Month: July 2015

Do we need ‘intelligent transparency’ in the English dementia policy?

Shibley Rahman 0 Comments

The Secretary of State’s speech given in the King’s Fund had distinct twangs of ‘déjà vu’ for me.

There are six subtexts to Jeremy’s speech which immediately raise alarm bells for me in English dementia policy.

Allow me for a moment briefly to tell you what they are.

 

 

Jeremy Hunt, Secretary of State for Health, yesterday said at the King’s Fund:

“With 40,000 health apps now on iTunes, these innovations are coming sooner than most people realise. The future is here, but it needs to be more evenly distributed. Heart rates and blood pressure will no longer be simply a matter for the doctor – patients will know them and monitor them too. Data sharing between doctor and patient means power sharing too. Intelligent transparency creates intelligent patients with healthier outcomes. Get this right and it is no exaggeration to say that the impact will be as profound for humanity in the next decade as the internet has been in the last.”

The full text of Jeremy’s speech “Making healthcare more human” is here. Please check against actual delivery.

This immediately brought back flashbacks of a document recently produced by the leading global management consultants, Oliver Wyman, called “The Patent-Consumer Revolution”, with main authors Tom Main and Adrian Slywotzky.

Note point number 1 – “consumer power” is back.

The subtitle of that Oliver Wyman document is in fact, “HOW HIGH TECH, TRANSPARENT MARKETPLACES, AND CONSUMER POWER ARE TRANSFORMING U.S. HEALTHCARE”

I went in fact to the launch of this document in Baker Street.

I, in fact, quizzed one of the Partners how ‘transparent’ markets can – in reality – be.

Markets can be notorious for having hidden sources of division, such as taxes and tariffs. Also, they can be legislated for to have lack of transparency as a factor which give them competitive advantage. Take for example a failing private provider which hides behind a veil meaning that you cannot get it at its staffing numbers due to ‘freedom of information laws’. The current Secretary of State has never been in a hurry to iron out this anomaly in the English law which directly affects patient (or ‘user’) quality.

Jeremy remarks,

“If intelligent transparency is Patient Power 1.0, this is Patient Power 2.0. We have the chance to make NHS patients the most powerful patients in the world – and we should leap at the opportunity.”

Oliver Wyman is much more brash in its use of “2.0” in talking about ‘consumer markets’.

“But in fact the tech attack is far more. It is both the symptom and driver of a much larger and more significant change sweeping through U.S. healthcare. The consumer tech companies are making valuable contributions, but they are making them in the context of a fundamental redrawing of industry lines that puts the consumer in charge and sets the foundation for Health Market 2.0. The tech entrepreneur developing a new app may not realize it, but he is helping to create the infrastructure of a new, more powerful way of delivering healthcare. The consumer who loads it on her smartphone just because it’s cool is contributing in a tiny way to a cultural shift that is changing the way we think about health.”

And this matters because Oliver Wyman’s thesis is much more wide-ranging. It could have a profound impact on the way in which the medical ‘side’ of dementia policy is carried out.

Take for example the vision of Oliver Wyman management consultancy on the growth of the Apple app.

“And remember, many life-preserving and life-enhancing activities don’t actually require the intervention of doctors. Could a company like Apple persuade a substantial number of consumers to open up their medical records, share their biometric data, and treat their iPhones as their main point of contact with care, then it persuade them it’s fun and cool? In many ways that sounds like Health Market 2.0 in a nutshell. In a few years, consumers will look back and realize how antiquated the medical system used to be: Measure a handful of numbers (HDL, LDL, triglycerides, glucose, A1c) every 12 to 18 months, hear a few admonitions about diet and exercise, and forget them without any follow-up or coaching. Is that really how we did things? Why didn’t we think to demand more?”

 

Note point number 2 – “prevention” in public health creates new markets. Kerrrchhinngg!

If such ‘apps’ became widespread in the NHS, would taxpayers’ money be used to develop them? And, if so, would such innovations have commercial viability? For a NHS to be free at the point of use, there’d be ideological objection to the NHS charging for such apps, but it could be argued that the NHS could use charging for apps as a source of income generation. In the past, any element of introducing income generation has been interpreted as rationing services or producing a ‘two tier approach’, where you get an enhanced service if you can pay for it.

Would there be room for such apps in dementia?

In theory yes.

Risk factors for the vascular dementias include the usual risk factors for cardiovascular disease, e.g. ‘bad diet’, high blood pressure, uncontrolled blood sugar if diabetic, etc.

If you had non-invasive ways of measuring your blood sugar via your smart watch (say you were diabetic), or you were collecting information about your blood pressure all the time, you could have all your data uploaded into a giant computer. Such computer could look at your metrics as “Big Data”, as a corporate service to the NHS, and then ‘calculate’ your ‘risk’ of progressing onto a vascular dementia. And provided the NHS paid for this ‘middle man’, in theory you could be offering a higher ‘value’ NHS.

Or alternatively, you could be being fed a load of junk. At the moment, there’s no way of telling whether an app is actually making a positive difference to health, or merely feeding you a load of mumbo jumbo.

The sting in the tail comes from one sentence buried away in the Oliver Wyman report.

This leads smoothly onto the ‘big one’.

 

Point 3. English dementia care can be, theoretically, outsourced abroad to make it cheaper, while ‘adding value’.

Oliver Wyman asserts that: “The cornerstone of traditional medicine is the idea that all healthcare is local. ”

The argument goes like this.

If you could outsource diagnostic services, say send digitised MRI scans to a cheaper diagnostic unit in India or Taiwan, then the cost of running them will be cheaper. This will be useful for exerting budgetary control over the NHS budget. In fact, the ideal would be to do away altogether with hospitals, and just have a supply chain of bits of the system being done most cheaply, e.g. low-cost diagnostic workers ‘reading scans’ not specialist neuroradiologists.

This is disruption ‘at its best’.

 

Point 4. The argument for outsourced dementia privatised medical healthcare can be made by rubbishing the NHS subtlely.

On Twitter yesterday there was a joke doing the rounds along the lines of: “Mrs Hunt: “What would you like for breakfast Jeremy?” Mr Hunt: “Mid Staffs”.” hashtag #r4today.

That might also be the Jeremy Hunt answer to whether India or Taiwan, being an outsourced industry, would be any more unsafe. Hunt can attempt to argue that international jurisdictions haven’t inferior safety standards, particularly if Morecambe Bay or Mid Staffs are not ‘isolated incidents’. Throwing sunshine as a disinfectant into bad parts of the NHS are doing potentially makes it easier to argue that somebody other than the NHS can ‘do it better’?

And ‘doing it better’, in theory should be the function of effective management of performance in NHS institutions. Hospitals should want to improve the quality of their services first internally, rather than getting the regulator to do all the work. Such financial incentives for this to happen in the system must be ironed out in dementia policy. It’s what Roy Lilley calls ‘too much time weighing the pig, rather than fattening the pig’. We must all be concerned, in fact, if improvement comes from the regulator not HR, or in fact “NHS Improvement” is in fact a hybrid regulator – new jointly-led Monitor and TDA.

The advantage of process mapping each part of the supply chain is that it becomes easier to fragment the delivery of care, disposing of continuity of care to some extent, such that services are much easier to sell off and privatise.

The theme of ‘intelligent transparency’ was expanded in a number of areas by the Secretary of State, including how data could be used to identify problem areas in patient safety. The unfortunate aspect of having so many metrics of patient safety is that clinical commissioning groups are bamboozled as to which metric represents the most accurate measure of a particular organisation.

But patient safety in dementia policy does indeed bridge a number of areas – Jeremy mentions one of them in his speech, the quality of care homes. With the majority of people with more advanced dementia choosing to live at homes, rather than in a residential home, there has to be some sort of measure of the quality of home-help too. Ideally, unpaid carers need reassurance that they are meeting an appropriate standard of care, without having such standards as a stick to beat them with.

 

Point 5. ‘Intelligent transparency’ should apply also, say, the sheer volume of potentially incorrect diagnoses being currently chucked out by the English NHS.

Patient safety, however, is more than that in dementia policy. For example, there’s never been a proper analysis of the ‘safety’ of the diagnosis of dementia. In other words, how reliable is the diagnosis that people are receiving from the NHS? For ‘intelligent transparency’ to work here, we need some sort of information about how diagnoses are made as ‘dementia’, say to reach national ambitions, which later turn out not to be dementia, such as minor cognitive impairment or depression? Such misdiagnoses, which can happen not as a mistake but because circumstances change, matter hugely not least for the patient.

 

Point 6. Competition is ‘back’.

Jeremy Hunt has never really got into the debate about whether competition drives up quality. This remnant from the Alan Milburn era, which became turbo-boosted in the notorious section 75 clause of the Health and Social Care Act [2012], gives ‘competition’ huge ideological importance. The main purpose of introducing competition is that introduces private markets; and if this is coupled with ‘radical change’, Hunt is able to give it some degree of urgency.

Take for example this section of his speech:

“Self-directed improvement is the most powerful force unleashed by intelligent transparency: if you help people understand how they are doing against their peers and where they need to improve, in most cases that is exactly what they do. A combination of natural competitiveness and desire to do the best for patients mean rapid change – without a target in sight.”

Most people feel intuitively that competition is not actually the determining factor to improve post-diagnostic services in dementia, however so defined, but collaboration perhaps is; or even a combination of competition and collaboration, called ‘co-epetition’.

In the same way, we all want to outperform each other with our Apple Watch apps, we all naturally want to be the person in the village with the lowest risk for vascular dementia – or something like that.

 

So do we need ‘intelligent transparency’ in the English dementia policy? 

Ironically, I do we do feel some sort of ‘intelligent transparency’ in dementia policy, but not for the reasons Hunt describes.

I think we should open up private providers, increasingly a ‘factor’ in both the NHS and social care, to the same freedom of information requirements, particularly if we are to ‘liberalise’ all parts of the market to an ‘equal playing field’.

I think NHS England should provide metrics about the volume of misdiagnoses in English dementia policy currently. A more intelligent way of constructing English dementia policy would have been to ensure that GPs had the skills, training and resources to diagnose dementia more accurately? Otherwise, we truly are running the risk of a high volume low quality approach.

We should be asking the right types of questions. I think there’s lots of excellent work being done by dementia advisors and dementia support workers. But if we’re to look at information, we should also be willing to look at whether dementia advisors or clinical specialist nurses are most likely to deliver a principal NHS outcome of reducing avoidable hospital admissions? Such data are actually vital for commissioning decisions.

Yes – it’s all a bit ‘motherhood and apple pie’.

It’s hard to oppose violently something which is ‘intelligent’ or ‘transparent’.

That is, unless of course the marketing gloss can be removed easily, rather, to reveal something which is inherently unintelligent and opaque.

 

‘Living better’ can become a reality for people with dementia if they lead policy

Shibley Rahman 0 Comments

In the penultimate chapter in my book, I provide a reasoned case why people living with dementia should be given a chance to articulate details of ‘policy’.

Virtually all of us who attended the event (“A conversation with Kate and Shibley” described in this previous blogpost of mine on this blog) found the afternoon ‘inspiring’ or the such like. Of course, this can be expected from fifty misguided hyperbolic attendees; but in fairness to us, we all had some sort of knowledge about dementia (in fact six of the delegates definitely could reasonably be called ‘experts’ living with dementia, so are experts in their dementia in their time.)

