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This study aims to draw together what is known regarding the characteristics and context of adult family violence, and to consider what practitioners and organisations in the UK might learn from the literature.

This study reviews literature on adult family violence and parricide and includes illustrative cases from a study of domestic homicide review reports involving older adults.

Adult family violence most often involves mothers killed by their adult sons. Mental health issues, alcohol/substance misuse and criminality are common themes for perpetrators. Caregiving responsibilities is a theme for both victims and perpetrators. Previous research identified two main categories of adult family homicide: perpetrators with major psychotic illness, and victims-perpetrators in complex relational contexts.

This study considers how practitioners respond to situations of adult family violence and learning for policymakers, agencies and practitioners.

This paper summarises what is known, argues that more research is needed and suggests practical ways forward for policymakers, relevant agencies and practitioners.

The purpose of this paper is to look at concerns about risk/abuse expressed spontaneously by people with dementia (PwD) and their carers in narratives describing their journeys with dementia.

A total of 35 narratives were elicited from PwD, carers of PwD and couples where one partner was living with dementia as part of a study on the impact of producing narratives on PwD and their carers. Participants were found to allude to risk/abuse, or specifically mention thoughts on risk and abuse in their narratives. A secondary analysis of the theme of risk/abuse is reported here.

Concerns about risk/exploitation were often expressed in the narratives, and covered a range of areas including driving, safety in the home, safety outdoors, falls, finances, risk to PwD from others, risk to others from PwD, potential or actual police incidents and neglect.

The narratives were elicited as part of another project and participants were not asked directly about risk; themes reported here were brought up spontaneously by participants.

In relation to dementia a wide range of risk/abuse issues is of concern to PwD and their carers, including driving and financial vulnerabilities. PwD and carers are prepared to talk about risk/abuse when given an opportunity. It is important to investigate and understand experiences and concerns about risk/abuse if they are to be addressed in health and social care practice.

The narratives offer unique insights into the concerns of PwD and family carers.

The purpose of this paper is to review the terminology used to describe family violence involving older adults in order to stimulate a discussion that may assist in the use of a more appropriate and clearer terminology.

Different definitions of terms used to describe violence are considered and the contexts in which they are used. Two cases are described to illustrate the use of overlapping terms, the assumptions that lie behind them and the different actions that they lead to.

The authors argue that legal, relational, health (physical and mental) and social perspectives are all useful and integration contributes to a fuller understanding of violence.

The importance of terminology used to describe family violence involving older adults has been neglected in the past, yet it influences understanding about violent incidents and shapes responses to them.

The scaling up of promising, innovative integration projects presents challenges to social and health care systems. Evidence that a new service provides (cost) effective care in a (pilot) locality can often leave us some way from understanding how the innovation worked and what was crucial about the context to achieve the goals evidenced when applied to other localities. Even unpacking the “black box” of the innovation can still leave gaps in understanding with regard to scaling it up. Theory-led approaches are increasingly proposed as a means of helping to address this knowledge gap in understanding implementation. Our particular interest here is exploring the potential use of theory to help with understanding scaling up integration models across sites. The theory under consideration is Normalisation Process Theory (NPT).

The article draws on a natural experiment providing a range of data from two sites working to scale up a well-thought-of, innovative integrated, primary care-based dementia service to other primary care sites. This provided an opportunity to use NPT as a means of framing understanding to explore what the theory adds to considering issues contributing to the success or failure of such a scaling up project.

NPT offers a framework to potentially develop greater consistency in understanding the roll out of models of integrated care. The knowledge gained here and through further application of NPT could be applied to inform evaluation and planning of scaling-up programmes in the future.

The research was limited in the data collected from the case study; nevertheless, in the context of an exploration of the use of the theory, the observations provided a practical context in which to begin to examine the usefulness of NPT prior to embarking on its use in more expensive, larger-scale studies.

NPT provides a promising framework to better understand the detail of integrated service models from the point of view of what may contribute to their successful scaling up.

NPT potentially provides a helpful framework to understand and manage efforts to have new integrated service models more widely adopted in practice and to help ensure that models which are effective in the small scale develop effectively when scaled up.

This paper examines the use of NPT as a theory to guide understanding of scaling up promising innovative integration service models.

The Faculty of Old Age Psychiatry, Royal College of Psychiatrists, has been involving users and carers in its work since 2002. The model that has been developed involves regular meetings of a consumer group, which was set up in partnership with the Alzheimer's Society and Age Concern, and which meets with the officers of the faculty. This development is in line with a number of recent policy initiatives and has had considerable influence on the work of the faculty.

The National Institute of Mental Health England (NIMHE) appointed a Fellow in Ageing and Mental Health to take on a national leadership role for a three‐year period from 2003 to 2006. Starting from a position where the NIMHE website could only address older adult issues under social exclusion, a group of committed individuals in a range of organisations came together and a regional and national work programme in older people's mental health was developed. This paper offers reflections on the issues raised during the Fellowship in respect of older people's mental health services and this Fellowship model of leadership.

Over the past few years there has been increasing interest in the importance of spirituality for those in the fourth age of life in care settings. The emphasis on person‐centred approaches has led to recognition of spiritual needs as well as the need for spiritual assessment and care planning. In this paper we reflect on what makes life worth living at different stages, and review the spiritual needs of the fourth age in relation to those inner needs with which many of us would identify.We suggest that several approaches are required in order to understand and meet the spiritual needs of people in the fourth age. While a person‐centred approach is essential, much can also be gained from a broader understanding that places the older person in the context of the wider community. Spiritual and other needs may be met through addressing social inclusion.If we are to properly understand and meet the spiritual needs of those in the fourth age, both in the community and in care settings, we need a new paradigm. The insights and practice tools developed in other areas (through the Valuing People and social inclusion agendas) could provide a useful framework to assist in meeting the spiritual needs of the fourth age. This paper aims to contribute to, and extend, the debate about meeting spiritual needs of people in care settings.

The authors describe how a user and carers were involved in teaching as part of the MSc in Applied Studies in Ageing and Mental Health at Staffordshire University, the impact that this had on students on the course and evolving plans to develop the work further.

We describe three homeless older people who presented to an old age psychiatry service. Homeless older adults are likely to have untreated mental and physical health problems and to be invisible to services. To detect and treat them, services need to be flexible.