Finding a way: long-term care homes to support dementia

An ageing demographic has increased the number of people with dementia. Although dementia is commonly associated with memory loss, other early symptoms include difficulty with wayfinding. Dementia alters visuo-spatial perception and the processes used to interpret the physical environment. The role of the design of the physical environment for people with dementia has gained increased recognition. Despite this, design for dementia is often overlooked, focusing on issues relating to physical impairment. This paper presents the results of a PhD study and aims to examine the role of the design of the physical environment in supporting wayfinding for people with dementia living in long-term care settings in Northern Ireland. Mixed methods combined the observation of wayfinding walks and conversational style interviews to elicit perspectives and experiences of residents with dementia. The findings aim to promote well-being for those with dementia living in long-term care settings

A tablet-based memory enhancement application for older users: design approach

This paper provides a case study of the design process undertaken in producing a mobile tablet memory assistant solution which was intended for older adults (\u3e65yo) living with early stage memory loss. We adopted an overall design framework consistent with “living laboratory” methodology, for which the associated design principles are: co-creation, multi-stakeholder participation, active user involvement, real-life setting, and multi-method approach. We describe here the detailed steps and provide examples of the application design decisions and outcomes, through successive stages of its evolution. Results of the various user engagements which informed our design choices and for validation of the artefact are presented

Repeatability and validity of a food frequency questionnaire in free-living older people in relation to cognitive function

Objectives: To determine the repeatability and validity of a self-administered, 175-item food frequency questionnaire (FFQ) in free-living older people and to assess whether these are influenced by cognitive function. Participants and setting: 189 free-living people aged 64-80y were recruited from participants in a previous study. Design: To assess repeatability, 102 (52M, 50F) participants completed the FFQ on two occasions three months apart. To assess validity, another 87 participants (44 M, 43 F) completed the FFQ and a four-day weighed diet record three months later. 25 nutrients were studied. Results: For repeatability, Spearman rank correlation coefficients were above 0.35 (p<0.05) for all nutrients. Cohen’s weighted Kappa was above 0.4 for all nutrients except starch, riboflavin, retinol, β-carotene, and calcium. There were no substantial differences in correlation coefficients between sub-groups divided by short-term memory test score. There was no clear pattern for correlation coefficients in sub-groups divided by executive function test score. For validity, the Spearman rank correlation coefficients were above 0.2 (p<0.05) for all nutrients except fat, mono-unsaturated fatty acids, niacin equivalents and vitamin D, and Cohen’s weighted kappa was above 0.4 for alcohol and was above 0.2 for 13 other nutrients. Participants in the lowest-score groups of short-term memory and executive function had the lowest median Spearman correlation coefficient. Conclusions: The FFQ had reasonable repeatability and validity in ranking nutrient intakes in this population though the results varied between nutrients. Poor short-term memory or executive function may affect FFQ validity in ranking nutrient intakes

‘All the corridors are the same’: a qualitative study of the orientation experiences and design preferences of UK older adults living in a communal retirement development

Environments need to be designed such that they support successful orientation for older adults and those with dementia who often experience marked difficulties in their orientation abilities. To better understand how environments can compensate for decreasing orientation skills, voice should be given directly to those experiencing dementia to describe how they find their way and to understand their design preferences. This study explored the navigational experiences and design preferences of older adults with memory difficulties living in a retirement development. In-depth semi-structured interviews with 13 older adults experiencing memory difficulties were conducted. All participants were residents of one retirement development in the United Kingdom. Questions began broadly, for example, to describe their experiences of navigating in their living environment, before discussing any specific navigation difficulties in detail. Thematic analysis identified three main themes: highlighting environmental design that causes disorientation, strategies to overcome disorientation, and residents’ suggestions to improve the design. The design suggestions were particularly informative, heavily focusing on the importance of having memorable and meaningful spaces which were favoured more than signage as an orientation aid. The findings demonstrate the need to consider environmental design to support orientation for those with memory difficulties. Of particular importance is the use of meaningful and relevant landmarks as orientation aids which can additionally stimulate conversation and increase wellbeing. Given the range of suggestions in dementia-friendly design guidelines aimed to support orientation, it is crucial to speak directly to those living in different environments to learn how they find their way around and what design works in their environment

In the moment: designing for late stage dementia

This paper presents international multidisciplinary design research to support the wellbeing of people living with dementia. The LAUGH project aims to develop playful artefacts that will contribute to non-pharmacological personalised approaches to caring for people living with late stage dementia in residential care. This paper presents the context for this research and explains the initial stages of the work currently in progress. An inclusive participatory methodology is described in which key experts including: health professionals, technologists, materials scientists and carers of people living with dementia are informing the development of design concepts. A positive design approach in which designing for pleasure, personal significance and virtue underpin the work. The initial stages of the research have identified the significance of: playfulness, sensory stimulation, hand use and emotional memory. This paper contends that designs should aim to promote ‘in the moment’ living in order to support subjective wellbeing of people living with late stage dementia

Maidstone Estates: Utilizing Research-Based Design to Create the Luxury, Location, and Lifestyle of a Continuing Care Retirement Community

