Local and national attention is needed to prevent 'drift' into activities that both support workers and registered practitioners consider outside their remit. Barriers to training and further qualification need to be addressed.

Background A sedentary lifestyle increases the risk of adverse health outcomes and frailty,particularly for older adults. To reduce transmission during the COVID-19 pandemic, people were instructed to stay at home, group sports were suspended, and gyms were closed, thereby limiting opportunities for physical activity. Whilst evidence suggests that physical activity levels reduced during the pandemic, it is unclear whether the proportion of older adults realising the recommended minimum level of physical activity changed throughout the various stages of lockdown. Methods We used a large sample of 3,660 older adults (aged ≥ 65) who took part in the UK Household Longitudinal Study’s annual and COVID-19 studies. We examined changes in the proportion of older adults who were realising the UK Chief Medical Officers’ physical activity recommendations for health maintenance at several time points before and after COVID-19 lockdowns were imposed. We stratified these trends by the presence of health conditions, age, neighbourhood deprivation, and pre-pandemic activity levels. Results There was a marked decline in older adults’ physical activity levels during the third national lockdown in January 2021. The proportion realising the Chief Medical Officers’ physical activity recommendations decreased from 43% in September 2020 to 33% in January 2021. This decrease in physical activity occurred regardless of health condition, age, neighbourhood deprivation, or pre-pandemic activity levels. Those doing the least activity pre-lockdown increased their activity during lockdowns and those doing the most decreased their activity levels. Conclusions Reductions in older adults’ physical activity levels during COVID-19 lockdowns have put them at risk of becoming deconditioned and developing adverse health outcomes. Resources should be allocated to promote the uptake of physical activity in older adults to reverse the effects of deconditioning.

Objective: To explore the complexities, circumstances, and range of services commissioned for people with dementia living at home. Methods:A national survey was used to collect data from English local authorities in 2015. Commissioners of services for older adults were invited to complete a questionnaire. An exploratory cluster analysis of nominal data was conducted using aTwoStep procedure to identify distinct groups.Results: A total of 122 authorities (83%) responded to the request. Four approaches to commissioning were identified, reflecting commissioning practices at the organisational, strategic, and individual service user levels. Commissioning at the service user level was most apparent. Bivariate analysis found that these configurations were not associated with the types of dementia specific services provided but were related to the number available. Authorities delivered a greater range of specialist services when joint commissioning between social care and health partners was undertaken. However, the joint commissioning of services was less observed in services specifically for people with dementia than in generic services for all older people. There was limited evidence that local circumstances (population configuration and deprivation levels) were associated with this approach to commissioning. Conclusions:The significant role of health partners in the delivery of social care services to support older people living with dementia in their own homes is evident.As the population with dementia ages and physical health needs increase, how dementia specific services differ from and complement those services available to all older people warrants further investigation. KEYWORDS adult social care, commissioning, dementia, home care, survey | INTRODUCTIONWith the population ageing globally, dementia presents a significant health and social care challenge. 1 This is apparent in primary (preventing development), secondary (offering early-stage treatment), and tertiary prevention-ameliorating difficulties and enhancing wellbeing. With regard to the latter, the need for appropriate care for those close to the end of life, in the context of comorbidity and frailty, has been emphasised. 2 Internationally, the tertiary care of people with dementia is often portrayed as a clinical pathway. 3-6 However, people with dementia in the oldest age groups have needs characterised by complexity which are often inadequately addressed in existing disease-based models of tertiary care. 7 Meeting the needs of people with dementia and their carers often requires substantial social care

Variations in the staff mix in CMHTs and memory clinics reflected their different functions. There was limited evidence in both of profession specific interventions relating to the provision of support, information, therapy and education, associated with either diagnosis or long-term support. The potential for a single service to undertake both diagnostic and long-term support and the associated costs and benefits are areas for future research.