︎
HealthbyDesign

HealthbyDesign  



︎  Community Wheels
Community as your ‘Sponsor’


Suppose the community rallied around its residents with dementia and offered outlets for them to get involved. In that case, there will be increased social engagement, resulting in a greater sense of independence and responsibility for those with dementia as they will be supported by those around them and in constant connection.
By Marianna Godfrey ︎ , Prakriti Vasudeva ︎, Prathamesh Patil ︎,  Yeon Lee ︎,





Who

Let's take the case of a 68-year-old retired mechanical engineer named John, who lost his wife six months ago. He lives alone, with no children or immediate family to care for him. He enjoys collecting stamps, working out, reading, and likes to keep a strict routine. John puts on a facade because he is lonely and isolated. He is starting to show some early signs of dementia, which are increasingly becoming noticeable to his friends and neighbors. These signs include memory changes that affect day-to-day abilities, difficulty doing familiar tasks, misplacing things, and losing initiative. Unfortunately, due to a lack of immediate family, his symptoms have been long missed. If there had been someone close to John, then he would have gotten diagnosed earlier, allowing him to take advantage of relevant information and treatment (Andrews).

Why

The number of people with dementia is projected to reach 82 million by 2030 and 152 million by 2050 (World Health Organization). The World Health Organization (WHO) has declared dementia a public health priority (World Health Organization), calling for global action to establish dementia-friendly initiatives. It is widely recognized that people with dementia and their informal caregivers face significant challenges that include stigma and social exclusion. It becomes more difficult for an aging population that has no immediate family or support and is living all by themselves.

Dementia in older adults can be a challenging condition, especially when individuals deny their symptoms, believing they are fit and independent (Andrews). The denial of dementia symptoms is a common barrier to seeking assistance among older adults. Many perceive themselves as healthy and strong, living out the golden years of their lives, rejecting the notion of cognitive decline despite subtle signs becoming apparent. It became evident that the intervention would need to address the needs of those without caregivers, provide resources to help people maintain good cognitive function, inform them of dementia treatment available, and take the strain off of formal caregivers. Overall, people should not feel shame for their diagnosis but instead look to those around them for support, and having an accessible intervention so that individuals feel comfortable taking advantage of it is a must.

How

To understand John's daily challenges, we visited The Pittsfield Township Library, Centerra Pointe Apartments (where John lives), Ann Arbor Hospice, and Ann Arbor Community Center. John sticks to a strict routine of working out and reading but will face more challenges with these activities in the future.

First, when visiting the Ann Arbor Community Center, we observed many people using the gym equipment and cardio machines. Additionally, the track and larger gyms were the perfect place for people to gather for indoor exercise. One aspect missing from all the spaces was access to natural light and fresh air; the environment felt stuffy. Most people, except those attending a workout class or group activity, worked out independently and did not socialize.

When visiting the Pittsfield Library and Centerra Pointe apartments, we tried to see the space as if we were John, taking note of any difficulties in accessing the space. We have noted the following:

Observation Sketches of site visits 


One aspect of the library that was similar to that of the community center was that outside of scheduled events, people rarely conversed with one another. The lack of interaction makes a strong argument for an intervention with an outcome of increasing social engagement.

Finally, we visited and learned about Arbor Hospice as a group. There are many preconceived notions about hospice being for only end-of-life care. We learned that this is not true and that this hospice facility offers aid to families having difficulty caring for loved ones, medication distribution, and help with planning treatment for dementia patients (Arbor Hospice). One observation we noticed was patients and caregivers picking up medication. We understood that the hospice was an underutilized resource and that destigmatizing hospice treatment in our intervention could make these helpful resources more straightforward (Fine).

What
The concept of inclusive dementia-friendly communities has the potential to promote social inclusion, change attitudes and behaviors, and support people with dementia to live in their community in meaningful ways. People with dementia can benefit from their local community network; social inclusion and social participation promote a sense of social citizenship, safety, and contribution (Wiersma). Our intervention aims to ease a dementia-friendly neighborhood with an adaptable model and space for social engagement and additional resources.

All stages of the intervention support the idea of 'community as your sponsor,' which ensures that various community stakeholders come together to design for an individual with declining cognitive health without immediate caregivers. We used the six pillars of brain health as a guideline for a well-rounded solution (Lindberg).

Now.

The "Now" focuses on a Mobile App showing how and where people can go for support and activities within the community. Our design helps individuals locate what is happening in their community and reminds them of events, encouraging more socialization and access within the community. The app would be easy to use, identifying key locations and how to access them, along with alerts. It is necessary to establish what resources are available before intervening, as so many resources are underutilized, and once comfortable using the app, individuals would be more likely to engage in the rest of our intervention.


