Walking in the neighbourhood: Performing social citizenship in dementia

Technology-based group exercise interventions for people living with dementia or mild cognitive impairment: A scoping review

Older people living with dementia or mild cognitive impairment (MCI) are more vulnerable to experiencing social isolation and loneliness due to their cognitive and physical impairments. Increasingly integrating technology into group exercises contributed to the improved resilience and well-being of older adults living with dementia and MCI. The purpose of this scoping review was to identify the various types, feasibility, outcome measures, and impacts of technology-based group exercise interventions for people with dementia or MCI. We utilized the Joanna Briggs Institute approach, a three-step process. A comprehensive literature search on five databases-CINAHL, MEDLINE, Embase, Web of Science, and PsycInfo-until January 2024 yielded 1,585 publications; the final review included 14 publications that recruited a total of 379 participants, with mean age of 69 (SD = 4.21) years to 87.07 (SD = 3.92) years. Analysis of data showed three types of technology-based group exercise interventions for people with dementia or MCI: (a) exergames, (b) virtual cycling or kayak paddling, and (c) video-conferencing platforms. In addition, we identified three key impacts: (a) feasibility and accessibility; (b) physical, psychosocial, and cognitive benefits; and (c) adaptations necessary for persons with dementia or MCI. Our study suggests that technology-based group exercise interventions are feasible and acceptable to persons with dementia or MCI. Future studies should involve individuals with dementia and their caregivers in the design and implementation of technology-based group exercise programs.

Dementia-Inclusive Choices for Exercise Toolkit: Impact on the Knowledge, Perspectives, and Practices of Exercise Providers

Physical activity improves the well-being of persons living with dementia but few exercise programs include them. The Dementia-Inclusive Choices for Exercise (DICE) toolkit aims to improve exercise providers' understanding of dementia and ability to support persons living with dementia in physical activity. We evaluated the co-designed DICE toolkit with exercise providers using a mixed-methods approach comprising pre/post questionnaires and interviews and reflection diaries. Among 16 participants, self-efficacy for exercise delivery to persons living with dementia and both knowledge and attitudes toward dementia significantly improved. Thematic analysis suggested participants (a) had a deeper understanding of the variability of dementia, (b) were planning for equitable access for persons living with dementia, (c) planned to promote social connection through exercise, and (d) were optimistic for future engagement with persons living with dementia. The DICE toolkit may improve exercise providers' knowledge and confidence to plan proactively to support persons living with dementia in programs and services.

Dementia resources for eating, activity, and meaningful inclusion (DREAM) toolkit co-development: process, output, and lessons learned

Promoting wellbeing of persons with dementia and their families is a priority of research and practice. Engaging diverse partners, including persons with dementia and their families, to co-develop interventions promotes relevant and impactful solutions. We describe the process, output, and lessons learned from the dementia resources for eating, activity, and meaningful inclusion (DREAM) project, which co-developed tools/resources with persons with dementia, care partners, community service providers, health care professionals, and researchers with the aim of increasing supports for physical activity, healthy eating, and wellbeing of persons with dementia. Our process included: (1) Engaging and maintaining the DREAM Steering Team; (2) Setting and navigating ways of engagement; (3) Selecting the priority audience and content; (4) Drafting the toolkit; (5) Iterative co-development of tools and resources; (6) Usability testing; and (7) Implementation and evaluation. In virtual meetings, the DREAM Steering Team confirmed the toolkit audiences (primary: community service providers; secondary: persons with dementia and care partners) and identified and evolved content areas. An environmental scan identified few existing, high-quality resources aligned with content areas. The Steering Team, additional multi-perspective partners, and external contractors iteratively co-developed new tools/resources to meet gaps over a 4-month virtual process that included virtual meetings, email exchange of documents and feedback, and one-on-one calls by telephone or email. The final DREAM toolkit includes a website with seven learning modules (on the diversity of dementia, rights and inclusion of persons living with dementia, physical activity, healthy eating, dementia-inclusive practices), a learning manual, six videos, nine handouts, and four wallet cards ( www.dementiawellness.ca ). Our co-development participants rated the process highly in relation to the principles and enablers of authentic partnership even though all engagement was virtual. Through use of the co-developed DREAM toolkit, we anticipate community service providers will gain the knowledge and confidence needed to provide dementia-inclusive wellness programs and services that benefit persons with dementia and their families.

Conceptualizing access to community-based supports from the perspectives of people living with young onset dementia, family members and providers

People living with young onset dementia and their families have significant support needs, but experience difficulties accessing services. This study explored the process of accessing community-based services drawing on semi-structured interviews with people living with dementia, family members and providers in Winnipeg, Canada. Data analysis involved a combination of inductive coding and theoretical analysis using the candidacy framework as a conceptual lens. Forced to navigate services that do not recognize people with young onset dementia as a user group, participants experienced ongoing barriers that generated continuous work and stress for families. Access was constrained by information resources geared towards older adults and restrictive eligibility criteria that constructed people with young onset dementia as "not impaired enough" or "too impaired". At the organizational level, fragmentation and underrepresentation of young onset dementia diminished access. Our findings underscore the need for continuous, coordinated supports alongside broader representation of young onset dementia within research, policy, and practice. We conclude with a discussion of how the candidacy theory could be extended to account for the social and political status of user groups.

Media discourses on the socio-spatial rights of older people living with dementia and their carers

Introduction

Media discourses about people living with dementia and carers contribute to the ways in which public, social spaces are designed, planned, and used. Negative media discourses play an important role in the socio-spatial exclusion of people living with dementia and stigmatising and dehumanising language prevents the achievement of genuine, rights-based dementia-friendly environments. Because the media plays a powerful role in shaping public attitudes, there is a need to understand media constructions of people living with dementia and carers in relation to their socio-spatial rights, which is the aim of this paper.

