Background: Dementia friendly initiatives share similarities with the age-friendly movement in a focus on active engagement and creating a good quality of life for older adults. Dementia friendly initiatives offer a welcoming optimistic narrative in dementia studies by embracing dignity, empowerment, and autonomy to enable well-being throughout the dementia trajectory. Purpose: The purpose of this review is to explore the current science of dementia friendly initiatives, identify gaps, and inform future research. Method: Quantitative, qualitative, and conceptual/theoretical peer-reviewed dementia friendly research literature were evaluated for their current evidence base and theoretical underpinnings. Results: The dementia friendly initiatives research base is primarily qualitative and descriptive focused on environmental design, dementia awareness and education, and the development of dementia friendly communities. Person-centered care principles appear in dementia friendly initiatives centered in care settings. Strong interdisciplinary collaboration is present. Research is needed to determine the effect of dementia friendly initiatives on stakeholder-driven and community-based outcomes. Due to the contextual nature of dementia, the perspective of persons with dementia should be included as dementia friendly initiatives are implemented. Theory-based studies are needed to confirm dementia friendly initiative components and support rigorous evaluation. Dementia friendly initiatives broaden the lens from which dementia is viewed.

Background: Improving care for people living with dementia when they are admitted to hospital is a national priority. Interventions have been designed and implemented to support staff to improve how they provide care to patients with dementia. However, there is limited understanding of how these interventions work in practice and what the outcomes are for patients and their family carers. Objective: To develop, test, and refine a theory-driven explanation of what supports hospital staff to provide dementia-friendly care and with what outcomes for people living with dementia and their carers. Method: A two-phase study design employing realist methodology. Phase one was a realist review which combined evidence from stakeholder interviews and literature searches. Phase two used realist evaluation to analyse data collected from two NHS Hospital Trusts in the East of England to test the theory developed in phase one. Findings: Initial scoping in the realist review identified three candidate theories which structured the literature searches and analysis. Six related context-mechanism-outcome configurations were identified and collectively made the initial programme theory. The review found that single strategies, such as dementia awareness training, would not on their own change how staff provide care for patients with dementia. An important context was for staff to understand behaviour as a form of communication. Organisational endorsement for dementia care and clarity in staff roles was important for staff to recognise dementia care as a legitimate part of their work. The realist evaluation refined the programme theory. While the study sites had applied resources for patients with dementia differently, there were crosscutting themes which demonstrated how key mechanisms and contexts influenced staff actions and patient outcomes. When staff were allocated time to spend with patients and drew on their knowledge of the patient with dementia and dementia care skills, staff could provide care in ways that reassured patients and recognised their personhood. However, accepted organisational and social norms for care practices influenced whether staff considered providing skilled dementia care was an important contribution to the work on the ward. This impacted on how staff prioritised their work, which influenced whether they recognised and addressed patient needs such as pain or hunger, made attempts to reduce distress, and if patients and carers considered they were listened to. Organisational focuses, such as risk management, influenced how patient need was defined and how staffing resources were allocated. Staff commitment to continuing in dementia care was influenced by whether or not they valued dementia care as skilled work. Discussion: Single strategies, such as the use of dementia awareness training, will not on their own improve the outcomes for patients with dementia when they are admitted to hospitals. In addition, attention needs to be paid to the role of senior managers and their knowledge of dementia to support staff to provide care in ways that recognise the needs of the person. The way dementia care is valued within an organisation has implications for how resources are organised and how staff consider their role in providing dementia care. Evidence from observations demonstrated that when staff are supported to provide good dementia care, patients experienced positive outcomes in terms of their needs being addressed and reducing distress. Dementia care needs to be recognised as skilled work by the staff and the organisation.

Yes / The development of dementia friendly communities is a current global and national priority for the UK. As a response to policy, there have been a number of dementia awareness initiatives disseminated with the aim of reducing the stigma associated with a diagnosis of dementia. The inclusion of adolescents in such initiatives is imperative in order to sustain dementia friendly communities. With this in mind, the aim of this study was to establish the dementia education needs of adolescents and effective dissemination strategies to convey key messages. A total of 42 adolescents aged 12 to 18 years participated in eight focus group discussions. Key themes to emerge from discussions included: the importance of dementia awareness, topics of interest within dementia, preferred methods of learning, the inclusion of the person living with dementia and the use of social media. The findings of the study will enable the development of appropriate dementia awareness initiatives for adolescents and thus facilitate the sustainability of dementia friendly communities.

