Social Policy, Sociology and Social Research

 

Professor Alisoun Milne

Professor of Social Gerontology and Social Work

School of Social Policy, Sociology and Social Research

Location:
G2.09
Gillingham Building
Chatham Maritime
Kent ME4 4AG

 

I am a Professor of Social Gerontology and Social Work at the University of Kent’s School of Social Policy, Sociology and Social Research. Read about the Health and Social Care research cluster.

My key research interests are: mental health in later life; family carers; long term care for older people; and social work with older people.

Career

I have been working at SSPSSR since 1995.  I’ve worked in two of the school’s research units - the Personal Social Services research unit and the Tizard Centre - before moving to the Social Work group as a Reader in 2010.

I have an extensive background in social work and social work management. For three years I was also a Visiting Fellow at the Nuffield Institute for Health at the University of Leeds (1998-2001). Since 2009, I have been an Honorary Research Fellow at Canterbury Christchurch University Dementia Services Development Centre.  

Education

I have a first degree from the University of Liverpool in Geography (1980) and a social work qualification from Goldsmiths College (1985). I also have an MA in Social Policy and Social Research and a PhD in Social Policy. 


 

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Also view these in the Kent Academic Repository
Articles

    Larkin, M. and Milne, A.J. (2014) Carers and Empowerment in the UK: A Critical Reflection. Social Policy and Society, 13 (01). pp. 25-38. ISSN 1474-7464.

    Abstract

    This article provides a critical reflection on carer empowerment in the UK, an issue which has received limited attention in policy and research. The arena is characterised by considerable conceptual confusion around key terminology, carer, care and caring, and by limited understanding of the meaning and outcomes of carer empowerment. Despite increased national acknowledgment of carers, a politically active carers' movement and a number of policies intended to enhance the recognition and rights of carers, many carers remain invisible and receive little support from services, to the detriment of their own health and well-being. Addressing these challenges, alongside developing a robust theoretical foundation for taking the ‘carers' agenda’ forward, is needed if carers are to move towards a more empowered status in the twenty-first century.

    Hamilton-West, K.E. and Rowe, J. and Katona, C. et al. (2013) A concordance therapy to help older people self-manage type 2 diabetes. Diabetes and Primary Care, 15 (5). pp. 240-248. ISSN 1466-8955.

    Milne, A.J. and Brigden, C.L. and Palmer, A.P. et al. (2012) The intersection of employment and care: evidence from a UK case study. European Journal of Social Work. ISSN 1369-1457(Print);1468-2664(Online).

    Abstract

    Working carers are a key focus of UK policies on health and social care and employment. Complementing national and European evidence, this paper presents a local case study of working carers. It draws on data from a county-wide survey containing a module on caring. Data were primarily categorical and were analysed using SPSS. Three quarters of all carers who responded to the survey were of working age: two thirds were employed and one third had been employed previously. The majority of working carers were mid-life extra-resident women. Over half of cared for relatives were elderly parents/in law; ‘physical illness’ was the primary cause of dependency. A tenth provided intensive care and half reported that caring adversely affected their health. Both were triggers for leaving employment. Two thirds of households received input from services and/or friends/family; being a co-resident carer appeared to mitigate against service allocation. Four issues were identified as pivotal to facilitating employment: access to advice and information, the availability of a matrix of affordable good-quality social-care services, ‘joined up’ needs assessment of the carer and cared for person, and employers identifying carers in their workforce. Europe's ageing profile underscores the study's timeliness.

    Milne, A.J. and Cambridge, P. and Beadle-Brown, J. et al. (2012) The characteristics and management of elder abuse: evidence and lessons from a UK case study. European Journal of Social Work, 16 (4). pp. 489-505. ISSN 1369-1457(Print);1468-2664(Online).

    Abstract

    Despite older people representing a significant majority of victims of abuse in the UK and Europe, evidence about its characteristics and management is limited. This article reports on an analysis of adult protection referrals for older people over an eight year period in two English local authorities. It extends understanding of the characteristics of elder abuse and identifies lessons for its effective management. Findings suggest that older people are at particular risk of multiple and physical abuse. Those living alone are especially vulnerable to financial abuse and those living in a care home to multiple abuse. The most common sites of abuse were the person's own home or a care home. Just two fifths of abuse referrals were confirmed, with the vast majority involving multi-agency consultation and most resulting in ongoing monitoring. Findings also suggest that risk is a product of the intersection of dependency and setting and that information about user and carer need—especially the nature of disability—could enhance the quality of adult protection data and safeguarding responses. The study underscores the need for adult protection legislation and of committing professional resources to the prevention, identification, assessment and management of elder abuse across Europe.

    Mackenzie, Robin and Batchelor, Rachel and Bobrowicz, Ania et al. (2012) Challenges of Ethical and Legal Responsibilities When Technologies’ Uses and Users Change: Social Networking Sites, Decision-Making Capacity and Dementia. Ethics and Information Technology, 14 (2). pp. 99-108. ISSN 1388-1957.