Method

A Foucauldian-inspired discourse analysis (FDA) was conducted on the public news media texts of one regional Australian city, to identify discourses relating to the socio-spatial rights of people living with dementia and carers. Lefebvre’s (1996) ‘right to the city’ concept was used as a conceptual framework, to define socio-spatial rights.

Results

Analysis revealed discourses relating to the right to urban citizenship, the right to difference and socio-spatial justice. Representations of participatory democracy, important to urban citizenship, are absent, as are the voices of people living with dementia. Through advocacy from others and a lens of citizenship, socio-spatial rights for people living with dementia, and in one instance carers, are recognised, in the context of dementia-awareness and dementia-friendly initiatives. While a lens of personhood constructs people living with dementia as historical and relational beings, a citizenship lens adds a spatial dimension.

Conclusions

Advocacy and the lenses of personhood and citizenship are important in creating positive constructions of people living with dementia, however, their participation in decision-making processes would confer an active citizenship status, and the inclusion of their authentic voices in media discourse would contribute to raising awareness towards rights-based dementia-friendly communities.

Rethinking Spaces of Leisure: How People Living with Dementia Use the Opportunities Leisure Centres Provide to Promote their Identity and Place in the World

We report on research that found joining activities within community leisure and fitness centres (Centres) enabled people living with dementia to create meaning about everyday life and foster identity. Focusing on three Centres in England, the study was informed by the experiences and accounts of four people living with dementia, their life-partner (if applicable) and the sports professional most closely associated with the person as each participated within a range of leisure opportunities. The methodology was underpinned by phenomenological philosophy and utilised participative methods. Theoretically, the paper draws upon considerations of serious leisure that provide ways in which the participants’ experiences could be understood and wider implications considered. Conceptual themes we derived from the data analysis were place, citizenship, and belonging (where the Centre acting as a physical space was important); identity and interaction (where the focus was upon space making and embodiment); safe spaces and care (i.e., how wellbeing was sustained and how participation and meaningful engagement occurred within the space); and, the value of Centres as opportunity structures (where all of these themes coalesced). Amid current public health debates over resourcing and care, this research provides timely insights and continued needed debates on the relationship between adequate social, economic and political support/resourcing, and the ability of Centres to facilitate and sustain meaningful and safe spaces. Beyond, we suggest our findings offer learning that might extend to wider contexts; for example, through including Centres within social care and health initiatives, where emphasis will be upon participation as a citizen rather than as a patient.

Peer support for people living with rare or young onset dementia: An integrative review

Objectives

The aim of this integrative review was to identify and synthesize the literature on peer support interventions for people living with or caring for someone with a rare or young onset dementia.

Design

A literature search of articles was performed using the Nipissing University Primo search system, a central index that enables simultaneous searches across databases which included MEDLINE (PubMed), Web of Science, PsycINFO, CINAHL, Sociological Abstracts, Cochrane Library.

Results

The eleven papers that met the inclusion criteria spanned eighteen years and from five countries. Studies reported on peer support programs that were either hospital-based (n = 6) or community-based (n = 4), and were predominantly led by disciplines in the health sciences. Only one study did not involve delivering services. There was a range of methodological quality within the studies included in the review. Further analysis and synthesis led to the identification of three overarching peer support themes. These included: (1) peers as necessarily part of social support interventions; (2) a theoretical portmanteau; and (3) dementia spaces and relationality.

Conclusion

Consistent with a much larger body of work examining peer involvement in social interventions, this review reinforced the valuable contribution of peers. A full understanding of the mechanisms of change was not achieved. Notwithstanding, the issue of studies neglecting to sufficiently conceptualize and describe interventions is an important one – drawing attention to the need to continue to explore varied delivery, including co-produced models, and more effective evaluation strategies to inform the dementia care sector.

Conceptualizing citizenship in dementia: A scoping review of the literature

Citizenship has provided an important conceptual framework in dementia research and practice over the past fifteen years. To date, there has been no attempt to synthesize the multiple perspectives that have arisen in this literature. The purpose of this paper is to explore, reflect on, and contrast, the key concepts and trends in the citizenship discourse as it relates to people with dementia. Using a scoping review methodology, forty-nine articles were identified for review. Despite the use of different descriptors, thematic analysis revealed four core themes underpinning citizenship discourse: 1) the relationality of citizenship; 2) facilitated agency and autonomy; 3) attention to stigma, discrimination and exclusion; and 4) recognition of the possibilities of identity and growth. Overall, this scoping review found a major emphasis on expanding definitions of agency and autonomy to render citizenship unconditional and inclusive of the diverse life experiences of people living with dementia. Notably, there is recognition that a more intersectional lens for embedding the subjective experience within a broader socio-political context is needed. Whilst the adoption of a citizenship lens in dementia research and practice has had real-world implications for policy and research, its exploration and use continue to be led by academics, highlighting the importance that future research involve input form people with dementia.

