Dementia-friendly Communities Research Articles

POLICY SERIES: THE HRSA GERIATRICS EDUCATION INITIATIVES: A POLICY AND PROGRAM UPDATE

This session will address the evolving work of Geriatric Workforce Enhancement Programs (GWEP) to educate and train the primary care workforce and partner with community based organizations to address gaps in healthcare. The inaugural GWEP awardees were announced at the 2015 White House Conference on Aging. In November 2018 the Health Resources and Services Administration (HRSA), released the second GWEP Notice of Funding Opportunity (NoFO). The new funding opportunity reflects current policy priorities. In addition, for the first time in 9 years a Notice of Funding Opportunity was released for the Geriatric Academic Career Award (GACA) program. The return of the GACA program indicates the success of advocacy efforts to increase programs to support geriatric training and the development of geriatric academic professionals. Individual symposiums will explore the policy priorities reflected in the GWEP NoFO including the use of technology for training and care delivery, the age-friendly healthcare and dementia-friendly community initiatives, and value-based care including improving partnership with community based organizations. Additionally, an individual symposium will present the GACA program and discuss the advocacy process leading to the reintroduction of this program. During the last congress advocates of the GWEP and GACA programs supported authorization and funding of geriatric programs. Geriatrics programs describing the work of the GWEPs and GACAs were reinserted into the legislative process, although this reauthorization was not completed. This advocacy process garnered strong bipartisan and agency support. The session will describe these efforts and will conclude with an update on current authorization and appropriation status.

Effects of Dementia Friendly Community Project on Awareness of Dementia and Changes in Attitude

Effects of Dementia Friendly Community Project on Awareness of Dementia and Changes in Attitude

Dementia-friendly prisons: a mixed-methods evaluation of the application of dementia-friendly community principles to two prisons in England

ObjectivesTo apply and evaluate dementia-friendly community (DFC) principles in prisons.DesignA pilot study and process evaluation using mixed methods, with a 1-year follow-up evaluation period.SettingTwo male prisons: a category C sex...

Ecological relationship between social capital and cognitive decline in Japan: A preliminary study for dementia-friendly communities.

Building community social capital is important for socially inclusive societies, leading to dementia-friendly communities. However, quantitative evidence is currently lacking regarding the effectiveness of dementia-friendly communities, including the association with community social capital. The current study examined the ecological relationship between social capital and the proportion of people with cognitive decline. Data were obtained from population-based, cross-sectional surveys (mail-in questionnaire survey and home-interview survey) of community-dwelling older adults aged ≥65 years, living in 17 district areas in Machida City, Tokyo, Japan. Social capital included social networks (neighborly ties) and social support (emotional support and instrumental support). Cognitive function was assessed using the Mini-Mental State Examination, Japanese version (with a cut-off of 23/24). The proportions of people with high social capital and cognitive decline (Mini-Mental State Examination, Japanese version ≤23) were calculated for residential districts and used in the analysis. The district-level social capital indicators were positively and moderately correlated with the proportion of people with cognitive decline. After adjusting for the aging rate, educational level and population density of the district, an ordinal logistic regression analysis showed that higher proportions of people with strong neighborly ties and people with strong instrumental support were significantly associated with a higher proportion of people with cognitive decline. This trend was stronger among women than men. People can continue to live in communities with high social capital, even if they are experiencing cognitive decline. Although this study was preliminary, it provided empirical evidence for the benefits of promoting dementia-friendly communities. Geriatr Gerontol Int 2019; 19: 950-955.

Dementia-friendly community indicators from the perspectives of people living with dementia and dementia-family caregivers.

To identify dementia-friendly communities' indicators and their current conditions in Taiwan from the perspectives of people with dementia and dementia-family caregivers. This qualitative study explored the opinions and experiences of people with dementia and dementia-family caregivers regarding dementia-friendly communities. Participants (16 people with dementia and 20 family caregivers) were recruited from neurological clinics, day care centres for people with dementia and support groups for family caregivers in the Taipei community from July - October, 2016. Data were collected in face-to-face interviews, which were tape recorded and transcribed verbatim. Transcripts were analysed by Miles and Huberman's (1994) guidelines. Similar indicators for dementia-friendly communities were identified in Taiwan as in other countries, including dementia-friendly care services, dementia-friendly hospitals, dementia-friendly community environment, dementia-friendly transportation, dementia-friendly stores and shops, dementia friendly people, integrated dementia-related information and community contribution- and -involvement opportunities for people with dementia. However, Taiwanese people with dementia and family caregivers described no emphasis on the potential of people with dementia to contribute to developing dementia-friendly communities and more top-down expectations for the government's role. These indicators can be a guide for developing and evaluating dementia-friendly communities in Taiwan. Differences between Taiwan and Western developed countries in indicators for dementia-friendly communities can be further explored. Community nursing assessment, interventions, and evaluation based on these dementia-friendly communities indicators can be further developed. This study developed indicators for dementia-friendly communities in an Asian country. These indicators can be used as a guide for developing and evaluating dementia-friendly communities.

