Residential Care Settings Research Articles

Augmented Decision-Making in wound Care: Evaluating the clinical utility of a Deep-Learning model for pressure injury staging

BackgroundPrecise categorization of pressure injury (PI) stages is critical in determining the appropriate treatment for wound care. However, the expertise necessary for PI staging is frequently unavailable in residential care settings. ObjectiveThis study aimed to develop a convolutional neural network (CNN) model for classifying PIs and investigate whether its implementation can allow physicians to make better decisions for PI staging. MethodsUsing 3,098 clinical images (2,614 and 484 from internal and external datasets, respectively), a CNN was trained and validated to classify PIs and other related dermatoses. A two-part survey was conducted with 24 dermatology residents, ward nurses, and medical students to determine whether the implementation of the CNN improved initial PI classification decisions. ResultsThe top-1 accuracy of the model was 0.793 (95% confidence interval [CI], 0.778–0.808) and 0.717 (95% CI, 0.676–0.758) over the internal and external testing sets, respectively. The accuracy of PI staging among participants was 0.501 (95% CI, 0.487–0.515) in Part I, improving by 17.1% to 0.672 (95% CI, 0.660–0.684) in Part II. Furthermore, the concordance between participants increased significantly with the use of the CNN model, with Fleiss’ κ of 0.414 (95% CI, 0.410–0.417) and 0.641 (95% CI, 0.638–0.644) in Parts I and II, respectively. ConclusionsThe proposed CNN model can help classify PIs and relevant dermatoses. In addition, augmented decision-making can improve consultation accuracy while ensuring concordance between the clinical decisions made by a diverse group of health professionals.

Common elements to reduce seclusion in child and adolescent residential care settings: A synthesis of literature and semi-structured interviews

In the past decades, awareness of the harmful effects of seclusion has led to a strong desire to reduce its use in child and adolescent residential care settings. As a response, various seclusion reduction interventions have been developed and implemented in practice. These interventions consist of both methods as well as more practice-based and ad hoc actions. Identification of common elements within this wide variety of seclusion reduction interventions would be beneficial for the further understanding and implementation of these interventions, training of staff, and research aimed at the reduction of seclusion. Therefore, the objective of this study was to identify the common elements of both methods and practice-based actions to reduce seclusion in child and adolescent residential care settings. A literature review and semi-structured interviews with experienced professionals involved in child and adolescent residential care were used to determine the common elements of seclusion reduction interventions. In total, 21 studies and 11 interviews were assessed. This led to the identification of two domains with six common elements each. Further investigation of how these common elements influence the reduction of seclusion could potentially build strong universal methods and training modules for the reduction of seclusion in a broad range of child and adolescent residential care settings.

Family Physicians’ Roles in Long-Term Care Homes and Other Congregate Residential Care Settings during the COVID-19 Pandemic: A Qualitative Study

Family Physicians’ Roles in Long-Term Care Homes and Other Congregate Residential Care Settings during the COVID-19 Pandemic: A Qualitative Study

Elder abuse prevalence among older people living in the community in Australia

AbstractThe National Elder Abuse Prevalence Study, conducted by the Australian Institute of Family Studies, was the first major national study to gauge the prevalence and nature of elder abuse in Australia. [The phrase, “conducted by the Australian Institute of Family Studies”, was added to the preceding sentence on 19 October 2023, after first online publication.] A survey of older people aged 65 years and older living in private dwellings was carried out in 2020, with 7000 participants across the nation who were interviewed by telephone. The survey data suggested that 14.8 per cent of the population aged 65 and older who live in the community (rather than residential care settings) have experienced elder abuse in the past 12 months. Psychological abuse was found to be the most common subtype (11.7 per cent), followed by neglect (2.9 per cent), financial abuse (2.1 per cent), physical abuse (1.8 per cent) and sexual abuse (0.7 per cent). Interconnected with an experience of elder abuse were poorer physical health, poorer psychological health and a lower sense of social support. The findings demonstrate that elder abuse has strong familial dynamics, with perpetrators involving intergenerational and intimate partner relationships to a significant extent. Most older people who experienced elder abuse tended to manage the experience themselves—not seeking help, taking actions which would not expose the perpetrator.

