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The purpose of this paper is to report on a scoping review of the advantages and challenges of extra care housing (ECH) provision in the UK for people living with dementia. Access to suitable housing is a fundamental right for people living with dementia and can enable people to live as well as possible (Twyford and Porteus, 2021). Understanding the advantages and disadvantages of different models of housing with care has been identified as a research priority by people living with dementia (Barrett et al., 2016) but “there is no current consensus on the best model of specialist housing for people with dementia” (Twyford and Porteus, 2021, p. 29).

This scoping review identifies the advantages and disadvantages of living in ECH for people with dementia. It is the preliminary stage of a study that seeks to develop knowledge about different models of ECH for people living with dementia (Atkinson et al., 2021).

Advantages include the promotion of independence, flexible staffing, safety and security, social inclusion, physical design and integrated service provision. Disadvantages include barriers to entry, tensions between independence and support, managing advanced dementia, resourcing flexible care, managing social exclusion, loneliness and stigma and a disabling environment.

The scoping review reinforces the need for further research into different models of ECH provision in the UK for people living with dementia. The review provides insight that is of benefit to all stakeholders involved in ECH and contributes to the development of evidence-based provision called for in the recent All Party Parliamentary Group inquiry (Twyford and Porteus, 2021).

This scoping review summarises the current position for people living with dementia in ECH.

Recent years have seen a growing interest in and awareness of the importance of environmental design to the well-being of people living with dementia, in terms of both policy and practice. This trend has been accompanied by a plethora of advice, guidance and tools that aim to encourage and promote the development of inclusive environments. Not all of these are evidence-based, and even those that claim to be so are limited by a paucity of good quality, comprehensive research studies. This paper aims to consider the current state of knowledge in the field of dementia-friendly design and describes a project that refreshed and updated the suite of Environmental Assessment Tools originally developed by The Kings Fund and now managed by the Association for Dementia Studies.

The mixed methods project reported on in this paper comprised a review of the literature, a survey of people who have used the five design assessment tools and an iterative process of updating the tools to make them as evidence-based and user-friendly as possible.

The suite of five assessment tools was refreshed and updated to reflect the latest evidence and the views of professionals and others who use the tools. The authors conclude that while a focus on dementia-friendly design is to be welcomed, there remains a need for relevant high-quality evidence to inform such work. In particular, there is a lack of research within people’s own homes and studies that include the perspectives of people living with dementia.

Few assessment tools and guidelines for dementia-friendly environments are truly evidence-based. This paper reports on a project that combined a comprehensive literature review with the views of practitioners to update a widely used suite of tools that aim to make a range of settings more suitable for people living with dementia.

There is growing interest in and evidence for the benefits of connecting with nature for people living with dementia, sometimes known as “green care”, including reduced stress, improved sleeping and even enhanced cognition. However, many people living with dementia are denied such opportunities, often because of practitioner perceptions of risk and poor design of outdoor spaces. This paper reports on the evaluation of a project that worked with national providers to give people living with dementia opportunities and support to access the natural environment.

The evaluation adopted a mixed-methods approach, using a combination of bespoke and commonly used tools and in-depth case study work to identify the facilitators and challenges to delivering the project and explore the experiences of activity participants.

Qualitative measures indicated a significant improvement in mental well-being for participants with dementia and family carers following attendance at activity sessions. Research interviews indicated that participants enjoyed activities based on connecting with nature. Being outdoors was a major factor in the experience, along with taking part in activities that were meaningful and opportunities for social interaction.

This paper provides evidence for the benefits of connecting with nature for people living with dementia. This paper concludes that access to the outdoors is not a luxury, it is a basic human right and one which has become increasingly important in light of restrictions that have emerged as a result of the COVID19 pandemic.

There is increasing interest in the UK in developing environments that support people who are neurodiverse. This paper aims to report on a project to develop a cognitively supportive environmental assessment tool to improve the design of health centres, where the majority of National Health Service consultations take place, for all users, including people living with dementia and those who are neurodiverse.

A three-stage process was used: a literature review; the development of a matrix of key design features for people living with dementia, autism and other neurodiverse conditions; and the development of an environmental assessment tool and guide for users, which included easy-to-read versions to maximise service user involvement.

