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Conception and construction of nursing homes focuses mostly on architectural design. The cost of gardens and amount of work they require is usually underestimated. This often results in inaccessible, unfit and poorly designed outdoor spaces. This article describes a partnership between three French institutions established in response to the needs of people with cognitive disabilities. This partnership led to three different approaches (scientific, pedagogical and practical) with a common objective to provide dementia-friendly outdoor spaces.

A recent review of Cochrane meta-analyses on psychosocial interventions (PIs) concludes that clinical trials fail to confirm PIs effective for all types of dementia at every stage of the disease. This article describes how and to what extent it is necessary to identify treatment indications when researching PIs and employing them in clinical practice. Twelve Cochrane reviews on PIs for people with dementia, selected because of their systematic methodology, were searched to identify outcomes related to treatment indications (dosage, type of dementia, severity…). The authors identified several research and practice issues that related to treatment indications: sample profiling, hypothesizing and statistical interpretation, external validity, effectiveness of interventions, contraindications and limits of interventions, and tailoring. Developing an effective PI requires empirical, developmental, exploratory, and confirmatory development stages to achieve credibility and robustness.

Touchscreen tablets are increasingly used to support people with dementia. An inventory of the literature is proposed to specify the nature and intentions of use, the modalities of use and technical characteristics. Tablets are used for psychosocial interventions, life support, social living and leisure activities. Autonomously use is possible and group uses promote interpersonal relationships. The equipment must take into account the physical, sensory, cognitive and interests of people with dementia. Use of tablets should promote social inclusion in a non-stigmatizing approach.

Assistive technologies became pervasive and virtually present in all our life domains. They can be either an enabler or an obstacle leading to social exclusion. The Fondation Médéric Alzheimer gathered international experts of dementia care, with backgrounds in biomedical, human and social sciences, to analyze how assistive technologies can address the capabilities of people with dementia, on the basis of their needs. Discussion covered the unmet needs of people with dementia, the domains of daily life activities where assistive technologies can provide help to people with dementia, the enabling and empowering impact of technology to improve their safety and wellbeing, barriers and limits of use, technology assessment, ethical and legal issues. The capability approach (possible freedom) appears particularly relevant in person-centered dementia care and technology development. The focus is not on the solution, rather on what the person can do with it: seeing dementia as disability, with technology as an enabler to promote capabilities of the person, provides a useful framework for both research and practice. This article summarizes how these concepts took momentum in professional practice and public policies in the past 15 years (2000-2015), discusses current issues in the design, development and economic model of assistive technologies for people with dementia, and covers how these technologies are being used and assessed.

More and more dwelling facilities for people with dementia invest gardens as convivial, resourceful, and relational places. However, there is a demand for scientific evidence of such statements. The aims of this literature review are to enlighten scientific evidence concerning uses and therapeutic virtues of garden for people with dementia, and to contribute to an evidence-based design approach by identifying key dimension of garden design. Twenty two articles were selected for this literature review and six clusters were identified. These clusters are discussed in a conceptual frame and discussed in an environment-behaviour approach.

Background: Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals recently proposed reformulating the static WHO definition of health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia., Method: Based on the expertise of the Social Health Taskforce members (N = 54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: (1) capacity to fulfil potential and obligations; (2) ability to manage life with some degree of independence; (3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD)., Results: The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified., Conclusion: A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.

Environmental psychology has been a topic of great interest for many researchers in the field of aging and dementia. Thus, several orientations can be identified in the contemporary scientific literature concerning environmental design for people with dementia. In this article, we discuss recent research on environmental design models for people with dementia and propose an approach referring to the concept of use of space and human rights.We use a methodology based on observation of special care units to determine an environmental design framework that should be taken into account when designing residential facilities for people with dementia. Content analysis identified 6 primary dimensions and 13 secondary dimensions relevant to the rights of people with dementia. We then discuss the results according to the related literature in environmental psychology and gerontology in terms of well-being and quality of life.

Psychosocial interventions for people with dementia have expanded in the last decades, and have been subject to an important number of evaluation attempts that often lead to scientifically flaw results. To study these failures we analysed the meta-analyses of the Cochrane Library. Among 18 meta-analyses, 11 were selected for the purpose of this study. These papers were analysed on the basis of the Cochrane selection criteria, methodological quality and biases, principal outcomes and implication for practice and research. Results are discussed and analysed according to the clinical practice and scientific literature of the matter of concern. Main outcomes of this review point that: (1) it is necessary to adopt an investigation methodology adapted to specific characteristics of psychosocial interventions; (2) methodological weaknesses of randomised control trials are prejudicial to quality of research and clinical practice; (3) implementation of randomised control trials call for necessary fundamental prerequisites; and (4) other research methods than randomised control trials are susceptible to give as much, if not more, informative results. A research and practice implementation strategy is suggested.

Objectives: In certain health care facilities, the staff commonly wear uniforms for dementia care. Wearing uniforms are often believed to improve the well-being of institutionalized people with dementia (PwD) by facilitating orientation and preserving hygiene. However, when studied more thoroughly, it appears that their use counters to person centeredness. This study aims to investigate the impact of wearing uniforms on the quality of life (QoL) of institutionalized PwD., Method: A natural experimental design was operated in 4 special care units (SCUs) in France. Two SCUs served as an experimental group (caregivers wearing street clothes except when performing hands-on physical care; N = 13) and 2 served as a comparison group (caregivers wearing uniforms; N = 14). The QoL of PwD was measured using the QoL-Alzheimer's Disease scale, and focus groups were carried out with caregivers., Results: Overall and significantly enhanced QoL scores were observed for the experimental street clothing staff group when compared to the uniform group. Caregivers also reported subjective impressions of overall beneficial outcomes for PwD when the caregivers were not wearing uniforms and reported feeling more at ease when interacting with them., Conclusion: Results are discussed in terms of intergroup relationships, living and working conditions, and ethical issues.

People with Alzheimer's disease and related disorders in nursing homes are also subject to sleep disorders. An in-depth study was therefore carried out to install a familiar setting that is based on the architectural environment and on specific support taking into account the size of healthcare teams.

Nutritional deficiency can have dramatic effects on the physical and psychological status of older adults. Although food supplements can enhance nutritional status, several authors suggest that more ecological means could also have beneficial impacts. Therefore, a natural experiment was conducted to study the impact of changed mealtime experiences for people with Alzheimer-type dementia. Two special care units (in separate facilities) in France were included in this study: one implemented shared meal times between residents and caregivers and the other served as a comparison group. Weight was measured and staff observations were collected. Positive outcomes were observed for the experimental group. Implications for practice are discussed.