A qualitative study of the experiences of long-term care for residents with dementia, their relatives and staff.

Most older people living in 24-hour care settings have dementia. We employed qualitative interviews to explore positive and negative aspects of the experience of family carers, staff and people with dementia living in 10 homes in London and West Essex, selected to cover the full range of 24-hour long-term care settings. The interview used open semi-structured questions. We interviewed 21 residents, 17 relatives and 30 staff and five main themes were identified: Privacy and choice; relationships (abuse and vulnerability); activities; physical environment; and expectations of a care environment by carers, should they one day live in long-term care themselves. Despite being no longer responsible for the day-to-day care of the residents there was a continuing level of psychological distress among some relatives. We found that residents with a range of severity of dementia were able to participate. The most striking theme from their interviews was the need for choice. All groups talked about improving lines of communication amongst residents, relatives and staff and about the importance of activities. We recommend that homes should set up formal structures for engaging with user and carer views at all levels. This would mean relatives on the board, and regular meetings for residents, relatives, advocates and staff. This should lead to cultural changes where residents are perceived as individuals and care is provided in a more flexible way. There should be a programme of activities in each 24-hour care setting, which all care staff are given time to implement. These activities need to be tailored to the individual resident rather than the whole group.

Delayed discharge--a solvable problem? The place of intermediate care in mental health care of older people.

The National Service Framework for Older People envisages the development of intermediate care for older people. This study examined the possible role of intermediate care beds within mental health trusts. We interviewed senior clinicians in an inner city old age psychiatry service about the 91 current in-patients on the old age psychiatric wards. Sixty-five were classified as acute patients and the remaining 26 were continuing care patients. Structured instruments were used to collect information regarding neuropsychiatric symptoms, activities of daily living and current met and unmet needs. Where discharge was delayed an assessment was made regarding the appropriateness for an intermediate care setting according to the criteria set by the Department of Health guidelines. A total of 30 (46%) patients' discharges were delayed. Of these, 19 (29%) patients met the DOH criteria for intermediate care; 10 (53%) had dementia, five (26%) affective disorder, and four (21%) with schizophrenia. The 11 other delayed discharges were because of lack of availability of finance for placements. The study found that the prompt discharge of older patients from acute psychiatric care was a significant problem and many of those patients may benefit from the therapeutic and rehabilitative process afforded by intermediate care.

The needs and mental health of older people in 24-hour care residential placements.

At present one in five men and one in three women who reach the age of 65 in the UK today can expect to require 24-hour residential care. They are assessed according to needs as to the type of placement that is required. Little is known about the changing needs and symptoms of residential clients over 65 with mental health problems. The needs and neuropsychiatric symptoms of older people living in residential, nursing and hospital settings were assessed by standardized questionnaire. Seventy-seven residents were interviewed using the Camberwell Assessment of Needs for the Elderly (CANE) and the Neuropsychiatric Inventory (NPI). The mean CANE for all settings was high. The highest mean CANE was for a residential home and the lowest for a hospital setting. Similar settings had varying NPI and CANE. The data suggests that once placed, subjects needs and neuropsychiatric symptoms do not remain static. It may make both clinical and fiscal sense to reassess subjects. The development of more residential settings, which allow flexibility of degree of care, is recommended.

The promiscuity pill principle (P-P-P).

PIP: An unusually high increase in the incidence of suspicious Papanicolaou smears among women 15-22 years old is reported. Cervical tissue from these patients has shown a different form of atypia than usually encountered. Both dyskaryosis and karyomegaly have been observed. Follow-up study revealed that the majority of the patients were sexually promiscuous and/or using birth control pills. However, whether these factors are causally involved in this 8-fold increase in the incidence of suspicious smears has yet to be determined.^ieng