The nature of this essay explores the implementation of research-based design to the senior living concept and showcases how design can improve and empower the lives of our seniors as they hit retirement age. Over the course of the essay, the project will begin as a concept and navigate its way through the design processes until the concept is fully developed as a stand-alone package that speaks for itself. Maidstone Estates is built upon the guidelines of the Green House Project and outlines the mixed-use nature of design involving branding, building code, ADA compliance, universal design, and the three acuity levels of senior living: Independent Living, Assisted Living, and Memory Care. As of now, there are over 371 Green House homes across the country. This essay is designed to utilize the research-based design and implement it into the aesthetic of East Hampton, an area where there is a set standard for architecture and lifestyle, and to show that this model can be used anywhere and transform eldercare across the country and around the world

Enhancing Virtual City with Collective Memory to Support Urban Design Learning

This research investigates the pedagogical effects of collective memory enhanced virtual city models as an e-learning environment for urban design in an Indonesian university context. In this study, collective memory refers to expressions people made when remembering buildings, spaces and places of the past and present city living. A city's collective memory is either elicited from or produced directly by the city's residents or visitors. The thesis presents the outcomes of designing an experimental collective memory enhanced virtual city (CREATI) platform and applying it to the urban design course at the Department of Architecture, Atma Jaya Yogyakarta University, Indonesia. The Jalan Malioboro area in Yogyakarta was chosen as the case study site for constructing 30 virtual city models and gathering records of collective memory associated with the street and city. Student participants were invited to use CREATI while undertaking the urban design course. The usability and effects of CREATI on the students' learning outcomes are analysed according to the learning experiences reported by the students as well as the urban design proposals they produced for the course. The study finds that students appear more knowledgeable about the urban contextual issues because of accessing and sharing the resources hosted on CREATI. Students also reported that they felt better supported in developing more context­ sensitive design proposals by working with the collective memory enhanced virtual city models

The development of service user-led recommendations for health and social care services on leaving hospital with memory loss or dementia – the SHARED study

YesBackground Health and social care services are under strain providing care in the community particularly at hospital discharge. Patient and carer experiences can inform and shape services. Objective To develop service user-led recommendations enabling smooth transition for people living with memory loss from acute hospital to community. Design Lead and co-researchers conducted semi-structured interviews with 15 pairs of carers and patients with memory loss at discharge, 6 and 12 weeks post-discharge and one semi-structured interview with health and social care professionals and Admiral Nurses. Framework analysis was guided by co-researchers. Two focus groups of study participants, facilitated by co-researchers, met to shape and finalize recommendations. Setting and participants Recruitment took place in acute hospitals in two National Health Service (NHS) Trusts in England. Patients were aged 65 and over, with memory loss, an in-patient for at least 1 week returning to the community, who had a carer consenting to be in the study. Results Poor delivery of services caused considerable stress to some study families living with memory loss. Three key recommendations included a need for a written, mutually agreed discharge plan, a named coordinator of services, and improved domiciliary care services. Discussion and conclusions Vulnerable patients with memory loss find coming out of hospital after an extended period a stressful experience. The SHARED study contributes to understanding the hospital discharge process through the eyes of the patient and carer living with memory loss and has the potential to contribute to more efficient use of resources and to improving health outcomes in communities.National Institute for Health Research. Grant Number: PB-PG-1112-2906

A clinical study to evaluate the efficacy of Ashtanga Ghrita in Dementia

Dementia is defined as an acquired deterioration in cognitive abilities that impairs the performance of activities of daily living. In Ayurveda literatures this disease is explained under the concept of Jara Vyadhi. In elderly people there will be loss of cognitive abilities viz. Grahana, Dharana and Smarana because there is gradual diminution in the qualities of Dhatu and dominance of Vata. An individual can lead a normal happy life if one has a sound intellectual capacity with a good memory. Any impairments to his memory will has an effect on the quality of his living standards, thus this condition is chosen for the present study. Present study is a single group open clinical trial with pre and post-test design on 30 subjects. Subjects were administered with Ashtanga Ghrita for 60 days. The results were obtained on parameter viz. Impaired memory, Visuospatial disorientation, Apraxia, Impaired visuoconstructional drawing, Impaired judgement, Impaired language the result obtained statistically non-significant in the management of Dementia. However, it was observed the symptoms such as anger and irritability were reduced

Designing for wellbeing in late stage dementia

This paper presents research that is developing new ways of supporting the wellbeing of people with late stage dementia through the development of playful objects. The LAUGH project is an international AHRC funded design research project that is using qualitative and participatory approaches to inform innovative concepts for new playful artefacts to stimulate fun, joy and in the moment pleasure for people living with dementia. The research is partnered by Gwalia Cyf and supported by Age Cymru and Alzheimer’s Society, including people living with dementia from their Service User Review Panels (SURP). Data presented is informed by three pre-design development workshops in which a multidisciplinary group of experts in the fields of dementia care and design have contributed their professional experience. This paper specifically focuses on data from the third of these workshops exploring procedural memory in relation to hand-use and craft making. This paper contends that hand-use, gesture and haptic sensibilities can provide access to procedural and emotional memories, which are retained even into the late stages of the disease. Craft and making activities learned in earlier life, provide rhythmic patterns of hand activity that can enhance wellbeing by supporting in the moment sensory experience, competency and reaffirmation of personhood. Playful activities provide a person with dementia freedom to explore, learn and have positive experiences even when cognitive function and memory recall is severely impaired. Future planned workshops will see the iterative development of prototype designs and their evaluation in ‘live labs’ with people living with late stage dementia