    Abstract

    Successful technologies’ ubiquity changes uses, users and ethicolegal responsibilities and duties of care. We focus on dementia to review critically ethicolegal implications of increasing use of social networking sites (SNS) by those with compromised decision-making capacity, assessing concerned parties’ responsibilities. Although SNS contracts assume ongoing decision-making capacity, many users’ may be compromised or declining. Resulting ethicolegal issues include capacity to give informed consent to contracts, protection of online privacy including sharing and controlling data, data leaks between different digital platforms, and management of digital identities and footprints. SNS uses in healthcare raise additional issues. Online materials acting as archives of ‘the self’ bolster present and future identities for users with compromised capacity. E-health involves actual and potential intersection of data gathered for the purpose of delivering health technological support with data used for social networking purposes. Ethicolegal guidance is limited on the implications of SNS usage in contexts where users have impaired/reduced capacity to understand and/or consent to sharing personal data about their health, medication or location. Vulnerable adults and family/carers face uncertainty in regard to consent, data protection, online identity and legal liabilities. Ethicolegal responsibilities and duties of care of technology providers, healthcare professionals, regulatory bodies and policymakers need clarification.

    Cambridge, P. and Mansell, J. and Beadle-Brown, J. et al. (2011) A study of adult protection referrals in two local authorities: An overview of findings for managers and practitioners. Journal of Adult Protection, 13 (5). pp. 238-250. ISSN 14668203.

    Abstract

    Purpose - The purpose of this paper is to report the key findings from a study of adult protection referrals collected by two English local authorities during 1998-2005.Design/methodology/approach - Referrals were analysed for patterns relating to risk with client level data supplemented by information from the local authority databases and from the Care Quality Commission. The analysis also examined associations between adult protection processes and outcomes and looked at how adult protection monitoring data could be improved to better inform safeguarding management and practice at local and national level.Findings - Sexual abuse was most frequently reported for people with intellectual disabilities, who were also at higher risk of abuse when living out of area. Older people were most at risk of financial abuse in community settings and of neglect in residential care.Originality/value - The study identifies patterns of risk in the abuse of older people and those with intellectual disabilities and informs preventive interventions. It also indicates priorities for improving the quality and comparability of adult protection monitoring data. © Emerald Group Publishing Limited.

    Milne, A.J. (2011) Living with dementia in a care home: Capturing the experiences of residents. Quality in Ageing and Older Adults, 12 (2). pp. 76-85. ISSN 14717794.

    Abstract

    Purpose - The purpose of this paper is to consider the experiences and perspectives of residents with dementia living in a care home. Design/methodology/approach - The paper reviews current sources of evidence about ''the care home experience'', including material drawn from: research instruments, interviews, observational methods and phenomenological research which aims to capture the lived experiences of residents. Findings - Research that is attempting to capture the lived experiences of residents further adds to the understanding of quality of life (QoL) and quality of care. Specifically, residents prioritise non-disease-related domains of QoL, which is somewhat different than those identified by relatives, care home staff and ''objective'' measures. Originality/value - Not only is it evident that residents are able to describe aspects of their situation but they appear to retain a sense of self and identity. There is a distinctive need for assessment of QoL amongst residents with dementia that places their subjective view of this concept at its core. © Emerald Group Publishing Limited.

    Wilkie, D. and Middleton, J. and Culverwell, A. et al. (2011) The aims, role and impact of an intermediate care service for people with dementia: Reflections on a conference workshop. Quality in Ageing and Older Adults, 12 (2). pp. 109-118. ISSN 14717794.

    Abstract

    Purpose - This article aims to describe the aims, role and impact of a specialist intermediate care service for people with dementia in Kent, entitled the Home Treatment Service (HTS). The authors reflect on two workshops about the service, delivered as part of the ''Dementia Care: A Positive Future'' conference held in May 2010. Design/methodology/approach - The 45 participants in the workshops included service roviders, professionals and family carers. The aimsand nature of the servicewere outlinedbymembers of the clinical team as: adopting a multi-professional approach, emphasising the value of a shared assessment process and having a commitment to flexible and intensive working within a person centred framework. Findings - Focusing on the HTS's work with care homes, presenters offered case illustrations to highlight its collaborative approach to working with service users, staff, managers and families to improve the quality of life for users presenting with ''challenging behaviour'' and preventing placement breakdown. Discussion with participants explored the obstacles and opportunities in working productively with care homes. The HTS's potential to reduce reliance on anti-psychotic medication was specifically highlighted. In addition to improving user and carer quality of life, outcomes of HTS intervention include a reduction in and quicker discharge from, mental health hospitals and maintainingthe person in their existing setting. Originality/value - The importance of including all parties - the older person with dementia, relatives, care staff and professionals - in co-creating ''solutions'' was identified as one the HTS's keys to success. © Emerald Group Publishing Limited.

    Cambridge, P. and Beadle-Brown, J. and Milne, A.J. et al. (2011) Patterns of Risk in Adult Protection Referrals for Sexual Abuse and People with Intellectual Disability. Journal of Applied Research in Intellectual Disabilities, 24 (2). pp. 118-132. ISSN 13602322.

    Abstract

    Background Adult protection monitoring data held by local authorities in England provide opportunities to examine referrals for alleged sexual abuse for people with intellectual disability to identify patterns of risk. Methods Adult protection monitoring data collected by two local authorities was analysed, with referrals for alleged sexual abuse compared to referrals for other types of abuse for people with intellectual disability and the wider research evidence. Results Over a fifth of referrals related to alleged sexual abuse, with two-thirds of these for women. Sexual abuse was confirmed in just over a quarter. Similarities were found with the findings of Brown et al. (Mental Handicap Research, 8, 1995:3) across a range of key characteristics. Conclusions Adult protection monitoring data can be used to provide risk management information on the sexual abuse of people with intellectual disability. To maximize its potential, detailed case characteristics need to be included and attention given to improving comparability between databases. © 2010 Blackwell Publishing Ltd.