Focusing on the relationship between individuals with dementia and their environments, this research explores how to improve quality of life for those with dementia by increasing the capacity of existing urban public spaces. A content analysis of municipal planning documents (N =51) contextualized interviews, conducted with municipal urban planners (N =13) in the province of British Columbia, exploring their perspectives on designing dementia-friendly public spaces. Seven themes were identified from the findings. Furthermore, planners did not know much about planning for dementia, either suggesting they were perhaps already addressing dementia through other disability guidelines, or saying they did not know what could be done in the urban environment regarding dementia. They were open to learning more about dementia-friendly approaches. Incorporating the key dementia-friendly principles of familiarity, comfort, distinctiveness, accessibility, safety, inclusiveness and independence into age-friendly policy or Official Community Plans would promote designs that benefit persons with dementia, as well as many others with mental and physical impairments. / Graduate / 0573 / 0999 / mprzy@uvic.ca

Yes / Dementia friendly communities, in which people living with dementia actively participate and those around them are educated about dementia, may improve the wellbeing of those living with dementia and reduce the associated stigma. The Adopt a Care Home scheme aims to contribute towards this by teaching schoolchildren about dementia and linking them with people living with dementia in a local care home. Forty-one children, ten people living with dementia and eight school / care home staff participated in a mixed methods (questionnaires, observations, interviews and focus groups) evaluation to assess the scheme’s feasibility and impact. Data were analysed statistically and thematically. The scheme was successfully implemented, increased children’s dementia awareness and appeared enjoyable for most participants. Findings, therefore, demonstrate the scheme’s potential to contribute towards dementia friendly communities by increasing children’s knowledge and understanding of dementia and engaging people living with dementia in an enjoyable activity, increasing their social inclusion. / University of Sheffield's Faculty of Medicine Dentistry & Health Innovation Fund.

Yes / Communities play an important role in supporting people living with affected by dementia. The aim of this study was to explore what could be changed in the local community to enable those with dementia to live well. People with dementia and carers taking part in the IDEAL programme responded to open-ended questions. Responses from 1,172 people with dementia and 702 caregivers were analysed using thematic analysis. Four themes were identified: raising awareness, improving access to support services, providing social events and activities, and supporting people to engage in the community. These highlight the role of individuals, resources and the environment in supporting those with dementia. Longer-term investment in services is needed to underpin dementia-inclusive communities. / The IDEAL study was funded jointly by the Economic and Social Research Council (ESRC) and the National Institute for Health Research (NIHR) through grant ES/L001853/2. The IDEAL-2 study’ is funded by Alzheimer’s Society, grant number 348, AS-PR2-16-001. The support of ESRC, NIHR and Alzheimer’s Society is gratefully acknowledged.

The growing global prevalence of dementia coupled with a shift in public perception from a hopeless disease to the possibility of living well with dementia has led to the formation of dementia friendly communities (DFC). DFCs are a new phenomenon in the United States, with a gap in knowledge on input from people living with dementia (PLWD). This study investigated DFCs from the perspective of PLWD in Western North Carolina, with the following research questions: How are interactions and relationships experienced by persons living with dementia in the community? How is community engagement experienced by PLWD? To what extent and in what way is the impact of stigma associated with dementia? What are the attributes of a DFC from the perspective of PLWD? Eighteen older adults with reported dementia or memory loss were recruited from support groups or community organizations. Semi-structured interviews were conducted in participants’ homes and analyzed using conventional qualitative content analysis. Three major themes emerged from the transcribed interviews (a) transitions in cognition: vulnerable identities, (b) social connections, and (c) engagement in life activities. The dynamic experience of living with dementia revealed by participants suggested the following attributes of a DFC: (a) social inclusion, (b) support for role continuity, (c) availability of meaningful and contributory activities, (d) flexible support as cognition transitions, (e) community dementia awareness (to combat stigma), and (f) a supportive diagnostic process. The presence of care partners in the interviews was supportive, and the evaluation to sign consent tool assisted in determination of participant capacity to self-consent. The findings were interpreted through the theoretical frameworks of personhood, the social model of disability, human rights and citizenship, the environmental press model, and transitions theory. DFC development requires a contextual lens focused on well-being with input from multiple stakeholders including PLWD. Collaboration among community organizations supported by local, regional, and national policy supporting flexible service provision through cognitive transitions has the potential to provide a strong social network on which to build a DFC.

