This technical consensus statement is jointly produced by the Old Age Psychiatry section of the World Psychiatric Association and the World Health Organization, with the collaboration of several NGOs and the participation of experts from different Regions. It is intended to be a tool for (i) promoting debate at all levels on the stigmatisation of older people with mental disorders; (ii) outlining the nature, causes and consequences of this stigmatisation; and (iii) promoting and suggesting policies, programmes and actions to combat this stigmatisation.

Background: Several studies on the effect of physical exercise on activities of daily living (ADL) for people with dementia exist; yet, data concerning the specific context of acute psychiatric hospitals remain scant. This study measured the effect of a physical exercise program on ADL scores in patients with moderate to severe dementia hospitalized in an acute psychiatric ward.

OBJECTIVE. We describe the development of a questionnaire, Participation in Activities and Places Outside Home (ACT-OUT), for older adults with cognitive impairment and align it to people with mild-to moderate-stage dementia. METHOD. ACT-OUT was developed in a cross-cultural collaboration in combination with three rounds of cognitive interviews in Switzerland with 26 older adults without cognitive impairment and five older adults with dementia. Qualitative data from the interviews were analyzed using a constant comparison approach. RESULTS. The final ACT-OUT Version 1.0 consists of three parts: (1) questions targeting places older adults visit; (2) questions on aspects influencing participation, such as transportation, familiarity, and risk perception; and (3) questions on perception of self. CONCLUSION. The development of an instrument such as ACT-OUT is more a cyclical than a linear process. This study is a first step toward a more systematic evaluation of out-of-home participation among older adults with and without dementia. O lder adults with dementia and their significant others value participation in activities outside the home, such as grocery shopping, pharmacy visits, and dog walking (Egan et al., 2006; Teitelman et al., 2010). Participation in outside activities offers numerous benefits, including maintaining cognitive functioning and autonomy, keeping in touch with others, and exercising in nature (Rao et al., 2014; Sugiyama & Ward Thompson, 2007; Winchester et al., 2013). It also involves an endless variety of places in combination with activities in which older adults want and need to engage. Being immersed in activity in places-being in place-is an ongoing life process that generates important meaning (Rowles, 2008). It is closely related to the process of place integration-the continual adjustment of person-place relationships to enhance well-being (Cutchin, 2004)-and is consistent with the transactional perspective on occupation: Participation in occupation is seen as fundamental to the functional coordination of person and place in response to problematic situations (Cutchin & Dickie, 2013; Dickie et al., 2006). Person-place relationships may change in relation to the development of dementia as the relationships that were once central to one's life are disrupted by loss of familiarity, loss of ability to navigate and access places, or fear of embarrassment. These changes can have a cascading effect on participation and amplify risk of further disengagement. Thus, having regular access to outside places and activities is critical for maintaining familiarity for people with dementia (Brorsson et al., 2011). The interdependency of places and activities can facilitate or hinder participation, for example, through distances and layout of the physical environment, availability of transportation and support, meaning of activities, risk perception, and familiarity. Maintaining a level of out-of-home participation can be a complex endeavor for people with dementia, who face challenges such as getting los...

The objectives of this study were to describe the different modalities of physical activity programs designed for moderate to severe dementia and to identify their impact on functional independence in activities of daily living (ADL). A critical review of randomized controlled trials related to the impact of physical activity programs in moderately to severely demented persons on ADL performance and meta-analysis of the identified studies were performed. Among the 303 identified articles, five responded to the selection criteria. Four out of the five studies demonstrated limited methodological quality. In one high-quality study, physical activity programs significantly delayed deterioration of ADL performance. The program components and ADL assessment tools vary widely across studies. Although the proposed treatments have not proven their efficiency in improving the ADL status of the patients, they were able to limit the decline in ADL functioning. Future research is warranted in order to identify clinically relevant modalities for physical activity programs for people with moderate to severe dementia.