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.

Thesis advisor: Christina Matz-Costa / Given the rising numbers of community-dwelling older adults in the United States (US), understanding the effect of home and community factors on health and well-being is critically important. Although important contributions have been made, most existing studies have used unidimensional measures of neighborhoods, which provide insufficient empirical evidence to develop holistic interventions. Also, despite the prevalence of disability among older adults, only a handful of studies have explored the effect of physical functioning in the relationship between home and neighborhood environments and older adults’ well-being. Finally, the role of the global assessment of community in mediating the effect of home and neighborhood environments on older adults’ well-being has not been explored. To fill these knowledge gaps, this dissertation examined the relationship between home and community environments and well-being (i.e., self-reported health, global assessment of community, and likelihood of aging-in-place) among adults age 65 and older (n=4,066). Based on the press-competence model, differences in hypothesized relationships by respondents’ physical functioning was also examined. Further, this dissertation explored the mediating effect of older adults’ global assessments of their community to see if the effect of home and neighborhood environments on older adults’ likelihood of aging-in-place operates through the global assessment of community. Data were analyzed from the AARP Age-Friendly Communities 2015 survey, which was collected from 14 communities in the US and includes 66 items capturing aspects of home and community environments under eight domains. Results of multi-level regression analyses suggest that both availability of resources and the fit between respondents’ needs and available resources are associated with their health, global assessment of community, and the likelihood of aging-in-place. The impact of home and neighborhood environments was greater among respondents with functional limitations and with low income. Home and neighborhood environments are associated with older adults’ likelihood of aging-in-place through their effect on the global assessment of community. These findings provide a fuller understanding of the impact of surrounding environments on older adults’ well-being, which will inform policy and practice efforts to better serve community-dwelling older adults. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

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.

The impact of transportation concerning older adults is under scrutiny as the number of older adults is expected to significantly increase in the coming years. The World Health Organization (WHO) spearheaded a world wide initiative that sought to examine what contributed to an “age-friendly community” in both developed and underdeveloped nations. This paper examines, in particular, the role that transportation plays in relation and contribution to an “age-friendly” community in Saanich, British Columbia, as an addition to the WHO initiative. Focus groups were conducted to ensure that information received was the lived experience of the individual. Results suggested that transportation was more than the ability to operate a vehicle, but in the ability to move safely within an environment. Additional information provided by participants spoke to the necessity of increasing awareness of licensing systems and improvements that could be implemented to ensure safety for older adult drivers and the community.

The impact of transportation concerning older adults is under scrutiny as the number of older adults is expected to significantly increase in the coming years. The World Health Organization (WHO) spearheaded a world wide initiative that sought to examine what contributed to an “age-friendly community” in both developed and underdeveloped nations. This paper examines, in particular, the role that transportation plays in relation and contribution to an “age-friendly” community in Saanich, British Columbia, as an addition to the WHO initiative. Focus groups were conducted to ensure that information received was the lived experience of the individual. Results suggested that transportation was more than the ability to operate a vehicle, but in the ability to move safely within an environment. Additional information provided by participants spoke to the necessity of increasing awareness of licensing systems and improvements that could be implemented to ensure safety for older adult drivers and the community.