I brought up the idea that we appear to have a new national policy document every year almost. The wheel keeps on being reinvented. I cited the work of Wendy Hulko (@IncredibleHulko), that the views of people living with dementia had been systematically disenfranchised. I also cited the work of Ruth Bartlett (@RuthLBartlett) to do with reframing the narrative, e.g. away from a person being defined by his or her dementia.

The notion that “nothing can be done” is as untrue now, as it is untrue for the time in the future where we do happen to have stumbled across “cures” for the dementias in a piecemeal fashion in times to come. Here I’m arbitrarily defining a cure as a practical means of reliably stabilising a disease process of a dementia. For example, various psychological therapies have been demonstrated to improve cognitive functioning as well as other factors such as confidence and wellbeing. It’s likely that such psychological reablement and rehabilitation may provide some of resilience-boosting effect through the maintenance of appropriate activity-based neural connections.

The shift towards identifying the precise cognitive ‘make up’ of a person living with dementia allows identification of the precise abilities that a person with dementia at a given time has. This is a more productive use of the ‘follow up’. If in England services were commissioned fulfilling the s.1(1) Care Act (2014), to promote wellbeing, we could re-orient the Titanic that is the deficits-based medical model.

I gave a presentation on citizenship and living better with dementia as part of an event, co-hosted with Kate Swaffer, last Saturday. The slides for this presentation are here.

I am delighted that Chris Roberts accepted my invitation to give a brief speech in support of my book. Chris wrote one of the Forewords to the book (the other two are written by Kate Swaffer [@KateSwaffer] and Beth Britton [@BethyB1886]).

Both Kate and Beth need no introduction for their campaigning about dementia. I strongly commend to you blogs by Kate (here) and Beth (here) which will begin to introduce you to their substantial output.

Somebody in the audience, based on substantial experience of looking after her mum with dementia, warned against the volume of policies and strategies. This is not the first time I’ve heard this criticism, which invariably starts with, “I don’t know the details of these policies, but I do know what happened with mum”. Such feedback really is gold-dust.

That’s because in forming our views about how to progress with dementia care, there’s a feeling that “people don’t do ‘macro'”. In other words, people are more concerned about their living standards or zero hour contracts than they are about the national GDP. A person might be more interested in his or her personal wellbeing as a person living with dementia or carer, than the design of the post-diagnostic support systems (howeverso defined).

Through having completed two books on the subject of wellbeing in dementia, I’ve decided that there is a place for an overview of the general landscape. This is hugely fortified by personal experiences of people living with their dementias. Kate Swaffer is ‘unusual’ in that she can make sense of her living with dementia in the context of a huge and varied personal and professional background.

To work out what might be the lived experience of a Frenchman, you might ask a Parisian for an account (but even then this is a highly personal account for that particular Frenchman in his time and place). Or you can learn about the history, language, culture, infrastructure or geography of France as background, and still entirely miss what is important to that Frenchman. But that is not to say the cultural back story is entirely irrelevant.

But back to my primary point.

I think the way of turning around the iceberg is for people living with dementia leading on policy, not being ‘involved’ or ‘engaged’ with it at a superficial level. I’ve been struck by the remarkable success of Wendy Mitchell (@WendyPMitchell) in promoting research in dementia, amongst many other projects; or Ken Howard (@KenHowardUK) and Dr Jennifer Bute in a alerting people to what it’s like to live with dementia; or Hilary Doxford, as a member of the World Dementia Council, in alerting people to what matters to people living with dementia in global policy. I thank them all for their contributions on Saturday.

One of the many things which were discussed ultimately in how the media cannot be entirely to be blamed for negative perceptions of living with dementia. Part of a solution is for people living with dementia to present positive stories (as indeed Chris Roberts – @mason4233 – provided in a recent Alzheimer’s Society magazine, or Ken Clasper – @Ken_Kenc – did too.)

One mechanism for people living with dementia to participate in membership of national bodies. That’s why I am hoping that some individuals will put themselves forward (e.g. living with dementia or in a carers’ rôle) for the committee revising the NICE CG42 dementia guideline; applications close at 5 pm on 5 August 2015. 

I hope, if you haven’t already done so, engage with these issues at a personal level in some way. I think it’s an enormous honour and privilege to be allowed a window into people’s lives. Dementia for me is not a medical ‘problem'; it is an opportunity for us to show, socially, solidarity and justice.

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Kate did a separate – (much better in my personal view) – presentation. One slide from it says it all for me.

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(“Living better with dementia” by me will be published in the UK on Jult 21st 2015, pre-order link here.)

It is the implementation of the law, not the law itself, which is holding back progress

Shibley Rahman 1 Comment

One of the key aspects about the law, both domestically and internationally, is that the law has to be clear and enforceable.

We can see this ‘in action’ where most of the criticisms of the National Minimum Wage have not been the way it’s been drafted, but the way it’s been implemented.

There can, of course, be ‘bad law’. Arguably, the freedom of information should contain a ‘carve out’ where public interest overrides commercial gain say for outsourced NHS providers (where surplus generation might trump safe staffing).

And so it goes on.

A lot of effort has been put into an instrument called the United Nations Convention on Rights of People with Disabilities. Under the guidance to the Equality Act, dementia is clearly a disability. Framing dementia as a disability totally alters the nature of the narrative, where the emphasis shifts from ‘friendliness’ to legal rights of people with dementia.

That rights are universal and inalienable means that it is not legally possible internationally to discriminate against somebody on the grounds of mental capacity, or to breach fundamental human rights in a disproportionate way.

Prof Peter Mittler is a very modest man, quite remarkable given his groundbreaking achievements. He has had a glittering career as a leader in putting disability on the political agenda. One of his recent speeches will give you a flavour of his work.

Mittler in fact habitually resides in Manchester. #DevoManc won’t have escaped your notice. Manchester, in particular the local areas such as Salford, has been at the forefront of living better with dementia, not least due to the massive successful work of Hazel Blears. Blears’ work has been second to none as a parliamentarian in promoting dementia in English policy.

But here Mittler makes a fundamental point which should concern us all. That instruments such as the United Nations Convention on the Rights of People with Disabilities have been known about for some time. In our jurisdiction, the governing party is about to replace the Human Rights Act with another framework, a Bill of Rights. Currently it is unclear whether the UK will remain signatories to the European Convention on Human Rights, but most legal scholars expect us to be not least because of the legal mess in devolution agreements if we left. We are, notwithstanding, signed up to the United Nations Declaration on Human Rights.

The ‘rub’ comes into the enforceability of these rights, and for people at large to take these rights seriously. I personally notice a massive sea-change on the ground, in terms of the embedding of a ‘rights based consciousness’. Clicking on the link below will take you to Prof Peter Mittler’s question at the end of Dr Dennis Gillings’ progress report for the Alzheimer’s Society annual conference (#Dementia2015). Jeremy Hughes, CEO of the Alzheimer’s Society, brings up the correct point about the “rulebook”. Kate Swaffer, as Co-Chair of Dementia Alliance International, a group consisting of and campaigning on behalf of people living with dementia, is praised in Mittler’s comment.

Link to Audioboom recording

Dr Dennis Gillings’ thoughts on what the World Dementia Council will achieve viz cure

Shibley Rahman 1 Comment

Gillings rocked up in London in a pretty chirpy mood, it has to be said.

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listen to ‘Dennis Gillings #Dementia2015’ on audioBoom

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(please do cite the audioboo correctly if you wish to quote it.)

 

Dr Dennis Gillings gave one of the plenary talks yesterday at #Dementia2015, the annual conference of the Alzheimer’s Society. Gillings was appointed in February 2014, with the foundation of the World Dementia Council shortly thereafter. Following the main #G8dementia event, there have been four legacy events, in London, in Ottawa, in Tokyo, and in Washington DC. They have covered finance, partnering, care and research.

The G8dementia event talked about cure by 2025, but Gillings said he did not wish to get into the cure vs care debate. But the actual fact is that there is very little on care, and it is clear that the World Dementia Council feels that their mandate is to find a solution for delaying the onset of dementia. Their approach is “how to amplify the resources, such as technology and information, to make them more available and efficient.”

Gillings used the word “devastation” at one point. He later used the term “victims … if you call them victims”. This clearly offends the guidelines of his own country, on the use of language, for the use of language in dementia discourse, from Alzheimer’s Australia.

Gillings feels that he has built a momentum, and I completely agree with this. Whatever one thinks of David Cameron MP’s politics, or that of Jeremy Hunt MP, they showed formidable leadership, especially in galvanising a sympathetic media to drive for a ‘cure’ for dementia. The issue also is in England that social care monies have been reduced by about 30% in the last five years, leading social care to be on the knees.

Gillings talks euphemistically about risk reduction as an ‘untapped source’, and indeed we do know from the MRC CFAS study that primary care management of vascular risk factors is likely to have had an effect on reducing the prevalence of dementia in England in the last few decades. It is, however, possible to ‘over egg’ the risk factor pudding, as it’s currently thought that a sizeable number of dementias are, in fact, predominantly caused by non-modifiable risk factors.

There was report of a “Dementia Development Fund”, a £100 mn fund from the pharmaceutical industry. This is meant to cover looking at new therapies in the early stage. However, this poses problems with the “follow the money” argument. One will be right to be mindful of his comment that, “I have a corporate side to me, so we are heavily involved in the trials and clinical trials.” We desperately do need high quality research in what might cause people to live better with dementia, and there’s a lot of them about – 47 million globally in fact.

The World Dementia Council is to be reconstituted, with a ‘nominations committee’ so people can actually now be nominated to the World Dementia Council. The democratic right of people with dementia to be elected in such organisations is incredibly important, as I have long argued. Article 29 of the United Nations Convention on Rights with Dementia enshrines this, and dementia is a disability.

Gillings feels that there is cause for optimism. “I don’t want people to think that cure will necessarily involve taking a pill”. It is quite unclear what he means by this – this might mean that the ‘cure’ might be entirely preventive through non-drug means (highly unlikely), or that the drug or combinations of drugs might be administered through another route, such as intramuscular, intravenous or subcutaneous.

This all leads onto Richard Taylor PhD’s fundamental question of ‘what will a cure for dementia look like?’ Could this literally mean a vaccine to stop the population acquiring dementia? Such an approach has been taken, for example, in the ‘cure’ for cervical cancer in targeting the human papilloma virus, based on seminal research done at Cambridge. A number of international charities talk openly about ‘ending dementia’, and a ‘world free of dementia’. This of course sits uneasily with the 47 million of people living with dementia, who do not wish their lives to be perceived as in any way ‘substandard’, or to be ignored.

Gillings talks of how ‘neuronal pathways will have to be relearned’ through drugs ‘or by some other means’. This idea based on neuronal plasticity means that there might be some boosting of neuronal pathways, once the damage has somehow been stabilised. It’s already felt anecdotally by some, including myself, that people living better with dementia, who regularly use social networking sites and keep themselves active meeting people through speaking, blogging or whatever, somehow build up a resilience against further progress of the dementia condition. This of course has never been subject to a randomised control trial, or other scientific method. And nor is it likely to be with resource allocations so heavily biased towards molecular neuroscience and translationary medicine. We similarly have a relative dearth of research looking at the efficacy of ‘social interventions’, which might be ‘prescribed’ in future, such as music.

