Examining the challenges of implementing different dementia care models in Scotland

Background: Dramatic projected increases in the incidence and prevalence of dementia has prompted health and social care systems to respond. The delivery of dementia care in the community has spawned a variety of care and service delivery models.

Aim: The aim of this study is to examine the history and differences in the implementation of dementia service models in Scotland, compare these models across urban, mixed rural/urban and remote rural contexts and to examine to what extent these models are evidence-based.

Methods: The study used a multi-method approach combining a structured literature review with a case-study based in-depth interview approach. The literature review explored the evidence base for community-based dementia care service models involving multiple scientific literature databases (MEDLINE, CINAHL, EMBASE, PSYCINFO) and grey literature through Google TM. Three different community-based dementia service models in Fife, Angus and Perth and Kinross were explored using observational and interview-based methods. The sample included, 10 people with early onset dementia,10 non-professional carers and 10 health professionals (community nurses, general practitioners, psychologists).

Results: Service model evaluations continues to be sparse. Available evidence favours multi-disciplinary community-based approaches and mulit-agency coordination. The literature review highlighted that individual level focus needs to be replaced by a systemic and prospective perspective. Multi-agency goals fall particularly short in remote and rural areas. Individual interviews showed that the use of evidence-based models in providing care is still limited.

Conclusion: Emergent legislation and policy is responding to the changing epidemiology of dementia, therefore evidence-based support for interventions is urgently needed.