Dementia-friendly Communities Research Articles

A departing mystery: dementia related knowledge and attitude among dental professionals in Chennai

Background: Improving dentist’s knowledge, perceptions and attitudes of dementia is important in the formation of dementia-friendly communities. The aim of the study was to evaluate dentist’s knowledge and attitudes of dementia. The purpose of this study was to examine dentist’s, interns, postgraduate’s knowledge and attitudes towards dementia and to provide basic data for educating about knowledge of dementia and strengthening positive attitudes towards dementia related patients.Methods: One hundred and ten dentists, dental post graduates, interns aged 22-46 years, from dental schools in Tamil Nadu were invited to complete a series of questions that assessed their dementia knowledge and attitudes.Results: A total of 110 dentists completed the questionnaire. Out of 24 questions on dementia knowledge and attitude, participants were on average able to answer less than half correctly. Responses to the attitude’s questionnaire showed that dentists had both positive and negative attitudes toward dementia.Conclusions: There is scope for dentists to improve their dementia knowledge and attitudes. Until a validated measure of dementia knowledge has been developed specifically for an dentist sample, researchers should avoid summary statistics (i.e.; total score) and instead focus on interrogating where the gaps in knowledge.

Needs, issues, and expectations on dementia care at home across Europe to inform policy development: Findings from a transnational research study

This qualitative descriptive study explored needs, issues, and expectations on dementia care at home as expressed by relatives of people living with dementia (PwD), health and social care professionals (HSCPs), and members of civil society organisations (CSOs) from four European countries. A focus group methodology integrated with individual semi-structured interviews was adopted to collect data by employing a purposeful sampling method. A total of 13 focus groups and 12 individual interviews were conducted in 2019, involving 65 relatives of PwD, 32 HSCPs, and 23 members of CSOs. Deductive content analysis and findings triangulation were performed to analyse data, and a subgroup of participants confirmed the findings. Relatives need to be (a) informed and trained to cope with changes in PwD, (b) recognised for their caregiving role, and (c) assisted by specialised HSCPs. Professionals who work in partnership with PwD and their relatives call for a reorganisation of available services. CSOs compensate for the lack of proper support, promoting networks, and cooperation with local communities.Several commonalities emerged across countries, highlighting the chance to inform and develop common policies to improve the quality of life of PwD and their relatives across Europe. Policies improving person- and family-centred care and spreading dementia-friendly community concepts and practices are suggested. Strong collaborations between formal and informal services and communities are also needed as well as information on educational strategies to improve the use of resources, promote PwD care, and support PwD relatives’ needs.

Dementia-Friendliness in Danish and International Contexts: A Critical Discourse Analysis.

Initiatives to create dementia-friendly environments are subject to political attention all over the world. As the interpretation of dementia-friendliness is influenced by current cultural trends, the concept is highly ambiguous. The present study aims to explore how discourses concerning dementia-friendliness are manifested in Danish and international policy documents and how they interact internationally. Inspired by Fairclough's critical discourse approach, 21 policy documents were analyzed to reveal how power is exerted through language and the discursive construction. We identified 5 types of discourses, namely, those concerning the domains of socioeconomy, rehabilitation, knowledge, responsibility, and a good life. Dementia-friendliness was found to be embedded in an overall ideology aimed toward supporting the individual's autonomy in life and health choices and their participation in society. Our analysis furthermore suggests that dementia-friendly initiatives are used collectively as a lever to achieve these policy aims to ultimately compensate for and protect people with dementia against the consequences of the loss of competencies, identity, and control. Thus, to develop and establish sustainable dementia-friendly environments and communities that meet the needs of people living with dementia, we need to be aware of and discuss the implications of the discourses constructing dementia-friendliness and their influence on the appearance of dementia-friendliness in society.

