Interventions In Dementia Care Research Articles

IN VIVO STAFF EDUCATION TO USE AN OBJECTIVE MEDICATION GUIDELINE IN THE MANAGEMENT OF BPSD BY THE CONSULTING PSYCHIATRIST IN THE LONG TERM SETTING TO REDUCE UNNECESSARY ANTIPSYCHOTIC MEDICATIONS.

Introduction Antipsychotics have had a history of being prescribed at a high rate in nursing homes(NH). 30% of all newly-admitted NH residents received antipsychotic medications in 2006. In 2012, Centers for Medicare & Medicaid Services (CMS) launched the Partnership to Improve Dementia Care in Nursing Homes to promote comprehensive dementia care and therapeutic interventions for NH residents with dementia-related behaviors in partnership with various national organizations. The appropriate use of the medication is still an uneven practice and clinicians often are unclear when to start, continue or stop the medication. We endeavor to present the outcomes following the implementation of the guidelines at our facility. Methods In an 800 bed facility, the psychiatrists implemented a user-friendly objective medication guideline in the management of BPSD, while concurrently providing staff education to the frontline staff beginning 2011.The elements of the guideline include - a) non-medication interventions, b) when to start, continuation and discontinuation criteria. We reviewed changes in antipsychotic medication rate over the past 7 years at the facility while comparing the commensurate national data available in CMS archives from quarter 1 of 2011 (2011Q1) to quarter 1 of 2018 (2018Q1). Results Point prevalence of antipsychotics at the facility in Q1 of each year were 38%(2011), 25%(2012), 12.9%(2013), 13.6%(2014), 14.1%(2015), 14.55%(2016), 11.67%(2017) and 9.14%(2018). The national point prevalence during the same duration were 23.6%(2011), 23.8%(2012), 21.64%(2013), 19.79%(2014), 18.68%(2015), 16.6%(2016), 15.7%(2017) and 14.8%(2018). The point prevalence for the facility went down from 38% in Q1 of 2011 to 9.14% in Q1 of 2018, a decrease of 76%. The national point prevalence during the same duration of 7 years decreased from 23.6% to 14.8%, a decline of 37%. The prevalence for the facility has registered a faster decline than the national average (76% vs 37%). The prevalence of antipsychotics was higher for the facility in 2011 (38% vs 23.6%) and 2012 (25% vs 23.8%) compared to the national average. We are collecting data for the rate of use of psychotropics other than antipsychotics in the management of BPSD at the facility. Conclusions Psychiatry can play a significant role in implementing appropriate medication use guidelines while providing in-vivo education to the primary care team. The guidelines help provide an objective standardized manner of right-sizing the dose or appropriate usage of the medication. It helps involve all stakeholders, including, the psychiatrist, primary care provider, nursing and family, in providing adequate care to the NH residents. Using an objective behavior assessment tool (Neuropsychiatric Inventory Questionnaire - NPI) may further improve medication prescribing practices. The pattern of prescription of other classes of psychotropics will also help rationalize appropriate behavioral management. This research was funded by None.

Costing resource use of the Namaste Care Intervention UK: a novel framework for costing dementia care interventions in care homes.

To develop a representative full cost model for a UK version of the multi-component, non-pharmacological Namaste Care intervention for care home residents with advanced dementia. The Namaste Care Intervention UK comprises multiple individual cost components, and a comprehensive list of all possible resources that could be expended in each cost component formed the initial stage of the cost model development. Resource use was divided into three key areas: staff, capital and consumables. Representative costs were identified for each of the possible resources, with a standard approach being used for all resources within each of the three key areas.Assumptions were made regarding the number and duration of sessions, group size, involvement of different staff members, and additional activity before and after a session, as these all have an impact on resource use and hence cost. A comparable 'usual care' session for residents not receiving Namaste Care was also costed to enable the 'additional' cost of delivering Namaste Care to be calculated. The full cost model indicates that Namaste Care Intervention UK costs approximately £8-£10 more per resident per 2-hour session than a comparable period of usual care. However, positive impacts on resident and staff well-being resulting from receiving Namaste Care will also have their own associated costs/benefits which may negate the 'additional' cost of the intervention. The cost model provides the first opportunity to investigate the full costs associated with Namaste Care, and will be refined as additional information is captured during subsequent phases of the research.