    Milne, A.J. (2011) Commentary on Protecting my mother. Journal of Adult Protection, 13 (1). pp. 53-56. ISSN 14668203.

    Abstract

    Protecting my mother offers a moving account of a daughter's experiences of her mother's placement(s) in long term care and her exposure to poor care and/or abuse. The article highlights a number of the key features of the care of nursing home residents that need to addressed if standards are to improve and abuse become a rarity. The very dependent and frail nature of most residents renders them vulnerable to receiving poor care which may, if unchecked, become routinised abusive or neglectful practice. Risk is compounded for residents with dementia who often have limited communication skills and high levels of need. The fact that most residents are not known by care staff on admission is a primary challenge to offering good care, an issue that is compounded by a focus on tasks rather than relationships. The combined impact of dependency on staff for survival and having no, or few, opportunities for advocacy places residents in a profoundly powerless position to complain about mistreatment. This experience is mirrored by relatives. A primary deficit is that the emotional well-being of residents is given limited attention by the care home sector or agencies tasked with inspecting them. Raising the status of care home work; improving pay, conditions and training; and embedding person-centred values in care home practice are key to raising standards. Ensuring that all residents have access to an advocate and improving the capacity of safeguarding systems to address abuse in care homes are also important elements of reducing risk. © Pier Professional Ltd.

    Cambridge, P. and Beadle-Brown, J. and Milne, A.J. et al. (2011) Adult protection: The processes and outcomes of adult protection referrals in two english local authorities. Journal of Social Work, 11 (3). pp. 247-267. ISSN 14680173.

    Abstract

    This article examines the processes and outcomes of adult protection referrals in two local authorities in England using adult protection monitoring data collected between 1998 and 2005, identifying learning for the use and development of adult protection monitoring. â?¢ Findings: Associations were found between aspects of process and outcome in adult protection case management; police and regulatory agency involvement increased over time, over four-fifths of referrals resulted in investigations which were associated with higher levels of inter-agency involvement, abuse was confirmed for over two-fifths of referrals, there was significant territorial variation across a range of process and outcome measures and specialist adult protection coordinators were associated with higher levels of monitoring and post-abuse work. The study concluded that more work is needed to improve and standardize adult protection monitoring data if it is to more effectively inform case management and inter-authority comparisons. â?¢ Applications: The evidence from the study suggests that adult protection monitoring data can be used to help review and organize adult protection work at agency, team and case levels and is consequently of potential value to team managers, social workers and specialist co-ordinators working in adult protection.

    Hamilton-West, K.E. and Milne, A.J. (2010) Help-seeking in relation to signs of dementia: A pilot study to evaluate the utility of the common-sense model of illness representations. Psychology, Health and Medicine, 15 (5). pp. 540-549. ISSN 1354-8506.

    Abstract

    Despite the importance of early diagnosis of dementia, little is known about the factors underlying help-seeking in relation to signs of the condition. In this pilot study we aimed to examine the potential utility of the Common Sense Model (CSM) of illness representations for understanding lay perceptions of dementia and predicting intentions to seek help in relation to possible signs and symptoms. A secondary aim was to develop a measure of (dementia-related) illness representations as a tool for future research. After reading a vignette describing a ‘relative’ with mild or moderate dementia, participants (N=118) completed measures of illness representations and help-seeking intentions. Analyses compared perceptions of the mild and moderate vignettes and determined the extent to which illness perceptions differentiated between alternative forms of help-seeking (e.g. seeking professional help vs. help from family members). Results indicated that cognitive deficits were more readily identified as dementia than non-cognitive symptoms; these were commonly attributed to stress or depression. Participants were more likely to indicate an intention to seek professional help if they identified the problem in the vignette as dementia, perceived symptoms as severe, as having serious consequences and as likely to be permanent, but less likely to do so if they identified the problem as stress or attributed symptoms to psychological causes. Our preliminary data suggests that help-seeking may be prevented by inaccurate illness representations or misattribution of symptoms. The CSM may provide a useful framework for understanding perceptions of dementia symptoms and for informing help-seeking pathways.

    Hamilton-West, K.E. and Katona, C. and King, A.M. et al. (2010) Improving Concordance in Older People with Type 2 Diabetes (ICOPE-D). Final Report to the National Institute for Health Research. Annex A: Concordance Therapy Manual.

    Abstract

    The purpose of this research is to help patients to control their diabetes more effectively, by allowing them to develop a greater understanding of their condition and increase their confidence to keep to necessary behaviour changes such as appropriate diet and regular exercise. The method used here is based on an ‘adherence therapy’ manual originally developed to help older people comply with their antidepressant medication. We think that this approach can be adapted to improve the extent to which people with diabetes stick to their treatment plans. We have selected this group of patients because diabetes presents a significant challenge, both to the patient and healthcare system. Diabetes is also increasingly common in the ageing population and can increase the risk of other serious conditions such as heart disease and stroke. If people can control their diabetes effectively, the risk of complications and further health problems can be reduced. In this study we compare patients’ ability to control their diabetes before and after therapy by looking at blood test results and rating-scale scores. If the treatment is effective, we plan to conduct a larger study in which patients receiving adherence therapy will be compared with patients having usual treatment only. The larger study would also allow us to see if any changes are maintained over the long-term.

    Beadle-Brown, J. and Mansell, J. and Cambridge, P. et al. (2010) Adult protection of people with intellectual disabilities: incidence, nature and responses. Journal of Applied Research in Intellectual Disabilities, 23 (6). pp. 573-584. ISSN 13602322.

