USING A SOCIAL ECOLOGICAL MODEL TO DEVELOP DEMENTIA-FRIENDLY COMMUNITIES
Rationale/Background: In response to the upcoming dementia crisis, WHO urges governments worldwide to set dementia as a public health priority and promote building a dementia-friendly society globally. Nevertheless, there are gaps in the existing dementia-friendly literature: 1) no agreed-upon definition for the term dementia-friendly; and 2) scant research conducted on the concept of dementia-friendly or building dementia-friendly communities in the U.S.
Methods: Focus groups were held with PWDs who met the following criteria: age 55 years and older, speak English, have a diagnosis of dementia made by a healthcare provider, and are aware of their diagnosis of dementia. Additionally, caregivers also participated who met the following criteria: age 18 years and older, have experience taking care of PWDs, and speak English. Participants were recruited from senior centers, adult day health facilities, retirement communities, Alzheimer’s Services Coalition email subscribers, and snowball sampling. All interviews were audio recorded, transcribed, and analyzed thematically. Recommendations for building dementia-friendly communities were organized using a social ecological model (SEM). The SEM consists of 5 concentric circles representing 5 levels of social ecological environments: (from innermost to outermost) intrapersonal, interpersonal, institutional, community, and public policy (McLeroy et al, 1988).
Results: We conducted 6 focus groups, 1 couple interview, and 1 individual interview. Among 23 eligible participants: 8 were PWDs (6 females) and 15 were caregivers (8 females); and 19 were Caucasian, 3 were Hispanic and 1 was African American. Mean age of PWDs was 71.9 years (range 60-85). Mean age of caregivers was 75 years (range 62-92). Definition of “dementia-friendly” themes included compassion and understanding, a helping attitude, tolerance of differences, supportive environments, being friends with PWDs, and “It’s OK”/living a normal life. Recommendations made by PWDs and their caregivers included: increased dementia awareness (intrapersonal), more people who are willing to and able to provide help (interpersonal), the provision of all-inclusive programs and services (institutional), reduced sigma (community), culture changes in the neighborhood (community), better dementia education for the public (public policy), better accessibility to social services and health insurance (public policy), as well as accommodations in transportation systems and physical environments (public policy).
Implications: The SEM serves as a framework to organize recommendations for building dementia-friendly communities. The recommendations made by participants indicate that they recognized the need for changes at all levels of the SEM to create dementia-friendly communities.