Design and Assessment Tool for an Enabling Environment for Dementia Care

According to the World Health Organisation (WHO), dementia is an umbrella term for a neurogenerative disease with irreversible and progressive symptoms, which include memory loss, mood changes, disorientation and issues with communication and reasoning. Globally, the total number of people with dementia have been increased from 41 million in 2015 to 131.5 million in 2050, where much of the increase is in developing countries, against the backdrop of deteriorating quality of care and high turnover rates among formal care staff. Dementia-friendly environment is designed to support their symptoms within a physical environment, which lead to a ‘specialised’ environment. An enabling environment enables the psychosocial barriers of environments and attitudes imposed by care stakeholders. Caring is the experience and feeling of a strong positive effect in defining identity in certain places and the communities, such as home, workplace, and neighbourhood. In this case, transnational dementia care produces a new perception of place and identity by introducing the emotional design of distance/place attachment in ageing. Thus, designing is not a static process but requires opening the world for people with dementia.

Case studies of transnational dementia care facilities in Thailand were selected. The primary aim of the research study is to develop design and assessment tools for an enabling environment for dementia care by negotiating attachment/sense of place for the overall quality of care. There are five main research objectives. The first is to explore designers’ perceptions of an enabling environment for dementia care. The second objective is to investigate how care stakeholders use spaces and meet the observed needs of the enabling environment for dementia care. The third objective is to observe how people with dementia and care stakeholders use spaces and meet the observed needs of the enabling environment for dementia care. The fourth objective is to develop a design framework demonstrating how the designed environment and user needs are met to enhance their capabilities. The last objective is validating and contextualising the users' cultural value needs and providing sustainable health promotion settings.

The main findings include five overarching domains – creative functionality (including three themes: concept, learning environment, flexibility), organisational security (including five themes: emotional health, levels of care, person-centred care, comfort, and surveillance), embodied selfhood (including two themes: personal spaces, and social inclusion), self-esteem (including four themes: dignity, recognition, respect, and national character) and self-actualisation (including two themes: roles and the self). – which indicate how the design of an enabling environment can support the quality of dementia care. The findings expand how the needs of people with dementia are related to the care professionals, and how the capability management from care managers or designers can support the needed environment. In addition, Ainsworth’s work on the quality of attachments has given rise to the suggestion that caregivers are the ‘architects’ of the quality of attachments, and that attachment, non-attachment or disordered attachment with the person cared for lies in the hands of caregivers. However, the context of Thailand has suggested the condition of an ambiguous society, where personal boundaries are shifting, disorienting, belonging to no place, or an unknown ‘home’. The sense of uncertainty and in-betweenness experienced by people are underlined. Therefore, this raises the question of the application of the culture of unbounded form and non-attachment. The design and assessment tools attempt to contribute to knowledge by conceptualising the important issues and aspects of an enabling environment for dementia care. The overriding objective of this research is to create new insights that provide original and effective ideas, which may have important social, cultural, economic, and political consequences. The research study attempts to contribute new knowledge to design and assessment tools for an enabling environment for dementia care by contextualising and testing the tools with potential user groups.