    Abstract

    There has been increasing recognition of the importance and extent of abuse of vulnerable adults, including people with intellectual disabilities, leading to the development of monitoring systems. This paper reports findings from one of the largest databases in the UK collected between 1998 and 2005.Method Analysis of the 1926 referrals relating to people with intellectual disabilities included description of the nature of abuse and the responses to the referrals, comparisons to those relating to other client groups and comparisons between those placed locally and those placed out-of-area. Results About one-third of all adult protection referrals related to people with intellectual disability, remaining consistent over time. However, the number of referrals increased significantly. The majority of people lived in residential care or supported living and this was reflected in the nature of the referrals – people were more likely to have been abused in the care home and by staff or service users than those without an intellectual disability. The most common type of abuse was physical abuse. Sexual abuse was more prevalent in the intellectual disability sample than in other client groups. People with intellectual disability were more likely to have experienced follow-up action, usually through more monitoring. There was a different pattern of abuse seen in those placed out-of-area. The overall pattern of abuse is similar to that reported in earlier studies. There is some indication that residential situation and in particular being placed in a residential placement out-of-area, may be an important factor in predicting adult protection referrals.

    Milne, A.J. (2010) Dementia Screening and Early Diagnosis: the case for and against. Health, Risk & Society, Special Issue:Risk and Screening, 12 (1). pp. 65-76. ISSN 1369-8575.

    Abstract

    Over 700,000 people have dementia in the UK. There is increasing policy and practice consensus that early intervention in identifying and treating dementia is beneficial and that much can be done therapeutically and practically to help users and their relatives at an early stage. Research evidences early diagnosis as allowing users the chance to come to terms with it when they can still understand its implications. It also provides an opportunity for key decisions to be made and is what the majority of people want. However, early diagnosis also carries risks: loss of status, acquisition of a stigmatising label, loss of employment and, for a minority, depression. Not all users want to know they have dementia; the diagnosis may also be incorrect. Evidence from the field of medical sociology offers a different perspective on the early intervention debate suggesting not only that targeting ‘well’ older people at possible risk of dementia may be the latest product of surveillance medicine but that efforts to resist being diagnosed may represent strategies to challenge medical intrusion, knowledge and power. Further, the imposition by an older person and their family of their individualised values onto the clinical encounter may be viewed as an attempt to import user generated forms of knowledge into a medically managed process and provide a nuanced approach to defining, and dealing with, risks. Accommodating both perspectives in practice development may hold considerable potential to enhance the nature of care and the quality of lives of people with dementia and their families.

    Milne, A.J. (2010) The D word: Reflections on the Relationship between Stigma and Dementia. Journal of Mental Health, 19 (3). pp. 227-233. ISSN 0963-8237.

    Abstract

    The author reflects on the impact of dementia amongst older people. The author mentions that dementia is a major health related problem in the developed countries. The author mentions that according to a statistics around 700,000 people in Great Britain are suffering from dementia and it is expected to cover around 1.7 million people by the year 2050. The author further discusses the reluctance of the society to help people suffering from dementia.

    Mansell, J. and Beadle-Brown, J. and Cambridge, P. et al. (2009) Adult protection: incidence of referrals, nature and risk factors in two English local authorities. Journal of Social Work, 9 (1). pp. 25-40. ISSN 1468-0173.

    Abstract

    Summary This study focused on the incidence of adult protection referrals, the people involved as victims, perpetrators and referrers and the type of abuse in two local authorities in the south-east of England. Findings The number of referrals increased over time; those for older people stabilised but those for younger adults were still rising. There was a clear association between location or setting, perpetrator and type of abuse. A referral about someone living in a care home was more likely to identify abuse by multiple staff and institutional abuse or neglect, especially if the individual was an older person with mental health problems. People with learning disabilities were more likely to experience sexual abuse, mainly from other service users or members of their family. Those living in a private home with others, primarily relatives, tended to be at risk of financial, physical or psychological abuse. Older people living alone were particularly vulnerable to financial abuse by family members or, less frequently, home care workers. Applications This study suggests that well-developed adult protection procedures identify many more cases than previously estimated. Further research is needed to explain the low level of referrals from mental health services and variation between territories.

    Seabrooke, V. and Milne, A.J. (2009) Early intervention in dementia care in an Asian community: Lessons from a dementia collaborative project. Quality in Ageing and Older Adults, 10 (4). pp. 29-36. ISSN 14717794.

    Abstract

    The number of older Asians in the UK is increasing placing greater numbers at risk of developing dementia. The emerging need to address early diagnosis is especially prominent in areas where Asian communities are long established. This was the specific focus of a Dementia Collaborative Project in North West Kent. The project, working through a primary care practice, aimed to raise awareness of dementia and to facilitate early intervention and access to specialist dementia services. Using an evaluation methodology adopted by the Collaborative and working through a multiagency steering group, the pilot project successfully identified an appropriate primary care practice, established a link with a specially trained Asian nurse and devised a set of project materials. By inviting older Asian patients with memory problems to make an appointment with the nurse, and enclosing a culturally relevant information leaflet, older people were encouraged to come forward. Although the number of individual patients identified was small, the project outcomes include: significantly increased referral rates from black and minority ethnic communities to specialist services and greater awareness of dementia-related issues in both primary care and Asian care services. Overall, the evaluation suggests that by engaging with a committed primary care practice it is possible to engage a hitherto marginal group of older people in early intervention in dementia and raise awareness about its benefits. That this approach underpins the development of a larger scale five year project in the same area additionally endorses its relevance for the mainstream population. © Pier Professional Ltd.

