Dementia-friendly Communities Research Articles

Implementation of the Macao dementia policy: a scoping review for the way forward

BackgroundThe implementation of dementia policy is a complex process of translating policy goals to actions to address the changing needs of people living with dementia. Leveraging on others’ experiences would help policy decision-makers and actors better prepare for the challenges.PurposeThis study explored the development, the implementation and the impact of the dementia policy in Macao, a “role model” recognized by the Alzheimer’s Disease International.MethodsA scoping review of policies, strategies, and news articles, as well as scholarly work from 6 scientific databases dated till March 2023 was conducted under the guidance of the Health Policy Triangle Framework.ResultsAccording to 284 documents, the dementia policy in Macao, driven by government leadership and supported with public-private partnership, aimed to integrate health and social services to achieve the goals of “Early prevention, Early detection, Early diagnosis, Early treatment and Early support.” Promoting the preparedness according to the dementia burden trajectory, empowering the public and the service providers with training and education, and encouraging services-related research were among the key actions. With major changes in dementia care configuration, a dementia service network, a dementia-friendly community and a one-stop service model for disease screening, diagnosis, treatment and support have been developed.DiscussionReconfiguring existing resources in the health and social services to form an integrated service network at the community level could be considered a priority of action. Continuous engagement, collaboration and empowerment at different levels across these sectors is crucial for the sustainability of a dementia policy.

Using Smart Wearable Devices for Supporting Patients Affected by Dementia in Rural Areas of Calabria

The improvement of health and social care needs the introduction of shared solution at transnational level. The SI4CARE (Social Inno- vation for Integrated Health Care) project is a transnational initiative within the Adriatic-Ionian regions aiming to develop strategies to improve the current status of health and social care. The project member Municipality of Miglierina, a small rural town in Calabria, is developing a pilot action related to the use of wearable device for monitoring people affected by dementia together with the project partner Ra.Gi.. Ra.Gi. is a non-profit organization dedicated to assisting people with dementia in day care centers and so-called dementia-friendly communities. The pilot is based on the use of smart wearable devices to monitor these patients during their daily lifetime. This paper focuses on the design and implementation of the system discussing the proposed application, the strengths and weaknesses. We report results from a pilot experiment showing the effectiveness of this approach. Finally, the possibility of extending the experiment to the other Adriatic-Ionian region is presented.

Dementia-Friendly Transportation Services: A Scoping Review.

Transportation is an important component of dementia-friendly communities. People living with dementia have the right to access transportation services to keep their mobility in their community, which is essential for independence, well-being, and quality of life. This scoping review maps the literature on dementia-friendly transportation services and explores their characteristics to inform future development and research. Empirical quantitative and qualitative studies in English or French that informed on transportation services for people living with dementia in the community were searched in 15 databases. Two authors independently screened records and charted relevant characteristics from selected publications. Important findings were summarized with a narrative synthesis approach. Thirty-five studies informed on important dimensions of transportation services in urban and/or rural context: availability, accessibility, acceptability, adaptability, and affordability. Important insights were identified: the importance of staff training and attitude, and the challenges of availability of affordable services in the rural context. Emerging policy and program intervention areas include the need for access to quiet areas in transit hubs, training to use mass public transit and mobility management. The literature on dementia-friendly transportation services is important in the expansion and maintenance of mobility for people living with dementia in the community. The scope of the existing scientific literature remains limited. Although several studies indicated a clear need for better access to dementia-friendly transportation services, the best practices still need to be demonstrated in the scientific literature.

'Practice what you preach'. Perspectives on the involvement of people with dementia and carers in community-based dementia friendly initiatives, a qualitative study.

