Rosalind Willis

In this article, I offer reflections on providing gerontological education to a global audience at the University of Southampton, both on campus and at a distance. I identify challenges we have faced as a teaching team, including the lack of recognition of the discipline of gerontology, the lack of prioritisation of ageing by governments, how student motivation is affected by learning at a distance and how lecturers need to ensure their teaching material is relevant to their global audience. In each case, I also discuss opportunities that arise and hope to provoke debate about how the global gerontology education community can continue to thrive.

Background: Pelvic organ prolapse and dementia are both common conditions which increase in prevalence with age. Women who have prolapse and dementia may have a different clinical presentation from those with prolapse alone. This development study aimed to understand: Which services currently deliver pessary care for women with dementia and how those services manage/support the women and their family supporters, and what women with prolapse and dementia and/or their family supporters would like from services to alleviate the women’s symptoms. Methods: Multimethod development study. An anonymous online survey for Health and Social Care Professionals (HSCPs) was circulated via various professional networks. Semistructured interviews were conducted with HSCP, women with a dual diagnosis of prolapse and dementia and their family supporters. Results: Survey results ( n = 336) indicated that care was delivered predominantly in secondary care and that HSCPs encounter some challenges in providing best care to women with a dual diagnosis. Two women with prolapse and dementia, two family supporters and six HSCPs were interviewed. Interview data suggested the need for further information about features of prolapse and pessary care directly aimed at family supporters and that care experiences vary for women with a dual diagnosis, especially regarding decision‐making. Conclusions: The study demonstrates that the care for women with prolapse and dementia may be different from care for those who do not have a dual diagnosis. Further research is needed to inform clinical practice.

Decisions about ethnic groups studied in health research shape recommendations. If a group is not included in research, its ability to call for policy change is limited. Despite health inequalities for the Irish in Britain in the 20th century, recent research on health is likely to combine the White Irish with White British, whereas Irish people of colour are not mentioned at all. This paper aims to understand why the interest in this group has declined. A state‐of‐the‐art literature review of 140 papers on Irish health in Britain from 2001 to 2023 was conducted. Findings show the Irish are still disadvantaged in mortality, mental health and suicide, with important socioeconomic status and gender disparities. The shifting way the Irish are constructed over time is critically examined, paying attention to historical depictions and postcolonial identities. Sociological theories of migration are challenged by the Irish because this migrant group does not conform to theoretical assumptions. The Irish may have dropped from the agenda because of incorrect assumptions about assimilation and the relationship between Ireland and the UK. Given that the health outcomes of the Irish in Britain differ from those of the White British population, they should be recognised in health research as a distinct group.

Background: Around the world, individuals are living longer, but an increased average lifespan does not always equate to an increased healthspan. With advancing age, the increased prevalence of ageing-related diseases can have a significant impact on health status, functional capacity, and quality of life. It is therefore vital to develop comprehensive classification and staging systems for ageing-related pathologies, diseases and syndromes. This will allow societies to better identify, quantify, understand, and meet the healthcare, workforce, wellbeing, and socioeconomic needs of ageing populations, while supporting the development and utilisation of interventions to prevent or to slow, halt or reverse the progression of ageing-related pathologies. Methods: The foundation for developing such classification and staging systems is to define the scope of what constitutes an ageing-related pathology, disease or syndrome. To this end, a consensus meeting was hosted by the International Consortium to Classify Ageing-Related Pathologies (ICCARP), on February 19 ^th , 2024, in Cardiff, UK, and was attended by 150 recognised experts. Discussions and voting were centred on provisional criteria that had been distributed prior to the meeting. The participants debated and voted on these. Each criterion required a consensus agreement of ≥70% for approval. Results: The accepted criteria for an ageing-related pathology, disease or syndrome were: Develops and/or progresses with increasing chronological age. Should be associated with, or contribute to, functional decline, or an increased susceptibility to functional decline. Evidenced by studies in humans. Conclusions: Criteria for an ageing-related pathology, disease or syndrome have been agreed by an international consortium of subject experts. These criteria will now be used by the ICCARP for the classification and ultimately staging of ageing-related pathologies, diseases and syndromes.

Background: With the growing population of older adults in Nigeria comes a simultaneous rise in the incidence of dementia in the country. Adequate knowledge of dementia is needed to effectively administer interventions for persons living with dementia. Physiotherapy is one of the professions providing care for people with dementia. The aim of this study was to evaluate the knowledge of dementia among physiotherapists in Nigeria. Methods: An online survey method was used to collect data from the sample population of practicing physiotherapists in Nigeria. Data was collected using the 21-item Dementia Knowledge Assessment Tool Version Two (DKAT2) and the respondents also provided some demographic information. Mann Whitney test, Kruskal Wallis test and Spearman’s rho correlation were used to test for association between the DKAT2 scores and the demographic variables and this association was further explored with multiple linear regression analysis. Results: A total number of 223 physiotherapists participated in this study. The findings of the study show that there is limited knowledge of dementia among the physiotherapists. Number of years of professional experience and specialty groups predicted significantly higher knowledge scores. Conclusion: The knowledge deficits found among physiotherapists in Nigeria indicate that older adults living with dementia might not be receiving the best evidence-based physiotherapy treatments for their condition. This research therefore advocates for an educational intervention to be carried out within the physiotherapy profession in order to improve the quality of services rendered to their patients.

