Involving persons with dementia in the evaluation of outdoor environments

Using virtual reality (VR), we examined the barriers to and facilitators of functioning outdoors in persons with dementia (PwD) and investigated the generalizability of findings in VR to the real world. An existing town center was modeled in VR. PwD took part in both real- world and VR walks. Based on the results, the model was redesigned and then tested again. Performance on the walks improved, and potentially beneficial adaptations to outdoor environments were identified, but limitations of VR as a representation of the real world were also identified. We conclude that VR models, together with a rigorous behavioral testing method, can be a useful tool for the evaluation of outdoor environments and for identifying improvements for PwD

Information and communication technology solutions for outdoor navigation in dementia

INTRODUCTION: Information and communication technology (ICT) is potentially mature enough to empower outdoor and social activities in dementia. However, actual ICT-based devices have limited functionality and impact, mainly limited to safety. What is an ideal operational framework to enhance this field to support outdoor and social activities? METHODS: Review of literature and cross-disciplinary expert discussion. RESULTS: A situation-aware ICT requires a flexible fine-tuning by stakeholders of system usability and complexity of function, and of user safety and autonomy. It should operate by artificial intelligence/machine learning and should reflect harmonized stakeholder values, social context, and user residual cognitive functions. ICT services should be proposed at the prodromal stage of dementia and should be carefully validated within the life space of users in terms of quality of life, social activities, and costs. DISCUSSION: The operational framework has the potential to produce ICT and services with high clinical impact but requires substantial investment

The design of caring environments and the quality of life of older people

There has been little systematic research into the design of care environments for older people. This article reviews empirical studies from both the architectural and the psychological literature. It outlines the instruments that are currently available for measuring both the environment and the quality of life of older people, and it summarises the evidence on the layout of buildings, the sensory environment and the privacy of residents. The conclusion is drawn that all evidence-based design must be a compromise or dynamic and, as demands on the caring environment change over time, this compromise must be re-visited in the form of post-occupancy evaluation

Use of nonintrusive sensor-based information and communication technology for real-world evidence for clinical trials in dementia

Cognitive function is an important end point of treatments in dementia clinical trials. Measuring cognitive function by standardized tests, however, is biased toward highly constrained environments (such as hospitals) in selected samples. Patient-powered real-world evidence using information and communication technology devices, including environmental and wearable sensors, may help to overcome these limitations. This position paper describes current and novel information and communication technology devices and algorithms to monitor behavior and function in people with prodromal and manifest stages of dementia continuously, and discusses clinical, technological, ethical, regulatory, and user-centered requirements for collecting real-world evidence in future randomized controlled trials. Challenges of data safety, quality, and privacy and regulatory requirements need to be addressed by future smart sensor technologies. When these requirements are satisfied, these technologies will provide access to truly user relevant outcomes and broader cohorts of participants than currently sampled in clinical trials

Wayfinding in People with Alzheimer’s Disease: Perspective Taking and Architectural Cognition—A Vision Paper on Future Dementia Care Research Opportunities

Based on a targeted literature review, this vision paper emphasizes the importance of dementia-sensitive built space. The article specifically focuses on supporting spatial orientation and wayfinding for people living with dementia. First, we discuss types of wayfinding challenges, underlying processes, and consequences of spatial disorientation in the context of dementia of the Alzheimer’s type. Second, we focus on current efforts aimed at planning and evaluating dementia-sensitive built space, i.e., environmental design principles, interventions, evaluation tools, strategies, and planning processes. Third, we use our findings as a starting point for developing an interdisciplinary research vision aimed at encouraging further debates and research about: (1) the perspective of a person with dementia, specifically in the context of wayfinding and spatial orientation, and (2) how this perspective supplements planning and design processes of dementia-sensitive built space. We conclude that more closely considering the perspective of people with dementia supports the development of demographically sustainable future cities and care institutions

Sowing in the autumn season : exploring benefits of green care farms for dementia patients

