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

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?

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

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

safety & health

community

comfort

physical support

physical support

choice & control

comfort

personalisation

Quality of life

High dependency

Low dependency

Research findings DICE

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

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

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

Living environments

Private home

Sheltered flat

Care home lounge

Care home bedroom

• 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

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

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

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’

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

Contact with the natural world

Seasonal affective disorder and daylight illuminance

Circadian rhythms

A diurnal cycle of darkness and bright light

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

Meaning of space

Meaningful spaces

• Misinterpretation of space can inhibit participation in activity

• Mixed messages often given out in purpose-built settings

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).

Reinforcing meaning

Spatial hierarchy

Light/ dark

Upstairs/ downstairs

Visual processing – what and where pathways

Physical memory

Behaviour

Guidance to Activity in

Dementia CareA checklist and design guide to promote

enjoyable activity for people with dementia

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

Potential Barriers to the use of a ‘window on the world’:

6-Private home

14-Sheltered flat

54-Care home lounge53-Care home bedroom

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

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?