In March 2015, 93 nations attended a conference convened, and signed up to a ‘Call to Action’. This momentum is incredibly important ‘to generate cures and improved pathways for care’, for developed and developing countries. But Gillings is right to bring up the notion that, even if the new curative drugs get approved, will they be widely available?

I agree with Gillings that there is unlikely to be one big bang ‘cure for dementia’. In the cancers, there has been an incremental development in the cures for different types of cancer. Earlier this year, news of a successful monoclonal antibody for malignant melanoma was widely discussed in the scientific journals and mainstream media. Also earlier this year, it was reported that 25 cancer drugs would be ‘denied’ on the NHS. The concern would be that, if the NHS is relentless in pursuing £22 bn ‘efficiency savings’, a cure for dementia would fast be removed from the agenda quicker than a plaque might be removed from a person with Alzheimer’s disease.

In the UK, investment in research has ‘doubled in the last several years’, and is set to be maintained in the years to 2020. The differences between US and UK budgets are easily understood in terms of size – $650 mn in the US, compared to £60 mn ‘level’ of the UK. But we do need a careful look at the breakdown of the types of research we are investing in globally. If a cure comes it will be truly be wonderful, but we also have a strong moral obligation to the 47 million people around the world living better with dementia.

Jeremy Hughes, the formidable CEO of the Alzheimer’s Society, urged the audience of the annual Alzheimer’s Society to be see the World Dementia Council as a ‘critical friend’ (and supporter) of all stakeholders. But likewise, I feel that we in the research community need to be a critical friend of the World Dementia Council. And it is imperative that other influential world stakeholder groups, such as the Dementia Alliance International, advocacy by  and for people living with dementia, become ‘critical friends’ too?

 

 

Disinvesting to invest is essential for delivering high value post-diagnostic support in dementia

Shibley Rahman 0 Comments

Medicine has always had fads and fashions.

There’ve been so many pilots in the past, that one cannot help whether any of the ‘new models’ of care will in fact offer anything new this time. Likewise there have been countless reports to say that the care and support following the diagnosis of dementia can be woefully adequate, that one can rightly doubt the long-term impact of yet another one.

For a person who is newly diagnosed with dementia, the diagnosis will not ‘unlock’ services, unless, say, certain certain social care criteria are met, certain nursing ‘continuing healthcare’ criteria are met, a person becomes eligible for residential care settings, or so forth. The aim that a means-tested social care system can be clamped onto a universal healthcare system, free at the point of delivery, inevitably sounds like a ‘lemon car’.

For a person with a new diagnosis of dementia, a NHS patient who wants to live better with dementia can find himself (or herself) locked into the medical model of dementia. In other words, the ‘treatment’ on offer are some drugs, which are not terribly effective for some, and do not actually slow down progression, for dementia, the most common of which is Alzheimer’s disease.

This money could be better spent in promoting living better with dementia, from a workforce which can promote dealing with the social model of disability, such as reablement or rehabilitation. This means divesting from the huge budget for drugs for dementia, towards ways of promoting wellbeing, the key statutory aim of the Care Act (2014). This means giving social care practitioners the correct tools the job, including training (such as Skills for Care or specialist dementia-oriented vocational skills).

The way in which the NHS negotiates the diagnosis of dementia is very often a farce. A GP is expected to make a diagnosis of dementia given very limited time and resources, and may not himself (or herself) feel very comfortable in distinguishing the common types of dementia anyway (such as vascular, Alzheimer’s, diffuse lewy body disease). The patient with a suspected diagnosis may end up with a memory clinic, psychogeriatricians, acute medicine or medicine for the elderly, and so on; and even some in secondary care may not wish to ‘offend’ the diagnosis given in primary care, however unsure.

Of course, it’s not feasible that all dementias can go through a lumbar puncture, sophisticated brain scanning, or elaborate psychometry; and nor indeed is this clinically desirable. On the other hand, one has to worry at the large volume of potential incorrect diagnoses of dementia which are currently going unchecked, which is doing neither patients nor the medical profession favours. Current ‘clinical leaders’ in dementia have resoundingly failed to address this fundamental issue.

This is where I strongly commend to you Sir Muir Gray’s work.

Watch it for yourself here.

It should be on everyone’s RADAR for anyone involved in dementia care to think about what is most likely to produce the best outcomes from the current expenditure. Replacing drugs with innovative drugs is not likely to be the answer; however replacing drugs with social prescribed interventions, such as iPods for residents in care homes, is likely to be constitute a better outcome for wellbeing.

With 850,000 people approximately in the UK with dementia, there’s a good sample size on which to operate a programme budget of sufficient power to make a difference to the service.

“Productivity” is not a particularly helpful paradigm for dementia care, whereas it might be useful in a hip replacement; unless one is thinking about a reduction in production of infections or falls in a nursing home. The mantra of “effectiveness” is probably best understood in terms of “cost effectiveness”, and the money spent by NHS England on diagnosis compared to the money spent elsewhere in the system on post-diagnostic support must be cause for alarm.

Vascular dementia is a common type of dementia across all age groups, and factors which impact on this tend to be the ones which impact on general cardiovascular health; such as diet, smoking, blood pressure. If we know where and how many patients exist who might be particularly at risk for such vascular conditions, such as some Bangladeshis in parts of the country, we might be able to provide a programme-based medical approach more tailored to patients’ needs on a systems and programme level.

And the inequality and inequity in the systems are massive problems. It should not be case there should be such Russian Roulette in the provision of dementia services according to eligibility from local authorities. Persons wanting to live better with dementia, and carers are not focused on how delivery of care will be delivered by institutions; they form part of a dynamic network, can learn off one another in behaviours, skills and knowledges, and can make decisions, sometimes with professionals, about the things which might improve their health and social care. This doesn’t just include physical or mental health; but might include advice on assistive technology, ambient technology, design, transport, or housing (where the policy of ‘dementia friendly communities’ to promote independent living has made substantial inroads) are all highly valued.

Now is the time to be cruel to be kind. As Sir Muir Gray rightly says, “Disinvest to invest”.

In ‘dementia friendly communities’, it’s how we relate to one another which really matters

Shibley Rahman 0 Comments

I actually don’t know what ‘a better shopping experience’ is, although I’ve had plenty of awful shopping experiences down Oxford Street in the run up to Christmas. Joking aside, despite the developments in anti-discrimination legislation in England for people with physical disability, there’ve been concerns that there’s still room for improvement.

Anecdotally, people living with dementia tell me that there’s been a huge ‘sea change’ in their shopping experience on the high street. Some of this might be due to the Prime Minister’s Dementia Challenge, or initiatives such as from the Alzheimer’s Society regarding ‘dementia friendly’ banks or businesses.

A major aim of the policy of ‘dementia friendly communities’ was originally to enable independent living, by having transport and housing which was ‘fit for purpose’. With the current problems in social housing nationally, and with cutbacks to certain transport infrastructure projects, it is utterly reasonable to think about how ‘friendly’ policy is, let alone ‘dementia friendly’.

Try listening to George Osborne’s budget this week through the prism of dementia friendly communities. Listen especially to the political rhetoric about ring fencing NHS spend (but probably not in reality at a pace in keeping with increased demand). And listen to the deafening silence about the continued cuts in social care.

One aspect of a community is the relation of members of that community with statutory services or other providers. If one takes a ‘supply side’ approach, you are meant to have better choice if there are more providers. Then you get into the language of the consumer and the market, and we end up going down a certain ally. ‘Dementia friendly businesses’ then exert competitive advantage by ‘adding value’, in other words by being civil to people with dementia.

But of course it should be more than that. People living with dementia in fact have civil rights – some of this comes from the law, some of these rights are moral rights. But whether your religion is the Human Rights Act, the UN Declaration of Human Rights, or the UN Convention on Rights for People with Disabilities, these rights definitely exist. In theory, they can be exerted through bodies such as the Equalities and Human Rights Commission, but the reality is that any law is as good as its implementation – take the national minimum wage for example.

Whilst dementia friendly communities had (and still does) have a thrust in promoting independent living, it’s also been mooted that care homes form a ‘community hub’. A big proponent of this idea is Prof Martin Green, Care England’s CEO. There’s a huge swathe pointing in the direction of why many would like living in a care home to be reconcilable with independent living.

For a start, residents in care homes are still individuals who are entitled to the best standards of NHS care. It’s said moving into a good care home should mean that all you’re doing is ‘changing your address’. There have even been yet further pilots looking at the implementation of personal budgets in care homes – but we’re all too aware of the direction of travel of these pilots. The aim is, somehow, to see ‘care homes’ de-institutionalised, a form of ‘home’ where there’s ‘care’.

At first blush, the term ‘dementia friendly communities’ is awful as it implies a ‘them against us’, with people with dementia identifiable as a single homogeneous mass. But I think the strength of the word ‘community’ comes from if we’re all considered as citizens, with equal participatory rights, bounded in powerful relations to one another.

It matters enormously that we understand culture and diversity. This is NOT so we understand ‘BAME’, ‘LBGT’, ‘low/middle income countries’, ‘young onset dementia’ and ‘prior intellectual disabilities’, in isolation.

Each member of these groups is an unique individual. We cannot homogenous all Asian people, in the same way we can’t homogenise all people above the age of 65, or all males. But these groups matter overall in understanding how the relate to others. This is NOT a case of meticulously charting their similarities and differences, but learning from each other so that we understand our community as a whole.

While I’m on the subject, if you’re a citizen who’s just been given a diagnosis of dementia, vast inequalities do exist in the quality of the diagnosis and ‘post-diagnostic support’ (howeverso defined). It’s crucial we begin to understand these inequalities to improve health and social care as a whole.

As is often the case, the whole is much stronger than its individual components.

We need to talk about care homes

Shibley Rahman 0 Comments

King's Fund panel

Care homes happen to come onto my turf because of my interest in the English dementia strategy.

Eighty per cent of people living in care homes – more than ever thought before – have either dementia or severe memory problems according to a Alzheimer’s Society report published in April 2013. It was also reported that less than half of these, 322,000 people are enjoying a good quality of life.

I found yesterday’s conference on enhancing health in care homes a real ‘breath of fresh air’. The audience didn’t consist of ‘clones’ who were “on message”, but consisted of a large range of people from different backgrounds. I know because Prof David Oliver, the Chair for the morning, asked what these backgrounds were – ranging from care home managers to University academics.

‘Co-production’ came across very strongly as an emergent theme in a number of presentations. And rightly so. Innovation, whilst cracking a few eggs to make omelette, is also about avoiding those turkeys which don’t fly. I, in fact, asked a question off NHS England on how we’re to know whether the ‘Care Home Vanguards’ will be just like the million ‘pilots’ which have preceded them. And yes – many of us don’t like the military terminology.

We do need to talk about care homes. Somebody pointed out that the people who ‘own’ care homes are the residents, and this is indeed reflected in the wish that all people do when they move into a care home ‘is change address’. The concern that residents in care homes are quite divorced from friends and family is a very real one, I feel. I often get asked simply why care homes don’t have WiFi – this aversion to WiFi seems to be shared elsewhere in the NHS, such as in GP practices.

Prof David Alldred presented an overview of the strand of policy focusing on the use of medications in care homes, ranging from the well known CHUMS study bang up to date with the recent NICE guidelines. Prof Adam Gordon presented a coherent range of peer-reviewed evidence including his work and that of his principal collaborators on service provision in care homes. Both presentations, I felt, had as a common theme how we negotiate risk in policy, and certainly how we ultimately turn the health and social care service from being reactive to illness to being proactive to health.