Typology of Technology-Supported Dementia Care Interventions From an In-Home Telehealth Trial.

Identifying the needs of dementia caregivers is critical for supporting dementia home care. This study identified a typology of expert interventions delivered to dementia caregivers during an innovative telehealth trial that used in-home video recordings to directly observe care challenges. Qualitative content analysis was used to analyze narrative notes describing interventions that were developed based on video data submitted by 33 caregiver-care recipient dyads. Two major themes emerged: education and skills for dementia care and caregiver support. Ten subthemes included education and skills related to: behavioral and psychological symptoms of dementia, disease expectations, safety, activities of daily living, medical care optimization, and medication utilization and caregiver support related to: respite, positive reinforcement, social and financial support, and self-care. Families providing in-home dementia care experience a wide range of care challenges. By using video data, dementia care experts were able to witness and evaluate challenging care situations and provide individualized feedback.

Perceptions of precision medicine among diverse dementia caregivers and professional providers

IntroductionUnderrepresented groups experience health disparities and a history of exploitation by researchers and the health-care system that may contribute to distrust of new treatments and technologies. This study aims to understand how diverse family caregivers and health-care professionals view the benefits and risks of precision medicine as well as cultural dimensions to consider when developing and implementing precision medicine interventions in dementia care. MethodsEight focus group sessions and one individual interview were conducted over a 6-month period. Fifty-four focus group participants included African-American, American Indian, rural Caucasian, Latino, and West African caregivers and health professionals. The majority of participants were female (73%) and were of Hispanic/Latino ethnicity (68%). About a third of participants identified their race as white. Participants were presented with four hypothetical scenarios related to precision medicine diagnostic and treatment approaches in dementia care: (1) genetic testing for dementia risk, (2) health-care informatics to determine individualized medication dosages based on health and family history, (3) a smartphone application providing dementia caregiving tips, and (4) remote activity monitoring technology in the home. Focus groups' responses were coded using thematic analysis. ResultsParticipants indicated skepticism regarding the use of precision medicine in their communities. Concerns included cost of precision medicine and insurance coverage; lack of alignment with cultural norms; fraught relationships between communities, health professionals, and researchers; data ownership and privacy; and the trade-off between knowing risk and treatment benefit. DiscussionEstablishing relationships with underserved communities is crucial to advancing precision medicine in dementia care. Appropriate engagement with diverse racial, ethnic, and geographic communities may require significant investment but is necessary to deliver precision medicine effectively.

Facilitating creativity in dementia care: the co-construction of arts-based engagement

AbstractThis paper seeks to understand the engagement of people with dementia in creative and arts-based activities by applying a relational model of citizenship and incorporating concepts of contextual and embodied learning from adult learning theory. A theoretically driven secondary analysis of observational and interview data focuses on the engagement of staff, volunteers and people with dementia during an arts-based intervention in a day centre and care home. The processes through which learning is co-constructed between the person with dementia, staff/volunteer facilitators and peers in the group to co-produce a creative engaged experience involves: increasing confidence for learning, facilitating social and physical connections, and affirming creative self-expression. The role of facilitator is central to the process of creative engagement to reinforce a sense of agency amongst participants and recognise people's prior experiences of learning and engagement in creative activities. People with dementia continue to learn and grow through engagement in creative activities to produce positive outcomes for the individual participants and for the care staff who observe and participate in this creativity. Facilitating creativity requires attention to lifelong experiences of learning in addition to the immediate interactional context to integrate arts-based interventions in dementia care successfully.

An intervention to improve sleep for people living with dementia: Reflections on the development and co-production of DREAMS:START (Dementia RElAted Manual for Sleep: STrAtegies for RelaTives).