Young people leaving care and institutionalised vulnerability in the Russian Federation

Care leavers are often considered to constitute some of the most disadvantaged young people in society, and there exists a significant body of research that seeks to understand why some young people ‘succeed’, whereas others struggle due to accumulated ‘vulnerabilities’. Despite this extensive research base, policy and practice aiming to support young people leaving care remain diverse, indicating a lack of consensus on why some experience ‘poor outcomes’ and what might be done better to support them. This article focusses on the experiences of young people leaving care in the Russian Federation and makes two contributions; firstly, it provides theoretical insights through a critical discussion of the notion of vulnerability. We argue for attention to institutional vulnerabilities, which heavily structure the potential outcome of transitions available to young people leaving care in Russia. We note discourses and practices of dependency-related victim-blaming, which indicate the operation of ‘attribution errors’ in the Russian care and post-care systems, erroneously positioning individuals as responsible for their vulnerability rather than the dysfunction of systems of care. To fully understand the reasons for many young people’s ‘poorer outcomes’, we suggest refocussing attention towards the combined operation of discourses, systems and structures through the conceptual approach of ‘institutionalised vulnerability’. Secondly, the paper provides an empirical contribution in shedding light on the experiences of young people transitioning out of the care system as well as practitioners working in both the state and third sector in Russia, as the country experiences an ongoing process of deinstitutionalisation. This is important for other contexts given global efforts to deinstitutionalise residential child care settings.

Integrating a child into an adoptive family in times of COVID-19: Lessons learned from adopters’ and professionals’ views

COVID-19 pandemic has brought multiple challenges for families and child welfare professionals, but also represent a unique psico-socio-ecological context to re-think fundamental working practices. The present work had two main aims: (1) to understand the impact of COVID-19 pandemic on the child’s transition to an adoptive family, in terms of challenges and adjustments made to adoption practice, perceived difficulties as well as benefits, from the views of adopters and adoption professionals, and (2) to identify promising practices to be maintained in pandemic and free-pandemic situations. Semi-structured interviews were conducted online with 13 Portuguese adopter families who received a child during the first wave of COVID-19 (March-June 2020) and 4 dyads of adoption professionals who followed and supported those families. Thematic analysis showed that adopters and professionals highlighted predominantly benefits for different phases of the transition as a result of the COVID-19 pandemic tough some difficulties were experienced. Delays and uncertainties of child’s placements caused anxiety for most children and adopters. However, the strategies undertaken during this waiting time (e.g., recorded video, reflection activities) were viewed as beneficial for parent–child mutual knowledge and preparation for parenthood. The impossibility of adopters to visit the child’s residential care setting and the inconsistency of practices between services were consensually perceived as major difficulties. Confinement and telework were consistently viewed as an opportunity for both adopters to be concurrently at home with the child, which facilitated establishing family bonds and routines. However, adopters reported mixed opinions towards social distancing. Among the several benefits perceived from the adjustments made to adoption practice, virtual (e.g., videoconferences) and informal (e.g., through WhatsApp groups) communication consistently emerged as the most relevant ones. Lessons relevant for adoption policy and practice over the transition to adoptive parenthood are discussed, including suggestions for future research.