People with dementia and their carers experience social stigma and often refrain from social participation. Significant improvement might be achieved by creating Dementia Friendly communities (DFCs) for which dementia friendly initiatives (DFIs) are needed. DFIs are developed by a variation of stakeholders. However, people with dementia and their carers are often unrepresented herein. This study aims to get insight into the perspectives of stakeholders (e.g., health- and social care professionals, volunteers, people with dementia and their carers) about the involvement of people with dementia and their carers during the development and sustainment of DFIs. Descriptive qualitative study, using a co-research design with a carer as co-researcher. Nineteen semi-structured interviews with stakeholders, including people with dementia and their carers, were performed. Inductive content analysis took place using Atlas Ti. Four themes were found: 1) the involvement of people with dementia and their carers is important for both people with dementia and their carers and other stakeholders; 2) personal character traits, life histories, and associated emotions evoke the need for involvement; 3) involvement requires an open, responsive stance and building relationships; and 4) the estimation of one's own and others' capacities influences perspectives on involvement. As such, practice what you preach means actively adopting an open, responsive approach and acknowledging the unique abilities and backgrounds of people with dementia and their carers. It emphasizes the importance of actually living by the values you advocate for. Central to perspectives on involving people with dementia and their carers is the emphasis on working relationally, differing from service-led and pre-structured patient and public involvement (PPI). Working relationally calls for organizational shifts aligned with a rights-based perspective to avoid tokenism, and promotion of user-led organizations with genuine partnerships. Creative methods, problem-solving, and communication skills are essential for the development and sustainment of inclusive, supportive, person-centered DFIs. Future studies should explore the long-term impact of the involvement and working relationally on the well-being of people with dementia and their carers.

Age-friendly initiatives – GHANA

The global increase in the population of older persons has profound inter-sectoral implications, necessitating the development of age-friendly initiatives at the global and national levels. While progress has been relatively slower across Sub-Saharan African countries, highlighting existing commendable initiatives is essential to identify the current gaps and promote the development of strategies and interventions to promote age-friendly societies. This mini-review highlights some of the key initiatives in Ghana in the areas of policy, healthcare, finance, social services, education and research and in promoting dementia-friendly communities.

Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process

BackgroundImproving quality of nursing home care for residents is a constant focus of stakeholders involved within quality improvement projects. Though, achieving change in long-term care is challenging. Process evaluations provide insight into the nature, exposure and experiences of stakeholders and influencing mechanisms for implementation. The aim of this study is to gain insight into the process and facilitating and hindering mechanisms of implementing a quality improvement project that seeks to create a dementia-friendly community with a nursing home at its core.MethodsFor the process evaluation we planned a case study design with an ethnographic approach. Various research methods were used: qualitative observations, focus groups, interviews and questionnaires for various stakeholders and document review. Data collection and analyses in this study is based on the Consolidated Framework for Implementation Research.ResultsFour main lessons were learned. Firstly, nursing staff are crucial to achieve more freedom for residents. Secondly, high-impact changes in daily care need strong and sustainable focus from the care organisation. Thirdly, dementia-friendly societies should be deployed from multiple actors, which entails long-term collaborations with external stakeholders. Fourthly, the transition to a dementia-friendly society requires meeting spaces for and a focus on both residents and people from the community. Consequently, local residents are shifting from external to internal stakeholders, extending beyond the regular involvement of informal carers and volunteers within the nursing home.ConclusionsNursing homes are part of the local community and provide opportunities to collaborate on a dementia-friendly society. However, the change that is required (promoting freedom, residents’ autonomy and the redesign of care processes) is complex and influenced by various mechanisms. Understanding these mechanisms can benefit other care organisations that strive to implement a similar initiative.

Realist Evaluation Comparison of Dementia-Friendly Communities in England and the Netherlands

Realist Evaluation Comparison of Dementia-Friendly Communities in England and the Netherlands

Physical Activity Inclusion in Dementia-Friendly Communities: A Mixed Methods Study.

