A national survey of dementia diagnosis and care in English memory services

A national survey of dementia diagnosis and care in English memory services | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A national survey of dementia diagnosis and care in English memory services Oliver Kelsey, Harriet Demnitz-King, Charlotte Kenten, Hannah Chapman, and 12 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6322268/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Feb, 2026 Read the published version in BMC Geriatrics → Version 1 posted 10 You are reading this latest preprint version Abstract Background: In England, NHS memory services provide most dementia diagnostic and immediate post-diagnostic care. We aimed to co-design and conduct a survey regarding diagnostic and post-diagnostic care, and perceived readiness for new treatments. Methods: We invited all memory services in England to complete the survey. We compared services by provider type, investigating whether service characteristics (provider type, rurality, region, referral rates, staffing mix, accreditation) were associated with diagnosis rates and psychological therapy provision. Results : 139/188 (73.9%) memory services participated, 130 (93.5%) provided by mental health/community and 9 (6.5%) by acute trusts. We estimated that English memory services receive 192,418 referrals/year, 98.7% to mental health/community trust services. In these services, the median annual referral rate was 100.8, 56.7-132.8 [95% Confidence Interval (CI)] per Full Time Equivalent [FTE] staff, of whom 14% (9-19%) were doctors). Acute trust-based services reported fewer referrals (45.8, 21.1-99.5) and had more doctors (33%, 23-43% FTE). More acute trust services felt ready to prescribe dementia Disease Modifying Treatments (N=8 [88.9%]) than mental health/community services (N=50, [41.7%]), while fewer acute trusts offered post-diagnostic psychological therapy routinely (N=5 [55%]) vs (N=100 [72.5%]) in community services. NHS region (β=0.700 [95% CI: 0.078, 1.322]) and rurality (β=2.142, [95% CI: 1.320, 2.964]) predicted lower diagnostic rates; regions with highest dementia diagnosis rates (67%+) had more memory service staff relative to the local aged 65+ population size. Conclusion: We identified marked geographical inequalities. People in regions with less resourced memory services and rural areas had less access to timely diagnosis and care. Clinical Trial Number: Not applicable Memory services Health policy Dementia Mild Cognitive Impairment Figures Figure 1 Background An estimated 982,000 people have dementia in the UK, this is predicted to rise to over 1.4 million by 2040 (1). In England, most dementia diagnostic assessment and post-diagnostic care is provided by National Health Service (NHS) memory services. Most memory services are provided within mental health services, staffed by psychiatrists, while some are run within hospital-based services, primarily by neurologists. The UK National Institute for Health and Care Excellence (NICE) dementia assessment and treatment guideline advocates integrated, multidisciplinary care, diagnostic assessments using validated cognitive tests and structural imaging, and post-diagnostic support, including pharmacological symptomatic treatments where appropriate, and psychosocial and environmental interventions to reduce distress (2). Memory service audits in England (2019-23) found average waiting times for assessment and diagnosis increased over this time, with longer waiting times in deprived areas. These audits did not include acute NHS Trust based services (henceforth acute trust services). Over two-thirds of audited patients received a diagnosis of “unspecified dementia”, suggesting many people did not access accurate, subtype-based dementia diagnoses. Following diagnosis, only a third of people with dementia eligible for Cognitive Stimulation Therapy (CST) were offered it, with similar proportions of carers offered structured support (3). A survey of 73 memory services in 2015 found no association between staffing levels and waiting times or service provision (4). Memory services operate in challenging contexts, as described in the Darzi report on the NHS (5). Anticipated developments include introducing first generation anti-amyloid Disease Modifying Treatments (DMTs), and blood-biomarker tests which can potentially increase dementia diagnostic accuracy (6). A 2021 survey found that only 36% of London memory services felt capable of adapting to the demands of delivering DMTs within a year (7). Implementing these new developments without delivering more inclusive, integrated care will pose challenges (8). To understand current memory service provision, we completed a comprehensive survey of acute trust and community/mental health trust (henceforth community) based memory services in England. To investigate variations in provision and how they might relate to service delivery, we aimed to: Describe the referral, diagnostic and post-diagnostic procedures of English memory services. Describe the perceived readiness for DMTs and blood biomarkers, comparing acute and community services. Explore whether service characteristics (NHS region, referral rates, staffing mix, provider type and Royal College of Psychiatrists Memory Services National Accreditation Programme (MSNAP) accreditation) are associated with local diagnosis rates and psychological therapy provision. Explore changes in the past five years that staff feel most proud of, those that cause them most concern, and key changes anticipated in the next five years. Methods The cross-sectional survey was conducted by the NIHR Dementia and Neurodegeneration Policy Research Unit - at Queen Mary (DeNPRU-QM), commissioned by the English Department of Health and Social Care (DHSC) and approved by National Research Ethics service and Health Research Authority on 14.5.24 (24/IEC08/0008). Survey design We purposively invited a diverse group of people with academic, clinical and lived experience from across English regions and staff roles, and NHS England and MSNAP representatives to three online co-design workshops in March-April 2024. Prior to workshops, we circulated an accessible summary of relevant research ( 4 ), ( 9 ), ( 10 ), audits ( 3 ) ( 11 ) ( 12 ) and policy documents ( 13 ) ( 14 ). Using a structure, process and outcome framework, group members proposed and discussed survey items. All attendees were sent the final survey and invited to further comment; a core study group comprising academic, clinical and lived experience agreed the final survey content. The survey elicited service characteristics including structure (e.g. staffing mix and referral numbers), and processes (how the services diagnosed dementia and provided post-diagnostic services). Respondents were asked about service changes over the last five years, those planned in the next five years and how prepared services were for introduction of blood biomarkers and DMTs. The survey was developed for the purposes of this study and is available in the supplementary materials (S4). Survey sample and data collection We developed a sampling frame of all English memory services from publicly available information; and invited services to participate, between May 2024 and January 2025. Responding services were asked to identify a staff member knowledgeable of service structures and processes, service history and plans. After providing informed consent, the staff member completed the survey with a researcher by video-call, phone or if they preferred directly via the online software survey platform Qualtrics ( https://www.qualtrics.com ). Participants/ services received no compensation. Researchers used publicly available data to record whether each service was currently MSNAP registered ( 15 ) and area-level data regarding: Local Authority District (LAD) rurality, using 2011 Office for National statistics Rural-Urban classifications: 1 (Mainly rural), 2 (Largely Rural), 3 (Urban with significant rural), 4 (Urban with city or Town), 5 (Urban with Minor Conurbation), 6 (Urban with major Conurbation) ( 16 ); we categorised 1 and 2 as ‘rural’ and 3–6 as ‘urban’. Dementia diagnosis rates, obtained from NHS primary care dementia 2024 data ( 17 ). We attributed the relevant LAD diagnostic rate for service catchment areas and calculated the mean diagnostic LAD rates if where catchment areas encompassed > 1 LAD (n = 25). Where we could not map LADs to catchment areas (n = 8), we used rates for service Integrated Care Boards (ICB). The number of older people (aged 65+) living in each region, from publicly available data ( 18 ). Analysis Data were exported from Qualtrics and analysed using Statistical Package for the Social Sciences (SPSS; version 29). During data cleaning we removed outlier statistics more than three Standard Deviations (SD) from the mean (n = 4). We summarised findings descriptively, partitioning into community and acute services as they operate distinct models. For each region we estimated total overall staff FTE (Full Time Equivalent) of all memory services, imputing the median value for that region for non-participating services. We calculated regional number of older people per memory service FTE and compared this across regions and to regional diagnostic rates. We used RStudio ( 19 ) to map memory service locations. For each service, we calculated the average number of referrals estimated in the past year per staff FTE. We used parametric statistics to describe and analyse data approximating the normal distribution (evaluated graphically) and non-parametric statistics otherwise. We conducted, linear and logistic regression analyses with: (i) local area diagnostic rates and (ii) any psychological therapies offered as dependent variables. For each outcome, in model 1, we included referral rate: staff ratios; in model 2, we added NHS region and rurality; in model 3 we added: staffing mix (% of FTE staff who were doctors), service type (acute or community) and MSNAP accreditation as independent variables. We conducted content analysis of responses recorded (primarily by researchers conducting interviews, or by respondents online) to open-ended questions, using published methods ( 20 ). We used the Dementia Well pathway to develop our coding framework, combining deductive and inductive analytic approaches ( 21 ). Two authors (from CC, SZ, OK) independently coded > 10% of responses for each question, developed initial groupings of themes and then met to discuss a coding framework. One author coded the remaining responses. Results Survey response Managers and senior staff members from 139/189 (73.9%) English memory services, employed in their current roles for on average 5.2 years (SD=4.8) completed the survey. Respondents included 52 team managers/leaders, 32 service leads/managers, 19 nurses, nine psychiatrists, four neurologists, two Advanced Clinical Practitioners and two clinical psychologists. Eight respondents, with pan-service operational roles, completed surveys for multiple (<6) services. Figure 1 shows the geographical distribution of participating services. Completion rates were highest in the South West NHS region (12/12 [100%] services) and lowest in the North East and Yorkshire (19/33 [57.6%] services). The 49 services not responding were all community services. 132 (94.9%) services were dedicated to memory assessment, while 7 (5%) fulfilled other functions, most commonly also acting as older person’s Community Mental Health Team’s (CMHTs) (5, 71.4%). 47 (33.8%) services were MSNAP accredited: 2 (22.2%) acute and 45 (34.6%) community services. Service structure 130 (93.5%) participating services were NHS community services (121 (93%) provided by mental health trusts, 7 (5.5%) by mental health trusts with GP/community service providers, and 2 (1.5%) by GP/community services providers. The remaining 9 (6.6%) were acute-provider services, 6 (66.6%) within neurology services, and 3 (33.3%) where medical input was primarily from psychiatry. Table 1 compares referral rates and staffing between community and acute services. Assuming median service referral rates applied to non-responding services, we estimated there were 192,418 referrals to English memory services in the past year, of which 98.7% (n=189,917) were to community, and 1.3% (n=2,501) to acute services. Community services reported high annual referral rates (median 100.8, 95% Confidence intervals (95% CI) 56.7-132.8 per memory service FTE staff member). Doctors made up 14% of FTE staff; and 30% (20-50%) of clients were seen at home. Acute services were all located in urban areas. They reported fewer referrals (45.8, 21.1-99.5 per FTE), more doctors (33%, 23-43% of FTE) and saw few patients at home (0%, 0-15%). Table 1: A comparison of structural characteristics of services by service type Mental health/ community services Acute Services Overall Rurality (N=139) Urban (%) 103 (79.2%) 9 (100%) 112 (80.6%) Rural (%) 27 (20.8%) 0 (0%) 27 (19.4%) Annual referral rate (N=104) Median (IQR) Past year 1000 (650-1590) 275 (112.5 - 575) 960 (IQR=600 - 1588) Per FTE staff member 100.8 (56.7-132.8) 45.8 (21.1-99.5) 96.8 (51.03- 131.3) Change relative to 5 years ago +205 (95.5-484.5) +50 (12.8- 200) +200 (84.8 - 446.3) Median (IQR) staff who are: (N=123) Doctors 1.5 (1 - 2.5) 2.5 (0.5 - 4) 1.60 (1-2.6) Nurses 5.06 (3 - 8.1) 1.5 (0.4-4.1) 5.0 (2.6-7.9) Occupational therapists 1.0 (0.4 - 2) 0.0 (0 - 0.5) 1.0 (0.0-1.8) Clinical Psychologists 0.8 (0.3 - 1.5) 0.5 (0.1 -1.5) 0.8 (0.3-1.5) Band 4 Support workers 1.1 (0 - 3.4) 0 (0 - 1) 1.0 (0.0-3.12) Median (IQR) proportion of FTE staff who are: (N=123) Doctors 14% (9 - 19%) 33% (23 - 43%) 14% (9 - 20%) Nurses 45% (32 - 54%) 30% (13 - 52%) 44% (30 - 54%) Occupational therapists 8% (4 - 12%) 0% (0 - 6%) 7% (1% - 12%) Clinical Psychologists 6% (2% - 10%) 1% (1% - 2%) 6% (2% - 10%) Band 4 Therapists & Support workers 12% (0 - 21%) 0% (0 - 12%) 12% (0 - 21%) Most services accepted referrals from people living in residential care (131, 94.2%), with symptoms consistent with advanced dementia (127, 91.4%), complex needs (126, 90.6%) or aged under 65 (126 (90.6%). Around two-thirds accepted referrals of people with learning disabilities (97, 69.8%), or those dependent on drugs or alcohol (89, 64%). Diagnostic processes (Table 2) Acute services more frequently reported using MRI brain scans in their diagnostic pathway (7, 77.8%) compared with community services (32, 23.1%) who more frequently used CT scans (95, 72.3%). Respondents in acute services were more likely, relative to community services, to consider biomarkers likely to change diagnostic practice. Table 2: A comparison of the current and anticipated diagnostic processes of memory services across service type. ( All averages reported as medians as data not normally distributed). Mental health/ community services Acute Trust Overall Main types of brain imaging supporting diagnosis (N=139) MRI 32 (23.1%) 7 (77.8%) 37 (26.6%) CT 95 (72.3%) 2 (22.2%) 96 (69.1%) SPECT/PET / DAT 2 (1.6%) 0 (0.0%) 1 (0.7%) No Imaging 2 (1.5%) 0 (0.0%) 2 (1.4%) Clinicians can view brain scans (N=139) 79 (60.8%) 8 (88.9%) 87 (62.6%) Interfacing with neuroradiology (N=138) No direct interface 30 (23.3%) 0 (0.0%) 30 (21.7%) Ad-hoc discussions 59 (45.7%) 5 (55.6%) 64 (46.4%) MDT meeting 26 (20.2%) 3 (33.3%) 29 (21%) Other 14 (10.9%) 1 (11.1%) 15 (10.9%) Cognitive testing used (N=138) Specific tools for cultural inclusion 88 (67.7%) 5 (55.6%) 93 (68.4%) ACE 125 (96.2%) 7 (77.8%) 132 (95.0%) Montreal cognitive examination 39 (30.0%) 6 (66.7%) 45 (32.4%) MMSE 38 (29.2%) 6 (66.7%) 44 (31.7%) RUDAS 59 (45.4%) 0 (0.0%) 59 (42.4%) Is neuropsychological testing routinely available (N=138) For all patients where would support diagnosis 101 (78.3%) 8 (88.9%) 109 (79.0%) For limited patients 25 (19.4%) 1 (11.1%) 26 (18.8%) Not available 3 (2.3%) 0 (0.0%) 3 (2.2%) Where are clients seen for initial assessment Median proportion (IQR) (N=134) At home 30% (20-50%) 0% (0-15%) 30% (15-50%) In the clinic 62.5% (40-80%) 95% (85-100%) 70% (40-70%) Online/telephone 0% (0-0%) 0% (0-3%) 0% (0-0%) Can request bloods directly (N= 138) 64 (49.6%) 8 (88.9%) 72 (52.2%) Anticipated influence of biomarkers on diagnostic practice (N=138) Will not change practice 28 (21.7%) 1 (11.1%) 29 (21.0%) Enhance accuracy in certain areas 67 (51.9%) 5 (55.6%) 72 (52.2%) Will be part of routine practice 34 (26.4%) 3 (33.3%) 37 (26.8%) Post diagnostic support (Table 3) Two-thirds (94, 67.6%) of services provided post-diagnostic support for all patients, most frequently CST. Few services offered additional or alternate groups or therapies. 131 (94.9%) of services offered the opportunity for patients to take part in research; 99 (71%) services reported higher research engagement over the last 5 years than in preceding years, with only seven (5.4%) reporting lower engagement. These figures were similar across acute and community services. Acute services felt more ready to prescribe dementia DMTs than community services (8 [88.9%] vs 50 [41.7%]) but were less likely to offer post-diagnostic psychological therapy routinely (5 [55%] vs 100 [72.5%]). Table 3: Provision of post diagnostic support across service type Community/mental health services Acute Trust Overall Provision of therapies/groups (N=138) Cognitive Stimulation Therapy 99 (76.8%) 3 (33.3%) 102 (73.9%) Maintaining Quality of Life 23 (17.8%) 2 (22.2%) 25 (18.1%) Other cognitive focused groups 8 (6.2%) 0 (0%) 8 (5.8%) Other therapies 9 (6.6%) 1 (11.1%) 10 (6.4%) Total number of therapies offered after dementia diagnosis (N=138) 0 29 (22.5%) 4 (44.4%) 33 (23.9%) 1 66 (51.2%) 4 (44.4%) 69 (50%) 2 25 (19.4%) 1 (11.1%) 27 (19.6%) 3+ 9 (7%) 0 (0%) 9 (6.5%) Change in post-diagnostic support over the past 5 years (N=137) More support 53 (41.4%) 5 (55.6%) 58 (42.3%) Less support 22 (17.2%) 0 (0%) 22 (16.1%) No change 53 (41.4%) 4 (44.4%) 57 (41.5%) Specific support for minority communities (N=138) 61 (47.3%) 3 (33.3%) 64 (46.4%) Cognitive concerns The number of Mild Cognitive Impairment (MCI) diagnoses made increased more in community compared with acute services over the past 5 years (62 [44.7%] vs 2 [22.2%]). Acute services more frequently restricted MCI diagnosis to those who received formal neuropsychological assessment, compared with community services (3 [33.3%] vs 20 [15.5%]). 26 (18.1%) services (all community) routinely offered therapies for people with MCI, most usually groups to help maintain and improve cognitive function (16, 11.6%). When describing the cognitive symptoms of individuals without a Dementia, MCI or mood disorder diagnosis, most referred only to absence of dementia; others used the terms functional cognitive/ neurological disorder (n=4), or subjective cognitive complaint, decline or impairment (n=3) (Table 4). A quarter of services (36, 26.1%) reported offering additional support to these individuals. Most only offered onward referrals (n=11) and/or signposting (n=25). Two referred to brain health clinics. Others provided written resources (n=4) or targeted advice in feedback appointments. One community team manager commented that “for many the consultation (including formulation of memory problems and care plan) is therapeutic in itself”. Three services asked GPs to rerefer for repeat assessments, after 1-3 years. Other services offered: a functional pathway involving “assessment with specific senior practitioner to offer assessment and support and possible signposting”; a brain health pathway, and in one case the MCI group was open to these clients. Table 4: Terms used to describe service users who receive no diagnosis of dementia, MCI or a treatable mood disorder Term Frequency No specific term (recorded as no dementia diagnosis) 18 Functional cognitive disorder 3 Z diagnosis 3 Person with feared complaint but no diagnosis has been made 3 Age related memory issues 1 Brain fog 1 Cognitive impairment due to other causes 1 Functional neurological disorder 1 Subjective cognitive complaint 1 Subjective cognitive decline 1 Subjective cognitive impairment 1 Comparing service characteristics with local diagnostic rates The number of FTE memory service staff per size of the aged 65+ population ranged from 3020 to 8276. Regions with highest dementia diagnosis rates (67%+) had more memory service staff relative to local aged 65+ population size (Table 5). In our adjusted multiple linear regression model (R²= 0.251), with local diagnostic rates as the dependent variable, Rurality (β=2.142, [95% CI: 1.320, 2.964]) and NHS region (β=0.700 [95% CI: 0.078, 1.322]) were associated with local diagnostic rates (Table 6). Table 5: Referral and diagnostic rates and FTE staff across NHS region NHS Region Median (IQR) referral/FTE rate Population aged 65+(Pop) Total FTE in region services Pop/FTE Diagnostic rate Midlands 79.44 (59.9-79.4) 2,110,274 225 8,276 65.0% East of England 107.43 (65.1-132.5) 1,273,300 204 6,239 63.8% South West 108.57 (97.4-143.4) 1,302,863 238.8 5,456 61.2% South East 44.61 (40.8-137.5) 1,847,827 375 4,928 63.0% London 109.42 (71.5-150.0) 1,072,807 313.5 3,422 67.4% North West 87.77 (35.9-150.5) 1,413,029 440.8 3,206 70.3% North East & Yorkshire 74.3 (30.6-104.8) 1,619,300 536.25 3,020 67.8% TOP: Total Older Population Table 6: Linear regression demonstrating associations between local area diagnostic rates and service characteristics Coefficient (β) Standard Error t 95% Confidence interval p-value Model 1 Referral rate: staff ratio -0.022 0.011 -2.062 [-0.43, -0.001] 0.042 Model 2 Referral rate: staff ratio -0.14 0.010 -1.424 [-0.033, 0.005] 0.158 NHS Region 0.675 0.305 2.213 [0.07, 1.28] 0.029 Rurality 1.841 0.379 4.855 [1.09, 2.59] <0.001 Model 3 Referral rate: staff ratio -0.016 0.010 -1.525 [-0.036, 0.005] 0.130 NHS Region 0.700 0.313 2.234 [0.078, 1.322] 0.028 Rurality 2.142 0.414 5.170 [1.320, 2.964] <0.001 MSNAP accreditation -2.176 1.363 -1.596 [-4.881, 0.530] 0.114 Service type -2.969 2.710 -1.058 [-8.248, 2.510] 0.292 Staffing mix (Doctor %) 0.008 0.047 0.173 [-0.085, 0.102] 0.863 Associations of service characteristics with provision of psychological therapies (Table 7) In a fully adjusted logistic regression with receipt of psychological therapies as dependent variables, only referral rate: staff ratio was an independent predictor of therapies offered (B=1.011, OR=1.011, [95% CI: 1.001, 1.022]), indicated that services with higher referral rates were slightly more likely to provide post-diagnostic care. Table 7: Logistic regression demonstrating associations between psychological therapy provision and service characteristics Estimate (B) Exp(B) (Odds Ratio) 95% Confidence interval p-value Model 1 Referral rate: staff ratio 0.010 1.010 [1.000, 1.020] 0.046 Model 2 Referral rate: staff ratio 0.011 1.011 [1.001, 1.021] 0.037 NHS Region 0.074 1.077 [0.836, 1.387] 0.568 Rurality 0.131 1.140 [0.850, 1.530] 0.099 Model 3 Referral rate: staff ratio 0.011 1.011 [1.001, 1.022] 0.037 NHS Region 0.055 1.057 [0.815, 1.370] 0.676 Rurality 0.167 1.181 [0.849, 1.644] 0.323 MSNAP accreditation -0.068 0.934 [0.305, 2.864] 0.905 Service type -0.391 0.676 [0.097, 4.694] 0.692 Staffing mix (Doctor %) -0.022 0.978 [0.942, 1.015] 0.240 What changes in the past five years are you most proud of? (Table 1S) Responses were obtained from 138/139 services; as some individuals responded for multiple services, we received 124 unique responses. We developed five codes describing preventing well (providing Brain Health clinics, secondary prevention; testing hearing). 42 codes mapped to diagnosing well described improvements in referral triage, training related to diagnosing, a “one stop approach” – where initial assessment and diagnostic feedback were provided in one visit, nurse-led or multiprofessional diagnostic pathways and increasing diagnostic accuracy – through greater availability of scanning or biomarker testing, or more consistent history-taking and cognitive testing. Four respondents described support for diagnosing in primary care. One service reserved assessment slots for people from minority ethnic groups, providing no specific rationale. 81 codes mapped to supporting well ; 19 to improved integration with other services, at the point of referral (single access point), multidisciplinary meetings, or joint assessments. 18 codes described post-diagnostic group provision. Nine codes describe measures to enhance continuity – through providing a named worker, and/or more capacity for follow-ups. Five codes referred to prescribing: non-medical staff involvement in prescribing or post-prescribing monitoring, or readiness for DMTs. Other codes referenced inclusivity of post-diagnostic support, support for people with dementia with specialist needs, or research engagement. 17 codes mapped to living well , describing liaison with third sector agencies, outreach and public engagement. 3 codes related to dying well (palliative care liaison and Advanced Care Planning). 150 codes related to cross-cutting service work: meeting performance targets, MSNAP accreditation, service redesign, pandemic or post-pandemic work, staffing team attitude or diversity, staff recruitment or retention, changes in staff skill mix, or administrative changes. What service changes in the past five years are you most concerned by? (Table 2S) Responses were reported for 137/139 services, with 119 unique responses. Loss of MCI support was the one code that described preventing well. 33 codes mapped to diagnosing well: describing increased waiting times, and difficulties accessing scanning. Supporting well was described by 21 codes, 10 codes related to post-diagnostic support and 5 to medication including difficulties sending out prescriptions to patients. 11 codes mapped to living well; 13 describing limited carer support and 7 limited community support such as social services. What changes are you anticipating in over the next 5 years? (Table 3S) Responses were reported for 135/139 services, with 135 unique responses. Nine codes described preventing well (linking to community services to address risk factors, providing Brain health clinics, and secondary prevention). 201 codes were mapped to diagnosing well . Anticipated changes to pathways to include blood and cerebrospinal fluid (CSF) biomarkers, genetic testing and greater neuroimaging access predominated. There was an expectation that more diagnoses would be made in primary care and care homes, and by non-medical prescribers. Multi-Disciplinary Team (MDT) working and “one-stop shops” were proposed to support earlier, more accurate diagnosis. Notably few respondents discussed the potential impact of more private providers; only two respondents discussed functional assessments. 95 codes were mapped to supporting well , with an expectation that DMTs would change diagnostic pathways, with more integrated pathways the most frequently coded responses. Relatively few respondents discussed availability of psychological therapies, or staff training. 