As architects, we are involved in the conception of several ambitious projects for Huis Perrekes, an organization that initiated a place where people live with dementia. Our submission consists of a specific design approach for the refurbishment of an old villa and its garden into a house for residents with dementia. The core idea of the House is to reconnect the former villa and its new program to the social network of the village, and society in general. This is done by opening up the House and by creating a strong coherence between residents, family, people living nearby, artists and organizations. The concept allows several interior and exterior spaces to be shared in a significant way in a warm and secure environment. The principles of normalization of dementia, lived experience and focused care are the starting points of the project, which was developed and realized in close collaboration with Huis Perrekes, its director and many members of the staff.

The following text is an ethnographical study of relations in which care is shaped. On the example of care homes with special regime I describe how power is made and how different ideals are enacted in care of people with dementia. Through the analysis of daily activities' micro practice, I introduce two possible ways (modes of ordering) of care for frail elderly with cognitive impairment. The first of the modes is based on an enactment of ideals introduced into the practice by the Social Services Act and related system of quality standards: autonomy, individualisation, activation, and inclusion. It relies on standardisation of procedures, detailed specification of actions and management by objectives. The second mode of ordering, which could be located in the stories from care homes, is founded on an inevitable human dependency and vulnerability, and on general human need of giving and receiving care. In it, relationships and care improvisation here and now play the key role. My ethnographic fieldwork has shown that in everyday practice these two ways of doing good care co-exist - they complement each other, overlap and sometimes clash. People in care homes, striving for the better and the best care, either keep together, or hold apart these different and non-coherent ways of care. In discourse of...

The following text is an ethnographical study of relations in which care is shaped. On the example of care homes with special regime I describe how power is made and how different ideals are enacted in care of people with dementia. Through the analysis of daily activities' micro practice, I introduce two possible ways (modes of ordering) of care for frail elderly with cognitive impairment. The first of the modes is based on an enactment of ideals introduced into the practice by the Social Services Act and related system of quality standards: autonomy, individualisation, activation, and inclusion. It relies on standardisation of procedures, detailed specification of actions and management by objectives. The second mode of ordering, which could be located in the stories from care homes, is founded on an inevitable human dependency and vulnerability, and on general human need of giving and receiving care. In it, relationships and care improvisation here and now play the key role. My ethnographic fieldwork has shown that in everyday practice these two ways of doing good care co-exist - they complement each other, overlap and sometimes clash. People in care homes, striving for the better and the best care, either keep together, or hold apart these different and non-coherent ways of care. In discourse of...

Bakgrund: Alzheimer och vaskulär demens är de vanligaste demensdiagnoserna som drabbar den äldre patienten. Diagnoserna påverkar patienten olika beroende på var i hjärnan skadan sitter. Agitation, oro och svårigheter att förstå sin omgivning är dock vanliga symptom. Husdjursrobot definieras som ett gemensamt begrepp då det finns olika benämningar för tekniken. Denna teknik har blivit vanligare att använda inom vården särskilt t inom äldreomsorgen som terapi för patienter med demensdiagnos och syftet är att förbättra deras välbefinnande och livskvalité. Syfte: Att beskriva vårdpersonalens erfarenhet av husdjursrobotar i omvårdnaden av patienter med en demensdiagnos. Metod: En allmän litteraturöversikt där resultatet baserades på tolv artiklar varav sex med mixad metod, fem kvalitativa och en kvantitativ. Resultat: Analysen av resultaten resulterade i tre kategorier: omvårdnad, vårdmiljö och designens betydelse. Vårdpersonal som beskriver att arbetsmiljön i demensvården ofta är psykiskt påfrestande erfor att arbetsmiljön blir mindre psykiskt påfrestande vid användning av husdjursrobot. Slutsats: Husdjursrobot är ett viktigt och positivt verktyg som både gynnar vårdpersonalen och patienten med demensdiagnos. När patienterna med demensdiagnos integrerade med husdjursrobot, såg vårdpersonalen att tekniken husdjursrobot frambringade känslor som kärlek och trygghet. / Background: Alzheimer’s and vascular dementia are the most common dementia diagnoses affecting elderly patients. Dementia affects patients differently depending on the location of the damage in the brain. Agitation, anxiety and difficulty understanding one's surroundings are, however, common symptoms. Pet robots is defined as a common term, as although this technology has various names. This technology has become more common to use in healthcare particularly in elderly care as therapy for patients with dementia and the aim is to improve their well being and life quality. Purpose: Is to describe the nursing staff's experience with pet robots in the care of patients diagnosed with dementia. Methods: A general literature review was conducted on twelve articles, six of which were mixed methods, five qualitative, and one quantitative. Results: The analysis of the results was separated into three categories: nursing; the care environment; and the design’s importance for the interaction. The care staff, who often describe the work environment in dementia care as psychologically stressful, found that their work became less psychologically stressful when using a pet robot. Conclusion: Pet robots are an important and positive tool that benefits both patients with a diagnosis of dementia and the staff responsible for their care. When patients with a diagnosis of dementia integrated with the pet robot, the care staff could see that the pet robot brought out emotions such as love and security.