    Milne, A.J. and Dening, T. (2009) Editorial: Depression, Suicide and Self-Harm in Older Adults. Quality in Ageing (Special Issue), 10 (2). pp. 2-4. ISSN 1471-7794.

    Abstract

    This special issue of Quality in Ageing contains a range of expert papers drawn from a conference held in London in September 2008. The papers address several interlinked subjects that will be of interest to a wide audience, including older people, family carers and health and social care practitioners working with older people whose mental health is at risk. All of the papers are clinically informed, evidence based and situated at the intersection of mental distress, ageing and care practice. Taken together, they will help to advance our thinking and shed new light on key components of the care system alongside deepening understanding of mental health need and current approaches to understanding and supporting older people with mental illness. The fact that the contributors bring a wealth of personal and/or professional experience to their subjects is an additional strength.

    Dening, T. and Milne, A.J. (2009) Depression and mental health in care homes for older people. Quality in Ageing (Special Issue), 10 (1). ISSN 1471-7794.

    Abstract

    About five per cent of – generally very frail – older people live in long-term care in the UK; approximately a fifth of all deaths occur in care homes. Depression and dementia are prevalent mental health conditions in care homes; depression is reported in around a third of residents and dementia in two thirds. While there is some evidence about efficacy of medication in treating psychiatric and behavioural symptoms among residents, much less is known about the potential role of psychosocial interventions in enhancing mental health and quality of life. Quality of care varies widely across the carehome sector including support from primary and specialist health and quality and level of training. In terms of enhancing care quality, there is evidence that investing in staff training and conditions, establishing good links with healthcare providers, and developing care standards that genuinely promote good practice are likely to improve resident quality of life. This is an exciting area for research development and practice innovation for the future; taking account of users perspective, holds particular potential.

    Livingston, G. and Cooper, C. and Woods, J. et al. (2008) Successful ageing in adversity: the LASER-AD longitudinal study. Journal of Neurology Neurosurgery and Psychiatry, 79 (6). pp. 641-645. ISSN 0022-3050.

    Abstract

    Background: Most models of successful ageing do not allow for the possibility of living '' successfull,'' despite some degree of cognitive or physical impairment. We reviewed the successful ageing and related quality of life literature to identify their potential predictors. We then tested our hypotheses that wellbeing in adversity would be predicted by mental health (anxiety and depression) and social factors rather than physical health and that it would be stable over time. Method: We interviewed 224 people with Alzheimer's disease (AD) and their family carers, recruited to be representative of those living with AD in the community. We re-interviewed 122 (73.1% of eligible) participants 18 months later. Our main outcome measure was the perception of the person with AD on their life as a whole. Results: Mean '' wellbeing in adversity '' scores did not change significantly over time (t= 0.23). Social relationships, subjective mental health, health perception, activities of daily living and baseline wellbeing in adversity were the significant correlates of wellbeing in adversity on univariate analysis. Only baseline wellbeing in adversity and mental health score were significant predictors in our regression analysis. In a well fitting structural equation model, less severe dementia and better health perception predicted fewer mental health problems and social relationships, but were not direct predictors of wellbeing in adversity at 18 months. Conclusion: Successful ageing was common among a cohort of people with dementia. The most important predictors of this were mental health and social relationships, which fully mediated the relationship we found between health perception and wellbeing 18 months later.

    Beadle-Brown, J. and Mansell, J. and Cambridge, P. et al. (2008) Adult protection alerts for people with intellectual disabilities: Patterns of risk. Journal of Intellectual Disability Research, 52 (8-9). pp. 788. ISSN 0964-2633.

    Abstract

    Aims: The study explored monitoring data from adult protection alerts collected by two local authorities in England between 1998 and 2005. This paper examines the data relating to people with intellectual disabilities to identify the nature, location and patterns of abuse. Method: Additional client information was imported from other client databases and integrated into a single database. The data for people with intellectual disabilities was then analysed in order to ascertain associations and patterns in the data. Results: The specific vulnerabilities of people with intellectual disabilities to abuse were identified in relation to the type and location of abuse, the perpetration of abuse, outcomes and responses. People with intellectual disabilities placed by other authorities were also found to be at a higher risk from multiple abuse and abuse from more than one perpetrator than those placed locally but with abuse more likely to be investigated and action more likely to be taken. Conclusions: Distinct patters are discernable in the abuse of people with intellectual disabilities and people in out of authority placements are more vulnerable to particular forms and types of abuse, information helpful for risk management in this area of policy and practice.

    Healey, F. and Oliver, D. and Milne, A.J. et al. (2008) The effect of bedrails on falls and injury: a systematic review of clinical studies. Age and Ageing, 37 (4). pp. 368-378. ISSN 0002-0729.

    Abstract

    Background: around one-fourth of all falls in healthcare settings are falls from bed. The role of bedrails in falls prevention is controversial, with a prevailing orthodoxy that bedrails are harmful and ineffective. Objective: to summarise and critically evaluate evidence on the effect of bedrails on falls and injury Design: systematic literature review using the principles of QuoRoM guidance. Setting and Subjects: adult healthcare settings Review Methods: using the keyword, bedrail, and synonyms, databases were searched from 1980 to June 2007 for direct injury from bedrails or where falls, injury from falls, or any other effects were related to bedrail use. Results: 472 papers were located; 24 met the criteria. Three bedrail reduction studies identified significant increases in falls or multiple falls, and one found that despite a significant decrease in falls in the discontinue-bedrails group, this group remained significantly more likely to fall than the continue-bedrails group; one case-control study found patients who had their bedrails raised significantly less likely to fall; one retrospective survey identified a significantly lower rate of injury and head injury in falls with bedrails up. Twelve papers described direct injury from bedrails. Discussion: it is difficult to perform conventional clinical trials of an intervention already embedded in practice, and all included studies had methodological limitations. However, this review concludes that serious direct injury from bedrails is usually related to use of outmoded designs and incorrect assembly rather than being inherent, and bedrails do not appear to increase the risk of falls or injury from falls.

