Examples included a lack of continuity of care in the community and considerable differences in access to services based on geographical location. The constraint in community services creates a situation where in the absence of adequate support, even for a short term crisis, families are forced to consider admitting their loved one to hospital. A further complicating factor is that in the face of lengthy waiting lists for community services, health and social care professionals will sometimes advsie a family to admit the person with dementia to hospital as a way to speed up access to services. When someone is admitted to acute care, this is seen to accelerate admission to long term care with people with dementia reprorted to often deteriorate during their stay. It is also often at this point that health care professionals take the lead in decision making and control moves away from the family. Irish government policy advocates supporitng people to live well in their own homes for as long as possible but the authors suggest current indaequacies in the system, that were exacerbated by the economic crisis, have resulted in community services that fail to meet policy objectives.

Across the UK there was a significant increase in the number of people diagnosed, with figures in Northern Ireland and Scotland being consistently higher, altough more recent figures indicate an upward trend for England and Wales. Prescription rates for anti-dementia drugs have increased with rates being consistently higher in Northern Ireland. This increase began before the release of the National Strategy n 2009 and was continuing to rise at the end of 2015. The general increase across the UK may be in part related to a change in NICE guidelines giving people with mild dementia access to these drugs. Prescription of anti-psychotic drugs significantly decreased from 22.1% in 2005 to 11.4% in 2015. The authors highlight the potential impact of 2004 guidance from the Committee on Safety of Medicines and the Time for Change Report 2009. While acknowledging that this study can not confidently link any changes to specific initiatives, the authors suggest that national initiatives appear to have had a positive impact.

It concentrates on the content of submissions made by stakeholders, individuals and organisations, as part of the consultation process for the developmentment of the Irish National Dementia Strategy and the content of the National Dementia Strategy itself. Using content analysis, the article reports on the number of direct references to personhood and personhood synonyms in the organisational submissions and in the Strategy and its priority areas of action. It categorises the organisations submissions into one of three models: biomedical, psychosocial and social and cross-references these models with regard to the explicit use of personhood or one of its synonyms. It found that the use of personhood and its synonyms correlates highly with submissions categorised as falling within a social model. It discusses the findings and whether the principle of personhood in the strategy is a sufficient condition for changing dementia care in Ireland.

 They highlight the difficulties of establishing capacity and consent and the need for more open discussion, debate and research in this area.  A particular gap identified in research is the lack of service user perspectives.  They conclude that staff must be better informed on legislation and policy and must receive better training and support on effectively managing sexuality and dementia.  

 Ballard highlights the complexity of capacity and competency, mandatory or discretionary reporting, trespass, homelessness and confidentiality concluding that it is often unclear where the community nurse’s legal responsibilities lie.

 While the paper is not about people with dementia it highlights the need for timely, legal advice on diagnosis of dementia and the impact on carers who are often exhausted and do not have the energy to pursue legal issues.