the design of technology and environments to support enjoyable activity for people with dementia...
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The design of technology and environments to support enjoyable activity for people with dementia
Judith Torrington
University of Sheffield
Telecare: Dialogue and Debate - the emergence of new technologies and responsibilities for healthcare at home in Europe
20 - 21 September 2007‘De Driehoek’ (The Triangle) Utrecht, Holland
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Physical environments and technology in relation to people with dementia
• How well do the physical environment and technology support wellbeing?
• What are the factors that enhance well-being?
• What are the barriers?• How can we design and manage the
physical environment and technology for the best possible outcomes?
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Mental health and depression in older people
• 1 in 4 people aged 65+ have symptoms of depression
• 3 million people in the UK experience mental health problems that impact on their quality of life
• The majority of older people with mental health problem do not receive services
UK Inquiry into mental health and well-being in later life 2003-2007 Age Concern
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INDEPENDENT: Investigating Enabling Domestic Environments for People with DementiaUniversities of Liverpool, Bath, Sheffield, Dementia Voice, Northamptonshire County Council, Sheffcare, Huntleigh Healthcare
Design in Caring Environments (DICE)Universities of Sheffield and Loughborough, Sheffield City Council
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safety & health
community
comfort
physical support
physical support
choice & control
comfort
personalisation
Quality of life
High dependency
Low dependency
Research findings DICE
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Safety and health
•The DICE study found buildings with high scores for safety and health had low scores for quality of life
•Security concerns frequently prevent people from accessing gardens
•The challenge is to provide safe environments without restricting freedoms
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Use of buildings
131410 131410N =
type and size of building
large nursingsocial/sheffcaresmall/conversion
80
70
60
50
40
30
20
10
CHOIBLD
CHOIUSE
33
13
choice and control
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Independent - summary
End user involvement in setting agendaA wish list of technology to enhance quality of life Develop and test new technologies: music player, window on the world, conversation prompt, sequencing aid Criteria for assessment, installation, maintenance and exploitation
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Living environments
Private home
Sheltered flat
Care home lounge
Care home bedroom
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• Social contact, conversation, communication, relationships
• Reminiscence• Activities of daily living• Pottering in the house, or garden• Music (listening, singing, social participation,
dancing, etc) • Getting outside, the natural environment• Community participation• Laughter • Physical activity, walking & exercise• Creative activity• Mental stimulation• Meals & food
Wish list – favourite activities
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Wish list – favourite activities
Memory loss• Social contact, conversation, communication,
relationships• Reminiscence• Activities of daily living• Pottering in the house, or garden• Music (listening, singing, social participation,
dancing, etc) • Getting outside, the natural environment• Community participation• Laughter • Physical activity, walking & exercise• Creative activity• Mental stimulation• Meals & food
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Activity for well-being
• People with dementia have low levels of participation in enjoyable activity
• Interactions between a person, and their social and physical environments are complex and change over time
• Methods are needed to support activity• Holistic approach is more likely to
succeed
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Person factors
Formal support network
Social network
Physical environment
Aspirations
experiences meaning
well-being
‘Never the time and the place and the loved one all together’
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Functional space needs
Maximum 600mm from where the chair supports the back to the drink
Table heights:Table top 700mmThigh clearance 640mm
Seats need good back support
Stable arm rests
Chairs need to be resistant to being pushed backwards as people lower themselves into them
Having a drink or meal
43
0m
m 70
0m
m
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Contact with the natural world
Seasonal affective disorder and daylight illuminance
Circadian rhythms
A diurnal cycle of darkness and bright light
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So you don’t put music on for yourself…‘No.’ Not here. ‘Not here. Oh no, no.’ Why not? ‘I know it’s not my place, is it really’
Ownership and belonging
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Meaning of space
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Meaningful spaces
• Misinterpretation of space can inhibit participation in activity
• Mixed messages often given out in purpose-built settings
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Meaning of space
It is clear that some residents do not feel ‘at home’ because they worry about paying for their meals when they go into the dining room
..she goes in for her dinner, her tea. “I can’t have any. I haven’t paid for it. I haven’t got any money to pay for it;” they might have done it for 70, 80 years …And now all of a sudden it’s all done for them (a daughter speaking about her mother).
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Reinforcing meaning
Spatial hierarchy
Light/ dark
Upstairs/ downstairs
Visual processing – what and where pathways
Physical memory
Behaviour
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Guidance to Activity in
Dementia CareA checklist and design guide to promote
enjoyable activity for people with dementia
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GUIDANCE: a checklist identifying needs for participation and enjoyment
Activity The person
The place
Social
Entertainment, communication
Work, hobby, physical
Natural world
Spirit and aspiration
Circulation
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Potential Barriers to the use of a ‘window on the world’:
6-Private home
14-Sheltered flat
54-Care home lounge53-Care home bedroom
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Guidance to activity in dementia care tool can be used for:
• Design guidance• Selection and installation of assistive
technology• Care management tool• Support for family carers• Evaluation of buildings in use over time
www.atdementia.org.uk
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Physical environments and technology in relation to people with dementia some questions….• How to provide safe environments
that do not restrict activity?• How to make better use of buildings?• How can we help older people to feel a
sense of ownership of the spaces they inhabit?
• How can an awareness of design issues be brought into the management of buildings and the delivery of care?