Out-of-home participation among people living with dementia: A study in four countries

Social participation in out-of-home activities is important for people living with dementia, yet little is known about such participation. The aim of this study was to explore and compare out-of-home participation among people living with dementia in four countries by assessing different types of places of participation visited or no longer visited. A cross-sectional design was used to gather self-reported experiences concerning out-of-home participation among people with mild stage dementia living in Canada (n = 29), Sweden (n = 35), Switzerland (n = 35) and the UK (n = 64). Interviews were conducted using the Participation in ACTivities and places OUTside the Home for older adults (ACT-OUT) instrument. Participants still visited 16 (Median) places out of a possible total of 24, and they had abandoned 5 (Median) places. Neighbourhood was the place most participants still visited, whereas 50% of them had stopped going to a Sports facility, with no significant differences between country samples regarding how many participants had abandoned that place (Fisher’s exact test, p > 0.01). There were significant differences between country samples in the frequency of present participation and abandonment of the Hospital, Dentist’s office, Cemetery, Garden, and Forest (Fisher’s exact test, all p < 0.01). Although the participants still visited a variety of places, they had stopped going to places previously visited, which indicates reductions in participation, posing an inherent risk to well-being. The similarities and differences across samples from the four countries suggest that healthcare services and access to public transport may contribute to the complex interactional process of out-of-home participation for people living with dementia. The findings highlight the need for initiatives targeting specific types of places to support continued participation in society, especially places at a higher risk of abandonment such as places for recreation and physical activity.

How do community based dementia friendly initiatives work for people with dementia and their caregivers, and why? A rapid realist review

OBJECTIVES

To describe and explain the outcomes of community dementia friendly initiatives (DFIs) for people with dementia and their caregivers to inform the development and tailoring of DFIs.

METHODS

Literature searches on DFIs were performed through two systematic online database searches of PubMed, Embase, ASSIA, CINAHL and Google scholar. Papers were only included if they evaluated outcomes using empirical data from people with dementia or caregivers. Data collection and analysis were guided by the categorization in the DEM-FACT taxonomy and RAMESES guidelines for realist reviews.

RESULTS

Of 7154 records identified, 22 papers were included with qualitative, mixed method and quantitative study designs. The synthesis led to a description of programme theories addressing caring, stimulating and activating communities. Outcomes for people with dementia and caregivers included having contact with others, enjoyment and decrease of stress and, lastly, support. This synthesis also indicated how people with dementia participated in a specific role in DFIs, such as patient, team member or active citizen.

CONCLUSIONS

DFIs generate different outcomes for people with dementia and caregivers, depending on the kind of initiative and the specific role for people with dementia. These findings could be a catalyst for initiation and further development of DFIs in a dementia friendly community (DFC). This draws attention to the multiple aspects of DFCs and supports reflection on their essential principles.

"It's just so important that people's voices are heard": The dementia associate panel

Including the views and experiences of people living with dementia in research and wider decision making is vital. The impact for the subjective wellbeing of its members of an approach known as The Dementia Associate Panel (DAP) is explored. The panel, based on a social citizenship model, aimed to provide a platform to work with and hear the voices of people living with dementia in a region of England. A mixed method approach using semi-structured interviews, self-report questionnaires, and focus groups was adopted. There were 16 participants; six people living with dementia and ten care partners. Participant motivations to join the panel were based on a desire for individuals' voices and experiences to be heard. Following participation in the panel, participants reported experiencing belonging and purpose. Collective and personal contributions to the development of local health and care policies, education provision, research studies, and to raising general public awareness about dementia was beneficial to reported participant wellbeing. The DAP model has the potential to be developed and adapted when working with people living with dementia in different settings; at national or regional levels across the globe.

The Effects of Aerobic Exercise in Patients with Early-Onset Dementia: A Scoping Review

BACKGROUND

Early-onset dementia (EOD) defines all dementia related conditions with an onset before the age of 65 years. EOD places a large and distressing psychological, emotional and financial burden on the individuals themselves and their caregivers. For various reasons, diagnostic and treatment strategies for EOD are very challenging. There is a general agreement that not only the human body but also the mind benefits from physical activity and/or exercise. Especially aerobic exercise has shown to have favorable effects on cognitive functions in healthy older adults, as well as in patients with MCI and dementia. However, there are major differences in age, physical fitness level and clinical presentation between EOD and late-onset dementia. Therefore, one cannot just assume that the same type and intensity of exercise will lead to similar effects in the former population. By conducting this scoping review, the authors aimed to identify the evidence on the effectiveness of aerobic exercise on physical and mental health outcomes in individuals with EOD, display gaps in this context, and formulate related directions for future research.

SUMMARY

There are a number of reasons to assume that aerobic exercise might be extremely valuable within individuals with EOD. However, this scoping review led to the surprising and striking finding that not a single study so far has investigated the effects of physical exercise on cognition, physical performance and feelings of well-being and quality of life in EOD. Although nowadays the disease is increasingly recognized, coping and (non-pharmacological) treatment strategies for EOD are virtually non-existent. Key Messages: Exercise intervention studies in EOD are lacking. With this scoping review the authors hope to inspire researchers in the field for related directions for future research. The potential beneficial effects of aerobic exercise in individuals with EOD should be explored and assessed extensively. Secondarily, decent guidelines for non-pharmacological treatment and coping strategies should be developed, with the aim of supporting people with EOD and their caregivers.

A socially prescribed community service for people living with dementia and family carers and its long-term effects on well-being

Support services for people with dementia are variable depending on the area or town they live. People with dementia and family carers can often get very little support after a diagnosis. Services might not be suitable or they may not be aware of the service in the first place. The aim of this study was to evaluate a socially prescribed community service provided to people with dementia and family carers offering physical and mental activities. People with dementia and family carers were recruited from a community centre in the North West of England to complete in this study. Participants provided demographic information and completed the Short Warwick-Edinburgh Mental Well-Being Scale at baseline, and after 3 and 6 months. Postcode data were used to generate an Index of Multiple Deprivation score for information on participants' socioeconomic background. Data were analysed using paired samples t-tests to compare well-being scores between baseline and follow-up assessments. A total of 25 people with dementia (n = 14) and family carers (n = 11) participated in the service. Visits ranged from 1 to 36, with 22 and 15 participants completing the 3- and 6-month follow-up respectively. Some reasons for discontinuation were lack of transport and other commitments. Most participants lived in some of the most disadvantaged neighbourhoods. Compared to baseline, well-being was significantly higher at both follow-ups. This is one of the first studies reporting the benefits of a social prescribing service in dementia. Future implementation work needs to design an implementation plan so that the service can be implemented in other community centres across the country.