In the Netherlands an increasing number of farms combine agricultural production with care services for people with care needs. It is generally believed that these green care farms (GCFs) have beneficial effects on the health status of a diversity of target groups. At present, empirical studies testing this hypothesis are scarce. The main objective of the studies described in this thesis was to gain insight into the potential benefits of day care at GCFs for community‐dwelling older dementia patients. Day care at GCFs was therefore compared with day care at regular day care facilities (RDCFs). In view of the differences between both day care types regarding the day care setting and day care program it was hypothesized that they would differ in their effects on the health status of dementia patients. In two cross‐sectional studies it was tested to what extent the day program of dementia patients at GCFs differed from those at RDCFs. It appeared that at GCFs, dementia patients were (physically) more active, participated in more diverse activities, were more outdoors, and had more opportunities to perform activities in smaller groups than those at RDCFs. It was tested whether these differences resulted into different effects for five domains of health: dietary intake, cognition, emotional well‐being, behaviour, and functional performance. In a comparative cross‐sectional study dietary intake of dementia patients attending day care at GCFs or RDCFs was recorded both at home and during their time at the day care facility. The study showed that dementia patients attending day care at GCFs had significantly higher intakes of energy, carbohydrate, and fluid than their counterparts attending day care at RDCFs. In a cohort study, rates of change during 1 year in cognitive functioning, emotional well‐being, behavioural symptoms, and functional performance were compared between dementia patients attending day care at GCFs and RDCFs. Functioning in these domains remained rather stable and no differences were observed between subjects from GCFs and RDCFs. In the cohort study, also caregiver burden of family caregivers of these dementia patients was assessed. Caregivers’ quality of life, emotional distress, and feelings of competence remained rather stable in family caregivers of dementia patients from both day care settings. In conclusion, the present work has shown that GCFs exceeded RDCFs in offering older dementia patients a diverse day program and in stimulating their dietary intake. The latter may result into a better preserved nutritional status in dementia patients attending day care at GCFs than in those attending day care at RDCFs. GCFs and RDCFs were equally effective in preventing significant decrease of cognitive functioning, emotional well‐being, and functional performance and in preventing significant increase of the number of behavioural symptoms. Both day care types further prevented significant increase of caregiver burden. Day care at GCFs is a new and valuable addition to the present care modalities for community‐dwelling older dementia patients and their caregiver

Human experience in the natural and built environment : implications for research policy and practice

22nd IAPS conference. Edited book of abstracts. 427 pp. University of Strathclyde, Sheffield and West of Scotland Publication. ISBN: 978-0-94-764988-3

Systematic review of psychological approaches to the management of neuropsychiatric symptoms of dementia

Objective: The authors systematically reviewed the literature on psychological approaches to treating the neuropsychiatric symptoms of dementia.Method: Reports of studies that examined effects of any therapy derived from a psychological approach that satisfied prespecified criteria were reviewed. Data were extracted, the quality of each study was rated, and an overall rating was given to each study by using the Oxford Centre for Evidence-Based Medicine criteria.Results: A total of 1,632 studies were identified, and 162 satisfied the inclusion criteria for the review. Specific types of psychoeducation for caregivers about managing neuropsychiatric symptoms were effective treatments whose benefits lasted for months, but other caregiver interventions were not. Behavioral management techniques that are centered on individual patients' behavior or on caregiver behavior had similar benefits, as did cognitive stimulation. Music therapy and Snoezelen, and possibly sensory stimulation, were useful during the treatment session but had no longer-term effects; interventions that changed the visual environment looked promising, but more research is needed.Conclusions: Only behavior management therapies, specific types of caregiver and residential care staff education, and possibly cognitive stimulation appear to have lasting effectiveness for the management of dementia-associated neuropsychiatric symptoms. Lack of evidence regarding other therapies is not evidence of lack of efficacy. Conclusions are limited because of the paucity of high-quality research ( only nine level-1 studies were identified). More high-quality investigation is needed