Many people living with dementia experience sleep disturbances yet there are currently no known effective, safe and acceptable treatments. Working with those affected by dementia to co-produce interventions is increasingly promoted to ensure that approaches are fit for purpose and meet the specific needs of target groups. Our aim here is to outline and reflect upon the co-production of Dementia RElAted Manual for Sleep; STrAtegies for RelaTives (DREAMS:START), an intervention to improve sleep for people living with dementia. Our co-production team brought together experts in the development and testing of manualised interventions in dementia care and cognitive behavioural interventions for sleep disorders, with Alzheimer's Society research network volunteers (ASRNVs) whose lives had been affected by dementia. Here we present the process of intervention development. We worked with (ASRNVs) at each stage of the process bringing together 'experts by training' and 'experts by experience'. (ASRNVs)shared their experiences of sleep disturbances in dementia and how they had managed these difficulties, as well as suggestions for how to overcome barriers to putting the intervention into practice; making (DREAMS:START) more accessible and usable for those in need. In this paper we discuss both the benefits and challenges to this process and what we can learn for future work. Collaborating with 'experts by experience' caring for a relative with sleep difficulties helped us to develop a complex intervention in an accessible and engaging way which we have tested and found to be feasible and acceptable in a randomised controlled trial.

Music therapy and dementia care practice in the United Kingdom: A British Association for Music Therapy membership survey

The place of music therapy in the spectrum of musical interventions in dementia care needs to be better understood in light of the ‘supply’ and ‘demand’ of this provision. A semi-structured, online survey of British Association for Music Therapy members and affiliates was undertaken in summer 2017. It asked respondents to report on employment practice and settings, and experience in dementia-related music therapy. It asked about training received and given, and what barriers prevent wider availability of music therapy for people with dementia in the United Kingdom. Replies came from 188 people, 142 of whom were working with people with dementia. Most respondents reported working in the public or voluntary sector, but one in five was self-employed. Most (61%) were employed in residential care or hospital settings, for an average of 20 hours per week. The main factor that would increase music therapy provision in dementia care was seen as ‘greater awareness’ of music therapy amongst the general public and within the National Health Service. Nearly one-quarter (23%) thought that training and development could help increase provision. This was the largest survey undertaken to date of dementia practice by Music Therapists in the United Kingdom. It has implications for recruitment, professional development, promotion of the specialism and research.

Stakeholder Engagement to Enhance Interventions for Family Caregivers of People with Dementia: A Case Study of Care to Plan

ABSTRACTFamily members are prominent providers of necessary care to persons with dementia. The psychological, emotional, and social costs of care have led to the development of interventions to support these families. Although evidence supports the effectiveness of dementia caregiver interventions, few have been implemented into practice. Stakeholder involvement may increase the potential for interventions to be integrated into community contexts. Utilization of community advisory boards (CABs) have been identified as a successful strategy to engage stakeholders in research and intervention development. Yet, little is known about the use of CABs when developing and refining interventions in dementia care. This article presents a case study of a CAB intended to inform the development and translation of an online dementia caregiver resource: Care to Plan. Qualitative thematic analysis of transcripts from seven CAB meetings over a 3-year period identified two major categories. First, the CAB process: who participated, how meetings were conducted, and issues that arose. Second, Care to Plan improvement: how CAB members provided key stakeholder perspectives resulting in changes in language, functionality, substance, and dissemination. Findings demonstrate how CABs can inform gerontological social work when facilitating the development, translation, and implementation of meaningful, community-based resources for dementia caregivers.