Die Zahl demenzerkrankter Patienten in Akutkrankenhäusern wird zukünftig ansteigen. Ein Aufenthalt in einer fremden Krankenhausumgebung bedeutet für diese Patientengruppe psychisch eine extrem belastende Situation. Die Folgen sind für die Betroffenen, das Personal und die Kliniken schwerwiegend. Seitens der Patienten sind besonders die Einbußen des kognitiven und physischen Status sowie ein Verlust an Selbstständigkeit zu nennen. Für das Pflegepersonal ist vor allem die hohe Arbeitsbelastung aufzuführen. Lösungsansätze einer besseren Versorgung schenken einer demenzsensiblen Gestaltung der gebauten Umwelt in Deutschland bislang zu wenig Beachtung. Das Ziel dieser Arbeit besteht daher in der Entwicklung eines Katalogs demenzfreundlicher Planungskriterien für Akutkrankenhäuser. Die Zusammenfassung der bisherigen, wissenschaftlich belegten positiven Auswirkungen einer demenzsensiblen Architektur in Altenpflegeeinrichtungen dient als Basis für die Überlegungen zu einer Übertragbarkeit dieser Planungskriterien. Hier beeinflussen beispielsweise eine segregative Betreuung, klare Grundrissstrukturen mit einprägsamen Referenzpunkten oder eine milieutherapeutische, wohnlich gestaltete Umwelt mit Gemeinschaftsräumen die Bewohner positiv. Kriterien, die speziell die Einbußen der kognitiven und funktionellen Fähigkeiten von demenziell erkrankten Menschen berücksichtigen, sind das Kaschieren von Türen und die Umsetzung visueller Barrieren. Auch ein durchgehend gleichmäßig gestalteter Bodenbelag, der dem Wahrnehmen von Stufen oder Abgründen und damit Stürzen vorbeugt, ist bei der Planung von demenzsensiblen Gebäuden wichtig. Weiterhin liefert neben der Analyse international bereits realisierter Konzepte, wie die Einrichtung von Spezialstationen oder Tagesbetreuungsräumen, ein Interview mit dem Pflegepersonal des Diakonissenkrankenhauses Dresden wichtige Ansatzpunkte für den erarbeiteten Kriterienkatalog. Viele der evidenzbasierten Handlungsanweisungen zur Planung von stationären Altenpflegeeinrichtungen sind auf die Architektur von Akutkrankenhäusern anwendbar wie zum Beispiel Maßnahmen, die die Orientierung erleichtern. Diese führen dort im Sinne eines Design for all bzw. Universal Designs für alle Menschen zu einer leichteren Nutzbarkeit. Gemeinschaftsräume für die Einnahme der Mahlzeiten oder tagesstrukturierende Angebote sind in der Planung von Akutkrankenhäusern nicht vorgesehen. Dies stellt einen wesentlichen Unterschied zum Raumprogramm stationärer Altenpflegeeinrichtungen dar. Für demenzerkrankte Patienten könnte jedoch so dem Verlust der Selbstständigkeit und kognitiver Fähigkeiten vorgebeugt werden. Die Übertragung einer wohnlichen Atmosphäre muss in Bezug auf Machbarkeit und Sinnhaftigkeit kritisch diskutiert werden. Die demenzsensible Anpassung des Eingangsbereichs und der Notaufnahme am konkreten Beispiel des Diakonissenkrankenhauses Dresden zeigt die Anwendbarkeit des Kriterienkatalogs. Dieser gliedert sich in die Punkte Orientierung, räumliche Organisation, Sicherheit und milieutherapeutische Gestaltung. Weiterhin wird hier die Einrichtung einer Spezialstation als Anbau an das Bestandsgebäude vorgeschlagen.

