When walking becomes wandering: representing the fear of the fourth age

Peripheral and central sensation: multisensory orienting and recognition across species

Attentional bottlenecks force animals to deeply process only a selected fraction of sensory inputs. This motivates a unifying central-peripheral dichotomy (CPD), which separates multisensory processing into functionally defined central and peripheral senses. Peripheral senses (e.g., human audition and peripheral vision) select a fraction of the sensory inputs by orienting animals' attention; central senses (e.g., human foveal vision) allow animals to recognize the selected inputs. Originally used to understand human vision, CPD can be applied to multisensory processes across species. I first describe key characteristics of central and peripheral senses, such as the degree of top-down feedback and density of sensory receptors, and then show CPD as a framework to link ecological, behavioral, neurophysiological, and anatomical data and produce falsifiable predictions.

'Vulnerable Monsters': Constructions of Dementia in the Australian Royal Commission into Aged Care

This paper argues that while regulatory frameworks in aged care authorise restraints to protect vulnerable persons living with dementia from harm, they also serve as normalising practices to control challenging monstrous Others. This argument emerges out of an observed unease in aged care discourse where older people living with dementia are described as 'vulnerable', while dementia behaviours are described as 'challenging'. Using narrative analysis on a case study from the Final Report of the Australian Royal Commission into Aged Care Quality and Safety (RCAC), this paper investigates how the RCAC (re)produced constructions of persons with dementia as 'vulnerable monsters'. Drawing upon monstrous theory about 'unruly and leaky' bodies, extracts from the case study reveal how the RCAC repeated and reinforced monstrous constructions of dementia. Dementia behaviours, particularly 'wandering', were constructed through a dehumanising crisis frame that produced 'challenging' bodies and legitimised 'last resort' normalising practices, such as physical and chemical restraints. In failing to resist monstrous constructions of dementia behaviours, the RCAC accepted and authorised a regime of scaled responses leading to restrictive practices for control of challenging bodies in aged care. Although dementia care and restrictive practices received substantial attention in the RCAC, this paper reveals a missed opportunity for deeper review of institutionalised use of restraints that has relevance for ongoing reform of Australian aged care following conclusion of the RCAC.

Identifying adoption and usability factors of locator devices for persons living with dementia

A growing number of Canadians live with dementia. Strategies to reduce the risks of getting lost include physical barriers, restraints and medications. However, these strategies can restrict one’s participation in meaningful activities and reduce quality of life. Locator devices can be used to manage safety risks while also supporting engagement and independence among persons living with dementia. As more locator devices become available on the market, adoption rates would be affected by certain factors. There is no clear, standardized approach to identify the factors that have an influence on the acceptance and usability of locator devices for persons with dementia and their care partners. This project aimed to identify factors related to acceptance and usability of locator devices that are important to individuals with dementia, their care partners, service providers and technology developers. Qualitative description and conventional content analysis guided our approach. We conducted 5 focus groups with 21 participants. Trustworthiness strategies included multiple data sources, data verification for accuracy and peer debrief. Five overarching factors emerged as critical aspects in the acceptance and usability of locator devices. These factors were inclusivity, simplicity, features, physical properties and ethics. Participants thought that locator devices do not adequately consider privacy and stigma. Therefore, the acceptance and usability of locator devices could be enhanced if privacy and stigma are addressed. The factors identified will inform the creation of an acceptance and usability scale for locator devices used by persons living with dementia, their care partners and service providers.

"I have no reason not to be happy": The social and bodily conditions of positive aging for Latin-American men in Mexico

CONTEXT

Latin-American countries are faced with the challenge of trying to adapt to an aging population, which is exacerbated by the unequal access to income through social security. Previous research from Mexico has focused on the negative consequences of aging in contexts of social adversity.

OBJECTIVES

To explore, describe, and characterize the lived experience of old age in Mexican retired men who, despite having diverse medical conditions and meager funds in retirement, led independent and fairly fulfilling lives.

METHODS

An in-depth idiographic analysis was conducted following the experiential methodology of Interpretive Phenomenological Analysis (IPA). Ten participants (aged 65-81) were interviewed.

RESULTS

Two superordinate themes emerged as the subjective conditions for a positive experience in old age: (1) the conservation of social agency, and (2) the preservation of a strong bodily identity. Participants from different occupations prior to retirement depicted contrasting narratives.

CONCLUSIONS

Perceived financial security, despite modest means, was the underlying condition upon which subjective experiences of old age was based. The results show that in countries like Mexico, there is a possibility to reimagine old age as a fulfilling stage in life.