The effectiveness of community-based coordinating interventions in dementia care: a meta-analysis and subgroup analysis of intervention components

BackgroundInterventions aiming to coordinate services for the community-based dementia population vary in components, organisation and implementation. In this review we aimed to evaluate the effectiveness of community-based care coordinating interventions on health outcomes and investigate whether specific components of interventions influence their effects.MethodsWe searched four databases from inception to April 2017: Medline, The Cochrane Library, EMBASE and PsycINFO. This was aided by a search of four grey literature databases, and backward and forward citation tracking of included papers. Title and abstract screening was followed by a full text screen by two independent reviewers, and quality was assessed using the CASP appraisal tool. We then conducted meta-analyses and subgroup analyses.ResultsA total of 14 randomised controlled trials (RCTs) involving 10,372 participants were included in the review. Altogether we carried out 12 meta-analyses and 19 subgroup analyses. Meta-analyses found coordinating interventions showed a statistically significant improvement in both patient behaviour measured using the Neuropsychiatric Inventory (NPI) (mean difference (MD) = −9.5; 95% confidence interval (CI): −18.1 to −1.0; p = 0.03; number of studies (n) = 4; I2 = 88%) and caregiver burden (standardised mean difference (SMD) = −0.54; 95% CI: -1.01 to −0.07; p = 0.02; n = 5, I2 = 92%) compared to the control group. Subgroup analyses found interventions using a case manager with a nursing background showed a greater positive effect on caregiver quality of life than those that used case managers from other professional backgrounds (SMD = 0.94 versus 0.03, respectively; p < 0.001). Interventions that did not provide supervision for the case managers showed greater effectiveness for reducing the percentage of patients that are institutionalised compared to those that provided supervision (odds ratio (OR) = 0.27 versus 0.96 respectively; p = 0.02). There was little evidence of effects on other outcomes, or that other intervention components modify the intervention effects.ConclusionResults show that coordinating interventions in dementia care has a positive impact on some outcomes, namely patient behaviour and caregiver burden, but the evidence is inconsistent and results were not strong enough to draw definitive conclusions on general effectiveness. With the rising prevalence of dementia, effective complex interventions will be necessary to provide high quality and effective care for patients, and facilitate collaboration of health, social and third sector services.

Telling life stories: a dyadic intervention for older Korean couples affected by mild Alzheimer's disease.

Fifty six couples (n = 102) completed the five-week intervention from December 2013 to October 2015. The participants completed a survey including open-ended questions one week after finishing the intervention. A thematic content analysis was conducted to analyze the responses. Qualitative analysis revealed benefits and challenges in the experience of CLSA. Themes related to benefits were: (1) emotional benefits of reminiscing; (2) positive evaluation of life as a couple; (3) gratitude toward spouse; (4) changes in communications or activities with spouse; and (5) changes in relationship quality. Couples' experience varied, with some having mixed feelings about the intervention. Challenges perceived by participants included revival of bitterness and identification of loss. Findings suggest the CLSA contributes to enhancing the quality of life for couples affected by Alzheimer's disease and improving their relationship. Challenges that emerged in the CLSA will guide future research to identify the sub-population that is appropriate for the couple-oriented intervention in dementia care.

Building a Population Based Cognitive Screening System to Improve the Early Diagnosis of Dementia in Japan

