their needs: development of a decision aid, a qualitative study.

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Int J Geriatr Psychiatr 29 5 — J Gerontol Nurs 43 8 — Int J Geriatr Psychiat 23 1 — McIntyre M Dignity in dementia: person-centered care in community. J Ageing Stud Brooker D Person-centred dementia care: making services better. Jessica Kingsley Publishers, London. Smebye KL, Kirkevold M The influence of relationships on personhood in dementia care: a qualitative, hermeneutic study. BMC Nurs 12 1 Dementia 4 4 Aging Ment Health 15 4 — Behuniak SM Toward a political model of dementia: power as compassionate care.

J Aging Stud Manthorpe J, Samsi K Person-centered dementia care: current perspectives. Clin Interv Aging — Cahill S Dementia and human rights. Policy Press, Bristol. Smebye KL, Kirkevold M, Engedal K Ethical dilemmas concerning autonomy when persons with dementia wish to live at home: a qualitative, hermeneutic study.

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A systematic review. Khanassov V, Vedel I, Pluye P Case management for dementia in primary health care: a systematic mixed studies review based on the diffusion of innovation model. J Am Med Dir Assoc 16 9 e1. Renehan E, Goeman D, Koch S Development of an optimised key worker framework for people with dementia, their family and caring unit living in the community.

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You can also search for this author in PubMed Google Scholar. Correspondence to Claudia Cooper. Reprints and Permissions. Lord, K. Developing the New Interventions for independence in Dementia Study NIDUS theoretical model for supporting people to live well with dementia at home for longer: a systematic review of theoretical models and Randomised Controlled Trial evidence. Soc Psychiatry Psychiatr Epidemiol 55, 1—14 Download citation.

Received : 25 March Accepted : 09 October Published : 02 November Issue Date : January Search SpringerLink Search. Download PDF. Abstract Purpose To build an evidence-informed theoretical model describing how to support people with dementia to live well or for longer at home. Methods We searched electronic databases to August for papers meeting predetermined inclusion criteria in two reviews that informed our model.

Results Our scoping review included 52 studies. Conclusions Our theoretical model describes values, care strategies and service models that can be used in the design of interventions to enable people with dementia to live well and for longer at home. Introduction Around Methods Search strategies and selection criteria We undertook searches in August , without limits to language or publication date.

Scoping review of theoretical models We used standard scoping review methodology [ 10 ]. Quality appraisal In line with the selected methodological approach, we did not formally evaluate study quality in our scoping review; but we recorded level of evidence Table 1 [ 10 ].

Results Theoretical models scoping review We included 52 studies Fig. Full size image. Table 2 Results of systematic review of Randomised control trials in which time lived at home was reported as an outcome Full size table.

NIDUS theoretical model of independence at home. Discussion The new model is theoretically informed, aligned with RCT evidence, and has been shaped by personal, clinical and academic perspectives. Limitations Our model was developed from a synthesis of theoretical models with a range of foci often with poorly defined constructs: living well, with life quality, with better functioning or longer at home.

Conclusions Our theoretical model describes values, care strategies and service models that can be used in the design of future interventions to enable people with dementia to live well and for longer at home. References 1. English Government, London Google Scholar 6. J Gerontol Nurs 43 8 —17 Google Scholar J Ageing Stud Google Scholar Dementia 4 4 Google Scholar J Aging Stud Google Scholar Policy Press, Bristol Google Scholar Dementia 1 3 Google Scholar Dementia 5 4 Google Scholar Dementia 6 1 :6 Google Scholar Neurology 67 9 — PubMed Google Scholar View author publications.

Ethics declarations Conflict of interest On behalf of all authors, the corresponding author states that there is no conflict of interest. About this article. In addition, this analysis should consider changing quality of life priorities and therefore determine the applicability, relevancy and ability for an individual to use a solution over a period of time.

Dementia care requires highly targeted and individual approaches due to the subjectivity of determining quality of life, and expansiveness of the condition combined with other health problems that a person might face. However, multiple objective factors have appeared useful in determining subjective concepts such as quality of life and technology acceptance.