In the same way we wish to celebrate good care as well as identify bad care, we can’t ignore the things we keep on ignoring. A strong message from the #kfcarehomes day was the need for a holistic view to attending to a person’s needs. This not only includes mental health needs, but physical health. Often medics are very good at ignoring oral health, eye care and foot care; and yet this came across loud and clear as important issues.

The day did not shy away from THE main issue – decades of chronic underinvestment in social care services. Prof Julienne Meyer was robust in her opinions, which were hugely popular with the audience. It seems further that many agreed that care homes have been reputationally neglected (and that any focus in the media on care homes has generally been a negative one). This is clearly having repercussions in attracting, say, the best nursing staff to work in care homes, and maybe the professional College may need to think of fast-tracking a specialty competence qualification for care homes. It would be wonderful if there were some continuity with clinical specialist nurses in the community, hospices and hospitals. It’s critically important that all staff are not paid ‘bargain basement’ rates for the sake of the “bottom line” – there were several calls for the implementation of a living wage (and the national minimum wage).

In the same way that care homes cannot be considered islands in policy, surrounded by unbridgeable water, it’s hard to make a clean break for care homes from the rest of policy. Aside from the ongoing discussions about pooling budgets, and so forth, a recurrent theme was that residents in care homes are entitled to the same health care as would be expected from the best of the NHS. In fact, as Alldred and Gordon were doing their presentations, the thought crossed my mind why their work was not more openly aligned with the NHS Outcomes Framework.

There is currently a pause in the legislation, as we wait  with baited breath for the Part 2 of the Care Act to be implemented, and there’s a further new carers’ strategy from Alistair Burt, the current Government Care Minister. Part 1 of the Care Act is highly significant in its statutory duty of the promotion of wellbeing, and this is a must obviously in care homes too.

When   I think ‘back to basics’ of the work of the late great Prof Tom Kitwood, it must be the case that, where possible, residents of care homes must be in touch with factors which reinforce personhood, like their past, and current relationships including friends and families. Also, I think care homes are a great place for reablement and rehabilitation for people with dementia,  in a social model of disability.

It’s incredibly easy to chant ‘no decision about us without us’, ‘person centred integrated care’ or ‘let’s break down the silos’ like weird followers of a strange sect. But I did find a paucity of evidence presented yesterday on how ‘users’ of the new services were finding their experiences, apart from a few anecdotes which could easily have come from a marketing pitch. One was left wondering first of all how one would break down the silos – and I think Dr Phil Earnshaw, lead for the Wakefield NHS CCG, did well to convey how an ideal would literally be people talking freely to one another.

And we do need to pool learnt skills, behaviours, and knowledge – the very best of knowledge end of life research in hospitals and hospices should be made available to those looking after patients in care homes.

There are reasons why these silos exist (and I don’t wish to defend them) – the history of the health and social care services, the training of professionals and practitioners in the health and social care services, lack of communication, employment renumeration, different skill sets, etc. I don’t want to rehearse them yet again here. It’s though struck me how medics tend to overestimate their ability to share decisions with other professionals or practitioners (for example specialist physicians from the Royal College of Physicians having ‘lightbulb moments’ on being trained to work better with other stakeholders.)

I think some of this is down to how well leaders in different fields are able to respond to feedback. Shared, distributed, leadership, or whole systems regulation, all makes intuitive sense. Of course it does. That is, until you think about who ultimately takes responsibility for key decisions concerning a patient (e.g. “the medication review”). I asked who is best placed to erase from a drug chart an inappropriate prescription of an antipsychotic, to replace it with a ‘social prescription’ such as an iPod. Talk about ‘collaborative working’ ‘sharing risk’ and ‘not looking for blame’ trips off the tongue for advocates of alliance contracting, say, but the reality of what is happening ‘on the ground’ is worth thinking about in the English dementia policy.

The list of researchers I cite in my book on dementia

Shibley Rahman 0 Comments

Contemporaneous peer-reviewed research, from the UK and other jurisdictions, and evidence guidelines pervade my text like letters in a stick of rock.

I am grateful for the following members of the research community who’ve made it into my book ‘Living better with dementia: good practice and innovation for the future‘, to be published in the next ten days I reckon.

Eyeballing the list, it seems as if Sube Banerjee, Jill Manthorpe and Liz Sampson are my most extensively cited authors – this does not surprise me at all, given their spectacular research output.

 

Final list

 

Aalten, P. 194

AARP 233

Aarsland, D. 325, 326

Ablitt, A. 70, 364

Abma, I. 121

Aboriginal and Torres Strait Islander Healing Foundation Development Team 64

Adams, K.B. 143

Adams, S. 107, 362

Adams, T. 131, 359

Addis, D.R. 313

Adelman, R.D. 135, 138, 144

Adelman, S. 69

Adkins, J. 372

Aguero-Torres, H. 151

Ahlskog, J.E. 38

Ahmed, S. 116, 118, 119

Ahtiluoto, S. 72

Alagiakrishnan, K. 174

Alarc.n, R.D. 86

Alaszewski, H. 281

Albert, M.S. 29, 206

Algase, D.L. 244, 246

Alisky, J.M. 323

All-Party Parliamentary Group (APPG) on Dementia 27, 28, 42, 65, 67–8, 92,

329–30

Allan, L. 180

Alred, D. 359

Alvarez, P. 307, 312

Alvaro, L.C. 276

Alzheimer Scotland 88, 89, 266

Alzheimer’s Association 45, 137

Alzheimer’s Australia 55, 92, 93, 152

Alzheimer’s Disease International 83, 92, 104, 145, 151, 173, 175

Alzheimer’s Society 42, 236

Amabile, T.M. 290

Amaducci, L. 295

American Psychiatric Association 114, 291

Amieva, H. 141

Anckaert, L. 364

Andersberg, P. 247

Anderson, A.K. 309

Anderson, D. 326

Anderson, N. 290

Andrews, S. 71

Andrieu, S. 35

Aneshensel, C. 73

Arai, A. 107

Archbold, P.G. 142

Archer, D. 203

Argyle, E. 231

Armari, E. 101

Arnheim, G. 55

Arseven, A. 115

Arthur, D.G. 244

Arto Rajala, A. 323

Ask, H. 140

Atchison, T.A. 205

Attali, E. 367

Attoe, R. 243

Audit Commission 265

Australian Department of Health 86

Australian Health Ministers’ Conference 88

Australian Institute of Health and Welfare 155

Authors undisclosed (Vanderbilt Law Review) 271

Aveling, E.L. 351

Aveyard, B. 233

Awata, S. 137

Aylward, E.H. 74

Ayres, S. 214

Azermai, M. 88, 325

 

 

Backhouse, T. 324, 327–8

Bail, M. 253

Bailey, M. 231

Baker, L.D. 372

Baker, M. 106

Baldwin, C. 243

Balint, E. 198

Ballard, C. 325, 326

Ballenger, J. 56

Balteş, F.R. 297

Bambra, C. 41, 225

Banerjee, S. 25, 30–1, 42, 69, 82, 185, 225, 321, 325, 352

Baran, M. 105

Baranowski, M. 367

Barberger-Gateau, P. 40, 171

Bardsley, M. 210

Barley, V.M. 107

Barnard, C. 58

Barnes, C. 212

Barnes, T.R. 328, 333

Barron, E.A. 114

Bartlett, F.C. 56

Bartlett, R. 57, 58, 130

Barton, A. 206

Basaglia-Pappas, S. 296

Basso, A. 295

Bastawrous, M. 137

Bates, M.S. 107

Batsch, N.L. 52, 53, 59

Battilana, J. 349

Baxter, J. 36

Bazinet, R.P. 172

BBC News 259

Beail, N. 74

Beard, R.L. 59, 294

Beattie, A.M. 103, 108

Beattie, B.L. 249

Beck, A.P. 345

Becker, D. 251

Beckman, S.L. 204

Beer, C. 352

Beerens, H.C. 151

Behuniak, S.M. 58

Benbow, S.M. 54, 66

Bender, M. 130

Benford, R.D. 56, 332

Beninger, R.J. 280

Bennett, S. 206–7, 368

Bennett, V. 244

Beresford, P. 59, 265, 269

Berkhout, A.M. 175

Bernstein, M.S. 59, 365

Berntsen, D. 312

Berrios, G.E. 103, 182

Bertram, L. 362

Best, A. 374

Bettens, K. 172

Bevan, H. 347, 352

Beydoun, H.A. 39

Beydoun, M.A. 39

Bhanji, R.A. 174

Bhattacharyya, S. 66, 101

Bickerstaffe, S. 195, 203, 209

Biessels, G.J. 35

Bigby, C. 276

Bikhchandani, S. 165

Billings, J.A. 247

Billings, P.R. 269

Binney, R.J. 307

Bisla, J. 324

Bj.rneby, S. 237

Black, S.E. 37

Blackburn, D.J. 38

Blackstock, K.L. 85

Blessed, G. 103

Blood, A.J. 295

Bo, K. 184

Boettger, S. 120

Boeve, B.F. 102, 104

Boller, F. 295

Bond, J. 32

Bonuccelli, U. 367

Borelli, P. 367

Borroni, B. 101

Boudrault, C. 172

Bourn, C. 226

Boustani, M. 70

Bower, P. 198, 199, 210

Bowling, A. 32, 141

Bowman, C.E. 276

Boyd, A. 333

Braak, E. 280

Braak, H. 280

BRACE 348

Braddock, D. 74

Bradford Dementia Group 231

Bradley, M.M. 311

Brand, M. 280

Brandon, D. 133

Braun, M. 143

Brayne, C. 82

Brearley, C. 281

Breibart, W. 120, 121

Bremberg, S. 248

Brennan, M. 73

Breteler, M.M. 39

Bridges, J. 153, 351

British Geriatrics Society 116

British Psychological Society 327, 331, 332

Britton, B. 98–9, 187

Brocklehurst, J. 182

Brodal, A. 316

Brodaty, H. 26, 102, 140, 143, 200, 326, 362

Bronfenbrenner, U. 233

Brooker, D. 231, 342

Brooks, J. 268

Brotman, S. 73

Brotons, M. 298

Brown, R. 294–5

Bruce, V. 315

Brunet, M. 28

Brunnstr.m, H. 43

Bryden, C. 17

Buchman, A.S. 39

Buck, H.G. 197

Buckwalter, K.C. 132, 325

Budrys, V. 294

Buisson, E. 149

Bujak, J.S. 205

Bunn, F. 369

Bupa 145, 151

Burant, C.J. 212

Burgener, S.C. 54

Burgess, P.W. 314

Burnham, W.H. 309

Burns, A. 26, 64, 103

Burns, L.R. 205

Burton, A.M. 315

Burton, E. 237, 238

Burton, J. 144

Busemeyer, J.R. 280

Bush, A. 74

Bush, S.H. 119

Bushe, G.R. 345, 347

Butler, M. 194

Butt, J. 64

Byrne, P. 198–9

 

 