An introduction: Since the global population is rapidly ageing dementia has become a worldwide concern; the illness places considerable burdens on individuals and their family members as well as on a health and social care provisions. By 2050, 135 million people are estimated to have dementia in the world. In 2010 the global cost of dementia care was estimated at $604bn and was estimated to increase to $1tr by 2030. Japan, a rapid ageing country, is requiring urgent interventions regarding dementia. Of all chronic diseases, dementia is one of the most significant contributors to dependence and disabilities of individuals. Because of the absence of a cure, a professional's belief; nothing can be done to dementia, has contributed to the delay of its diagnosis. However, the increasing number of evidences showing possibilities of prevention, earlier diagnosis and interventions of dementia begin to draw international attentions. In Japan, although every municipality is obligated to have a multidisciplinary team to cope with dementia since 2015 under the national policy, the actual implementation hasn't developed so much yet. This research aims to summarise establishment of the population based cognitive screening system project in M-city in Japan to provide the evidences of the diagnosis and early interventions in dementia care. Short description of practice change implemented: We conducted a pilot project in M-city. We chose this city, located within 20km area from the centre of Tokyo, because of the great necessity to develop interventions for dementia while their elderly population rises rapidly. We organized a study committee composed of the city workers, the representatives of long-term care providers, and academic experts in order to develop methodologies for the dementia screening and the steps of interventions afterward. The intervention includes following steps; 1) consultation of memory problems, 2) explanation of the project to individuals with dementia and their families, 3) execution of the questionnaire survey (DASC-21 (AWATA2016., et al)), 4) care management (i.e. encourage visiting a home doctor or medical institutes supporting dementia, education of self-care, adjust the use of long-term care services etc.) and 5) monitoring, and they were applied in all Community-based integrated Centres and some of primary care doctors, pharmacists, and long-term care providers. DASC scores of each participant at the points of the screening and the monitoring were collected together with the participant's self-reports about their daily practices in self management. Key findings: In order to promote the early diagnosis and interventions for people with dementia, it is necessary to focus on patients who are discharged from acute hospitals. Moreover, cooperation with primary care doctors is indispensable (essential) in cognitive screening systems, and it is important that those doctors take a role in exclusion of non-dementia diseases and in an appropriate management of coexisting conditions and daily lives of dementia patients. Although DASC-21 is useful as a screening tool, development of a simpler tool is needed. Highlights: M-city continues the project of the cognitive screening system and publishes the results to the citizens. Furthermore, M-city is considering to strengthen the coordination between Community-support centers and primary care providers in order to establish a screening system. The city is also preparing to introduce financial incentives to encourage screening. Conclusion: While Japan is promoting to construct the community-based integrated care system, the measures to achieve so are depending on the decisions of each municipal government. M-city started to build the cognitive screening system to improve early diagnosis of dementia and they investigate whether the screening system influences on containment of future medical and care cost as one of the outcomes. Although this practice is currently considered as advance in Japan, such practices need to be more common in the future.

Exploring the theoretical foundations of visual art programmes for people living with dementia.

Despite the growing international innovations for visual arts interventions in dementia care, limited attention has been paid to their theoretical basis. In response, this paper explores how and why visual art interventions in dementia care influence changes in outcomes. The theory building process consists of a realist review of primary research on visual art programmes. This aims to uncover what works, for whom, how, why and in what circumstances. We undertook a qualitative exploration of stakeholder perspectives of art programmes, and then synthesised these two pieces of work alongside broader theory to produce a conceptual framework for intervention development, further research and practice. This suggests effective programmes are realised through essential attributes of two key conditions (provocative and stimulating aesthetic experience; dynamic and responsive artistic practice). These conditions are important for cognitive, social and individual responses, leading to benefits for people with early to more advanced dementia. This work represents a starting point at identifying theories of change for arts interventions, and for further research to critically examine, refine and strengthen the evidence base for the arts in dementia care. Understanding the theoretical basis of interventions is important for service development, evaluation and implementation.

Dementia care mapping in nursing homes: effects on caregiver attitudes, job satisfaction, and burnout. A quasi-experimental trial.

The Dementia Care Mapping (DCM) method is an internationally recognized complex intervention in dementia research and care for implementing person-centered care. The Leben-QD II trial aimed to evaluate the effectiveness of DCM with regard to caregivers. The nine participating nursing home units were allocated to three groups: (1) DCM method experienced ≥ 1 year, (2) DCM newly introduced during this trial, and (3) regular rating of residents' quality of life (control group). Linear mixed models were fit to cluster-aggregated data after 0, 6, and 18 months, adjusting for repeated measurements and confounders. The primary outcome was the Approaches to Dementia Questionnaire (ADQ) score; the secondary outcomes were the Copenhagen Psychosocial Questionnaire (COPSOQ) and the Copenhagen Burnout Inventory (CBI). The analysis included 201 caregivers with 290 completed questionnaires (all three data collection time points). The ADQ showed a significant time and time*intervention effect. At baseline, the estimated least-square means for the ADQ were 71.98 (group A), 72.46 (group B), and 71.15 (group C). The non-linear follow-up of group A indicated an estimated-least square means of 69.71 (T 1) and 68.97 (T 2); for group B, 72.80 (T 1) and 72.29 (T 2); and for group C, 66.43 (T 1) and 70.62 (T 2). The DCM method showed a tendency toward negatively affecting the primary and secondary outcomes; this finding could be explained by the substantial deviation in adherence to the intervention protocol.

