title: Prioritizing problems in and solutions to homecare safety of people with dementia: supporting carers, streamlining care.
abstract: Dementia care is predominantly provided by carers in home settings. We aimed to identify the priorities for homecare safety of people with dementia according to dementia health and social care professionals using a novel priority-setting method.
  
  
  
  The project steering group determined the scope, the context and the criteria for prioritization. We then invited 185 North-West London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to homecare safety of people with dementia. 76 clinicians submitted their suggestions which were thematically synthesized into a composite list of 27 distinct problems and 30 solutions. A group of 49 clinicians arbitrarily selected from the initial cohort ranked the composite list of suggestions using predetermined criteria.
  
  
  
  Inadequate education of carers of people with dementia (both family and professional) is seen as a key problem that needs addressing in addition to challenges of self-neglect, social isolation, medication nonadherence. Seven out of top 10 problems related to patients and/or carers signalling clearly where help and support are needed. The top ranked solutions focused on involvement and education of family carers, their supervision and continuing support. Several suggestions highlighted a need for improvement of recruitment, oversight and working conditions of professional carers and for different home safety-proofing strategies.
  
  
  
  Clinicians identified a range of suggestions for improving homecare safety of people with dementia. Better equipping carers was seen as fundamental for ensuring homecare safety. Many of the identified suggestions are highly challenging and not easily changeable, yet there are also many that are feasible, affordable and could contribute to substantial improvements to dementia homecare safety.
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK. l.tudor.car@imperial.ac.uk.|Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA. l.tudor.car@imperial.ac.uk.|Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. l.tudor.car@imperial.ac.uk.
authors.forename: Lorainne
authors.initials: L
authors.lastname: Tudor Car
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Mona
authors.initials: M
authors.lastname: El-Khatib
authors.affiliation: Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.|Department of Psychiatry and Psychotherapy, Technische Universität München, Munich, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Perneczky
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papachristou
authors.affiliation: Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, UK.
authors.forename: Rifat
authors.initials: R
authors.lastname: Atun
authors.affiliation: Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh Medical School, Edinburg, UK.
authors.forename: Igor
authors.initials: I
authors.lastname: Rudan
authors.affiliation: Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
authors.forename: Josip
authors.initials: J
authors.lastname: Car
authors.affiliation: Department of Experimental Psychology, Medical Sciences Division, University of Oxford, Oxford, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Vincent
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, UK.
authors.forename: Azeem
authors.initials: A
authors.lastname: Majeed
mesh_terms: D000368:Aged; D017028:Caregivers / Q000193:education / Q000592:standards / Q000706:statistics & numerical data; D003704:Dementia / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D006699:Home Care Services / Q000458:organization & administration / Q000592:standards; D006801:Humans; D008131:London; D008297:Male; D061214:Patient Safety; D058996:Quality Improvement; D017751:Safety Management / Q000379:methods / Q000458:organization & administration; D012934:Social Isolation; D016903:Drug Monitoring
keywords: Clinicians; Collective wisdom; Dementia care; Homecare; Patient safety; Priority-setting