Near.

Our "Near" focuses on establishing a nostalgic network for the airstream within Ann Arbor, identifying locations to park and activities that can occur with the aid of the extra space and resources from the airstream. This will result in a "third place" that forms a sponsorship network to promote well-being with some sense of responsibility and independence.

Airstreams are known for their nostalgic value and, in this case, help associate memories for those with dementia. Despite their cognitive impairment, people living with dementia experience nostalgia in similar ways to cognitively healthy adults, with their nostalgic narratives containing self-oriented, social, and existential properties (Ismail et al.). Studies report that reminiscence and life review (recalling former times or life story recall) can benefit those with various kinds of dementia. These include improving mood, communication, cognitive function, and quality of life (Ismail et al.). In this case, the airstream would jog pleasant memories.

Within the airstream itself, there would be resources that pair with the location where the airstream is parked. For example, when parked at the community center, there would be a rhythm for resilience to encourage exercise outside. Which is an adaptable dance program that uses music to de-stress, move, and promote association memory—responding to the observation of few social engagements at the community center along with a lack of access to the outdoors.

In this stage, the goal would be one airstream for the Ann Arbor community. We were utilizing the interior, parking porch, and surrounding parking lots for extra space for programming. Using the dementia design checklist from the Alzheimer's Society of the United Kingdom, we included quiet indoor spaces, chairs, and easy navigation.

Far.
The "Far" is focused on an established and seamless network of airstreams within the community. Everywhere that John or other individuals with dementia go, the airstream would be providing support and guidance. An aid for them to live independently from diagnosis to death. This would result in a strong sense of belonging and connection in the community, independence throughout the stages of dementia, and social engagement.

Broader network goals for the airstreams, connecting and changing policy, allow more individuals to receive the support they need and lead independent lives while taking some of the burden off family and caregivers.



So What

Through a more connected network of available information and the addition of airstreams, individuals will feel a greater sense of support for their communities. The increase in activities, social engagement, and reducing the stigma of dementia treatment will be beneficial to reducing cognitive decline and increasing independence for those with dementia. At the same time, it will decrease the strain on traditional caregivers, as caregiving will involve the entire community. People feel the urge to help, and in this case, ensuring everyone is cared for is beneficial to the community as a whole, as it will strengthen it.

While this solution is not the most affordable option, it does account for people who would be most likely overlooked: individuals who need caregivers. This option provides comfortable spaces for everyone in the community and helps prevent potentially harmful situations through collective sponsorship. By implementing Community Wheels; Ann Arbor will see a spike in connectivity amongst generations with more people engaged and informed.


Design To Outcomes

Design to Outcome Diagram showcasing interventions in the Now, Near, and Far Approach




Links to Follow:
    ︎︎︎Two Page Report
︎
Works Cited

  1.  Andrews J. Social Care Institute for Excellence (SCIE). "Early Diagnosis and Intervention for Dementia." 2020.
  2. SCIE. Arbor Hospice, https://arborhospice.org/.
  3. “Dementia-Friendly Environment Checklist. Alzheimer’s Society. 2023. https://www.alzheimers.org.uk/get-involved/dementia-friendly-communities/organisations/dementia-friendly-environment-checklist.
  4. Fine P. G. Hospice Underutilization in the U.S.: The Misalignment of Regulatory Policy and Clinical Reality. Journal of pain and symptom management, 56(5), 808–815. 2018. https://doi.org/10.1016/j.jpainsymman.2018.08.005
  5. Ismail S, Dodd E, Christopher G, Wildschut T, Sedikides C, Cheston R. The Content of Nostalgic Memories Among People Living with Dementia. 2022. The International Journal of Aging and Human Development. 94(4):436-458.doi:10.1177/00914150211024185
  6. Lindberg L. The Six Pillars of Brain Health. AARP Virginia. 2021. https://states.aarp.org/virginia/the-six-pillars-of-brain-health
  7. Reid W. The Psychological Impact of Nostalgia for people with dementia. Total Communications. 2023. https://www.totalcommunication.org/single-post/the-psychological-impact-of-nostalgia-for-people-with-demen tia#:~:text=Studies%20report%20that%20reminiscence%20and,function%20and%20quality%20of%20life.
  8. “The 10 Warning Signs of Dementia.” Alzheimer Society of Canada. 2020. https://alzheimer.ca/en/about-dementia/do-i-have-dementia/10-warning-signs-dementi
  9. Wiersma E. C. The experiences of place: Veterans with dementia making meaning of their environments. 2008. Health & Place, 14(4), 779–794. 10.1016/j.healthplace.2008.01.001
  10. World Health Organization. Dementia. 2020. https://www.who.int/news-room/fact-sheets/detail/dementia



Mark