Die Zahl demenzerkrankter Patienten in Akutkrankenhäusern wird zukünftig ansteigen. Ein Aufenthalt in einer fremden Krankenhausumgebung bedeutet für diese Patientengruppe psychisch eine extrem belastende Situation. Die Folgen sind für die Betroffenen, das Personal und die Kliniken schwerwiegend. Seitens der Patienten sind besonders die Einbußen des kognitiven und physischen Status sowie ein Verlust an Selbstständigkeit zu nennen. Für das Pflegepersonal ist vor allem die hohe Arbeitsbelastung aufzuführen. Lösungsansätze einer besseren Versorgung schenken einer demenzsensiblen Gestaltung der gebauten Umwelt in Deutschland bislang zu wenig Beachtung. Das Ziel dieser Arbeit besteht daher in der Entwicklung eines Katalogs demenzfreundlicher Planungskriterien für Akutkrankenhäuser. Die Zusammenfassung der bisherigen, wissenschaftlich belegten positiven Auswirkungen einer demenzsensiblen Architektur in Altenpflegeeinrichtungen dient als Basis für die Überlegungen zu einer Übertragbarkeit dieser Planungskriterien. Hier beeinflussen beispielsweise eine segregative Betreuung, klare Grundrissstrukturen mit einprägsamen Referenzpunkten oder eine milieutherapeutische, wohnlich gestaltete Umwelt mit Gemeinschaftsräumen die Bewohner positiv. Kriterien, die speziell die Einbußen der kognitiven und funktionellen Fähigkeiten von demenziell erkrankten Menschen berücksichtigen, sind das Kaschieren von Türen und die Umsetzung visueller Barrieren. Auch ein durchgehend gleichmäßig gestalteter Bodenbelag, der dem Wahrnehmen von Stufen oder Abgründen und damit Stürzen vorbeugt, ist bei der Planung von demenzsensiblen Gebäuden wichtig. Weiterhin liefert neben der Analyse international bereits realisierter Konzepte, wie die Einrichtung von Spezialstationen oder Tagesbetreuungsräumen, ein Interview mit dem Pflegepersonal des Diakonissenkrankenhauses Dresden wichtige Ansatzpunkte für den erarbeiteten Kriterienkatalog. Viele der evidenzbasierten Handlungsanweisungen zur Planung von stationären Altenpflegeeinrichtungen sind auf die Architektur von Akutkrankenhäusern anwendbar wie zum Beispiel Maßnahmen, die die Orientierung erleichtern. Diese führen dort im Sinne eines Design for all bzw. Universal Designs für alle Menschen zu einer leichteren Nutzbarkeit. Gemeinschaftsräume für die Einnahme der Mahlzeiten oder tagesstrukturierende Angebote sind in der Planung von Akutkrankenhäusern nicht vorgesehen. Dies stellt einen wesentlichen Unterschied zum Raumprogramm stationärer Altenpflegeeinrichtungen dar. Für demenzerkrankte Patienten könnte jedoch so dem Verlust der Selbstständigkeit und kognitiver Fähigkeiten vorgebeugt werden. Die Übertragung einer wohnlichen Atmosphäre muss in Bezug auf Machbarkeit und Sinnhaftigkeit kritisch diskutiert werden. Die demenzsensible Anpassung des Eingangsbereichs und der Notaufnahme am konkreten Beispiel des Diakonissenkrankenhauses Dresden zeigt die Anwendbarkeit des Kriterienkatalogs. Dieser gliedert sich in die Punkte Orientierung, räumliche Organisation, Sicherheit und milieutherapeutische Gestaltung. Weiterhin wird hier die Einrichtung einer Spezialstation als Anbau an das Bestandsgebäude vorgeschlagen.