Cabeza, R. 296, 311

Cacioppo, J.T. 141

Caddell, L.S. 55, 104, 212

Cahill, S. 253

Cai, W. 184

Caldwell, C.E. 290

Callahan, C.M. 143

Cameron, A. 203

Cameron, K. 322, 323

Camic, P.M. 299

Campbell, A. 180

Campbell, D. 100

Campbell, J.C. 131, 282

Campbell, S. 185

Campo, M. 233

Candy, B. 174

Cankurtaran, M. 370

Cannon, W.B. 309

Cant, B. 72

Cantley, C. 150

Cantor, M. 73

Capitani, E. 295

Carbonneau, H. 322

Care Commission 165–6

Care Quality Commission (CQC) 166, 210–11, 232, 232, 324

Carers Trust, Royal College of Nursing (RCN) 129, 133, 134, 144

Carey, G. 230

Caron, C. 322

Carpentier, N. 140

Carr, D. 249

Carr, S. 265

Carreon, D. 149

Carroll, G.R. 165

Carruthers, I. 33–4

Carter, A.I. 140

Casciaro, T. 349

Cass, B. 102

Cassel, E.J. 200

Casten, R.J. 64

Centre for Welfare Reform 88

Cermak, L.S. 314

Cermakova, P. 368

Chakravarty, A. 293

Challis, C. 316

Chan, K.Y. 85

Chan, S.W. 144

Chang, M. 38

Chapin, K. 298

Chappell, N.L. 138, 234

Charles, C. 200

Charon, R. 135

Charpentier, P.A. 119

Charter of Fundamental Rights of the European Union 276–7

Chassot, C.S. 359

Chaudhury, H. 233

Chaufan, C. 98

Chen, R. 226

Chen, T. 89

Cheng, A. 70

Chenoweth, B. 73

Cherry, D.L. 352

Chesbrough, H. 334

Chetty, S.K. 323

Chinthapalli, K. 267

Cholerton, B. 372

Chonchurhair, N.A. 114

Choo, W.Y. 139

Christensen, C.M. 322, 343

Christmas, M. 75

Chryssanthopoulou, C. 66

Chung, J.C. 87

Chung, L.C. 144

Clancy, D. 231

Clare, L. 55, 104, 130, 211, 212, 276

Clark, C.N. 297

Clark, H. 267

Clark, R. 361

Clark, V.P. 315

Clarke, A. 151, 197

Clarkson, P. 180

Clayman, M.L. 135

CLBC 274

Clegg, A. 116

Clemerson, G. 102, 105–6

Clore, G.L. 309

Coetzer, G.H. 345

Cohen, C.A. 13

Cohen, C.A. 139

Cohen, D. 18

Cohen, E. 237

Cohen-Eliya, M. 251

Cohen-Mansfield, J. 55, 324, 330

Cohen, M.E. 243

Cohen, N.J. 307

Cohen, S. 132, 139

Coile, R.C. 204

Cole, L. 180, 185

College of Occupational

Therapists 253

Collins, C. 194

Collins, P.A. 226

Combes, H. 72

Commonwealth Fund 88

Commonwealth of Australia 93

Conklin, J. 351

Conner, M. 350

Connolly, S. 87

Conservative Party 22

Conway, M.A. 312, 313, 314

Cook, C. 174

Cooke, H.A. 232, 234

Cooley, S.J. 247

Cools, H.J. 175

Coons, H.L. 202

Cooper, C. 70, 71, 72

Coppola, G. 172

Coriell, M. 132

Corneg.-Blokland, E. 325, 326

Corrigan, P.W. 54

Corsonello, A. 328

Cortes-Blanco, A. 372

Cottrell, V. 51, 58

Covinsky, K.E. 181

Craft, S. 170, 372

Craig, C. 289

Crammond, B. 230

Cranswick, K. 137

Crawley, H. 164, 169, 175

Creese, B. 325, 326

Crespy, D.A. 205

Cronin-Stubbs, D. 206

Croom, B. 142

Crossley, M.L. 324

Crossley, N. 324

Croucher, K. 231

Crutch, S.J. 291, 291–2

Cummings, J.L. 82, 140, 167,

292

Cunningham, C. 122

Cunningham, E.L. 31, 32

Cunningham, H. 75

Curb, J.D. 69

Currie, G. 351

Cushman, L.A. 245

Cutcliffe, J. 367

 

 

Dagerman, K. 325

Dahlgren, G 228, 229

Dalton, A. 75

Dalton, J.M. 136

Damiani, G. 368

Dasgupta, M. 114

Dauphinot, V. 138

Davies, N. 361

Davies, P. 114

Davies, S. 131

Davies, S.L. 149

Daviglus, M.L. 35

Davis, D.H. 120, 122

Davis, G.F. 165

Davis, R. 199

Davis, S. 149

Day, A. 64

Day, A.M. 367

Day, K. 149

de Ajuriaguerra, J. 291

De Bellis, A. 248

De Boer, M.E. 276

De Civita, M. 135

de Haes, H. 200

De Lepeleire, J. 27, 214

De Martino, B. 309

de Medeiros, K. 233

De Meyer, A. 205

De Rosa, E. 309

de Vugt, M.E. 130, 142, 143, 327

Defanti, C.A. 249

Degner, L.F. 352

Delancey, J.O.L. 184

Delany, N. 108

Delazer, M. 280

Delgado, M.R. 311

Deloitte 210, 334

Dementia Action Alliance (DAA) 30, 146–7, 147–8, 332–3, 333

Dementia Alliance International (DAI) 58–9, 364

Dementia Services Development Centre 234

Dementia UK 66

Department of Health 29–30, 31, 34, 65, 66, 68, 69, 72, 74, 101, 117, 149, 150, 179, 188, 199, 200, 202, 203, 207, 209, 210, 214, 215, 216, 237, 264, 265, 266, 281, 281–2, 325, 345, 368

DeRienzis, D. 103

Desmond, D.W. 38

Desrosiers, J. 322

Devi, G. 37

Devine, M. 185

Devore, E.E. 40

Dewing, J. 144, 244, 250–1

Diabetes UK 217

DiClemente, C.C. 346

Diderichsen, F. 226

Dike, C.C. 367

Dillane, J. 182

DiNatale, Johnson, B. 185

Dingjan, P. 243

Dixon-Fyle, S. 195

DNA Web Team 276

Dobkin, P.L. 135

Dodd, K. 75

Dodds, P. 245

Dolan, J. 357

Donelan, K. 138

Donkin, M. 102, 362

Donnelly, M. 249

Doran, T. 121

Dosman, D. 137

Dougherty, T.-M.P. 334

Downs, M. 27, 180

Doyle, P.J. 233

Drance, E. 132

Draper, B. 351–2

Drennan, G. 359

Drennan, V.M. 180, 185, 186

Drentea, P. 139

Dr.es, R.-M. 276

Duarte, N.T. 334

DuBeau, C.E. 184, 188

Dubet, F. 140

DuBois, B. 243

Ducharme, F. 361

Duchen, L.W. 167

Duffy, C.J. 245

Duffy, S. 258

Dunlap, S. 204

Dupuis, S.L. 132

Dutton, R. 231

 

 

Ebersbach, G. 293

EClipSE 37

Edquist, C. 323

Edvardsson, D. 87, 130, 152, 197

Edward, H.G. 174

Edwards, A.B. 137

Eeles, E. 113–14, 119

Eidelman, S. 72

Ekelund, P. 179

Ekman, P. 297

El-Murad, J. 290

Ellis, K. 267

Ellis, R.P. 89

Eltis, K. 246, 251

Embrett, M.G. 230

Emilsson, U.M. 89

Engel, S.A. 199, 200

Ennis, E.M. 197

Equality and Human Rights

Commission 252, 259

Ericsson, I. 233

Eriksson, S. 205–6

Estabrook, C.A. 352

EU ‘Rhapsody Project’ 108

Eustace, A. 142

Evandrou, M. 65

Evans, S. 237

 

 

Fainstein, C. 187

Fairburn, C.G. 168

Fairman, S. 347, 352

Farah, M.J. 315

F.art, C. 171

Feightner, J. 37

Feinberg, L.F. 251

Ferraro, F.R. 85

Ferreira, M. 372

Ferri, C.P. 86

Fetherstonhaugh, D. 87

Fick, D.M. 123

Field, E.M. 141

Finkel, S. 326

Firth, L. 136

Fisk, J.D. 249

Fitch, W.T. 289

Flatley, M. 153

Fletcher, P.D. 297

Foebel, A.D. 326

Folkman, S. 70

Follett, M.P. 346

Fong, T.G. 118

Forder, J. 264

Forstelund, L. 331

Fortinsky, R.H. 212

Fossey, J. 106, 149, 331

Foster, D.P. 107

Fox, N.C. 81

Fozard, J.L. 247

Francisco, A. 64

Fratiglioni, L. 371

Frawley, P. 276

Freeth, S. 102

French, J. 58

Freyne, A. 107

Fried, L.P. 181

Friedson, E. 199

Friesen, W.V. 297

Füller, J. 18

Furst, M. 108

 

G8 Summit Declaration 321–2

Gabbay, J. 188

Gabrieli, J.D. 309

Gafni, A. 200

Gamsu, D.S. 107

Ganz, M. 332, 346, 348

Gao, S. 37

Garand, L. 52

Gardener, S. 171

Gardiner, P. 131

Gastmans, C. 277, 364

Gaugler, J.E. 137

Gauthier, I. 315

Gauthier, S. 29

Gawande, A. 370

Genomic Data Sharing 100

George, D.R. 56

George, L.K. 199

Giannakouris, K. 137

Giblin, F.J. 270

Gibson, C. 121

Gibson, F. 282

Gibson, G.D. 70

Giebel, C.M. 82

Gill, D. 113

Gilleard, C. 88

Gillette-Guyonnet, S. 35

Gilmour, H. 282

Girard, T.D. 120

Gitlin, L.N. 237

Gladwell, M. 204

Glasby, J. 267

Glassman, R.N. 18

Gleckman, H. 99

Gleicher, D. 230

Gleichgerrcht, E. 278, 279

Glendinning, C. 267, 268, 269

Glover, J.C. 244

Glymour, M.M. 226

Godden, S. 150

Goffman, E. 52, 54, 56, 130, 197, 360

Goh, A.M. 269, 270

Golander, H. 55

Goldacre, M.J. 369

Goldacre, R. 369

Goldberg, D. 74

Goldman, J.S. 363

Goldsilver, P.M. 322

Golics, C.J. 361

Goodchild, C. 268

Goodman, C. 149, 350–1

Goodson, J.R. 334

Goodwin, N. 202, 207, 208

Gordon, N. 291

Gore, R.L. 122

Gorno-Tempini, M.L. 168

Gort, A.M. 138

Graham, K.S. 313

Grant, G. 131

Grant, R.L. 206

Grassi, E. 295

Green, D. 281

Green, R.C. 56

Green, S. 53, 54

Greenberg, D.L. 312

Greene, J.D. 315

Greene, M.G. 135

Greenhalgh, T. 322, 344

Greenwood, N. 137, 364

Gregory, C. 342

Grenier, A. 140

Greve, H.R. 165

Gridley, K. 268

Griffith, E.E.H. 367

Griffith, R. 262

Griffiths, P. 368

Grimley Evans, J. 248

Gruneir, A. 329

Gruneir, M.R. 322

Guan, J.-Z. 172

Guardian website 375

Gu.tin, S. 298

Gupta, A.K. 335

Gustafson, D.R. 39

 

 