Beyond the shrinking world: dementia, localisation and neighbourhood

Abstract‘Dementia-friendly communities’ herald a shift toward the neighbourhood as a locus for the care and support of people with dementia, sparking growing interest in the geographies of dementia care and raising questions over the shifting spatial and social experience of the condition. Existing research claims that many people with dementia experience a ‘shrinking world’ whereby the boundaries to their social and physical worlds gradually constrict over time, leading to a loss of control and independence. This paper reports a five-year, international study that investigated the neighbourhood experience of people with dementia and those who care for and support them. We interrogate the notion of a shrinking world and in so doing highlight an absence of attention paid to the agency and actions of people with dementia themselves. The paper draws together a socio-relational and embodied-material approach to question the adequacy of the shrinking world concept as an explanatory framework and to challenge reliance within policy and practice upon notions of place as fixed or stable. We argue instead for the importance of foregrounding ‘lived place’ and attending to social practices and the networks in which such practices evolve. Our findings have implications for policy and practice, emphasising the need to bolster the agency of people living with dementia as a route to fostering accessible and inclusive neighbourhoods.

Living on the edge of the community: factors associated with discontinuation of community living among people with cognitive impairment

BackgroundAs Japanese society continues to age, the isolation of older people is increasing, and community living for people with cognitive impairment is becoming more difficult. However, the challenges faced by people with cognitive impairment living in the community have not been fully explored because of methodological difficulties. This study re-accessed people with cognitive impairment identified in a previous epidemiological survey to explore their current situation and the risk factors associated with all-cause discontinuation of community living.MethodsUnder a community-based participatory framework, we examined a high-risk approach for people with cognitive impairment and a community action approach in parallel, to build a dementia-friendly community. For the high-risk approach, we achieved stepwise access to 7614 older residents, which enabled us to select and visit the homes of 198 participants with a Mini-Mental State Examination score < 24 in 2016. In 2019, we re-accessed these individuals. For the community action approach, we built a community space in the study area to build partnerships with community residents and community workers and were able to re-access participants using multiple methods.ResultsWe found that 126 (63.6%) participants had continued living in the same community, but 58 (29.3%) had discontinued community living. Of these, 18 (9.1%) had died, 18 (9.1%) were institutionalized, 9 (4.5%) were hospitalized, and 13 (6.6%) had moved out of the community. A multiple logistic regression analysis identified the following risk factors associated with discontinuation of community living: being certified under long-term care insurance, needing housing support, and needing rights protection.ConclusionsThree years after the baseline survey, 29.3% of people with cognitive impairment had discontinued community living. Despite having cognitive impairment or living alone, older people were able to continue living in the community if their needs for housing support and rights protection were met. Both social interventions and medical interventions are important to build age-friendly communities.Trial registrationUMIN, UMIN000038189, Registered 3 October 2019, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000043521

Dementia-Friendly Neighborhood and the Built Environment: A Scoping Review

There has been a proliferation of research on dementia-friendly communities in recent years, particularly on interpersonal and social aspects. Nonetheless, the neighborhood built environment remains a co-constituent of the lived experience of people living with dementia (PLWD) that is amenable to interventions for health and well-being in the community. This scoping review presents a narrative synthesis of empirical research on dementia-friendly neighborhoods, with a focus on the built environment and its associated sociobehavioral aspects. Planning and design principles are distilled to identify research and policy implications. We reviewed 29 articles identified through a systematic search of AgeLine, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Global Health, Medical Literature Analysis and Retrieval System Online, and Scopus. Peer-reviewed articles that employed quantitative and/or qualitative methods in community settings were included. An equal number of studies focused on behavioral/psychosocial aspects of the built environment and assessment of specific environmental features. The former often used qualitative methods, whereas statistical methods were common in studies on discrete features of the neighborhood built environment. Few studies focused on rural contexts. Emerging research areas include interactions between dementia risk factors and neighborhood environments to support primary and secondary prevention. The body of literature needs expansion into planning and design fields to foster community participation of PLWD by optimizing environmental stimuli, minimizing environmental barriers, and engaging PLWD in dementia-friendly community initiatives. While evidence has accumulated on landmarks and social participation at the individual level, research at the community and policy levels is limited. This requires advanced mixed methods.