As the global population of people with dementia is projected to reach 139 million by 2050, there is a growing focus on strategies supporting their Health and Care Outcomes (HCOs), one of which is dementia-friendly design in healthcare facilities. The built environment of healthcare facilities plays a key role in dementia care. To design healthcare facilities that better align with the HCOs for people with dementia, it is beneficial to assess the effects of Architectural Variables (AVs) on HCOs. The more extensive the consideration of AVs’ effects in design, the greater the capacity to achieve alignment between the built environment and HCOs. For this purpose, this PhD thesis develops a new assessment software which assesses the effects of AVs on HCOs more effectively, shifting from traditional and manual assessment tools in architecture towards systematic and digital approaches. Its development is guided by a methodology that addresses correspondingly three main challenges in previous assessment tools including lack of standard set of AVs and HCOs with widespread consensus, limitation in the holistic and systematic coverage of their interactions in the assessment calculations, and application difficulties of assessment tools. Firstly, this thesis creates a new set of AVs and HCOs through terminology analysis and introduces a new structure of classification for allocating and positioning the AVs and HCOs. In the terminology analysis, AVs and HCOs were extracted from a source of Evidence-Based Design (EBD) studies, then through frequency analysis and statistical tests, representative terms with the most potential for consensus were identified. For the structure of classification, a new structure was developed for AVs and HCOs based on both theoretical and practical investigation approaches to meet a set of fundamental classification criteria. Secondly, Model-Based Systems Engineering (MBSE), a subset of Systems Engineering, is utilized to model the interactions between AVs and HCOs. This approach enables the consideration of all different types of interactions between AVs and HCOs. It considers both direct interactions (AV-HCO) and indirect interactions, such as AV-HCO-HCO (an AV affects an HCO, which in turn affects another HCO) and AV-AV-HCO (an AV affects another AV, which then affects an HCO). Through systematic modeling with MBSE, a logical model has been developed that automates assessment calculations. Thirdly, the application difficulties of the previous assessment tools are addressed through considerations in the software features and capabilities. Namely, the logical model obtained in the second step is integrated into the computational engine of the software to support it as a calculative engine without any need for manual intervention by users. Users can enter the specifications of the facilities supposed to be assessed through AVs in the software, then the assessment is carried out through data exchange between the computational engine and its logical model on the backend. The results of the assessment are displayed online through quantitative and qualitative analysis. Users are informed about how many negative or positive effects each HCO receives from which AVs. It also provides root cause analysis through the impact chains of direct and indirect interactions to clarify why an effect, whether positive or negative, occurs. The total result for all of the HCOs is also available. Currently, the software conducts the assessment based on 396 interactions between AVs and HCOs, extracted from a source of previous studies. However, the model obtained through implementing MBSE is so developed that new findings could be added into the model and subsequently automatically into the software, along with all relevant assessment calculations. This makes the software dynamic and adaptable to new findings. Moreover, the software was implemented in two real-world case assessments in Cambridge, UK. Additionally, expert feedback was gathered through a series of feedback sessions.:Table of content SUMMARY OF THESIS KURZFASSUNG TABLE OF CONTENT GLOSSARY INTRODUCTION CHAPTER 1.BUILT ENVIRONMENT AND HUMAN OUTCOMES 1.1. Introduction to built environment and human outcomes 1.1.1. Definition of built environment and human outcomes 1.1.2. The impact of built environment on human outcomes, with a focus on older occupants 1.2. Theories linking the