Marissa Wilson Graduate Student | College of Design | School of Interiors | University of Kentucky interiors
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Research
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D e s i g n i n g to R e m e m b e r : The impact of environment and product design on Alzheimer’s and dementia patients
IDEC Fall 2016
research q u e st i o n
?
How can we design environments and products for those with Alzheimer’s to improve care and enhance quality of life?
alzheimer’s disease and dementia
-- Neurocognitive chronic and progressive disorder of the brain (Breslow, 2012). -- Disrupts a person’s memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement (Breslow, 2012). -- Four types: Alzheimer’s disease, vascular dementia, dementia with Lewy bodies, and frontotemporal lobar degeneration (Alzheimer’s, 2015). -- Alzheimer’s disease is the most common form of dementia making up 60-80% of the cases (Breslow, 2012).
60%-80%
Alzheimer’s disease vascular dementia Lewy body dementia frontotemporal lobar degeneration
alzheimer’s disease and dementia
Alzheimer’s
disease
is
the
6th
leading
cause
of
death
in
america
year 2030: 65.7 million 2050: 115.4 million Data from 2015 states over 46 million people live with Alzheimer’s disease or some form of dementia worldwide.
Data from 2016 reveals that 5.4 million Americans are living with Alzheimer’s disease.
The amount of people with Alzheimer’s is expected to double every 20 years.
3.2 million women make up the 5.1 million people age 65 and older who have Alzheimer’s.
Those who are between 75-84 years old make up 43% of those with Alzheimer’s.
(Alzheimer’s, 2015) (Breslow, 2012).
the problem
-- There are no current treatments, preventions, or cures for dementia that are successful. -- Biomedical researchers have also been able to increase longevity of life for the aging population. -- Because of the increase in the years of life, neurocognitive disorders, such as Alzheimer’s, and other disabilities have increased, and the large baby boomer population is a major contributing factor as well. -- A person’s cognitive functions are impaired, which often leads to deterioration of control, behavior, and motivation.
(Alzheimer’s, 2015)
behavioral responses
-- Personalities and behavior change.
disruptive behaviors: verbal & physical actions
-- Many display disruptive behaviors when their stress threshold is surpassed.
wandering self-abuse resisting care
-- Disruptive behavior is caused by the executive control functions in the frontal lobe of the brain.
-- A person has to rely on environmental cues or differences for help.
hoarding throwing objects general agitations aggression
(Morgan & Stewart, 1997).
E n v i r o n m e n ta l D o c i l i t y H y p o t h e s i s
-- The Environmental Docility Hypothesis - formed by researcher M. Powell Lawton - states that people who have health or cognitive impairments cannot always change the environment to meet their specific needs, but rather they are dependent on external environmental cues for help (Aging, Health, and the Environment: An Ecological Model, 2005). -- Behaviors are built up and learned over time through stimuli in the environment.
Environment
Behavior
(Marquardt, 2011; Morgan & Stewart, 1997).
conceptual framework
Ecological models from The U.S. Department of Health and Human Services and from researcher’s M. Powell Lawton and Lucille Nahemow’s Environmental Press-Competence Model.
Aging, Health, and the Environment: An Ecological Model. (2005). Retrieved May, 2016, from http://www.jblearning.com/samples/0763726559/SampleChapter02.pdf
conceptual framework disruptive behaviors Stimulation
Actions
Experiences
Quality of Life
social environment
The social environment includes living arrangements, marital status, and social networks. Many studies have indicated that those with stronger social connections have greater health, functioning, and live longer than those who are socially isolated. * People Alz Participants Volunteers Care Staff
g
Person en c Ag
y
Well -be in
Accessibility Care Garden Nature Outdoors
physical environment
Au to
Identit y
* Care Facility Design Function Comfort Efficiency
ry e Sto Lif
biology
Family Communication Language Signage
Adult care center
Behavior The physical environment includes exposure to environmental pollutants and toxins as well as elements of the built environment, such as housing, transportation, and land use.
my no
Adult care center
How one acts in response to the environment.
Aging Factors: a decline or change in functioning abilities
Biological
Physical
Cognitive
Sensory
Motor
Genetic Diseases
Alzheimer’s DISEASE
Adaptation Belonging person-environment Life Changes
Well-being Quality of life
research methodologies
Observations Questionnaires Focus Group Interviews
-- Participants = people with Alzheimer’s and dementia who attend day care center. -- All research was IRB approved and was conducted over an 8 week time span from June 10th - July 29th 2016
research Location Site location: Best Friends Adult Day Center at Bridgepointe at Ashgrove Woods, 5220 Grey Oak Lane Nicholasville, KY 40356
study population Average Number of Participants
Average Number of Volunteers
11
5
*limitations: -- Data was only collected at one adult day care center in Nicholasville, Kentucky -- Research was only collected on Friday’s during the summer over an 8 week time period. -- On Friday’s the volunteer to participant ratio is low - they usually try to assign one volunteer per participant.
