Designing for dementia : an assessment of the impact of the physical environment on wayfinding success for residents in long term care settings

It is acknowledged that one of the consequences of the ageing process is cognitive decline, which leads to an increase in the incidence of illnesses such as dementia. This has become ever more relevant due to the projected increase in the ageing demographic. Dementia affects visuo-spatial perception, causing difficulty with wayfinding, even during the early stages of the disease. The literature widely recognises the physical environment’s role in alleviating symptoms of dementia and improving quality of life for residents. It also identifies the lack of available housing options for older people with dementia and consequently the current stock is ill-equipped to provide adequate support.
Recent statistics indicate that 80% of those residing in nursing or residential care homes have some form of dementia or severe memory problems. The shift towards institutional care settings, the need for specialist support and care, places a greater impetus on the need for a person-centred approach to tackle issues related to wayfinding and dementia.
This thesis therefore aims to improve design for dementia in nursing and residential care settings in the context of Northern Ireland. This will be undertaken in order to provide a better understanding of how people with dementia experience the physical environment and to highlight features of the design that assist with wayfinding. Currently there are limited guidelines on design for dementia, meaning that many of these are theoretical, anecdotal and not definitive. Hence a greater verification to address the less recognised design issues is required. This is intended to ultimately improve quality of life, wellbeing, independence and uphold the dignity of people with dementia living in nursing or residential care homes.
The research design uses a mixed methods approach. A thorough preparation and consideration of ethical issues informed the methodology. The various facets were also trialled and piloted to identify any ethical, technological, methodological, data collection and analysis issues. The protocol was then amended to improve or resolve any of the aforementioned issues. Initially a questionnaire based on leading design recommendations was conducted with home managers. Semi-structured interviews were developed from this and conducted with staff and resident’s next of kin. An evidence-based approach was used to design a study which used ethnographic methods, including a wayfinding task. This followed a repeated measures design which would be used to actively engage residents with dementia in the research. Complementary to the wayfinding task, conversational and semi-structured interviews were used to promote dialogue and direct responses with the person with dementia. In addition to this, Space Syntax methodologies were used to examine the physical properties of the architectural layout. This was then cross-examined with interview responses and data from the wayfinding tasks.
A number of plan typologies were identified and were determined as synonymous with decision point types which needed to be made during the walks. The empirical work enabled the synthesis of environmental features which support wayfinding.
Results indicate that particular environmental features are associated with improved performance on the wayfinding tasks. By enhancing design for dementia, through identifying the attributes, challenges with wayfinding may be overcome and the benefits of the physical environment can be seen to promote wellbeing.
The implications of this work mean that the environmental features which have been highlighted from the project can be used to inform guidelines, thus adding to existing knowledge. Future work would involve the dissemination of this information and the potential for it to be made into design standards or regulations which champion design for dementia. These would increase awareness for designers and stakeholders undertaking new projects, extensions or refurbishments.
A person-centred, evidence-based design was emphasised throughout the project which guaranteed an in-depth study. There were limitations due to the available resources, time and funding. Future research would involve testing the identified environmental features within a specific environment to enable measured observation of improvements.

Research Ethics in Divided and Violent Societies: Seizing the Ethical Opportunity

This chapter explores how to conduct social research in divided and violent societies by developing the concept of the ‘ethical opportunity’. The ‘ethical opportunity’ is situated in a brief discussion of ‘action’ and feminist approaches to research. It argues that seizing the ethical opportunity requires researchers to: plan for their personal safety, plan for participants’ personal safety and plan how they will communicate and disseminate their results. It draws on the author’s personal experience researching in South Africa, Zimbabwe and Northern Ireland, concluding that it is in the communication and dissemination phase that researchers’ hopes for ‘making a difference’ may be realised or dashed. It cautions would-be researchers to manage their own – and research participants’ – expectations about what social research can achieve. Its effects may not often be as transforming and liberating as idealistic researchers hope for, but that should not dissuade them from striving towards those ends.

Equality, justice and feasibility: an ethical analysis of the WBGU’s budget approach

According to the Budget Approach proposed by the German Advisory Council on Global Change (WBGU), allocating CO2 emission rights to countries on an equal per-capita basis would provide an ethically justified response to global climate change. In this paper, we will highlight four normative issues which beset the WBGU’s Budget Approach: (1) the approach’s core principle of distributive justice, the principle of equality, and its associated policy of emissions egalitarianism are much more complex than it initially appears; (2) the “official” rationale for determining the size of the budget should be modified in order to avoid implausible normative assumptions about the imposition of permissible intergenerational risks; (3) the approach heavily relies on trade-offs between justice and feasibility which should be stated more explicitly; and (4) part of the approach’s ethical appeal depends on policy instruments which are “detachable” from the approach’s core principle of distributive justice.