23 codes mapped to people living well . There was an expectation that third sector organisations would be more frequently commissioned to deliver post-diagnostic support. Discussion This is the largest survey of acute and community memory services in England to date. Findings can inform implementation of treatment advances in England and provide an evidence base of how service structures and processes influence outcomes, for other countries. We found community services see on average twice as many referrals as acute services with half as many doctors, and see more people at home, across urban and rural areas. Relative to acute services, community services have less access to tests and imaging (MRI scans and directly to blood tests) and perhaps unsurprisingly feel less equipped to implement and deliver DMTs, which will require disease specific biomarkers for entry and MRI scanning both for eligibility and monitoring ( 22 ). In line with their workforce predominantly being psychiatrists and mental health nurses, community services were more likely than acute services to provide routine post-diagnostic psychosocial support. It was surprising that having fewer staff per referral numbers predicted being more likely to offer post-diagnostic support; analyses may not have fully accounted for potential confounders, for example the greater likelihood that community-based, urban services had higher referral rates and greater capability to deliver post-diagnostic groups. Acute services, where neurologists and general nurses are the predominant workforce, felt more prepared for advances in biomarkers and DMTs, though almost half provided no formal psychosocial, post-diagnostic support. Of almost 200,000 annual referrals to memory services in England, less than 2% are currently made to acute services. The clinical and budgetary implications of shifting even a relatively small, triaged proportion of these referrals and assessments to acute services for the more intensive diagnostic processes acute services provide is substantial. Shifting all would potentially be ruinous. Service modelling, development and change might best focus on upskilling the existing community memory service network to identify patients who would benefit from specialist services provided in acute care, and to develop clearly defined pathways facilitating this. Our community service respondents reflected this view: a quarter felt biomarkers would become part of routine practice in the next five years, and half expected this to enhance diagnostic accuracy for some clients. Strengthening relationships across primary, secondary and tertiary services can also be key for improving dementia diagnosis and care. Integrated Care Systems provide the potential for this ( 23 ). DMTs are expensive now and require intensive monitoring, but costs may change with implementation ( 8 ). Respondents described plans designed to address challenges with volume of referrals and delivery of care such as training other health professionals to diagnose and prescribe, more integrated working in “one stop shops” and collaboration with third sector organisations. Currently only 23% of community services have regular neuroradiology MDT meetings, and only 60% can view scans. Upskilling psychiatrists in community services to interpret brain scans would enhance DMT readiness. Good quality psychological support can save money and increase care quality. There are economic and moral arguments for ensuring NHS commissions evidence-based post-diagnostic psychosocial interventions that improve care, as well as delivering advancement in diagnostics and pharmacological treatment ( 24 ). Acute services were less likely than community services to report increased MCI diagnoses in recent years, restricting the label to those receiving neuropsychological assessment and not providing specific support to this group. Evidence for whether addressing potentially modifiable dementia risk factors in people with memory concerns reduces dementia incidence is limited ( 25 , 26 ); some factors, including depression may be part of a prodromal dementia syndrome for some patients ( 27 ). Prevention is prioritised in the Darzi report ( 5 ), but there are no NICE guidelines on diagnosing and managing MCI. One in ten services routinely provide support for people with MCI, and a small number for clients who do not receive a diagnosis of dementia, MCI or mood disorder, with variation in terminology and support for this diagnostically heterogenous group. Very few memory services report referring to NHS brain health clinics. Our findings suggest a need for standardisation of care pathways for those with MCI and those with cognitive symptoms without any objective deficits. We identified marked geographical inequalities: people in regions where memory services were less resourced, and rural areas had less access to timely diagnosis and care. Previous research shows those residing in more deprived areas more commonly receive a ‘unspecified’ dementia diagnosis ( 28 ), this work suggests this may be due to variation in memory service resources. The three English NHS regions with highest dementia diagnosis rates had more memory service staff relative to regional 65 + populations. At a service level, main predictors of local dementia diagnostic rates were NHS region and greater rurality. Our survey has important limitations. There may be responder bias, including towards services under less strain, but it is positive our response rate was high compared with previous research. We did not independently verify data, which may have been subject to desirability bias. Some services may facilitate post-diagnostic support through referral to third sector providers that was not captured. Some acute services are tertiary referrals centres, and so their work may not be accurately represented by local diagnostic rates. We mitigated this to some extent through investigating regional relationships between staffing and diagnostic rates. Conclusions Dementia is a complex condition that requires integrated working across medical and social specialties and services, if we are to deliver the inclusive, accurate diagnostic and quality post-diagnostic care that recent advances could enable. Work to map future NHS dementia care pathways is ongoing and should take account of how to ensure existing inequalities, including the stark geographical inequalities identified here, are addressed not worsened. Abbreviations NHS National Health Service NICE National Institute for Health and Care Excellence CST Cognitive Stimulation Therapy DMT Disease Modifying Treatment MSNAP Memory Services National Accreditation Programme NIHR National Institute for Health and Care Research DHSC Department of Health and Social Care LAD Local Authority District ICB Integrated Care Board SD Standard Deviation FTE Full Time Equivalent MCI Mild Cognitive Impairment CSF Cerebrospinal fluid MDT Multi-Disciplinary Team ACE Addenbrookes cognitive exam MMSE Mini Mental State exam RUDAS Rowland Universal Dementia Scale TOP Total older population Declarations Ethics approval and consent to participate This research has been approved by National Research Ethics service and Health Research Authority on 14.5.24 (24/IEC08/0008). Informed consent was obtained online before participants completed the survey. This study was conducted in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Consent for publication Informed consent for publication was obtained online before participants completed the survey. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interest The manuscript has been read and approved by all authors and there are no competing of interest to be declared. Funding This research is funded through the NIHR Policy Research Unit in Dementia and Neurodegeneration – Queen Mary University of London (reference NIHR206110). Authors’ contributions OK and CC wrote the main manuscript text. HDK, CC and SZ assisted with data preparation and analysis. OK, MM, HC, EW, SW, AJ, EW, EC were involved in data collection and conducted surveys with participants. All authors read and approved the manuscript. Acknowledgements This research is funded through the NIHR Policy Research Unit in Dementia and Neurodegeneration – Queen Mary University of London (reference NIHR206110). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. References The economic impact of dementia | Alzheimer’s Society [Internet]. [cited 2025 Jan 19]. Available from: https://www.alzheimers.org.uk/about-us/policy-and-influencing/economic-impact-of-dementia Overview | Dementia: assessment, management and support for people living with dementia and their carers | Guidance | NICE [Internet]. NICE; 2018 [cited 2025 Jan 19]. Available from: https://www.nice.org.uk/guidance/ng97 HQIP [Internet]. 2024 [cited 2025 Jan 19]. Dementia audit: Memory Assessment Services 2023/2024 (NAD). Available from: https://www.hqip.org.uk/resource/nad-memory-assessment/ Can Memory Assessment Services (MAS) in England be categorized? A national survey | Journal of Public Health | Oxford Academic [Internet]. [cited 2025 Jan 20]. Available from: https://academic.oup.com/jpubhealth/article-abstract/39/4/828/3058977 GOV.UK [Internet]. 2024 [cited 2025 Jan 19]. Independent investigation of the NHS in England. Available from: https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england Teunissen CE, Verberk IMW, Thijssen EH, Vermunt L, Hansson O, Zetterberg H, et al. Blood-based biomarkers for Alzheimer’s disease: towards clinical implementation. Lancet Neurol. 2022 Jan;21(1):66–77. Dobson R, Patterson K, Malik R, Mandal U, Asif H, Humphreys R, et al. Eligibility for antiamyloid treatment: preparing for disease-modifying therapies for Alzheimer’s disease. J Neurol Neurosurg Psychiatry. 2024 Sep 1;95(9):796–803. Cooper C, Marshall CR, Schott JM, Banerjee S. Preparing for disease-modifying dementia therapies in the UK. Nat Rev Neurol. 2024 Nov;20(11):641–2. Brown S, Livingston G, Mukadam N. A National Memory Clinic Survey to Assess Provision for People from Diverse Ethnic Backgrounds in England and Wales. Int J Environ Res Public Health. 2021 Jan;18(4):1456. Holden E, Stoner CR, Spector A. Cognitive stimulation therapy for dementia: Provision in National Health Service settings in England, Scotland and Wales. Dementia. 2021 Jul 1;20(5):1553–64. Cok L. The 2019 national memory service audit. www.rcpsych.ac.uk [Internet]. [cited 2025 Jan 20]. Memory Services Spotlight Audit National Report. Available from: https://www.rcpsych.ac.uk/improving-care/ccqi/national-clinical-audits/national-audit-of-dementia/fifth-round-of-audit/memory-services-spotlight-audit-national-report GOV.UK [Internet]. [cited 2025 Jan 19]. Living Well With Dementia: a national dementia strategy. Available from: https://www.gov.uk/government/publications/living-well-with-dementia-a-national-dementia-strategy www.rcpsych.ac.uk [Internet]. [cited 2025 Jan 20]. MSNAP standards. Available from: https://www.rcpsych.ac.uk/improving-care/ccqi/quality-networks-accreditation/memory-services-national-accreditation-programme-msnap/msnap-standards www.rcpsych.ac.uk [Internet]. [cited 2025 Jan 10]. List of MSNAP Members. Available from: https://www.rcpsych.ac.uk/improving-care/ccqi/quality-networks-accreditation/memory-services-national-accreditation-programme-msnap/list-of-members 2011 rural/urban classification - Office for National Statistics [Internet]. [cited 2025 Jan 19]. Available from: https://www.ons.gov.uk/methodology/geography/geographicalproducts/ruralurbanclassifications/2011ruralurbanclassification NHS England Digital [Internet]. [cited 2025 Jan 19]. Primary Care Dementia Data, August 2024. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-dementia-data/august-2024 Varbes [Internet]. [cited 2025 Feb 20]. England Demographics | Age, Ethnicity, Religion, Wellbeing. Available from: https://www.varbes.com/demographics/england-demographics Posit [Internet]. [cited 2025 Feb 4]. Posit. Available from: https://www.posit.co/ The qualitative content analysis process - Elo - 2008 - Journal of Advanced Nursing - Wiley Online Library [Internet]. [cited 2025 Jan 20]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2648.2007.04569.x?casa_token=A_XbpPkWBOAAAAAA%3AaxRnsJebRkBMwRQcTnwgA9ZMntwkx1xdM8McfCQTzvTLrAfFhNXUzwQLryUYQUyN3pQ7Y-L7SE2U00qq England NHS. NHS England » Dementia wellbeing pathway [Internet]. 2022 [cited 2025 Jan 20]. Available from: https://www.england.nhs.uk/publication/dementia-wellbeing-pathway/ Belder CRS, Schott JM, Fox NC. Preparing for disease-modifying therapies in Alzheimer’s disease. Lancet Neurol. 2023 Sep 1;22(9):782–3. The King’s Fund [Internet]. [cited 2025 Feb 12]. The Role Of Integrated Care Systems In Improving Dementia Diagnosis. Available from: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/role-integrated-care-systems-improving-dementia-diagnosis Isaaq A, Cooper C, Vickerstaff V, Barber JA, Walters K, Lang IA, et al. Cost-utility of a new psychosocial goal-setting and manualised support intervention for independence in dementia (NIDUS-Family) versus goal setting and routine care: an economic evaluation embedded within a randomised controlled trial. Lancet Healthy Longev [Internet]. 2025 Feb 17 [cited 2025 Feb 20];0(0). Available from: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00202-2/fulltext Moon SY, Park YK, Jeong JH, Hong CH, Jung J, Na HR, et al. South Korean study to prevent cognitive impairment and protect brain health through multidomain interventions via face-to-face and video communication platforms in mild cognitive impairment (SUPERBRAIN-MEET): A randomized controlled trial. Alzheimers Dement [Internet]. [cited 2025 Jan 29];n/a(n/a). Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/alz.14517 Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet Lond Engl. 2015 Jun 6;385(9984):2255–63. Paris A, Amirthalingam G, Karania T, Foote IF, Dobson R, Noyce AJ, et al. Depression and dementia: interrogating the causality of the relationship. J Neurol Neurosurg Psychiatry [Internet]. 2025 Jan 11 [cited 2025 Jan 29]; Available from: https://jnnp.bmj.com/content/early/2025/01/11/jnnp-2024-334675 Jitlal M, Amirthalingam GNK, Karania T, Parry E, Neligan A, Dobson R, et al. The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001–2017. J Alzheimers Dis. 2021 Jan 1;81(1):321–8. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6322268","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":442172149,"identity":"b86135d6-6392-4a9d-be22-9a53d0cc794e","order_by":0,"name":"Oliver 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16:38:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6322268/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6322268/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12877-026-07155-w","type":"published","date":"2026-02-19T15:58:27+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":80993834,"identity":"7195444c-4f8a-4aa3-9fa3-6a3e835344c9","added_by":"auto","created_at":"2025-04-21 04:19:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":186581,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLocation of English memory clinics. Blue dots indicate services that participated, red dots services that did not participate; grey boundaries show the 42 English Integrated Care Boards, an inset map shows London services.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6322268/v1/59373511a794caf54e9eda25.png"},{"id":103251709,"identity":"af5cb452-f771-473c-96cd-c902a9963ab3","added_by":"auto","created_at":"2026-02-23 16:11:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1877400,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6322268/v1/e0b34f18-da80-4d46-ad96-104081f14eb9.pdf"},{"id":80993372,"identity":"37b9e761-8684-44ad-bf77-b38219584946","added_by":"auto","created_at":"2025-04-21 04:03:40","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":75669,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterials.docx","url":"https://assets-eu.researchsquare.com/files/rs-6322268/v1/61f12138abeec88e707f59a0.docx"},{"id":80993365,"identity":"a9772110-e94e-40e6-883d-5e5374d1e135","added_by":"auto","created_at":"2025-04-21 04:03:39","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16299,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-6322268/v1/c06ba5c7bcc56f30c8ce600c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A national survey of dementia diagnosis and care in English memory services","fulltext":[{"header":"Background","content":"\u003cp\u003eAn estimated 982,000 people have dementia in the UK, this is predicted to rise to over 1.4 million by 2040 (1). In England, most dementia diagnostic assessment and post-diagnostic care is provided by National Health Service (NHS) memory services. Most memory services are provided within mental health services, staffed by psychiatrists, while some are run within hospital-based services, primarily by neurologists. The UK National Institute for Health and Care Excellence (NICE) dementia assessment and treatment guideline advocates integrated, multidisciplinary care, diagnostic assessments using validated cognitive tests and structural imaging, and post-diagnostic support, including pharmacological symptomatic treatments where appropriate, and psychosocial and environmental interventions to reduce distress (2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMemory service audits in England (2019-23) found average waiting times for assessment and diagnosis increased over this time, with longer waiting times in deprived areas. These audits did not include acute NHS Trust based services (henceforth acute trust services). Over two-thirds of audited patients received a diagnosis of “unspecified dementia”, suggesting many people did not access accurate, subtype-based dementia diagnoses. Following diagnosis, only a third of people with dementia eligible for Cognitive Stimulation Therapy (CST) were offered it, with similar proportions of carers offered structured support (3). A survey of 73 memory services in 2015\u0026nbsp;found no association between staffing levels and waiting times or service provision\u0026nbsp;(4).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMemory services operate in challenging contexts, as described in the Darzi report on the NHS\u0026nbsp;(5). Anticipated developments include introducing first generation anti-amyloid Disease Modifying Treatments (DMTs), and blood-biomarker tests which can potentially increase dementia diagnostic accuracy\u0026nbsp;(6). A 2021 survey found that only 36% of London memory services felt capable of adapting to the demands of delivering DMTs within a year\u0026nbsp;(7). Implementing these new developments without delivering more inclusive, integrated care will pose challenges\u0026nbsp;(8).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTo understand current memory service provision, we completed a comprehensive survey of acute trust and community/mental health trust (henceforth community) based memory services in England.\u0026nbsp;To investigate variations in provision and how they might relate to service delivery, we aimed to:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eDescribe the referral, diagnostic and post-diagnostic procedures of English memory services.\u003c/li\u003e\n \u003cli\u003eDescribe the perceived readiness for DMTs and blood biomarkers, comparing acute and community services.\u003c/li\u003e\n \u003cli\u003eExplore whether service characteristics (NHS region, referral rates, staffing mix, provider type and Royal College of Psychiatrists Memory Services National Accreditation Programme (MSNAP) accreditation) are associated with local diagnosis rates and psychological therapy provision.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eExplore changes in the past five years that staff feel most proud of, those that cause them most concern, and key changes anticipated in the next five years.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Methods","content":"\u003cp\u003e The cross-sectional survey was conducted by the NIHR Dementia and Neurodegeneration Policy Research Unit - at Queen Mary (DeNPRU-QM), commissioned by the English Department of Health and Social Care (DHSC) and approved by National Research Ethics service and Health Research Authority on 14.5.24 (24/IEC08/0008).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurvey design\u003c/h2\u003e \u003cp\u003eWe purposively invited a diverse group of people with academic, clinical and lived experience from across English regions and staff roles, and NHS England and MSNAP representatives to three online co-design workshops in March-April 2024. Prior to workshops, we circulated an accessible summary of relevant research (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), audits (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e) (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e) and policy documents (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Using a structure, process and outcome framework, group members proposed and discussed survey items. All attendees were sent the final survey and invited to further comment; a core study group comprising academic, clinical and lived experience agreed the final survey content.\u003c/p\u003e \u003cp\u003eThe survey elicited service characteristics including structure (e.g. staffing mix and referral numbers), and processes (how the services diagnosed dementia and provided post-diagnostic services). Respondents were asked about service changes over the last five years, those planned in the next five years and how prepared services were for introduction of blood biomarkers and DMTs. The survey was developed for the purposes of this study and is available in the supplementary materials (S4).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSurvey sample and data collection\u003c/h3\u003e\n\u003cp\u003eWe developed a sampling frame of all English memory services from publicly available information; and invited services to participate, between May 2024 and January 2025. Responding services were asked to identify a staff member knowledgeable of service structures and processes, service history and plans. After providing informed consent, the staff member completed the survey with a researcher by video-call, phone or if they preferred directly via the online software survey platform Qualtrics (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.qualtrics.com\u003c/span\u003e\u003cspan address=\"https://www.qualtrics.com\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e). Participants/ services received no compensation.\u003c/p\u003e \u003cp\u003eResearchers used publicly available data to record whether each service was currently MSNAP registered (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e) and area-level data regarding:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eLocal Authority District (LAD) rurality, using 2011 Office for National statistics Rural-Urban classifications: 1 (Mainly rural), 2 (Largely Rural), 3 (Urban with significant rural), 4 (Urban with city or Town), 5 (Urban with Minor Conurbation), 6 (Urban with major Conurbation) (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e); we categorised 1 and 2 as \u0026lsquo;rural\u0026rsquo; and 3\u0026ndash;6 as \u0026lsquo;urban\u0026rsquo;.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eDementia diagnosis rates, obtained from NHS primary care dementia 2024 data (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). We attributed the relevant LAD diagnostic rate for service catchment areas and calculated the mean diagnostic LAD rates if where catchment areas encompassed\u0026thinsp;\u0026gt;\u0026thinsp;1 LAD (n\u0026thinsp;=\u0026thinsp;25). Where we could not map LADs to catchment areas (n\u0026thinsp;=\u0026thinsp;8), we used rates for service Integrated Care Boards (ICB).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe number of older people (aged 65+) living in each region, from publicly available data (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e\n\u003ch3\u003eAnalysis\u003c/h3\u003e\n\u003cp\u003eData were exported from Qualtrics and analysed using Statistical Package for the Social Sciences (SPSS; version 29). During data cleaning we removed outlier statistics more than three Standard Deviations (SD) from the mean (n\u0026thinsp;=\u0026thinsp;4). We summarised findings descriptively, partitioning into community and acute services as they operate distinct models. For each region we estimated total overall staff FTE (Full Time Equivalent) of all memory services, imputing the median value for that region for non-participating services. We calculated regional number of older people per memory service FTE and compared this across regions and to regional diagnostic rates.\u003c/p\u003e \u003cp\u003eWe used RStudio (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) to map memory service locations. For each service, we calculated the average number of referrals estimated in the past year per staff FTE. We used parametric statistics to describe and analyse data approximating the normal distribution (evaluated graphically) and non-parametric statistics otherwise.\u003c/p\u003e \u003cp\u003e We conducted, linear and logistic regression analyses with: (i) local area diagnostic rates and (ii) any psychological therapies offered as dependent variables. For each outcome, in model 1, we included referral rate: staff ratios; in model 2, we added NHS region and rurality; in model 3 we added: staffing mix (% of FTE staff who were doctors), service type (acute or community) and MSNAP accreditation as independent variables.\u003c/p\u003e \u003cp\u003eWe conducted content analysis of responses recorded (primarily by researchers conducting interviews, or by respondents online) to open-ended questions, using published methods (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). We used the Dementia Well pathway to develop our coding framework, combining deductive and inductive analytic approaches (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Two authors (from CC, SZ, OK) independently coded\u0026thinsp;\u0026gt;\u0026thinsp;10% of responses for each question, developed initial groupings of themes and then met to discuss a coding framework. One author coded the remaining responses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cu\u003eSurvey response\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eManagers and senior staff members from 139/189 (73.9%) English memory services, employed in their current roles for on average 5.2 years (SD=4.8) completed the survey. Respondents included 52 team managers/leaders, 32 service leads/managers, 19 nurses, nine psychiatrists, four neurologists, two Advanced Clinical Practitioners and\u0026nbsp;two clinical psychologists. Eight respondents, with pan-service operational roles, completed surveys for multiple (\u0026lt;6) services. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFigure 1 shows the geographical distribution of participating services. Completion rates were highest in the South West NHS region (12/12 [100%] services) and lowest in the North East and Yorkshire (19/33 [57.6%] services). The 49 services not responding were all community services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e132 (94.9%) services were dedicated to memory assessment, while 7 (5%) fulfilled other functions, most commonly also acting as older person\u0026rsquo;s Community Mental Health Team\u0026rsquo;s (CMHTs) (5, 71.4%). 47 (33.8%) services were MSNAP accredited: 2 (22.2%) acute and 45 (34.6%) community services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eService structure\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003e130 (93.5%) participating services were NHS community services (121 (93%) provided by mental health trusts, 7 (5.5%) by mental health trusts with GP/community service providers, and 2 (1.5%) by GP/community services providers. The remaining 9 (6.6%) were acute-provider services, 6 (66.6%) within neurology services, and 3 (33.3%) where medical input was primarily from psychiatry.