Evidence of what works to support and sustain care at home for people with dementia: a literature review with a systematic approach

Abstract

Background This paper synthesises research evidence about the effectiveness of services intended to support and sustain people with dementia to live at home, including supporting carers. The review was commissioned to support an inspection regime and identifies the current state of scientific knowledge regarding appropriate and effective services in relation to a set of key outcomes derived from Scottish policy, inspection practice and standards. However, emphases on care at home and reduction in the use of institutional long term care are common to many international policy contexts and welfare regimes.

Methods Systematic searches of relevant electronic bibliographic databases crossing medical, psychological and social scientific literatures (CINAHL, IngentaConnect, Medline, ProQuest, PsychINFO and Web of Science) in November 2012 were followed by structured review and full-text evaluation processes, the latter using methodology-appropriate quality assessment criteria drawing on established protocols.

Results Of 131 publications evaluated, 56 were assessed to be of 'high' quality, 62 of 'medium' quality and 13 of 'low' quality. Evaluations identified weaknesses in many published accounts of research, including lack of methodological detail and failure to evidence

conclusions Thematic analysis revealed multiple gaps in the evidence base, including in relation to take-up and use of self-directed support by people with dementia, use of rapid response teams other multidisciplinary approaches, use of technology to support community dwelling people with dementia, and support for people without access to unpaid or informal support.

This article centers on authenticity and social relations within a commodified Celtic music festival framework. The impact of the tourism commodification process upon environs and culture has generated a veritable plethora of studies, the precursor to this being MacCannell's theorization of the leisure class. In an attempt to explain the meaning and significance of social relations within a festival context, specific attention is paid to Maffesoli's theory of the neo-tribe and emotional community. Drawing upon empirical data from a questionnaire survey and in-depth interviews with festival producers and consumers of a Celtic music festival in Scotland, this article challenges Maffesoli's dismissal of the relevance of class grouping and suggests dimensions of the backstage region of festival social space: first, through participating in real culture in an intimate environment; second, by playing an instrument or singing; third, through the strengthening of social networks. It is argued that the tourism commodification process is resisted to attain authentic social relations through the backstage region of social space.