Human Perception of Laughter from Context-free Whole Body Motion Dynamic Stimuli

Laughter is a ubiquitous social signal in human interactions yet it remains understudied from a scientific point of view. The need to understand laughter and its role in human interactions has become more pressing as the ability to create conversational agents capable of interacting with humans has come closer to a reality. This paper reports on three aspects of the human perception of laughter when context has been removed and only the body information from the laughter episode remains. We report on ability to categorise the laugh type and the sex of the laugher; the relationship between personality factors with laughter categorisation and perception; and finally the importance of intensity in the perception and categorisation of laughter.

Law's Ethical, Global and Theoretical Contexts: Essays in Honour of William Twining

Law's Ethical, Global and Theoretical Contexts examines William Twining's principal contributions to law and jurisprudence in the context of three issues which will receive significant scholarly attention over the coming decades. Part I explores human rights, including torture, the role of evidence in human rights cases, the emerging discourse on 'traditional values', the relevance of 'Southern voices' to human rights debates, and the relationship between human rights and peace agreements. Part II assesses the impact of globalization through the lenses of sociology and comparative constitutionalism, and features an analysis of the development of pluralistic ideas of law in the context of privatization. Finally, Part III addresses issues of legal theory, including whether global legal pluralism needs a concept of law, the importance of context in legal interpretation, the effect of increasing digitalization on legal theory, and the utility of feminist and postmodern approaches to globalization and legal theory.

Reconstructing ethical conduct within financial firms

This chapter explores whether ethical cultures can be created within a financial market context. Ongoing regulatory and legal actions, and press coverage of these, suggest that a definition of ethical problems in terms of ‘rogue traders’ and ‘bad apples’ would be inadequate, since entire business areas have been resorting to collusive illegal behaviour. The concept of ‘bad barrels’ seems to capture the situation rather better: the culture of firms fails to discourage transgression and indeed supports it. Unpacking the links between regulatory objectives and the cultural settings of firms and their employees, this chapter questions the chances of success of measures such as enhanced controls on individuals and restructured reward mechanisms. Financial firms typically have very flat, nodal structures, within which traders conceptualise themselves as an elite, in contrast to back office staff and also in contrast to managers. Traders’ functions and their occupational mobility mean that their linkages and attachments may be much stronger with others outside ‘their’ firm than their firm and those within it. Performance, camaraderie and their linkages are important in all work situations, yet all the more so for traders in financial markets. Thus, whether regulators and senior management combine to send a clear and consistent message to traders – or whether the logic of the financial marketplace leads some firms to continue send conflicting or ambivalent messages to them – misconduct is likely to continue to be a tough nut to crack.

Understanding perception and action in sport:How can virtual reality technology help?

Although technology can facilitate improvements in performance by allowing us to understand, monitor and evaluate performance, improvements must ultimately come from within the athlete. The first part of this article will focus on understanding how perception and action relate to performance from two different theoretical viewpoints. The first will be predominantly a cognitive or indirect approach that suggests that expertise and decision-making processes are mediated by athletes accruing large knowledge bases that are built up through practice and experience. The second, and alternative approach, will advocate a more 'direct' solution, where the athlete learns to 'tune' into the relevant information that is embedded in their relationship with the surrounding environment and unfolding action. The second part of the article will attempt to show how emerging virtual reality technology is revealing new evidence that helps us understand elite performance. Possibilities of how new types of training could be developed from this technology will also be discussed. © 2014 Crown Copyright.

New methods for studying perception and action coupling

To study perception and action, Gibson advocated that “the laboratory must be like life” (Gibson, 1979, p. 3). In other words, the interactive relationship between an organism and his/her envi- ronment must be maintained so that the behavior observed in an experimental context mirrors, as closely as possible, the behavior observed in a realistic sport setting. The concept of repre- sentative design introduced by Brunswik in 1956 emphasized the need to have experimental tasks that allow the player to pick up perceptual information that specifies a property of the environment-actor system (Araújo et al., 2005; see also Chapter 24). In this chapter we will provide a brief overview of the methodologies used to study perception and action in sport and present, in some detail, the opportunities new methodologies such as immersive, interactive vir- tual reality can offer researchers in sport expertise.