Dementia is one of the biggest global challenges within healthcare of our timeand to develop the interventions and preventions of this condition is important tobetter the quality of life for these individuals (Livington et al., 2017). In fall of 2018 the municipality of Kalmar established a team of specialists to assistassistant nurses in their care of the elders. The aim of this study is to understandhow a team of specialists cooperates with assistant nurses who work in dementiacare and if there are any differences in the view that the team has opposite to theassistant nurses. This study is based on semi-structured interviews with the teamof specialists and assistant nurses that works in residential homes with a focuson dementia and has had experiences from the team's work. The interviews arealso analyzed through the theoretical model cooperation theory. The studyindicates that there are several areas where the team of specialists has a positiveimpact in helping the assistant nurses. They provide education, both practicaland emotional support by giving advice and being a source where the assistantnurses can ventilate their concerns. They provide security for the workers whohave good attitudes towards the team in most areas of their work.

Aims: The aim of this study was to understand the eating and drinking experiences of people living with dementia and dysphagia in care homes from their perspective and those of their family members, formal care staff and Speech and Language Therapists (SLT). Design and methods: In this multi-method qualitative study, semi-structured interviews were carried out with 14 care home residents, seven family members of people living with dementia and dysphagia, and 13 care home staff with a variety of roles. Structured observations, using Dementia Care Mapping, were carried out with eight people living with dementia and dysphagia. Additionally, focus groups were carried out with a total of 31 SLTs. Data were analysed using thematic analysis. Findings: The findings of this study highlighted the changes experienced by people living in care homes, and those living with dementia and dysphagia, in relation to eating and drinking. In particular an impact on identity was found. This study highlighted the challenges of multiple people being involved in dysphagia care, with unclear roles and responsibilities and ineffective channels of communication. Despite the challenges identified, there were also examples of positive eating and drinking experiences through connections with others and the celebration of meaningful events. Conclusion: This was the first study that sought to explore and understand the eating and drinking experiences of people living with dementia and dysphagia from multiple perspectives. The findings highlight the challenges involved and possible solutions to promote a more person-centred approach to eating and drinking for people living with dementia and dysphagia. / Alzheimer’s Society; Compass Group

