With an ageing population comes an increasing risk of illnesses such as dementia and a growing need for care. There are 670,000 informal, unpaid carers in the UK, reducing costs for health and social care services but presenting other concerns for healthcare professionals. Carer burden and carer stress are well-documented concepts, and can lead to depression and a risk of suicide in some individuals. It is important that this risk is considered when supporting informal carers of people living with dementia. Admiral Nurses work with families living with dementia to provide the one-to-one support and expert guidance they need to manage. This article discusses a case study that highlights how caring can affect an individual, leading to thoughts of suicide. It also demonstrates how an Admiral Nurse could support the carer in a relationship-centred way, using appropriate interventions to avoid crisis. The article offers implications for practice and provides recommendations for nurses working in this field.

The guidance available for tailoring mental health services for autistic people is limited and dispersed. Practitioners attempting to appropriately adapt mental healthcare and therapy provision report low confidence and inconsistency in their approach. This study contributes to the guidance by providing a shortlist of usable and priority adaptations for diagnostic and therapy services as described by multidisciplinary staff members responsible for the design and delivery of a specialist autism service in the UK. Individual freelisting interviews were conducted with 15 staff, who were asked to list the ways that they adapt their practice individually, within therapy, and collectively as a service. Salience and cultural consensus analyses demonstrated the following agreed priority service adaptations: ensuring the suitability of the service environment with consideration of sensory demands, adapting communication, knowing individual gender identity preferences and minimising client uncertainty. Detailed examples are given for flexibly adapting therapy to individual needs to inform general and specialist services. The findings require replication and evaluation.

Background: Dementia is an increasingly common condition, affecting over 50 million people worldwide, with approximately 850 000 living with dementia in the UK. In recent years, there has been a significant rise in the number of older prisoners, many of whom may also have dementia; however, there is little in the literature about the needs of this population. This is the first in a series of clinical articles on dementia in underserved populations. Aims: To explore current literature; academic, policy and guidance to develop an understanding of what is currently known about this population. Methods: A literature review. Findings: There is insufficient data on the amount of dementia in the ageing prison population and limited research that defines the needs of this underserved population. This results in prison services often failing to meet the needs of this underserved population, with prison staff struggling in this regard due to limited knowledge, resources and training. The Prisons and Probation Ombudsman argues the failure to strategically respond to this population leads to each prison and its local healthcare providers being left to respond in a piecemeal fashion. Conclusions: This paper discusses the demographic changes related to prisoners with dementia and details how Dementia UK and Admiral Nurses can support a specialist care solution to this underserved population.

Background: The veteran community are at increased risk of poor mental health and developing dementia as a result of their miliary service, with the potential to lead to delayed onset post-traumatic stress disorder (DOPTSD). The manifestation of DOPTSD may be misinterpreted as behavioural and psychological symptoms of dementia (BPSD), which create difficulties in caring for the person experiencing these distressing symptoms. Aims: This paper details the development of a screening tool for people with dementia, which aims to reframe and contextualise some of the behaviours under the lens of historic traumatic events. Methods: The utility of the screening tool is demonstrated through the presentation and an analysis of an anonymised case study to support nurse practice development. Conclusions: A trauma history tool offers a more comprehensive and interpretive view of the possible historic, trauma-related causes of current behaviours and can aid informal carers' understanding of the stress and distress reactions of their family members.

Admiral Nurses, hosted within the Royal British Legion, sought to reframe behavioural and psychological symptoms of dementia in veterans with a diagnosis of dementia by focusing on the symptoms of possible delayed-onset post-traumatic stress disorder. Through an innovative approach to assessment, the authors propose that a greater understanding of underlying causes for behaviours in this population may afford caregivers a greater understanding of presenting behaviours and provide a more person-centred response to their management.