Dementia Friendly Care: Methods to Improve Stakeholder Engagement and Decision Making

Dementia friendly (DF) is a term that has been increasingly used in the international literature to describe approaches that include and involve people living with dementia within their communities and wider society. How to support the involvement of people living with dementia to achieve dementia friendly care or support outcomes is an area that has begun to receive attention. We begin by introducing the concept of dementia friendly, the policy context and what has already been evidenced via prior reviews and conceptual discussions. We conducted a systematic review following PRISMA guidelines, resulting in the inclusion of nineteen papers that reported on the methods and approaches used to involve people living with dementia in achieving dementia friendly or supportive care outcomes. Five primary themes were identified: the potential of group-based activities to facilitate inclusion and engagement; achieving engagement in decision making; the value of developing tools to help service providers to engage those living with dementia in care decisions; the role of awareness raising and education to support the inclusion of a range of stakeholders in achieving DF support and care outcomes; the need for cultural and contextual sensitivity when seeking to engage stakeholders to achieve positive care outcomes. We conclude by considering how both the underpinning ethos of social citizenship and social inclusion need to be in place alongside a range of approaches that are adapted to fit local contexts and needs to enable the involvement of people living with dementia in achieving dementia friendly care outcomes.

An Intentionally Designed Walking Program for Seniors Results in Enhanced Community Connection

Social connection is vital for older adults' physical and psychological well-being, yet nearly one third of them report feeling lonely. The purpose of this study was to evaluate the influence of a monthly walking program (walking once a month for 8 months) on older adults' community connection. Older adults (Mage = 78.06 ± 5.98 years) completed a focus group at the completion of the program (n = 15). Qualitative findings indicate that participation in the walking program led to enhanced social connection. Researchers developed six major themes: (1) frequent and engaging walking programs, (2) benefits of group activity, (3) enhanced social connections, (4) connection to the community, (5) knowledge about transit, and (6) personal well-being, and 10 subthemes. Implications from this study highlight the importance of designing a walking program with older adults' needs and desires in mind.

Stigma Reduction Interventions of Dementia: A Scoping Review

Despite its global importance and the recognition of dementia as an international public health priority, interventions to reduce stigma of dementia are a relatively new and emerging field. The purpose of this review was to synthesize the existing literature and identify key components of interventions to reduce stigma of dementia. We followed Arksey and O'Malley's scoping review process to examine peer-reviewed literature of interventions to reduce dementia-related stigma. A stigma-reduction framework was used for classifying the interventions: education (dispel myths with facts), contact (interact with people with dementia), mixed (education and contact), and protest (challenge negative attitudes). From the initial 732 references, 21 studies were identified for inclusion. We found a variety of education, contact, and mixed interventions ranging from culturally tailored films to intergenerational choirs. Findings from our review can inform the development of interventions to support policies, programs, and practices to reduce stigma and improve the quality of life for people with dementia.

Neighbourhoods and dementia: An updated realist review of the qualitative literature to inform contemporary practice and policy understanding

This realist review of the literature provided a contemporary understanding of neighbourhoods and dementia and described how people living with dementia and their neighbourhood interacted via ongoing place-making and remaking processes. Drawing on 44 articles, neighbourhoods were revealed to have fluid and dynamic qualities where people with dementia used their strength and resources to connect to significant people and places. The review also indicated that the person with dementia-neighbourhood relationship was underpinned by four themes: 'home', 'social interactions', 'activities' and 'transportation'. Further research is encouraged to use innovative, participatory methods to explore the neighbourhood-dementia nexus in depth whilst paying close attention to social inclusion and diversity.

Creating Dementia-Friendly Communities for Social Inclusion: A Scoping Review

Aims: This scoping review explores key strategies of creating inclusive dementia-friendly communities that support people with dementia and their informal caregiver. Background: Social exclusion is commonly reported by people with dementia. Dementia-friendly community has emerged as an idea with potential to contribute to cultivating social inclusion. Methods: This scoping review follows the Joanna Briggs Institute scoping review methodology and took place between April and September 2020. The review included a three-step search strategy: (1) identifying keywords from CINAHL and AgeLine; (2) conducting a second search using all identified keywords and index terms across selected databases (CINAHL, AgeLine, MEDLINE, PsycINFO, Web of Science, ProQuest, and Google); and (3) hand-searching the reference lists of all included articles and reports for additional studies. Results: Twenty-nine papers were included in the review. Content analysis identified strategies for creating dementia-friendly communities: (a) active involvement of people with dementia and caregivers (b) inclusive environmental design; (c) public education to reduce stigma and raise awareness; and (d) customized strategies informed by theory. Conclusion: This scoping review provides an overview of current evidence on strategies supporting dementia-friendly communities for social inclusion. Future efforts should apply implementation science theories to inform strategies for education, practice, policy and future research.