Ha, J. 280

Haase, H. 41

Habell, M. 259

Hachinski, V. 72

H.gglund, D. 180, 184

Hahn, C. 352

Hailstone, J.C. 297

Hall, G.R. 132, 325

Hall, N.M. 312

Hall, R.J. 113

Hallberg, I.R. 90

Hampton, A.N. 280

Hancock, G.A. 188

Hannah, M.T. 165

Hansen, M.T. 204

Hanson, E.J. 151

Haque, S. 313

Haralambous, B. 71

Harari, D. 188

Harding, R. 139, 140

Harris, L.F. 64

Harris, M. 202

Harris, P.G. 104

Hart, V. 265

Harvey, R.J. 108

Hasegawa, J. 180

Hasselkus, B.R. 367

Hauser, R.M. 249

Hawkins, R.L. 142

Hawkley, J.C. 141

Haxby, J.V. 315

Haycox, A. 99

Hayes, M.V. 226

Health Foundation 129, 150,

153, 154, 210, 264, 265

Heath, I. 358

Heaven, A. 120

H.bert, R. 38

Hecaen, H. 291

Heggestad, A.K. 277

Hein, C. 115, 120

Heller, L. 18, 81, 214

Heller, T. 18, 81, 214

Hellstr.m, I. 233

Helvik, A.S. 205, 368, 369

Henderson, V.W. 245

Hendrie, H.C. 85

Hennessy, S. 328

Henry, W.D. 116

Herman, P.M. 195

Hermans, D.G. 247, 248

Heru, A.M. 143

Hewer, R.L. 138

Heywood, F. 237

Hick, R. 74

Higgins, D. 227

Higgs, P. 88

Hilgeman, M.M. 142

Hillier, L.M. 114

Hinchliffe, A.C. 129

Hirasawa, Y. 181

Hirsch, M.A. 136

Hirsh, D. 187

Hirshleifer, D. 165

Hirstein, W. 290, 291

HM Government 68, 87

Hobfauer, R.K. 206

Hocking, E. 164, 169, 175

Hodges, J.R. 314, 315

Hoe, J. 351

Hofman, A. 39

Holford, P. 172

Holland, A.C. 279, 297, 313

Holland, A.J. 74

Holland, W. 26

Hollander, D. 358

Hollander, M.J. 138

Holman, C. 350–1

Holman, H. 212

Holmes, J.D. 114

H.ltt., E.H. 115

Hoof, J. 231

Hope, K.W. 144

Hope, R.A. 168

Hope, T. 168, 250, 252

Hopkins, R.O. 312

Horimoto, Y. 180

Horizon Scanning Centre 101

House, A.O. 114

House of Lords 247, 262

Housing Learning and Improvement Network 234, 235, 236, 237

Houwelingen, H.C. 175

Hovens, I.B. 122

Hsieh, S. 296, 362

Hsu, M. 280

Htay, U.H. 247

Huang, H.L. 142

Huang, T.L. 172

Hubbard, R. 73

Hudson, D.L. 243

Hughes, B. 103

Hughes, J.C. 243, 244, 246, 253

Hughes, T.F. 171

Hulko, W. 57

Humphrey, K. 315

Hunter, P.V. 365

Hunter, R. 153

Huppert, F.A. 359

Hurley, A.C. 245

Hussein, S. 54

Hutchins, R.M. 246

Hutchinson, N. 74

Huybrechts, K.F. 329

Hynan, L.S. 40

 

 

Ibarra, H. 204

Iemmi, V. 92

Igbedioh, C. 188

Iguchi, A. 180

Ikeda, M. 167, 168

Ikegami, N. 131

Ilies, R. 343

Iliffe, S. 26, 54, 72, 180, 185,

193, 197, 322, 344, 363

Iltanen-T.hk.vuori, S. 185

Imtiaz, B. 37, 372

Independent Commission

for Whole Person Care

(ICWPC) 203, 205

Innes, A. 32, 82, 92, 128, 154,

253

Innovations in Dementia 72

Inoue, K. 169

Inouye, S.K. 115, 115, 119

Insel, N. 309

Insel, P. 325

Ionicioiu, I. 28

Iqbal, A. 143

Iris, M. 68–9, 70

Irish, M. 314

Isaac, C. 102, 105–6

Isaacs, R. 291–2

Isern, J. 345

 

 

Jack, R. 133

Jacobs, S. 267

Jacobs, W.J. 245

Jacome, D.E. 297

Jaglal, S. 139

James, I.A. 367

James, M. 315

James, W. 309

Janata, P. 296

Janicki, M.P. 74, 75

Jansen, K.J. 346

Jansen, S.J.T. 201

Jan.en, C. 230

Jarmolowicz, A. 101

Jasinarachchi, K. 150

Jenewein, J. 120

Jenkins, C. 366

Jenkins, C.R. 33

Jirovec, M.M. 182

Johannessen, A. 106, 106–7

Johansson, L. 38

Johl, N. 70

Johnson, E.J. 18

Johnston, R.A. 315

Joling, K.J. 361, 362

Jolley, D. 37

Jones, A. 107

Jones, G.M.M. 306

Jones, G.V. 70, 364

Jones, L. 174

Jones, R.N. 226

Jones, R.W. 211

Jong-Wook, L. 227

Joosten, L. 366

Jorm, A.F. 37

Josefowitz, N. 58

Joseph Rowntree Foundation 150, 370, 372

Josephs, K.A. 102, 104

Josephson, B.R. 295

Judge, T.A. 343

 

 

Kahana, Z. 251

Kaiser, S. 108

Kalaria, R.N. 39, 92, 121

Kalsy-Lillico, S. 74

Kammer, S. 298, 299

Kapur, N. 293

Kar, N. 66, 326

Karnieli-Miller, O. 72

Katz, M.L. 204

Kaufman, G. 290

Kaufmann, E.G. 199, 200

Kawamura, K. 247

Kay, D.W. 107

Kazer, M.W. 197

Keady, J. 104, 108, 135, 151, 233

Kearney, M. 196

Kearns, W.D. 247

Keast, R. 230

Keenan, T.D. 369

Keene, J. 168

Kehne, J.H. 39

Kellaher, L. 174

Kelleher, D. 107

Keller, H.H. 174

Keller, L.J. 173

Kellett, U. 87

Kelley, B.J. 102, 104

Kelley, W.M. 315

Kelly, J.F. 202

Kemshall, H. 281

Kendrick, M.J. 274

Kensinger, E.A. 279, 297, 313

Kercher, K. 212

Kerr, D. 75

Kertesz, A. 291

Keyes, C.L.M. 359

Keyes, S.E. 364

Khachaturian, Z.S. 34, 372

Khalfa, S. 297

Kibayashi, K. 245

Kickbusch, I. 230

Kiecolt-Glaser, J.K. 143

Killaspy, H. 360

Killick, J. 289

Kim, D.H. 370

Kim, J.W. 39

King, M. 73

King, N. 290

King’s Fund 216

Kingston, P. 101

Kinney, J.M. 129

Kirk, A. 291

Kirk, L.J. 74

Kirkevold, M. 365

Kitwood, T. 57, 58, 130, 151, 211, 324, 364, 365

Kivipelto, M. 39

Kjellstrom, S. 233

Kloeters, S. 279

Kmietowicz, Z. 27

Knapp, M. 66, 92

Knauss, J. 59

Knight, A. 227, 228

Knight, B.G. 70

Knocker, S. 73

Koch, T. 26, 54, 72, 197, 322

Koehn, S.D. 132

Koester, R. 244

Koger, S.M. 298

K.hler, L. 137, 141

Kolanowski, A.M. 132

Kopelman, P.G. 39

Korczyn, A.D. 103

Kort, H.S.M. 231

Kotter, J.P. 348, 349

Kovach, C.R. 132

Kowalski, C. 230

Kozak, J.-F. 132

Kozin, M. 294

KPMG 208

Kramer, M.W. 205

Kratzer, J. 334

Krieger, J. 227

Krishnamoorthy, A. 326

Krishnamoorthy, E.K. 82

Kristensen, S.R. 117

Kroenke, K. 206

Kroll, N.E. 307

Krull, A.C. 69

Kulik, J. 294–5

Kümpers, S. 89

Kurian, M. 174

Kuruppu, D.K. 102

Kuzuya, M. 180

 

 

La Fontaine 72

La Placa, V. 227, 228

LaBar, K.S. 296, 311

Labudda, K. 280

Laeng, B. 292

Lai, C.K.Y. 244

Lai, F. 75

Laing, W. 149

Lakey, B. 139

Lalonde, M. 228, 228

Lambert, A. 72, 315

Lancet Global Mental Health

Group 359

Landau, R. 248, 249, 251

Lane, H.P. 55

Lane, L. 195

Lapane, K.L. 329

Laraway, A. 74

Larsson, M. 316

Lauque, S. 173

Laurila, J.V. 115

Lautenschlager, N.T. 37

Lautrette, A. 249

Law, K. 359

Lawley, D. 113, 115, 116, 333

Lawrence, V. 70

Lawton, M.P. 226, 245–6

Lazarus, R.S. 70

Leary, A. 368

LeDoux, J.E. 316

LeDuc, L. 139

Leech, D. 344

Legh-Smith, J. 138

Leibing, A. 371

Leonard, B.E. 39

Leonard, M. 115, 116

Leppert, J. 180

Letter to the Prime Minister 42

Leung, F.W. 185, 187

Leurent, B. 116, 118, 119

Levenson, R. 297

Levine, B. 296, 314

Lewin, S.A. 130

Lewis, G.H. 228, 229

Liberzon, I. 315

Lieb, W. 40

Lievesley, N. 64, 66

Ligthart, S.A. 35

Limb, M. 267, 268

Lin, F.R. 206

Lin, L.C. 175

Lin, N. 350

Lincoln, P. 35

Lindsay, J. 38

Lingler, J.H. 136

Link, B.G. 52

Linsk, N.L. 200

Liperoti, R. 326, 328

Litch, B.K. 204

Littlechild, R. 267

Liu, G. 138

Liu, H.Y. 143

Liu, S. 226

Livingston, G. 66, 70

Lloyd, B.T. 140

Locadia, M. 201

Lockeridge, S. 107

Logsdon, R.G. 244

Loiselle, L. 132

Long, B. 198–9

Lopez, O.L. 142

Lorig, K.R. 212

Louw, S.J. 244, 246, 253

L.vd.n, M. 371

Loveday, B. 342

Low, L.F. 68

Lucas, C. 237

Lucas, J.A. 328

Lucas, M. 180

Lupton, D. 27

Luscombe, C.E. 89

Luscombe, G. 102, 103–4

Lussier, M. 181

Lutz, C.J. 139

Lyketsos, C.G. 140

Lyman, K.A. 32

Lynn, M.R. 33

Lyons, K. 143

 

 