Building A Dementia-friendly Community from Kobe City

Building A Dementia-friendly Community from Kobe City

Dementia Friendly Communities in England: A scoping study.

ObjectivesTo describe the characteristics of Dementia Friendly Communities (DFCs) across England in order to inform a national evaluation of their impact on the lives of those affected by dementia.MethodsDFCs in England were identified through online searches and Alzheimer's Society records. A subsample (n = 100) were purposively selected for in‐depth study based on online searches and, where necessary, follow‐up telephone calls. Data collection and analysis were guided by a pilot evaluation tool for DFCs that addressed how DFCs are organised and resourced and how their impact is assessed. The evidence was predominantly qualitative, in addition to some descriptive quantitative information.ResultsOf 284 DFCs identified, 251 were defined by geographical location, while 33 were communities of interest. Among 100 sampled DFCs, 89 had been set up or started activities following policy endorsement of DFCs in 2012. In the resourcing of DFCs, statutory agencies and charities played an important role. Among DFC activities, awareness raising was cited most commonly. There was some evidence of involvement of people living with dementia in organisational and operational aspects of DFCs. Approaches to evaluation varied, with little evidence of findings having effected change.ConclusionsDFCs are characterised by variation in type, resourcing, and activities. England has policy endorsement and a recognition system for DFCs. These can be important catalysts for initiation and growth. A systematic approach to evaluation is lacking. This would enable DFCs to be consistent in how they demonstrate progress and how they enable people living with dementia to live well.

Experiences of Living in the Community for Older Aboriginal Persons With Dementia Symptoms in Taiwan.

Improving quality of life for community-dwelling older persons with dementia symptoms (PWDS) and family caregivers requires promoting dementia-friendly communities (DFC). However, little is known regarding older Taiwanese Aboriginal PWDS' experiences of living in the community. We explored these experiences for older Atayal PWDS and their families in Taiwan. This grounded theory research used in-depth interviews to explore the perspectives of older PWDS (n = 4), their family members (n = 3), and key persons (n = 10) in an Atayal community in northern Taiwan. Data were analyzed using constant comparative analysis. Participants were interviewed between January and May 2015. Participants' experiences were captured by the overarching concept of "low dementia awareness, high family-like ambience in the community." Despite the low/absent community awareness of dementia, older Atayal PWDS functioned as freely in the community as at home due to a family-like supportive environment. Aboriginal PWDS and their families also faced environmental challenges, e.g., environmental constraints and barriers to transportation access. Our results suggest that this Aboriginal community and culture offer important DFC components, and these strengths could be further studied to enhance DFC models elsewhere. Despite these strengths in supporting PWDS, environmental challenges to transportation access still cause difficulties for PWDS and their families and need improvement. The Atayal community's low dementia awareness suggests that services introduced must be culturally appropriate and nondisruptive to existing supportive helping systems. Our study can be a model for future studies to understand and identify PWDS' needs in Indigenous communities.

Anticipatory anxiety about future dementia-related care needs: towards a dementia-friendly community.

Although a dementia-friendly community is a global goal, community-dwelling persons with dementia continue to have unmet care needs. The aim of this study was to explore the characteristics of persons who experience anxiety about the possibility of not receiving proper dementia care should they need it in the future. A questionnaire was mailed to all residents aged 65 years or older (n = 132 005) living in one Tokyo district. The questionnaire included an item that measured anxiety about the possibility of not receiving proper dementia care as well as items about sociodemographic variables, depressive symptoms, frailty, housebound status, socioeconomic status, social support, access to a general practitioner (GP), and experience of dementia care. Of the 74 171 participants who responded to the anxiety item, 58 481 (78.8%) reported anxiety about the possibility of not receiving proper dementia care should they need it in the future. Simultaneous multiple logistic regression analysis indicated that factors associated with this anticipatory anxiety were depressive symptoms, frailty or prefrailty, being female, not being currently socioeconomically disadvantaged, not having someone who can take you to the hospital when you do not feel well, being younger (65-74 years), being married, not trusting in neighbours, higher educational level (>9 years), not having someone to consult when you are in trouble, not working, having been socioeconomically disadvantaged in childhood, only greeting or less with neighbours, and not having the experience of dementia care. Having access to a GP, living alone, and going out less than once a week did not show a significant association. This large-scale study explored factors associated with anticipatory anxiety about the possibility of not receiving proper dementia care should it be needed in the future. Further studies concerning interventions to decrease such anxiety are needed.

