The recommendations can be utilised at a local, national and European level to benchmark progress.

With over two-thirds of people with dementia living in the community and one-third of those living alone, it is important to consider the future housing needs of this population, particularly as symptoms of cognitive impairment increase. Policy in England has focused on enabling people living with dementia to remain in their own homes for as long as possible, often with the support of a family carer. However, many people struggle to maintain an acceptable quality of life in their own homes as their dementia advances, often due to the design limitations of mainstream housing and the challenge of finding specialist domiciliary care that is affordable and of sufficient quality. Extra care housing offers a model that aims to support older people living in their own apartments, whilst also offering specialist person-centred care as and when it is needed. This paper reports on a longitudinal project that explored how extra care housing can respond to the changing social care needs of residents, including those living with dementia. Participants included residents and staff from four extra care housing schemes, one of which was a specialist dementia scheme, in two regions of England. Interviews were carried with 51 residents across 4 rounds at 5 month intervals between October 2015 and June 2017. Interviews were also carried out with 7 managers, 20 care staff and 2 local authority commissioners of housing for older people. Key factors included person-centred care and support, flexible commissioning and staffing, appropriate design of the environment and suitable location of the scheme within the wider community. The challenge of delivering services that addresses these issues during a period of reduced public spending is acknowledged. Further research is suggested to compare different approaches to supporting people with dementia, including integrated and separated accommodation, and different stages of dementia.

Objectives: This paper reports on the acceptability and effectiveness of the FITS (Focussed Intervention Training and Support) into Practice Programme. This intervention was scaled up from an earlier cluster randomised-controlled trial that had proven successful in significantly decreasing antipsychotic prescribing in care homes. Method: An in depth 10-day education course in person-centred care was delivered over a three-month period, followed by six supervision sessions. Participants were care-home staff designated as Dementia Care Coaches (DCCs) responsible for implementing interventions in 1 or 2 care homes. The course and supervision was provided by educators called Dementia Practice Development Coaches (DPDCs).Effectiveness data included monitoring antipsychotic prescriptions, goal attainment, knowledge, attitudes and implementation questionnaires. Qualitative data included case studies and reflective journals to elucidate issues of implementation. Results: Of the 100 DCCs recruited, 66 DCCs completed the programme. Pre-post questionnaires demonstrated increased knowledge and confidence and improved attitudes to dementia. Twenty per cent of residents were prescribed antipsychotics at baseline which reduced to 14% (31% reduction) with additional dose reductions being reported alongside improved personalised goal attainment. Crucial for FITS into Practice to succeed was the allocation and protection of time for the DCC to attend training and supervision and to carry out implementation tasks in addition to their existing job role. Evaluation data showed that this was a substantial barrier to implementation in a small number of homes. Discussion and conclusions: The FITS into practice programme was well evaluated and resulted in reduction in inappropriate anti-psychotic prescribing. Revisions to the intervention are suggested to maximise successful implementation.

Purpose The benefits of “green dementia care”, whereby people living with dementia are supported to connect with nature, are increasingly being recognised. Evidence suggests that these benefits span physical, emotional and social spheres and can make a significant contribution towards quality of life. However, care settings often present specific challenges to promoting such connections due to a range of factors including risk-averse cultures and environmental limitations. The purpose of this paper is to report on a project that aims to explore the opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in residential care and extra care housing schemes in the UK. Design/methodology/approach Data were gathered from 144 responses to an online survey by managers/staff of extra care housing schemes and care homes in the UK. In depth-case studies were carried out at three care homes and three extra care housing schemes, involving interviews with residents, staff and family carers. Findings A wide variety of nature-based activities were reported, both outdoor and indoor. Positive benefits reported included improved mood, higher levels of social interaction and increased motivation for residents, and greater job satisfaction for staff. The design and layout of indoor and outdoor spaces is key, in addition to staff who feel enabled to promote connections with nature. Research limitations/implications This paper is based on a relatively small research project in which the participants were self-selecting and therefore not necessarily representative. Practical implications The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes. Social implications Outdoor activities can promote social interaction for people living with dementia in care settings. The authors’ findings are relevant to the recent policy focus on social prescribing. Originality/value The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.

Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. Given the limited capacity of the formal health care sector to address these public health issues, attention is turning to the role of agencies active in civil society. This paper sought to evaluate the associations between participation in community centre activities, the psycho-social wellbeing and health related behaviours. This was based on an evaluation of the South West Well-being programme involving ten organisations delivering leisure, exercise, cooking, befriending, arts and crafts activities. The evaluation consisted of a before-and-after study with 687 adults. The results showed positive changes in self-reported general health, mental health, personal and social well-being. Positive changes were associated with diet and physical activity. Some activities were different in their outcomes—especially in cases where group activities were combined with one-to-one support. The results suggest that community centre activities of this nature offer benefits that are generically supportive of health behaviour changes. Such initiatives can perform an important role in supporting the health improvement objectives of formal health care services. For commissioners and partner agencies, accessibility and participation are attractive features that are particularly pertinent to the current public health context.

