Provision of psychosocial interventions for people with mild to moderate dementia and their supporters following diagnosis: findings from evidence reviews and survey of memory services in Yorkshire and Humber region
Gail Mountain, Phil Joddrell, Bukola Otensile and Sue Easton University of Sheffield
In collaboration with:
Dr Oliver J. Corrado, Leeds Teaching Hospitals’ ‘Dementia Champion’ and Co-Clinical Lead for Yorks and Humber SCN for Dementia
Ms Penny Kirk, lead for Yorks and Humber SCN for Dementia (http://www.yhscn.nhs.uk/mental-health-clinic/Dementia.php)
In 2014/15 funding was received through the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, Yorkshire and Humber (NIHR CLAHRC YH) to survey the extent and nature of interventions being delivered to people in the post-diagnostic period. This survey was complemented by a review of existing evidence.
Two systematic scoping reviews were conducted in July 2016 and updated in October 2016 and February 2017 to determine the range and breadth of evidence-based interventions that have been designed and researched for people post-diagnosis of dementia, and those supporting them.
Review findings were complemented by a survey of memory services in the Yorkshire and Humber region of the UK in 2015 to elucidate current and future intended practice.
Findings from the evidence reviews highlighted the limited number of psychosocial interventions developed and researched for people diagnosed with dementia in the mild to moderate stages. Research evidence was difficult to interpret due to inconsistent reporting.
Survey results uncovered a high degree of variation in provision, some of which could be explained by different service structures and staffing configurations. It also identified some innovation in practice.
It is evident that services need to develop the capacity to provide interventions for people post-diagnosis (both the person with a diagnosis and their family carers). Whole-system service innovation, including providers outside of the NHS, is recommended, but consideration must be given to elicit the views of these services from the perspectives of intended users.
Service providers are also strongly encouraged to embrace research into psychosocial interventions within their services, as this will both drive up quality of existing provision and provide much needed evidence for service development.
Researchers must engage in standardised study reporting so that findings can be compared across studies and also to enhance ability to implement in practice. Clarity is essential regarding who the described interventions have been designed for. Further to this, international agreement regarding the optimum standardised screening instrument for use in psychosocial research (including score interpretation) is required. Clear reporting of factors such as personal circumstances, living situation (including the presence of carer support) and attitudes (including readiness to engage in post diagnostic interventions) is essential for all forms of study if results are going to prove valuable for practice.
Research investment into the development and testing of psychosocial interventions for people with dementia in the mild to moderate stages is insufficient to meet the needs of both service commissioners and providers. If people are to receive the range of services they require, the knowledge and evidence gaps need closing.
This research was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care Yorkshire and Humber (NIHR CLAHRC YH). www.clahrc-yh.nihr.ac.uk. The views and opinions expressed are those of the author(s), and not necessarily those of the NHS, the NIHR or the Department of Health.