Persons living with dementia are at risk of becoming lost. While return discussions after missing incidents are common with children, these discussions are seldom done with persons living with dementia. Our objective was to describe the use of return discussions with persons living with dementia according to the literature and practice. We conducted a scoping review using 19 databases to locate scholarly and grey literature on return discussions, followed by 20 semi-structured interviews with first responders and service providers in Canada and the United Kingdom (UK). Eleven scholarly and 94 grey sources were included, most from the UK, related to missing children, none included persons with dementia. According to participants, although there was no standardized procedure, there were themes about conditions that facilitate return discussions. This was the first study to examine return discussion practice in dementia, and results can inform development of evidence-based protocols.

The implementation in Ontario of 15 primary-care–based interprofessional memory clinics represented a unique model of team-based case management aimed at increasing capacity for dementia care at the primary-care level. Each clinic tracked referrals; in a subset of clinics, charts were audited by geriatricians, clinic members were interviewed, and patients, caregivers, and referring physicians completed satisfaction surveys. Across all clinics, 582 patients were assessed, and 8.9 per cent were referred to a specialist. Patients and caregivers were very satisfied with the care received, as were referring family physicians, who reported increased capacity to manage dementia. Geriatricians’ chart audits revealed a high level of agreement with diagnosis and management. This study demonstrated acceptability, feasibility, and preliminary effectiveness of the primary-care memory clinic model. Led by specially trained family physicians, it provided timely access to high-quality collaborative dementia care, impacting health service utilization by more-efficient use of scarce geriatric specialist resources.

Following previous studies on the associations between aluminium (Al) water concentrations and relatively high risks of a measure of mental impairment, the role of silica (SiO2) as a possible confounding variable is investigated. The bivariate associations show that the lowest odds, representing an approximation of relative risks, are observed at “mild” SiO2 concentrations. Multivariate analyses indicate that, if interaction terms are included, the odds comparing higher and lower SiO2 concentrations are different than if an interaction term is not included. There are also indications that at relatively high Al levels, high SiO2 concentrations lower the odds, consistent with previous suggestions by Birchall. The implication is that when investigating the role of Al in the etiology of various measures of mental impairment, it is important to consider the effects of other water constituents, and also the different chemical forms of Al present in treated water. The desirability of additional work is stressed, preferably using more definitive outcomes than indications of mental impairment.