An ethnography study exploring factors that influence social isolation in care home residents living with dementia and hearing loss

BackgroundHearing loss and dementia are highly prevalent conditions amongst older adults living in residential care. The consequences of living with these conditions may include social withdrawal and reduced communication opportunities. We sought to examine patterns of communication and interaction in residential care and explore resident, staff, and relative perspectives within two care homes located in Birmingham, UK. This enabled an understanding of how communication environments contributed to social isolation.MethodsThis work used ethnography methodology to explore mechanisms that created and maintained social isolation in older adults living with dementia and hearing loss. A planning and engagement phase took place in four care homes. This was followed by an environmental audit, observations, and interviews. Data generated were analysed using Grounded Theory methods.ResultsThere were 33 participants (16 residents, 11 care staff, and six relatives) who took part in the observations and interviews. Residents experienced social isolation through lack of meaningful conversation with others and being misunderstood. Additionally, observations of residents’ interactions informed the overall findings. A Grounded Theory model was employed to explain the core phenomenon of social isolation. The main contributors were internal and external barriers to communication, and reduced opportunities for meaningful conversation.ConclusionsThere is a wide range of social isolation that care home residents experience. This was not always associated with the severity of hearing loss but rather communication ability. Simple interventions such as staff dining with residents and focussing on improving communication could reduce social isolation within residential care settings.

55 Dysphagia identification practices in residential long-term care settings in the Republic of Ireland: a cross-sectional electronic survey

Abstract Background Dysphagia is common in older adults with neurological and/or neurodegenerative conditions requiring early identification to avoid serious complications, including malnutrition, dehydration and aspiration pneumonia. The aim of this study was to describe dysphagia identification practices in Residential Long-Term Care Settings (RLTCS) in the Republic of Ireland. Methods A cross sectional electronic survey was designed using Qualtrics XM Platform that included 40 questions divided in 5 sections. The survey was circulated via email to RLTCS to be completed by either a clinical nurse or nurse manager in each facility. Descriptive data analysis was conducted on survey responses using RStudio. Results There were 45 surveys completed out of N = 429 electronically circulated (10% response rate). All RLTCS that completed the survey reported to routinely implement dysphagia identification practices. Observation of signs and symptoms of dysphagia at mealtimes (100%), review of clinical records to identify dysphagia risk factors and comorbidities (93%) and resident self-report of swallowing difficulties (91%) were the most common dysphagia identification practices. Poor oral motor function (89%) and history of aspiration pneumonia (87%) were reported as the main dysphagia risk factors. A swallow screening test was less commonly used to identify dysphagia (42%). Coughing or choking on food or fluids, inability to swallow medication, oral or pharyngeal residue, delayed or absent initiation of swallow, leaking of food or fluids and difficulty with coordination of breathing and swallowing were identified by all respondents as key criteria for risk of dysphagia. Almost all participants reported that residents at risk of dysphagia were routinely referred to speech and language therapy services for further assessment. Conclusion A range of practices were identified in RLTCS that participated in the survey. Further research approaches are required to provide a more in-depth perspective of dysphagia identification practices and protocols used in RLTCS for timely and accurate identification of dysphagia to avoid associated complications.

247 Assessing the impact of a new integrated care framework for nursing home residents

Abstract Background Nursing home residents represent the frailest patients in our community and are often referred to the Emergency Department (ED) for acute care. These referrals may have limited benefit and are associated with an increased risk of complications. This programme initiated a new acute outreach service providing urgent geriatric care in residential care settings, with the aim of avoiding unnecessary referrals. Methods A framework to deliver specialist acute geriatric care to 4 Residential Care Facilities (RCFs) (423 beds) was developed. Direct access by phone to a daily team lead was developed and provided on a Monday–Friday 8 am -5 pm basis. Referrals were triaged and acute response service provided through ANP and consultant geriatrician. Protocols to support iv fluid and antibiotic administration were agreed. Framework RCFs also engaged in specific Quality Improvement (QI) initiatives that focussed on falls reduction, skin integrity assessment, appropriate use of ED and safe staffing. Outcome measures for hospital admissions and 90-day mortality over a 7 month period (April—Oct 2022) was collected from patient’s medical records, electronic data and RCF records. Results 174 urgent referrals were seen. Of these reviews, 5 (2.9%) required subsequent admission to hospital. Treatment with antibiotics was initiated in 9.8%. 1.7% required iv fluids and palliative measures recommended in 20.7%. The 90-day mortality was 12.9%. A total of 132 patients were referred directly to ED from the same 4 nursing homes over the same time period (4% reduction from 2021). QI initiatives demonstrated improvements in compliance with falls and continence risk assessments. Conclusion Specialist acute liaison care to nursing homes complimented with appropriate QI focus could present an opportunity for optimised care in RCF residents and mitigate risk of avoidable transfers.