Overview of systematic reviews: Effective home support in dementia care, components and impacts-Stage 1, psychosocial interventions for dementia.

To synthesize evidence to identify the components of effective psychosocial interventions in dementia care to inform clinical practice, policy and research. With population ageing, dementia represents a significant care challenge with 60% of people with dementia living at home. Overview of systematic reviews with narrative summary. Electronic searches of published systematic reviews in English using Cochrane Database of Systematic Reviews, DARE and EPPI-Centre, between September 2013 - April 2014. Systematic reviews were appraised against Cochrane Collaboration levels of effectiveness. Components of psychosocial interventions were identified with their theoretical rationale. Findings were explored with a Patient, Public and Carer Involvement group. Thirty-six systematic reviews were included. From interventions, 14 components were identified, nine for people with dementia and five for carers, mostly undertaken in nursing/care homes. For people with dementia, there was evidence of effectiveness for cognitive stimulation and cognitive training, but less evidence for sensory stimulation, reminiscence, staff education, behavioural therapy and ADL training. For carers, there was evidence of effectiveness for education and training, psychotherapy and counselling. There was a lack of definitive evidence of effectiveness for most psychosocial interventions. Further studies with stronger methodology or replication of existing studies would strengthen the evidence base. Few interventions were undertaken with people with dementia and their carers living at home. Further work will investigate the extent to which components identified here are present in models of home support for people with dementia and carers and their effectiveness.

INFORMATION AND COMMUNICATIONS TECHNOLOGY IN DEMENTIA CARE: ACCEPTANCE AMONG PROFESSIONAL CAREGIVERS

AbstractWhen it comes to dealing with symptoms associated with dementia, a number of studies have established the effectiveness of psychosocial interventions. However, in view of limited financial and human resources, implementing effective interventions in daily practice can be a major challenge for care providers. Recently, there has been a growing interest in the use of Information and Communication Technologies (ICTs) for supporting psychosocial interventions in nursing home settings. ICTs are cost-effective and widely available, and using them could potentially ease the burden of dementia care delivery. Therefore, in order to assess acceptance and attitudes of professional caregivers regarding ICTs in dementia care, a sample of N = 205 professional caregivers (M = 38,81 yrs; 70% female) from 10 residential care facilities located in Berlin completed a standardized questionnaire (TA-EG) on factors associated with technology use and acceptance. Additionally, 11 semi-structured interviews were conducted. Results showed that older and female caregivers, respectively, reported less Competence (z = -4.21, p < .01 and z = -4.44, p < .01, resp.) and Enthusiasm (z = -2.38, p < .05 and z = -4.01, p < .01, resp.) regarding the use of technology in their work environment. Furthermore, qualitative content analysis of the interview transcripts revealed both factors promoting the use of ICTs in residential dementia care, and potential barriers. Important recommendations for the development of ICT-based interventions in dementia care will be reported and general implications for their design and successful adoption will be discussed.

USING IPADS TO PROMOTE PATIENT SAFETY AND REDUCE STAFF INJURIES IN DEMENTIA CARE

Background: The changes associated with dementia can lead to mood alterations and behavioral and psychological symptoms of dementia (BPSD). BPSD are common, affecting up to 90% of persons with dementia over the course of their illness. Not only do BPSD cause distress for the patients with dementia, but also place hospital staff at risk for injury.This project examines whether using an iPad to play a video purposively created for the patient by his or her family may contribute to preventing and reducing BPSD of patients with dementia. Methods: We used a single case study design and mixed methods. With an ABAB withdrawal design, a patient was observed in four phases, A1 (baseline, no intervention), B1 (intervention), A2 (withdrawal, no intervention) and B2 (intervention again). Also, we conducted staff interviews and video analysis to investigate contextual factors and staff experiences. Results: Our preliminary findings support positive effects of the intervention. Staff described the benefits and barriers of integrating iPad into everyday care activities on the hospital unit. Conclusions: This research contributes to the knowledge base of using technology (iPad) as a non-pharmacological intervention in dementia care. The iPad has great potential to be a safe, easy and low cost solution for supporting patient safety and reduction of staff injuries in clinical settings.

