The present paper describes and traces the emergence of an innovative psychoeducational model of support for family caregivers of dependent elderly persons, its associated systematic evaluation and leadership training process, provides details of a small group programme and its underlying philosophy, and reports on outcome evaluation research ascertained from both quantitative and qualitative data analyses. Details of these analyses are presented within the context provided by a three-level model of support, which recruits and trains professionals from a range of disciplines to help families in caregiving situations. The 72 treatment and 29 waiting-list control subjects were assessed at pretreatment and at posttest on measures of anxiety and psychological well-being. Statistically significant differences emerged between the treatment and waiting-list control groups on these measures. Positive changes for programme participants were further demonstrated by contextual analysis of evaluative responses. Implications for practitioners, educators, and policy specialists, as well as for research and programme development are discussed.

This paper describes where elderly people with moderate to severe (‘advanced’) cognitive impairment are living, what resources they use and the costs of these services to different funding agencies. It operationally defines dementia in terms of cognitive impairment and uses the OPCS disability surveys to estimate the prevalence of moderate to severe cognitive impairment in England. The paper goes on to describe services received by this client group on the basis of the same surveys, and costs these by supplementing the data with information from related studies by the PSSRU. Since accommodation is a major cost, the population of elderly people with cognitive impairment is classified according to their place of residence. Thus we are able to estimate the ‘baseline’ global cost of provision for this client group at current prices. We make cost projections at 1991/92 price levels to the national level, and discuss the implications in terms of burdens to different agencies.

A description of the microstructure of interpersonal processes is developed, based on the analysis of interaction as a succession of reflexive triadic units. This account can be modified in some aspects so as to provide a detailed theory of the process of dementia care. The theory is particularly relevant to moderate and severe dementia, and to formal care settings. A key concept is that of facilitation. The idea of a ‘culture of dementia’ is explored. Cautiously optimistic conclusions are reached about the possibilities for enabling dementia sufferers to remain in a state of relative well-being.

After noting the centrality of local authority homes for older people in British research on institutionalisation, influential research undertaken in this setting during the 19803 is reviewed. Three problems are identified in this current of research. Firstly, the assumption that there is a uniform process of institutionalisation is questioned. Secondly, the lack of comparative studies is highlighted. Thirdly, the absence of the structured dependency thesis is regarded as indicative of the lack of attention paid to social divisions. In conclusion, it is suggested that the concept of institutionalisation may have outlived its usefulness and that an alternative approach needs to be developed which is capable of focusing on the degree of dependency, independence and interdependence existing in a range of care settings.

The article reports on a study which explored the relationship female undergraduates and student nurses experienced with their maternal and paternal grandmothers. In addition, the article identifies some of the factors closely associated with the relationship, considers the role played by grandmothers with regard to their granddaughters and examines differences in granddaughters' perceptions of maternal and paternal grandmothers. The results highlight the intimate relationship between granddaughter and grandmother. When compared to paternal grandmothers, maternal grandmothers were perceived by granddaughters to be emotionally closer, provide a greater sense of security, be more influential in shaping their beliefs and were more likely to be preferred. They were also found to play a more active role in granddaughters' lives.