Using Appreciative Inquiry to Build a Dementia- Inclusive Community

This is a story of hope in a time of despair. Dementia is the leading cause of death in Australian women. Dementia-friendly communities support people living with dementia to live with meaning, purpose and value. Community members, people living with dementia and their carers began building a dementia-friendly community. Appreciative Inquiry was used to mobilise the community to build this story of hope.

Creating Dementia-Friendly Communities for Social Inclusion: A Scoping Review.

Aims: This scoping review explores key strategies of creating inclusive dementia-friendly communities that support people with dementia and their informal caregiver. Background: Social exclusion is commonly reported by people with dementia. Dementia-friendly community has emerged as an idea with potential to contribute to cultivating social inclusion. Methods: This scoping review follows the Joanna Briggs Institute scoping review methodology and took place between April and September 2020. The review included a three-step search strategy: (1) identifying keywords from CINAHL and AgeLine; (2) conducting a second search using all identified keywords and index terms across selected databases (CINAHL, AgeLine, MEDLINE, PsycINFO, Web of Science, ProQuest, and Google); and (3) hand-searching the reference lists of all included articles and reports for additional studies. Results: Twenty-nine papers were included in the review. Content analysis identified strategies for creating dementia-friendly communities: (a) active involvement of people with dementia and caregivers (b) inclusive environmental design; (c) public education to reduce stigma and raise awareness; and (d) customized strategies informed by theory. Conclusion: This scoping review provides an overview of current evidence on strategies supporting dementia-friendly communities for social inclusion. Future efforts should apply implementation science theories to inform strategies for education, practice, policy and future research.

Building Community Space for Supporting Residents Living With Dementia in a Housing Complex District in Tokyo, Japan

It is estimated that by 2025 the number of people with dementia will reach around 600 thousand, approximately one out of five in the older population in Tokyo, Japan. At the same time, the number of older people living in a single, couple household is expected to increase. We built a community space for older people in the largest housing complex district in Tokyo, and with the goal of creating a dementia friendly community (DFCs). In this study, we used the community-based participatory research approach to create a model of an inclusive community space with a human-rights-based approach, which is embodied in the PANEL framework by the Alzheimer Scotland organization. The community space where everyone, regardless of with or without dementia, can freely spend their time, and seek consultation on healthcare and older care. It also serves as a Dementia Café, where people with dementia can get together and chat. Places open 3 days a week. Those users can casually seek consultation by physicians, health nurses and psychologists. From April 1, 2017 to March 30, 2018, the average number of visitors was 11.6. Number of consultation was 182 times (female 81.3%, 80s’ =31.3%; 70s’ =23.1%). Historically, service delivery for the people with dementia was hospital-based in japan, but our community space established a new method to provide consultation to people with dementia, from a professional perspective, and to cooperate with appropriate social resources and related organizations as needed.

Fireside Chats During COVID-19: Caregiver Community-Based Education

The Utah Geriatric Education Consortium (UGEC) provides education about Age-Friendly Health Care and Dementia-Friendly Communities to both informal and professional caregivers. As such, we have collaborated with our community partners to hold 12 “Fireside Chats” (2 in person, and 10 virtually due to COVID-19) between December 2019 and September 2020. Our expert speakers and panelists have given presentations on a variety of topics, specifically focused on coping with COVID-19, such as physical, music, and arts-based activities to do in the home, advance care planning, local services and supports, resiliency, and mindfulness. A total of 463 participants attended the Fireside Chats. A total of 169 attendees completed evaluations regarding the programs (a completion rate of 37%). Attendees were primarily White (86%), non-Hispanic (95%), well educated (86% had a college degree or higher), about half of the group were community caregivers (55%), while the other attendees were primarily from health professional backgrounds (e.g., nursing, social work, physical therapy). We obtained evaluation data in seven domains based on a 5-point Likert scale (1=strongly disagree to 5=strongly agree). The mean level of agreement in the seven following domains were: satisfaction (M=4.68/SD=.53), effectiveness (M=4.72/SD=.52), met stated goals (M=4.70/SD=.53), met educational needs (M=4.64/SD=.6), will improve the care they provide (M=4.57/SD=.70), included useful examples (M=4.59/SD=.66), and was better than similar trainings (M=4.23/SD=.86). These results along with steady attendance of our “Fireside Chats” demonstrate the need and satisfaction with our community-based education based on improving geriatric care practices within the community and in long-term services and support programs.