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 1 compares referral rates and staffing between community and acute services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAssuming median service referral rates applied to non-responding services, we estimated there were 192,418 referrals to English memory services in the past year, of which 98.7% (n=189,917) were to community, and 1.3% (n=2,501) to acute services. Community services reported high annual referral rates (median 100.8, 95% Confidence intervals (95% CI) 56.7-132.8 per memory service FTE staff member). Doctors made up 14% of FTE staff; and 30% (20-50%) of clients were seen at home. Acute services were all located in urban areas. They reported fewer referrals (45.8, 21.1-99.5 per FTE), more doctors (33%, 23-43% of FTE) and saw few patients at home (0%, 0-15%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003eA comparison of structural characteristics of services by service type\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"640\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health/ community services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcute Services\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRurality (N=139)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eUrban (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e103 (79.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e9 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e112 (80.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eRural (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e27 (20.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e27 (19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnnual referral rate (N=104)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePast year\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1000 (650-1590)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e275 (112.5 - 575)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e960 (IQR=600 - 1588)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003ePer FTE staff member\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e100.8 (56.7-132.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e45.8 (21.1-99.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e96.8 (51.03- 131.3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eChange relative to 5 years ago\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e+205 (95.5-484.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e+50 (12.8- 200)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e+200 (84.8 - 446.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR) staff who are:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=123)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eDoctors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.5 (1 - 2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2.5 (0.5 - 4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.60 (1-2.6)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNurses\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e5.06 (3 - 8.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1.5 (0.4-4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e5.0 (2.6-7.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eOccupational therapists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.0 (0.4 - 2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.0 (0 - 0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.0 (0.0-1.8)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eClinical Psychologists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e0.8 (0.3 - 1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0.5 (0.1 -1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.8 (0.3-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eBand 4 Support workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e1.1 (0 - 3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0 (0 - 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.0 (0.0-3.12)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"5\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR) proportion of FTE staff who are:\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=123)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eDoctors\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e14% (9 - 19%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e33% (23 - 43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e14% (9 - 20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eNurses\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e45% (32 - 54%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30% (13 - 52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e44% (30 - 54%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eOccupational therapists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e8% (4 - 12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0% (0 - 6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e7% (1% - 12%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eClinical Psychologists\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e6% (2% - 10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e1% (1% - 2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e6% (2% - 10%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 124px;\"\u003e\n \u003cp\u003eBand 4 Therapists \u0026amp; Support workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 151px;\"\u003e\n \u003cp\u003e12% (0 - 21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0% (0 - 12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e12% (0 - 21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Most services accepted referrals from people living in residential care (131, 94.2%), with symptoms consistent with advanced dementia (127, 91.4%), complex needs (126, 90.6%) or aged under 65 (126 (90.6%). Around two-thirds accepted referrals of people with learning disabilities (97, 69.8%), or those dependent on drugs or alcohol (89, 64%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDiagnostic processes (Table 2)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAcute services more frequently reported using MRI brain scans in their diagnostic pathway (7, 77.8%) compared with community services (32, 23.1%) who more frequently used CT scans (95, 72.3%). Respondents in acute services were more likely, relative to community services, to consider biomarkers likely to change diagnostic practice.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e \u003cstrong\u003e\u003cem\u003eA comparison of the current and anticipated diagnostic processes of memory services across service type. (\u003c/em\u003eAll averages reported as medians as data not normally distributed).\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"633\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental health/ community services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcute Trust\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain types of brain imaging supporting diagnosis (N=139)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eMRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e32 (23.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e7 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e37 (26.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e95 (72.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e96 (69.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eSPECT/PET / DAT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2 (1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e1 (0.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eNo Imaging\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e2 (1.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e2 (1.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinicians can view brain scans (N=139)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e79 (60.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e87 (62.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterfacing with neuroradiology (N=138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eNo direct interface\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30 (23.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e30 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAd-hoc discussions\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e59 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e5 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e64 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eMDT meeting\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e26 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e29 (21%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e14 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e15 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCognitive testing used (N=138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eSpecific tools for cultural inclusion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e88 (67.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e5 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e93 (68.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eACE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e125 (96.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e7 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e132 (95.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eMontreal cognitive examination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e39 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e45 (32.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eMMSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e38 (29.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e6 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e44 (31.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eRUDAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e59 (45.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e59 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIs neuropsychological testing routinely available (N=138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eFor all patients where would support diagnosis\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e101 (78.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e109 (79.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eFor limited patients\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e25 (19.4%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e26 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eNot available\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e3 (2.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e3 (2.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhere are clients seen for initial assessment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMedian proportion (IQR) (N=134)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eAt home\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e30% (20-50%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0% (0-15%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e30% (15-50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eIn the clinic\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e62.5% (40-80%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e95% (85-100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e70% (40-70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eOnline/telephone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e0% (0-0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0% (0-3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0% (0-0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCan request bloods directly (N= 138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64 (49.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (88.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e72 (52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 158px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnticipated influence of biomarkers on diagnostic practice (N=138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eWill not change practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e28 (21.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e\u0026nbsp;29 (21.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eEnhance accuracy in certain areas\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e67 (51.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e5 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e72 (52.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 131px;\"\u003e\n \u003cp\u003eWill be part of routine practice\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 130px;\"\u003e\n \u003cp\u003e34 (26.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e37 (26.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cu\u003ePost diagnostic support (Table 3)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eTwo-thirds (94, 67.6%) of services provided post-diagnostic support for all patients, most frequently CST. Few services offered additional or alternate groups or therapies. 131 (94.9%) of services offered the opportunity for patients to take part in research; 99 (71%) services reported higher research engagement over the last 5 years than in preceding years, with only seven (5.4%) reporting lower engagement. These figures were similar across acute and community services.\u003c/p\u003e\n\u003cp\u003eAcute services felt more ready to prescribe dementia DMTs than community services (8 [88.9%] vs 50 [41.7%]) but were less likely to offer post-diagnostic psychological therapy routinely (5 [55%] vs 100 [72.5%]).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 3: Provision of post diagnostic support across service type\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCommunity/mental health services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAcute Trust\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProvision of therapies/groups\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(N=138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCognitive Stimulation Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e99 (76.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e102 (73.