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 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 Age Concern

INDEPENDENT: Investigating Enabling Domestic Environments for People with Dementia Universities 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 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 choice and control

Independent - summary End user involvement in setting agenda A 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

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 700mm Thigh 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 430mm 700mm

Contact with the natural world Seasonal affective disorder and daylight illuminance Circadian rhythms A diurnal cycle of darkness and bright light

So you dont put music on for yourself… No. Not here. Not here. Oh no, no. Why not? I know its 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 cant have any. I havent paid for it. I havent got any money to pay for it; they might have done it for 70, 80 years …And now all of a sudden its 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 Care A checklist and design guide to promote enjoyable activity for people with dementia

GUIDANCE: a checklist identifying needs for participation and enjoyment ActivityThe personThe 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 lounge 53-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

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?