    Milne, A.J. and Culverwell, A. and Guss, R. et al. (2008) Screening for dementia in primary care: a review of the use, efficacy and quality of measures. International Psychogeriatrics, 20 (5). pp. 911-926. ISSN 1041-6102.

    Abstract

    Background: Despite evidence that early identification of dementia is of growing policy and practice significance in the U.K., limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice-based evidence on the utility efficacy and quality of dementia screening measures. Method: The study has three elements: a review of research literature, a small-scale survey of measures employed in three primary care trusts, and a systematic clinical evaluation of the most commonly used screening instruments. The study integrates data from research and clinical sources. Results: The General Practitioner Assessment of Cognition (GPCOG), the Memory Impairment Screen (MIS), and the Mini-Cognitive Assessment Instrument (Mini-Cog) were found to be brief, easy to administer, clinically acceptable, effective, and minimally affected by education, gender, and ethnicity. All three have psychometric properties similar to the Mini-mental State Examination (MMSE). Conclusions: Although the MMSE is widely used in the U.K., this project identifies the GPCOG, MIS and Mini-Cog as clinically and psychometrically robust and more appropriate for routine use in primary care. A coherent review of evidence coupled with an indepth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

    Culverwell, A. and Milne, A.J. and Guss, R. et al. (2008) Screening for dementia in primary care: how is it measuring up? Quality in Ageing and Older Adults, 9 (3). pp. 39-44. ISSN 14717794.

    Abstract

    Despite evidence that early identification of dementia is of growing policy and practice significance in the UK, limited work has been done on evaluating screening measures for use in primary care. The aim of this paper is to offer a clinically informed synthesis of research and practice-based evidence on the utility, efficacy and quality of dementia screening measures. The study has three elements: a review of research literature; a small-scale survey of measures employed in three primary care trusts; and a systematic clinical evaluation of the most commonly used screening instruments. The authors integrated data from research and clinical sources. The General Practitioner Assessment of Cognition (GPCOG), Memory Impairment Screen (MIS) and Mini-Cognitive Assessment Instrument (Mini-Cog) were found to be: brief; easy to administer; clinically acceptable; effective; minimally affected by education, gender, and ethnicity; and to have psychometric properties similar to the Mini Mental State Examination (MMSE). Although the MMSE is widely used in the UK, this project identifies the GPCOG, MIS and Mini-Cog as more appropriate for routine use in primary care. A coherent review of evidence coupled with an in-depth evaluation of screening instruments has the potential to enhance ability and commitment to early intervention in primary care and, as part of a wider educational strategy, improve the quality and consistency of dementia screening.

    Milne, A.J. and Hatzidimitriadou, E. and Wiseman, J. (2007) Health and quality of life among older people in rural England: Exploring the impact and efficacy of policy. Journal of Social Policy, 36 (Part 3). pp. 477-495. ISSN 0047-2794.

    Abstract

    There is increasing evidence that characteristics of place influence health and that the dimensions of rurality interlock with the process of ageing to produce a number of distinctive patterns. For the rising number of older people living in rural England, it is clear that, overall, the countryside promotes the health and wellbeing of the newly retired, fitter cohort who have access to financial and community resources. However, it carries a number of risks for elders who are frail, deprived or isolated; inequalities combine to undermine health and deepen exclusion. The efficacy of policy in taking account of the needs of rural elders is uneven. Analysis of the three most pivotal policy arenas - rurality, ageing and health, and community development suggests that while some initiatives do promote quality of life, significant limitations remain. Further, the overarching policy response is incoherent and fragmented. Key deficits relate to resource allocation, limited recognition of rural disadvantage, and minimal incorporation of the perspectives of rural elders. That the majority of policy is rurally blind is a fundamental challenge; for rural elders to benefit from policy investment, a systemic shift is required in the mechanisms that steer its development, funding and implementation.

    Milne, A.J. and Chryssanthopoulou, C. (2005) Dementia care-giving in black and Asian populations: refining the research agenda. Journal of Community and Applied Social Psychology, 15. pp. 319-337.

    Hatzidimitriadou, E. and Milne, A. (2005) Planning for the future: meeting the needs of older people with intellectual disabilities. Dementia, 4 (3). pp. 341-359.

    Milne, A. and Hatzidimitriadou, E. and Wiseman, J. (2005) Aging in the English Countryside: Is it Good or your Health? Social Policy and Administration, tbc. pp. tbc-tbc. (submitted)

    Milne, A.J. and Hamilton-West, K.E. and Hatzidimitriadou, E. (2005) GP Attitudes to Early Diagnosis of Dementia: Evidence of Improvement. Aging and Mental Health, 9 (5). pp. 449-455. ISSN 1360-7863.