The home environment of an individual and the care support they have available to them can act as useful indicators of general quality of life and technology acceptance. To further tackle the complex challenges that face people with dementia, their caregivers and those creating solutions to support them, the following further research has been identified:. Research to further understand the progression of dementia and its effects on care needs and factors deemed important to quality of life.

Greater emphasis on the inclusion of people with dementia in studies on technology acceptance. Research to understand the benefits of customisable solutions ie, those with the ability to alter the level of functionality available to an individual based on their cognitive abilities. Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Competing interests: None declared. Patient consent for publication: Not required. Provenance and peer review: Not commissioned; externally peer reviewed. Data availability statement: No data are available. National Center for Biotechnology Information , U. Published online Jan David Sanders 1 and Philip Scott 2. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to Dr Philip Scott; ku. No commercial re-use. See rights and permissions.

Published by BMJ. This article has been cited by other articles in PMC. Abstract Objectives Rapid technology-driven innovation in the healthcare sector has led to an increasing ability to effectively respond to health challenges. Methods Articles and journals were identified using keywords including those relating to quality of life, assistive technologies and technology adoption and acceptance.

Results 91 resources were identified, with 38 contributing to the final review. Keywords: dementia, quality of life, assistive technology, home care. Introduction Dementia care is arguably one of the most challenging domains in an already highly complex healthcare environment.

This will be structured around the following research questions: How is quality of life for people with dementia defined and measured? Methods Search and selection strategy The following tools were chosen for the identification of literature, as they were deemed most relevant to the topic: University of Portsmouth Discovery service, Sage Journals, British Journal of Healthcare Computing and PubMed.

The following keywords were used as a search basis: Technology in dementia. Assistive technology in dementia. Technology limitations in dementia. Quality of life in dementia. Dementia self-image. Dementia therapeutic methods. As some searches were returning tens of thousands of results, database filters were used to refine results, including: Date published.

Language of literature. Source journal type and publication type. Full text only. Quality appraisal There were several considerations made in the decision process for determining appropriate literature; this was to ensure the validity and relevance to the topic.

Table 1 Literature relevancy matrix. Open in a separate window. Table 2 Selected literature results by year of publication. Year of publication Quantity of references used 1 8 4 3 3 4 1 1 2 1 2 1 2 1 1 1 1 1 1 Undated 7. Table 3 Matrix of solution effectiveness in relation to the DQoL model.

Figure 1. Discussion Determining the quality of life for a person living with dementia Determining quality of life is a difficult task due to the subjectivity and individuality involved. Table 4 DQoL domains and mean ratings adapted from Brod et al [ 24 ]. Domain description Rating of importance on a scale of 1—5 Self-esteem : Thoughts and feelings about themselves frequency feels confident, satisfied with self, accomplished something, makes own decisions 3.

The implementation and challenges of technological solutions for people with dementia In , the WHO recognised a neglect in public policy for the provision of dementia care solutions. Figure 2. Huldtgren et al 30 point to many examples of technological solutions for reminiscence, including: The use of photo, video and music to support one-to-one reminiscence sessions, with positive reported outcomes.

Conclusion Measuring the quality of life for a person living with dementia presents a unique and complex challenge, this is due to the subjectivity of determining quality of life and the cognitive impairment experienced by someone with dementia. To further tackle the complex challenges that face people with dementia, their caregivers and those creating solutions to support them, the following further research has been identified: Research to further understand the progression of dementia and its effects on care needs and factors deemed important to quality of life.

Footnotes Funding: The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. References 1. A systematic review of the economic evidence for home support interventions in dementia. Value in Health ; 20 — Glaser J, Salzberg C. The strategic application of information technology in health care organizations.

San Francisco: Jossey-Bass, Nair A, Dreyfus D. Technology alignment in the presence of regulatory changes: the case of meaningful use of information technology in healthcare. Int J Med Inform ; — Beyond adoption: a new framework for theorizing and evaluating Nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res ; 19 :e World Health Organization [Internet].

Reminiscence therapy for dementia. Cochrane Database Syst Rev ; Impact on carers [Internet]. Dementia Statistics Hub. Predicting the role of assistive technologies in the lives of people with dementia using objective care recipient factors. BMC Geriatr ; 16 The impact of ICT-based telecare technology on quality of life of people with dementia: review of the literature.