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMaintaining Quality of Life\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23 (17.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25 (18.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eOther cognitive focused groups\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8 (5.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eOther therapies\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (6.6%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e10 (6.4%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal number of therapies offered after dementia diagnosis (N=138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e29 (22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e33 (23.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e66 (51.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e69 (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e25 (19.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e1 (11.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e27 (19.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e3+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (6.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eChange in post-diagnostic support over the past 5 years (N=137)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMore support\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e53 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5 (55.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e58 (42.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eLess support\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (17.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eNo change\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e53 (41.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4 (44.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e57 (41.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSpecific support for minority communities (N=138)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e61 (47.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e64 (46.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003cu\u003eCognitive concerns\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe number of Mild Cognitive Impairment (MCI) diagnoses made increased more in community compared with acute services over the past 5 years (62 [44.7%] vs 2 [22.2%]). Acute services more frequently restricted MCI diagnosis to those who received formal neuropsychological assessment, compared with community services (3 [33.3%] vs 20 [15.5%]). 26 (18.1%) services (all community) routinely offered therapies for people with MCI, most usually groups to help maintain and improve cognitive function (16, 11.6%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhen describing the cognitive symptoms of individuals without a Dementia, MCI or mood disorder diagnosis, most referred only to absence of dementia; others used the terms functional cognitive/ neurological disorder (n=4), or subjective cognitive complaint, decline or impairment (n=3) (Table 4). A quarter of services (36, 26.1%) reported offering additional support to these individuals. Most only offered onward referrals (n=11) and/or signposting (n=25). Two referred to brain health clinics. Others provided written resources (n=4) or targeted advice in feedback appointments. One community team manager commented that \u0026ldquo;for many the consultation (including formulation of memory problems and care plan) is therapeutic in itself\u0026rdquo;. Three services asked GPs to rerefer for repeat assessments, after 1-3 years. Other services offered: a functional pathway involving \u0026ldquo;assessment with specific senior practitioner to offer assessment and support and possible signposting\u0026rdquo;; a brain health pathway, and in one case the MCI group was open to these clients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTable 4: Terms used to describe service users who receive no diagnosis of dementia, MCI or a treatable mood disorder\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTerm\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eNo specific term (recorded as no dementia diagnosis)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eFunctional cognitive disorder\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eZ diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003ePerson with feared complaint but no diagnosis has been made\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eAge related memory issues\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eBrain fog\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eCognitive impairment due to other causes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eFunctional neurological disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSubjective cognitive complaint\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSubjective cognitive decline\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 444px;\"\u003e\n \u003cp\u003eSubjective cognitive impairment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cu\u003eComparing service characteristics with local diagnostic rates\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe number of FTE memory service staff per size of the aged 65+ population ranged from 3020 to 8276. Regions with highest dementia diagnosis rates (67%+) had more memory service staff relative to local aged 65+ population size (Table 5). In our adjusted multiple linear regression model (R\u0026sup2;= 0.251), with local diagnostic rates as the dependent variable, Rurality (\u0026beta;=2.142, [95% CI: 1.320, 2.964]) and NHS region (\u0026beta;=0.700 [95% CI: 0.078, 1.322]) were associated with local diagnostic rates (Table 6).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5: \u003cem\u003eReferral and diagnostic rates and FTE staff across NHS region\u003c/em\u003e\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNHS Region\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (IQR) referral/FTE rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePopulation aged 65+(Pop)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal FTE in region services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePop/FTE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDiagnostic rate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eMidlands\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e79.44 (59.9-79.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2,110,274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8,276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e65.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eEast of England\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e107.43 (65.1-132.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1,273,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6,239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e63.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eSouth West\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e108.57 (97.4-143.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1,302,863\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e238.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e5,456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e61.2%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eSouth East\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e44.61 (40.8-137.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1,847,827\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4,928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e63.0%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eLondon\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e109.42 (71.5-150.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1,072,807\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e313.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3,422\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e67.4%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eNorth West\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e87.77 (35.9-150.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1,413,029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e440.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e3,206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e70.3%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eNorth East \u0026amp; Yorkshire\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e74.3 (30.6-104.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;1,619,300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; 536.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;3,020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e67.8%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eTOP: Total Older Population\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6: Linear regression demonstrating associations between local area diagnostic rates and service characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eCoefficient (\u0026beta;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eStandard Error\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e95% Confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReferral rate: staff ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-2.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[-0.43, -0.001]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.042\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReferral rate: staff ratio\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[-0.033, 0.005]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.158\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eNHS Region\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.213\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.07, 1.28]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eRurality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.841\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[1.09, 2.59]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReferral rate: staff ratio\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[-0.036, 0.005]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eNHS Region\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e2.234\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.078, 1.322]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eRurality\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;2.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.414\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.170\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[1.320, 2.964]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMSNAP accreditation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[-4.881, 0.530]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eService type\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-2.969\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2.710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-1.058\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[-8.248, 2.510]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.292\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eStaffing mix (Doctor %)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[-0.085, 0.102]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.863\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cu\u003eAssociations of service characteristics with provision of psychological therapies (Table 7)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eIn a fully adjusted logistic regression with receipt of psychological therapies as dependent variables, only referral rate: staff ratio was an independent predictor of therapies offered (B=1.011, OR=1.011, [95% CI: 1.001, 1.022]), indicated that services with higher referral rates were slightly more likely to provide post-diagnostic care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7: Logistic regression demonstrating associations between psychological therapy provision and service characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eEstimate (B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eExp(B) (Odds Ratio)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e95% Confidence interval\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ep-value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eModel 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReferral rate: staff ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[1.000, 1.020]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eModel 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReferral rate: staff ratio\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[1.001, 1.021]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eNHS Region\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.074\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.836, 1.387]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eRurality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.850, 1.530]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.099\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eModel 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eReferral rate: staff ratio\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[1.001, 1.022]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eNHS Region\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.055\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.057\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.815, 1.370]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eRurality\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;0.167\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e1.