Dementia is a syndromal concept. It is characterized by acquired and often progressive cognitive deficits, including impairment of memory and new learning, together with additional changes in aspects of personality. Although seen in some people in middle age, it becomes more common in very late life (20% plus in 80+ age groups) where differentiation from the natural, non-pathological aspects of ageing may be difficult or controversial. The categorical ‘diagnosis’ of dementia is in reality based on arbitrarily set cut-offs of function measured on valid and reliable scales and reflecting an accumulation of underlying pathologies, the most common of which is Alzheimer change, followed by cerebro-vascular disease, Lewy Body disease and Fronto-temporal dementia.

Whilst most people prefer to live in their own private household throughout life, dementia so undermines personal competence that 40% percent of people with dementia are housed in residential or nursing homes at any one time and more than 70 percent will be in institutional care at the time of dying.

Whist health and social care needs have been met over many centuries by faith organizations, the tradition of Health and Social Care in the UK provided by Government and Local Government, has largely excluded the spiritual dimension of health and illness from consideration in recent decades. It is absent from training and has been all-but taboo in practice. Yet personal spirituality is central to the experience and quality of life for the majority of individuals and for many this is framed within a system of faith belief and practices. These are particularly exercised at times of stress, including illness which produces altered self image and competence and carries the prospect of departure and death.

Sarah Mullally (now Reverend Dame) did a great deal during her nursing career to encourage the re-introduction of respect and knowledge of spirituality and faith within health care.

Neil Moreland considers the phenomenon of dementia and its impact on individuals and their carers from the perspective of those who cherish their spirituality and that of others, but do so without a framework in a Faith.

Clive Baldwin addresses the use of language associated with spiritual experience and faith and relates this to approaches which encourage holistic and person-centred care in dementia. Explorations of these may lead us some way toward a better understanding of the nature of spirituality and its relationship to faith and religious belief.

Rob Merchant has researched Judeo-Christian approaches to the care and ministry of vulnerable and impaired older people from antiquity – seeking to glean lessons learned which might be transferable into a modern context and understanding of the scenarios.

Richard Allen looks at the present range of spirituality and faith as represented amongst older people and families living in the UK. This includes a range of Faiths and Religions as well as a spectrum of spirituality/non-spirituality and Faith/non-Faith with intergenerational schisms.

Our questions:

• How do these affect understandings of the experience of dementia and dementia care?
• How are these to be interpreted to provide appropriate spiritual care for individuals, families and other carers in the face of progressive dementia and the approach of death?