Learning points for clinical professionals following a multi-site dementia environments

evaluation

Dr Tracey Williamson - Reader in Public Involvement, Experience & Engagement , School of Nursing, Midwifery, Social Work & Social Sciences

Presentation focus

• Overview of two dementia environments studies undertaken in 2014

• Key elements of dementia friendly environments

• Learning points from the study findings • Learning points from the process of

undertaking environment evaluations

The Salford Institute for Dementia

• Emerged from a ‘dementia design’ focus in 2011

• Unique network of academics in the Schools of the Built Environment, Health and Social Sciences, Technology, and Arts and Media

• Internationally unique inter-disciplinary lens on

living well with dementia

• 10 Dementia Associates with experience of dementia personally or as an informal carer

• Involved in: Engagement activities e.g. World Dementia Envoy visit; Education e.g. development and delivery of a Dementia Masters programme; Enterprise e.g. dementia communication Knowledge Transfer Partnership

• Research design and undertaking e.g. young onset dementia study; environments studies

Dementia Associates model

Dementia environments studies

• 2 evaluations of projects to undertake capital works to improve environments for people living with dementia e.g. signage, flooring, colour schemes, art work, lighting, outdoor space

• Greater Manchester study sites – 3 residential care homes– 1 mental health Trust– 2 acute hospital Trusts

Methods

• Informal site observations

• Questioning of staff (patients, residents, visitors)• Formal one-to-one interviews with project leads

in each setting; architects; estates

• Focus groups with staff

• Economic evaluation – value for money• Internal/external audits with dementia Associates

Tools

Audit tools included: • Cohen Mansfield Agitation Inventory• AEDET - Achieving Excellence Design Evaluation Tool • ASPECT - A Staff and Patient Environment Calibration Tool • Bespoke interview guides - site project leads, focus

groups, estates/architects• Kings Fund Dementia Environments tools• Australian Alzheimer’s Society Dementia Therapeutic

Garden Audit Tool

Learning points

• Allow sufficient ‘run in’ time• Comprehensively engage stakeholders –

clinical staff, support staff, people with experience of dementia, informal carers, visitors

• Balance scale with depth of investment in hospital areas to prevent dilute impact and maximise impact where needed most

Learning points

• Support environmental changes with training and education so staff understand rationale and practice implications

• Can do this kind of work without ward closures

• Inform staff fully of plans and progress• Be confident in changing design plans

Learning points

• Plan to evaluate from the outset and ideally ‘build in’ evaluation rather than ‘evaluate on’

• Support people with dementia to help evaluate service development – clear role, easy access, value insights

Artwork

Artwork

Purpose & location of facilities

Social areas

Social areas

Views

Outside spaces

Outside spaces

Outside spaces

Signage

Orientation

Navigation

Public involvement in design

Conclusions

• Environments for people with dementia can be enhanced using relatively low cost approaches

• Changes in environments are most effective where they are integrated into a whole-systems care approach rather than stand-alone

• Balance evidence base with judgement• Involving people with dementia in research and

service development can be very effective• King's Fund tool overly open to interpretation and

not suitable for use with people with more advanced dementia.

References

• King’s Fund (2013) Is your hospital dementia friendly? Environmental Assessment Tool, King’s Fund, London.

• Department of Health (2009) Living Well with Dementia: A National Dementia Strategy. The Stationery Office, London.

• Bridges J, Flatley M, Meyer J et al (2009) Best Practice for Older People in Acute Care Settings (BPOP): Guidance for Nurses (2009). Nursing Standard. 24, 10, CD-Rom.

Further info

Dr Tracey WilliamsonReader (Public Involvement, Engagement & Experience) School of Nursing, Midwifery, Social Work & Social SciencesUniversity of Salford t: +44 (0) 161 295 6424  |  m: +44 (0)7887 556345 |  e: T.Williamson@salford.ac.uk Acknowledgements

Funding: from UHSM and Salford City Council. Research Team: Dementia Associates, Natalie Yates-Bolton, Ricardo Codinhoto, Kathryn Yates, Marcus Ormerod, Steven Ruddock

 Salford Institute for Dementiahttp://www.salford.ac.uk/salford-institute-for-dementia