Dementia is a chronic progressive debilitating disease that is largely a disorder of old age. It is characterised by widespread impairment of mental functioning, progressive memory loss, language difficulties, confusion and disorientation. These impairments are often accompanied by behavioural and psychological disturbance . The behavioural disturbances associated with dementia are defined as symptoms of disturbed perception, altered thought content, mood and behaviour .
Studies on the prevalence of dementia indicate a sharp rise with age, doubling with every 6.3 year increment in age in Western Europe . Current projections indicate that there will be a significant increase in the number of people with dementia in Ireland, from approximately 40,000 at present to 100,000 by 2036 . International estimates suggest that approximately half of those with dementia will be cared for in a residential care setting at some point during the disease . There is limited information on prevalence rates for dementia within long-stay settings, but what is available suggests that the majority of long-stay residents are likely to have dementia. It is estimated, for example, that between 50% and 80% of residents in various types of residential care settings in the UK may have dementia . Recent small-scale estimates for Ireland suggests that a large majority of long-stay residents have cognitive impairment (up to 89%), the majority of whom are likely to have undiagnosed dementia . This data is at variance with official statistics for Ireland, which suggests that only 26% of residents in long-stay care have dementia .
The Action Plan for Dementia (APD) for Ireland  advocates a person-centred approach to care in both community and long-stay settings that emphasises the individual needs of the person with dementia. Such an approach focuses on what people are still able to do and remember, and on maintaining the individuality of the person with dementia . Promoting a sense of well-being among older people with dementia is enhanced by creating a supportive social environment, thereby enabling people to communicate and connect with family and friends [10, 11]. Integrating evidence-based psychosocial approaches with medical and nursing care models of service delivery is key to the person-centred approach. If healthcare professionals are to develop the skills necessary for such an approach to care delivery, education about dementia and staff training in psychosocial treatments are essential [4, 9]. Unfortunately, residential care staff in Ireland do not always have the skills and knowledge necessary to respond effectively to the individual needs of residents with dementia .
Psychosocial interventions have the potential to improve the quality of life of people with dementia and those who care for them, and a number of systematic reviews have been undertaken [13–15], including Cochrane reviews of specific approaches [16, 17]. Reminiscence is a psychosocial intervention commonly used in dementia. It involves the discussion of past activities, events and experiences with another person or group of people, usually with the aid of tangible prompts such as photographs or other familiar items. One factor contributing to the popularity of reminiscence is that it can be used with early memories, which remain relatively intact for people with dementia, thus drawing on the person's preserved abilities rather than focusing on level of impairment induced by the illness. Although used extensively, little is known about the effectiveness of reminiscence as a care intervention for people with dementia , , .
Most studies that have examined the effectiveness of reminiscence have employed qualitative, descriptive or observational designs, with few robust experimental designs having been undertaken [19, 21–23]. The most recent Cochrane systematic review of reminiscence therapy in dementia  showed that there was evidence of an improvement in cognition and in general behaviour in people with dementia, as well as a decrease in caregiver strain following reminiscence therapy. Five randomised controlled trials were included in this Cochrane review, although only four, with a combined total of 144 participants, had extractable data. The studies were small in scale, incorporating diverse forms of reminiscence therapy, resulting in inconclusive evidence on overall effectiveness. Therefore, the effectiveness of reminiscence on the quality of life of people with dementia remains uncertain, pointing to the need for a more robust and fair assessment of interventions using treatment protocols that set out clearly the type of reminiscence being undertaken, overall objectives, process and outcomes.
Our proposed DementiA education programme incorporating REminiscence for Staff (DARES) intervention is designed to address some of the unanswered questions regarding the effectiveness of reminiscence in the care of people with dementia. The main component of DARES is a structured education reminiscence-based programme for staff which is delivered at the level of the long-stay residential unit to dyad combinations of nursing and care staff who are directly engaged in the care of specified people with dementia.
In this study, we define reminiscence as the deliberate use of prompts, including photographs, smells, music and questioning, to promote the recall of pleasant memories. We view reminiscence as a one-to-one interaction between the person with dementia and a staff member, except where working in a small group is more appropriate, as determined by the capacity and needs of the individual with dementia. Reminiscence is both planned, i.e. where reminiscence is the specific focus of the interaction with the person with dementia, and spontaneous, i.e. the opportunistic use of reminiscence while providing nursing care. The aim of using reminiscence with people with dementia is to stimulate the person, provide enjoyment and foster a sense of achievement and self-worth. The anticipated outcomes for people with dementia of using reminiscence are improvement in the person's quality of life, behaviour and mood.