台灣在過去的數十年內，罹患失智症人口逐漸增多，其中的多數皆有接受了各層面的照護，舉凡藥物治療、醫護治療、復健治療以及職能治療，然其中的成效與需求之研究仍相當缺乏。故本研究採以質性與量性研究方法，以便於探索目前失智症患者家屬照護時所面臨的實際抉擇歷程與主要需求，並同時探索個案醫院內的治療效果與病患入院時狀況之關係，本研究希望藉由中部地區失智症病患照護的需求及機構之供給的角度來探索研究所能增進其醫療服務品質之處。 在質性研究方法部分，本研究以民族誌決策樹研究法來洞悉與探索家屬在面臨照護失智症病患時是否要採行機構式照護的決策歷程以及決策條件。藉由深度訪談結果粹取出的判斷準則發現，影響家屬決策之最主要考量為失智症病患者的失智程度，其餘包含道德規範、照護負擔、病患是否需要騎他的專業醫療照護以及照護中心的軟硬體環境。本研究整合考量這些判斷準則的優先順序、輕重緩急以及因果關係後將之建立決策樹，並以另外五十名家屬驗證該模型之預測力，得到預測準確率為92%。 此外，本研究再以量性方法來探索治療對於不同失智症病患的成效。結果顯示入住時狀況較好的失智症住民會以更積極的態度來接受職能治療，也因此他們擁有較大的改善或控制病情的機會，然而當住民以消極的態度接受職能治療時，則其治療效果遠不及積極治療者，也因此病情退步的機會較大，主要原因在於多數情況較差的住民具有攻擊、抗拒治療的傾向，使得照護工作變得更為艱鉅，故本研究建議家屬應重視職能治療以及與病人互動之重要性，不論是在居家照護亦或是機構式照護 / Over the past decade, the number of long-term care (LTC) residents has increased, and many have accepted treatments such as medication, rehabilitation and occupational therapy. This study employs both qualitative and quantitative techniques in order to discuss senile dementia patient care in long-term care institutions, and we use a supply and demand viewpoint to explore what services are really necessary for the patient and their family. In qualitative method, the main purpose of this stage is to use the ethnographic decision tree model to understand and explore the decision criteria of the subject. Our study found that the degree of dementia of the patient always affects the decisions made by family members – in fact, this is the most important of all criteria elicited from the interviews with family members. There are also ethical constraints, care burden, norm of filial obligation, patient need professional medical care and institutional environment, etc. which mentioned by families. We linked together the decision criteria considered most important in accounting for the decision-making sequence of family members to be the ethnographic decision tree model which predictive power is 92%. In quantitative stage, our study discussed the effectiveness of occupational therapy when given to dementia patients of different contexts. The results of this stage showed that patients of a good condition in the first stage present a more positive attitude towards participation in the occupational therapy designed by the institution; therefore, they have a greater chance of their condition improving or remaining the same. However, patients of an average condition have a more passive attitude towards taking part in any therapy; therefore, they have a greater chance of their condition deteriorating, because of their violent tendencies and their resistance to care, the task of caring for these patients is more difficult than caring for patients in the other groups. Above all, we suggest that families adopt the therapies no matter in homecare or institutionalization, as early as possible in order to improve the likelihood of being able to control the patient’s condition. It is understandable that accepting more therapies and interaction in the early stage of dementia, having higher chance to go well, however, by waiting until then they also miss the best opportunity to attempt to improve the patient’s condition, it is really not the good way we suggest to be.

For People Living with Dementia (PLwD), wandering behaviour can cause undesired consequences, such as falling, getting lost or even fatalities. For caregivers, taking care of PLwD with wandering behaviours is burdensome. If not intervened early, some wandering behaviours will escalate into crisis events. This design research aims to explore how to convert the wandering behaviour to a guided activity with the minimum input from caregivers by intervening early, that is, engaging PLwD, to avoid potential escalations. Based on Need-driven Dementia-compromised Behaviour (NDB) model, Crisis Development model and via a co-design approach, we developed De-light. De-light is a set of interactive sticks enhanced by light, audio and tactile experiences. Based on the degree of wandering behaviours of PLwD, De-light can be placed by the caregiver in a safe and suitable area in the nursing home to provide a controlled setting for guiding PLwD to perform physical activity. Our design research implies the possibilities of applying NDB model, Crisis Development model, and co- design approach in designing for the wandering behaviours for PLwD.

Within dementia care, there is a need to facilitate appropriate sensory experiences and opportunities for meaningful engagement for people living with dementia, particularly in later stages. As such, the provision of multisensory environments designed to meet the needs of these individuals and offering suitable occupation and stimulation, have increasingly gained significance. In this context, this paper explores the meaning of experience-focused, sensory design and the importance of appropriate sensory stimulation for wellbeing. It refers to recent interdisciplinary research in this area and a new guide advising on design of sensory enhanced spaces in residential dementia care. The primary focus of the paper is a case study showcasing the implementation of sensory design, based on these guidelines. The case study reports on the co-creation of a sensory, experience-focused space for residents with dementia in a London care-home. Based on this example, the paper highlights the value and impact of appropriate sensory design on the wellbeing of people with dementia and their carers. The conclusion discusses the learning and knowledge gained from this process as well as perspectives on further research activities including the analysis of user feedback and evaluation of the design intervention.

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