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Professor Richard Fleming is the Director of the NSW/ACT Dementia Training Study Centre. A key element of his work is translating knowledge around dementia-friendly environmental design into practice. IIR Healthcare spoke to him about overcoming barriers in transforming the build environment to meet the needs of people with dementia and what discussions need take place to enable change.
IIR Healthcare: What are the main barriers in transforming and adapting the built environment to the needs of people with dementia? How can we overcome them?
Richard Fleming: The barriers can be described in relation to the stages of Knowledge Translation described by Pathman “The awareness-to-adherence model of the steps to clinical guideline compliance. The case of pediatric vaccine recommendations.”
Awareness: Before people can put new practices into place they must be aware of the new knowledge that informs the new practice. Key people, including many architects and managers of aged care services, do not know about the research that has taken place over the last 30 years.
Agreement: Some of those who do know about the knowledge do not agree with it, referring to stick with existing models. (Comparisons with climate change come to mind).
Adoption: This can only occur when there is an opportunity to refurbish old or build new facilities. These opportunities do not come along every day. In the typical aged care facility making changes that require capital works often takes many years.
Adherence: This refers to the influence of legislation and regulation to the adoption and maintenance of new practices. Unfortunately many of the regulations governing the design of places for people with dementia can be construed as limiting the application of the principles. This is not their intent and when well presented, evidence based, arguments are made to the regulators it is very often possible to achieve a good design. Nevertheless, in many people’s minds, the regulations are an obstacle to good design.
A related obstacle is the fact that it is rarely the person with dementia who chooses their accommodation. It is most often chosen by a younger family member. Their selection is unlikely to be based on knowledge of the needs of people with dementia. It is more likely to be based on first impressions which tend to lead them to choose hotel style accommodation.
IIR Healthcare: You have helped developing the Iphone app BEAT-D that is designed to help building and redesigning aged care facilities across Australia. Users are able to upload information about their facility. Based on this your team generates a report that is sent back to them to aid the (re)design process. Were there any new insights you have gained from the information people have uploaded? What are the biggest transformations you are aware of?
Richard Fleming: No new insights from the information uploaded.
The users are invited to take part in a telephone discussion of the report. These have proven to be very interesting and, I believe, useful. My team is involved in evaluating the impact of this service at the moment.
IIR Healthcare: You are part of the team that initiated the Dementia Enabling Environments Project (DEEP). Can you tell us a bit more about the project and what motivated you to set it up?
Richard Fleming: This project was initiated by Jason Burton in WA Alzheimers Association. I was very pleased to be invited to join him. It has proven to be a very successful way of providing high quality information.
IIR Healthcare: You will be speaking at the National Dementia Congress in February in Melbourne. What discussions would you like with government representatives, policy makers, advocates and healthcare professionals at the event?
Richard Fleming: The discussions that need to take place are around
- Overcoming the knowledge translation obstacles
- Extending our thinking into the design of dementia friendly communities. Not just for compassionate reasons but because we simply can’t afford to build the number of new facilities required to keep pace with the increasing number of people with dementia. It is predicted that there will be 1,000,000 people with dementia in Australia in 40 years’ time. If we are to provide the same proportion of residential aged care beds for them as we have today we need to open 750 new beds every month for the next 40 years.
Prof Richard Fleming will deliver a presentation about dementia-friendly environmental design at the National Dementia Congress, to be held on the 20th and 21st February 2014 in Melbourne. Now in its 5thyear, the event examines case studies and the latest innovations from across the whole dementia pathway, from diagnosis to end of life, focusing on the theme of “Making Dementia Care Transformation Happen Today”. To view the full speaker line-up or to register for the congress, please visit the event website.
Related articles
- 10 design principles to create a better environment for people with dementia (iirhealthcare.wordpress.com)
- All stick and no carrot? How much diagnosis, but how much actual care, of dementia? (livingwelldementia.org)
- Dementia in Aboriginal and Torres Strait Islander Communities (dementiaresources.wordpress.com)