Research into practice

Studies of people with dementia continue to throw much needed light
on local needs. They develop local understanding of trends and
circumstances. Rural areas are now providing data and these again
confirm the importance of local context.

In a study from Northern Ireland, Gilmour and her
colleagues¹ show how residential care homes continue to
be a major plank of service provision. In their locality, they
found that over a 10-year period hospital long-term care had
virtually disappeared and the numbers of statutory care homes for
older people had decreased but private nursing care homes had
increased.

More people from urban settings (52 per cent) appear to be living
in residential care compared to a similar rural group of people
with dementia (36 per cent). Overall, the researchers believed new
services should be developed that would enable more people to stay
at home in rural communities.

This study is also useful in that it is a follow-up to another
study conducted 10 years ago. The findings show that the number of
people with dementia appears to have more than doubled over the
decade. This may be the result of rising numbers but the
researchers also suggest it is because of an increase in knowledge
and understanding about dementia by professionals and the public.
In a rural area, close and relatively stable professional networks
may make identification of dementia easier. However, some people
are not known to services and so caution is needed when planning
services. We should not assume information is complete.

In contrast, Wenger and her colleagues did not identify many
differences in their study of rural dementia care compared to the
urban setting of Liverpool.² They found generally high
levels of satisfaction with services. Contrary to expectations, the
carers they interviewed said they felt well supported by family and
neighbours. The research team suggests that neighbours appeared
generally well disposed and were appreciated and so this norm of
behaviour needs more recognition. If it is culturally valued then
practitioners and planners should develop ways in which neighbourly
concern and support can be acknowledged and promoted.

This may be particularly worthwhile in rural areas and can prove
effective for people living alone as well as for carers.

In this study, carers seemed very committed overall to continuing
in their caring role. The authors observe that in rural areas
residential and nursing care homes are likely to be some distance
from families which, in turn, can make visiting problematic. This
is especially the case given the increasingly significant decline
of rural public transport. For carers this may tellingly make
residential care a particularly negative option.

The two articles suggest that rural communities can support people
with dementia but that residential care is still used, particularly
when levels of disability are high. As the knowledge and
understanding of dementia appears to be increasing among
professionals and carers this may mean that they may be better able
to spot signs and symptoms. However, in the final analysis,
services remain under-developed and rural factors need to be
addressed in any plans.

1 H Gilmour, F Gibson, and J Campbell, “People with dementia in a
rural community: issues of prevalence and community care”, Dementia
2 (2), 2003

2 G C Wenger, A Scott and D Seddon, “The experience of curing for
older people with dementia in a rural area: using services”, Aging
and Mental Health 6 (1), 2002

Jill Manthorpe is reader in community care at the
University of Hull and the recent editor (with Trevor Adams) of
Dementia Care, Arnold Publishers, 2003