245 ‘Pad culture: the use of continence wear in older people in an Irish University Hospital’

Abstract Background Incontinence in hospital patients can result in a longer length of stay, a greater risk of being discharged to a residential care setting, as well as increased healthcare and personal costs. Older adults may find it difficult to regain continence post discharge contributing to caregiver strain, social isolation and functional decline. There is evidence to suggest that there is an over-reliance on continence aids (wearable absorbent ‘pads’ & urinary catheters) for older adults in hospital. The aim of this study was to assess the prevalence of continence aids among older in-patients in an Irish University Hospital, as part of wider service improvement project. Methods Data was collected on consecutive in-patients 65 years or older on a single day. Medical, surgical, oncology, coronary care and medical assessment unit were included. Current incontinence aid usage and pre-admission continence aid usage was recorded, along with demographics and current mobility status. Results 156 older adults were included. 53.5% were male and the median age was 81. A total of 57.4% (N = 89) of older patients were wearing disposable pads. Of these, 64.5% (N = 58) were not wearing continence pads pre-admission. A total of 23.2% (N = 36) had a urinary catheter inserted. Of these, 91% (N = 33) did not have a urinary catheter pre-admission. 38.3% (N = 61) of those wearing pads could mobilise either independently or with assistance of one. We also found a direct correlation between pad use and length of stay. Conclusion This study highlights the high prevalence of continence aid deployment in the care of older adults admitted to an acute hospital, with conversion to an aid occurring even in those who are able to mobilise independently or with supervision. Continence care and rehabilitation may benefit from inter-disciplinary assessment and management, similar to other complications of ageing and hospitalisation, such as delirium.

Comparison of prehospital stroke care at private homes and residential care settings

Background: Suspected stroke is a common scenario among care home residents, who are typically older and have more complex health needs than the general population. Aims: The aim of this study was to describe the care of suspected stroke patients according to their residential status. Methods: Retrospective secondary analysis was carried out using a clinical record dataset from a UK ambulance service that described the care of patients labelled as having a suspected stroke between December 2021 and April 2022. Findings: Care home patients were older (median age 86 (interquartile range (IQR) 79–91) years) than those in their own homes (median age 75 (IQR 63–83) years; P≤0.001), with more comorbidities (median of five (IQR 3–6) versus median of three (IQR 2–5); P≤0.001) and taking more medications (median of six (IQR 4–9) versus median of four (IQR 1–7); P≤0.001). They were more likely to have difficulties completing the face, arms, speech, time test (17/170 (10%) versus 39/1305 (3%); P≤0.001) and present with facial droop (85/153 (55.6%) versus 506/1266 (40%); P≤0.001). Ambulance on-scene time was longer at care homes (median 41 (IQR 32–49.5) minutes versus median 35 (IQR 27–45) minutes; P≤0.001). Conclusion: Clinician awareness of characteristics associated with residential settings may be important for delivering emergency stroke care. Research is needed to optimise ambulance assessment for care home patients.

Changes in late-life assistance networks for Black and White older adults during the COVID-19 pandemic.

