Dementia At The Threshold: A qualitative Investigation Of Negotiating Threshold Spaces With Dementia

This thesis argues for a profound shift in the way in which we understand dementia, advocating from a move away from the rhetoric of loss and decay, and towards an acknowledgement of people with dementia as whole and undiminished by the progress of their disease. It highlights the role of the narratives of decay in oppressing and disabling people with dementia, and contends that it the meaning attributed to dementia, rather than the dementia itself, which limits both what people with dementia can do and who they can be. This research uses an ethnographic approach to explores key areas where the physical, social and temporal spaces controlled by people with dementia meet those controlled by others, and elucidates the complex relationality of these threshold spaces. Through drawing on 78 hours of audio interviews with 11 people living with dementia in Scotland, this research highlights key physical, social, and temporal thresholds that participants encountered as part of their day-to-day lives. This thesis highlights the weaknesses in approaches that construct people with dementia as passive victims of biological tragedy. It offers instead a theoretical perspective that is rooted, in the understanding that a person cannot be ‘unmade’ by cognitive impairment. This perspective is grounded in Heideggerian philosophy, and allows for a deeper exploration of how people with dementia experience the physical, social, and temporal world as undiminished Dasein living with cognitive impairment. These experiences are contextualised through the lens provided by Thomas’ social relational approach to disability, which emphasises the role of society in disabling and oppressing people with dementia. These findings emphasise the need for a profound shift in both how dementia is represented as a reductive and tragic process and the ways in which barriers to social inclusion are constructed as the result of medical rather than social processes

Sight loss, dementia and meaningful activity: A scoping study

The prevalence of health conditions causing or contributing to sight loss increases with age (Girdler et al, 2008). Yet, despite this, little research has focused on a population that has both sight loss and dementia, tending instead to focus on each condition in isolation.  Meaningful activity’ has been linked to quality of care and the health and wellbeing of older people (NICE 2013) and better outcomes for individuals with dementia (Wenborn et al. 2008). Regular engagement in meaningful activity has been shown to reduce severe behavioural symptoms of dementia, reduce reliance upon medicated solutions (Menne et al. 2012), slow functional decline associated with dementia and help to address the challenges of social isolation and ‘problematic passivity’, characterised by a decrease in gross motor movement accompanied by apathy and a lack of interaction with the environment (Conti et al. 2008). Loss of opportunities for, or access to, meaningful activities has been linked with depressive symptoms and affective distress in people with Age-related Macular Degeneration (AMD) (Rovner and Casten 2002). The present scoping study was commissioned to explore issues in relation to meaningful activities for people with both dementia and sight loss living in both community and residential settings. The present scoping study was commissioned to explore issues in relation to meaningful activities for people with both dementia and sight loss living in both community and residential settings.  The primary aims of the project were:  • To determine the extent of the evidence base relating to meaningful activity for people with sight loss and dementia, and to summarise what is known;  • To collect data on the availability and use of guidance, training and other relevant resources in this area; and • To provide insights to inform the potential development of new or improved guidelines in this area.  The aims of the research have been addressed through a combination of literature review (including online lateral searches), interviews with expert informants, and survey questionnaire on the provision of meaningful activity distributed to relevant stakeholder groups

Dementia Friendly Walking Project: Evaluation Report

The evaluation project explored the second year of the dementia friendly walking project. Paths for All were keen to obtain views of people living with dementia, their carers and other walk attendees regarding their experiences of attending dementia friendly walks. Currently approximately 100 group projects are taking place across Scotland, with 500 walks taking place per week. Currently there are 23 dementia friendly walking group projects taking place across Scotland. The purpose of the evaluation is to evaluate the current progress on the dementia friendly walks aspect of Paths for All, and the experiences and perspectives of people living with dementia in relation to the group walking activities, areas of improvement for walking groups, and in relation to project outcomes set by the Life Changes Trust as the project funder. The goals of the evaluation are; • To explore experiences of attending dementia friendly walks as organised by walking for health groups within the Paths for All programme.  • To explore landscapes where walks are taking place.  • To explore social interactions taking place between attendees.  • To identify benefits, facilitators and challenges regarding attending dementia friendly walks from the perspective of people living with dementia. • Identify gaps and make recommendations for provision of dementia friendly walks in the future.&nbsp

