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Design for Living with Person with Dementia
Social Innovation Inventor Competition
for Innovative Design
CHAN Chui King, Liliane (Dr)
Ho Cheung Shuk Yuen Charitable Foundation
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Outline of Presentation
Basics of dementia
Living with dementia: design principles on environment and daily living activity
Examples of application
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The Basics of Dementia
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Paola Panizon: Look Inside Your Brain
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Paola Panizon: Look Inside Your Brain
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Paola Panizon: Look Inside Your Brain
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Paola Panizon: Look Inside Your Brain
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What is Dementia?
An umbrella term for different brain disorders
Impairment includes reduced ability to remember, understand, reason and communicate and affects functioning of daily activities
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Causes of Dementia
The commonest cause - Alzheimer's disease (AD)
2nd commonest cause - vascular dementia (VaD)
Other causes include dementia with Lewy Bodies, brain tumour, head injury, excessive drugs and alcohol use, as well as vitamin B12 deficiency, etc.
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Alzheimer’s Disease (AD)
A degenerative disorder of the brain
The most commonnest type of dementia, makes up about 2/3 of all cases
Development of neurofibrillary tangles and amyloid plaques
Transmission of chemical messages through the brain cells is deranged and eventually blocked. Gradually, brain cells shrivel and die.
Still confusion over what constitutes the common disease process of AD
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Vascular Dementia (VaD)
A group of syndromes that relate to different mechanisms in the blood supply to the brain
Those who have had a stroke are at a higher risk for this type of dementia
Accounts for about another 15%, and a mixed type (AD and VaD) constitutes another 10-15%
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Clinical Features
Disorders of cognitive function
- memory loss is the salient feature
- usually memory loss for recent events
- confabulation may be present
- impaired attention and concentration
- disorientation
- impaired judgment and general knowledge
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Clinical Features
Language problem
- word finding difficulties initially
- may talk nonsense or incoherent or become mute at late stage
Delusion and hallucination
- paranoid ideas
- delusion of theft
- other delusions and hallucinations
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Clinical Features
Behavioural changes - impaired activities of daily living (physical and
functional ADL & IADL) - inappropriate behaviour and restlessness - change in personality e.g. sexual
disinhibition, lacking interests
Mood change - anxiety, irritability, depressive mood
Sleep and appetite disturbance
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Staging
Mild
capacity for independent living remains although work or social activities significantly impaired
Moderate
independent living hazardous
some degree of supervision necessary
Severe
continual supervision required
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Prevalence of Dementia
1034 ≥ 70 elderly examined
6% for those aged ≥ 70
Estimated to be 4% for those aged ≥65
Increasing rate with ageing
aged 85 to 89 - 25.8%
AD > VaD
(Chiu et al, 1998)
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Prevalence of Dementia
Rate of dementia (AD) increase with age
Sex: Female had a high rate of dementia (7.1%)
compared with males (4.7%) (AD)
Educational : prevalence of dementia increased for
those with low educational level (AD)
45% of dementia subjects were living in institutions
(Chiu et al, 1998)
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Risk Factors
Age :
rare before the age of 65
about 10% over the age of 65
more than 20% over the age of 80
Head injury with loss of conscious in an accident
Family history of dementia
? Low education
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Signs & Symptoms
Decline in short-term memory
Forgetting recent happenings
Unusually repeating the same questions
Forgetting dates and times of appointments
Decline in the ability to handle matters and problem solving
Difficulty in handling personal and financial matters independently
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Signs & Symptoms
Not being able to handle familiar tasks
Showing difficulties in preparing dinner
Showing difficulties in identifying time and location
Forgetting the time
Losing one's way
Confusion with visual images and spaces
Showing difficulties in identifying distance, colour and lighting
Misidentifying one's own image in a mirror as another person
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Signs & Symptoms
Communication barriers
Difficulty in self-expression
Difficulties in finding appropriate words
Decline in judgmental ability
Crossing the road carelessly
Misplacing materials
Misplacing things and not being able to identify the locations later
Suspecting materials were stolen after they have been lost
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Signs & Symptoms
Decrease in social activities
Refusing to participate in social activities
Decrease in the initiative to work
Changes in emotion and personality
Frequent ups and downs in emotion
Feelings of anxiety and uncertainty
Lacking the sense of security
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Feelings and Needs
Being lost
Being slow
Being blank
Being productive
Being autonomous
Being comfortable and secure
(Harris & Sterin, 1999; Phinney & Chesla, 2003)
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Environment & Dementia
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Person-environment interaction
Behaviour is a function of the individual’s competence and the demands of the environment (Lawton & Nahemow, 1973)
Demand too low, result in boredom, negative affect
and behavior seen in sensory deprivation.
Demand too great, result in anxious, overwhelmed
or hopeless. (Kiemat,1993)
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Environment and Activities
Significant effect: co-existence of physical and cognitive decline design to support or hasten deterioration design to facilitate positive and failure-free life
experience (more involvement, less anxiety)
(Ageing & Disability Department, NSW 2000)
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Design Implications
recognize the inevitability of decline minimize stress of the elder compensate the disabilities (e.g. not to rely on their
memories of where to find belongings) assist daily functioning - maximize independence and
enhance self confidence accommodate the various types of behaviours e.g.
wandering try to keep the elder comfortable and safe welcome social interaction (e.g. neighbours, relatives and friends)
(Judd et al, 1998)
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Design Features
controlled stimuli, especially noise unobtrusive concern for safety clear and multiple signage / cues where
possible use of objects rather than colour for orientation enhancement of visual access familiar, age-appropriate furniture and fittings opportunity to integrate past experience into
daily / ordinary activities (e.g. cooking, washing)
(Judd et al, 1998)
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Some Practical Tips
Contrast between objects and the background, or
between floor and wall contrast to facilitate people
to notice object from surrounding environment
(e.g. door, toilet bowl)
Use bright primary color for those you want them
to see (e.g. door / drawer handle)
Use non-slip flooring
Avoid shinny or reflective floor surface
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Some Practical tips
Lever action handle are easy to operate than door knobs
Cupboard door is transparent or no door to facilitate search and locate object
Round-edged furniture
Safety in bathroom and kitchen (e.g. handrails, water temperature control, sharp items)
Night light and toilet lighting to facilitate location of toilet at night
Bedroom to be nearer to the toilet
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Examples
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A simple formula in living with and designing for the person
with dementia….
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medical model of dementia –
The person with DEMENTIA
person-centred approach -
The PERSON with dementia
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Maintaining health
Safe and
supportive
environment
Meaningful
activities
The Person-centred Approach
Caregiver
involvement
and support
Elder
Social interaction
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“If your eyesight fails, you can get some glasses, but you can’t buy a pair of glasses for your memory.”
(Dementia Voice, 2002)
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Useful links
http://dementia.stir.ac.uk/design/design-guides
http://www.jccpa.org.hk/en/facts_on_dementia/hints_for_home_safety/index.php
http://www.hkhselderly.com/erc/en/facilities.php
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Thank you