The overarching concepts of dementia-friendly design can be adapted to create designs for everyone, including those who are neurodiverse.

There is a paucity of research in environmental design for primary care from the patient’s perspective, and, more generally, further research on design for adults with learning disabilities and autism is needed.

The tools are free to download. With adaptation, they have potential applicability across health and care settings.

This project has confirmed that the principles of dementia-friendly design are applicable, with modifications, to a wider group of neurodiverse people. Critically, each person’s response to sensory stimuli is individual rather than determined by their condition.

The purpose of this paper is to report on an independent evaluation of a three-year “Creative Ageing” programme, focussing on the impacts for participants and factors promoting successful delivery of sessions.

Artists provided feedback through reflective journals and questionnaires, while the views of care staff and participants were also captured in a standard format at the end of each arts session. Thematic analysis of the qualitative data identified common themes.

Twenty-three arts projects were delivered across a range of settings and through diverse art forms including dance, drama, music, visual arts and poetry. They reached nearly 2,200 participants who recorded over 8,100 session attendances in total. Participation in high quality creative experiences improved well-being for older people, as well as increasing social interaction and reducing isolation. Several factors facilitated successful implementation and delivery of the activities, particularly the need to hold planning meetings with staff to provide guidance around participant numbers and suitability, minimising disruption of the sessions and the supportive role of staff during the sessions. Opportunities for reflection enabled artists to address potential challenges and adapt their practice to meet the needs and preferences of participants and to the complexities of diverse settings.

Previous research has largely focussed on the impact of activities in a single setting. This study supports the role of creative arts in increasing social interaction as an attempt to tackle isolation and loneliness, both for older people living in the community and for those living in a communal setting such as care homes and supported living schemes.

The purpose of this paper is to examine the recent evidence relating to green (nature-based) dementia care for people living with dementia in long-term accommodation and care settings (housing for older people that provides both accommodation and care, such as residential care homes, nursing homes and extra care housing schemes). The review formed part of a pilot study exploring interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK. Rather than a comprehensive systematic or critical literature review, the intention was to increase understanding of green dementia care to support the pilot study.

The review draws together the published and grey literature on the impacts of green (nature-based) dementia care, the barriers and enablers and good practice in provision. People living with dementia in accommodation and care settings are the focus of this review, due to the research study of which the review is part. Evidence relating to the impacts of engaging with nature on people in general, older people and residents in accommodation and care is also briefly examined as it has a bearing on people living with dementia.

Although interaction with the natural environment may not guarantee sustained wellbeing for all people living with dementia, there is some compelling evidence for a number of health and wellbeing benefits for many. However, there is a clear need for more large-scale rigorous research in this area, particularly with reference to health and wellbeing outcomes for people living with dementia in accommodation and care settings for which the evidence is limited. There is a stronger evidence base on barriers and enablers to accessing nature for people living with dementia in such settings.

The literature review was conducted to support a pilot study exploring green (nature-based) dementia care in care homes and extra care housing schemes in the UK. Consequently, the focus of the review was on green dementia care in accommodation and care settings. The study, and thus the review, also focussed on direct contact with nature (whether that occurs outdoors or indoors) rather than indirect contact (e.g. viewing nature in a photograph, on a TV screen or through a window) or simulated nature (e.g. robot pets). Therefore, this paper is not a full review of all aspects of green dementia care.

This paper presents an up-to-date review of literature relating to green dementia care in accommodation and care settings. It was successful in increasing understanding to support a pilot study exploring opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in care homes and extra care housing schemes in the UK. It demonstrated the impacts, value and accessibility of nature engagement in these settings and identified gaps in the evidence base. This review and subsequent pilot study provide a strong platform from which to conduct future research exploring green dementia care in accommodation and care settings.

When new interventions are piloted, the implementation process often takes a back seat but can be key to ensuring that an intervention is successful. This paper aims to highlight the enablers and challenges encountered when implementing a nature-based intervention for people living with dementia.

The evaluation adopted a mixed methods approach including case studies, telephone interviews with delegates and interviews with participants. Thematic analysis was used to identify overarching themes relating to the enablers and challenges of implementing the intervention.