A Conceptual Framework of Person-Environment Relations in the Out-of-Home Mobility of People Living With Dementia

This paper proposes a conceptual framework on the relationship between neighbourhood mobility and developmental outcomes of persons living with dementia. While there is growing evidence on the importance of out-of-home mobility for community-dwelling people with dementia, there is a lack of theoretical understanding of the person-environment (P-E) interactions involved in out-of-home mobility in the context of dementia and their influence on psychosocial outcomes. The proposed framework adapts Chaudhury and Oswald’s Integrative Conceptual Framework of Person-Environment Exchange to address the influence of out-of-home mobility-related P-E interactions on processes of agency and belonging for people living with dementia and the cumulative effect on developmental outcomes of autonomy and identity. The framework describes a linear sequence of four components: (i) out-of-home mobility-related P-E interactions determined by individual, social, physical environmental, and technological factors; (ii) mobility-related environmental barriers and facilitators and perception of out-of-home mobility-related risk and benefit; (iii) interrelated positive and negative processes of behaviour-driven agency and experience-driven belonging; and (iv) interrelated developmental outcomes of autonomy and identity. This framework advances our conceptual understanding of the relations between the experience of living with dementia and different aspects of the neighbourhood environment by bridging objective and subjective dimensions of P-E interactions and framing out-of-home mobility as an important contributor in maintaining identity and autonomy. The framework could inform empirical research in this area, evaluation of dementia-friendly community initiatives, and policy decisions by drawing attention to both the functional aspects and meanings associated with out-of-home mobility for persons living with dementia.

Risk Factors for Older Pedestrian Injuries and Fatalities Among Communities in Massachusetts

The number of pedestrian crashes in the United States has increased by 35 percent from 2008 to 2017. Among all pedestrian fatalities in 2017, 48% were pedestrians aged 50 and older, which suggests a disproportionate threat to older residents’ health and safety. Massachusetts has a large older population and is experiencing increased numbers of older pedestrian crashes. This research identified risk factors and community characteristics contributing to older pedestrian crashes and suggests leveraging the state’s age-friendly efforts to speed the implementation of countermeasures. Based on ten-year statewide crash data (2006-2015) and community indicators from the 2018 Massachusetts Healthy Aging Data Report, this study examined 4,472 crashes across Massachusetts that involved pedestrians age 55 and over. The leading reasons for crashes were driver’s inattention, driver’s failure to yield right of way, and driver’s issues with visibility. Older pedestrians were hit while walking in the road, often in crosswalks at intersections. Many factors were found to contribute to older pedestrian crashes: time of day (rush hour), time of year (winter), and community factors (higher rates of disabilities, higher percentage of racial minority residents, higher number of cultural amenities, and lack of dementia-friendly community efforts. Greater awareness of older pedestrian safety risks is needed. Communities highlighted in this research warrant priority attention from planning, health, aging services, and transportation authorities to improve older pedestrian safety.

The Process of Developing a WHO Dementia-Friendly Community Global Toolkit: Input From Multiple Stakeholders

This study examined the process that the Department of Mental Health and Substance Abuse of WHO used to develop a global toolkit for dementia friendly initiatives (DFI). Data were collected through a mix-method approach consisting of individual interviews of 20 DFI leaders, four focus group interviews of persons living with dementia (PWD), three group interviews of professionals, and an online survey of 129 participants from 46 countries. Data from multiple sources were examined. The meaning of DFIs centered on the needs of PWD, multi-sector collaboration, and physical and social environmental changes. Over 70% participants in the survey reported their DFIs targeted PWD and included PWD as important partners. The EASTT model can be used to summarize DFI strategies including Education, Advocacy, Support, Training and Transforming environment. Countries advanced in DFI tended to focus on enhancing professional capacity and environmental adaptation, while countries launching DFI appeared to prioritize dementia awareness campaigns.

