David J Challis

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OBJECTIVE To evaluate a model of intensive case management for people with dementia based in a community-based mental health service for older people. METHOD Quasi-experimental design. Individuals in one community team setting received case management and were compared with those in a similar team without such a service. Forty-three matched pairs were(More)
Quality of Life (QoL) is now an established outcome measure for people with dementia. There is a need to understand if measures are sensitive to change and what factors are associated with change in QoL in dementia to develop interventions to improve QoL and identify who may be most likely to benefit. This study aimed to assess change in QoL in people(More)
BACKGROUND People with dementia often move into care homes as their needs become too complex or expensive for them to remain in their own homes. Little is known about how well their needs are met within care homes. METHOD The aim of this study was to identify the unmet needs of people with dementia in care and the characteristics associated with high(More)
OBJECTIVE To investigate psychiatric morbidity, cognitive impairment, dependency, and survival in residents newly admitted to care homes. METHODS A total of 308 older people were assessed using measures of cognitive impairment and depressive symptomatology, and interviewable residents completed a quality-of-life interview. Dependency levels were assessed(More)
BACKGROUND Health care policies in many countries aim to enable people with dementia to live in their own homes as long as possible. However, at some point during the disease the needs of a significant number of people with dementia cannot be appropriately met at home and institutional care is required. Evidence as to best practice strategies enabling(More)
England and Northern Ireland provide examples of different degrees of integration of health and social care within broadly similar administrative and funding frameworks. This paper examines whether integrated structures appear to impact upon the operation of care management, a key approach to providing coordinated care for vulnerable older people. There(More)
BACKGROUND Care management and assessment of need are the cornerstones of the community care reforms in the UK. Although much of the research base has been on highly vulnerable older people, in practice, care management has been implemented for a wider group. OBJECTIVE To examine how intensive care-management at home has developed. DESIGN Postal survey(More)
BACKGROUND Community-based care at the margin is a substitute for institutional care. Three factors are considered critical: definitions of eligibility, assessment procedures and balance of care. AIMS To examine determinants of the margin between institutional and home-based care, review current practice, identify the implications and contribute to(More)
OBJECTIVE to ascertain the value of employing a specialist clinician's contribution to the assessment of older people prior to care home entry. DESIGN randomised controlled trial. METHOD 256 older people at risk of care home entry were randomly allocated to either a control group, who received the usual care management assessment, or to an experimental(More)
BACKGROUND Older people with dementia living in residential care have complex unmet needs and decreased quality of life. AIM To reduce unmet needs in older people with dementia in residential care compared to a 'care as usual' control group. METHOD A single blind, multicentre, cluster randomised controlled trial recruited 238 people aged 60+ with(More)