Dementia-friendly communities (DFCs) are a policy-endorsed approach to community engagement in England that promotes social inclusion to enable people affected by dementia to live well. Research suggests that physical activity is beneficial in encouraging social connection and improving health. A mixed method sequential study design in England involving a national survey (n = 31) and semistructured interviews (n = 65) in three DFCs was carried out. The aim was to understand how DFCs enable people affected by dementia to participate in physical activities. An evaluation framework for DFCs was used to organize and interpret the data, and analysis was informed by the inclusive (social) citizen lens. Findings showed that DFCs offered a range of adapted dementia-inclusive and dementia-specific activities; however, people were not routinely offered information at time of diagnosis. Local authorities (councils) were key to enable access to information and infrastructure change to support sustainable inclusion within their local community.

From the Italian National Dementia Plan to the Dementia Friendly Communities

This article explores various aspects related to dementia care and support in Italy. It begins by discussing the National Dementia Plan of Italy, highlighting its goals and initiatives. It then focuses on the Veneto Region and their innovative approach to supporting people with dementia through the implementation of the Dementia Map, an online support system. The article also highlights the importance of dissemination publications in raising awareness and sharing knowledge about dementia care practices. Furthermore, it delves into the pilot project of Abbiategrasso, the first Dementia Friendly City in Italy, showcasing the efforts made to create a community that is inclusive and supportive of individuals with dementia. The experiences and lessons learned from this project serve as valuable insights for other communities aiming to become dementia friendly. In conclusion, the article emphasizes the significance of collaborative efforts, innovative approaches, and community engagement in improving the lives of individuals with dementia and their caregivers. It underlines the importance of continuous advancements in dementia care and the need for ongoing support systems to meet the evolving needs of those affected. The bibliography provides a list of relevant sources and references that further explore the topics covered in the article.

ASSET-BASED COMMUNITY DEVELOPMENT FOR DEMENTIA-FRIENDLY COMMUNITIES (ABCD FOR DFC): A PILOT PROJECT IN HONG KONG

Abstract There is little understanding about how a dementia-friendly community can be constructed in East Asian societies, particularly in geographically remote areas characterized with majority older adult residents and limited external support. A pilot project using an asset-based community development (ABCD) approach in constructing a dementia-friendly community in Hong Kong was implemented. Informed by the theoretical tenets of ABCD, the purpose of this paper is to examine the effects of this pilot project in enabling older adult residents and other community stakeholders to better respond to challenges resulting from growing prevalence of dementia. Multiple stakeholder interviews were conducted with older adult residents, church leaders, district councillors, and social workers. Participants were asked to share the strengths and challenges of this ABCD pilot project in building a dementia-friendly community. Data generated from interviews were analyzed using thematic analysis. Four key preliminary themes were identified, including on the individual level: enhanced dementia literacy, and enacted proactive behaviour; and on the community level: strengthened bridging social capital, and improved community caring capacity. Uncertain long-term financial and professional support posed challenges to participants. Nevertheless, findings underscore the importance of departing from traditional service delivery models, to one that infuses ABCD approaches in constructing a dementia-friendly community. Mobilising existing human and social capital in the community, and embedding older adults in co-creating solutions are key to improve dementia-related interventions. We contribute to ongoing theoretical and practice discussions on the intersections between population aging and employing community-based solutions to create a more dementia-friendly society.

ADVANCING ADOPTION AND SUSTAINABILITY OF AGE-FRIENDLY INITIATIVES THROUGH SYNERGIES AND IMPLEMENTATION SCIENCE

Abstract For communities interested in adopting age-friendly principles, the plethora of age-friendly initiatives (i.e., age-, disability-, and dementia-friendly cities and communities; age-friendly universities, health systems, and public health systems) can be overwhelming. For rural, frontier, underserved, and under-resourced communities, it can be challenging to consider tackling even one such initiative. A major barrier to implementation is the know-do gap between what is known and what gets accomplished in practice. This gap is widened as a result of overly complex models and practices that are difficult to disseminate and scale, difficult to reproduce, or do not apply across settings. The know-do gap can be effectively bridged by focusing on core features common across age-friendly ecosystem initiatives. To successfully advance this work, it is important to consider strategies to maximize the collective impact of age-friendly initiatives and explore opportunities to tailor these initiatives so they can be successfully adapted for and adopted by various settings, contexts, and populations. Using an implementation science approach, three models will be introduced (Strengths-Based Interprofessional Practice and Education (SB-IPE); Micro-, Meso-, Macro- M3: Aligning Your Nexus Through a Systems Lens; and Kennedy Model of Sustainability) to facilitate the adoption and sustainability of evidence-based age-friendly principles, programs, and policies.

