The Development of Environmental Assessment Tools to Support the Creation of Dementia Friendly Care Environments: Innovative Practice

The need for more dementia friendly design in hospitals and other care settings is now widely acknowledged. Working with 26 NHS Trusts in England as part of a Department of Health commissioned programme, The King’s Fund developed a set of overarching design principles and an environmental assessment tool for hospital wards in 2012. Following requests from other sectors, additional tools were developed for hospitals, care homes, health centres and housing with care. The tools have proven to be effective in both disseminating the principles of dementia friendly design and in enabling the case to be made for improvements that have a positive effect on patient outcomes and staff morale. This paper reports on the development,use and review of the environmental assessment tools, including further work that is now being taken forward by The Association for Dementia Studies, University of Worcester.

Towards a Better Modelling and Assessment of Construction Risk: Insights from a Literature Review

This paper reviews the literature of construction risk modelling and assessment. It also reviews the real practice of risk assessment. The review resulted in significant results, summarised as follows. There has been a major shift in risk perception from an estimation variance into a project attribute. Although the Probability–Impact risk model is prevailing, substantial efforts are being put to improving it reflecting the increasing complexity of construction projects. The literature lacks a comprehensive assessment approach capable of capturing risk impact on different project objectives. Obtaining a realistic project risk level demands an effective mechanism for aggregating individual risk assessments. The various assessment tools suffer from low take-up; professionals typically rely on their experience. It is concluded that a simple analytical tool that uses risk cost as a common scale and utilises professional experience could be a viable option to facilitate closing the gap between theory and practice of risk assessment.

Introduction to the Transforming Dementia Care in Hospitals Series

A short series of articles in Nursing Older People, starting in September, presents case study examples of the positive work achieved by trusts that participated in the RCN’s development programme to improve dementia care in acute hospitals. This introductory article reports on the independent evaluation of the programme. The programme included a launch event, development days, site visits, ongoing support by the RCN lead and carer representatives and a conference to showcase service improvements. The evaluation drew on data from a survey, the site visits, trust action plans and a range of self-assessment tools for dementia care. The findings highlight substantial progress towards programme objectives and learning outcomes and suggest that the programme provided the focus, impetus and structure for trusts to make sustainable changes. It also equipped participants with the strategies and confidence to change practice. Recommendations are made for taking the programme forward.

Adverse Childhood Life Events and Postpartum Psychosis in Bipolar Disorder

Background Women with bipolar disorder are at increased risk of postpartum psychosis. Adverse childhood life events have been associated with depression in the postpartum period, but have been little studied in relation to postpartum psychosis. In this study we investigated whether adverse childhood life events are associated with postpartum psychosis in a large sample of women with bipolar I disorder. Methods Participants were 432 parous women with DSM-IV bipolar I disorder recruited into the Bipolar Disorder Research Network (www.BDRN.org). Diagnoses and lifetime psychopathology, including perinatal episodes, were obtained via a semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry; Wing et al., 1990) and case-notes. Adverse childhood life events were assessed via self-report and case-notes, and compared between women with postpartum psychosis (n=208) and those without a lifetime history of perinatal mood episodes (n=224). Results There was no significant difference in the rate of any adverse childhood life event, including childhood sexual abuse, or in the total number of adverse childhood life events between women who experienced postpartum psychosis and those without a lifetime history of perinatal mood episodes, even after controlling for demographic and clinical differences between the groups. Limitations Adverse childhood life events were assessed in adulthood and therefore may be subject to recall errors. Conclusions We found no evidence for an association between adverse childhood life events and the occurrence of postpartum psychosis. Our data suggest that, unlike postpartum depression, childhood adversity does not play a significant role in the triggering of postpartum psychosis in women with bipolar disorder.

History of Premenstrual Mood Change and Postpartum Episodes are Associated with Perimenopausal Episodes in Women with Bipolar Disorder

Background and Aims: Reproductive life events are potential triggers of mood episodes in women with bipolar disorder. We aimed to establish whether a history of premenstrual mood change and postpartum episodes are associated with perimenopausal episodes in women who have bipolar disorder. Methods: Participants were 339 post-menopausal women with DSM-IV bipolar disorder recruited into the Bipolar Disorder Research Network (www.bdrn.org). Women self-reported presence (N = 200) or absence (N = 139) of an illness episode during the perimenopausal period. History of premenstrual mood change was measured using the self-report Premenstrual Symptoms Screening Tool (PSST), and history of postpartum episodes was measured via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry, SCAN) and inspection of case-notes. Results: History of a postpartum episode within 6 months of delivery (OR = 2.13, p = 0.03) and history of moderate/severe premenstrual syndrome (OR = 6.33, p < 0.001) were significant predictors of the presence of a perimenopausal episode, even after controlling for demographic factors. When we narrowed the definition of premenstrual mood change to premenstrual dysphoric disorder, it remained significant (OR = 2.68, p = 0.007). Conclusions: Some women who have bipolar disorder may be particularly sensitive to reproductive life events. Previous mood episodes in relation to the female reproductive lifecycle may help clinicians predict individual risk for women with bipolar disorder approaching the menopause. There is a need for prospective longitudinal studies of women with bipolar disorder providing frequent contemporaneous ratings of their mood to overcome the limitations of retrospective self-report data.

The Influence of Borderline Personality Traits on the Course of Bipolar Disorder

Background and Aims: Bipolar disorder and borderline personality disorder are commonly comorbid. Borderline personality disorder is diagnosed categorically, but personality pathology may be better characterised dimensionally. The impact of borderline personality traits (not diagnosis) on the course of bipolar disorder is unknown. We examined the presence and severity of borderline personality traits in a large UK sample of bipolar disorder, and the impact of these traits on illness course. Methods: Borderline Evaluation of Severity over Time (BEST) was used to measure presence and severity of borderline traits in 1447 individuals with DSM-IV bipolar I disorder (n = 1008) and bipolar II disorder (n = 439) recruited into the Bipolar Disorder Research Network (www.bdrn.org). Clinical course was measured via semi-structured interview (Schedules for Clinical Assessment in Neuropsychiatry) and case-notes. Results: BEST score was higher in bipolar II than bipolar I (36 v 27, p < 0.001) and 9/12 individual BEST traits were significantly more common in bipolar II than bipolar I. Within both bipolar I and bipolar II higher BEST score was associated with younger age of bipolar onset (p < 0.001), history of alcohol misuse (p < 0.010), and history of suicide attempt (p < 0.001). Conclusions: Borderline personality traits are common in bipolar disorder, and more severe in bipolar II than bipolar I disorder. Borderline trait severity was associated with more severe bipolar illness course; younger age of onset, alcohol misuse and suicidal behaviour. Clinicians should be vigilant for borderline personality traits irrespective of whether criteria for diagnosis are met, particularly in those with bipolar II disorder and younger age of bipolar onset.