Enacting citizenship through participation in a technological society: a longitudinal three-year study among people with dementia in Sweden

The role of Everyday Technology (ET) use is presented as subsidiary or neutral in policy for age- and dementia-friendly communities; and yet, research suggests that older people, especially those with dementia, experience increased challenges using ET in their everyday lives. Through the lens of micro-citizenship, the study aims to deepen the knowledge about how use of ET outside the home, including portable ETs, relates to participation in places visited within public space among people with dementia over time. Using a longitudinal study design, 35 people with dementia were recruited at baseline and followed over three years. Data were collected through semi-structured interviews using standardised questionnaires: the Participation in ACTivities and Places OUTside Home Questionnaire (ACT-OUT) and the Everyday Technology Use Questionnaire (ETUQ). Random intercept modelling and descriptive statistics were used to analyse the data. Throughout the three-year study, decreasing use of ET outside the home, including portable ETs, was associated with decreasing participation in places visited within public space, in a statistically significant way when controlling for age (F = 7.59, p = 0.01). The findings indicate that facilitating access and use of ET outside the home, among people with dementia, should be integral to promoting and maintaining participation in age- and dementia-friendly communities.

A socially-engaged lifestyle moderates the association between gait velocity and cognitive impairment

Objective: Cognitive status has been linked to impaired gait velocity, and diminished social and physical engagement. To date, the potential moderating influence of lifestyle engagement on gait-cognitive status associations has not been systematically explored. The present investigation examines whether a socially- or physically-engaged lifestyle moderates the association between diminished gait velocity and likelihood of amnestic mild cognitive impairment (a-MCI) classification.Methods: Participants (aged 65+, M_age=73 years) were classified as either healthy controls (n = 30) or a-MCI (n = 24), using neuropsychological test scores and clinical judgement. Gait velocity was indexed using a GAITRite computerized walkway, engaged lifestyle (social and physical subdomains) were measured using a well-validated self-report measure, the revised Activity Lifestyle Questionnaire.Results: Logistic regression, evaluating likelihood of a-MCI classification, yielded a significant interaction between a socially-engaged lifestyle and gait velocity (b=.01, SE=.003, p=.015). Follow-up simple effects were derived for two levels (+/-1SD) of social engagement; for individuals 1 SD below the mean, the association between gait velocity and increased likelihood of a-MCI classification was exacerbated (probability of a-MCI classification for those with slower gait velocity was 60% higher for individuals 1 SD below vs 1 SD above the mean of social engagement). Physically-engaged lifestyle did not significantly moderate the gait-cognitive status association.Conclusions: The significant moderating influence of social engagement has several implications, including the likelihood that distinct mechanisms underlie the relationships of social engagement and gait velocity to cognitive function, the value of social variables for well-being, and the potential utility of socially-based interventions that may prevent/delay a-MCI onset.

A dyadic approach for a remote physical activity intervention in adults with Alzheimer's disease and their caregivers: Rationale and design for an 18-month randomized trial

Adults with Alzheimer's disease and related dementia (ADRD) and their caregivers represent a sizeable and underserved segment of the population with low levels of moderate physical activity (MPA). Options for increasing MPA in community dwelling adults with ADRD and their caregivers are limited. A home-based physical activity intervention delivered remotely via video conferencing to groups of adults with ADRD and their caregivers (RGV), represents a potentially effective approach for increasing MPA in this group. We will conduct an 18-month randomized trial (6 mos. Active intervention, 6 mos. Maintenance, 6 mos. no contact) to compare the effectiveness of the RGV approach with usual care, enhanced with caregiver support (EUC), for increasing MPA in 100 community dwelling adults with ADRD and their caregiver. The primary aim is to compare MPA (min/wk.), assessed by accelerometer, across the 6-mo. active intervention in adults with ADRD randomized to RGV or EUC. Secondarily, we will compare adults with ADRD and their caregivers randomized to RGV or ECU on the following outcomes across 18 mos.: MPA (min/wk.), sedentary time (min/wk.), percentage meeting 150 min/wk. MPA goal, functional fitness, activities of daily living, quality of life, residential transitions, cognitive function, and caregiver burden. Additionally, we will evaluate the influence of age, sex, BMI, attendance (exercise/support sessions), use of recorded sessions, self-monitoring, peer interactions during group sessions, caregiver support, type and quality of dyadic relationship, and number of caregivers on changes in MPA in adults with ADRD and their caregiver across 18 mos.

Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review

BACKGROUND & AIMS

Evidence suggests that targeted exercise is important for people living with dementia. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to walking group exercise of older people living with dementia in the community.

METHODS

We have searched appropriate electronic databases between January 1990 until September 2019, in any language. Additionally, we searched trial registries (clinicaltrial.gov and WHO ICTRP) for ongoing studies. We included all study designs. Studies were excluded when participants were either healthy older people or people suffering from dementia but living in residential care. Narrative synthesis was used.

FINDINGS

10 papers met the inclusion criteria. The narrative analysis focused on barriers, facilitators, and adherence. All studies reported on barriers and facilitators. Barriers included: bio-medical reasons (including mental wellbeing and physical ability); relationship dynamics; and socio-economic reasons and environmental issues. Facilitators included: bio-medical benefits & benefits related to physical ability; staff, group relationship dynamics and social aspect of walking group; environmental issues and individual tailoring; and participants perceptions about the walks & the program. Most studies did not provide data about adherence or attendance; where reported, adherence ranged from 47 to 89%.

CONCLUSIONS

This systematic review of literature has highlighted known barriers and facilitators to adherence to walking groups type of exercise for people living with dementia in community. Carers' willingness to engage, their circumstances, perspectives and previous experiences of exercise seem to play a key role in facilitating adherence but there is little research that explores these. Also, the design, location and organisation of walking groups facilitate adherence. This reflects the need for such activities to be part of a wider 'program of care', tailored to the needs of the individual, flexible and convenient. Knowledgeable and well-trained instructors or healthcare professionals are recommended as group exercise leaders.

