Resource allocation in dementia care: comparing the views of people with dementia, carers and health and social care professionals under constrained and unconstrained budget scenarios

Exploring the Role of a Dietitian in an Early Intervention Program for People With Dementia and Their Care Partners: A Composite Case Series

Symptoms of dementia can impact the nutritional status and quality of life of people with dementia, but there is limited research exploring the dietitian's role in post-diagnostic care. This study aims to explore the role of a dietitian in a multidisciplinary dementia program for people living in the community. Participants in a twelve-week multicomponent, multidisciplinary post-diagnostic intervention for people with dementia and care partners were offered three consultations with a dietitian to receive dietary assessment, education and advice. Key clinical findings from dietetics case notes of 40 people with dementia were analyzed using a composite case series approach. Of these, 39 required ongoing nutrition support and intervention. Common issues identified include insufficient energy and/or nutrient intake, unintentional weight loss, poor management of comorbidities and difficulties with coordination of care. Dietitians are an integral part of a multicomponent intervention for dementia. Future work is needed to optimize dietetic care models. Running headline. Dietetics in an early intervention for dementia.

Pilot of a multicomponent program for people with dementia and their care partners: Health services staff expectations, experiences and observations

There is increased recognition of the need to improve post-diagnostic pathways for people with dementia and their care partners living in the community to access rehabilitation services to support independence and wellbeing. However, there is minimal evidence on implementing rehabilitation services for this population. The study aimed to present the expectations and experiences of allied health staff involved in piloting the Sustainable Personalised Interventions for Cognition, Care and Engagement (SPICE) program based at an outpatient clinic of a public rehabilitation hospital. Over twelve weeks, the program combines small group and dyadic evidence-based interventions including cognitive stimulation therapy, occupational therapy, physical activity, care partner education, and dietetics. A qualitative exploratory methodology was used with pre- and post-program interviews conducted with ten allied health staff. Questions were designed to elicit the expected and actual benefits and challenges of the initial implementation of the multicomponent program. The multidisciplinary team were motivated by the potential for the SPICE program to meet an important service gap, and confident people with dementia and their care partners would benefit. Staff reported enjoyment, satisfaction, and confidence in delivering the program, and believed the multiple components had synergistic effects on participants, particularly regarding social connection and functional engagement. While staff had pre-program concerns regarding retention, participant fatigue, and managing challenging situations, these were not realised. At times, staff observed program intensity to cause unintended stress for some care partners. Resourcing and strategies to ensure sustainability were identified as important by staff, as well as the need for ongoing support to participants post-program. Overall, the SPICE program exceeded expectations and was rewarding for staff. Further work to refine and evaluate the program is necessary to support its potential to continue providing dementia rehabilitation to promote the independence and wellbeing of people with dementia and care partners living in the community.

Do people with dementia and carers get what they need? Barriers in social care and carers needs assessments

BACKGROUND

People with dementia and unpaid carers need to go through a social care or carers needs assessment to access and receive subsidised or fully-funded social care. With no previous evidence, this qualitative study aimed to provide insights into the access to, experiences of receiving and conducting social care or carers needs assessments, and access to social care.

METHODS

Unpaid carers of people with dementia and professionals conducting social care or carers needs assessment living or working in England were interviewed remotely about their experiences between April and August 2023. Topic guides were co-produced with two unpaid carers, and both were supported to code anonymised transcripts. Thematic analysis was used to analyse the data.

FINDINGS

Twenty-seven unpaid carers (n = 21) and professionals (n = 6) participated. Four themes were generated: (1) Issues with accessing needs assessments, not the process; (2) Knowledge of needs assessments and the health and social care system; (3) Expectations of unpaid carers; and (4) Post-assessment unmet needs. The most prominent barriers unpaid carers and their relatives with dementia encountered were awareness of and access to needs assessment. Unpaid carers were mostly unaware of the existence and entitlement to a needs assessment, and sometimes realised they had participated in one without their knowledge. Professionals described the pressures on their time and the lack of financial resources within services.