This article presents an approach aimed at dealing with the difficulties faced by Black-led micro-organisations in England when accessing longer-term funding. The experiences of Black-led micro-organisations working in partnership with a mainstream organisation and a mid-level minority ethnic organisation are reported in the article. The participants of the research attributed the Black-led micro-organisations’ difficulties in accessing funds to institutional racism. To overcome this, the micro-organisations received targeted funding through a partnership that not only makes funding more accessible, but also builds the capacity of the Black-led micro-organisations. This was because a micro-organisation on its own or as a group of micro-organisations would not have been successful in a funding application. The formation of the three-tier partnership came with many challenges, but ultimately with the building of trust by skilled leadership and the right individuals, the Black-led micro-organisations were able to access sustainable long-term funding.

Background: Limited research has been carried out in sub‐Saharan Africa about knowledge of dementia, although studies report that supernatural causes predominate while the biomedical model has less adherence. The biomedical model has been called the pathway to care, but this is less useful when infrastructure and services for dementia are limited. Three African researchers sought to explore knowledge about dementia in three sub‐Saharan African countries. This article provides added value by performing a synthesis across the three countries.Method: Qualitative research was performed in Zambia (healthcare professionals and the general public), Kenya (people providing care for parents), and Nigeria (family members providing care for relatives). Individual interviews were analysed with thematic analysis. The findings from the three countries were synthesised to identify shared messages and areas of transferability.Result: Zambian findings showed partial adherence to the biomedical model of dementia among professionals but not among the general public. There was evidence of othering those who believed in supernatural origins. In Kenya information‐seeking strategies were used when carers realised something unusual was happening, indicating high levels of social capital are necessary. Nigerian findings demonstrated a similar process of gradual recognition of symptoms, but also labels of madness and expectations of recovery.Conclusion: Overall, the three sets of data imply that adherence to the biomedical model of dementia is more widespread in sub‐Saharan Africa than has been previously thought, but without care and support services and accompanying policies this will not benefit people with dementia and their families.

Objectives: Dementia research and services in Pakistan are limited. The following was explored in experiences of family caregivers of people with dementia in Pakistan: (a) to determine whether culture and religion play a role in caregiving; (b) to draw insights on how family caregivers cope, what barriers they face and what help they would be willing to accept and (c) to determine how these findings could be used to raise awareness and influence public policies in improving the lives of families living with dementia. Methods: The experiences of family caregivers of people with dementia in Pakistan were explored via semi-structured interviews (10 in Lahore; 10 in Karachi). This was part of a larger qualitative study conducted about dementia in Pakistan. Caregivers interviewed were aged 35–80 (14 female). Most caregivers in the study were educated and affluent. Interviews were conducted in Urdu, translated into English and thematically analysed. Results: Five themes emerged: knowledge and awareness; stigma; importance of religion and duty to care; use of day care centres and home-help; and barriers. A lack of dementia awareness exists in Pakistan. The religious duty to care for family influenced caregiving decisions. Day care centres and home-help were accessed and viewed positively. The caregivers also wanted extracurricular activities for people with dementia, support groups for caregivers and better training for healthcare staff. Novel findings included that caregivers felt that dementia should not be stigmatised, and awareness should be raised in Pakistan via TV, radio and social media, but not inside mosques. Discussion: Additional research is necessary to determine if positive views of day care centres and home-help exist more widely. Attitudes and experiences regarding stigma may be different for caregivers of people with more advanced dementia. We recommend raising dementia awareness, allocating more funds to dementia services and an emphasis on home-based care.

Background: Postoperative delirium (POD) is common in older people and can be distressing for patients and their relatives. This study aimed to describe the experience of postoperative delirium and explore the views of patients and relatives in order to inform the codesign of an intervention to minimize distress related to postoperative delirium.Methods: Qualitative study using a thematic analysis of semistructured interviews in patients (n = 11) and relatives (n = 12) who experienced and witnessed POD, respectively.Results: Patients and relatives find POD distressing and desire information on the cause and consequences of delirium. This information should be delivered pre‐emptively where possible for patients and relatives during the episode for relatives and in post episode follow up for patients and their families. Information should be provided in person by a health care professional who has experience in managing delirium, supplemented by written materials. In addition, participants suggested training to improve staff and public awareness of delirium.Conclusions: This qualitative study showed that patients and relatives find delirium distressing, report the need for an intervention to minimize this distress, and enabled codesign of a pilot intervention. Refinement and evaluation of this intervention should form the next step in this program of work.

Pakistan is a lower middle-income country, which to date has had very little research and policy making to address the challenge of dementia. This study aims to explore the perceptions of dementia in a group of Pakistani adults. A series of focus group discussions were completed during 2017 with men and women in two metropolitan centres in Pakistan (Lahore and Karachi) (N = 40). Two vignettes, depicting someone with mild dementia and someone with severe dementia, were used to facilitate discussions. An induction-led thematic analysis was completed. Five themes were identified, reflecting (a) dementia awareness, (b) responsibility, (c) barriers to health care, (d) identified support needs, and (e) religion. Most participants had little awareness and knowledge about dementia, commonly understood to be a disease of forgetting or just normal ageing. Thus, there is an urgent need of a nation-wide campaign to raise dementia awareness in Pakistan, though this needs to be accompanied by improved, accessible health and social care services.