Using the concept of activity space to understand the social health of older adults living with memory problems and dementia at home

Globally as the population ages, the prevalence of dementia will increase. Simultaneously, there is a trend toward people ageing at home. Therefore, more people will be ageing at home with dementia, as opposed to institutional environments. In this context, there has been a recent shift in research exploring ways that people can live well with the consequences of the disease. As a part of this emerging research, the social and spatial aspects of the lives of people living with memory problems are becoming increasingly of interest. The aim of this article is to use the concept of activity space to examine the social health of older adults with memory problems and dementia who live at home. Activity space data were collected from seven older adults experiencing memory problems and living at home in the Netherlands. Using a mixed-methods approach, insight into their activity spaces were gained through walking interviews, 14 days of global positioning system (GPS) movement data, travel diary entries and in-depth interviews. The GPS data, travel diary data and interview transcripts were analyzed using a grounded visualization approach. Our findings show that participants interact independently in routine activity spaces but depend on others to participate in occasional activity spaces. Interactions within both these spaces contribute to the social health of older adults with memory problems and dementia who live at home. Additionally, participants used coping strategies and decision-making to maintain autonomy in daily life. The findings can inform dementia-friendly initiatives and social health care planning.

Practicing in a person-centred environment - self-help groups in psycho-social rehabilitation

AIM

The increasing prevalence of chronic conditions and impairments in the population is putting new demands on health and rehabilitation services. Research on self-help groups suggest that participation in these groups might have a positive impact on people who are struggling with chronic illnesses or disabilities. In this study, we explore person-centred support in which participants in self-help groups are undergoing rehabilitation to develop their knowledge, skills and confidence necessary to handle life's challenges.

METHOD

The design is exploratory, analysing data from informant interviews and focus groups (a total of 32 participants) using a Grounded Theory inspired approach to analyse. The participants were rehabilitation clients aged between 20 and 60 years; eight were men and twenty-six were women.

RESULTS

Three main categories emerged as being important self-help processes that were likely to promote positive rehabilitation outcomes: (1) Learning and practicing safely, (2) A refuge from expectations, (3) Internal processes that accentuate the positives.

CONCLUSION

Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote acceptance and adjustment, facilitate the establishment of new skills and enable transfer of learning to new environments, including the workplace.IMPLICATIONS FOR REHABILITATIONSelf-help groups may support the process of rehabilitation.Participating in self-help groups provides an enabling context for individuals to address challenges and limitations.Peer support delivered through the structured self-help environment can facilitate the development of new self-awareness, promote adjustment, and facilitate the establishment of new skills.Participating in peer led self-help groups can assist with the transfer of learning to new environments, including development of potential work capacity.

Dementia-Friendly Neighbourhoods in Canada: A Carer Perspective

Based on findings from a study examining the lived experiences of dementia carers in their neighbourhoods, this article offers a vision of what dementia-friendly communities could look like from a carer perspective and in a Canadian context. Twelve carers in Ottawa and its surrounding regions were interviewed using a combination of social network maps, mobile interviews, and participant-driven photography. The findings, organized according to the categories "relationships", "places", and "everyday practices", reveal that many of the carers' choices regarding businesses, services, home location, outings, and everyday practices, are based on a desire to maintain social connections and social citizenship. The article concludes with recommendations for consideration in the planning of dementia-friendly neighbourhood initiatives.

Creating dementia-friendly and inclusive communities for social inclusion: a scoping review protocol

INTRODUCTION

The number of people with dementia is increasing worldwide, with the majority of people with dementia living at home in the community. WHO calls for global action on the public health response to dementia. Social exclusion is commonly reported by people with dementia and their families. Dementia-friendly and inclusive community has emerged as an idea that holds potential to contribute to the mitigation of social exclusion. The objective of the scoping review is to answer two questions: What social inclusion strategies that have been reported in the dementia-friendly and inclusive communities' literature? What strategies for developing dementia-friendly and inclusive communities that have shown to improve social inclusion?

METHODS AND ANALYSIS

This scoping review will follow the Joanna Briggs Institute scoping review methodology and will take place between April and September 2020. The proposed review will consider studies based in community settings with participants living at home with early to late stages of dementia and their families. This includes a three-step search strategy: (1) to identify keywords from MEDLINE and CINAHL; (2) to conduct a second search using all identified keywords and index terms across selected databases (MEDLINE, CINAHL, AgeLine, PsycINFO, Web of Science, ProQuest and Google) and (3) to handsearch the reference lists of all included articles and reports for additional studies. Further, we will search Google for grey literature on published organisational reports. Two researchers will screen titles and abstracts independently and then assess the full text of selected citations against inclusion criteria. Extracted data will be presented in a narrative accompanied by tables that reflect the objective of the review.

ETHICS AND DISSEMINATION

As the methodology of this study consists of collecting data from publicly available articles, it does not require ethics approval. This scoping review provides an overview of current evidence on strategies that support dementia-friendly and inclusive communities for social inclusion. The findings will offer insights to inform strategies for education, practice, policy and future research. We will share the scoping review results through conference presentations and an open-access publication in a peer-reviewed journal.

Green spaces, dementia and a meaningful life in the community: A mixed studies review

Engagement in green spaces impacts positively on wellbeing and quality of life. However, little is known about the impacts of green space engagement specifically for people living with the experience of dementia in the community; people with a heightened need to maintain a quality life. In this mixed study review, we explore existing evidence for quality of life impacts of contact with green spaces by people living with dementia in the community. Findings show that gardens and horticultural programs, green care farms, parks, urban woodlands and neighbourhood outdoor environments can impact positively in several ways. Four key mechanisms are identified: Engaging in meaningful activities; Empowerment; Positive risk taking; and Reinforcing Identity. These findings provide conceptual links between psychosocial understandings of the relationships between nature and wellbeing with rights-based dementia discourses. We conclude that evidence specific for people living with dementia in the community setting is growing and there is potential for green spaces to enable an active and meaningful community-life, despite cognitive decline. This is worthy of consideration by policy makers, practitioners and carers. Future studies can broaden this field of research and include investigations into lesser-explored aspects of quality of life, such as spirituality, and methods that incorporate the voices of people living with dementia.