Ma, D.W.L. 172

McCabe, L.F. 86

McCabe, M.P. 136

McCarthy, R.A. 315

McCormack, B. 87, 130, 197

McCosh, L. 180

McCoy, D. 150

McCrae, N. 352

McCullagh, C.D. 37

McDaniel, A.H. 170

McDonald, A. 272, 274

McDonald, R. 117, 120, 121

Mace, N. 180

McEwen, M. 197

McGettrick, G. 275

McGuinness, B. 82

Mack, W. 245

McKee, K. 133

McKee, M. 268–9

McKenna, B. 359

McKeown, J. 151

McKhann, G.M. 29

McKinnon, M.C. 296

McKinsey Centre for Business Technology 100

McLachlan, S. 55

McLaren, S. 231

MacLean, P.D. 316

MacLullich, A.M. 113, 121

Macmillan 144

McNess, G. 105

Macovei, M. 261

McShane, R. 244, 252

Magaki, S. 368

Magnus, R. 292

Maguire, E.A. 313

Mahieu, L. 364

Mahoney, D.F. 70

Mahoney, E.K. 245

Mainsbridge, A. 269

Maisog, J.M. 315

Malmberg, B. 186

Malnutrition Task Force 166–7

Mandell, A.M. 56

Manderson, B. 208

Mandler, G. 314, 316

Manes, F. 278

Mangialasche, F. 85, 366

Manly, J.J. 85

Mann, A.M. 116

Mann, D.M. 103

Manns, J.R. 312

Manthorpe, J. 32, 54, 73, 82, 92, 105, 106, 173, 193, 211, 232, 247, 281, 344, 363

Marcantonio, E.R. 116, 121

Marcusson, J. 140

Marino, C.K. 359

Markowitsch, H.J. 280, 316, 317

Markus, H.S. 100

Marmot, M. 227, 228, 229

Marquardt, G. 234, 235

Marr, D. 292, 313

Marshak, R.J. 347

Marshall, M. 149

Marslen-Wilson, W.D. 315

Martens, M.A. 297

Martin, C. 154

Martin, F. 197, 211, 213

Martin, M. 143

Martire, L.M. 142

Masaki, K.H. 69

Masi, C.M. 34

Mason, M. 236

Mather, L. 211

Matrix Evidence 331

Matsuzawa, T. 289

Matthews, B.R. 102

Matthews, F.E. 56, 82

Maurer, K. 142

M.vall, L. 186

Maxwell, J. 196, 196

Mayou, R. 113

Mayrhofer, A. 350–1

Mead, N. 198, 199, 210

Meagher, D. 115, 116

Means, R. 237

Medeiros de A Nunes, V. 149

Meeks, S. 359

Meeten, F. 299

Meeter, M. 312

Melkas, S. 122

Meltzer, D.O. 100

Mendes, F. 359

Mendez, M. 104

Mennell, S. 167

Mental Welfare Commission for

Scotland 261

Meri Yaadai Dementia Team 71

Merks-Van Brunschot, I. 207, 208

Meyer, J. 153

Meyer, L.B. 297

Meyerson, D.E. 347–8

Mgekn, I. 172

Michelfelder, I. 334

Milano, W. 169

Miles, S. 248

Miley, K.K. 243

Miller, B.L. 293

Mills, J.K. 118

Milne, A. 27, 66, 71

Milne, H. 247

Milner, B. 308, 312

Milton, J. 367

Minhas, J.S. 118

Mirra, S.S. 372

Miskelly, F. 247, 248

Mitchell, G. 367

Mitchell, L. 237, 238

Mithen, S.J. 297

Mitka, M. 326

Mittelman, M. 52, 53, 59

Mohamed, S. 137

Moise, P. 134

Molinari, V. 244

M.ller, A. 106, 106–7

Monastero, R. 41

Moniz Cook, E. 211, 214

Montgomery, P. 245, 249

Moon, H. 143

Moore, K.H. 184

Moore, W.R. 73

Moorman, S.M. 249

Morandi, A. 116, 119, 120,

122–3

Morgan, D.G. 120

Morgan, E. 113, 119

Morgan, S. 370

Moriarty, J. 68, 73

Moroney, J.T. 38

Morris, B.W. 203

Morris, C.H. 168

Morris, J.C. 29

Morriss-Kay, G.M. 290

Moscovitch, M. 307

Moss, S. 74

Mount, B. 196, 298

Mountain, G.A. 211

Moyer, D. 59

Moyle, W. 82, 90

Muers, J. 70, 364

Mukadam, N. 70, 85

Mukaetova-Ladinska, E.B. 121

Mulley, A. 200

Mulley, G. 206

Mummery, C.J. 168

Munro, S. 298

Murcott, A. 167

Murman, D.L. 327

Murray, J.A. 18

Musher, D. 187

Myferi Williams, C. 299

Nadel, L. 245, 307

N.den, D. 247

Nadler, A. 54

Nakanishi, M. 90, 93

Nakashima, T. 90, 93

Namazi, K.H. 185

 

Narayan, S. 143

National Audit Office 27, 66, 117

National Council for Palliative Care 149

National Housing Federation 234, 235, 235–6

National Institute for Health and Care Excellence (NICE) 81, 114, 116, 119– 20, 166, 217, 325, 326

National Institute for Health Research 101

National Institute for Mental Health 324

National Institute for Mental Health in England (NIMHE) 345

Nauta, W.J.H. 316

Nay, R. 87

Naylor, M.D. 91

Neary, D. 314

Neary, S.R. 70

Neilsen, E. 345

Nelson, C.A. 315

Nelson, R.R. 334

Neundorfer, M.M. 139

Newbronner, L. 145, 268

Newens, A.J. 107

Ngandu, T. 37, 39

NHS Confederation 29, 266, 268

NHS End of Life Care Programme 149

NHS England 117, 117–18

NHS Institute for Innovation and Improvement 30, 331, 332–3, 333

NHS Leadership Academy 343

Nickerson, R.S. 290

Nielsen, S.L. 309

Nielsen, T.R. 65

Nieuwenhuis, I.L. 313, 314

Nilstun, T. 248

Nobili, A. 154

Nogawa, H. 298

Nolan, M.R. 108, 130, 131, 135, 233

Nordenfelt, L. 277

Norton, S. 35, 82, 371

Nortvedt, P. 277

Nourhashemi, F. 154

Nuffield Council on Bioethics 250, 251, 277

Nuffield Trust 208, 210, 264

 

Obert, S. 345

Oboh, L. 334

Ochsner, K.N. 296

O’Connell, C.M. 70

O’Connor, D.O. 57, 58

O’Doherty, J.P. 280

O’Donnell, B.F. 188

O’Driscoll, A. 18

O’Dwyer, C. 87, 88

O’Hanlon, S. 114, 122, 333

Ohman, A. 309

O’Keefe, J. 245

O’Keeffe, S.T. 113, 114

Olafsd.ttir, M. 140

Oldman, C. 237

Oliver, M. 87

Olsson, H. 180

O’Malley, G. 121

O’Malley, L. 231

Omar, R. 296, 297

O’Neill, D.J. 253

O’Neill, K. 322, 323

Ormel, J. 206

Orrell, M.W. 141, 185, 188

Ortony, A. 309

Osborne, H. 365–6

Ouslander, J. 183, 187

Oveisgharan, S. 72

 

 

Pai, M.C. 245

Pak-Hin Kong, A. 323

Paller, K.A. 315–16

Palmer, J.L. 151

Panegyres, P.K. 101, 108

Panksepp, J. 294

Panza, F. 39

Pari, G. 280

Park, N.S. 359

Parker, K. 248

Parkinson, R. 183

Parmar, J. 140

Parsons, T. 199

Partanen, J. 323

Partridge, J.S. 115

Passini, R. 245

Passmore, A.P. 31, 32

Patel, P. 74

Paton, J. 73

Patterson, C. 37

Patterson, T. 70

Peacock, S. 211

Pearlin, L.I. 137

Pearson, L. 70

Pedone, C. 328

Peel, E. 139, 140

Peisah, C. 200

Peralin, L.I. 70

Perera, G. 115

Perretta, J.G. 280

Perry, R.J. 362

Persson, G. 114

Pertez, I. 297

Peters, R. 38

Petersen, G. 249

Petersen, K.A. 247

Petersen, R.C. 81

Peterson, C. 359

Petrea, I. 82, 83, 83–4, 91, 92,

94

Phelan, J.C. 52

Phelps, E.A. 309, 311, 312

Phil, R. 107

Philip, J. 55

Phillips, M.L. 310, 310

Phillipson, L. 54

Piccolo, R.F. 343

Piefke, M. 312

Pieisah, C. 324

Piercy, M. 291

Pike, K.E. 372

Pimlott, N.J.G. 140

Pinkston, E.M. 200

Piquet, O. 169

Platzer, H. 73

Pleydell-Pearce, C.W. 314

Ploeg, J. 352

Poggesi, A. 187

Poletti, M. 367

Policy Research Unit in

Commissioning and the

Healthcare System 264

Poline, J.B. 203

Pollock, A. 150

Polos, L. 165

Pons-Vigu.s, M. 230

Porat, I. 251

Pot, A.M. 82, 83, 83–4, 91,

92, 94

Powell, P.H. 184

Power, A. 274

Prasad, A.S. 41

Premi, E. 101

Price, B.H. 278

Price, E. 73

Price, J.D. 248

Prince, M.J. 66, 69, 81, 82, 86

Pringle, D. 139

Pritchard, J. 281

Prochaska, J.O. 346

Public Enquiry Unit 215–16

Public Health England 34, 38

Pulsford, D. 324

Pung, C. 345

Pusey, H. 153, 214

PwC 203

Pynoos, J. 237

 

 

Quadrio, C. 200

Quaid, K.A. 363

Quin, R. 211

Quinn, C. 130, 144

Quinn, R. 172

Qureshi, H. 133

 

Rabins, P. 180

Radley, A. 107

Rafferty, J. 154

Rahman, S. 17, 18, 20, 34, 55, 63, 88, 100, 155, 185, 195, 214, 236, 261, 277, 278, 279, 279, 370

Rai, J. 183

Raj, S.P. 335

Ramachandran, V.S. 290, 291

Randall, G.E. 230

Rankin-Hill, L. 107

Rankin, K.P. 292

Ransmayr, G.N. 186

Rao, H. 165

Rapaport, J. 276

Rapoff, M.A. 135

Rascovsky, K. 167

Ratnavalli, E. 100

Raven, B. 58

Ray, S. 165

Ray, W.A. 328

Ready, D.A. 347

Redman, R.W. 33

Reed, D.R. 170

Reese, S.D. 56

Reid, C. 232, 234

Reid, R.C. 234

Reinhardt, J.P. 361

Reinken, J. 180

Rempel-Clower, N.L. 311

Repper, J. 151

Resnick, N.M. 182, 183

Reutens, D.C. 297

Reynolds, D. 54

Ribot, T. 310–11, 312

Richard, E. 366

Richards, D. 214

Richards, M. 72

Richardson, T.J. 138, 143

Richter, T. 326, 331

Riegel, B. 135

Ringman, J.M. 172

Rink, L. 41

Rioux, M.H. 19

Ritchie, C.W. 36

Ritchie, K. 36

Riva, G. 259

Robert, P. 26

Roberts, C. 136

Robertson, J. 106

Robinson, C.A. 232, 234

Robinson, J. 68

Robinson, L. 247, 253, 322

Robotham, S.L. 118

Rockwood, K. 38, 114

Rogers, J. 266

Rohrer, J.D. 297

Roland, M. 121

Rolland, Y. 244

Romeo, R. 92

Roozendaal, M. 207

Rose, P. 73

Rosen, H.J. 168

Rosenbloom, M.H. 278

Rosenheck, R.A. 328

Rosenvinge, H. 108

Roses, A.D. 358

Ross, H. 151

Rossington, J. 73

Rossor, M.N. 102, 104, 291, 291–2

Roth, M. 103

Rovner, B.W. 64

Rowe, M.A. 244

Rowlands, J.M. 211

Royal College of General Practitioners 214, 215

Royal College of Nursing (RCN) 152

Royal College of Physicians 214

Royal College of Psychiatrists 207, 209

Royal Commission on Long Term Care 231

Royal Pharmaceutical Society 332–3

Rozario, P.A. 103

Rubin, D.C. 294, 312

Rundgren, A. 179

Runnymede Centre for Policy on Ageing 64

Rusanen, M. 39

Ryan, C.E. 143

Ryan, T. 131

Ryff, C.D. 359

 