The COVID-19 pandemic has disproportionately impacted older Black Americans. Given that assistance networks play a crucial role in older adults' ability to respond to challenges, we sought to investigate whether older adults' assistance network size changed during the COVID-19 pandemic and differed by race. We analyzed data from the 2018-2020 rounds of the U.S. National Health and Aging Trends Study for Black and White adults aged 70 and older receiving help in the community or residential care settings. We used ordinary least squares regression to compare changes in assistance network size in the 2 years pre-COVID-19 (2018-2019, N = 3438) to changes in size at the onset of COVID-19 (2019-2020, N = 3185). Black older adults had larger assistance networks with a greater number of family helpers before and during the pandemic compared to their White counterparts. Assistance network size for older adults increased before but not during the pandemic mostly due to declines in unpaid nonrelative helpers and lack of increase in paid helpers. These effects did not differ by race. Black and White older adults experienced similarly sized reductions in their assistance networks as a consequence of the COVID-19 pandemic. Future research should investigate the relationship between these network changes and the unmet needs of older adults.

Tensions between closure of the digital divide and acts of care in residential settings for persons with disabilities. A study of adopting customised information and communication technology

Purpose In contemporary society, being unable to take advantage of information and communication technology (ICT) can create barriers to maintaining social relations and, thus, can increase the risk of social exclusion and loneliness. Prior studies have revealed that, among persons with disabilities, customised ICT can contribute to the maintenance and improvement of personal social networks. Nevertheless, there is still a need for knowledge regarding the adaption of ICT of those involved when customized ICT are set up in the residents for persons with disabilities. Methods Through conducting interviews with four residents, as well as their relatives and members of staff this article explores how KOMP, a customised ICT product designed to enhance digital contact among people who are unable to use ICT independently, was applied in four different municipal residences in Norway. Collective qualitative analysis was utilised to perform this investigation. Results The analysis show that KOMP can help strengthen relationships, interferes with interactional practices, and underscores the institutionalised lives in the residences. These findings emphasise that applying customised ICT/KOMP in such settings highlights the underlying tensions regarding residents’ rights to self-determination and privacy. Conclusions This study provides insights into how formal and informal regulations developed by relatives and staff, with the purpose of both protecting residents and protecting oneself from digital exposure, impacts the residents’ ability to take advantage of customised ICT and overcome the digital disability divide.

Sociodemographic profiles and determinants of relapse risks among people with substance use disorders in the Philippines: A survey in community and residential care settings

BackgroundMethamphetamine use is a major social and health issue in the Philippines. Former president Rodrigo Duterte prioritized combating illicit drugs, and the government launched an anti-drug campaign. People with substance use disorders (SUD) receive treatment and care in the community or residential treatment at Treatment and Rehabilitation Centers (TRCs) established by the Department of Health. However, since the content and quality of service are not sufficient, there is an urgent need for improvement. To this end, it is necessary to understand demographic characteristics, the severity of drug use, and treatment needs of this population. MethodsWe conducted a questionnaire survey of people with SUD in the community (n=308) and all TRC patients (n=1770) to obtain their demographic profiles. We also used the Drug Abuse Screening Test-20 (DAST-20) and the Stimulant Relapse Risk Scale (SRRS). ResultsBased on DAST-20 scores, the severity of dependence was not well-matched to the care provided; 12.4% of the community sample was in the severe or substantial categories and 14.2% of the TRC sample was in the low category. The TRC sample had a significantly higher relapse risk than the community sample, which was associated with a lower educational attainment level and comorbid alcohol dependence. ConclusionsIt is important to use standardized psychometric tools to match treatment with the severity of drug dependence. In addition, a wide variety of medical and social services need to be provided based on consideration of treatment needs to improve the well-being of this population.

Storage-related stability and antimicrobial efficacy of bottled, neutral-pH Electrolysed Oxidising Water

