These issues should be considered in future research in this area. Another key issue that future research must address is the accessibility of the gardens for the residents either alone or accompanied.

The studies in this review reported a range of access from residents being able to http://www.selleckchem.com/products/obeticholic-acid.html go out in the gardens at any time after breakfast and before dinner (accompanied or not)24 to only being able to go outside if accompanied by a family member or a member of staff (who often did not have time or were reluctant to assist residents in the garden) and otherwise the doors would be locked.16 More exploration of the reasons behind limiting access would be useful to understand where barriers to garden accessibility are really initiated. For Selleck Ipilimumab example, do limitations in staff capacity (or other aspects of the residential care home system) legitimately restrict residents’ access to gardens, or is it about staff knowledge or attitudes to care, or is it about resident safety? Understanding how these systems and processes work will enable best practice to be identified and implemented. There

are promising impacts on levels of agitation in care home residents with dementia to spend time in a garden, although the topic is currently understudied and undervalued. Interpretation of the findings further suggest that gardens need to offer a range of ways of interacting, to suit different people’s preferences and needs. Future research also would benefit from a focus on key outcomes measured in comparable ways with a separate focus on what lies

behind limited accessibility to gardens within the residential care setting. Developing knowledge and understanding in these areas will help to further improve appropriate Carbohydrate care experiences and inform policy more accurately. “
“Antipsychotic medications are often prescribed to manage the behavioral and psychological symptoms of dementia (BPSD). However, several large studies have demonstrated a clear association between treatment with antipsychotic drugs and increased morbidity and mortality in people with dementia.1, 2 and 3 Treatment guidelines recommend that the first-line management of BPSD should be detailed assessment to identify any treatable cause of symptoms (eg, hunger, thirst, pain, infection, loneliness). Furthermore, underlying causes should be treated and alternative nonpharmacological interventions explored before the initiation of antipsychotics.4, 5 and 6 Risperidone is the only antipsychotic licensed in the United Kingdom for this indication, and then only for short-term use. Nevertheless, other antipsychotic agents are often prescribed and used on a long-term basis with infrequent medication review.7 BPSD can cause significant carer stress to family members and care home staff that, without intervention, may rapidly lead to acute hospital admission and/or transfer to a more intensive care setting.