Life-space mobility in dementia patients and family caregivers: A dyadic approach

BACKGROUND AND OBJECTIVE

Given that most dementia care is provided at home by family caregivers, caregivers' health and outdoor activities may influence persons with dementia (PWDs)' mobility. At the same time, PWDs' functional deterioration and mobility changes might affect mobility behaviours in their caregivers. The aims of this pilot study were to examine the relationship of PWD's life-space mobility (LSM) with their caregiver's LSM and to investigate the role of caregiver and PWD characteristics in determining the level of LSM in both PWDs and caregivers.

DESIGN AND METHOD

A cross-sectional survey was conducted with 26 caregivers providing dementia care at home. Caregivers were used as proxy for assessing sociodemographic, clinical and physical function in PWDs. Caregivers' sociodemographic characteristics, LSM, social support, depressive symptoms, caregiving burden and preparedness for caregiving were measured.

RESULTS

The level of LSM in caregivers was correlated with the PWD's LSM level. Caregivers who perceived high levels of social support and readiness for caregiving tended to report high levels of LSM. PWDs' age and independence in instrumental activities of daily living were correlated with caregivers' LSM.

CONCLUSIONS

The study findings suggest that the caregiver's LSM influenced and was affected by the PWD's LSM. This underscores the need for additional research that examines the role of caregivers' psychosocial and physical health on PWDs' mobility and the context of dementia care and its influences on how dementia care dyads decide and participate in mobility behaviours.

IMPLICATIONS FOR PRACTICE

The findings of this pilot study will be helpful in identifying a target for interventions designed to delay the onset of mobility disability and maintain and improve social participation in PWDs. To minimise the effects of mobility limitations in PWDs, it is critical to examine their mobility issues from multilevel perspectives, including their caregiver's LSM levels and characteristics that have implications for both research and clinical practice.

Development and validation of a conceptual model and strategy adoption guidelines for persons with dementia at risk of getting lost

Various solutions are available to address critical wandering; however, no guideline exists to allow for the successful adoption of these strategies. This study developed and validated a conceptual model and series of guidelines to facilitate choice of wander-management strategies. Face and content validity of the model and guidelines were assessed through an online and paper survey, individual interviews and focus groups across stakeholders. Directed content analysis was performed. Overall impression of the conceptual model and guidelines was positive. Valued features included the guidelines' ability to help users in choosing proactive wander-management strategies. Suggested changes included revisions in terminology and more factors and strategies to be added to the model and guidelines. This work is being disseminated and used by persons with dementia, caregivers, health practitioners and community service providers to identify strategies to mitigate the risks associated with critical wandering.

What do we require from surveillance technology? A review of the needs of people with dementia and informal caregivers

Introduction

Dementia has become a major global concern and surveillance technology might provide support for informal caregivers and people with dementia. However, the needs of caregivers and people with dementia for surveillance technology have not been reviewed.

Method

A scoping literature review was used to identify the needs of caregivers and/or people with dementia towards surveillance technology. Electronic database searching was undertaken on LexisNexis, PubMed, Scopus, EMBASE, MEDLINE, Cumulative Index to Nursing, Allied Health Literature, PsycINFO, Web of Science, Assistive Technology database, and Google Scholar. Eligible studies were synthesized by theme.

Results

Twenty-eight eligible studies were identified, with the majority reporting the needs of caregivers rather than people with dementia. The predominant themes for caregivers were location accuracy, and increasing the safety of the person with dementia. People with dementia wanted simple useful technology that fits within their capacity and existing routines.

Conclusions

The needs of people with dementia must be considered when designing surveillance products. Studies have mostly focused on caregivers and discount ST product requirements. Further work is required to establish effective use of surveillance technology in dementia care. Therefore, further research should cross analyze these results by examining both the needs of caregivers, and people with dementia.

An exploration of the experiences of informal carers supporting a relative living with dementia during and after the move to technology-enriched supported accommodation

The aim of this study was to explore the experiences of family carers supporting a relative living with dementia during and after the move to technology-enriched supported accommodation (TESA). The paper explores the informal carers (ICs) roles, the factors prompting the move to TESA, alongside their perceptions of their relatives’ experience of the move and of life in a technology-enriched environment. Within a qualitative study 25 semi-structured interviews were conducted with ICs and data were analysed following a thematic approach. Four themes were identified, reflecting the shift in roles and identity of both ICs and persons living with dementia. The move to TESA was linked to a perceived reduction in care-giving pressures, with positive outcomes reported for both the ICs and the people living with dementia. Smart home technologies in the facilities did not appear to impact on the decision-making during transition, however, they were valued as part of the lived experience for the people living with dementia within the TESA facilities. These findings are relevant to policy makers, commissioners and providers of services to highlight the engagement of all stakeholders in the provision of care for people living with dementia and their families early from diagnosis in order to facilitate person-centred practices in community settings.