Challenges related to understanding how the intervention fitted with existing work and practicalities of what an organisation can offer to support the implementation process. A stable underlying support structure for delegates is required, along with suitable advertising, transport and facilities to support participants. While there is no “one size fits all” approach to implementing an intervention, these findings will help organisations to consider where to focus their support.

The implementation of interventions is often poorly understood but is important when supporting the wider roll out of an intervention. While this paper reports on a nature-based intervention, the learning will be relevant and applicable more broadly for organisations aiming to implement a new intervention and complements previous work relating to the challenges of implementing arts activities.

The purpose of this paper is to explore the potential of housing with care schemes to act as community hubs. The analysis highlights a range of benefits, barriers and facilitators.

Data are presented from the Adult Social Services Environments and Settings project which used a mixed methods approach including a review of the literature, surveys and in-depth case study interviews.

Most housing with care schemes have a restaurant or café, communal lounge, garden, hairdresser, activity room and laundrette, while many also have a library, gym, computer access and a shop. Many of these facilities are open not just to residents but also to the wider community, reflecting a more integrated approach to community health and adult social care, by sharing access to primary health care and social services between people living in the scheme and those living nearby. Potential benefits of this approach include the integration of older people’s housing, reduced isolation and increased cost effectiveness of local services through economies of scale and by maximising preventative approaches to health and wellbeing. Successful implementation of the model depends on a range of criteria including being located within or close to a residential area and having on-site facilities that are accessible to the public.

This paper is part of a very new literature on community hub models of housing with care in the UK. In the light of new requirements under the Care Act to better coordinate community services, it provides insights into how this approach can work and offers an analysis of the benefits and challenges that will be of interest to commissioners and providers as well as planners. This was a small scale research project based on four case studies. Caution should be taken when considering the findings in different settings.

The benefits of “green dementia care”, whereby people living with dementia are supported to connect with nature, are increasingly being recognised. Evidence suggests that these benefits span physical, emotional and social spheres and can make a significant contribution towards quality of life. However, care settings often present specific challenges to promoting such connections due to a range of factors including risk-averse cultures and environmental limitations. The purpose of this paper is to report on a project that aims to explore the opportunities, benefits, barriers and enablers to interaction with nature for people living with dementia in residential care and extra care housing schemes in the UK.

Data were gathered from 144 responses to an online survey by managers/staff of extra care housing schemes and care homes in the UK. In depth-case studies were carried out at three care homes and three extra care housing schemes, involving interviews with residents, staff and family carers.

A wide variety of nature-based activities were reported, both outdoor and indoor. Positive benefits reported included improved mood, higher levels of social interaction and increased motivation for residents, and greater job satisfaction for staff. The design and layout of indoor and outdoor spaces is key, in addition to staff who feel enabled to promote connections with nature.

This paper is based on a relatively small research project in which the participants were self-selecting and therefore not necessarily representative.

The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.

Outdoor activities can promote social interaction for people living with dementia in care settings. The authors’ findings are relevant to the recent policy focus on social prescribing.

The paper makes some key recommendations for good practice in green dementia care in extra care housing and care homes.

The purpose this paper is to explore walking with purpose in extra care, retirement and domestic housing settings to better understand and support people living with dementia in these settings, develop recommendations and inform practice.

A mixed-methods study was used: scoping literature review; online survey of extra care and retirement housing managers in the UK; case studies involving interviews with staff and family carers (n = 14) of ten individuals who engaged in walking with purpose in the different housing settings.

Although residents who walk with purpose constitute a minority (0–2 residents), managing walking with purpose can be challenging and time consuming. Distraction or redirection was the most common response. Other strategies included identifying the resident’s motivations and accommodating their wishes or walking with them. Culture of care, staff training and dementia-friendly design are keys to effective support for safe walking with purpose. Responses to walking with purpose in the domestic housing settings have raised serious deprivation of liberty issues.

This study had a number of limitations. The completed survey questionnaires represent a self-selected sample of extra care and retirement housing settings, and responses are based on the perceptions of the staff members completing the survey. There were a relatively small number of case study sites (three extra care housing and three retirement housing), and it was not possible to interview family members for all of the residents who walked with purpose.

This study provides unique data on walking with purpose in extra care and retirement housing setting in the UK.