Changing the narrative: the role of frontline worker attitudes and beliefs in shaping dementia-friendly services in England

Applying the main principles of the social model of disability as a guide, this article argues that the attitudes and beliefs of staff and volunteers employed in frontline service delivery can play an important role in the achievement of dementia-friendly communities, particularly through influencing the types of services offered. This position is supported by findings from an evaluation of an awareness-raising intervention run by Age UK, aimed at organisations which provide services for people living with dementia in England. The article contributes to an understanding of the cultural climate within frontline service delivery, which is often neglected in favour of discussions around meeting more immediate care and support needs. More specifically, the article reflects on whether there is a need for an additional conceptualisation within the discourse around dementia-friendly communities which ensures inclusion of the cultural environment.

Effects of dementia knowledge and dementia fear on comfort with people having dementia: Implications for dementia-friendly communities.

Advocates for dementia-friendly communities emphasize the need for the public to know about the dementias and to experience social comfort with people having dementia. This research tested a conceptual model of influences on social comfort, including two types of dementia knowledge and personal dementia fear. Data were collected from 645 Wisconsin residents through an online platform (Qualtrics®) and community outreach efforts. A hierarchical multiple regression was conducted and its results were mapped onto a figure representing the conceptual model of social comfort. Greater personhood-based knowledge (based on observations of the capabilities and perspectives of persons with dementia) and less personal dementia fear significantly predicted higher levels of social comfort, while biomedical knowledge did not. Although more personhood-based knowledge improved overall comfort regardless of the level of biomedical knowledge, people with higher levels of biomedical knowledge benefitted the most from having personhood-based knowledge. These findings suggest that activities that promote personhood-based knowledge may enhance social comfort. These activities may be most effective for individuals who already have a high level of biomedical knowledge about people with dementia. Community members and professionals ought to strike a balance between biomedical knowledge and personhood-based knowledge, as the two together may be associated with higher levels of social comfort. This could benefit the promotion of dementia-friendly community initiatives.

Dementia-friendly community initiatives: An integrative review.

To synthesise international research conducted on dementia-friendly community initiatives. The number of people living with dementia is increasing as a result of population ageing. Impairments related to neurological changes, together with environmental challenges, result in disability for people who have dementia. Led by the World Health Organization and Alzheimer's Disease International, initiatives have been undertaken internationally to promote social inclusion for people who have dementia. Communities where people with dementia are able to remain socially included are known as dementia-friendly communities. An integrative review of the literature. Scopus, MEDLINE, Web of Science and CINAHL Plus via Ebsco databases were searched for relevant articles. The PRISMA framework guided the article search and screening; reporting is in accordance with the PRISMA guideline. Eight eligible studies were identified. The methodological quality of the eligible studies was evaluated using the MMAT checklist. The matrix method was used to extract, abstract and analyse the data. Of the eight studies reviewed, five were from the UK and one each from Australia, New Zealand and Canada. Four major concepts were identified in the literature, and these are characteristics of dementia-friendly communities, facilitators and barriers to community engagement for people with dementia, strategies for developing dementia-friendly communities and challenges encountered when developing dementia-friendly communities. People with dementia are at the centre of dementia-friendly initiatives, and these foster social inclusion. Collaborations and partnerships enhance development of dementia-friendly communities; however, lack of resources and difficulty ensuring representation of marginalised groups provide challenges. An understanding of the impact of marginalisation and inequality on community participation for people with dementia is important for practitioners, enabling them to support those people. Senior nurses with this understanding can ensure services are able to meet the needs of a growing population with dementia.

Unpacking 'the cloud': a framework for implementing public health approaches to palliative care.