A neighbour to consult with is important in dementia-friendly communities: associated factors of self-efficacy allowing older adults to continue living alone in community settings.

A neighbour to consult with is important in dementia-friendly communities: associated factors of self-efficacy allowing older adults to continue living alone in community settings.

P193: Participation of faith-based organizations in the secular health- and welfare- care system for the older people in Japan: evidence and challenges

Objective:Due to longevity, universal health coverage, declining population, and a stable society, it is estimated that the number of people with dementia will reach 10 million by the mid-21st century, accounting for 10% of the total population in Japan. To move toward a dementia-friendly community, it is essential to develop innovative and effective dementia care. However, human and economic resources are limited. Therefore, we focused on traditional Buddhist denominations that have organizations, educational systems, human resources, networks, and care venues. The fundamental question of this study is: Japanese Buddhism has created basis for mindfulness-based cognitive therapy, but is it also innovative in the care of older people?Methods:We looked for papers that 1) were written in a medical rather than a religious context, 2) were written in English, and 3) dealt with the care of the older people in Japan.Results:1) Institutional care workers’ need for Buddhist priests for helping anxiety of older residents was reported. 2) Effectiveness of community cafés for the family caregivers of people with dementia in the Buddhist temples were reported. 3) Potentials of monthly visit to bereaved families, Buddhist priests’ tradition, as the outreach of grief care was suggested. 4) Care workers’ own ideas about death after working in the landscape of dying and death was reported by the interview which used Buddhist priests as the interviewers.Conclusion:Participation of Buddhist priests as 1) spiritual cares for the residents in the institutions, 2) carers for the family carers in the community, 3) carers of the bereaved families in the outreach activity, and 4) carers for the care workers, were reported. However, robust evidence was not enough. From the standpoint of Japanese clinicians, there are too few papers compared to the actual contributions. More studies should be done which might also work as external monitoring. Traditional Buddhism in Japan has a closed membership system which is based on the family gravesite system and is generally not enthusiastic about propagation, which would also be compatible with a secular care system.

The Built Environment’s Role in Supporting Dementia Inclusive Communities: A Case Study of Canterbury‐Bankstown City

AbstractBackgroundInclusive and enabling cities are fundamental to the wellbeing of people impacted by dementia. How we implement these ideals in multicultural communities through the built environment remains understudied. The experience of place must be considered in the context of dementia‐friendly community (DFC) models to fully enable people experiencing dementia to remain autonomous, integrated, and connected. This study aimed to explore how diverse individuals with dementia perceive the built environment and its impacts on everyday activities using a mixed methods approach.MethodThis study was set in Canterbury‐Bankstown, New South Wales, Australia where a high proportion of people impacted by dementia speak English, Arabic, and/or Vietnamese. Seventeen people experiencing dementia, their care partners, and former carers (English: n = 7; Arabic: n = 5; Vietnamese: n = 5) were recruited for a semi‐structured interview, and two of these dyads (English: n = 1; Vietnamese n = 1) audited a local shopping centre and hospital using the DFC‐environmental assessment tool (DFC‐EAT). Interviews and audits were conducted in‐language with bilingual researchers, who then transcribed the data into English for analysis. Similarities and differences were identified across the interview transcripts and audit data to identify issues with the existing built environment and improvement opportunities.ResultWe found that participants would limit or avoid going outdoors for everyday activities because of safety concerns (especially when using paths and carparks). Furthermore, overwhelming indoor experiences were characterised by unfamiliar designs and fittings (particularly with bathroom facilities), unsupported movement and way‐finding due to excessive or insufficient signage, poor lighting, and high noise. Participants recommended greater access to door‐to‐door transport that caters to people experiencing dementia, establishing quiet resting areas, and improving navigation through signage that uses standardised symbols (e.g., for toilet facilities).ConclusionPeople experiencing dementia and carers reported an array of issues concerning built environment design and accessibility features that excluded them from everyday activities. These findings were translated into an implementation plan that informed the City of Canterbury‐Bankstown Council’s community planning efforts and the shopping centre’s facility operations. Critical areas for improvement in the built environment would benefit from co‐design practices that are inclusive and representative of the community.