ObjectivesDenture stomatitis is prevalent in older people and poses serious health risks. Ready-to-use (RTU) neutral-pH Electrolysed Oxidizing Water (EOW) is an effective environmental disinfectant used in residential care settings and geriatric wards. However, the influence of storage on stability and effectiveness for denture disinfection has not been established. This research investigated the storage-related stability and antimicrobial activity of RTU EOW, and its efficacy against Candida albicans biofilms formed on denture resin. MethodsThe pH, oxidation/reduction potential (mV), available chlorine content (mg/L) and [HOCl] (mM) of RTU EOW (Envirolyte, New Zealand) solutions (n = 22) were measured from bottle opening to 28 days following storage at 4 °C, room temperature (RT) or 37 °C. Staphylococcus aureus and C. albicans cells were incubated in 80% EOW for contact times (CTs) up to 15 min and colony-forming units (cfu) determined. Minimum inhibitory concentrations (MIC90 EOW-HOCl) after CTs up to five minutes were determined for S. aureus and C. albicans reference strains and clinical isolates. C. albicans-denture resin disc biofilms were assessed after a five-minute CT with undiluted EOW by XTT-metabolic activity assay. Results[HOCl] remained stable when RTU EOW was stored at 4 °C or RT for five months after manufacture. One-minute CT resulted in log10 cfu reductions of >6 for S. aureus and >5 for C. albicans. Mean MIC90 for five-minute CT was 37 µM (S. aureus) and 54 µM (C. albicans). Undiluted EOW reduced C. albicans biofilm metabolic activity by 86%. ConclusionsRTU neutral-pH EOW is stable over five-months storage and is an effective denture disinfectant. Clinical significanceThe efficacy of the RTU neutral EOW against C. albicans isolates and biofilms formed on denture resin surfaces supports its use as a denture disinfectant and can inform future research to assess its potential for preventing denture-related oral Candida infections in the older population, especially in resource-limited communities.

‘Doing family’ in adversity: Findings from a qualitative study exploring family practices in alternative care settings in Thailand

AbstractThis paper presents findings from a qualitative study that explored children's and families' experiences of alternative care in Thailand. The study used arts‐based methods to engage 160 children living in a range of care settings. This included government and NGO‐run residential care settings (RCS), children's villages, Buddhist temples, migrant learning centres and foster care homes. Interviews were also conducted with 20 parents/guardians who had placed their children in care. Findings show that despite the alternative care system presenting significant challenges, the participants revealed how they strived to preserve their family connections, and how they are ‘doing family’ in adversity.

What are the holistic care impacts among individuals living through the COVID-19 pandemic in residential or community care settings? An integrative systematic review.

To critically synthesise evidence in relation to the holistic care impacts (physical, psychological, social, spiritual, and environmental well-being) among individuals living in residential aged care facilities (RACFs) with restrictions during the COVID-19 pandemic. An integrative systematic review followed a pre-registered protocol and has been reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) Guidelines. Electronic databases were searched from inception to June 2022. Qualitative, quantitative, and mixed methods studies were included. All articles were double screened according to a pre-determined eligibility criterion. The review process was managed using Covidence systematic review software. Data from the studies were extracted, methodological quality appraisal conducted, and a narrative synthesis conducted. 18 studies were included. The impact of restrictive practices and periods of lockdown impacted older people on all levels of individual quality-of-life. With or without COVID-19, residents experienced functional decline and many experienced malnutrition, increased incontinence, increased pain, and poorer general health and significant psychological distress. Depression increased with reduced social contact, as did anxiety and loneliness. Some residents spoke of suicidal ideation. It is highly plausible that further outbreaks may prompt knee-jerk reactions from public health departments and governing bodies to continue to restrict and lockdown facilities. Public health COVID-19 outbreak policy for aged care across the globe will need to consider the benefits verses risk debate given the findings uncovered in this review. These findings showed that it is vital that policy considers quality-of-life domains not solely survival rates.