An Alzheimer’s Curriculum to Educate the Current and Future Public Health Workforce

Alzheimer’s disease is the 6th leading cause of death among adults in the United States and the 5th leading cause for those aged 65 and older. Nearly 14 million Americans will be diagnosed with Alzheimer’s dementia by 2060, but the public health workforce is struggling to meet current demands. As the older adult population continues to grow, the public health sector will need to ensure a sizable and competent workforce is prepared to meet the needs of those living with dementia as well as their caregivers. In support of national efforts to promote and ensure a competent workforce, the Alzheimer’s Association, Centers for Disease Control and Prevention, and Emory University developed “A Public Health Approach to Alzheimer’s and Other Dementias” (ADOD) curriculum. The free, introductory curricular resource was first piloted by faculty and students at undergraduate schools of public health across the country; however, due to its broad applicability the curriculum has since been updated and expanded to educate graduate students in schools of public health, students in related disciplines, and practicing public health professionals. The curriculum provides an introduction to ADOD as a public health crisis, basics of dementia, the role of public health in addressing the epidemic, and the creation of dementia-friendly communities. The purpose of the curriculum is to educate future public health workforces about ADOD; encourage the current public health workforce to apply knowledge to practice; and seek to improve health outcomes for those living with dementia, as well as their caregivers.

Learning While Doing: Community-Engaged Action Research With Age-Friendly Community Leaders

Age-Friendly Community Initiatives (AFCIs) are expanding throughout the United States to make social and built environments within local communities more responsive to population aging. With over 450 initiatives affiliated with the AARP Network of Age-Friendly Communities, Cities, and States (125 of which began in 2019-early 2020), rapid growth on the ground necessitates that theory and research develop alongside practice innovations. This symposium showcases the intersection of cutting-edge scholarship with community-based efforts to generate knowledge of community change processes that is immediately actionable by community leaders. Collectively, these papers emphasize the benefits of action research and developmental evaluation in community gerontology towards building the theories of age-friendly change that will set the stage for outcomes research. The first paper will present on work with 83 AFCIs in rural Maine involving interviews with organizational leaders to inform which types of supports could stimulate age-friendly changes to communities’ built and social environments. The second paper will share a mixed-methods approach used to develop a global toolkit for dementia-friendly communities. The third presenter will describe the collaborative development and utilization of social network analysis to help age-friendly leaders plan their work, while simultaneously advancing research on variation in AFCI implementation. The final paper will present an evaluative framework that identifies roles and outcome measures for collective impact at the intersection of public health and age-friendly communities.

Memory clinics- a model for dementia care

Alzheimer’s Disease International estimates there are around 4.1 million people in India with dementia. Services available in India are inadequate to meet the needs of people with dementia and their families. Memory clinics are multidisciplinary teams led by specialist doctors with inputs from other professionals like nurses and social workers. This paper will explore the predominant themes emerging from a qualitative study assessing the core principles of memory clinics. The procedural details and the basic characteristics of attendees to one of the earliest memory clinics in the region would be described. Parson centred nature of care, rationalising medications, psychosocial support, multidisciplinary approach and family support were the emerging themes the experts identified as the functions and core principles. In addition to medical treatment, memory clinics can play a major role in appropriately guiding the patients with dementia and their families to address various challenges associated with the condition thus reducing caregiver stress. Memory clinics can also contribute to training, education and research and can play a major role in creating dementia friendly communities. There should be a collaborative approach in establishing appropriate dementia care between various agencies including governmental and non-governmental agencies. Keywords: Memory clinic, Dementia, Alzheimer’s, ARDSI.

Health promotion initiative: A dementia-friendly local community in Sweden.