Designing and implementing population-based systems of care that address the social determinants of health, take action on multiple levels, and are guided by evidence-based principles is a pressing priority, and an international challenge. Aging persons are a priority demographic whose health needs span physical, psychosocial and existential care domains, increase in the last year of life, are often poorly coordinated and therefore remain unmet. Compassionate communities (CCs) are an example of a public health approach that fully addresses the holistic healthcare needs of those who are aging and nearing end of life. The sharing of resources, tools, and innovations among implementers of CCs is occurring globally. Although this can increase impact, it also generates complexity that can complicate robust evaluation. When initiating population health level projects, it is important to clearly define and organize concepts and processes that are proposed to influence the health outcomes. The Health Impact Change Model (HICM) was developed to unpack the complexities associated with the implementation and evaluation of a Canadian CC intervention. The HICM offers utility for citizens, leaders and decision-makers who are engaged in the implementation of population health level strategies or other social approaches to care, such as compassionate cities and age or dementia-friendly communities. The HICM's concepts can be adapted to address a community's healthcare context, needs, and goals for change. We share examples of how the model's major concepts have been applied in the development, evaluation and spread of a complex CC approach.

Muddling along in the city: Framing the cityscape of dementia.

There is growing interest in the social geography of dementia, with the development of dementia-friendly communities, localities and cities in the developed world. This paper considers the claims being made for cities to be risky spaces for people with dementia. It debates this through an analysis based on Bacchi's 'representation of problems' framework, evidencing this with policy documents and research findings. This reveals that the city is often seen as problematic for people with dementia, despite evidence to the contrary, and that local politicians are making claims for cities to be responsive dementia communities. The nature of local political ambitions is illustrated by strategies from London and from Manchester in the UK.

RISKS FOR ABUSE AND NEGLECT OF ELDERS WITH COGNITIVE IMPAIRMENT OR DEMENTIA: INSIGHTS FROM THREE GROUPS

Purposes. Cognitive impairment due to Alzheimer’s disease and related dementia places elders at a high risk for abuse and neglect. This study aims to identify risk factors for abuse and neglect of elders with dementia or cognitive impairment, and to develop strategies to prevent abuse and neglect from integrated perspectives of patients, family caregivers, and helping professionals. Method. Using semi-structured interviews, six focus group discussions were conducted consisting of fourteen service professionals (Mage=55.7), fifteen caregivers (Mage=68.7), and six patients (Mage =70.7) at early stages of dementia. Interviews were audiotaped and then transcribed for analysis. Based on the constant comparative method, three research members independently coded data and collectively developed the themes. Results. Care recipient related risk factors included reduced cognitive capability, limited physical health, social restriction, and the lack of participation in decision making. Risk factors associated with caregivers included caregiver burden and poor coping skills. Community factors consisted of lack of a dementia friendly community that respond to elder abuse and neglect in a preventive manner. Recommended strategies to prevent abuse and neglect included dementia education, more opportunities for social participation, more affordable and accessible long-term care, and training for community service professionals to work with adult protective services. Discussion. Elder abuse and neglect across individuals with dementia or cognitive impairment may occur because of lack of education and skills about coping with dementia. Thus, a dementia-friendly community should be developed by providing more opportunities regarding education and trainings for care recipient, caregivers, and service professionals and changing policies.

The place for dementia-friendly communities in England and its relationship with epidemiological need.

ObjectivesThe dementia‐friendly community (DFC) initiative was set up to enable people living with dementia to remain active, engaged, and valued members of society. Dementia prevalence varies nationally and is strongly associated with the age and sex distribution of the population and level of social deprivation. As part of a wider project to evaluate DFCs, we examined whether there is a relationship between provision of DFCs and epidemiological need.MethodsDementia‐friendly communities were identified through the formal recognition process of DFC status by the Alzheimer's Society and mapped against areas defined by English Clinical Commissioning Groups. We tested whether provision of a DFC was associated with: (1) dementia prevalence, (2) number of known cases, and (3) known plus estimated number of unknown cases.ResultsOf the 209 English Clinical Commissioning Group areas, 115 had at least one DFC. The presence of a DFC was significantly associated with number of known dementia cases (mean difference = 577; 95% CI, 249 to 905; P = 0.001) and unknown dementia cases (mean difference = 881; 95% CI, 349 to 1413; P = 0.001) but not prevalence (mean difference = 0.03; 95% CI, −0.09 to 0.16; P = 0.61). This remains true when controlling for potential confounding variables.ConclusionsOur findings suggest that DFC provision is consistent with epidemiological‐based need. Dementia‐friendly communities are located in areas where they can have the greatest impact. A retrospective understanding of how DFCs have developed in England can inform how equivalent international initiatives might be designed and implemented.