Wandering as a Sociomaterial Practice: Extending the Theorization of GPS Tracking in Cognitive Impairment

Electronic tracking through global positioning systems (GPSs) is used to monitor people with cognitive impairment who "wander" outside the home. This ethnographic study explored how GPS-monitored wandering was experienced by individuals, lay carers, and professional staff. Seven in-depth case studies revealed that wandering was often an enjoyable and worthwhile activity and helped deal with uncertainty and threats to identity. In what were typically very complex care contexts, GPS devices were useful to the extent that they aligned with a wider sociomaterial care network that included lay carers, call centers, and health and social care professionals. In this context, "safe" wandering was a collaborative accomplishment that depended on the technology's materiality, affordances, and aesthetic properties; a distributed knowledge of the individual and the places they wandered through, and a collective and dynamic interpretation of risk. Implications for design and delivery of GPS devices and services for cognitive impairment are discussed.

‘Overjoyed that I can go outside’: Using walking interviews to learn about the lived experience and meaning of neighbourhood for people living with dementia

This study explores the relationships between people living with dementia and their neighbourhood as they venture out from home on a regular and often routine basis. Here, we report findings from the Swedish field site of an international 5-year project: Neighbourhoods: our people, our places. The aims of this study were to investigate the lived experience of the neighbourhood for people with dementia and through this to better understand the meaning that neighbourhood held for the participants. In this study, we focus on the walking interviews which were conducted with 14 community-dwelling people with dementia (11 men and 3 women) and were analysed using an interpretative phenomenological method. Four themes were revealed from these interviews: life narratives embedded within neighbourhood; the support of selfhood and wellbeing through movement; the neighbourhood as an immediate social context; and restorative connections to nature. These themes were distilled into the ‘essence’ of what neighbourhood meant for the people we interviewed: A walkable area of subjective significance and social opportunity in which to move freely and feel rejuvenated. We have found that the neighbourhood for community-dwelling people with dementia holds a sense of attachment and offers the potential for freedom of movement. Our research indicates that a dementia diagnosis doesn’t necessarily reduce this freedom of movement. The implications for practice and policy are considered: future research should explore and pay closer attention to the diverse living conditions of people living with dementia, and not least the particular challenges faced by people living alone with dementia.

Personalisation, customisation and bricolage: how people with dementia and their families make assistive technology work for them

Assistive technologies (ATs) are being ‘mainstreamed’ within dementia care, where they are promoted as enabling people with dementia to age in place alongside delivering greater efficiencies in care. AT provision focuses upon standardised solutions, with little known about how ATs are used by people with dementia and their carers within everyday practice. This paper explores how people with dementia and carers use technologies in order to manage care. Findings are reported from qualitative semi-structured interviews with 13 people with dementia and 26 family carers. Readily available household technologies were used in conjunction with and instead of AT to address diverse needs, replicating AT functions when doing so. Successful technology use was characterised by ‘bricolage’ or the non-conventional use of tools or methods to address local needs. Carers drove AT use by engaging creatively with both assistive and everyday technologies, however, carers were not routinely supported in their creative engagements with technology by statutory health or social care services, making bricolage a potentially frustrating and wasteful process. Bricolage provides a useful framework to understand how technologies are used in the everyday practice of dementia care, and how technology use can be supported within care. Rather than implementing standardised AT solutions, AT services and AT design in future should focus on how technologies can support more personalised, adaptive forms of care.

Wandering in Dementia and Trust as an Anticipatory Action

The increase of dementia makes cognitive disorder a global challenge. Even if wandering is not a symptom of dementia in general, professionals and scientists dominate the definition of wandering as an aimless movement of people with cognitive impairment, mainly dementia. In consequence, professional types of wandering management were elaborated trying to avoid or replace it. However, this can cause negative effects. The article analyses an apparently common informal type of wandering management. It consists of slipping an address paper in the wallet of the ill person. The analysis reveals that this practice is normatively structured by a gift of trust.

Broadening the debate on creativity and dementia: A critical approach

In recent years there has been a growing interest in person-centred, ‘living well’ approaches to dementia, often taking the form of important efforts to engage people with dementia in a range of creative, arts-based interventions such as dance, drama, music, art and poetry. Such practices have been advanced as socially inclusive activities that help to affirm personhood and redress the biomedical focus on loss and deficit. However, in emphasizing more traditional forms of creativity associated with the arts, more mundane forms of creativity that emerge in everyday life have been overlooked, specifically with regard to how such creativity is used by people living with dementia and by their carers and family members as a way of negotiating changes in their everyday lives. In this paper, we propose a critical approach to understanding such forms of creativity in this context, comprised of six dimensions: everyday creativity; power relations; ways to operationalise creativity; sensory and affective experience; difference; and reciprocity. We point towards the potential of these dimensions to contribute to a reframing of debates around creativity and dementia.