CONCLUSIONS

To facilitate improved access to dementia care and support for carers, the pathway to accessing needs assessments needs to be clearer, with better integration and communication between health and social care.

Optimising Online Peer Support for People with Young Onset Dementia

People with Young Onset Dementia (YOD) can be hesitant to engage with online peer support. This work aims to explore (1) why people are hesitant to engage in online peer support, (2) how to get more people involved in online peer support, and (3) what makes online peer support work well. Nine interviews with people with YOD were conducted on MS Teams. Participants were recruited through purposive sampling. Data were analysed thematically. Reasons for being hesitant to engage with online peer support include being unsure what to expect and concerns about seeing others in more advanced stages of dementia. Additionally, it can be difficult to identify groups that suit one's needs and interests. Group facilitators of online peer support groups should provide a detailed description of their group so that people can better assess whether the group would suit them. The insights obtained from this study will be used to develop a Best Practice Guidance on online peer support for people with YOD. Moreover, the findings can be useful for further research exploring how to support people with dementia in general in accessing online health and social care services.

Online peer support: views and experiences of people with young onset dementia (YOD)

OBJECTIVES

This study explores (1) which platforms people with YOD use for online peer support, (2) reasons for using or not using online peer support, and (3) how to optimise potential benefits and accessibility.

METHODS

A mixed-methods online survey was conducted including fixed-choice and open questions. Participants were people with YOD recruited through dementia organisations, Join Dementia Research and the NHS using convenience sampling. Fixed-choice questions were analysed with Chi-square test of significance and free-text responses with thematic analysis.

RESULTS

A total of 69 completed surveys were analysed. Zoom was most popular for online peer support, followed by Facebook and Twitter. Positives included sharing social support, joining from home, and the option to choose a preferred platform. However, it can be difficult to follow the conversation or understand others. Many were unaware about online peer support and some felt uncomfortable talking to strangers online. To improve access and benefits of online peer support organisations and healthcare professionals should advertise and signpost more and groups should have a clear description.

CONCLUSION

Online platforms facilitate social support and make peer support accessible to those who do not have access to in-person options. Future research and practice should focus on raising awareness about online peer support.

Resource allocation across the dementia continuum: a mixed methods study examining decision making on optimal dementia care among health and social care professionals

Background

The understanding of appropriate or optimal care is particularly important for dementia, characterised by multiple, long-term, changing needs and the increasing expectations of people using services. However, the response of health and social care services is limited by resource constraints in most countries. This study sought to determine the optimal level, mix and cost of services for different dementia case types across the dementia continuum, and to better understand the resource allocation decision making process among health and social care professionals (HSCPs).

Methods

A balance of care framework was applied to the study questions and developed in three ways; firstly by considering optimality across the course of dementia and not just at the margin with residential care; secondly, through the introduction of a fixed budget to reveal constrained optimisation strategies; and thirdly through the use of a mixed methods design whereby qualitative data was collected at workshops using nominal group technique and analysed to obtain a more detailed understanding of the decision-making process. Twenty four HSCPs from a variety of disciplines participated in the resource allocation decision-making exercise.

Results

HSCPs differentiated between case type severity; providing 2.6 times more resources to case types with higher level needs than those with lower level needs. When a resource constraint was introduced there was no evidence of any disproportionate rationing of services on the basis of need, i.e. more severe case types were not favoured over less severe case types. However, the fiscal constraint led to a much greater focus on meeting physical and clinical dependency needs through conventional social care provision. There was less emphasis on day care and psychosocial provision when resources were scarcer following the introduction of a fixed budget constraint.

Conclusions

HSCPs completed complex resource allocation exercises for people with dementia, including expected differentiation across case type severity. When rationing was introduced, HSCPs did not discriminate in favour of case types with high levels of need. They did, however, support conventional home care provision over psychosocial care, although participants were still keen to provide some residual cover for the latter, especially for case types that might benefit.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-06230-9.