 

Sachdev, P.S. 64

Sacks, O. 297

Saczynski, J.S. 115

Sahlas, D.J. 293

Sakakibara, R. 182, 183, 186

Sakamoto, R. 122

Salem, L.C. 358

Salimpoor, V.N. 297

Salovey, P. 295

Sampson, E.L. 102, 104, 116, 117, 118, 119, 174, 322, 361

Samsi, K. 232

Sandman, P.O. 130, 152, 197

Sapolsky, R.M. 39

Sarason, I.G. 309

Saunders, A.M. 358

Saunders, P.A. 233

Sauter, S. 230

Saxena, S. 113, 115, 116

Scarmeas, N. 40, 171

Schalk, R. 207

Schein, E.H. 164, 345

Schermer, M. 367

Schleimer, S.C. 335

Schmahmann, J.D. 278

Schmidt, K.L. 136

Schmieg, P. 234, 235

Schmitz, T.W. 309

Schneider, L. 325

Schnelle, J.F. 182, 185, 187

Schofield, P. 269

Schrank, B. 360

Schrauf, R.W. 68–9, 70

Schultz, M. 197

Schulz, R. 51, 58, 136, 139, 142

Schumacher, K.L. 142

Schur, H.V. 107

Schwabenland, C. 19

Schwarzinger, M. 134

Scott, C.J. 206

Scottish Dementia Champions

Managed Knowledge Network 351

Scottish Development Centre for Mental Health 289–90

Scottish Government 91, 272, 272–3, 273–4, 289–90

Scoville, W.B. 308

Sculman, A.D. 335

Seabrooke, B. 71

Seelaar, H. 101

Seeley, W.W. 289

Senge, P. 165

Serino, S. 259

Setterlund, J. 370

Shaji, K.S. 129

Shallice, T. 314

Shany-Ur, T. 57

Sharif, N. 68

Sharot, T. 311

Shastry, B.S. 270

Sheehan, B. 237, 238

Sheline, Y.I. 372

Shen, L. 363

Shi, Y. 227

Shimizu, K. 247

Shinoda-Tagawa, T. 244

Shippy, A. 73

Shmotkin, D. 360

Shojo, H. 245

Shyu, Y.I. 143

Siddiqi, N. 114

Signoret, J.L. 295

Silkinson, J. 252

Silva, S.A. 130

Silverstone, F.A. 206

Simon, F. 245–6

Simpson, J. 107, 365–6

Sinclair, A.J. 216–17, 369

Singer, B. 359

Singer, J.A. 295

Singh, P. 365

Sinz, H. 280

Skevington, S.M. 211

Skills for Care/Skills for Health 217

Skladzien, E. 324

Skoog, I. 39, 114, 140

Slasberg, C. 269

Sleegers, K. 172

Slettb., A. 277

Slooter, A.J. 362

Smebye, K.L. 365

Smith, S.J. 297

Smith, T. 369

Smyth, K.A. 139

Smythe, A. 344

Snow, D.A. 56, 332

Snyder, A.W. 291, 293

Snyder, L. 366

So, T.T. 359

Soares, J.J. 309

Social Care Institute for Excellence (SCIE) 174, 260, 276

Sofi, F. 38

Sontag, S. 55

Soto, M.E. 372

Soyinka, A. 333

Spencer, B. 73

Sperling, R.A. 36

Sperlinger, D. 108

Spilsbury, K. 212

Sporting Memories Network 307

Spreng, R.N. 101

Squire, L.R. 307, 312

Srivastva, S. 345

Stanley, N. 233

Starbuck, W.H. 351

Stechl, E. 199–200

Steel, A. 82, 90

Stein, K. 245

Stein-Shvachman, I. 103

Stephens, M.A.P. 129

Stern, Y. 18, 37, 118

Stevens, A. 188

Stewart, B.J. 142

Stewart, J. 226

Stewart, R. 115

Stirling, C. 140

Stokes, C. 72

Stokes, G. 365–6

Stokes, L.A. 72

Stooksbury, D. 244

Stott, N. 199

Stout, J.C. 280

Strachan, P.H. 135

Strategy& 202, 208

Straus, S.M. 328

Stuckey, J.C. 139

Stump, C. 149

Sturmberg, J. 154

Sugarman, J. 249

Sullivan, K.A. 361

Sullivan, L. 274

Sung, H.C. 183

Sutton, M. 117

Svoboda, E. 296

Swaffer, K. 104–5, 136–7, 259, 260, 360

Szasz, T.S. 358

Szewczyk, B. 41

 

 

Tabet, N. 172

Tahir, T.A. 113, 119

Takahata, K. 291, 292

Takashima, A. 313, 314

Takehara-Nishiuchi, K. 309

Taket, A. 72

Tan, D. 181, 183

Tanaka, H. 298

Tanaka, Y. 298

Tanenbaum, S.J. 129

Tangney, C.C. 171

Tariot, P.N. 372

Tascone, L.S. 368

Tateno, A. 372

Taylor, N.S.D. 265

Taylor, S.E. 107

Teece, D.J. 323

10/66 Dementia Research Group 86

Teri, L. 182

Teuber, H.L. 315

The, A.-M. 276

The Princess Royal Trust for Carers 134

Thomas, A.J. 206–7, 368

Thomas, B. 227

Thompson, C.A. 212

Thompson, G.N. 352

Thompson, P.M. 366

Thompson, R. 324, 351

Thompson, R.G. 296

Thompson Coon, J. 327

Thomson, H. 226

Tilse, C. 370

Tilvis, R.S. 188

Timmins, N. 352

Timpson, T. 322

Tindall, L. 105, 106

Tingle, J. 262

Tischler, V. 33

Tobin, S.S. 365

Todd, R.M. 307

Tolbert, P.S. 165

Tolhurst, E. 101

Tomlinson, B.E. 103

Tomlinson, F. 19

Toot, S. 181, 185

Tooth, L. 129

Topo, P. 185, 298

Torres, A. 18

Tranv.g, O. 247

Traynor, V. 144

Tremblay, A. 121

Trigg, R. 211

Truswell, D. 65, 66

Trzepacz, P.T. 115

Tsang, S.W. 169

Tu, M.C. 245

Tulving, E. 305, 314

Turk, V. 75

Turner, D. 66

 

 

Udell, L. 74–5

UK Health Prevention Forum 34, 38

Um, M.Y. 134

Underwood, G. 315

Unison 195

United Nations (UN) 226, 258, 269, 274

University of Sheffield 294

US Courts 252

US Supreme Court 252

Uzzi, B. 204

Valcour, V.G. 69

Valentina, E. 197

Van Broeckhoven, C. 172

 

 

van de Ven-Vakhteeva, J. 329

Van Der Gaag, M. 142

van der Ham, K. 207

van der Lee, J. 139

van der Linde, R.M. 41

Van Dick, R. 346

Van Dijk, R. 346

van Duijn, C.M. 37

van El, C.G. 45

Van Gorp, B. 56

van Hoof, J. 206, 237

van Otterloo, A. 167

Vanhaverbeke, W. 334

Vardy, E. 122

Vedin, I. 172

Velilla, N.M. 116

Vellas, B. 35

Venturato, L. 82, 90

Vercruysse, T. 56

Verhey, F.R. 130, 142

Verity, C.M. 43

Vernooij-Dassen, M. 214

Vickrey, B.G. 352

Vileland, T. 33

Villars, H. 154

Visser, S.M. 365

Volicer, L. 245

Vollenberg, M. 207

von Strauss, E. 371

 

 

Waarde, H. 231

Wade, D.T. 138

Wagner, U. 311

Wais, P.E. 309

Walker, M.H. 141

Wallin, A. 249

Walsh, S. 102, 105–6

Walter, J.S. 184

Wang, H.X. 37, 371

Wang, Y. 39

Wanganeen, R. 64

Warchol-Biedermann, K. 362

Ward, G. 115

Ward, R. 185

Warren, J.D. 102, 104, 297

Warren, M.W. 40

Warrick, D.D. 165

Warrington, E.K. 315

Watchman, K. 74

Watson, G.S. 170

Watson, R. 173, 175

Watson-Wolfe, K. 334

Waugh, A. 352

Waugh, F. 238

Weatherhead, I. 173, 175

Webb, R.J. 184

Webber, M. 141, 142, 265

Weber, L.R. 140

Weiner, M.F. 40, 119

Weingarten, S.R. 212

Weinstein, J. 59

Weintraub, D. 280

Welch, I. 165

Wells, T.J. 182

Welsh, S. 246

Werner, P. 72, 103

Werner, S. 249, 251

Wessely, S. 52

West, D.G. 290

West, J. 334

West, M. 345, 351

Westendorp, R.G. 115

Westphal, A. 243

Whall, A.L. 132

Whalley, L. 105

Whear, R. 174

Wheeler, J.S. 184

Whelan, T. 200

Whitaker, R. 204, 325

White, C. 268

White, E.B. 245, 249

Whitehead, M. 228, 229

Whitehouse, P.J. 56

Whitlatch, C.J. 143, 251

Whitwell, J.L. 168

Wiersma, E. 132

Wight, M. 143

Wikberg, M. 185

Wilemon, D. 335

Wilken, J.P. 358

Wilkinson, C. 351

Wilkinson, H. 74, 75, 367

Wilkinson, R. 227

Wilks, S.E. 142

Willander, J. 316

Williams, B.W. 245

Williams, D.D.R. 106

Williams, K. 173, 175

Williams, R.S. 75

Williams, S. 151

Williamson, G.M. 142

Williamson, T. 58, 370

Willig, S. 298–9

Wills, T.A. 139

Wilson, J. 370

Wilson, P.D. 184

Wilson, R.C. 150

Wilson, S.J. 297

Wilson, S.N. 203, 204

Wimo, A. 82

Winblad, B. 130, 152, 197, 371

Wise, J. 27

Witlox, J. 115

Wittenberg, R. 69

Wolf Klein, G.P. 206

Wong, C.L. 114

Wong, F.K. 144

Woods, B. 200

Woods, R.T. 130, 306

World Health Organization (WHO) 41, 43, 53, 132, 226, 229, 356

Wortmann, M. 85

Wu, S.C. 175

Wyver, P.C. 130

 

Xiao, L.D. 137

Xu, W. 371

 

Yalla, S.V. 182

Yamaguchi, H. 141

Yamamoto, K. 247

Yang, C.T. 143

Yap, P. 181, 183

Year of Care Partnerships 215

Yonelinas, A.P. 314

Young, A. 315

Young, A.L. 371

Young, J.B. 116, 119

Young, K.W. 173

Young, R.S. 115

Yovel, G. 315–16

 

Zannas, A.S. 372

Zarit, J.M. 292

Zarit, S.H. 137

Zatorre, R.J. 295, 296, 297

Zecca, L. 40

Zeilig, H. 55

Zgola, J.M. 298

Zhan, L. 70

Zhong, S. 227

Zimmerman, S. 149

Zucker, L.G. 165

Zuidema, S