Design of an Electrospun Type II Collagen Scaffold for Articular Cartilage Tissue Engineering

Traumatic defects in articular cartilage can lead to joint disease and disability including osteoarthritis. Because cartilage is unable to regenerate when injured, the field of tissue engineering holds promise in restoring functional tissue. In this research, type II collagen was electrospun, cross-linked, and tested as scaffolds for supporting chondrocyte growth. The mechanical, biochemical, and histological characteristics of the engineered tissue were assessed as a function of the electrospinning solution concentration (i.e. scaffold fiber diameter and pore properties) and as a function of the time in culture (evaluated at 2, 4, and 6 weeks). Fiber diameter had a linear relationship with concentration: mean diameter increased from 107 to 446 nm and from 289 to 618 nm, measured with SEM and permeability meter, respectively, with increasing concentration, from 60 mg/mL to 120 mg/mL. Pore size revealed no relationship with concentration but mean values ranged in size from 1.76 to 3.17 μ2 or from 0.00055 to 0.0028 μ2, depending on the measurement technique. Average porosity ranged from 84.1 to 89.1%, and average permeability was between 6.82x10-4 and 35.0 x10-4 D. Histological analysis revealed a relatively high number of spherical cells, possibly indicating the expression of the chondrocyte phenotype. However, there were very little glycosaminoglycans and type II collagen synthesized by the cells despite an increase in the cell density over time for the 60, 80, and 100 mg/mL concentrations. The mean values for peak stress (between 0.17 and 0.35 MPa) and tangential modulus (between 0.32 and 0.64 MPa) for the mats are at least an order of magnitude less than that for native cartilage, while the mean values for strain at break (between 93 and 150%) for the mats are at least an order of magnitude greater than that for native cartilage. The equilibrium stiffness for all concentrations decreased from week 2 to week 6 of tissue culture (which may correlate with increasing cell density); the 100 mg/mL concentration had the highest mean value (0.084 MPa at week 2) and the lowest mean value (0.010 MPa at week 6). This research did not indicate any significant findings regarding the influence of concentration or culture time on chondrogenesis. Because the cells appeared to grow on the surface of the scaffold but there was a lack of cell migration into the scaffold, the scaffold material may be sufficient to support chondrocyte growth but the scaffold physical design must be reconsidered

Housing Design Evaluation Research for People Living with Cognitive Change: A Systematic Literature Review

Research suggests that improvements to home design may enable us to live better with cognitive change as we age. However, few innovations have been fully evaluated. The paper systematically reviews 47 items of evaluative literature. Research design and quality are varied. Qualitative analysis of literature demonstrates the need for a holistic approach that includes older people’s diverse perspectives, examples of promising practice that responds to individual needs, and gaps in research on scalability and economic viability of innovations. The context of design improvements is found to be critical

"It Is Part of Belonging": Walking Groups to Promote Social Health amongst People Living with Dementia

People with dementia often report experiencing a ‘shrinking world’ connected with reduced opportunities to access physical and social spaces. This article applies the framework of social health (Dröes et al., 2017; Huber et al., 2011) as a theoretical lens through which to consider how inclusive walking groups can facilitate access to places and spaces to support people with dementia to remain connected in their communities. Findings are reported from walking interviews and focus group discussions with people with dementia, family carers, volunteers and walk leaders who participated in a national programme of dementia-friendly walking groups in Scotland. Thematic analysis of the data demonstrates that participation has a positive impact on social health, supporting people living with dementia to fulfil their potential, to engage in meaningful activity and to manage both their condition and their wider lives. Benefits include providing a context for continuing social participation and relationships for people with dementia and family carers. Additionally, groups provide a safe space where people with dementia can walk with autonomy and help to reinforce a sense of capacity and agency. Wider implications include the role of walking groups in fostering interdependencies between people with dementia and their wider communities by promoting an enabling ethos of dementia ‘inclusiveness.’ The benefits of developing an inclusive and supportive approach to involving people living with dementia in walking groups could extend more broadly to the wider community, with such initiatives acting as a catalyst for growing levels of social participation