Average Number of Staff
3
study demographics
QUESTION: Do you have/ had a family member that has Alzheimer’s disease or dementia? NOTE: 3 volunteers did not respond use.
NO 16
yes 23
study demographics
QUESTION: How long have you volunteered at Best Friends? use.
one month
32 years
study questionnaire 8.3
To what degree would you rate the impact of the physcial environment on the behaviors of humans?
How well do you think the physical layout (floorplan and rooms) at Best Friends meets the needs of the participants? How well do you think the physical layout (floorplan and rooms) at Best Friends meets the needs of the care staff and volunteers? How well do you think the physcial layout functions at Best Friends? (e.g. how well each room/area operates and functions in relation to one another?) How comfortable is the physical environment at Best Friends? (e.g. furniture, windows, nature, fabric, lighting, etc.) How efficient is the physical environment at Best Friends? (e.g. is the environment organized, does it make sense, does it flow well with daily activities and needs? How accessible is the physical environment at Best Friends? (e.g. ease of access - for all participants and staff - with wheelchairs, walkers, in bathrooms, etc.) How would you rate the overall design of the environment at the Best Friends facility? (e.g. aesthetics, floorplan, different rooms, colors, furniture, garden, etc.)
7.1
7.4
Questions asked about the function, comfort, efficiency, accessibility, and overall design of the physical environment at Best Friends.
6.9
7.4
7.2
7.4
7.1
OVERALL AVERAGE: 7.2
study questionnaire & interviews
COMMON THEMES: 1 - Garden
6 - Kitchen
2 - lighting
7 - Exit/entrance
3 - Bathrooms
8 - Institutional feel
4 - Acoustics
9 - More areas for activities
5 - Need a sense of a community
10 - Table/chair arrangement
o b s e r vat i o n t e m p l at e Observations Template Behavioral Observations of Alzheimer’s participants at Best Friends happy/content affectionate calm/relaxed aloof
confused wandering repetitive disruptive
aggressive irritable sad tired
anxious mad/frustrated rude/mean quiet/loud other
Date:__________________________ # of Care staff/volunteers:__________ # of Participants:_________________ Assistive Devices: ________________ _______________________________
Time:___________________________________________
Time:___________________________________________
Room: _________________________________________
Room: _________________________________________
Activity: ________________________________________
Activity: ________________________________________
Engaged:______________Not Engaged:______________
Engaged:______________Not Engaged:______________
Behaviors: ______________________________________
Behaviors: ______________________________________
_______________________________________________
_______________________________________________
______________________________________________
______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Notes: _________________________________________
Notes: _________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
_______________________________________________
Time:___________________________________________
Time:___________________________________________
o b s e r vat i o n s : l o c at i o n
25
14
Back Room
Outside
55
Front Room
o b s e r vat i o n s : a r e a
9
25
15
Table & Circle of Chairs Table & Chairs Garden
36
Bridgepointe Entrance/Benches
use.
pa r t i c i pa n t b e h av i o r s
ACTIVITIES
pa rt i c i pa n t e n g ag e m e n t all engaged
most engaged
least engaged
• getting ready to eat lunch; eating lunch; or finishing lunch [back room]
• outdoor walk to Bridgepointe entrance/ benches, enjoying weather • outside to look at an old car for “car week” [outside]
• playing road trip game • playing ice cream ABC game
• snack time; ice cream, popcorn, fruit, etc. [back room] • moving outside to relax, talk, and enjoy weather [garden]
• circle chat time • dancing, singing, listening to music • storyteller • snack time; ice cream, smores • eating lunch • talking about birthdays and news • playing birthday game • talking about ice cream; ice cream social • playing with the parachute [back room] •talking and hanging out • hanging out • waiting for family member to pick up [front room]
• listening to piano and music, singing [back room ] • walked outside to Bridgepointe [outside] • hanging out [outside and back room]
dementia villages
design Proposal
questions + feedback
thank you!
references
Aging, Health, and the Environment: An Ecological Model. (2005). Retrieved May, 2016, from http://www.jblearning.com/samples/0763726559/SampleChapter02.pdf Alzheimer’s, A. (2015). 2015 Alzheimer’s disease facts and figures. Alzheimer’s & dementia: The Journal of the Alzheimer’s Association, 11(3), 332. Breslow, L. (Ed.). (2012). Encyclopedia of Public Health: SZ (Vol. 4). MacMillan Reference Library, 1-112. Marquardt, G. (2011). Wayfinding for people with dementia: A review of the role of architectural design. Health Environments Research & Design Journal, 4(2), 75-90. Morgan, D., & Stewart, N. (1997). The importance of the social environment in dementia care. Western Journal of Nursing Research, 19(6), 740-761. Images taken by Marissa at Best Friends Adult Daycare Center