Community participation in activities and places among older adults with and without dementia

Availability of community-based destinations and amenities can facilitate healthy aging by supporting older adults' functional abilities and enabling their participation in society, especially for those experiencing declining cognitive abilities. This study used a survey tool called participation in ACTivities and places OUTside the Home for older adults, specifically designed to examine the out-of-home participation of older adults living with or without dementia, to collect data on specific places and activities that individuals participate in over time. Thirty cognitively intact participants and 29 participants living with dementia were recruited. The past/present net participation figures indicate that all destinations are likely to be abandoned by persons with dementia over time. The findings indicate that both groups of participants were most likely to abandon recreation and physical activity places, although a higher number of persons with dementia reported that they would likely abandon these places in the future than the cognitively intact participants. Participants with dementia indicated multiple en route and at destination challenges, as well as their coping strategies. This study adds to our understanding of the out-of-home places visited by persons living with and without dementia and the patterns of changes in those visits over time. The findings are useful for health and social care professionals, including occupational therapists, social workers, as well as family caregivers, in recognizing the relative importance of certain out-of-home places and activities over others and the challenges faced by persons with dementia in getting to those places. This knowledge can inform programme and service providers to develop targeted interventions to support continued engagement by older adults with dementia and cognitively intact older adults.

The saliency of geographical landmarks for community navigation: A photovoice study with persons living with dementia

This study uses the photovoice method to explore how persons living with mild-to-moderate dementia perceive neighborhood landmarks and identify characteristics that render these landmarks salient for outdoor navigation. Previous research has highlighted the role of well-designed, stable geographical landmarks in improving the navigability of neighborhoods for persons living with dementia. However, the specific attributes that render landmarks salient have not yet been sufficiently explored, resulting in inadequate evidence-based environmental design guidelines for dementia-friendly communities. To address this gap, a photovoice study was conducted with five community-dwelling persons living with dementia and their care partners, as part of a dementia-friendly neighborhood walking program in the city of Seattle, USA. Photovoice facilitated the exploration of saliency of neighborhood landmarks from an emic perspective by (i) empowering persons living with dementia to identify and take photos of salient landmarks during the group walk and (ii) interpret and reflect on attributes that contributed to saliency using the photos as visual aids in a focus group discussion and survey questionnaire. Participants associated the saliency of landmarks with two groups of attributes: (i) visual distinctiveness, which encompassed physical aspects, such as size, shape, color, texture; and (ii) meaningfulness, which included subjective factors of personal and emotional significance that linked the landmarks to participants' pasts, passions, hobbies, and emotions related to having dementia. Findings suggest that outdoor landmarks should be designed for maximum legibility and noticeability, as well as familiarity, recognizability, and memorability. The evidence from this research also points to the likely positive effect of salient neighborhood landmarks on the community navigation of persons living with dementia.

‘… This is my home and my neighbourhood with my very good and not so good memories’: The story of autobiographical place-making and a recent life with dementia

As part of the wider Neighbourhoods and Dementia Study, co-researchers from the Open Doors Research Group (based in Salford, UK) produced a series of three films with the title ‘The Changing Face of our Neighbourhood’. These films were subsequently placed on ‘YouTube’ and document co-researchers’ storied experiences of Salford and the industrial, economic and social changes that have occurred over the inquiry group’s lifetime. Drawn directly from this autobiographical and socio-generational work, this article focuses on the experience of lead author Lesley Calvert, who was diagnosed with dementia in 2013 and has been a member of the Open Doors Research Group since 2014. Lesley grew up and worked as a district nurse for almost 40 years, remaining close to her place of birth in Salford all her life. In this article, Lesley draws upon her autobiographical narrative which she shares in the three films to describe the intersections between biography, place-making, belonging and dementia. The article concludes with the importance of democratising the research space and why academic researchers need to create opportunities for personal stories to be told, heard and acted upon.

Experiences of rural life among community-dwelling older men with dementia and their implications for social inclusion

Current international dementia care policies focus on creating 'dementia-friendly' communities that aim to support the social inclusion of people with dementia. Although it is known that the geo-socio-cultural rural environment can impact on the experiences of people living with dementia, this can be overlooked when exploring and implementing social inclusion policies. This paper addresses an important gap in the literature by exploring the perceptions of daily life for older men (65+ years) living with dementia in three rural areas of England. Open interviews were conducted with 17 rural-dwelling older men with dementia and the data elicited were analysed thematically to construct two higher order themes. The first focussed on 'Cracking on with life in a rural idyll' and highlighted the benefits of rural living including the pleasant, natural environment, supportive informal networks and some accessible formal dementia support. The second presented 'A challenge to the idyll' and outlined difficulties the men faced including a lack of dementia awareness amongst their family and the wider rural community as well as the physical and internal motivational barriers associated with the rural landscape and their dementia. The findings were interpreted through a lens of social inclusion and demonstrated how the geo-socio-cultural rural environment both enabled and inhibited facets of the men's experiences of life in their communities. Based on these findings, the paper offers recommendations for practitioners, researchers and policy makers wishing to promote social inclusion in rural-dwelling older men living with dementia.