Informal care at old age at home and in nursing homes: determinants and economic value

This paper provides a comprehensive analysis of informal care receipt by the French individuals aged 60 or older. The literature has focused on the community, leaving informal care in residential care settings in the shadow. We leverage data from a representative survey (CARE) conducted in 2015–2016 on both community-dwelling individuals and nursing home residents. Focusing on the 60+ with activity restrictions, we show that 76% of nursing home residents receive help with the activities of daily living from relatives, against 55% in the community. The number of hours conditional on receipt is yet 3.5 times higher in the community. Informal care represents 186 million hours per month and a value equivalent to 1.1% of GDP at least, care in the community representing 95% of the total. We investigate the determinants of informal care receipt. Using an Oaxaca-type approach, we disentangle between two mechanisms explaining that nursing home residents are more likely to receive informal care, namely the differences in population composition (endowments) and the differences in the association of individual characteristics with informal care (coefficients). Both are found to have a similar contribution. Our results imply that private costs make up for the majority (76%) of the costs associated with long-term care provision once informal care is taken into account. They also highlight that informal care is extremely common for nursing home residents. Existing evidence on the determinants of informal care receipt in the community has, however, limited relevance to understand informal care behaviors in nursing homes.

Evaluating infection risks and importance of hand hygiene during the household laundry process using a quantitative microbial risk assessment approach

Contaminated laundry contributes to infectious disease spread in residential and home health care settings. The objectives were to (1) evaluate pathogen transmission risks for individuals doing laundry, and (2) compare hand hygiene timing to reduce risks. A quantitative microbial risk assessment using experimental data from a laundry washing effectiveness study was applied to estimate infection risks from SARS-CoV-2, rotavirus, norovirus, nontyphoidal Salmonella, and Escherichia coli in 4 laundry scenarios: 1 baseline scenario (no hand hygiene event) and 3 hand hygiene scenarios (scenario 1: after moving dirty clothes to the washing machine, scenario 2: after moving washed clothes to the dryer, and scenario 3: hand hygiene events following scenario 1 and 2). The average infection risks for the baseline scenario were all greater than 2 common risk thresholds (1.0×10-6and 1.0×10-4). For all organisms, scenario 1 yielded greater risk reductions (39.95%-99.86%) than scenario 2 (1.35%-55.25%). Scenario 3 further reduced risk, achieving 1.0×10-6(SARS-CoV-2) and 1.0×10-4risk thresholds (norovirus and E. coli). The modeled results suggest individuals should reduce hand-to-facial orifice (eyes, nose, and mouth) contacts and conduct proper hand hygiene when handling contaminated garments. More empirical data are needed to confirm the estimated risks. The data and code that support the findings of this study can be retrieved via a Creative Commons Zero v1.0 Universal license in GitHub at https://github.com/yhjung1231/Laundry-QMRAproject-2022.git DOI: http://doi.org/10.5281/zenodo.7122065.

Narrative design for dementia care: Arranging the built environment of care homes to aid communication

AbstractBackgroundThe built environment has been shown to have significant potential to improve the quality of life and contribute to the well‐being of persons living with dementia. Persons with dementia in residential care suffer from isolation as it is difficult for staff and family members to find common routes of communication when the disease progresses. Within dementia care there is an urgent need to further facilitate communication especially with people living with late stage dementia. Storytelling has been effectively used in art therapy and art interventions for people affected by dementia to enhance communication, social connectivity and well‐being.This presentation explores the possibilities of incorporating a novel type of environmental design in care homes that would enhance narrative agency in residents with dementia thus allowing residents, caregivers and staff members to communicate through storytelling.MethodsDrawing on interdisciplinary research, the primary focus of the presentation is a case study examining the implementation of storytelling design in residential care settings. The case study reports on the co‐creation of a space focused on offering lived experiences for residents with dementia in a London care home highlighting design elements that trigger storytelling and stimulate imagination. Such elements include sensory wall surfaces, furniture, soft furnishings, configuration of space and inclusion of technology. The presentation explores whether this type of design could provide routes of communication between residents, staff and family members thus improving the quality of life of people living with dementia.ResultsBased on this case study example, the presentation discusses the value and impact of appropriate storytelling design on the wellbeing of people with dementia and their carers, and future avenues for improving the physical environment in care homes based on narrative design possibilities.ConclusionThere is a possibility for a significant impact of narrative design to communication, social connectivity and well‐being of people living with dementia.