Purpose The purpose this paper is to explore walking with purpose in extra care, retirement and domestic housing settings to better understand and support people living with dementia in these settings, develop recommendations and inform practice. Design/methodology/approach A mixed-methods study was used: scoping literature review; online survey of extra care and retirement housing managers in the UK; case studies involving interviews with staff and family carers (n = 14) of ten individuals who engaged in walking with purpose in the different housing settings. Findings Although residents who walk with purpose constitute a minority (0–2 residents), managing walking with purpose can be challenging and time consuming. Distraction or redirection was the most common response. Other strategies included identifying the resident’s motivations and accommodating their wishes or walking with them. Culture of care, staff training and dementia-friendly design are keys to effective support for safe walking with purpose. Responses to walking with purpose in the domestic housing settings have raised serious deprivation of liberty issues. Research limitations/implications This study had a number of limitations. The completed survey questionnaires represent a self-selected sample of extra care and retirement housing settings, and responses are based on the perceptions of the staff members completing the survey. There were a relatively small number of case study sites (three extra care housing and three retirement housing), and it was not possible to interview family members for all of the residents who walked with purpose. Originality/value This study provides unique data on walking with purpose in extra care and retirement housing setting in the UK.

The version presented here may differ from the published version or, version of record, if you wish to cite this item you are advised to consult the publisher's version. Please see the 'permanent WRaP URL' above for details on accessing the published version and note that access may require a subscription.For more information, please contact wrapteam@worc.ac.uk 13 18 28 37 44 46 52 2 3 Green dementia care in accommodation and care settings: a literature review Abstract 8 9 Purpose 10 11 This literature review examined the recent evidence relating to green (nature-based) 12 dementia care for people living with dementia in long-term accommodation and care settings 14 (housing for older people that provides both accommodation and care, such as residential 15 care homes, nursing homes and extra care housing schemes). The review formed part of a 16 pilot study exploring interaction with nature for people living with dementia in care homes 17 and extra care housing schemes in the UK. Rather than a comprehensive systematic or 19 critical literature review, the intention was to increase understanding of green dementia care 20to support the pilot study. 22Approach 23 24The review drew together the published and grey literature on the impacts of green (nature-25 based) dementia care, the barriers and enablers and good practice in provision. People 26 living with dementia in accommodation and care settings are the focus of this review, due to 27 the research study of which the review is part. Evidence relating to the impacts of engaging 29 with nature on people in general, older people and residents in accommodation and care is 30 also briefly examined as it has a bearing on people living with dementia. 31 32 Findings 33 34 Although interaction with the natural environment may not guarantee sustained wellbeing for 35 all people living with dementia, there is some compelling evidence for a number of health 36 and wellbeing benefits for many. However, there is a clear need for more large-scale 38 rigorous research in this area, particularly with reference to health and wellbeing outcomes 39 for people living with dementia in accommodation and care settings for which the evidence is 40 limited. There is a stronger evidence base on barriers and enablers to accessing nature for 41 people living with dementia in such settings. 42 43 Research limitations 45 This literature review was conducted to support a pilot study exploring green (nature-based) 47 dementia care in care homes and extra care housing schemes in the UK. Consequently, the 48 focus of the review was on green dementia care in accommodation and care settings. The 49 study, and thus the review, also focused on direct contact with nature (whether that occurs 50 outdoors or indoors) rather than indirect contact (e.g. viewing nature in a photograph, on a 51 TV screen or through a window) or simulated nature (e.g. robot pets). Therefore, this is not a 53 full review of all aspects of green dementia care.54 55 Originality/Value 56 57 This paper presents an up-to-date review...

Retirement villages have been slow to emerge as a housing model for older people in the United Kingdom (UK) but the sector is now growing rapidly, with an increasing number of both private and not-for-profit developers entering the market. Research findings to date have indicated high levels of satisfaction among residents, but commentators have criticised this form of provision on the grounds that they are only an option for the better off. This paper reports a study of a retirement village that has attempted to address this issue by integrating residents from a range of socio-economic backgrounds and by making various tenures available in the same development. The paper begins with a brief history of retirement villages in the UK and an overview of the concept of community, including those of communities of place and interest and their role in social policy. The presented findings highlight a number of factors that impact on a resident's sense of community, including social interaction, the development of friendships, the built environment and the existence of common interests. The discussion focuses on the development of cross-tenure social networks and how residents' health and social status shapes community experience. It is concluded that the clustering model of mixed tenure is likely to emphasise differences in the socio-economic backgrounds of residents and that the success of retirement villages as communities depends on grasping the subtleties of the diversity of later life.