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.849, 1.644]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.323\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eMSNAP accreditation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.934\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.305, 2.864]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eService type\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.097, 4.694]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003eStaffing mix (Doctor %)\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;-0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e0.978\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e[0.942, 1.015]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cu\u003eWhat changes in the past five years are you most proud of? (Table 1S)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eResponses were obtained from 138/139 services; as some individuals responded for multiple services, we received 124 unique responses. We developed five codes describing \u003cstrong\u003e\u003cem\u003epreventing well\u003c/em\u003e\u003c/strong\u003e (providing Brain Health clinics, secondary prevention; testing hearing). 42 codes mapped to \u003cstrong\u003e\u003cem\u003ediagnosing well\u003c/em\u003e\u003c/strong\u003e described improvements in referral triage, training related to diagnosing, a \u0026ldquo;one stop approach\u0026rdquo; \u0026ndash; where initial assessment and diagnostic feedback were provided in one visit, nurse-led or multiprofessional diagnostic pathways and increasing diagnostic accuracy \u0026ndash; through greater availability of scanning or biomarker testing, or more consistent history-taking and cognitive testing. Four respondents described support for diagnosing in primary care. One service reserved assessment slots for people from minority ethnic groups, providing no specific rationale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e81 codes mapped to \u003cstrong\u003e\u003cem\u003esupporting well\u003c/em\u003e\u003c/strong\u003e; 19 to improved integration with other services, at the point of referral (single access point), multidisciplinary meetings, or joint assessments. 18 codes described post-diagnostic group provision. Nine codes describe measures to enhance continuity \u0026ndash; through providing a named worker, and/or more capacity for follow-ups. Five codes referred to prescribing: non-medical staff involvement in prescribing or post-prescribing monitoring, or readiness for DMTs. Other codes referenced inclusivity of post-diagnostic support, support for people with dementia with specialist needs, or research engagement. 17 codes mapped to \u003cstrong\u003e\u003cem\u003eliving well\u003c/em\u003e\u003c/strong\u003e, describing liaison with third sector agencies, outreach and public engagement. 3 codes related to \u003cstrong\u003e\u003cem\u003edying well\u003c/em\u003e\u003c/strong\u003e (palliative care liaison and Advanced Care Planning).\u003c/p\u003e\n\u003cp\u003e150 codes related to cross-cutting service work: meeting performance targets, MSNAP accreditation, service redesign, pandemic or post-pandemic work, staffing team attitude or diversity, staff recruitment or retention, changes in staff skill mix, or administrative changes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eWhat service changes in the past five years are you most concerned by? (Table 2S)\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eResponses were reported for 137/139 services, with 119 unique responses. Loss of MCI support was the one code that described \u003cstrong\u003epreventing well.\u0026nbsp;\u003c/strong\u003e33 codes mapped to \u003cstrong\u003ediagnosing well:\u0026nbsp;\u003c/strong\u003edescribing increased waiting times, and difficulties accessing scanning. \u003cstrong\u003eSupporting well\u003c/strong\u003e was described by 21 codes, 10 codes related to post-diagnostic support and 5 to medication including difficulties sending out prescriptions to patients. 11 codes mapped to \u003cstrong\u003eliving well;\u003c/strong\u003e 13 describing limited carer support and 7 limited community support such as social services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eWhat changes are you anticipating in over the next 5 years? \u0026nbsp;(Table 3S)\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eResponses were reported for 135/139 services, with 135 unique responses.\u0026nbsp;\u0026nbsp;Nine codes described \u003cstrong\u003e\u003cem\u003epreventing well\u003c/em\u003e\u003c/strong\u003e (linking to community services to address risk factors, providing Brain health clinics, and secondary prevention). 201 codes were mapped to \u003cstrong\u003e\u003cem\u003ediagnosing well\u003c/em\u003e\u003c/strong\u003e. \u0026nbsp;Anticipated changes to pathways to include blood and cerebrospinal fluid (CSF) biomarkers, genetic testing and greater neuroimaging access predominated. There was an expectation that more diagnoses would be made in primary care and care homes, and by non-medical prescribers. Multi-Disciplinary Team (MDT) working and \u0026ldquo;one-stop shops\u0026rdquo; were proposed to support earlier, more accurate diagnosis. Notably few respondents discussed the potential impact of more private providers; only two respondents discussed functional assessments. 95 codes were mapped to \u003cstrong\u003e\u003cem\u003esupporting well\u003c/em\u003e\u003c/strong\u003e, with an expectation that DMTs would change diagnostic pathways, with more integrated pathways the most frequently coded responses. Relatively few respondents discussed availability of psychological therapies, or staff training. 23 codes mapped to people \u003cstrong\u003e\u003cem\u003eliving well\u003c/em\u003e\u003c/strong\u003e. There was an expectation that third sector organisations would be more frequently commissioned to deliver post-diagnostic support.\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the largest survey of acute and community memory services in England to date. Findings can inform implementation of treatment advances in England and provide an evidence base of how service structures and processes influence outcomes, for other countries.\u003c/p\u003e \u003cp\u003eWe found community services see on average twice as many referrals as acute services with half as many doctors, and see more people at home, across urban and rural areas. Relative to acute services, community services have less access to tests and imaging (MRI scans and directly to blood tests) and perhaps unsurprisingly feel less equipped to implement and deliver DMTs, which will require disease specific biomarkers for entry and MRI scanning both for eligibility and monitoring (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). In line with their workforce predominantly being psychiatrists and mental health nurses, community services were more likely than acute services to provide routine post-diagnostic psychosocial support. It was surprising that having fewer staff per referral numbers predicted being more likely to offer post-diagnostic support; analyses may not have fully accounted for potential confounders, for example the greater likelihood that community-based, urban services had higher referral rates and greater capability to deliver post-diagnostic groups. Acute services, where neurologists and general nurses are the predominant workforce, felt more prepared for advances in biomarkers and DMTs, though almost half provided no formal psychosocial, post-diagnostic support.\u003c/p\u003e \u003cp\u003eOf almost 200,000 annual referrals to memory services in England, less than 2% are currently made to acute services. The clinical and budgetary implications of shifting even a relatively small, triaged proportion of these referrals and assessments to acute services for the more intensive diagnostic processes acute services provide is substantial. Shifting all would potentially be ruinous. Service modelling, development and change might best focus on upskilling the existing community memory service network to identify patients who would benefit from specialist services provided in acute care, and to develop clearly defined pathways facilitating this. Our community service respondents reflected this view: a quarter felt biomarkers would become part of routine practice in the next five years, and half expected this to enhance diagnostic accuracy for some clients. Strengthening relationships across primary, secondary and tertiary services can also be key for improving dementia diagnosis and care. Integrated Care Systems provide the potential for this (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDMTs are expensive now and require intensive monitoring, but costs may change with implementation (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Respondents described plans designed to address challenges with volume of referrals and delivery of care such as training other health professionals to diagnose and prescribe, more integrated working in \u0026ldquo;one stop shops\u0026rdquo; and collaboration with third sector organisations. Currently only 23% of community services have regular neuroradiology MDT meetings, and only 60% can view scans. Upskilling psychiatrists in community services to interpret brain scans would enhance DMT readiness. Good quality psychological support can save money and increase care quality. There are economic and moral arguments for ensuring NHS commissions evidence-based post-diagnostic psychosocial interventions that improve care, as well as delivering advancement in diagnostics and pharmacological treatment (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAcute services were less likely than community services to report increased MCI diagnoses in recent years, restricting the label to those receiving neuropsychological assessment and not providing specific support to this group. Evidence for whether addressing potentially modifiable dementia risk factors in people with memory concerns reduces dementia incidence is limited (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e); some factors, including depression may be part of a prodromal dementia syndrome for some patients (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Prevention is prioritised in the Darzi report (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), but there are no NICE guidelines on diagnosing and managing MCI. One in ten services routinely provide support for people with MCI, and a small number for clients who do not receive a diagnosis of dementia, MCI or mood disorder, with variation in terminology and support for this diagnostically heterogenous group. Very few memory services report referring to NHS brain health clinics. Our findings suggest a need for standardisation of care pathways for those with MCI and those with cognitive symptoms without any objective deficits.\u003c/p\u003e \u003cp\u003eWe identified marked geographical inequalities: people in regions where memory services were less resourced, and rural areas had less access to timely diagnosis and care. Previous research shows those residing in more deprived areas more commonly receive a \u0026lsquo;unspecified\u0026rsquo; dementia diagnosis (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), this work suggests this may be due to variation in memory service resources. The three English NHS regions with highest dementia diagnosis rates had more memory service staff relative to regional 65\u0026thinsp;+\u0026thinsp;populations. At a service level, main predictors of local dementia diagnostic rates were NHS region and greater rurality.\u003c/p\u003e \u003cp\u003eOur survey has important limitations. There may be responder bias, including towards services under less strain, but it is positive our response rate was high compared with previous research. We did not independently verify data, which may have been subject to desirability bias. Some services may facilitate post-diagnostic support through referral to third sector providers that was not captured. Some acute services are tertiary referrals centres, and so their work may not be accurately represented by local diagnostic rates. We mitigated this to some extent through investigating regional relationships between staffing and diagnostic rates.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eDementia is a complex condition that requires integrated working across medical and social specialties and services, if we are to deliver the inclusive, accurate diagnostic and quality post-diagnostic care that recent advances could enable. Work to map future NHS dementia care pathways is ongoing and should take account of how to ensure existing inequalities, including the stark geographical inequalities identified here, are addressed not worsened.