built environment and human outcomes 1.2.1. Overview of theories linking built environment and human outcomes 1.2.2. Environmental gerontology 1.3. EBD: An approach to design for the theories linking built environment and human outcomes 1.3.1. Role of EBD in healthcare facility design 1.3.2. Role of EBD in environmental gerontology CHAPTER 2.DEMENTIA-FRIENDLY DESIGN IN NURSING HOMES 2.1. Understanding dementia: Definition to consequences 2.2. The built environment of people with dementia 2.3. Definition and history of dementia-friendly design 2.4. Effects of dementia-friendly design on people with dementia 2.5. Principles of dementia-friendly design in nursing homes CHAPTER 3.ASSESSMENT TOOLS IN DEMENTIA-FRIENDLY DESIGN 3.1. Role of assessment tools in dementia-friendly design 3.2. Overview of previous assessment tools 3.3. Analyzing the previous assessment tools CHAPTER 4.RESEARCH DESIGN AND METHODOLOGY 4.1. Research gap, objectives, and questions 4.2. Scope and boundaries 4.3. Methodology CHAPTER 5.TERMINOLOGY ANALYSIS FOR CONSISTENCY 5.1. Extraction of terminology through concept-based approach 5.1.1. Conducting content analysis of source studies 5.1.2. Application of a concept-based approach 5.2. Dataset generation of the extracted terminologies 5.3. Frequency analysis and statistical tests 5.3.1. Frequency analysis and chi-square test of the concepts for AVs 5.3.2. Frequency analysis and chi-square test of the concepts for HCOs 5.4. Selection of representative terms 5.5. Scenarios for establishing comprehensive standardized terminology Chapter 6. DEVELOPMENT OF CLASSIFICATION STRUCTURE 6.1. Development of the classification structure 6.1.1. Expected efficacies and importance of the classification structure 6.1.2. Criteria for the development of classification structure 6.1.3. Nature of classification criteria 6.1.4. Investigation approaches 6.1.5. Creating the structure of classifications for AVs and HCOs 6.2. Allocation of AVs and HCOs to their corresponding classifications 6.3. Extraction of the interactions between AVs and HCOs 6.4. Considerations for interactions between AVs and HCOs CHAPTER 7.IMPLEMENTING MODEL-BASED SYSTEMS ENGINEERING 7.1. The role and benefits of MBSE in the assessment software 7.2. Introduction to the Model-Based Systems Engineering (MBSE) 7.2.1. The foundation of MBSE: Systems Engineering (SE) 7.2.2. The core principles of MBSE 7.3. Implementing MBSE 7.3.1. Operational analysis phase 7.3.2. System analysis phase 7.3.3. Logical architecture phase 7.3.4. Physical architecture phase CHAPTER 8.DEVELOPMENT OF WEB-BASED ASSESSMENT SOFTWARE AND ITS IMPLEMENTATION IN PRACTICE 8.1. Overview of the software structure 8.2. Technical structure and key technologies 8.3. Key features and functionalities 8.3.1. Accessibility 8.3.2. Registration 8.3.3. Management of assessment cases 8.3.4. Creation of a new assessment case 8.3.5. Design assessment questionnaire 8.3.6. Displaying the assessment results 8.4. Considerations for interactions in the assessment software 8.4.1. Reliability awareness 8.4.2. Reflection of AV-HCO direct vs. indirect distinctions 8.4.3. Clarification of conflicts in studies’ findings 8.5. Case analysis 8.5.1. On-site assessment and data collection for AVs’ specifications 8.5.2. Assessment results of case analysis 8.5.3. Comparative analysis 8.6. Experts’ feedback 8.6.1. Selection of participants 8.6.2. Content of the feedback sessions 8.6.3. Feedback session process and outcomes CHAPTER 9.DISCUSSION AND CONCLUSION 9.1. Thesis implications for dementia-friendly design assessment 9.1.1. Standardization and organization of AVs and HCOs 9.1.2. Systematic consideration of interactions 9.1.3. Application capabilities 9.2. Limitations 9.2.1. Scope of interactions and benchmarking 9.2.2. Limitation in qualitative nature of EBD findings 9.2.3. Practical application and validation 9.2.4. Standardization of terminology 9.2.5. Stakeholder interplay 9.3. Future directions 9.3.1. Expanding scope of interactions 9.3.2. Expanding practical application and user feedback 9.3.3. Extending standardization of terminology 9.3.4. Region-specific versions of the assessment software 9.4. Conclusion APPENDICES TABLE OF TABLES TABLE OF FIGURES DECLARATION REFERENCES / Bis zum Jahr 2050 wird die Weltbevölkerung voraussichtlich 139 Millionen Menschen mit Demenz erreichen. Infolgedessen liegt der Schwerpunkt zunehmend auf