Dementia needs assessment in Latine communities: strengths, challenges and policy opportunities in Wisconsin, USA

AbstractBackgroundLatinx populations are 1.5 times more likely to develop ADRD than non‐Latinx whites. Despite their heightened risk, they are more likely to be undiagnosed, under‐diagnosed and misdiagnosed. This is exacerbated by the lack of culturally appropriate information addressing ADRD to combat culturally specific stigma and misconceptions, as well as a dearth of culturally suitable resources. Infrastructure development that engages the community and community organizations can assist in overcoming these challenges by addressing community needs, capitalizing on existing resources, fostering sustainability, and promoting health equity.MethodUsing a modified version of the instruments included in the ACT on Alzheimer’s® Dementia Friendly Communities Toolkit, we evaluated the ADRD related needs and other social needs (e.g. transportation) that Latine communities experience in Madison, Wisconsin (USA). The instrument was distributed via email to community organizations and individuals serving Latine individuals in the area. Additionally, a community advisory group contributed to the identification of existing assets/priorities and strategic planning.ResultThe strengths identified for the community were: a sense of community that leads to individuals caring for one another and wanting to provide for one another’s needs, and the availability of a variety of community organizations and individuals who play a role in serving people living with dementia and their care partners. The absence of bilingual/bicultural resources to serve individuals was cited as the most significant challenge, followed by the lack of information regarding dementia, and the paucity of care options for those who are not eligible for Medicare or Social Security benefits. Table 1 reflects the most important services needed in the community. Reimbursement/Service fees (e.g., organizations use Medicare/Medicaid funding and do not have additional revenue sources to serve individuals without insurance), educational requirements for employees without a comparable requirement on language proficiency, and limited funding for multi‐language services were identified as pertinent policies.ConclusionCommunity members viewed dementia education and awareness of care services as crucial. Collaboration with current organizations to provide additional resources that enable them to implement culturally and linguistically appropriate processes for all is key to ensure the sustainability of future endeavors.

Public library services for people with dementia: A study of students’ perceptions

Although librarians have not been traditionally recognized as professionals who provide care for persons with dementia, recent research indicates that libraries can contribute to the development of dementia-friendly communities. They can offer cognitive engagement and social inclusion events for people with dementia, provide information to their caregivers and educate the general public about dementia. In this article, the authors present the findings from a study that attempted to answer the following research questions: ‘How much do library and information science students in Croatia know about dementia?’ and ‘How do they perceive the role of public libraries in developing dementia-friendly communities?’ The study was conducted using a quantitative methodology among 183 library and information science students. Although the respondents had somewhat poor knowledge about dementia, they believed people with dementia have an inherent right to library materials and programmes suited to their specific needs, and that libraries can raise the quality of their life in the community.

Social Activity Restriction and Psychological Health Among Caregivers of Older Adults With and Without Dementia.

We examined associations between social activity restriction and psychological distress and well-being for caregivers of older adults with and without dementia, and if the identified associations are different for the two groups. Using data from the 2017 National Study of Caregiving, we identified caregivers of older adults with (N = 541) and without (N = 1701) dementia. Linear regression models were estimated, adjusting for caregivers' age, gender, race, education, relationship to care recipient, and self-rated health. Restriction in visiting friends and family and attending religious services were associated with higher distress in dementia caregivers. Restriction in visiting friends and family was associated with higher distress and lower well-being in non-dementia caregivers. Any activity restriction had stronger association with distress for caregivers of older adults with versus without dementia. Findings highlight the need for tailored interventions based on caregivers' perceptions of meaningful social activities and dementia-friendly communities to promote social participation.