    Abstract

    This paper offers a comparative analysis of GPs attitudes towards early diagnosis of dementia in 1997 and 2001. It draws on data from two studies conducted in the same area using the same research instrument. Overall, findings reveal a significantly greater commitment to early diagnosis at Time 2 than at Time 1. More GPs hold positive attitudes and consider early diagnosis to facilitate a number of practical and therapeutic benefits for users and carers. Further, fewer GPs regard early diagnosis as having negative consequences. Findings also support existing evidence about attitudes being underpinned by drivers and barriers. Those GPs who are committed regard it as an opportunity to offer preventive treatment and plan for the future; barriers include limited treatment options. Primary reasons for the attitudinal shift are greater accessibility of psychiatric colleagues, additional investment in support services, and enhanced policy and clinical emphasis on the value of early diagnosis.

    Milne, A.J. and Hatzidimitriadou, E. and Chryssanthopoulou, C. (2004) Carers of Older Relatives in Long Term Care: Support Needs and Services. Generations Review, 14 (3). pp. 4-9. ISSN 0965-2000.

    Milne, A.J. and Hatzidimitriadou, E. (2003) Isn't he wonderful? Exploring the contribution and conceptualisation of older husbands as carers. Ageing International, 28 (4). pp. 389-407. ISSN 0163-5158.

    Abstract

    This paper explores the relationship between the dimensions of a debate cited at the intersection of ageing, gender, and family care. It draws together evidence from the General Household Survey for Britain 2000 and social research to explore the contribution and conceptualization of caring by older husbands. UK research on caring reveals that among older spouses, equal numbers of husbands and wives provide intensive care. It has been argued that within late-life marriage an over-riding desire to retain independence erodes gender-determined task allocation, suggesting not only similarity but equality between wives and husbands as carers. More recent qualitative research challenges this assumption and suggests two key findings: that older husbands are motivated to care by a combination of marital duty and reciprocal love, and that they manage the tasks of caring within an instrumental framework. Further, it is clear that pre-existing gender relations continue to be powerful determinants of the experience of caring, and that marital power is retained by men in late-life marriage. Overall, the caring contribution of older husbands is imbued with positive meaning, is highly valued, and offers a distinctive role and identity; this contrasts sharply with the caring experiences of older wives.

    Milne, A.J. and Hatzidimitriadou, E. (2002) The Caring in Later Life report: A secondary analysis of the 1995 General Household Survey. Quality in Ageing – Policy, practice and research, 3 (3). pp. 3-15. ISSN 1471-7794.

    Milne, Alisoun and Woolford, H.H. and Mason, J. et al. (2000) Early diagnosis of dementia by GPs: an exploratory study of attitudes. Aging and Mental Health, 4 (4). pp. 292-300. ISSN 1360-7863.

    Abstract

    The capacity of early diagnosis of dementia to facilitate effective treatment and care is well established. The pivotal role of the GP has also been identified by research, although accuracy in detecting and diagnosing dementia at an early stage varies considerably. Despite the likely influence of attitude on practice, little is known about GP attitudes towards early diagnosis. This study collected attitudinal data, and supplementary commentary, from nearly 60% of GPs in one health authority. The research suggests consistency between belief in the value of early diagnosis and reported practice. Specifically, results reveal that three variables significantly predict practice-a belief there are benefits to patients from early diagnosis, a belief that negative outcomes may result from a failure to diagnose early and the accessibility of local support services. Overall, the study found that 40% of GPs hold positive views and 20% hold negative views towards early diagnosis. These views are underpinned by specific 'drivers' and 'barriers'. The study concludes that if GPs are to extend their commitment to early diagnosis, development work needs to focus on investing in the training and resources, which facilitate practice, and challenging attitudinal barriers, which undermine it.

Book Sections
Research Reports

    Vickerstaff, Sarah and Loretto, Wendy and Milne, Alisoun et al. (2009) Employment support for carers. Department for Work and Pensions, 182 pp. ISBN 9781847126306.

    Abstract

    This report presents the findings of a qualitative research study, commissioned by the Department for Work and Pensions (DWP) in April 2008, to examine and understand what employment support is needed for carers in order for them to take up and remain in work. Many carers who are not currently working would like to do so and the DWP is keen to understand the support they require to achieve this. The background to the project is the DWP’s aim to promote work as the best form of welfare for people of working age by ensuring that work is seen as the best way out of poverty, while protecting the position of those in greatest need. This summary provides an overview of the research findings and the policy implications of the study.

Monographs

    Palmer, A.P. and Milne, A.J. and Hastie, C.L. (2008) Caring in Kent: Patterns and Profiles, Evidence from the Kent Health and Lifestyle Survey, 2005. project_report. Centre for Health Services Studies and Tizard Centre, Canterbury

    Abstract

    The ‘Caring in Kent’ report draws on the results of a Kent wide ‘Health and Lifestyle Survey’ conducted in 2005; this included a module on caring. This enables a picture of caring to be reported including: a general profile of carers, levels and types of care-giving, carers’ health, and the level and types of support they receive. ‘Carers provide unpaid care by looking after an ill, frail or disabled family member, friend or partner’. The increasingly recognised importance of the role of the ‘informal carer’ is - in good part - due to the rising proportion of older people in the UK population. Not only do people live longer but many experience a number of chronic conditions; these require support from family members if the older person is to remain living in the community.

