Enhancing the evidence base for person-centred dementia care

In late January, the Association for Dementia Studies (ADS) delivered a webinar as part of a regular Research Seminar series organised by the College of Health, Life and Environmental Sciences, University of Worcester. This series provides an opportunity for researchers within the university to share their work with their peers in an informal setting.

The webinar was chaired by Professor Dawn Brooker who welcomed everyone and provided an introduction to ADS, before handing over to Dr Simon Evans for the first presentation looking at ‘Connections with nature for people living with dementia’.

Simon talked about our need as humans to interact with nature, and provided an overview of existing evidence of the benefits of nature on our psychological, physical and social wellbeing. In terms of people living with dementia, it has been shown that engaging with nature can reduce agitation, increase self-esteem, and increase social interaction and communication. It may also act as memory trigger for activities, but unfortunately many people living with dementia have limited opportunities to engage with the natural world. Health and safety concerns and an inability to access outdoor spaces are just two potential barriers they may face.

The presentation focused on the ‘Dementia Adventure In A Box’ project which was based on work done by Dementia Adventure to engage people with dementia with outdoor nature-based activities. ADS evaluated this pilot project which aimed to use a social franchise approach to roll out a of training programme and outdoor activity delivery to four participating organisations. During the three-year project, nearly 1,000 activity sessions were delivered across the UK with almost 2,500 attendances by people with dementia and nearly 600 attendances by carers. A significant improvement in wellbeing was seen for the participating people with dementia, together with enhanced mood, and increased social interactions. Participants enjoyed being outdoors, and taking part in relaxed and informal activities which were also meaningful for them. There was a benefit in being part of ‘real’ activities that need to happen, such as helping out with feeding animals on a farm, rather than activities that were created for the project.

Participation in the project enabled some organisations who had not previously worked with people with dementia to access a new client group, with a recognition that this did require more effort and resources. For other organisations with experience of working with people with dementia, the project was an opportunity to expand their provision and try activities that they had not considered before.

Simon handed over to Teresa Atkinson, who is Module Lead for the online module ‘Enabling Environments for people with dementia’. Teresa began her presentation on this same topic by posing a question around why we should design for people with dementia, before turning it around to ask why we don’t, when good design will work for everyone. Previously, when thinking about design, it has largely been down to architects and designers with little or no input from the people who will actually use the environments. Now, the focus is shifting to looking at what people with dementia may struggle with, in order to help identify environmental solutions that put the emphasis back on what people with dementia can still do when they are in an enabling and empowering environment.

Focusing on sight and visual problems, Teresa talked us through examples of some of the issues people with dementia may face, including seeing black door mats as holes to avoid, patterned furniture and décor – particularly stripes – which can look like they are moving, the importance of colour contrast to help make items or areas easier to see, and how shiny floors can look wet or slippery.

After looking at some of the problems, the focus shifted to consider what an enabling environment looks like, drawing on the principles from The King’s Fund Environmental Assessment Tools. The key points are that the environment should ease decision making, reduce agitation and distress, encourage independence and social interaction, promote safety, and enable activities of daily living. These can be achieved by focusing on legibility, orientation, wayfinding, familiarity, and meaningful activities. Other factors relating to these include considering using smaller groups for promoting social connection rather than having people sat around the edge of a room, reducing clutter, and having familiar appliances, fixtures and fittings that people can recognise and actually use. As seen in work carried out for the Dementia Dwelling Grant project, it’s not always necessary to make big changes to the environment in order to have a big impact for an individual.

The third presentation was delivered by Dr Julie Barrett, Research Coordinator for the Housing and Dementia Research Consortium (HDRC). The presentation focused on a survey carried out by the HDRC to explore ‘Provisions for people living with dementia in extra care housing settings’. After giving an overview of the housing options for older people living with dementia to show where extra care housing fits into the wider picture, Julie moved on to sharing findings from the survey which was completed by people across the majority of England and Wales. Respondents provided information about a variety of different types of extra care housing schemes to give a fairly comprehensive picture of current extra care provision. Some of the main findings from the survey are presented in the next two images.

Environmental design was also investigated by the survey, and the findings echoed several areas previously raised by Teresa. Orientation, wayfinding and outdoor spaces not being accessible or dementia friendly were raised as some of the key issues that extra care housing schemes need to address.

Recommendations arising from the survey regarding how providers can improve extra care settings for people with dementia can be seen below.

Following the presentations there was a question and answer session where the issue around putting research findings into practice was discussed. The ongoing delineation between indoors and outdoors was also addressed, with Teresa saying that many environmental principles are applicable regardless of whether a space is inside or outside, and actually we can create our own false barriers by seeing them as separate entities.

We’d like to thank the College of Health, Life and Environmental Sciences for hosting us and inviting us to be part of the research seminar series. We hope everyone found the webinar interesting and took away some new ideas to put into practice, or even just takes the time to look at nature and their own environment from a fresh perspective.

Connect with ADS on twitter @DementiaStudies and on Facebook @adsuow

Connect with the HDRC on twitter @HousingDementia

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