‘It's our pleasure, we count cars here’: an exploration of the ‘neighbourhood-based connections’ for people living alone with dementia

The extent of social isolation experienced by people living with dementia who reside in the community has been well acknowledged, yet little is known about how people living alone with dementia maintain neighbourhood-based connections. The purpose of this study is to examine the experiences of people with dementia who live alone, focusing upon how they establish social networks and relationships in a neighbourhood context, and how they are supported to maintain this social context within everyday life. Multiple data collection methods were used including, semi-structured interviews, walking interviews, guided home tours and social network mapping, which were conducted with 14 community-dwelling people living alone with dementia (11 women and three men) situated across the three international study sites in England, Scotland and Sweden. Data were analysed using thematic analysis. The analysis revealed four main themes: (a) making the effort to stay connected; (b) befriending by organisations and facilitated friendships; (c) the quiet neighbourhood atmosphere; and (d) changing social connections. The analysis suggests that people with dementia who live alone were active agents who took control to find and maintain relationships and social networks in the neighbourhood. Our findings indicate the need to raise awareness about this specific group in both policy and practice, and to find creative ways to help people connect through everyday activities and by spontaneous encounters in the neighbourhood.

Exploring the ‘active mechanisms’ for engaging rural-dwelling older men with dementia in a community technological initiative

Research has suggested ecopsychosocial initiatives can promote a sense of wellbeing and inclusion in people with dementia. However, few studies have elucidated the ‘active mechanisms’ whereby such initiatives can achieve these outcomes, so hindering their generalisability. This is particularly pertinent when seeking to support community-dwelling older men with dementia who are reluctant to engage with traditional health and social care initiatives. This paper reports on a study that drew from the principles of Participatory Action Research to explore the ‘active mechanisms’ of a technological initiative for older men (65+ years) with dementia in rural England. An individually tailored, male-only initiative, using off-the-shelf computer game technology (e.g. iPad, Nintendo Wii and Microsoft Kinect) was delivered over a nine-week period. Multiple qualitative methods were employed, including: focus groups, open interviews and extensive reflective field notes, to gather data from the perspective of 22 men, 15 care partners and five community volunteers. The data were analysed thematically and interpreted using a masculinity lens. Three mechanisms contributed to the initiative's success: the use of the technology, the male-only environment and the empowering approach adopted. The paper argues that initiatives aimed at community-dwelling older men with dementia would be advised to consider these gendered experiences and ensure participants can maximise their masculine capital when participating in them, by providing enabling activities, non-threatening environments and empowering approaches of delivery.

Muddling along in the city: Framing the cityscape of dementia

There is growing interest in the social geography of dementia, with the development of dementia-friendly communities, localities and cities in the developed world. This paper considers the claims being made for cities to be risky spaces for people with dementia. It debates this through an analysis based on Bacchi's 'representation of problems' framework, evidencing this with policy documents and research findings. This reveals that the city is often seen as problematic for people with dementia, despite evidence to the contrary, and that local politicians are making claims for cities to be responsive dementia communities. The nature of local political ambitions is illustrated by strategies from London and from Manchester in the UK.

‘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.

"The Filter is Kind of Broken": Family Caregivers' Attributions About Behavioral and Psychological Symptoms of Dementia

OBJECTIVES

Behavioral and psychological symptoms of dementia (BPSD) are common, often challenging to manage, and may erode caregivers' well-being. Few studies have explored caregivers' perspectives of what causes these behaviors, but such attributions may be important-particularly if they negatively impact the care dyad. This study examined causal attributions about BPSD among individuals caring for a family member with dementia.

DESIGN

In-depth qualitative data were obtained from family caregivers of older adults with dementia.

SETTING

As part of a larger study (NINR R01NR014200), four focus groups were conducted with caregivers by an experienced facilitator.

PARTICIPANTS

A total of 26 family caregivers participated in the four focus groups.

MEASUREMENTS

Caregivers reported their own attributions about the causes of their care recipient's BPSD. Sessions were audio-recorded. Data were transcribed, coded to determine relevant concepts, and reduced to identify major categories.

RESULTS

Five categories were determined. Caregivers attributed BPSD to: 1) neurobiological disease factors; 2) physical symptoms or comorbid health conditions; 3) psychological reactions to dementia; 4) shifting social roles and relationships following dementia onset; and 5) environmental changes such as lack of routine and medical transitions (e.g., hospitalization). Despite this seemingly multifactorial attribution to BPSD etiology, a number of respondents also indicated that BPSD were at least partly within the care recipient's control.

CONCLUSIONS

Family caregivers attribute BPSD to a range of care recipient and environmental factors. Caregivers' own causal beliefs about BPSD may reflect unmet educational needs that should be considered in the development of targeted interventions to minimize caregiving stress.

Building creative communities of care: Arts, dementia, and hope in the United States

This essay explores the history of the cultural community development model in the United States and its potential benefits for transforming the lived experience of dementia. Using her work with the 2011 Penelope Project as a case study, the author identifies core elements of a “Creative Community of Care:” open systems; all activities are accessible; the arts are immersed into the environment of care; projects build on existing assets and rituals; projects evolve over long periods of time; and projects have high cultural value/capital.

'We have different routes for different reasons': Exploring the purpose of walks for carers of people with dementia

This paper explores the purpose of walks for co-residing carers of people with dementia, using a social citizenship lens. The findings are based on the first phase of a study examining the everyday experiences of place, space, and neighbourhood of dementia carers. Using three forms of data collection - social network mapping, walking interviews, and participant-driven photography - the study brings forth information about why carers go on walks either alone or with the person with dementia. Carers explained that walks facilitate their connections with themselves, the person with dementia, their social environment, and their natural and built environment. In sum, walks provide a way of practicing and sustaining social citizenship. Carers' discourse about walks highlights their personal, everyday practices and strategies, as well as the larger tensions and contradictions of dementia care. The findings reinforce the need to bring into dialogue, from a carer perspective, a social citizenship model of dementia with the growing interest in dementia-friendly communities.