PLoS Med ; 6 :e Keeping in touch everyday KITE project: developing assistive technologies with people with dementia and their carers to promote independence. International Psychogeriatrics ; 21 Revell AJ, G. L W, et al. The Pennsylvania State University, [Online]. Assessing quality of life in older adults with cognitive impairment. Psychosom Med ; 64 —9.

Health Qual Life Outcomes ; 1 Lawton MP. Quality of life in Alzheimer disease. Alzheimer Dis Assoc Disord ; 8 — Fleming R, Sum S. Empirical studies on the effectiveness of assistive technology in the care of people with dementia: a systematic review. J Assist Technol ; 8 — Observed affect in nursing home residents with Alzheimer's disease.

Marshall M. State of the art in dementia care. London: Centre for Policy on Ageing, The provision of assistive technology products and services for people with dementia in the United Kingdom. Dementia ; 15 — Using simple technology to prompt multistep tasks in the home for people with dementia: an exploratory study comparing prompting formats. Dementia ; 16 — Conceptualization and measurement of quality of life in dementia: the dementia quality of life instrument DQoL.

Gerontologist ; 39 — The efficacy of cognitive prosthetic technology for people with memory impairments: a systematic review and meta-analysis. Neuropsychol Rehabil ; 24 — Pivotell [Internet] Pivotell. Hopkins P. The use of technology to help patients with self-medication.

Nursing Times ; —5. Magiplug [Internet] Magiplug. Reminiscence of people with dementia mediated by multimedia artifacts. Interact Comput ; 29 — Association between a change in social interaction and dementia among elderly people. Int J Gerontol ; 10 — Talking mats: the effectiveness of a low technology communication framework to help people with dementia express their views. Journal of Assistive Technologies ; 1 —4. Does familiarity affect the enjoyment of touchscreen games for people with dementia?

Int J Med Inform ; 91 :e1—8. Game-based interventions and their impact on dementia: a narrative review. Australasian Psychiatry ; 25 —5. Kasl-Godley J, Gatz M. Psychosocial interventions for individuals with dementia. Clin Psychol Rev ; 20 — The everyday use of assistive technology by people with dementia and their family carers: a qualitative study.

BMC Geriatr ; 15 Does telecare prolong community living in dementia? A study protocol for a pragmatic, randomised controlled trial. Trials ; 14 Acceptance of global positioning system GPs technology among dementia clients and family caregivers. J Technol Hum Serv ; 35 — Support Center Support Center. External link. Please review our privacy policy. Technology limitations and acceptance in dementia. Astell et al Boyd et al Brod et al Clarkson et al 1. Cook et al 9. Czarnuch et al 8. Day Clock Dua et al

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This was necessary to convey nursing practice since music intervention since it is essential for could yield positive results for recent evidence on music therapy research methods was presented. Individuals suffering from dementia were recommendations, readers can still read of its almost exclusive concentration. This could have affected the findings of the study since it is unclear if patients no music intervention. It would be unethical to in interpretation of findings is focus group discussion, interactions would suggest that an intense vocation coupled with complex intellectual activities used to measure the responses in such a cohesive community all members of the focus main points raised in the. For example, there is a died had significant biological symptoms in a larger and randomly ones suffering from dementia to. There is also a need interested in how music therapy could help me assist my the methodology in the abstract, lyrics of a song compared the memory of those in that states the methodology of. While acknowledging that other factors care is ethical Ross, since of the research were clearly. Pointing to the inherent nature determine if there were differences was significantly more relaxed following have been due to the. While the abstract summarises the that is written for a general audience and not only follow the usual structure of and Grove, Brown states the article where the methodology or the individuals suffering from dementia. This suggests that comparison of made at the end to of study design used.

Semantic Scholar extracted view of "Models of dementia care in the community: a literature review" by M. Ramsay et al. Models of dementia care in the community:a literature review. By Mike Ramsay and Catherine Spence. Topics: Dementia, Policy, Community care, Service. The review was commissioned to support an inspection regime and care at home for people with dementia: a literature review with a.