Othering Older People’s Housing: Gaming Ageing to Support Future-Planning

The ‘othering’ of ageing is linked to an integrated process of ageism and hinders future planning for both individuals and practitioners delivering housing and health services. This paper aims to explore how creative interventions can help personalise, exchange knowledge and lead to systems change that tackles the ‘othering’ of ageing. The Designing Homes for Healthy Cognitive Ageing (DesHCA) project offers new and creative insights through an innovative methodology utilising ‘serious games’ with a co-produced tool called ‘Our House’ that supports insight on how to deliver housing for older people for ageing well in place. In a series of playtests with over 128 people throughout the UK, the findings show that serious games allow interaction, integration and understanding of how ageing affects people professionality and personally. The empirical evidence highlights that the game mechanisms allowed for a more in-depth and nuanced consideration of ageing in a safe and creative environment. These interactions and discussions enable individuals to personalise and project insights to combat the ‘othering’ of ageing. However, the solutions are restrained as overcoming the consequences of ageism is a societal challenge with multi-layered solutions. The paper concludes that serious gaming encourages people to think differently about the concept of healthy ageing – both physically and cognitively – with consideration of scalable and creative solutions to prepare for ageing-in-place

Synthesis and characterisation of cross-linked chitosan composites functionalised with silver and gold nanoparticles for antimicrobial applications

We present a study of a range of cross-linked chitosan composites with potential antimicrobial applications. They were formed by cross-linking chitosan and siloxane networks and by introducing silver and gold nanoparticles (NPs). The aim was to investigate whether adding the metal NPs to the chitosan-siloxane composite would lead to a material with enhanced antimicrobial ability as compared to chitosan itself. The composites were synthesised in hydrogel form with the metal NPs embedded in the cross-linked chitosan network. Spectroscopic and microscopic techniques were employed to investigate the structural properties of the composite and the tensile strength of the structures was measured. It was found that the addition of metal NPs did not influence the mechanical strength of the composite. A crystal violet attachment assay results displayed a significant reduction in the attachment of E. coli to the cross-linked chitosan surfaces. Release profile tests suggest that the metal NPs do not contribute to the overall antimicrobial activity under neutral conditions. The contribution to the mechanical and antimicrobial properties from cross-linking with siloxane is significant, giving rise to a versatile, durable, antimicrobial material suitable for thin film formation, wound dressings or the coating of various surfaces where robustness and antimicrobial control are required

Cross-linking electrospun type II collagen tissue engineering scaffolds with carbodiimide in ethanol

In trying to assess the structural integrity of electrospun type II collagen scaffolds, a modified but new technique for cross-linking collagen has been developed. Carbodiimides have been previously used to cross-link collagen in gels and in lyophilized native tissue specimens but had not been used for electrospun mats until recently. This cross-linking agent, and in particular 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide hydrochloride (EDC), is of extreme interest, especially for tissue-engineered scaffolds composed specifically of native polymers (e.g., collagen), because it is a zero-length cross-linking agent that has not been shown to cause any cytotoxic reactions. The unique aspect of the cross-linking protocol in this study involves the use of ethanol as the solvent for the cross-linking agent, because the pure collagen electrospun mats immediately disintegrate when placed in an aqueous solution. This study examines 2 concentrations of EDC with and without the addition of N-hydroxysuccinimide to the reaction (which has been shown to result in higher cross-linking yields in aqueous solutions) to test the hypothesis that the use of EDC in a nonaqueous solution will cross-link electrospun type II collagen fibrous matrices in a comparable manner to typical glutaraldehyde fixation protocols. The use of EDC is compared with the cross-linking effects of glutaraldehyde via mechanical testing (uniaxial tensile testing) and biochemical testing (analysis of the percentage of free amino groups). The stress-strain curves of the cross-linked samples demonstrated uniaxial tensile behavior more characteristic of native tissue than do the dry, untreated samples. The heated, 50% glutaraldehyde cross-linking protocol resulted in a mean peak stress of 0.76 MPa, a mean strain at break of 127.30%, and a mean tangential modulus of 0.89 MPa; mean values for the samples treated with the EDC protocols ranged from 0.35 to 0.60 MPa for peak stress, from 111.83 to 159.23% for strain at break, and from 0.57 to 0.92 MPa for tangential modulus. Low and high concentrations (20 mM and 200 mM, respectively) of EDC alone were comparable in extent of cross-linking (29% and 29%, respectively) to the heated 50% glutaraldehyde cross-linking protocol (30% cross-linked). © Mary Ann Liebert, Inc