Exploring the experiences of people living with dementia in Dementia Friendly Communities (DFCs) in Northern Ireland: a realist evaluation protocol

BackgroundThe aim of this study is to 1) explore the experiences of people living with dementia interacting with DFCs and 2) identify factors that influence empower and support people living with dementia to live successfully in DFCs. The main elements of a DFC are related to people; communities; organisations and partnerships. There are over 200 organisations recognised as dementia-friendly in Northern Ireland (NI). This realist evaluation is to understand how DFCs work for people living with dementia, how positive outcomes are achieved, for whom and in what contexts do DFCs work best.MethodsA realist evaluation using case study methodology. The process evaluation includes a realist review of the literature, non-participant observation of people living with dementia in their local communities, semi-structured interviews to explore the facilitators and barriers to living well in DFCs and focus groups comprised of people living with dementia, family caregivers and people working in DFCs to support Context- Mechanisms and Outcomes (CMOs). This four-stage realist assessment cycle is used, including iterative rounds of theory development, data gathering, and theory testing. In the end, analysis will reveal context mechanisms that influence how dementia-friendly communities operate and present an initial theory of how people think, which, if adopted, may be able to alter current contexts so that "key" mechanisms are activated to generate desired outcomes.DiscussionTo give confidence in moving from hypothetical constructions about how DFCs could function to explanations of possible or observable causal mechanisms, the realist evaluation of a complex intervention incorporates a variety of evidence and perspectives. Despite playing a significant role in a person with dementia's everyday life, it appears that little is known about how communities function to achieve intended results. Even though there has been a lot of work to pinpoint the fundamentals and crucial phases of building DFCs, it is still unclear how people living with dementia benefit the most from these communities. This study intends to advance our understanding of how outcomes are produced for people living with dementia by contributing to the underlying theory of DFCs as well as addressing the primary research objectives.

Organizational Characteristics of Senior Centers and Engagement in Dementia-Friendly Communities.

Dementia-friendly communities (DFCs) are systematic and collaborative efforts to make local communities more supportive and inclusive of persons living with dementia and their care partners. This study explores how the organizational characteristics of senior centers influence their engagement in DFCs. We used a partially mixed, concurrent, equal status design, drawing on qualitative interviews with staff from 13 senior centers leading DFC initiatives as part of a statewide dementia-friendly network in Massachusetts, as well as quantitative data from 342 senior centers collected as part of a statewide survey. The qualitative results demonstrated ways in which human, social, tangible, and programmatic capital facilitate senior centers' DFC engagement. In particular, the results illuminated the importance of social capital with organizations and groups outside of the senior center, spanning the municipal, regional, and state levels. Findings from multivariate analyses further indicated robust and strong associations between higher levels of social capital, as well as more dementia-focused programming and greater variety of funding sources, with greater likelihood of engagement in DFC work. Results indicate the importance of policy and practice to foster both organizational capacity and multilevel systems conditions to enable and motivate senior centers' involvement in DFC initiatives.

Engagement of Persons with Dementia in Public Consultations: Process Evaluation

Engagement of persons living with dementia in public consultations is central to the development of dementia-friendly communities (DFC). However, due to a lack of resources and expertise in how to support their involvement, persons living with dementia are not always involved in processes for planning the development and implementation of DFC initiatives. To better understand processes and methods that facilitate the engagement of persons living with dementia in public consultations, we evaluated the public consultation processes of a Canadian DFC initiative. A partially mixed-methods sequential equal status design guided this process evaluation. Data sources included surveys completed by public consultation participants, focus groups with members of the group that led the public consultation process, and the report that outlines consultation findings. Study results highlight the strengths and limitations of the public consultations and include recommendations for engaging persons living with dementia in public consultations. Results emphasize the importance of including persons living with dementia in DFC initiatives as project partners and public consultation participants.