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNHS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Health Service\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNICE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institute for Health and Care Excellence\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCST\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCognitive Stimulation Therapy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDMT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisease Modifying Treatment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMSNAP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMemory Services National Accreditation Programme\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNIHR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Institute for Health and Care Research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDHSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDepartment of Health and Social Care\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLocal Authority District\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntegrated Care Board\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStandard Deviation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFTE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFull Time Equivalent\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMild Cognitive Impairment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCSF\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCerebrospinal fluid\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMDT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMulti-Disciplinary Team\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAddenbrookes cognitive exam\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMMSE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMini Mental State exam\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRUDAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRowland Universal Dementia Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eTOP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eTotal older population\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis research has been approved by National Research Ethics service and Health Research Authority on 14.5.24 (24/IEC08/0008). Informed consent was obtained online before participants completed the survey.\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConsent for publication\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent for publication was obtained online before participants completed the survey.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAvailability of data and materials\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCompeting interest\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript has been read and approved by all authors and there are no competing of interest to be declared.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eFunding\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis research is funded through the NIHR Policy Research Unit in Dementia and Neurodegeneration – Queen Mary University of London (reference NIHR206110).\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAuthors’ contributions\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eOK and CC wrote the main manuscript text. HDK, CC and SZ assisted with data preparation and analysis. OK, MM, HC, EW, SW, AJ, EW, EC were involved in data collection and conducted surveys with participants. All authors read and approved the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eAcknowledgements\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis research is funded through the NIHR Policy Research Unit in Dementia and Neurodegeneration – Queen Mary University of London (reference NIHR206110). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eThe economic impact of dementia | Alzheimer\u0026rsquo;s Society [Internet]. [cited 2025 Jan 19]. Available from: https://www.alzheimers.org.uk/about-us/policy-and-influencing/economic-impact-of-dementia\u003c/li\u003e\n \u003cli\u003eOverview | Dementia: assessment, management and support for people living with dementia and their carers | Guidance | NICE [Internet]. NICE; 2018 [cited 2025 Jan 19]. Available from: https://www.nice.org.uk/guidance/ng97\u003c/li\u003e\n \u003cli\u003eHQIP [Internet]. 2024 [cited 2025 Jan 19]. Dementia audit: Memory Assessment Services 2023/2024 (NAD). Available from: https://www.hqip.org.uk/resource/nad-memory-assessment/\u003c/li\u003e\n \u003cli\u003eCan Memory Assessment Services (MAS) in England be categorized? A national survey | Journal of Public Health | Oxford Academic [Internet]. [cited 2025 Jan 20]. Available from: https://academic.oup.com/jpubhealth/article-abstract/39/4/828/3058977\u003c/li\u003e\n \u003cli\u003eGOV.UK [Internet]. 2024 [cited 2025 Jan 19]. Independent investigation of the NHS in England. Available from: https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england\u003c/li\u003e\n \u003cli\u003eTeunissen CE, Verberk IMW, Thijssen EH, Vermunt L, Hansson O, Zetterberg H, et al. Blood-based biomarkers for Alzheimer\u0026rsquo;s disease: towards clinical implementation. Lancet Neurol. 2022 Jan;21(1):66\u0026ndash;77.\u003c/li\u003e\n \u003cli\u003eDobson R, Patterson K, Malik R, Mandal U, Asif H, Humphreys R, et al. Eligibility for antiamyloid treatment: preparing for disease-modifying therapies for Alzheimer\u0026rsquo;s disease. J Neurol Neurosurg Psychiatry. 2024 Sep 1;95(9):796\u0026ndash;803.\u003c/li\u003e\n \u003cli\u003eCooper C, Marshall CR, Schott JM, Banerjee S. Preparing for disease-modifying dementia therapies in the UK. Nat Rev Neurol. 2024 Nov;20(11):641\u0026ndash;2.\u003c/li\u003e\n \u003cli\u003eBrown S, Livingston G, Mukadam N. A National Memory Clinic Survey to Assess Provision for People from Diverse Ethnic Backgrounds in England and Wales. Int J Environ Res Public Health. 2021 Jan;18(4):1456.\u003c/li\u003e\n \u003cli\u003eHolden E, Stoner CR, Spector A. Cognitive stimulation therapy for dementia: Provision in National Health Service settings in England, Scotland and Wales. Dementia. 2021 Jul 1;20(5):1553\u0026ndash;64.\u003c/li\u003e\n \u003cli\u003eCok L. The 2019 national memory service audit.\u003c/li\u003e\n \u003cli\u003ewww.rcpsych.ac.uk [Internet]. [cited 2025 Jan 20]. Memory Services Spotlight Audit National Report. Available from: https://www.rcpsych.ac.uk/improving-care/ccqi/national-clinical-audits/national-audit-of-dementia/fifth-round-of-audit/memory-services-spotlight-audit-national-report\u003c/li\u003e\n \u003cli\u003eGOV.UK [Internet]. [cited 2025 Jan 19]. Living Well With Dementia: a national dementia strategy. Available from: https://www.gov.uk/government/publications/living-well-with-dementia-a-national-dementia-strategy\u003c/li\u003e\n \u003cli\u003ewww.rcpsych.ac.uk [Internet]. [cited 2025 Jan 20]. MSNAP standards. Available from: https://www.rcpsych.ac.uk/improving-care/ccqi/quality-networks-accreditation/memory-services-national-accreditation-programme-msnap/msnap-standards\u003c/li\u003e\n \u003cli\u003ewww.rcpsych.ac.uk [Internet]. [cited 2025 Jan 10]. List of MSNAP Members. Available from: https://www.rcpsych.ac.uk/improving-care/ccqi/quality-networks-accreditation/memory-services-national-accreditation-programme-msnap/list-of-members\u003c/li\u003e\n \u003cli\u003e2011 rural/urban classification - Office for National Statistics [Internet]. [cited 2025 Jan 19]. Available from: https://www.ons.gov.uk/methodology/geography/geographicalproducts/ruralurbanclassifications/2011ruralurbanclassification\u003c/li\u003e\n \u003cli\u003eNHS England Digital [Internet]. [cited 2025 Jan 19]. Primary Care Dementia Data, August 2024. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/primary-care-dementia-data/august-2024\u003c/li\u003e\n \u003cli\u003eVarbes [Internet]. [cited 2025 Feb 20]. England Demographics | Age, Ethnicity, Religion, Wellbeing. Available from: https://www.varbes.com/demographics/england-demographics\u003c/li\u003e\n \u003cli\u003ePosit [Internet]. [cited 2025 Feb 4]. Posit. Available from: https://www.posit.co/\u003c/li\u003e\n \u003cli\u003eThe qualitative content analysis process - Elo - 2008 - Journal of Advanced Nursing - Wiley Online Library [Internet]. [cited 2025 Jan 20]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2648.2007.04569.x?casa_token=A_XbpPkWBOAAAAAA%3AaxRnsJebRkBMwRQcTnwgA9ZMntwkx1xdM8McfCQTzvTLrAfFhNXUzwQLryUYQUyN3pQ7Y-L7SE2U00qq\u003c/li\u003e\n \u003cli\u003eEngland NHS. NHS England \u0026raquo; Dementia wellbeing pathway [Internet]. 2022 [cited 2025 Jan 20]. Available from: https://www.england.nhs.uk/publication/dementia-wellbeing-pathway/\u003c/li\u003e\n \u003cli\u003eBelder CRS, Schott JM, Fox NC. Preparing for disease-modifying therapies in Alzheimer\u0026rsquo;s disease. Lancet Neurol. 2023 Sep 1;22(9):782\u0026ndash;3.\u003c/li\u003e\n \u003cli\u003eThe King\u0026rsquo;s Fund [Internet]. [cited 2025 Feb 12]. The Role Of Integrated Care Systems In Improving Dementia Diagnosis. Available from: https://www.kingsfund.org.uk/insight-and-analysis/long-reads/role-integrated-care-systems-improving-dementia-diagnosis\u003c/li\u003e\n \u003cli\u003eIsaaq A, Cooper C, Vickerstaff V, Barber JA, Walters K, Lang IA, et al. Cost-utility of a new psychosocial goal-setting and manualised support intervention for independence in dementia (NIDUS-Family) versus goal setting and routine care: an economic evaluation embedded within a randomised controlled trial. Lancet Healthy Longev [Internet]. 2025 Feb 17 [cited 2025 Feb 20];0(0). Available from: https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00202-2/fulltext\u003c/li\u003e\n \u003cli\u003eMoon SY, Park YK, Jeong JH, Hong CH, Jung J, Na HR, et al. South Korean study to prevent cognitive impairment and protect brain health through multidomain interventions via face-to-face and video communication platforms in mild cognitive impairment (SUPERBRAIN-MEET): A randomized controlled trial. Alzheimers Dement [Internet]. [cited 2025 Jan 29];n/a(n/a). Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/alz.14517\u003c/li\u003e\n \u003cli\u003eNgandu T, Lehtisalo J, Solomon A, Lev\u0026auml;lahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet Lond Engl. 2015 Jun 6;385(9984):2255\u0026ndash;63.\u003c/li\u003e\n \u003cli\u003eParis A, Amirthalingam G, Karania T, Foote IF, Dobson R, Noyce AJ, et al. Depression and dementia: interrogating the causality of the relationship. J Neurol Neurosurg Psychiatry [Internet]. 2025 Jan 11 [cited 2025 Jan 29]; Available from: https://jnnp.bmj.com/content/early/2025/01/11/jnnp-2024-334675\u003c/li\u003e\n \u003cli\u003eJitlal M, Amirthalingam GNK, Karania T, Parry E, Neligan A, Dobson R, et al. The Influence of Socioeconomic Deprivation on Dementia Mortality, Age at Death, and Quality of Diagnosis: A Nationwide Death Records Study in England and Wales 2001\u0026ndash;2017. J Alzheimers Dis. 2021 Jan 1;81(1):321\u0026ndash;8.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Memory services, Health policy, Dementia, Mild Cognitive Impairment ","lastPublishedDoi":"10.21203/rs.3.rs-6322268/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6322268/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIn England, NHS memory services provide most dementia diagnostic and immediate post-diagnostic care. We aimed to co-design and conduct a survey regarding diagnostic and post-diagnostic care, and perceived readiness for new treatments.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eWe invited all memory services in England to complete the survey. We compared services by provider type, investigating whether service characteristics (provider type, rurality, region, referral rates, staffing mix, accreditation) were associated with diagnosis rates and psychological therapy provision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: 139/188 (73.9%) memory services participated, 130 (93.5%) provided by mental health/community and 9 (6.5%) by acute trusts. We estimated that English memory services receive 192,418 referrals/year, 98.7% to mental health/community trust services. In these services, the median annual referral rate was 100.8, 56.7-132.8 [95% Confidence Interval (CI)] per Full Time Equivalent [FTE] staff, of whom 14% (9-19%) were doctors). Acute trust-based services reported fewer referrals (45.8, 21.1-99.5) and had more doctors (33%, 23-43% FTE). More acute trust services felt ready to prescribe dementia Disease Modifying Treatments (N=8 [88.9%]) than mental health/community services (N=50, [41.7%]), while fewer acute trusts offered post-diagnostic psychological therapy routinely (N=5 [55%]) vs (N=100 [72.5%]) in community services. NHS region (β=0.700 [95% CI: 0.078, 1.322]) and rurality (β=2.142, [95% CI: 1.320, 2.964]) predicted lower diagnostic rates; regions with highest dementia diagnosis rates (67%+) had more memory service staff relative to the local aged 65+ population size.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eWe identified marked geographical inequalities. People in regions with less resourced memory services and rural areas had less access to timely diagnosis and care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u003c/strong\u003e Not applicable\u003c/p\u003e","manuscriptTitle":"A national survey of dementia diagnosis and care in English memory services","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 04:03:35","doi":"10.21203/rs.3.rs-6322268/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-24T13:05:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-03T11:28:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"2061208131150239348203388936487884266","date":"2025-05-21T09:07:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-18T18:30:31+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211880031323604788791361361840292920814","date":"2025-05-18T15:07:57+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-16T08:19:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-04-28T15:02:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-04-07T12:25:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-04-04T16:26:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-04-04T16:25:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d5f4b899-c0a3-42a6-9daf-24bd40ad5fde","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-02-23T16:08:20+00:00","versionOfRecord":{"articleIdentity":"rs-6322268","link":"https://doi.org/10.1186/s12877-026-07155-w","journal":{"identity":"bmc-geriatrics","isVorOnly":false,"title":"BMC Geriatrics"},"publishedOn":"2026-02-19 15:58:27","publishedOnDateReadable":"February 19th, 2026"},"versionCreatedAt":"2025-04-21 04:03:35","video":"","vorDoi":"10.1186/s12877-026-07155-w","vorDoiUrl":"https://doi.org/10.1186/s12877-026-07155-w","workflowStages":[]},"version":"v1","identity":"rs-6322268","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6322268","identity":"rs-6322268","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}