Lösungen zur Unterstützung ihrer Gesundheits- und Pflegeergebnisse (HCOs), zu denen auch die demenzfreundliche Gestaltung von Gesundheitseinrichtungen gehört. Um Gesundheitseinrichtungen zu gestalten, die besser mit den HCOs von Menschen mit Demenz übereinstimmen, ist es notwendig, die Auswirkungen von architektonischen Variablen (AVs) auf HCOs gründlich zu bewerten. Je umfassender die Berücksichtigung der Effekte von AVs im Design ist, desto größer ist die Fähigkeit, eine Übereinstimmung zwischen der gebauten Umgebung und den HCOs zu erreichen. Zu diesem Zweck wird in dieser Dissertation eine neue softwaregesteuerte Bewertungslösung entwickelt, mit der die Auswirkungen von AVs auf HCOs effektiver bewertet werden können, indem von traditionellen und manuellen Instrumenten auf digitale Lösungen umgestellt wird. Die Entwicklung wird von einer Methodik geleitet, die drei Hauptprobleme in früheren Bewertungsinstrumenten behandelt, darunter das Fehlen eines Standardsets von AVs und HCOs mit weitreichendem Konsens, Einschränkungen in der umfassenden und systematischen Abdeckung ihrer Interaktionen in den Bewertungsberechnungen sowie Anwendungsprobleme von Bewertungsinstrumenten. Erstens wird in dieser Arbeit durch eine Terminologieanalyse ein neues Set von AVs und HCOs erstellt und eine neue Klassifikationsstruktur für die Zuordnung und Positionierung der AVs und HCOs eingeführt. Bei der Terminologieanalyse wurden AVs und HCOs aus einer Quelle von Evidence-Based Design (EBD) Studien extrahiert, dann durch statistische und Häufigkeitsanalysen repräsentative Begriffe mit dem größten Konsenspotenzial ermittelt. Für die Struktur der Klassifizierung wurde eine neue Struktur für AVs und HCOs entwickelt, die sowohl auf theoretischen als auch auf praktischen Untersuchungsansätzen basiert, um eine Reihe von grundlegenden Klassifizierungskriterien zu erfüllen. Zweitens wird das modellbasierte System-Engineering (MBSE), ein Teilbereich des Systems-Engineering, zur Modellierung der Interaktionen zwischen AVs und HCOs eingesetzt. Dieser Ansatz ermöglicht die Berücksichtigung aller verschiedenen Arten von Interaktionen zwischen AVs und HCOs. Es berücksichtigt sowohl direkte Interaktionen (AV-HCO) als auch indirekte Interaktionen wie AV-HCO-HCO (ein AV beeinflusst ein HCO, das wiederum ein anderes HCO beeinflusst) und AV-AV-HCO (ein AV beeinflusst ein anderes AV, das wiederum ein HCO beeinflusst). Durch systematische Modellierung mit MBSE wurde ein logisches Modell entwickelt, das die Bewertungsberechnungen automatisiert. Drittens werden die Anwendungsprobleme der vorherigen Bewertungsinstrumente durch Überlegungen zu den Softwarefunktionen und -fähigkeiten behandelt. Insbesondere wird das im zweiten Schritt erhaltene logische Modell in den Berechnungsmotor der Software integriert, um es als einen rechnerischen Motor zu unterstützen, ohne dass Benutzer manuell eingreifen müssen. Benutzer können die Spezifikationen der Einrichtungen, die durch AVs der Software bewertet werden sollen, eingeben, und die Bewertung erfolgt durch den Datenaustausch zwischen dem Berechnungsmotor und seinem logischen Modell auf dem Backend. Die Ergebnisse der Bewertung werden online durch quantitative und qualitative Analysen angezeigt. Benutzer werden darüber informiert, wie viele negative oder positive Auswirkungen jede HCO von welchen AVs erhält. Es bietet auch Ursachenanalyse, um zu klären, warum ein Effekt, sei er positiv oder negativ, auftritt. Das Gesamtergebnis für alle HCOs ist ebenfalls verfügbar. Aktuell führt die Software die Bewertung auf der Grundlage von 396 Interaktionen zwischen AVs und HCOs durch, die aus einer Quelle früherer Studien extrahiert wurden. Das durch die Implementierung von MBSE erhaltene Modell ist jedoch so entwickelt, dass neue Erkenntnisse problemlos in das Modell und anschließend automatisch in die Software und alle relevanten Bewertungsberechnungen integriert werden können. Dies macht die Software dynamisch und anpassungsfähig für neue Erkenntnisse. Darüber hinaus wurde die Software in zwei realen Fallbewertungen in Cambridge, Großbritannien, implementiert. Zusätzlich wurde durch eine Reihe von Feedback-Sitzungen Expertenfeedback gesammelt.:Table of content SUMMARY OF THESIS KURZFASSUNG TABLE OF CONTENT GLOSSARY INTRODUCTION CHAPTER 1.BUILT ENVIRONMENT AND HUMAN OUTCOMES 1.1. Introduction to built environment and human outcomes 1.1.1. Definition