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Better patient information resources regarding urethral catheter management have potential to improve patient and relative carer quality of life and reduce service provision burden.

This paper examines the provision of integrated advanced dementia care within seven European countries and critically reviews the potential contribution of the Prudent Healthcare perspective as a starting point for reform. Progressive efforts to innovate, promote quality and integrate care are tempered with the reality of resource constraints. Some policy makers in Europe and North America have turned their attention to the principles of Prudent Healthcare as a potential mechanism to maximise benefits for patients within available resources. As dementia progresses, living well requires increasing levels of support and care, people living with advanced dementia have complex health and social care needs, are highly dependent on others but are not yet at the terminal end stage of the condition. People with advanced dementia can benefit from a dementia specific palliative approach to care (Palliare), that helps them to live the best life possible for the months and often years they live with advanced dementia. It is also highly desirable to align policy innovations with integrated palliative care practice models and the education of the dementia workforce to accelerate informed improvements in advanced dementia care. There may be some coherence, at least superficially between Prudent Healthcare and integrated palliative care models such as Palliare. It is argued that for successful implementation, both require practitioners to be equipped with knowledge and skills and be empowered to deliver high quality care often within impoverished care environments. Adoption of the prudent perspective will however require development of a repertoire of approaches to hear the voice or proxy voice of people living with advanced dementia and to commit to the development and implementation of new evidence for advanced dementia practice. Evidence informing this policy debate draws upon contemporary literature and policy and the findings from research activities undertaken by the Palliare project supported through the Erasmus+ K2 Strategic Partnerships funding programme.

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Older people are the largest group accessing and using care services within Europe (Eurostat 2015) and are often referred to as a "burden" (Beard and Bloom 2015). Improvements in public health, medical screening, timely treatments, and improved health and social care services in industrialized countries have all contributed to people living longer and healthier lives (Carr and Komp 2011). Average life expectancy is now estimated to be 78 years in developed countries and 68 years in less developed countries, with the gap continually narrowing every year. By 2045-2050, life expectancy is projected to reach 83 years in more developed countries and 75 years in less developed countries (Department of Economic and Social Affairs Population Division 2013). Whilst a defining characteristic of the ageing process may involve increased vulnerability to a decline in health and wellbeing (Kirkwood 2014), novel approaches to wellbeing alongside complex biological, medical, psychosocial, political, and economic factors can influence both individual and group trajectories in later life. Ageing remains an extremely complex field in terms of understanding the relationships between these contributory factors and the transitions that connect them.