Distilling authentic community-led strategies to support people with dementia to live well

ABSTRACTThe development of dementia-friendly communities underpins inclusion and enablement of individuals to live well with dementia in communities for as long as possible. A number of strategies are being developed that present communities with models of “how to” become dementia-friendly. Communities are unique, with varying demographics, strengths, and resources that support local action. Indeed, the most valuable first step in the process of building a dementia-friendly community may be a targeted conversation within the community itself. To this end, four unique Australian communities participated in facilitated workshops to explore their collective dementia knowledge, visions for the future, community strengths, and possible actions to promote dementia-friendly initiatives.The diversity of communities that attended confirms that no single model of dementia-friendly communities should be imposed. A consultative-transformative approach to planning may meet the needs of specific communities and will focus responsibility and reward for implementation at the local and individual level.

Recognition of preclinical signs of dementia: A qualitative study exploring the experiences of family carers and professional care assistants.

To identify preclinical signs of dementia by exploring the experiences of family caregivers and professional care assistants. Dementia results in disability, emotional strain and financial loss for people with dementia, family members and nations. Informal identification of social and behavioural risk signifiers could facilitate timely interventions with potential to delay onset of serious disability. A retrospective qualitative approach using a naturalistic interpretive design was used. Focus groups enabled in-depth understanding of the participants' experiences of life or work with people who subsequently developed dementia. Purposive sampling was used to recruit family carers and professional carers who had cared for people who later developed dementia. The data from focus groups were fully transcribed and anonymised, and transcripts were analysed by two researchers. These researchers coded and analysed the transcripts independently; subsequently, overlapping and similar themes were identified and consensus reached on final themes. A third researcher was invited to review the analysis and ensure trustworthiness of the study findings. Findings revealed that preclinical signs of dementia were identifiable in retrospect Participants' accounts resulted in four themes, "Lowered Threshold of Frustration", "Insight and Coping Strategies," "Early signs of poor memory" and "Alarming Events." Earlier recognition of preclinical signs of dementia would allow affected individuals to follow health promotion advice and plan for the future. Identification of social exclusion prior to diagnosis has implications for antistigma campaigns and development of "dementia-friendly communities." Healthcare professionals could work with those at risk, facilitating lifestyle changes to postpone symptoms and advance planning for improved autonomy. Predementia should be viewed as a disability for which reasonable adjustments can be made at a community level, to enhance and extend emotional well-being and social inclusion.

Scaling the Peaks Research Protocol: understanding the barriers and drivers to providing and using dementia-friendly community services in rural areas—a mixed methods study

IntroductionScaling the Peaks is a cross-disciplinary research study that draws on medical ethnography, human geography and Geospatial Information Science (GIS) to address the issues surrounding the design and delivery of...

A Rural Dementia-Friendly Village Project and Dementia Awareness, Cognition, and Depressive Symptom : A Preliminary Study

Objective：According to the 3rd Korean National Dementia Plan, the dementia-friendly community initiative was launched. The aim of this study was to evaluate the effects of a rural dementia-friendly village project on the participants. Methods：Jeollabukdo Provincial Dementia Center designated Sosu-maeul, located in Buan-gun Jeollabuk-do, as a rural dementia-friendly village. We conducted dementia partnership education, youth-elder matching activity, and cognitive enhancing program. The efficacy of this project was evaluated by the changes in dementia awareness, cognitive function, and depressive symptoms. We used dementia awareness questionnaire, Mini-Mental Status Examination for Dementia Screening (MMSE-DS), and Korean version of Short form of Geriatric Depression Scale (SGDS-K). Results：This study was carried out with 24 residents in this community. There was no significant change in dementia awareness score between pre- and post-intervention (p=0.25). MMSE-DS score was significantly increased from 24.5 to 25.5 (p＜0.001) and SGDS-K score was statistically improved from 3.5 to 2.5 (p=0.04) after interventions. Conclusion：We Jeollabukdo Provincial Dementia Center carried out a pilot study of a rural dementia-friendly village project. This project led to improvements on cognitive functions and depressive symptoms in the participants. But the improvement of dementia awareness was not achieved. More direct and experiencing interventions for people with dementia are necessary to improve dementia awareness.