1. Support at Home: Interventions to Enhance Life in Dementia (SHIELD) 1 Home Treatment Programme Development of a manual to use as an intervention to avoid hospital admission for people with dementia and their carers

2. Focus Groups People with dementiaFamily CarersHealthcare Professionals What causes a crisis for people with dementia and their carers? “Eating mouldy food” “Tripping over the carpet” “Family carers saying they can’t cope” “Not paying bills and getting heating cut off” “Not taking medication” 1.Behavioural & psychological 2.Physical health 3.Vulnerability 4.Family carer 5.Environment

3. 1.Professional Healthcare 2.Home Living Environment 3.Social Home Care 4.Family Carer Focus Groups What interventions help people in a crisis? “Going to hospital” “checking the medication” “keeping a routine” “having a carer or relative” “telling me what is happening”

4. Results 831 people started the questionnaire of which 719 (87%) people completed the questionnaire 620 (86%) of respondents had been involved in a crisis with people with dementia and their carers.

5. Secondary analysis Physical Healthcare Practitioners = 395 (54.9%) Mental Healthcare Practitioners = 227 (31.6%) Consumers (people with dementia, carers, voluntary sector) = 72 (10%) Academics = 25 (3.5%)

6. Conclusions Useful insight into the perspectives of consumers, particularly around the causes of crisis Further development of assessment processes e.g. risk assessments that capture individuals unmet needs Risk and needs assessments should explore carers’ perceptions particularly around incontinence and types of abuse that could shape carer education and support strategies Reconfigure services to provide support at home included alternatives to the use of accident and emergency facilities that could have quality of life benefits for the person with dementia

7. References Toot, S., Devine, M. and Orrell, M., 2011. The effectiveness of crisis resolution/home treatment teams for older people with mental health problems: a systematic review and scoping exercise. International journal of geriatric psychiatry, 26(12). 1221-1230. Toot, S., Hoe, J., Ledgerd, R., Burnell, K., Devine, M. and Orrell, M., 2012. Causes of crises and appropriate interventions: The views of people with dementia, carers and healthcare professionals. Aging & mental health, 1- 8. Causes of Crisis and secondary analysis is under review for publication