The value of life story work for staff, people with dementia and family members.

Dementia is a term used to describe a collection of symptoms that include problems with memory, self-care, reasoning and communication. Care interventions that focus on preserving people's dignity and identity are therefore essential. Using Driscoll's reflective model to guide critical thinking, this article reflects on the use of one intervention, namely life story work, to promote person-centred care for people with dementia. It explores the value or effect of life story work for healthcare staff, the person with dementia and family members. It also highlights best practice guidelines that are useful to consider to promote its optimal success as an intervention in dementia care, for example, instigating it early in the dementia journey and embedding it in a supportive culture. It is important to highlight to nursing students the many positive aspects of incorporating life story work into practice.

MODEM: A comprehensive approach to modelling outcome and costs impacts of interventions for dementia. Protocol paper

BackgroundThe MODEM project (A comprehensive approach to MODelling outcome and costs impacts of interventions for DEMentia) explores how changes in arrangements for the future treatment and care of people living with dementia, and support for family and other unpaid carers, could result in better outcomes and more efficient use of resources.MethodsMODEM starts with a systematic mapping of the literature on effective and (potentially) cost-effective interventions in dementia care. Those findings, as well as data from a cohort, will then be used to model the quality of life and cost impacts of making these evidence-based interventions more widely available in England over the period from now to 2040. Modelling will use a suite of models, combining microsimulation and macrosimulation methods, modelling the costs and outcomes of care, both for an individual over the life-course from the point of dementia diagnosis, and for individuals and England as a whole in a particular year.Project outputs will include an online Dementia Evidence Toolkit, making evidence summaries and a literature database available free to anyone, papers in academic journals and other written outputs, and a MODEM Legacy Model, which will enable local commissioners of services to apply the model to their own populations.DiscussionModelling the effects of evidence-based cost-effective interventions and making this information widely available has the potential to improve the health and quality of life both of people with dementia and their carers, while ensuring that resources are used efficiently.

Do interventions with staff in long-term residential facilities improve quality of care or quality of life for people with dementia? A systematic review of the evidence.

The review by Bird and colleagues (2016), published in this issue of International Psychogeriatrics, is notable for jointly examining the effect of dementia care interventions on both staff and resident quality outcomes. This is an important contribution to improving dementia care because it recognizes the dynamic and dyadic relationship between residents and their caregivers in residential settings. While evidence exists on the dyadic effect of family caregiver intervention on dementia patient outcomes (Gitlin and Hodgson, 2015), less attention has been given to formal caregivers in institutional settings (Dellefield et al., 2015).

Healing words: A study of poetry interventions in dementia care.

The personhood movement in dementia research has established the theoretical foundation for implementing cultural arts interventions in care practices. The underlying assumption is that professionals from the visual and the performance arts are well equipped to see the person behind the condition and to focus on possibilities for meaningful relationships in the here and now. This article focuses on poetry interventions as one example of cultural arts interventions. The use of poetry might seem counterintuitive, given that people with dementia lose their language abilities and that poetry is regarded to be the most complex literary form. I will argue that expanding on existing research on poetry interventions from a health and science perspective with a humanities approach will help illuminate how poetry works to enhance the exchange with people with dementia. Drawing on participant observations of poetry interventions by Gary Glazner (Alzheimer's Poetry Project, USA) at the New York Memory Center, I will frame poetry interventions as a specific form of oral poetry in which people with dementia are positioned as cocreators of embodied texts and directly benefit from the power of the spoken word.