The living environment and the great outdoors. Delivering dementia-friendly environments within care homes. An example of international collaboration and synergy between the UK, New Zealand and Australia

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The living environment and the great outdoors.
Delivering dementia-friendly environmentswithin
care homes. An example of international
collaboration and synergy between theUK, New
Zealand and Australia

• Dr Graham Stokes
• Divisional Director of Dementia Care
• Bupa

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Dementia and Care Homes in the UK

• Approximately two-thirds of people with dementia
  in the UK live in care homes.
• In the UK between 60-75 of older people living
  in care homes have dementia.
• Average age of a resident is 83 years old.
• In the UK 69 of people aged over 85 years old
  have a significant disability or disabling
  longstanding illness.
• Many care home residents living with dementia
  have complex, challenging and end-of-life care
  needs.
• Nearly 60 of people with dementia die in care
  homes.

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Bupa International Care Home census 2009 (i)

• United Kingdom
• 18,500 residents
• 8,140 diagnosed with dementia (44)
• 11,655 residents assessed by staff to be living
  with dementia (as measured by memory impairment
  and disorientation) 63 of residents
• New Zealand
• 2,947 residents
• 50 of residents diagnosed with dementia
• 62 of residents assessed to be living with
  dementia

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Bupa International Care Home census 2009 (ii)

• Australia
• 3,784 residents
• 53 of residents diagnosed with dementia
• 73 of residents assessed to be living with
  dementia
• Spain
• 4,091 residents
• 46 of residents diagnosed/assessed to be living
  with dementia

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A sense of home, a need for care. The balance to
be achieved.

• What people want from a home and want they want
  in their lives does not change because of age,
  nor are core needs lost in dementia
• But what does change in care is that residents
  can be disabled to the point where they can no
  longer carry out actions to fulfil their own
  aspirations and meet their needs.
• A need for security, belonging, affection,
  companionship, occupation, meaningfulness, choice
  and control.
• Building design contributes to well-being it
  cannot determine it

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Guiding design principles (i)

• A room as your home

Theres a world where I can go
and tell my secrets to In my
room, in my room In this world
I lock out all my worries and my fears
In my room, in my room
Do my dreaming and my scheming
Lie awake and pray Do my
crying and my sighing Laugh at
yesterday.
(Lyrics from In My Room, Wilson Usher, 1963)
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Guiding design principles (ii)

• Moments spent between rooms are as important as
  those spent within rooms.
• Communal and external areas that are legible and
  meaningful for residents.
• Prosthetic designs that compensate for abilities
  that are impaired or lost.

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Carpets

• Works carried out
• The same colouring with minimal pattern
  throughout the corridors minimizes misperception
  and creates a flow.

• Visual barriers created through differing shades

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Bupa ADI 5 March 2012
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Corridors

• Plain corridors throughout, with no
  differentiation

• Works carried out
• Each corridor length is decorated in a different
  colour to aid orientation and provide an
  aesthetically pleasing environment
• Refreshed artwork with nostalgic themes
• Memory boxes throughout

Bupa ADI 2 March 2012
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A corridor with interest
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A room as your home. Your front door
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A room as your home
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Tactile boards

• Walls absent of any engaging items

• Works carried out
• Tactile boards located within the corridor areas
  as interactive features for residents

Bupa ADI 5 March 2012
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Handrails

• Bold handrails on corridors only

• Works carried out
• Contrasting handrails were already in place,
  however staff-access doors now have handrails
  across them to disguise the fact they are doors.

Bupa ADI 2 March 2012
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An institutional lounge becomes a sitting room

• Works carried out
• Partition introduced to create a smaller warmer
  space
• Wallpaper to create a homely, meaningful and
  inviting setting to sit.
• Visual access maintained allowing carers to
  observe effectively.

• Large open space, the same throughout

Bupa ADI 5 March 2012
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The sitting room
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Meaningful destination points

• Works carried out
• Two linen cupboards are now culture- and
  age-appropriate destination points. A newsagents
  and textile mill. activity zone has been
  created. Promote interest and engagement, as
  well as a reason to walk around.

• Originally a corridor linen cupboard for storage
  (doors taken off in this photo)

Dementia Friendly Environment Colton Lodges
trial, Before and After photos
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The Pub
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The cafe

• 2nd ill-focused lounge not used very often

• Works carried out
• Last of the Summer Wine (BBC comedy drama)
  café created, with nostalgic items from the
  programme, along with artwork of Compo, Foggy,
  Clegg and Nora Batty encouraging staff to use
  this area for tea and scones (for example)

Dementia Friendly Environment Colton Lodges
trial, Before and After photos
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A sense of arrival, not confinement.
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Chooks aka chickens
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The outside becomes a place of interest and
occupation
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A real life experience
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Bupa Australias Backyard Evaluation Study

• To evaluate the utilisation and impact of the
  experiential gardens
• Hypothesis was that the project would
• validate that experiential gardens and themed
  destinations have a positive impact for people
  with dementia and those around them by enabling
  people with dementia to
• engage purposefully and actively
• be stimulated and show interest
• provide enjoyment and pleasure
• create meaningful moments
• focus on abilities and promote independence and
  self esteem

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Methodology and Measures

• A case study methodology including pre and post
  clinical measures of each person selected (71
  case studies)
• Use of validated observational tools
• Emotional Responses In Care (ERIC) - measures a
  persons response when in the external
  environment/ destinations
• Quality of interactions Schedule (QUIS) which
  measures the quality of support and interactions
  of those supporting the person
• Cornell Depression Scale
• Incident reports relating to unresolved
  distressed behaviours

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Findings from Australia

• 21 reduction in Cornell Depression Score gt
  5points
• A reduction of 30 in reports of unresolved
  distressed behaviours such as verbal and physical
  aggression

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What we found
Findings from Australia
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What we found out
Findings from Australia
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What we found
Findings from Australia
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What we found out
Findings from Australia
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What we found
Findings from Australia
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Thank you