of built environment and human outcomes 1.1.2. The impact of built environment on human outcomes, with a focus on older occupants 1.2. Theories linking the built environment and human outcomes 1.2.1. Overview of theories linking built environment and human outcomes 1.2.2. Environmental gerontology 1.3. EBD: An approach to design for the theories linking built environment and human outcomes 1.3.1. Role of EBD in healthcare facility design 1.3.2. Role of EBD in environmental gerontology CHAPTER 2.DEMENTIA-FRIENDLY DESIGN IN NURSING HOMES 2.1. Understanding dementia: Definition to consequences 2.2. The built environment of people with dementia 2.3. Definition and history of dementia-friendly design 2.4. Effects of dementia-friendly design on people with dementia 2.5. Principles of dementia-friendly design in nursing homes CHAPTER 3.ASSESSMENT TOOLS IN DEMENTIA-FRIENDLY DESIGN 3.1. Role of assessment tools in dementia-friendly design 3.2. Overview of previous assessment tools 3.3. Analyzing the previous assessment tools CHAPTER 4.RESEARCH DESIGN AND METHODOLOGY 4.1. Research gap, objectives, and questions 4.2. Scope and boundaries 4.3. Methodology CHAPTER 5.TERMINOLOGY ANALYSIS FOR CONSISTENCY 5.1. Extraction of terminology through concept-based approach 5.1.1. Conducting content analysis of source studies 5.1.2. Application of a concept-based approach 5.2. Dataset generation of the extracted terminologies 5.3. Frequency analysis and statistical tests 5.3.1. Frequency analysis and chi-square test of the concepts for AVs 5.3.2. Frequency analysis and chi-square test of the concepts for HCOs 5.4. Selection of representative terms 5.5. Scenarios for establishing comprehensive standardized terminology Chapter 6. DEVELOPMENT OF CLASSIFICATION STRUCTURE 6.1. Development of the classification structure 6.1.1. Expected efficacies and importance of the classification structure 6.1.2. Criteria for the development of classification structure 6.1.3. Nature of classification criteria 6.1.4. Investigation approaches 6.1.5. Creating the structure of classifications for AVs and HCOs 6.2. Allocation of AVs and HCOs to their corresponding classifications 6.3. Extraction of the interactions between AVs and HCOs 6.4. Considerations for interactions between AVs and HCOs CHAPTER 7.IMPLEMENTING MODEL-BASED SYSTEMS ENGINEERING 7.1. The role and benefits of MBSE in the assessment software 7.2. Introduction to the Model-Based Systems Engineering (MBSE) 7.2.1. The foundation of MBSE: Systems Engineering (SE) 7.2.2. The core principles of MBSE 7.3. Implementing MBSE 7.3.1. Operational analysis phase 7.3.2. System analysis phase 7.3.3. Logical architecture phase 7.3.4. Physical architecture phase CHAPTER 8.DEVELOPMENT OF WEB-BASED ASSESSMENT SOFTWARE AND ITS IMPLEMENTATION IN PRACTICE 8.1. Overview of the software structure 8.2. Technical structure and key technologies 8.3. Key features and functionalities 8.3.1. Accessibility 8.3.2. Registration 8.3.3. Management of assessment cases 8.3.4. Creation of a new assessment case 8.3.5. Design assessment questionnaire 8.3.6. Displaying the assessment results 8.4. Considerations for interactions in the assessment software 8.4.1. Reliability awareness 8.4.2. Reflection of AV-HCO direct vs. indirect distinctions 8.4.3. Clarification of conflicts in studies’ findings 8.5. Case analysis 8.5.1. On-site assessment and data collection for AVs’ specifications 8.5.2. Assessment results of case analysis 8.5.3. Comparative analysis 8.6. Experts’ feedback 8.6.1. Selection of participants 8.6.2. Content of the feedback sessions 8.6.3. Feedback session process and outcomes CHAPTER 9.DISCUSSION AND CONCLUSION 9.1. Thesis implications for dementia-friendly design assessment 9.1.1. Standardization and organization of AVs and HCOs 9.1.2. Systematic consideration of interactions 9.1.3. Application capabilities 9.2. Limitations 9.2.1. Scope of interactions and benchmarking 9.2.2. Limitation in qualitative nature of EBD findings 9.2.3. Practical application and validation 9.2.4. Standardization of terminology 9.2.5. Stakeholder interplay 9.3. Future directions 9.3.1. Expanding scope of interactions 9.3.2. Expanding practical application and user feedback 9.3.3. Extending standardization of terminology 9.3.4. Region-specific versions of the assessment software 9.4. Conclusion APPENDICES TABLE OF TABLES TABLE OF FIGURES DECLARATION REFERENCES