Dementia Therapeutic Environments: Cultural, Social, and Physical

Transcription

1 Dementia Therapeutic Environments: Cultural, Social, and Physical Kathleen Garvey, OTRL, CAPS Dementia Care Specialist, UMRC, Towsley Village October 7, 2017 Michigan Occupational Therapy Association Fall Conference, Grand Hotel

2 Research Bias and Exclusion (Swaffer, 2014) Descriptors: Demented, Sufferers, Subjects, Victims, Not all there Exclusion from discussion, planning and decisions about what is dementia friendly Exacerbation of social inequality, stigma, isolation, loss of identity and discrimination Authenticity of voice versus tokenistic and patronizing inclusion for fundraising or media attention Diagnosis= Prescribed Disengagement

3 Framework for analyzing long term services and supports (LTSS) programs. Adapted and expanded from Kane, Kane, and Ladd, 1998, p. 162, and Wilson, 2007, p.10.

4 Dementia Friendly Designs 1. Unobtrusively reduce risks. 2. Provide a human scale. 3. Allow people to see and be seen. 4. Reduce unhelpful stimulation. 5. Optimize helpful stimulation 6. Support movement and engagement. 7. Create a familiar space. 8. Provide opportunity to be alone or with others. 9. Provide links to the community. 10. Respond to a vision for a way of life.

5 Affordances Open plans, automatic doors and elevators, movement between floors and in communal areas, garden Variation in rooms for different activities, rest, changes Smooth flooring and safety devices in apartments and dining room Garden between buildings created safe outdoor space Large windows, access to daylight and visibility of outside activity observations Residential area, smooth ground and walking loop Large private rooms, space for personal belongings, sense of home Barriers Closed doors, heavy doors and thresholds hindered movement Long corridors made self mobility more challenging No handrails in building Steep slope and traffic noise hindered outside activity Small private rooms limited mobility, activities and opportunities for social interaction Large dining room =loud noises

6 Feature Advantage Examples Flexible spaces Multiple Cueing Systems Comprehensible plans and bedroom groups Openness and privacy Variety of spaces Allow for free roaming lack of orientation or destination Reaching a destination, enriched environment, encourage movement and reminders Reduces confusion and institutional impact Doors to allow choice for level of engagement Matching mood and encompassing a wide range of differing realities Way finding, walking, therapy or individual activity Plan forms, landmarks, grouping of chairs or single, Signage: arrow/stop sign, familiar icons Shapes which allow place to pause, landmarks to assist navigation (bays, mats, pictures), proximity to activity space. Safe locking Size, view, atmospheres, textures, colors, sensory stimulating features, variety of experiences and recall to reassure and calm.

7 Feature Advantage Example Provision for animals Source of comfort, increase socialization, reduce agitation, benefit care partners Birds, cats, dog, donkeys, chickens, geese, etc. Visuoperceptual safeguards and aids Removal of hallucination triggers : heavy shadows, stains, patterns Contrasts and visual clues: floor, position of door, bathroom, stair treads Icons and Cues Strong visual relationship to the exterior Use of non verbal visual aides to encourage new habits or ressurect old ones Take advantage of available space to encourage usage, conversational prompt Shapes, signs, colors, objects, bright color on bathroom door. Awareness of nature, seasons, weather, venturing, and exercise. Challenge and exercise Offer personal and shared experience, roles for resident, relatives, care partners Memory trail, stairs

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9 Quality of Life (QoL) Stewart-Archer, Afghani, Toye, Gomez, 2016, Canada Subjective definition: Freedom: unrestricted ability to do what one wants Basic needs met produces feelings of well being and caring. Independence to choose type, quality and quantity of help. Tranquility to meet need for safety, security and comfort. Meaningfulness be yourself, by yourself to preserve meaning and worth. Good physical health Self determination reaffirmed with continuance of even small decisions

10 Caring Organization Characteristics Type A Type B Manager s Role Authoritarian, remote Exemplary, accessible Staff status divisions Large, rigid Small, flexible Status of residents Lowest of all Equal to staff Communication One way, impersonal Two way, interpersonal Feelings/vulnerabilities Concealed In the open Power differential High Low Dementia Reconsidered, p. 106

11 Progression of Change Dementia Awareness Dementia Knowledgeable Dementia Skilled Dementia Competent

12 Until there is a cure, there is care -Teepa Snow, OTRL, FAOTA Understanding changes in brain structure and chemistry and how that affects perceptions, reactions, and abilities. Changing the social and physical environment to be accepting, supportive, and positive. Empowering care partners with new habits and routines to respond effectively so as to reduce stress and improve daily life for all.

13 Barriers to Change Tradition: containing the misfits, low status of care workers Power and prestige of the medical profession: limitations of diagnoses for care improvement Commercial interest in the promise of cure Cost of person centered care and public sector reimbursement Personal defenses: distancing and depersonalization

14 Sources for Presentation Act No. 476, State of Michigan, 90 th Legislature, Regular Session of 2000, House Bill 5761 and Fleming, R. et al (2016) The relationship between quality of the built environment and t he quality of life of people with dementia in residential care. Dementia, 15(4), Habell, M. (2013) Specialised design for dementia. Perspectives in Public Health, 133(3), Kane, R. and Cutler, L. (2015) Re-Imaginging Long-Term Services and Supports: Towards Livable Environments, Service Capacity and Enhanced Community Integration, Choice and Quality of Life for Seniors. The Gerontologist, 55(2), Kitwood, T. (1997) Dementia Reconsidered. New York: Open University Press. Lee, S., Chadbury, H. and Hung, L. (2016) Exploring staff perceptions on the role of physical environment in dementia care setting. Dementia, 15(4),

15 Nordin, S. et al (2016) The physical environment, activity and interaction in residential care facilities for older people: a comparitive case study. The Scandanavian Journal of Caring Sciences, Phinney, A., Caudhury, H., O Conner, D. (2006)Doing as much as I can do The meaning of activity for people with dementia. Aging and Mental Health, 11(4), Richards, K. et al (2015) Comparison of a traditional and non- traditional residential care facility for persons living with dementia and the impact of the environment on occupational engagement. Australian Occupational Therapy Journal, 62,

16 Stewart-Archer, L. Afghani, A. Toye, C., Gomez, F. (2016) Subjective quality of life of those 65 years and older experiencing dementia. Dementia, 15(6), Swaffer, K. (2014) Dementia: Stigma, Language, and Dementia friendly. Dementia 13(6), Ward, R. Clark,A. Campbell, S. et al. (2017)The lived neighborhood: understanding how people with dementia engage with their local environment. International Psychogeriatrics, Dementia Western Australia, Dementia Enabling Environment Project, Building dementia friendly communities, September 3, [ Illustration of 10 principles of creating dementia friendly communities. Copied from dementia-friendlycommunities/.

17 Lum, F. (2013) In Pictures: Montessori Method for Dementia. (January 24, 2013) The Globe and Mail. Retrieved from parenting/in-pictures-montessori-method-for-dementia/ article /? ref=