    Palmer, A. and Milne, A. and Hastie, C.L. (2008) Caring in Kent: Summary ReportEvidence from the Kent Health and Lifestyle Survey, 2005. project_report. Centre for Health Services Studies, University of Kent, Canterbury

    Abstract

    The 2005 `Kent Health and Lifestyle Survey' conducted by the Centre for Health Services Studies and commissioned by Kent County Council, contained a specific module on carers adapted from the national General Household Survey, 2000. This short summary report summarizes the findings from the main report on the carers module: Caring in Kent: Patterns and Profiles. The report offers a review of the epidemiology, characteristics and needs of family carers in Kent drawing on analysis of data from the survey. It focuses its analysis and commentary in four key areas: a general profile of carers in Kent levels and types of caregiving carers' health including the impact of caring support from formal and informal sources It also offers analysis of data around specific groups of carers including mid life carers, older carers and co resident carers.

Conference Items

    Milne, A.J. and Hatzidimitriadou, E. and Hamilton-West, K.E. (2004) GP Attitudes to Early Diagnosis of Dementia: Evidence of Improvement. In: The Annual Conference of the British Society of Gerontology, September 9-11, 2004., Surrey. (unpublished)

    Abstract

    This paper offers a comparative analysis of GPs attitudes towards early diagnosis of dementia in 1997 and 2001. It draws on data from two studies conducted in the same area using the same research instrument. Overall, findings reveal a significantly greater commitment to early diagnosis at Time 2 than at Time 1. More GPs hold positive attitudes and consider early diagnosis to facilitate a number of practical and therapeutic benefits for users and carers. Further, fewer GPs regard early diagnosis as having negative consequences. Findings also support existing evidence about attitudes being underpinned by drivers and barriers. Those GPs who are committed regard it as an opportunity to offer preventive treatment and plan for the future; barriers include limited treatment options. Primary reasons for the attitudinal shift are greater accessibility of psychiatric colleagues, additional investment in support services, and enhanced policy and clinical emphasis on the value of early diagnosis.

Reviews

    Milne, A.J. and Williams, J. (2000) Meeting the mental health needs of older women: taking social inequality into account. Ageing and Society, 20. pp. 699-723. ISSN 0144-686X.

    Abstract

    Whilst there is increasing acceptance that social inequalities have implications for mental health, there is minimal acknowledgement of their effects on the development and treatment of mental ill health in older people. This paper focuses on older women, as they are the majority sufferers of mental illness in later life, and are particularly vulnerable to the cumulative effects of lifelong and age-related inequalities. The authors, who draw upon literature from the fields of gerontology and mental health, argue that for effective care to be developed, older women's mental ill health needs to be seen within the context of their past and present experience of social inequalities. Evidence particularly relates to socio-economic disadvantages as well as to the consequences of discrimination. It is argued that psychological vulnerability is further compounded by the gendered effects of social policy, and by a care system which constructs mental health needs as unrelated to oppression, and dislocated from their economic, social and historical roots. Finally, the authors outline the key components of a care and service system which takes account of social inequalities, and which accords centrality to the experiences, views and opinions of older women with mental health problems.

    Milne, A. (1997) Good practice in risk assessment and risk management. Review of: Good Practice in Risk Assessment and Risk Management by Kemshall, H. and Pritchard, J. Social Work & Social Sciences Review, 7 (3). pp. 189-190. ISSN 0953-5225.

Total publications in KAR: 42 [See all in KAR]
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Research interests

My key research interests are: mental health in later life; family carers; long term care for older people; and social work with older people.

Current


My current work focuses on late life caring, particularly former carers; quality of life - and care - of people living with dementia in a care home; and social work with older people.

Recent

  • An ESRC seminar series, 'Carers in the 21st Century'
  • A systematic review of the identity of carers whose relative in in long term care
  • A study of working carers
  • Analysis of adult protection data for Kent and Medway Social Services Departments
  • A ground breaking review of dementia screening instruments
  • An evaluation of a psycho-educational support service for relatives of people with early stage dementia, and
  • A review of psychosocial well being in people with an early diagnosis of dementia.

Other work includes contributions to professional training and good practice guidance including authoring a set of e-learning objects for the Social Care Institute for Excellence entitled an ‘Introduction to the Mental Health of Older People’. I have received funding from a range of sources including the Department of Health, the Mental Health Foundation, the Department for Work and Pensions, and the Nuffield Foundation.  

Past


Between August 2000 and January 2004, I was seconded for two days a week to the Mental Health Foundation, a UK-wide charity based in London.

My remit was to co-lead the development of a programme of research and service development in “Mental Health & Later Life”. Projects included: an evaluation of a nation-wide scheme of early intervention services for people with dementia and an analysis of the support needs of older Asians with dementia in north west Kent.

Supervision

I am seeking a PhD student to further develop work particularly in the field of family care, care homes and social work with older people. I am also happy to explore other issues. Particular foci include: “becoming” or developing into a “carer”, the promotion of self and identity amongst care home residents with dementia, mealtimes and care homes, and the role and efficacy of social work with older service users and their families.

If you have a proposal in these areas and you are interested in studying at the University of Kent, please contact me to discuss further.

 


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Current

I teach on the BA and MA in Social Work based at the University’s Medway campus.

My teaching is primarily focused on ageing, mental health and later life, caregiving and age and care-related policy and services.


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Memberships

  • Registered with the Health and Care Professionals Council
  • Member of the National Health and Clinical Excellence Quality Standards Topic Expert Group: Social care for people with dementia (2011/12)
  • Member of the Standing Commission on Carers (2009-)
  • Member of the British Society of Gerontology Executive Committee (2009-)
  • Trustee of a Kent-based dementia charity.
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Telephone: +44(0)1227 823072 Fax: +44(0)1227 827005 or email us

SSPSSR, Faculty of Social Sciences, Cornwallis North East, University of Kent, Canterbury, Kent CT2 7NF

Last Updated: 23/01/2014