Dementia is a great public health concern worldwide. Despite this, little is known from a health-promoting perspective about dementia in general as a public health issue, in dialog with people living with dementia, applicable at individual, group, and societal levels with regard to policies and practice. This study therefore aims to explore the experiences related to living with dementia in the local community by advancing a health-promoting perspective. Semi-structured individual and group interviews were conducted with participants (n = 22) with lived, professional, and personal experiences of dementia living in a medium-sized municipality in Sweden. Transcripts were analyzed by thematic analysis. Four themes emerged: health promotion through knowledge and public awareness, health promotion through opportunities to be active, health promotion through meaningful meeting places, and health promotion through improvements in the welfare system. We found that more knowledge and public awareness about dementia are needed to advance a health-promoting perspective and increase the prominence of dementia as a public health issue. Further research and policy need to focus more on how professionals in dementia care practice could be involved in promoting health and well-being for people with dementia.

Dementia knowledge, art, research and education - Teaching primary school children about dementia.

To develop, implement and evaluate the impact of a short education intervention on the understanding of dementia through visual art by primary school-aged children. A series of three lessons were developed in consultation with a local schoolteacher and community artists and taught in a local primary school. Stage 2 students (8-10years old) created an artwork about memory, learned about dementia and adapted their artworks to represent their developing understanding of dementia. Empirical data were collected through pre and postinterventions surveys and content analysis of the artworks. Matched pre and postintervention survey data were obtained for 74 students and showed a significant improvement in seven domains. This indicated that the students had an increased understanding of dementia and its impact on the individual following the intervention. Matched artwork was analysed from lessons 1 and 3 for 109 students using a coding schema developed specifically for this project. The students developed their artwork to show memories fading or being lost altogether. They also used abstract shapes to create a sense of disorder and chaos. Participation in the intervention was shown to increase students' understanding and knowledge of dementia using both qualitative and quantitative measures. SO WHAT?: It is likely that by educating children about dementia, we have the potential to reduce the stigma faced by people living with dementia and their carers. This is important, as the ageing population means that more people within the community, including children, will know someone living with dementia. Further, this represents the cornerstone in creating dementia-friendly communities.

A survey of the experience of living with dementia in a dementia-friendly community

Dementia-friendly communities (DFCs) are one way in which people living with dementia can be supported to be active, engaged and valued citizens. Quantitative evaluations of the experiences of those with dementia living within these communities are scarce. This article reports findings from a survey of people living with dementia on their experience of living in a DFC. Two-hundred and forty people living with dementia completed a cross-sectional survey in six DFCs across England. Around half of respondents reported they were aware they were living in a DFC. Being aware of living in a DFC was associated with taking part in leisure activities (p = 0.042), community centre attendance (p = 0.009), being involved in organised activities or groups (p < 0.001), feeling understood (p = 0.008), and feeling valued for their own contributions to the community (p = 0.002). This study illustrates the contribution that surveys can make in facilitating the expression of views and experiences of people living with dementia. Awareness of living within a DFC is associated with greater involvement in, and belonging to, the wider community.

Dementia-Friendly Communities: a Review of Current Literature and Reflections on Implementation

This review examines current trends in research on dementia-friendly communities (DFC). This includes promising evaluation methods, priority areas identified by persons living with dementia (PLWD) for DFCs, and sector-specific dementia-friendly initiatives. In addition, the authors add to existing literature by describing the experience—including challenges and lessons learned—of developing a DFC. The authors found few rigorous evaluations of DFCs but identify promising approaches that are likely to render important findings in the future. Research on the priorities of PLWD is far more developed. Multiple studies that draw on the perceptions of those living with dementia describe the importance of social inclusion and reducing stigma. Studies on sector-specific initiatives also reveal the valuable and complimentary contributions that different community sectors bring to DFC, such as through delivering person-centered healthcare for PLWD, meeting community-based service needs, and increasing professional awareness and countering negative perspectives. Self-assessment of efforts undertaken by a new DFC revealed ongoing challenges with sustaining funding and involved volunteers, especially those living with dementia. Findings from this review uncover considerable progress in creating DFC that meet the needs of PLWD and their families and caregivers. Communities are successfully engaging multiple diverse sectors, and multiple studies now describe the priorities of people living with dementia to guide future efforts. Still, there remains a dearth of rigorous evaluation to guide the direction of community initiatives and track progress. Further research is also needed to understand how dementia-friendly movements can be more culturally tailored. Increasing social inclusion should remain a priority for all dementia-friendly communities.